By Theme or Subject Matter - Health - Public Health and Prevention - Concluding Observations

III. CONCLUDING OBSERVATIONS, CONTINUED

CERD

• Uganda, CERD, A/58/18 (2003) 50 at para. 280.

280. While acknowledging the efforts that the Government has made to combat HIV/AIDS, the Committee is concerned about the rapid spread of this disease which affects the population throughout the country, particularly marginalized ethnic groups. The Committee recommends that the State party continue to develop strategies in this regard and that, in this context, due consideration be given to the specific situation of women.

• Suriname, CERD, A/59/18 (2004) 36 at paras. 194 and 196.

194. The Committee notes with concern complaints by indigenous and tribal peoples in the interior about the deleterious effects of natural-resource exploitation on their environment, health and culture. It regrets that the State party does not seem to have attached the highest priority to dealing with the problem of mercury contamination in parts of the interior.

The Committee wishes to point out that development objectives are no justification for encroachments on human rights, and that along with the right to exploit natural resources there are specific, concomitant obligations towards the local population; it recommends adoption by the State party of a legislative framework that clearly sets forth the broad principles governing the exploitation of the land, including the obligation to abide by strict environmental standards. It recommends the State party to set up an independent body to conduct environmental impact surveys before any operating licenses are issued, and to conduct health and safety checks on small-scale and industrial gold-mining.

...

196. The Committee is concerned at information about the spread of sexually transmitted diseases such as HIV/AIDS amongst indigenous and tribal people, in connection with the expansion of mining and forestry operations in the interior of the country.

The Committee recommends that the State party introduce a plan of action to combat AIDS in the interior.

ICCPR

• Georgia, ICCPR, A/57/40 vol. I (2002) 53 at para. 78(7).

(7) The Committee expresses its concern at the still very large number of deaths of detainees in police stations and prisons, including suicides and deaths from tuberculosis. The Committee also remains concerned about the large number of cases of tuberculosis reported in prisons.

The State party should take urgent measures to protect the right to life and health of all detained persons as provided for in articles 6 and 7 of the Covenant. Specifically, the State party should improve the hygiene, diet and general conditions of detention and provide appropriate medical care to detainees as provided for in article 10 of the Covenant. It should also ensure that every case of death in detention is promptly investigated by an independent agency.

• Republic of Moldova, ICCPR, A/57/40 vol. I (2002) 76 at para. 84(9).

(9) The Committee is deeply concerned at the conditions prevailing in the State party's detention facilities, in particular its failure to comply with international standards (as acknowledged by the State party), including the guarantees provided in articles 7 and 10 of the Covenant. It is particularly disturbed at the prevalence of disease, notably tuberculosis, which is a direct result of prison conditions. It reminds the State party of its obligation to ensure the health and life of all persons deprived of their liberty. Danger to the health and lives of detainees as a result of the spread of contagious diseases and inadequate care amounts to a violation of article 10 of the Covenant and may also include a violation of articles 9 and 6.

The State party should take immediate steps to ensure that the conditions of detention within its facilities comply with the standards set out in articles 6, 7 and 10 of the Covenant, including the prevention of the spread of disease and the provision of appropriate medical treatment to persons who have contracted diseases, either in prison or prior to their detention.

• Suriname, ICCPR, A/59/40 vol. I (2004) 43 at para. 69(21).

(21) The Committee...notes allegations that mercury has been released into the environment in the vicinity of such communities, which continues to threaten the life, health and environment of indigenous and tribal peoples...

...The State party should take the necessary steps to prevent mercury poisoning of waters, and thereby of inhabitants, in the interior of the State party’s territory.

• Lithuania, ICCPR, A/59/40 vol. I (2004) 52 at para. 71(12).

(12) While noting the information provided orally by the delegation on sex education in schools, the Committee is concerned at the high rate of unwanted pregnancies and abortions among young women between the ages of 15 and 19, and the high number of these women contracting HIV/AIDS, with consequent risks to their life and health (art. 6).

The State party should take further measures to help young women avoid unwanted pregnancies and HIV/AIDS, including strengthening its family planning and sex education programmes.

• Namibia, ICCPR, A/59/40 vol. I (2004) 64 at para. 74(10).

(10) The Committee appreciates the efforts undertaken by the State party to combat HIV/AIDS and to provide wider sexual education in this regard. However, these efforts are not adequate in view of the magnitude of the problem.

The State party should pursue its efforts to protect its population from HIV/AIDS. It should adopt comprehensive measures encouraging greater numbers of persons suffering from the disease to obtain adequate antiretroviral treatment and facilitating such treatment.

ICESCR

• Colombia, ICESCR, E/2002/22 (2001) 110 at paras. 774, 795 and 799.

774. The Committee is concerned about the reduction of the vaccination programs in the country, which has resulted in a heightened exposure of the population, especially children, to a variety of infections diseases.

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795. The Committee calls upon the State party to increase its efforts concerning vaccination programmes to combat diseases and infections, especially among children.

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799. The Committee recommends that the State party comply with the standards of the International Guidelines on HIV/AIDS and human rights21/.

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Notes

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21/ HIV/AIDS and Human Rights: International Guidelines. Second International Consultation on HIV/AIDS and Human Rights, Geneva, 23-25 September 1996 (United Nations publication, Sales No. E.98.XIV.1).

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See also:

• Czech Republic, ICESCR, E/2003/22 (2002) 25 at para. 109.

• Algeria, ICESCR, E/2002/22 (2001) 116 at para. 842.

842. The Committee urges the State party to ensure that its laws, regulations and practices in relation to HIV/AIDS are non-discriminatory and are in conformity with the International Guidelines on HIV/AIDS and human rights21/.

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Notes

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• France, ICESCR, E/2002/22 (2001) 121 at para. 858.

858. The Committee...commends the State party for its campaign against alcohol and tobacco abuse, especially among young people.

• Jamaica, ICESCR, E/2002/22 (2001) 130 at paras. 935, 936, 939 and 940.

935. The Committee expresses its concern about the situation of boys in the State party, where serious problems exist such as increasing rates of school dropout, juvenile criminality and delinquency, a high suicide rate, drug addiction and unemployment among the youth.

936. The Committee is deeply concerned about the lack of laws, policies or programmes to address explicitly the proliferation of sex tourism and its consequences which include the sexual exploitation and prostitution of women and children and the spread of sexually transmitted diseases. In particular, the Committee is alarmed that school dropout rates have increased as young girls are induced to leave school to enter the sex trade, sometimes even with the consent and encouragement of parents who benefit from their earnings.

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939. The Committee is alarmed that, according to information received from United Nations organizations, HIV/AIDS is currently the leading cause of death among men and women in the 15-44 age group. The Committee is particularly concerned that the overall mortality rate for persons infected with HIV/AIDS is 60 per cent, largely because they do not have access to affordable medicines, treatment and care. The Committee is also concerned that the prevalence of HIV infection among girls in their late teens is twice that of older women according to UNAIDS, which attributes this phenomenon to young women participating in the sex tourism trade.

940. The Committee is concerned about the health of adolescents in the State party, who are at high risk of many diseases, in particular those related to sexual and reproductive health. The Committee also notes with concern the rising incidence of teenage pregnancies, leading to higher mortality rates related to abortion of unwanted pregnancies and to higher dropout rates for girls who leave school to take care of their babies.

• Czech Republic, ICESCR, E/2003/22 (2002) 25 at paras. 88, 89 and 108.

88. The Committee is deeply concerned about the high rate of drugs and tobacco use as well as the high level of alcohol consumption, especially among children and youth.

89. The Committee notes with concern that the incidence of HIV/AIDS is increasing, especially among young people.

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108. The Committee calls upon the State party to adopt effective measures to reduce tobacco smoking, drug abuse and alcohol consumption, especially among children.

• United Kingdom of Great Britain and Northern Ireland, ICESCR, E/2003/22 (2002) 39 at paras. 224 and 243.

224. The Committee is concerned about the high incidence of HIV/AIDS in some of the State party's Caribbean territories. It is particularly concerned about the number of HIV/AIDS cases in the Turks and Caicos Islands and St. Vincent and the Grenadines, and the lack of availability of, and access to, anti-retroviral medication for migrant workers and AIDS orphans.

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243. In the context of HIV/AIDS, the Committee urges the State party to ensure the availability of, and equal access to, anti-retroviral medication for all individuals in Overseas Dependent Territories.

• Trinidad and Tobago, ICESCR, E/2003/22 (2002) 45 at para. 293.

293. The Committee while noting the sustained efforts made to address HIV/AIDS problems, urges the State party to step up its measures to combat HIV/AIDS and, in particular, to enhance the provision of education on sexual and reproductive health.

• Slovakia, ICESCR, E/2003/22 (2002) 50 at paras. 322 and 336.

322. The Committee is deeply concerned about the high rate of tobacco smoking as well as the high level of alcohol consumption among adults.

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336. The Committee calls upon the State party to adopt effective measures, including public awareness campaigns, to reduce tobacco smoking and alcohol consumption.

• Poland, ICESCR, E/2003/22 (2002) 54 at para. 352.

352. The Committee notes with appreciation the initiatives undertaken by the State party to reduce alcohol consumption and tobacco smoking in the country, including the recent ban on the selling of alcohol to minors and on the promotion and advertising of tobacco products.

• Georgia, ICESCR, E/2003/22 (2002) 59 at para. 443.

443. The Committee encourages the State party to undertake preventive measures against HIV/AIDS, particularly awareness-raising campaigns, in order to prevent the spread of the disease in the country.

• Solomon Islands, ICESCR, E/2003/22 (2002) 65 at paras. 459 and 475.

459. While commending the intensive efforts made by the State party to combat malaria, the Committee notes with concern that malaria remains a major public health problem in the State party. The Committee is also concerned that acute respiratory infections, as well as sexually transmitted infections, remain the main cause of health problems, as indicated in the Human Development Report 2002, published by UNDP.

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475. The Committee also urges the State party to intensify its malaria control programme and to address the problem of acute respiratory infections and sexually transmitted diseases, inter alia, through appropriate education and training of caregivers at all levels. The Committee encourages the State party to continue its close cooperation with the WHO and other health-care organizations in this regard.

• Estonia, ICESCR, E/2003/22 (2002) 68 at paras. 491, 510-512, 533-535 and 537.

491. The Committee commends the State party on its initiatives in the area of public health, which have led to a number of improvements, including a reduction in infant mortality, from 15.4 per 1000 in 1993 to 8.4 in 2000, and in maternal mortality, from 0.47 per 100,000 in 1995 to 0.13 in 1999. The Committee notes with satisfaction that public awareness campaigns have been launched in order to combat the phenomenon of widespread alcohol and tobacco abuse.

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510. The Committee expresses its concern that, in spite of the measures undertaken by the State party to combat HIV/AIDS, the incidence of reported new cases is still very high.

511. The Committee notes with concern the high rate of cases of tuberculosis.

512. The Committee is concerned about the high morbidity rate due to alcohol and tobacco abuse, particularly among men.

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533. The Committee...recommends that the State party intensify its efforts to control the spread of HIV/AIDS, including through public information campaigns...

534. The Committee recommends that the State party intensify its efforts to combat the spread of tuberculosis.

535. The Committee urges the State party to ensure the effective implementation of national strategies and measures to address the problem of alcohol and tobacco abuse.

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537. The Committee also recommends that the State party strictly enforce the domestic and international standards for environmental protection, so as to prevent harmful effects on the health of the population in Estonia.

• Luxembourg, ICESCR, E/2004/22 (2003) 24 at paras. 85, 86, 99 and 100.

85. The Committee reiterates its concern about adolescent health problems, owing in particular to drug abuse and high rates of alcohol and tobacco consumption.

86. The Committee is concerned about the high incidence of suicide in the State party, especially among young people.

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99. The Committee recommends that the State party strengthen its efforts to prevent and combat drug abuse, especially among young people, and step up its campaign against alcohol and tobacco abuse.

100. The Committee recommends that the State party take measures to address the high incidence of suicide, especially among young people.

• Brazil, ICESCR, E/2004/22 (2003) 28 at paras. 145 and 169.

145. Although the State party has reduced HIV/AIDS-related mortality, the Committee is concerned that, despite these efforts, there has been a significant increase in cases among women and children.

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169. The Committee urges the State party to continue its prevention and care efforts in the field of health by providing sexual and reproductive health services to the population, with particular emphasis on those for women, young people and children.

• New Zealand, ICESCR, E/2004/22 (2003) 35 at paras. 189 and 204.

189. The Committee is concerned about the relatively high suicide rate, especially among young people, in the State party.

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204. The Committee calls upon the State party to take effective measures to address the relatively high suicide rate, particularly among young people...

• Iceland, ICESCR, E/2004/22 (2003) 39 at paras. 219, 229 and 239.

219. The Committee notes with satisfaction the amendments enacted in the Tobacco Control Act, the objective of which is to reduce the consumption of tobacco products by imposing supplementary restrictions on their sale and by reinforcing the prohibition of their advertisement.

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229. The Committee expresses its concern about the high level of alcohol and drug consumption in the State party, in particular among young people.

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239. The Committee calls upon the State party to take effective measures to address the high level of alcohol and drug consumption, particularly among young people.

• Republic of Moldova, ICESCR, E/2004/22 (2003) 49 at paras. 315, 316, 318, 337, 338 and 340.

315. The Committee is alarmed about the rising incidence of tuberculosis in the State party and notes with particular concern the acuteness of this problem in prisons where the infection rate is more than 40 times higher than the national average, according to the “Baseline Study on the Human Rights Status in the Republic of Moldova”.

316. The Committee is concerned about the rising incidence of HIV/AIDS and sexually transmitted diseases in the State party. In this regard, it is also concerned that sex education classes held in urban areas are almost non-existent in rural areas.

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318. The Committee is concerned that drug abuse is a serious problem in the State party, with the number of drug addicts having more than doubled in the last five years despite the establishment of an interdepartmental commission to fight drug addiction in 2000 and the launching of a programme to fight drug addiction and the drugs business in the period 2003-2004.

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337. The Committee recommends that the State party intensify its efforts under the National Programme of Tuberculosis Control to combat the spread of tuberculosis, including by ensuring the availability of medicines and adequate sanitary conditions in prisons.

338. The Committee recommends that the State party intensify its efforts to combat the spread of HIV/AIDS and other sexually transmitted diseases, including through public information campaigns and by ensuring that sex education is also introduced to schools in rural areas.

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340. The Committee calls on the State party to ensure the effective implementation of programmes to prevent and combat drug abuse, especially among young people...

• Yemen, ICESCR, E/2004/22 (2003) 55 at paras. 358, 362-364, 377 and 381-383.

358. The Committee is concerned about the high rate of infant and maternal mortality and the insufficient availability of health services, especially for women in rural areas. The Committee is also concerned about the lack of a comprehensive sexual and reproductive health programme in the State party.

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362. The Committee is concerned about the persisting water crisis which constitutes an alarming environmental emergency in the State party, and which prevents access to safe and affordable drinking water, particularly for the disadvantaged and marginalized groups of society, and for rural areas.

363. The Committee is concerned about the rising incidence of HIV/AIDS and other sexually transmitted diseases in the State party.

364. The Committee is also concerned that people suffering from HIV/AIDS do not always have full access to the necessary services, food and facilities.

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377. The Committee urges the State party to increase its efforts to reduce the rate of infant and maternal mortality by providing adequate access to health services and vaccination programmes, especially for women and children in rural areas. The Committee urges the State party to adopt and implement a national sexual and reproductive health programme.

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381. The Committee further urges the State party to introduce strategies, plans of action, and legislative or other measures to address the scarcity of water problems, in particular sustainable management of the available water resources. The Committee recommends that effective water management strategies and measures be undertaken in urban areas, exploring possibilities for alternative water treatment and developing ecological dry sanitation methods in rural areas...

382. The Committee recommends that the State party intensify its efforts to control the spread of HIV/AIDS...

383. The Committee, in line with its general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12 of the Covenant), recommends that the State party provide adequate health care for people suffering from HIV/AIDS and that public information programmes be provided to raise awareness of these problems in Yemeni society.

• Guatemala, ICESCR, E/2004/22 (2003) 59 at paras. 418 and 436.

418. The Committee is alarmed about the increasing level of drug addiction in the State party, especially among young people.

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436. The Committee urges the State party to undertake effective measures to combat drug addiction, such as awareness-raising campaigns and educational activities.

• Russian Federation, ICESCR, E/2004/22 (2003) 64 at paras. 475, 476, 478, 503, 504 and 506.

475. The Committee remains concerned about the high incidence of tuberculosis in the State party, particularly in prisons, in the Republic of Chechnya and in the regions of the Far North, in particular among indigenous communities.

476. The Committee notes with concern the sharp increase in the HIV-infection rate during the last three years, the increasing incidence of HIV contracted through heterosexual contacts, and the increasing number of children born of HIV-positive mothers.

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478. The Committee remains concerned about the spread of drug addiction in the State party.

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503. The Committee recommends that the State party intensify its efforts to combat tuberculosis, under the special federal programme on urgent measures to tackle tuberculosis for the period 1998-2004, including by ensuring the availability of medicines and adequate sanitary conditions in prisons, and by taking special measures to combat the epidemic in the worst affected regions.

504. The Committee, in line with its general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12 of the Covenant), calls upon the State party to take urgent measures to stop the spread of HIV/AIDS. The State party should ensure that all persons know about the disease and how to protect themselves, including through sex education in schools, and that methods of protection are available at affordable prices. Moreover, awareness-raising campaigns should aim at preventing discrimination against HIV-positive people.

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506. The Committee recommends that the State party ensure the effective implementation of programmes to prevent and combat drug abuse, targeted at young people and the worst affected regions of the country...

• Democratic People’s Republic of Korea, ICESCR, E/2004/22 (2003) 71 at para. 554.

554. The Committee recommends that the State party adopt a comprehensive HIV/AIDS prevention strategy, including awareness-raising campaigns and a blood safety programme. The Committee invites the State party to continue and enhance its collaboration with United Nations programmes and specialized agencies, such as WHO, UNDP and UNAIDS...

• Lithuania, ICESCR, E/2005/22 (2004) 18 at paras. 92-94 and 114-116.

92. The Committee is concerned about the high suicide rate in the State party, particularly among the rural population.

93. The Committee is concerned about the high mortality rate due to alcohol and tobacco abuse, particularly among men.

94. The Committee is concerned that the number of young women (aged 19 years and under) who have abortions is increasing, and regrets that the State party has not furnished any information on reproductive health.

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114. The Committee recommends that the State party undertake a study of the root causes of suicide in the State party and strengthen its efforts under the National Suicide Prevention Programme to reduce the suicide rate.

115. The Committee recommends that the State party ensure the effective implementation of programmes to combat tobacco smoking and alcoholism...

116. The Committee calls upon the State party to strengthen its efforts to promote awareness of sexual and reproductive health, safe contraceptive methods and the health risk of using abortion as a method of birth control...

• Greece, ICESCR, E/2005/22 (2004) 23 at paras. 145 and 167.

145. The Committee notes with concern that the State party has one of the highest tobacco and alcohol consumption rates in Europe, in particular, among minors.

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167. The Committee recommends that the State party strictly enforce the prohibition of smoking in public areas and of the sale of strong alcoholic beverages to minors, adopt effective measures against “subtle” forms of tobacco and alcohol advertisement, in addition to existing restrictions, and intensify its efforts in the field of anti-smoking education and information campaigns.

• Spain, ICESCR, E/2005/22 (2004) 34 at paras. 246 and 264.

246. The Committee is concerned about the high rate of drug and alcohol abuse and tobacco smoking in the State party, particularly among young persons.

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264. The Committee recommends that the State party ensure the effective implementation of programmes to prevent drug consumption, tobacco smoking and alcoholism...

• Denmark, ICESCR, E/2005/22 (2004) 49 at paras. 385, 396 and 409.

385. The Committee notes with satisfaction the reduction in the number of smokers, owing to the sustained campaign undertaken by the State party to promote a healthy lifestyle, including awareness-raising on the negative effects of smoking.

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396. The Committee is concerned about the high rate of illicit drug consumption and alcohol abuse in the State party, and about the conditions of those who suffer from mental illnesses caused by such consumption and abuse.

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409. The Committee recommends that the State party continue taking measures for the effective implementation of programmes to prevent the consumption of illicit substances, tobacco smoking and alcohol abuse...

• Azerbaijan, ICESCR, E/2005/22 (2004) 59 at paras. 496 and 522.

496. While welcoming the information provided by the State party’s delegation that prison medical doctors are now under the supervision of the Ministry of Justice and that cases of human rights violation can be immediately brought to the attention of the Office of the Commissioner for Human Rights of Azerbaijan, the Committee is concerned about overcrowding and sub-standard conditions in prisons in Azerbaijan which have given rise to a disproportionately high rate of tuberculosis and other health problems among prisoners.

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522. The Committee recommends that the State party continue to take measures to improve the sanitary and hygienic conditions in prisons and to ensure that the right to mental and physical health of all prisoners in Azerbaijan is respected, in accordance with article 12 of the Covenant.

• Chile, ICESCR, E/2005/22 (2004) 67 at paras. 553 and 580.

553. The Committee is concerned that, despite the progress made in controlling the spread of HIV/AIDS infections in the State party, HIV/AIDS is still on the increase. It also notes with concern the high rates of sexually transmitted infections among young women.

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580. The Committee recommends that the State party strengthen measures to promote education programmes on sexual and reproductive health and to raise awareness about and access to safe contraception methods. It also recommends that the State party intensify its efforts, including through public information campaigns, to control the spread of sexually transmitted infections.

• Zambia, ICESCR, E/2006/22 (2005) 19 at paras. 99 and 122.

99. The Committee is alarmed about the devastating impact of the HIV/AIDS pandemic on the enjoyment of economic, social and cultural rights by the people of Zambia. The Committee is also concerned that people afflicted with HIV/AIDS seldom have adequate access to the necessary health-care services, including antiretroviral drugs, appropriate facilities and food.

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122. The Committee recommends that the State party intensify its efforts to check the spread of HIV/AIDS, inter alia, by strengthening the policy of both providing and encouraging the use of condoms. The Committee also recommends that the State party continue its efforts in prevention and health care by providing sexual and reproductive health services, particularly to women and young people... The Committee, in line with its general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12 of the Covenant), recommends that the State party provide adequate health care for people suffering from HIV/AIDS, taking into account the particular needs of widows and orphans.

• China, ICESCR,E/2006/22 (2005) 25 at paras. 162 and 189.

162. The Committee is concerned about the insufficient preventive care programmes that have resulted in the spread of infectious diseases, including sexually transmitted diseases and HIV/AIDS.

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189. In line with its general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12 of the Covenant), the Committee urges the State party to undertake effective measures to improve the delivery of health services in rural areas and ethnic minority regions, inter alia, by allocating adequate and increased resources. The Committee encourages the State party to take urgent measures to stop the spread of HIV/AIDS and other sexually transmitted diseases, including by means of sex education in schools and awareness-raising campaigns to eliminate discrimination against HIV-positive persons.

• China (Macao Special Administrative Region), ICESCR, E/2006/22 (2005) 38 at paras. 244 and 254.

244. The Committee is concerned about the high incidence of consumption of illicit drugs in the Macau Special Administrative Region and the ineffective enforcement of the law prohibiting it.

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254. The Committee recommends that measures be continued and strengthened for the effective implementation of programmes to prevent illicit drug consumption...

• Serbia and Montenegro, ICESCR, E/2006/22 (2005) 41 at paras. 294 and 321.

294. The Committee deplores the high rates of tobacco consumption and of cardiovascular diseases in Serbia and Montenegro, in particular in the autonomous province of Vojvodina.

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321. The Committee recommends that the State party intensify its anti-smoking and healthy diet campaigns with a view to combating the causes of cardiovascular diseases.

• Norway, ICESCR, E/2006/22 (2005) 48 at paras. 348 and 368.

348. The Committee is concerned about the high incidence of eating disorders among adolescents in the State party and about the high incidence of suicide among adolescent boys aged between 15 and 19.

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368. The Committee recommends that the State party continue and strengthen the measures taken to implement the coherent strategy developed in 2000 against eating disorders, and also ensure adequate follow-up to the National Plan for Suicide Prevention.

CEDAW

• Estonia, CEDAW, A/57/38 part I (2002) 13 at paras. 111 and 112.

111. While recognizing some improvements in the area of health, after a deterioration of the situation in the years following independence, the Committee is concerned with the increase of tuberculosis, sexually transmitted diseases and HIV, as well as with high suicide rates among women. The Committee notes with concern the high rate of abortion among women and the significance of this fact with regard to effective access to family planning methods, including contraceptives, especially among women in rural areas and low incomes.

112. The Committee draws attention to its general recommendation 24 on women and health and recommends that comprehensive research be undertaken into the specific health needs of women, including reproductive health, the financial and organizational strengthening of family planning programmes addressed to women and men and the provision of wide access to contraceptives for all women. The Committee urges the State party to reinforce programmes on sexual education for both girls and boys in order to foster responsible sexual behaviour. It also recommends that structures be established aimed at addressing the mental health problems faced by women, as well as those areas where negative developments have occurred.

• Russian Federation, CEDAW, A/57/38 part I (2002) 40 at paras. 397 and 398.

397. Noting the measures taken by the State party to combat the effect of HIV/AIDS on pregnant women, the Committee is concerned that the State party regards HIV/AIDS as primarily resulting from the conduct of individuals in the context of drug abuse and alcoholism.

398. The Committee urges the State party to address the gender aspects of HIV/AIDS, including the power differential between women and men, which often prevents women from insisting on safe and responsible sex practices. It encourages the State party to strengthen its efforts to raise awareness and educate women and girls on ways to protect themselves from HIV/AIDS. The Committee urges the State party to ensure the equal rights and the access of women and girls to detection, health care and social services.

• Suriname, CEDAW, A/57/38 part II (2002) 82 at paras. 61 and 62.

61. The Committee notes with concern that rates of HIV/AIDS infection have increased and that the majority of those who are HIV positive are young people between the ages of 15 and 29, with girls tending to become infected at a younger age than boys.

62. The Committee urges the State party to address the gender aspects of HIV/AIDS, including the power differential between women and men, which often prevents women from insisting on safe and responsible sex practices. It encourages the State party to strengthen its efforts to raise awareness and educate women and girls on ways of self-protection. The Committee urges the State party to ensure that women and girls have equal rights and access to health care and social services.

See also:

• Barbados, CEDAW, A/57/38 part III (2002) 177 at paras. 247 and 248.

• Saint Kitts and Nevis, CEDAW, A/57/38 part II (2002) 90 at paras. 107 and 108.

107. Noting that marijuana is used in the country, the Committee is concerned about the lack of sex-disaggregated data on drug use.

108. The Committee encourages the State party to collect data on the use of drugs and alcohol and its possible correlation with violence against women. It further encourages the State party to implement measures in order to prevent addiction to all types of drugs by young people.

• Zambia, CEDAW, A/57/38 part II (2002) 107 at paras. 244 and 245.

244. The Committee expresses concern at the increasing rate of HIV/AIDS and the absence of measures for the care of women and girls infected with HIV/AIDS.

245. The Committee urges the State party to take holistic measures to combat the HIV/AIDS pandemic and to take further practical preventive measures, including by providing access to condoms for women and men. It also urges the State party to ensure that women and girls infected with HIV/AIDS are not discriminated against and are given appropriate assistance. The Committee also emphasizes that the collection of reliable data on HIV/AIDS is critical to gaining an understanding of the pandemic.

• Uganda, CEDAW, A/57/38 part III (2002) 164 at paras. 126, 145 and 146.

126. The Committee commends the State party for the measures taken to address the HIV/AIDS pandemic and notes with satisfaction the decrease in HIV/AIDS prevalence rates from 22 per cent in 1992 to an average of 6.1 per cent in 2002.

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145. ...The Committee is...concerned that the prevalence of HIV/AIDS and other sexually transmitted diseases among prostitutes is increasing.

146. ...The Committee urges the State party to pay full attention to the provisions of health services for prostitutes, so as to curb the rise in HIV/AIDS.

• Argentina, CEDAW, A/57/38 part III (2002) 196 at paras. 360 and 361.

360. The Committee is concerned at the high maternal mortality rate and at the fact that, with the increasing deterioration in health services, women, in particular those in situations of vulnerability, are losing their right to comprehensive health care, in particular as regards sexual and reproductive health. The Committee is also concerned because, in this critical context, the incidence of HIV/AIDS is tending to increase, especially among women.

361. The Committee recommends that the State party should guarantee women’s access to health services, including sexual and reproductive health services, and that it should adopt the necessary measures to reduce the high maternal mortality rate. The Committee recommends that the State party should pay special attention to preventing and combating HIV/AIDS.

• Peru, CEDAW, A/57/38 part III (2002) 212 at paras. 482 and 483.

482. The Committee is concerned about the situation of women’s health and particularly their reproductive health...The Committee notes with concern the high maternal mortality rate and particularly mortality resulting from illegal abortions, including among adolescents, and the requirements that may prevent women from obtaining medical treatment in abortion cases. The Committee is also concerned about the inadequacy of sex education and the limited dissemination, availability and supply of all contraceptive methods, particularly among indigenous women and in the most vulnerable sectors of the population, as well as among adolescents. The Committee notes with concern that the rate of HIV/AIDS infection among women is increasing, particularly among young women.

483. ...The Committee recommends that the State party should give priority to the situation of the adolescent population and also urges it to adopt measures to strengthen the family planning programme and to guarantee access to sexual and reproductive health services, attending to the information needs of the population, particularly adolescents, by pursuing programmes and policies geared to increasing knowledge about various contraceptive methods and their availability, on the understanding that family planning is the responsibility of both partners. It also urges the State party to promote sex education for the entire population, including adolescents, giving special attention to efforts to prevent and combat HIV/AIDS and to improve the dissemination of information about risks and ways of transmission.

See also:

• Mexico, CEDAW, A/57/38 part III (2002) 205 at paras. 445 and 446.

• Switzerland, CEDAW, A/58/38 part I (2003) 20 at paras. 122 and 123.

122. ...The Committee is concerned that foreign women sometimes encounter additional difficulties in obtaining access to health care and that the percentage of women with HIV/AIDS is increasing among foreign women, those from sub-Saharan Africa being the most affected...

123. ...The Committee recommends that foreign women’s health needs, in particular as regards information on preventing HIV infection, be fully addressed...

• Congo, CEDAW, A/58/38 part I (2003) 29 at paras. 176 and 177.

176. The Committee expresses concern that the State party has not developed a strategic plan to address the issue of HIV/AIDS as it affects women, nor has it taken measures for the care of women and girls infected with and affected by HIV/AIDS.

177. The Committee urges the State party to take comprehensive measures to combat the HIV/AIDS pandemic, to take strong preventive measures and to ensure that women and girls infected with HIV/AIDS are not discriminated against and are given appropriate assistance.

• Kenya, CEDAW, A/58/38 part I (2003) 35 at paras. 221 and 222.

221. While noting the State party’s commitment to combatting the spread of HIV/AIDS and the reduction in infection rates from 14 per cent to 10.2 per cent in 2002, the Committee is concerned at the lack of sex-disaggregated data on HIV/AIDS and the absence of strategic measures for the care of women and girls infected with and affected by HIV/AIDS.

222. The Committee urges the State party to take comprehensive measures to combat the HIV/AIDS pandemic, to take strong preventive measures and to ensure that women and girls infected with HIV/AIDS are not discriminated against and are given appropriate assistance. The Committee also emphasizes that the collection of reliable data on HIV/AIDS is critical in order to understand the impact of the pandemic on women and men.

• El Salvador, CEDAW, A/58/38 part I (2003) 41 at paras. 259 and 260.

259. The Committee observes with concern the lack of necessary sex education programmes and their dissemination and the resulting impact on the high rate of teenage pregnancy, in particular in rural areas, and on the increase in the spread of sexually transmitted diseases and HIV/AIDS. The Committee is concerned at the obstacles that women face in gaining access to adequate health-care services, including those for the prevention of cancer.

260. The Committee recommends to the State party that it adopt measures to guarantee and expand access to health-care services, paying special attention to the implementation of programmes and policies for disseminating and raising awareness of sex education, particularly among adolescents, including information on contraceptives and their availability in society as a whole, taking into account that family planning is the responsibility of the couple and placing special emphasis on preventing and combating sexually transmitted diseases and HIV/AIDS.

• Canada, CEDAW, A/58/38 part I (2003) 53 at para. 346.

346. The Committee commends the State party for the creation, in 2000, of the Institute of Gender and Health to contribute to the reduction of health disparities and the promotion of equity for vulnerable populations of women, including women with disabilities. The Committee notes with appreciation the adoption of the Guidelines on the Inclusion of Women in Clinical Trials to ensure that women are enrolled in such trials at all stages of drug development

• Costa Rica, CEDAW, A/58/38 part II (2003) 86 at para. 69.

69. The Committee requests the State party to strengthen its health-care programmes, including those for sexual and reproductive health, and to launch as soon as possible a national programme to provide women and men with timely and reliable information on the available contraceptive methods and those capable of allowing them to exercise their right of free and informed choice of the number and spacing of the children they wish to have, as well as to reinforce the measures for preventing sexually transmitted diseases and HIV/AIDS, including the availability of condoms. It also requests the State party to continue strengthening support programmes for pregnant teenagers and mothers and sex education programmes aimed at preventing pregnancies among the teenage population.

• Brazil, CEDAW, A/58/38 part II (2003) 93 at paras. 126 and 127.

126. The Committee is concerned at the high maternal mortality rate, particularly in the more remote regions where access to health facilities is very limited. The Committee is also concerned at the health condition of women from disadvantaged groups and at the high rate of clandestine abortion and its causes, linked to, among others, poverty, exclusion and a lack of access to information. The Committee is further concerned that, notwithstanding progress in relation to the control of HIV/AIDS, the number of infected women, particularly young women, had increased.

127. The Committee recommends that further measures be taken to guarantee effective access of women to health-care information and services, particularly regarding sexual and reproductive health, including young women, women from disadvantaged groups and rural women. Those measures are essential to reduce maternal mortality and to prevent recourse to abortion and protect women from its negative health effects. It further recommends that programmes and policies be adopted to increase the knowledge of and access to contraceptive methods with the understanding that family planning is the responsibility of both partners. The Committee also recommends that sex education be widely promoted, particularly targeting adolescents, with special attention to the prevention and further control of HIV/AIDS.

• Ecuador, CEDAW, A/58/38 part II (2003) 122 at paras. 317 and 318.

317. The Committee is concerned that, although there is a National Education Plan for Love and Sexuality, it is not applied consistently and little is done to publicize women’s right to sexual and reproductive health care, which would help to make both sexes aware of their rights and responsibilities in the area of reproduction. The Committee is also concerned at the high rate of pregnancy and abortion among teenagers, particularly in rural areas.

318. The Committee urges the State party to implement the National Education Plan for Love and Sexuality and to strengthen its health-care programmes, including sexual and reproductive health, and, as soon as possible, to implement a national programme that provides women and men with adequate and reliable information on available contraceptive methods and methods that can enable them to exercise their right to make a free and informed decision concerning the number and spacing of their children and to strengthen methods for preventing sexually transmitted diseases and HIV/AIDS, including the availability of condoms. It also requests the State party to continue strengthening support programmes for pregnant teenagers and teenage mothers and sexual education programmes to prevent pregnancies among the teenage population...

• Ethiopia, CEDAW, A/59/38 part I (2004) 42 at paras. 257 and 258.

257. The Committee is concerned about the very low level of life expectancy for women, the high rate of maternal mortality and the high prevalence of HIV/AIDS among women. The Committee is also concerned at the high rate of clandestine abortion and its causes, which include poverty, a lack of access to information on women’s reproductive health and rights and low prevalence of contraceptive use.

258. The Committee recommends the adoption of measures to guarantee effective access for women, including young women, to health-care information and services, in particular regarding reproductive health, with the aim of reducing clandestine abortions. It further recommends that programmes and policies be adopted to increase knowledge about and access to affordable contraceptive methods, as well as to increase the understanding that family planning is the responsibility of both partners. The Committee also recommends that sex education be widely promoted and provided, targeting men, women and adolescent boys and girls, with special attention to the prevention and further control of HIV/AIDS.

• Latvia, CEDAW, A/59/38 part II (2004) 103 at paras. 71 and 72.

71. The Committee is concerned at the spread of HIV/AIDS, the increase in the infection rates of women and the absence of a strategic national plan to address the issue of HIV/AIDS and how it affects women.

72. The Committee urges the State party to take comprehensive measures to combat the spread of HIV/AIDS, to take strong preventive measures and to ensure that women and girls infected with HIV/AIDS are not discriminated against and are given appropriate assistance. The Committee also recommends that sex education, particularly targeting adolescents, be made widely available, with special attention to the prevention and further control of HIV/AIDS.

• Equatorial Guinea, CEDAW, A/59/38 part II (2004) 126 at paras. 207 and 208.

207. The Committee notes with concern the high incidence of HIV/AIDS among women, particularly younger women, and the absence of an adequately funded strategic plan to address HIV/AIDS.

208. The Committee urges the State party to take comprehensive measures and allocate sufficient funds to combat HIV/AIDS, to take strong preventive measures, including education and awareness-raising, and to ensure that women and girls infected with HIV/AIDS are not discriminated against and are given appropriate assistance and medical treatment.

• Dominican Republic, CEDAW, A/59/38 part II (2004) 141 at paras. 308 and 309.

308. The Committee notes with concern the increase in the number of cases of sexually transmitted diseases and HIV/AIDS. It is also concerned about the violation of the human rights of infected persons, the majority of whom are women, who are denied access to employment and adequate medical services. The Committee is concerned that these women are largely prevented from obtaining adequate health services, including those directed towards cancer prevention. The Committee expresses concern about the high rates of female mortality and morbidity, of which unsafe abortions are among the primary causes.

309. The Committee recommends the adoption of measures to ensure that women, especially young women, the disabled and women living in rural areas, have access to information and health services, particularly those relating to sexual and reproductive health and cancer prevention. Such measures are essential in order to reduce the rate of maternal mortality, prevent women from resorting to unsafe abortion and protect women against the negative effects on their health. In this regard, the Committee recommends that the State health services should provide an abortion when the pregnancy is a result of rape or when the mother’s health is in danger. It also recommends the development of programmes and policies to increase knowledge of and access to contraception, bearing in mind that family planning is the responsibility of both members of the couple. The Committee also recommends promoting sex education widely, particularly for adolescents, with special emphasis on combating sexually transmitted diseases and HIV/AIDS. The Committee also requests the State party to adopt measures to eliminate discrimination against women infected with HIV/AIDS.

• Argentina, CEDAW, A/59/38 part II (2004) 155 at paras. 380 and 381.

380. While appreciating the establishment of the National Programme for Sexual Health and Responsible Parenthood, the Committee is concerned about the lack of information on the State party’s efforts to evaluate the effectiveness of that Programme. The Committee also expresses concern about the high pregnancy rate among adolescents, the high rate of maternal mortality, one third of which is caused by illegal abortion, and the increase in sexually transmitted diseases, including HIV/AIDS. The Committee is also concerned that the crisis is having a negative impact on women’s and adolescent girls’ access to comprehensive health services, particularly for reproductive and sexual health.

381. The Committee urges the State party to ensure that women’s and adolescent girls’ access to health services, including sexual and reproductive health services, is fully ensured at the present time. It calls upon the State party to ensure that education on sexual and reproductive health is undertaken in all schools. It also urges the State party to adopt all necessary measures to reduce the high maternal mortality rate, as well as the rate of sexually transmitted diseases, including HIV/AIDS, among women...

• Samoa, CEDAW, A/60/38 part I (2005) 9 at paras. 56 and 57.

56. The Committee expresses concern that complications of pregnancy and childbirth remain one of the leading causes of morbidity for women. It is also concerned about the rising incidence of teenage pregnancy, the limited family-planning efforts, the low contraceptive prevalence rate and the lack of sex education in schools, despite comprehensive access for women to health services, including reproductive health services. The Committee is also concerned about the insufficient information provided about the HIV/AIDS infection rates of women.

57. The Committee urges the State party to increase its efforts to improve the provision of sexual and reproductive health services to reduce fertility rates and maternal morbidity. It calls upon the State party to step up the provision of family-planning information to women and girls and to promote widely sex education targeted at girls and boys, with special attention to the prevention of teenage pregnancy and the control of HIV/AIDS...

• Lao People’s Democratic Republic, CEDAW, A/60/38 part I (2005) 16 at paras. 100 and 101.

100. The Committee is concerned that the Lao People’s Democratic Republic is increasingly exposed to the danger of HIV/AIDS and other sexually transmitted diseases, in particular around construction sites and along trade routes.

101. The Committee recommends that the State party take all measures necessary to raise awareness among men and women, especially in rural areas, around construction sites and along existing and emerging trade routes, of the risk of HIV/AIDS infection.

• Democratic People’s Republic of Korea, CEDAW, A/60/38 part II (2005) 101 at paras. 65 and 66.

65. While welcoming the efforts of the Government to raise awareness of the risks and effects of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic, the Committee expresses concern that stigma might affect the disclosure of actual cases of infection.

66. The Committee emphasizes that the collection of reliable data on HIV/AIDS is critical in order to understand the extent of the problem, specifically the impact of the pandemic on women and men, and to ensure that women infected with HIV/AIDS are not discriminated against or stigmatized and are given appropriate assistance. The Committee urges the State party to strengthen HIV/AIDS prevention measures for women and men; to conduct a nationwide awareness-raising campaign on the risks and effects of HIV/AIDS; to develop a comprehensive HIV/AIDS research and control programme based on partnerships with stakeholders; and to ensure access to affordable antiretroviral drugs.

• Lebanon, CEDAW, A/60/38 part II (2005) 109 at paras. 113 and 114.

113. The Committee notes with concern the high incidence of HIV/AIDS among women, who make up 18.2 per cent of those infected, and that no special programmes have been designed to protect women from HIV/AIDS.

114. The Committee urges the State party to design and implement comprehensive gender-sensitive programmes and allocate sufficient funds to combat HIV/AIDS, to step up preventive measures, including awareness-raising, and to ensure that women and girls infected with HIV/AIDS are not discriminated against and are given appropriate assistance and treatment.

• Gambia, CEDAW, A/60/38 part II (2005) 122 at paras. 205 and 206.

205. The Committee expresses concern about the high rates of malnutrition, malaria and HIV/AIDS affecting women and girls in the country. The Committee is further concerned that women lack access to information and services related to reproductive health and that, although contraceptive use increased from 6.7 per cent in 1990 to 13.4 per cent in 2001, it continues to remain low. The Committee regrets that women’s access to family planning services is, in general, dependent on several social and cultural factors.

206. The Committee recommends the implementation of comprehensive policies and programmes to prevent and combat malnutrition, malaria and HIV/AIDS. The Committee calls upon the State party to implement measures to guarantee effective access for women, including young women, to reproductive health-care information and services. It further recommends that programmes and policies be adopted to increase knowledge about, and access to, affordable contraceptive methods and to increase the understanding that family planning is the responsibility of both partners. It also encourages the State party to ensure that women have easy access to family planning services. The Committee also recommends that sex education be widely promoted and provided, targeting men and women, and adolescent boys and girls, and including information on the prevention of HIV/AIDS.

• Guyana, CEDAW, A/60/38 part II (2005) 136 at paras. 305 and 306.

305. While welcoming the adoption of the National Strategic Plan for HIV/AIDS 2002-2006, the Committee notes with concern the high and growing prevalence of HIV/AIDS among women, especially younger women, who are particularly vulnerable because of unequal power relations and limited socio-economic opportunities. The Committee is especially concerned that the low minimum age of sexual consent (13 years) puts young women and girls at particular risk of becoming victims of sexual exploitation and infection with the virus.

306. The Committee urges the State party to strengthen attention to the gender dimensions in its efforts to combat the HIV/AIDS pandemic. It calls on the State party to increase its emphasis on men’s responsibilities in preventing the spread of the disease, including through awareness-raising and prevention campaigns, and the implementation of education programmes on sexual and reproductive health and rights directed at both women and men, including the provision of condoms. It also urges the State party to increase the minimum age of sexual consent to protect girls effectively against sexual exploitation.

• Burkina Faso, CEDAW, A/60/38 part II (2005) 144 at paras. 349 and 350.

349. While noting the efforts made by the State party to improve reproductive health care for women, including through subsidizing contraceptives, the Committee remains concerned about the limited access for women to adequate health-care services, including those related to family planning. It is particularly concerned about high rates of fertility, infant and maternal mortality, and death due to clandestine abortions, inadequate family planning services and low rates of contraceptive use. The Committee is further concerned that the report contained insufficient information on the impact of measures taken to reduce infant and maternal mortality rates, and improve access to family planning services. The Committee is concerned about the limited information provided on the prevalence of HIV/AIDS and trends in the spread of the epidemic.

350. The Committee recommends that the State party take measures to improve women’s access to health care and health-related services and information, in accordance with article 12 of the Convention and the Committee’s general recommendation 24 on women and health. It calls upon the State party to improve the availability of sexual and reproductive health services, including family planning, with the aim also of preventing clandestine abortions. It encourages the State party to enhance the availability of contraceptive services. It further recommends that sex education be widely promoted and targeted at girls and boys, with special attention to the prevention of early pregnancies and sexually transmitted diseases...The Committee calls upon the State party to carefully monitor, and to reflect in its next report, the implementation and results of the national plans to combat HIV/AIDS and sexually transmitted infections (2001-2005) and any follow-up programmes and strategies.

CAT

• Ukraine, CAT, A/57/44 (2002) 31 at paras. 57 and 58.

57. The Committee expresses its concern about the following:

...

(j) Overcrowding and lack of access to basic hygienic facilities and adequate medical care, as well as the high incidence of tuberculosis, in prisons and pre-trial detention centres;

...

58. The Committee recommends that the State party:

...

(p) Continue the programme against tuberculosis in prisons and pre-trial detention centres;

...

• Azerbaijan, CAT, A/58/44 (2003) 36 at para. 87.

87. The Committee notes the following positive developments:

...

(h) The assurances by the State party that it is taking action to reduce the incidence of tuberculosis in places of detention;

...

• Republic of Moldova, CAT, A/58/44 (2003) 53 at para. 137.

137. The Committee welcomes the following positive aspects:

...

(c) The efforts of the Moldovan authorities to improve prison conditions, inter alia by removing 89 per cent of the metal shutters which covered cell windows in remand prisons, increasing efforts regarding the treatment of tuberculosis patients and increasing employment offers for detainees;

...

• Cameroon, CAT, A/59/44 (2003) 23 at paras. 40 and 44.

40. The Committee recalls that, in 2000, it found that torture seemed to be a very widespread practice in Cameroon, and expresses concern at reports that this situation still exists. It is troubled by the sharp contradictions between consistent allegations of serious violations of the Convention and the information provided by the State party. In particular, the Committee declares serious concern about:

...

(b) The continued existence of extreme overcrowding in Cameroonian prisons, in which living and hygiene conditions would appear to endanger the health and lives of prisoners and are tantamount to inhuman and degrading treatment. Medical care reportedly has to be paid for, and the separation of men and women is not always ensured in practice. The Committee notes with particular concern the large number of deaths at Douala central prison since the beginning of the year (25 according to the State party, 72 according to non-governmental organizations);

...

44. The Committee urges the State party to take all necessary measures to end the practice of torture on its territory. It recommends that the State party should:

...

(c) Adopt urgent measures to reduce overcrowding in prisons. The State party should enact a law establishing the maximum duration of pre-trial detention, and consider immediately releasing offenders or suspects imprisoned for the first time for petty offences, particularly if they are under 18 years of age; such persons should not be imprisoned until the problem of prison overcrowding has been solved;

(d) Guarantee free medical care in prisons, ensure the right of prisoners to adequate food in practice, and effectively separate men and women;

...

• Latvia, CAT, A/59/44 (2003) 48 at para. 100.

100. The Committee expresses concern about the following:

...

(f) The overcrowding in prisons and other places of detention, taking into account, inter alia, the potential risk of this situation for the spread of contagious diseases;

...

CRC

• Portugal, CRC, CRC/C/111 (2001) 48 at paras. 228, 229, 244, 245, 254 and 255.

228. The Committee joins the State party in expressing concern at the extremely high number of accidents, including road accidents, of which children are victims.

229. The Committee recommends that the State party, taking into account the conclusions of its Working Group for the Prevention of Accidents, promote initiatives with a view to diminishing the number and consequences of accidents involving children through, inter alia, legislation, standardization of toys and child care articles and the training of relevant professionals and of families with children in the prevention of accidents.

...

244. Noting the launching of the State party's Health Education Programme to address, inter alia, HIV/AIDS, the Committee remains concerned at the incidence of HIV transmission, including mother-to-child transmission, and at the high incidence of AIDS (10.4 cases per 100,000) in the State party.

245. The Committee recommends that the State party:

(a) Continue to strengthen its HIV/AIDS prevention programmes, including safe sex education programmes;

(b) Increase interventions at primary health-care level aimed at limiting mother-to-child transmission of HIV.

...

254. The Committee notes the "National Strategy in the Fight Against Drugs", but remains concerned at the lack of data on substance and alcohol abuse and smoking.

255. The Committee recommends that the State party:

(a) Continue its efforts to prevent substance abuse by children, including through the prohibition of the sale of such substances to children and through addressing factors leading to vulnerability;

(b) Study the interrelationship between accidents and substance abuse and take prevention and law enforcement measures in this regard;

(c) Pursue its efforts to use information campaigns to alert children and adults to the risks of substance abuse, and that the child victims of substance abuse be provided with appropriate care, rehabilitation and assistance.

• Cameroon, CRC, CRC/C/111 (2001) 71 at paras. 371 and 372.

371. While noting the existence of a national AIDS prevention programme and the efforts of the State party in that respect (e.g. agreement with pharmaceutical companies to ensure cheap access to AIDS drugs), the Committee remains extremely concerned at the high and increasing prevalence of HIV/AIDS among adults and children, and the resulting number of children orphaned by HIV/AIDS. In this regard, the Committee is concerned at the lack of alternative care for these children.

372. The Committee recommends that the State party:

(a) Increase its efforts to prevent the spread of HIV/AIDS and take into consideration the recommendations the Committee adopted on its day of general discussion on children living in a world with HIV/AIDS (CRC/C/80, para. 243);

(b) Urgently consider ways of minimizing the impact on children of the HIV/AIDS-related deaths of parents, teachers and others, in terms of children's reduced access to a family life, to adoption, to emotional care and education;

(d) Seek further technical assistance from, inter alia, UNAIDS.

See also:

• Gambia, CRC, CRC/C/111 (2001) 89 at paras. 444 and 445.

• Gabon, CRC, CRC/C/114 (2002) 47 at paras. 223 and 224.

• Malawi, CRC, CRC/C/114 (2002) 104 at paras. 426 and 427.

• Uzbekistan, CRC, CRC/C/111 (2001) 117 at paras. 572 and 573.

572. While noting efforts to strengthen the primary health sector, the Committee is nevertheless concerned at the deterioration in the health of the most vulnerable groups, especially women and children, and in particular at:

The high infant mortality rates;

The high under-five mortality rates;

The high maternal mortality rates;

The high incidence of infectious diseases, such as tuberculosis, despite high rates of immunization;

The fact that accidents and injuries are a main cause of mortality and morbidity among children and that children in rural and disadvantaged regions, such as Karakalpakstan and Khorezm, suffer the most.

573. The Committee recommends that the State party:

(a) Ensure that its commitment to primary health care is met by adequate allocation of human and financial resources, and that all children, especially from the most vulnerable groups, have access to health care;

(b) Continue and strengthen implementation of the WHO Promoting Effective Perinatal Care strategy, to address high maternal, infant and child mortality;

(d) Implement WHO recommendations and guidelines, such as "Essential newborn care and breastfeeding", "First action plan for food and nutrition", and "Feeding and nutrition of infants and young children", to address nutritional deficiencies;

(e) Implement the 2000 Amsterdam Declaration to Stop TB and the Strategy to Roll Back Malaria in the European Region;

(f) Implement the recommendations of the WHO report, "Childhood injuries - a priority area for the transition countries of Central and Eastern Europe and the newly independent States";

(g) Continue to cooperate with and seek assistance from, among others, UNICEF and WHO.

• Cape Verde, CRC, CRC/C/111 (2001) 135 at paras. 640, 641, 658 and 659.

640. While noting the significant progress made, the Committee remains concerned at health problems among children such as the deaths of infants and children caused by diarrhoeal diseases, respiratory infections and malnutrition. The Committee is concerned, in particular, by the limited access to health services of children living in rural communities, and particularly on more remote islands, and the threat of HIV/AIDS.

641. The Committee recommends that the State party:

(a) Pursue and strengthen its efforts to improve access to health care, including primary health care, giving particular attention to major causes of infant and child mortality and to major illnesses and diseases;

(b) Give particular attention to children living in rural areas and on remote islands and to the prevention of the spread of HIV/AIDS.

...

658. Noting the work of the national committee combating drug abuse, the Committee is concerned at the incidence of substance abuse by children, particularly in the urban centres of Praia, Mindelo and Sal.

659. The Committee recommends that the State party:

(a) Reinforce the work of the National Committee;

(b) Strengthen its efforts to address the abuse of substances by children.

• Lebanon, CRC, CRC/C/114 (2002) 11 at paras. 69 and 70.

69. While welcoming the extensive legislation adopted for children with disabilities, the Committee remains concerned that children with disabilities continue to be subject to discrimination in the areas of health coverage, access to specialized services, family support and education.

70. The Committee urges the State party:

...

(d) To make greater efforts in the area of prevention by reviewing, inter alia, health programmes and policies relating to pregnancy, birth and child health; ...

...

• Greece, CRC, CRC/C/114 (2002) 25 at para. 128, 129, 166 and 167.

128. The Committee is concerned:

(a) At the very high rate of accidents, especially road accidents and domestic accidents of poisoning, of which children are victims in the State party;

...

129. The Committee recommends that the State party take steps:

(a) To prevent road accidents and domestic accidents of poisoning involving children;

...

166. The Committee is concerned:

(a) At the smoking of cannabis and the sniffing of petrol and glue by children;

...

167. Noting the State party’s efforts in this regard, the Committee recommends that the State party:

(a) Implement its primary, secondary and tertiary prevention programmes for the prevention and combating of substance abuse throughout the country;

...

• Gabon, CRC, CRC/C/114 (2002) 47 at paras. 217-220.

217. ...[T]he Committee is concerned that the survival and development of children within the State party continue to be threatened by early childhood diseases such as acute respiratory infections and diarrhoea and by malaria, tuberculosis and malnutrition. Concern is also raised at the very low rate of breastfeeding. The Committee is further concerned at the regular outbreaks of epidemics of diseases such as the Ebola virus.

218. The Committee recommends that the State party:

...

(b) Facilitate greater access to primary health services; reduce the incidence of maternal, child and infant mortality; prevent and combat malnutrition, especially among vulnerable and disadvantaged groups of children; and promote proper breastfeeding practices;

...

(d) Take the necessary measures to deal with emergency situations, including to combat epidemics of diseases such as the Ebola virus;...

...

219. The Committee notes the existence of an extended vaccination programme and the provisions of articles 16 to 29 of the 1995 Ordinance on Health Policy dealing with the extension of vaccination coverage and follow-up, but remains deeply concerned that there is a lack of adequate resources, and that the vaccination coverage has worsened during the last past years.

220. The Committee recommends that the State party continue and strengthen its efforts, including the provision of financial resources, to extend the vaccination coverage to all parts of the country. It also recommends that the State party seek further assistance from, among others, WHO and UNICEF.

• Mozambique, CRC, CRC/C/114 (2002) 65 at paras. 279, 280, 301, 302, 319 and 320.

279. The Committee is concerned that:

(a) Ninety per cent of cases of people being run down by cars involve children, as indicated in the State party’s report;

(b) Landmines continue to pose a serious threat to children’s survival and development.

280. The Committee recommends that the State party:

(a) Develop and implement a policy for the prevention of accidents involving children, including through information campaigns targeting children, drivers, traffic police, teachers and parents;

(b) Continue efforts to clear landmines and ensure the provision of physical rehabilitation and other relevant support to victims.

...

301. While noting the State party’s efforts in this domain, including the establishment of the National AIDS Council (NAC) in 2000 and the adoption of a comprehensive multisectoral strategic plan to combat HIV/AIDS, the Committee remains deeply concerned at:

...

(b) The extremely high, and rising, incidence of HIV/AIDS infection in the State party;

(c) Mother to child transmission of HIV/AIDS and related factors, such as the lack of access of mothers to affordable breast-milk substitute, which would help reduce the risk of transmission;

...

(e) The continuing lack of knowledge among many people of how HIV/AIDS is transmitted and the role of men in terms of inadequate prevention and repeated transmission;

...

302. The Committee recommends that the State party:

...

(b) Conduct a national study on public attitudes, taboos and bias with regard to HIV/AIDS and infected persons in order to strengthen existing policies and programmes with regard to HIV/AIDS;

(c) Continue and strengthen its efforts to address the incidence of HIV/AIDS, including through the current multisectoral approach, through improving the education of the public as to how it is transmitted, can be prevented and treated, with particular focus on the training of relevant professionals, such as teachers and civil servants;

(d) Give particular attention to the role of men in the prevention of HIV/AIDS transmission and involve children in discussions on prevention strategies;

...

(f) Strengthen efforts to reduce mother to child transmission of HIV/AIDS including through voluntary prenatal HIV/AIDS testing of mothers and assistance to infected mothers in obtaining breast-milk substitutes for their children;

(g) Include children in devising and implementing strategies for HIV/AIDS prevention,

...

319. While noting the establishment of a central office for the prevention and control of drug abuse, the Committee is concerned that:

(a) Substance abuse, including inhaling glue and the consumption of narcotic drugs, is practised by children, particularly street children, in the State party, particularly in the south of the country;

...

320. The Committee recommends that the State party:

(a) Strengthen its efforts to prevent substance abuse by children, giving particular attention to street children and other vulnerable groups, including children in the south of the country;

(b) Include in school curricula education programmes and information on drug abuse and its prevention;

...

(e) Consider adopting legislation regulating the sale of harmful substances to children;

(f) Implement its own recommendations as set out in its initial report, including: developing improved methods for fighting substance abuse, additional “technical training for staff involved in preventing and combating drug abuse, reducing the vulnerability of Mozambique’s borders and other entry and exit points, institutional capacity building, and strengthening the anti-drug education strategy at all levels”.

• Guinea-Bissau, CRC, CRC/C/118 (2002) 12 at paras. 64, 65 and 71.

64. The Committee is deeply concerned at:

...

(b) The high rates of infant and maternal mortality, malnutrition, inadequate immunization and high mortality from malaria;

(c) The limited proportion of the population with access to safe water and adequate sanitation, including in schools, and related cholera and meningitis epidemics;

...

65. The Committee recommends that the State party:

...

(c) Take action to address specific concerns, including infant and maternal mortality, malnutrition, inadequate immunization, malaria rates and cholera and meningitis epidemics;

(d) Take action to ensure that all children have access to drinking water and adequate sanitation, including in schools, and to ensure adequate waste disposal arrangements;

...

71. The Committee recommends that the State party:

...

(c) Strengthen programmes to prevent the transmission of HIV/AIDS and to ensure protection of the rights of AIDS orphans;

...

• Niger, CRC, CRC/C/118 (2002) 37 at paras. 171 and 172.

171. ...[T]he Committee is concerned that the survival and development of children in the State party continue to be threatened by early childhood diseases and that malnutrition is an acute problem. Concerns also exist at the low coverage of vaccination and at the lack of prenatal health care

172. The Committee recommends that the State party:

...

(d) Increase the rate of vaccination and carry out campaigns similar to that for polio;

...

• Belarus, CRC, CRC/C/118 (2002) 54 at paras. 241 and 242.

241. The Committee, while noting efforts to reorganize maternity and child care services and various programmes to improve children's health, is concerned about the increase in child morbidity, including the increase of HIV in newborns, the almost epidemic scope of tuberculosis, and the high incidence of iodine deficiency and nutrition problems, especially among children from low-income households and families with three and more children. It further notes the high rates of transport and motor vehicle accidents and the high rates of suicide which also affect children.

...

242. The Committee recommends that the State party:

(a) Continue to implement the WHO Strategy on Promoting Effective Perinatal Care in order to further decrease maternal, perinatal and infant mortality;

(b) Ensure that all children, in particular children from the most vulnerable groups, have access to free basic health care of good quality;

(c) Develop a national policy in order to ensure an integrated and multidimensional approach to early childhood development, with a focus on health and nutrition;

(d) Address the increase in HIV in newborns, focusing on the prevention of mother-to-child transmission;

(e) In order to prevent childhood injuries, develop adequate legislation to protect children from accidents and injuries, include the prevention of injuries in national policy priorities and objectives, and develop injury control programmes;

(f) Undertake a comprehensive and multidisciplinary study to assess the extent of and reasons for suicide among children and develop adequate policies and programmes to prevent and combat this phenomenon; and

(g) Continue technical assistance from, among others, WHO and UNICEF.

• Switzerland, CRC, CRC/C/118 (2002) 78 at paras. 344, 345, 358 and 359.

344. While taking into account the advanced health care system, the very low infant mortality rate and the decrease in HIV/AIDS prevalence, the Committee is nevertheless concerned about the high number of suicides among adolescents and the limited measures to prevent this phenomenon, and the insufficient access by adolescents to counseling services, including outside schools. In addition, the Committee is concerned at the high and increasing, prevalence - notably among girls - of alcohol and tobacco use. Moreover, while noting that the fatality rate is decreasing, the Committee is still concerned at the high number of children who die or are injured in road traffic accidents. Finally, the Committee is concerned at cases of female genital mutilation performed abroad.

345. The Committee recommends that the State party

(a) Pursue its efforts to decrease the prevalence of HIV/AIDS and take all necessary measures to prevent suicides among adolescents, including the collection and analysis of information, the launching of awareness-raising campaigns, and the establishment of specific programmes and counseling services;

(b) Increase its efforts to promote adolescent health policies, particularly with respect to alcohol consumption and tobacco use;

(d) Develop awareness campaigns targeted at the relevant population to put an end to the practice of female genital mutilation and to conduct a comprehensive study on this issue.

...

358. While noting the current policy of the State party to prevent and fight drug use by adolescents, the Committee is concerned at the increasing use and sale of illegal drugs among adolescents.

359. The Committee recommends that the State party to pursue its awareness-raising and preventive measures, including awareness raising of the danger of drugs in schools. It further recommends that the State party allocate more resources to the child welfare service system for prevention, treatment therapies and services for recovery and social reintegration specifically tailored for children and adolescents.

• Saint Vincent and the Grenadines, CRC, CRC/C/118 (2002) 101 at paras. 451 and 452.

451. The Committee is concerned that:

(a) Adolescents face health risks, including from sexual exploitation, maltreatment, drug and alcohol abuse, and HIV/AIDS;

(b) The rate of teenage pregnancy is high.

452. The Committee recommends that the State party:

(a) Increase its efforts to promote adolescent health, including mental health, policies, particularly with respect to reproductive health and substance abuse and health education in schools, ensuring the full participation of adolescents;

(b) Consider means of reducing teenage pregnancy, including strengthening reproductive health education for adolescents, and ensure the provision of full health and counselling support for pregnant girls and that these girls are able to continue their formal education.

• Spain, CRC, CRC/C/118 (2002) 117 at paras. 505 and 506.

505. The Committee notes with concern the number of children and adolescents addicted to drugs, in particular synthetic drugs, alcohol and smoking, and the fact that consumption of alcohol and tobacco is socially accepted and not perceived as a risk. It further expresses its concern at the increase in the number of teenage pregnancies.

506. The Committee recommends that the State party:

(a) Enforce existing programmes, such as the National Drug Plan for 2002-2008 and those at Autonomous Community level, with a focus on preventive action and awareness raising on the danger of synthetic drugs, alcohol and tobacco;

(b) Take steps to address adolescent health concerns, including teenage pregnancy and sexually transmitted diseases, through, inter alia, sex education, including birth control measures such as the use of condoms;

(c) Strengthen its mental health and counselling services, ensuring that these are accessible and sensitive to adolescents.

• Argentina, CRC, CRC/C/121 (2002) 8 at paras. 71, 72, 75 and 76.

71. While noting the decrease in the infant, child and maternal mortality rates, the Committee is nevertheless concerned that the rates remain high and that there are great disparities in these rates, in particular with regard to children from a lower socio-economic background, those living in rural areas, in particular in the northern provinces, and indigenous children. It also notes that 6 out of 10 infant deaths could be avoided by low-cost actions.

72. The Committee recommends that the State party:

(a) Allocate appropriate resources and develop comprehensive policies and programmes to improve the health situation of all children without discrimination, in particular by focusing more on health promotion and prevention;

(b) In order to further decrease child mortality and morbidity and maternal mortality rates, take measures to implement the Reproductive Health and Responsible Procreation Act of July 2000;

(c) Provide adequate antenatal and post-natal health-care services and develop campaigns to inform parents about basic child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation, family planning and reproductive health, especially in the provinces.

...

75. The Committee notes with concern the growing number of cases of HIV/AIDS among the youth, notwithstanding the existing National Plan of Action for HIV/AIDS, and reiterates its concern ([CRC/C/15/Add.36], para. 12) about the number of teenage pregnancies, in particular in some of the provinces.

76. The Committee recommends that the State party:

(a) Review and reactivate its programmes against HIV/AIDS and increase its efforts to promote adolescent health policies. Due attention should be given to reproductive health, and the programme of health and sexual education in schools should be further strengthened;

(b) Undertake a comprehensive and multidisciplinary study to assess the scope and nature of adolescent health problems, including the negative impact of sexually transmitted diseases and HIV/AIDS, and continue to develop adequate policies and programmes;

(c) Take further measures, including the allocation of adequate human and financial resources, to evaluate the effectiveness of training programmes in health education, in particular as regards reproductive health, and to develop youth-sensitive and confidential counselling, care and rehabilitation facilities that are accessible without parental consent when this is in the best interests of the child;

(d) Seek technical cooperation from, among others, UNFPA, UNICEF, WHO and UNAIDS.

See also:

• Republic of Moldova, CRC, CRC/C/121 (2002) 89 at paras. 406 and 407.

• United Kingdom of Great Britain and Northern Ireland, CRC, CRC/C/121 (2002) 23 at paras. 135 and 136.

135. While noting the efforts undertaken by the State party to reduce the number of teenage pregnancies, the Committee remains concerned at the high rate of teenage pregnancies in the State party. The Committee welcomes the one-to-one mentoring system and the multidisciplinary approach to detecting and managing mental health problems and notes that the mental health of children has been introduced in the National Priorities Guidance 1999/2002, but remains concerned that many children suffer from mental health problems and that the rate of suicide among young people is still high...The Committee is furthermore concerned at the rising incidence of sexually transmitted diseases among young persons.

136. In line with its previous recommendations ([CRC/C/15/Add.34], para. 30), the Committee recommends that the State party:

(a) Take further necessary measures to reduce the rate of teenage pregnancies through, inter alia, making health education, including sex education, part of the school curricula, making contraception available to all children, and improving access to confidential and adolescent-sensitive advice and information and other appropriate support (as recommended by the independent Advisory Group on Teenage Pregnancy);

...

(c) Take all necessary measures to strengthen its mental health and counselling services, ensuring that they are accessible and sensitive to adolescents, and undertake studies on the causes and backgrounds of suicides;

...

• Seychelles, CRC, CRC/C/121 (2002) 41 at paras. 205, 206, 211 and 212.

205. The Committee is concerned that:

(a) Adolescents face health risks, including from sexual exploitation, maltreatment, smoking, drug and alcohol abuse, and HIV/AIDS and sexually transmitted diseases;

(b) The rate of teenage pregnancies and illegal abortions is high;

206. The Committee recommends that the State party:

(a) Increase its efforts to promote adolescent health, including mental health, by focusing, in particular, on the issues of reproductive health, substance abuse and health education in schools and institutions;

(b) Consider means of reducing teenage pregnancy, including through strengthened reproductive health education and access to contraception without parental consent for adolescents;

...

211. The Committee is concerned at the increasing use of marijuana and other illicit substances by children in the State party and at the lack of adequate data and treatment programmes specifically for children abusing drugs.

212. The Committee recommends that the State party:

(a) In light of article 33 of the Convention, continue to take all appropriate measures, including administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and to prevent the use of children in the illicit trafficking of such substances;

(b) Support rehabilitation, reintegration and recovery programmes specifically designed for child victims of drug and substance abuse.

• Sudan, CRC, CRC/C/121 (2002) 53 at paras. 262, 263, 268 and 269.

262. The Committee notes the progress with regard to child immunization programmes, but remains deeply concerned at the very poor availability, accessibility and quality of basic health-care services. The Committee is concerned, among other things, at the high rates of infant, child and maternal mortality, the significant inequalities in the provision of health-care services between the north and the south of the country, the very limited access to safe drinking water responsible for 40 per cent of deaths of children under 5, and other serious health problems like malaria, acute respiratory diseases, lack of iodine and malnutrition. These and other concerns of the Committee regarding health care are reflected in the following recommendations.

263. The Committee urgently recommends that the State party:

(a) Take immediate action to reduce infant, child and maternal mortality rates;

...

(c) Reduce inequalities in the levels of health of children in the State party through, inter alia, improving access to safe drinking water and adequate sanitation and strengthening the availability of health services in rural areas;

...

(e) Take immediate action to address preventable health problems among children, including with regard to iodine deficiency, malaria, diarrhoea, acute respiratory diseases, measles, meningitis and malnutrition;

...

268. The Committee is seriously concerned at reports, including the State party’s report, that HIV/AIDS infection rates are likely to rise and at the lack of adequate measures in the area of prevention, care and treatment.

269. The Committee recommends that the State party integrate into its policies and practices the International Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37, annex I) in consultation with and participation of religious leaders.

• Ukraine, CRC, CRC/C/121 (2002) 70 at paras. 350-352.

350. With regard to adolescent health, the Committee is concerned at the rise in the number of children and adolescents addicted to drugs, alcohol and smoking. The Committee expresses concern about the lack of access, without parental consent, to medical counselling and advice. The Committee is also concerned about the large number of teenage abortions, this being the principal cause of maternal mortality.

351. While noting the State party’s efforts in the area of HIV/AIDS, the Committee remains concerned at:

(a) The growing number of cases of HIV/AIDS among the youth;

(b) The very serious impact of HIV/AIDS on the cultural, economic, political, social and civil rights and freedoms of children infected with or affected by HIV/AIDS, including the Convention’s general principles, in particular non-discrimination, health care, education, food and housing, as well as information and freedom of expression;

(c) The absence of an effective national system to manage, monitor, implement and evaluate the efficiency of the State party’s HIV/AIDS prevention programmes and the lack of uniform standards regulating care, treatment, medical services and social assistance for people and families living with HIV;

(d) Insufficient counselling services provided to people with HIV/AIDS, especially adolescents.

352. The Committee recommends that the State party:

(a) Take the necessary measures to address the increase in alcohol abuse, smoking and drug addiction and provide adolescents with access to medical counselling and advice without parental consent, taking into consideration the evolving capacities of the child;

(b) Ensure that adolescents have access to and are provided with education on reproductive health and other adolescent health issues, including mental health, as well as with child-sensitive and confidential counselling services;

(c) Undertake a comprehensive and multidisciplinary study to assess the nature and extent of adolescent health problems, including the negative impact of sexually transmitted diseases and HIV/AIDS and, with the full participation of adolescents, use this as a basis to formulate adolescent health policies and programmes;

(d) Integrate respect for the rights of the child into the development and implementation of its HIV/AIDS policies and strategies on behalf of children infected with and affected by HIV/AIDS, as well as their families, including by making use of the International Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37, annex I) and with particular reference to children’s rights to be protected from discrimination and to health, education, food and housing, as well as the rights to information and freedom of expression;

(e) Increase its efforts to prevent HIV/AIDS and take into consideration the recommendations of the Committee adopted at its day of general discussion on children living in a world with HIV/AIDS (CRC/C/80, para. 243);

(f) Seek further technical cooperation from, among others, UNAIDS and the United Nations Development Programme.

• Republic of Moldova, CRC, CRC/C/121 (2002) 89 at paras. 404, 405, 408 and 409

404. While noting efforts to reorganize maternity and childcare services and various programmes to improve children’s health, the Committee remains concerned about the relatively high rates of infant and child mortality and, in particular, notes that approximately 80 per cent of under-5 deaths are due to preventable causes and that the State party has the highest rate in the region of accidents and poisoning. It further expresses its concern at the limited access to health-care services, especially for disadvantaged households. It also notes the high incidence of tuberculosis, alcohol consumption and drug abuse, as well as the high incidence of iodine deficiency disorders in schoolchildren.

405. The Committee recommends that the State party:

(a) Implement the National Health Policy and enforce the Strategy on Promoting Effective Perinatal Care of the World Health Organization (WHO) in order to further reduce perinatal and infant mortality;

(b) Define sustainable financing mechanisms for the health-care system, including adequate salaries for child health-care professionals, in order to ensure that all children, in particular children from the most vulnerable groups, have access to free basic health care of good quality;

(c) In order to prevent childhood injuries, develop adequate legislation to protect children from accidents and injuries, include the prevention of injuries in national policy priorities and objectives and develop injury control programmes;

(d) Combat alcohol consumption and drug abuse;

(e) Iodize salt;

(f) Continue to seek technical assistance from, among others, WHO and UNICEF.

...

408. The Committee expresses its deep concern at the increasing number of children with disabilities and at the insufficient support provided to their families...

409. In light of article 23 of the Convention, the Committee recommends that the State party:

(a) Undertake studies to determine the causes of and ways to prevent disabilities in children;

...

• Burkina Faso, CRC, CRC/C/121 (2002) 103 at paras. 465, 466, 469 and 470.

465. While taking note of the adoption of several national programmes relating to child survival, the Committee is deeply concerned at the high infant and under-5 mortality rates and low life expectancy in the State party. The Committee also remains concerned that health services in the local areas continue to lack adequate resources (both financial and human). In addition, the Committee is concerned that the survival and development of children in the State party continue to be threatened by early childhood diseases, infectious diseases, diarrhoea and malnutrition. Concern is also expressed at the poor state of sanitation and at the insufficient access to safe drinking water, especially in rural areas.

466. The Committee recommends that the State party:

(a) Reinforce its efforts to allocate adequate resources and develop and implement comprehensive policies and programmes, including the strengthening of the expanded programme of immunization, to improve the health situation of children, particularly in rural areas;

(b) Facilitate greater access to primary health services, reduce the incidence of maternal, child and infant mortality, prevent and combat malnutrition and malaria, especially among vulnerable and disadvantaged groups of children, and promote proper breastfeeding practices;

(c) Take the necessary measures to deal with emergency situations, including to combat epidemics of diseases such as meningitis;

(d) Pursue additional avenues of cooperation and assistance for the improvement of child health with, among others, WHO and UNICEF.

...

469. While noting the establishment of a National Anti-AIDS Committee and of the National Youth Forum to Fight against HIV/AIDS, and the efforts of the State party in that respect (e.g. agreement with pharmaceutical companies to secure access to low-priced AIDS drugs), the Committee remains extremely concerned at the high incidence and increasing prevalence of HIV/AIDS amongst adults and children and the resulting number of children orphaned by HIV/AIDS.

470. The Committee recommends that the State party:

(a) Increase its efforts to prevent HIV/AIDS, taking into consideration the recommendations of the Committee adopted on its day of general discussion on children living in a world with HIV/AIDS (CRC/C/80, para. 243);

...

• Poland, CRC, CRC/C/121 (2002) 120 at paras. 535 and 536.

535. The Committee is concerned that:

(a) The rate of teenage pregnancies is relatively high and that adolescents have limited access to reproductive health education or services;

(b) Smoking amongst adolescents is excessive;

536. The Committee recommends that the State party institute health education and awareness programmes specifically for adolescents on sexual and reproductive health and the dangers of smoking and drug and alcohol abuse in schools, community clubs, family centres and other institutions working with children.

• Estonia, CRC, CRC/C/124 (2003) 9 at paras. 62, 63, 68 and 69.

62. The Committee notes the existence of the State-sponsored ongoing prevention programme on alcoholism and substance abuse, 1997-2002, and welcomes information in the written replies concerning the development of new programmes to address the problems affecting the reproductive health of youths, including sexually transmitted diseases and HIV/AIDS. However, the Committee is concerned at the prevailing mental health problems, the high suicide rate, the large number of abortions and incidence of sexually transmitted diseases, the increasing number of HIV infections among injecting drug users and the high number of accidents, and reiterates the concerns expressed by the Committee on Economic, Social and Cultural Rights (E/C.12/1/Add.85, paras. 27-30) where these relate to children.

63. The Committee recommends that the State party:

(a) Strengthen and ensure that its programmes for adolescent health are effectively implemented, including through the provision of adequate resources;

(b) Ensure that future measures are formulated with the full participation of adolescents;

(c) Ensure that adolescents have access to child-sensitive and confidential counselling services, including mental health counselling;

(d) Strengthen efforts in the area of adolescent health education within schools.

...

68. The Committee notes the information related to the ongoing “Alcoholism and substance abuse prevention programme, 1997-2007”; however, it remains concerned that children are not effectively protected from the illicit use of narcotic drugs and psychotropic substances and at the increasing use of drugs and the rise in the number of injecting drug users.

69. The Committee encourages the State party to continue its efforts to provide children with accurate and objective information about substance use and to take all appropriate measures, including drug education in schools. The Committee urges the State party to evaluate the ongoing prevention programme with a view to reconsidering modalities of implementation to maximize its effectiveness. Furthermore, the State party is urged to enhance rehabilitation services for children who are victims of substance abuse.

• Republic of Korea, CRC, CRC/124 (2003) 24 at paras. 126 and 127.

126. ...The Committee is...concerned that the proportion of mothers breastfeeding their children declined significantly during the 1990s, and that the number of adolescents smoking and using amphetamines and other illicit substances is increasing.

127. The Committee recommends that the State party:

...

(b) Take steps to encourage and educate mothers on the benefits of exclusive breastfeeding of infants during the first six months and adopt a national code on breastfeeding;

...

(d) Undertake a study of adolescent health with a view to developing a comprehensive adolescent health policy that addresses, inter alia, education on HIV/AIDS and other sexually transmitted diseases, the problem of smoking and drug abuse amongst teenagers as well as other relevant issues.

• Romania, CRC, CRC/124 (2003) 49 at paras. 242-245, 248 and 249.

242. The Committee is encouraged by the adoption of a national strategy for the health sector by the Ministry of Health and Family in December 2001 and by its aims and goals as noted in the written replies to the list of issues. It further welcomes the cooperation of the State party with international organizations in the domain of health care. Nevertheless, the Committee is deeply concerned:

...

(b) At the high infant mortality rate, particularly in rural areas;

(d) At the high rate of child morbidity as a result of accidents, including traffic accidents.

243. The Committee recommends that the State party:

...

(b) Improve the effectiveness of antenatal care, maternal health education and immunization programmes;

...

244. The Committee is concerned at:

(a) The limited availability of programmes and services in the area of adolescent physical and mental health;

(b) The number of suicides;

(d) The high rate of sexually transmitted diseases;

(e) The alarming increase in the number of children addicted to drugs, the high rate of smoking and alcohol consumption and the lack of awareness of the problems caused by these negative behaviours.

245. The Committee recommends that the State party:

(a) Provide for adolescents’ access to medical counselling and advice without parental consent, taking into consideration the evolving capacities of the child;

(b) Establish comprehensive family planning programmes, as well as undertake measures to ensure that abortion is neither perceived nor practised as a method of contraception, such as through campaigns to raise awareness of the importance of contraceptive use to reduce the number of unwanted pregnancies;

(d) Undertake all the necessary measures to address the rise in alcohol abuse and smoking, including through media campaigns.

...

248. The Committee welcomes the efforts of the State party, undertaken in cooperation with United Nations partners, to combat HIV/AIDS, but remains concerned at:

(a) The incidence of HIV/AIDS among young children and the high rate of new infections affecting young people, particularly among minorities;

...

249. The Committee recommends that the State party:

(a) Actively pursue its ongoing activities supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and UNICEF to counter HIV/AIDS;

...

• Viet Nam, CRC, CRC/C/124 (2003) 67 at paras. 292, 293, 304-307, 310 and 311.

292. The Committee is concerned at the high number of children who are injured, disabled or killed by accidents, such as traffic accidents, or by natural disasters.

293. While noting the State party’s efforts, in particular the National Programme of Action for Accident Control (2000), the Committee recommends that the State party conduct a study on the scope and causes of accidental deaths and strengthen its efforts to reduce accident-related deaths through, inter alia, awareness-raising campaigns and education programmes aimed at parents, children and the public at large.

...

304. The Committee notes with appreciation the extremely high rate of immunization coverage in the State party. While the maternal mortality rate is declining, the Committee is nevertheless concerned at the persistently high rates of maternal mortality, infant mortality and under-5 mortality, as well as the high rates of malnutrition among children, the frequency of anaemia amongst pregnant women, and the low proportion of women who breastfeed their children exclusively for the first six months. In general, it appears that antenatal care is inadequate, primarily because of a lack of access to such services and clinics. In addition, the Committee notes with concern the re-emergence of typhoid and cholera in the State party.

305. The Committee recommends that the State party:

...

(b) Take steps to encourage and educate mothers, as well as village health workers and traditional birth attendants, on the benefits of exclusive breastfeeding of infants for the first six months and take measures to limit the distribution of infant formulas, for instance through the formulation of a national marketing code;

(c) Increase the resources available to district health centres and commune health stations and ensure that they have adequate human and material resources, in particular for maternal health and care of newborns;

(d) Take all appropriate measures to prevent the spread of communicable diseases, specifically typhoid and cholera.

306. The Committee is concerned at the poor environmental health conditions, in particular the low percentage of the population with access to safe drinking water and sanitation facilities, in particular in rural and mountainous areas, as well as the after-effects of Agent Orange and other chemical defoliants.

307. The Committee recommends that the State party prioritize the construction and expansion of water and sanitation infrastructure in rural and mountainous regions and ensure that all vulnerable groups have equal access to safe drinking water and sanitation. It also recommends that the State party continue its efforts to prevent and combat the damaging effects of environmental pollution, such as chemical defoliants, on children, including through international cooperation.

...

310. The Committee is concerned that HIV/AIDS is spreading and increasingly affects children, either because they have been infected or because they may have lost parents to the disease.

311. The Committee recommends that the State party take into account the Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37, annex I), and:

(a) Integrate respect for the rights of the child into the development and implementation of its HIV/AIDS policies and strategies, with a particular emphasis on the Convention’s four general principles of non-discrimination (art. 2), best interests of the child (art. 3), right to life (art. 6) and respect for the views of the child (art. 12);

(b) Take all effective measures to avoid institutionalization of children infected and affected by HIV/AIDS;

(c) Take effective measures to prevent stigmatization and discrimination against children living with HIV/AIDS, in particular through public education campaigns.

• Czech Republic, CRC, CRC/C/124 (2003) 78 at paras. 354, 355, 367, 368, 371 and 372.

354. The Committee is encouraged by the decline in infant mortality rates in the State party, but remains concerned at the high rate of accidents, including injuries, poisoning and traffic accidents. Furthermore, it is concerned that the suicide rate is relatively high despite the declining trend.

355. The Committee recommends that the State party:

(a) Strengthen efforts to raise awareness about, and undertake public information campaigns in relation to, accident prevention;

(b) Study the possible causes of suicide among youths and the characteristics of those who appear to be most at risk, and take steps to put into place additional support and interventional programmes which would reduce this tragic phenomenon.

...

367. The Committee is encouraged by the decline in the infant mortality rate. However, the Committee is deeply concerned that the present economic situation in the health sector does not allow for compulsory preventive medical check-ups of children from birth to the age of 3 to be covered by public health insurance. Furthermore, the Committee regrets the insufficient information provided following the Committee’s previous recommendation (CRC/C/15/Add.81, para. 38) to undertake research on the possible effects of environmental pollution on the health of children.

368. The Committee recommends that the State party urgently:

(a) Define sustainable financing mechanisms for the primary health-care system and an effective utilization of resources, including adequate salaries for child health-care professionals, in order to ensure that all children, in particular children from the most marginalized vulnerable groups, have access to free basic health care of good quality;

(b) Undertake comprehensive research on the possible effects of environmental pollution on the health of children with a view to effectively addressing this problem.

...

371. The Committee reiterates the concerns expressed by the Committee on Economic Social and Cultural Rights (E/C.12/1/Add.76, paras. 21 and 41) at tobacco smoking, drug abuse and alcohol consumption, as well as at the decreasing but still high number of teenage pregnancies and abortions.

372. The Committee recommends that the State party undertake further measures, including through the allocation of adequate human and financial resources, to evaluate the effectiveness of training programmes in health education, in particular as regards reproductive health and substance abuse, and to develop youth-sensitive and confidential counselling, care and rehabilitation facilities that are accessible without parental consent when this is in the best interests of the child.

• Haiti, CRC, CRC/124 (2003) 95 at paras. 436, 437, 440 and 441.

436. The Committee welcomes the efforts undertaken by the State party in the area of basic health and welfare, such as the expanded programme of immunization, the participation in the Integrated Management of Childhood Illness and the Baby Friendly Hospital Initiative and the promotion of breastfeeding, but remains deeply concerned at the high infant, under-5 and maternal mortality rates and low life expectancy in the State party. The Committee also remains concerned that access to health services in the rural areas is limited, and that the survival and development of children in the State party continue to be threatened by early childhood and infectious diseases, diarrhoea and malnutrition. The Committee is further concerned at the poor state of sanitation and at the insufficient access to safe drinking water, especially in rural areas.

437. The Committee recommends that the State party, by, inter alia, implementing as soon as possible its National Health Plan:

...

(b) Facilitate greater access to primary health services, notably in rural areas; reduce the incidence of maternal, child and infant mortality; prevent and combat malnutrition, especially among vulnerable and disadvantaged groups of children; and continue to promote proper breastfeeding practices;

...

(e) Pursue additional avenues for cooperation and assistance for the improvement of child health with, among others, WHO and UNICEF.

...

440. The Committee notes the adoption of the HIV National Strategic Plan, but is extremely concerned at the high incidence and increasing prevalence of HIV/AIDS amongst adults and children, more particularly at the high incidence of children infected at birth and at the number of children orphaned by HIV/AIDS. The Committee is further concerned at the lack of knowledge among adolescents on how to prevent HIV/AIDS in spite of real efforts by the State party to raise awareness on this issue.

441. The Committee recommends that the State party:

(a) Increase its efforts to prevent HIV/AIDS, taking into consideration the recommendations of the Committee adopted at its day of general discussion on children living in a world with HIV/AIDS (CRC/C/80, para. 243);

(b) Urgently take measures to prevent mother-to-child transmission, inter alia by combining it with the activities to reduce maternal mortality, and take adequate measures to address the impact upon children of the HIV/AIDS-related deaths of parents, teachers and others, in terms of children’s reduced access to family life, adoption, emotional care and education;

(c) Strengthen its efforts to raise awareness about HIV/AIDS among adolescents, particularly among those belonging to vulnerable groups;

(d) Seek further technical assistance from, among others, UNAIDS.

• Iceland, CRC, CRC/124 (2003) 109 at para. 463.

463. The Committee notes with appreciation the follow-up measures taken by the State party pursuant to the previous recommendations. It further welcomes:

...

(d) The adoption of the National Health Plan, which includes strategies for children aimed at addressing alcohol and tobacco consumption and improving the reach of psychiatric services, as well as reducing accident-related injuries and deaths.

• Eritrea, CRC, CRC/C/132 (2003) 8 at paras. 27 and 63-66.

27. The Committee notes with appreciation the State party’s successful efforts, following its independence in 1993:

(a) To reduce child mortality by over 50 per cent and increase immunization coverage from 10 to 60 per cent;

...

63. The Committee notes with appreciation the State party’s programme to extend health services which has increased access from 10 to 70 per cent of the population since independence in 1991, as well as its programme of cooperation with UNICEF in the area of health and health services. However, the Committee is concerned at the high rate of child and infant mortality due to acute respiratory infections, diarrhoeal diseases, malaria and malnutrition. It is further concerned that a considerable number of families lack access to safe drinking water and sanitation facilities, which contributes to the spread of communicable diseases.

64. The Committee recommends that the State party:

...

(b) Continue to strengthen the implementation of existing health policies and programmes, in particular the National Policy on Breastfeeding and Weaning Practices (1995) and the Eritrean Rural Water Supply and Environmental Sanitation Programme;

65. The Committee is concerned at the lack of available data regarding the prevalence of substance abuse, tobacco use and suicide. It is also concerned about the growing problem of sexually transmitted infections (STIs) among adolescents.

66. The Committee recommends that the State party take all necessary measures to assess the prevalence of substance abuse, tobacco use and suicide and take effective measures to prevent and treat health problems affecting adolescents, including the spread of STIs, through, inter alia, sex education, counselling and availability of condoms.

• Sri Lanka, CRC, CRC/C/132 (2003) 48 at paras. 265-268.

265. While acknowledging the improvements in mortality rates and immunization coverage, the Committee remains concerned at the high levels of child malnutrition, the significant proportion of children born with low birth weight, the prevalence of mosquito-borne diseases, including malaria, and the lack of access to safe drinking water and sanitation, particularly in conflict-affected areas.

266. The Committee recommends that the State party:

...

(b) Prioritize the provision of drinking water and sanitation services in reconstruction activities;

(c) Strengthen ongoing efforts to prevent malnutrition, malaria and other mosquito-borne diseases and continue to promote exclusive breastfeeding for the first six months of an infant’s life, and extend these programmes to all conflict-affected areas;

(d) Seek technical assistance from, among others, UNICEF.

267. The Committee notes the establishment of Presidential Task Forces to deal with the problems of suicide and alcohol, drug and tobacco use by adolescents, and the subsequent improvement in the rate of youth suicide. Nevertheless, the Committee is concerned that these issues remain a problem for adolescents and that an organized system of reproductive health counselling and services for youth, as well as education on HIV/AIDS and STDs, does not yet exist.

268. The Committee recommends that the State party continue to strengthen its efforts to address youth suicide, drug abuse, alcoholism and tobacco use and develop a comprehensive policy on adolescent health which, inter alia, supports the implementation of the recommendations of the Presidential Task Forces, promotes collaboration between State agencies and NGOs [non-governmental organizations] in order to establish a system of formal and informal education on HIV/AIDS and STDs, and ensures access to reproductive health counselling and services for all adolescents. The State party should make use of the International Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37) and the Committee’s general comment No. 3 on HIV/AIDS and the rights of the child, in order to promote and protect the rights of children infected with and affected by HIV/AIDS.

• Libyan Arab Jamahiriya, CRC, CRC/C/132 (2003) 74 at paras. 382 and 383.

382. The Committee notes the establishment of the National Committee for AIDS Prevention in 1987 and other measures to address the problem of HIV/AIDS, but is concerned at the relatively high number of children afflicted by HIV/AIDS in Benghazi. The Committee is also concerned at the insufficient information available in relation to adolescent health, particularly in relation to mental health issues.

383. The Committee recommends that the State party:

(a) Continue and strengthen its activities to prevent HIV/AIDS;

(b) Provide the special AIDS clinic in the children’s hospital with all the necessary human and financial resources to treat the child victims of HIV/AIDS in the best possible way, avoiding any form of discrimination;

(c) Ensure that adolescents have access to, and are provided with, education on adolescent health issues, in particular regarding mental health, in a sensitive manner;

(d) Take appropriate measures to reduce substance dependency amongst young people;

(e) Strengthen efforts in the area of adolescent health education within the school system;

(f) Seek assistance from, among others, UNICEF and WHO.

• Jamaica, CRC, CRC/C/132 (2003) 86 at paras. 434 and 435.

434. The Committee notes with appreciation the State party’s considerable achievements in the area of health care and its awareness of and intention to further improve the health situation among children through, inter alia, the adoption of the National Health Services Act, the expansion of health programmes and campaigns and the establishment of a quality assurance programme for the training of health personnel. However, the Committee remains concerned about:

...

(b) The problems of environmental degradation within the State party, including air pollution and difficulties accessing safe, clean water in a number of rural and inner-city areas;

435. The Committee recommends that the State party:

...

(b) Intensify its efforts to address environmental health concerns, particularly with regard to air pollution and solid waste management, and increase access to safe drinking water and sanitation;

(c) Intensify efforts to improve safety for all children by reducing violence and abuse as well as preventing accidents through, inter alia, life-skills education campaigns and undertaking a review of existing preventive and guidance measures, including counselling, and mental health-care services.

• Kazakhstan, CRC, CRC/C/132 (2003) 129 at paras. 637, 640 and 641.

637. ...The Committee...shares the concerns of CEDAW with respect to access to free medical care for women and the degree of environmental degradation, particularly as it affects access to clean drinking water, which has an extremely negative impact on the whole population and, in particular, women and children.

...

640. The Committee expresses its concern at problems of poor access to safe drinking water, lack of food security and serious hazards arising from the Aral Sea disaster, as well as those relating to the Semipalatinsk nuclear testing site (closed in 1989), and notes that insufficient attention has been given to the long-term health and psychosocial consequences of the affected population.

641. The Committee urgently recommends that the State party:

(a) Ensure that all children, especially from the most vulnerable groups and in rural areas, have access to primary health care, and encourages the State party to pursue its efforts in this respect and to implement the recommendations of CEDAW as they relate to children;

...

(d) Improve the specialized health care provided to children affected by the Semipalatinsk nuclear testing site, including its psychosocial aspect;

(e) Strengthen its efforts to detect and prevent diseases related to nuclear contamination;

...

(g) Take all appropriate measures, including seeking international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution of the environment and food products.

• Canada, CRC, CRC/C/133 (2003) 14 at paras. 86 and 87.

86. The Committee is encouraged by the average decline in infant mortality rates in the State party, but is deeply concerned at the high mortality rate among the Aboriginal population and the high rate of suicide and substance abuse among youth belonging to this group.

87. The Committee suggests that the State party continue to give priority to studying possible causes of youth suicide and the characteristics of those who appear to be most at risk, and take steps as soon as practicable to put in place additional support, prevention and intervention programmes, e.g. in the fields of mental health, education and employment, that could reduce the occurrence of this tragic phenomenon.

• New Zealand, CRC, CRC/C/133 (2003) 27 at paras. 147 and 148.

147. The Committee welcomes the adoption of the Child Health Strategy in 1998. However, the Committee is concerned that immunization coverage is not universal and at the relatively high rates of infant mortality and injuries among children...

148. The Committee recommends that the State party:

...

(b) Take all necessary measures to ensure universal immunization coverage and develop preventive health care and guidance for parents and families that effectively address the relatively high rates of infant mortality and injuries;

...

• Pakistan, CRC, CRC/C/133 (2003) 37 at paras. 218 and 219.

218. The Committee notes the efforts of the State party in the area of basic health and welfare, such as the immunization and control of diarrhoeal diseases programmes and the consequent decreases in polio and the infant mortality rate. The Committee also welcomes the promulgation of the Protection of Breastfeeding and Young Child Nutrition Ordinance (2002). Nonetheless, the Committee is extremely concerned at the very poor health situation of children and the unavailability of health-care services in the State party for them. Particular matters of concern are:

...

(b) The insufficient focus on preventive health care;

(c) The still very high infant, under-5 and maternal mortality rates, due partly to weak antenatal and postnatal care and maternal malnutrition;

(d) The high prevalence of malnutrition among children as well as diarrhoea, acute respiratory tract infections, malaria and iodine deficiency which leads to both physical and mental health problems among children;

...

(f) The still very low immunization coverage, with an estimated 160,000 deaths due to vaccine-preventable diseases;

...

219. The Committee recommends that the State party:

...

(b) Emphasize the role of preventive health care;

(c) Continue and strengthen efforts to decrease the infant, under-5 and maternal mortality rates by, inter alia, providing adequate ante- and post-natal care;

(d) Expand programmes to alleviate widespread child and maternal malnutrition and its serious consequences on health and psychological development, notably by promoting breastfeeding;

...

(f) Improve immunization.

• Singapore, CRC, CRC/C/133 (2003) 84 at paras. 421 and 422.

421. The Committee notes with appreciation the excellent level of health indicators for children and the wide availability of high-quality health-care services... However, it remains concerned that the incidence of exclusive breastfeeding is relatively low and that youth suicide rates are on the rise.

422. The Committee recommends that the State party:

(a) Strengthen its efforts to promote exclusive breastfeeding during the first six months of an infant’s life through, inter alia, the adoption and implementation of the International Code of Marketing of Breast Milk Substitutes, obtaining certification for hospitals as baby-friendly hospitals and extending maternity leave;

(b) Strengthen adolescent health services, in particular counselling services and suicide prevention programmes.

• Bangladesh, CRC, CRC/C/133 (2003) 93 at paras. 483-486.

483. The Committee notes with appreciation the efforts undertaken and the achievements made by the State party to reduce infant and under-5 mortality rates, as well as the eradication of polio and the improved immunization coverage. Nevertheless, the Committee remains deeply concerned:

(a) That infant and under-5 mortality rates remain high, and that stunting, wasting and severe malnutrition among both children and their mothers are extremely widespread;

(b) At the unhygienic practices surrounding childbirth, which results in, among other things, tetanus, and at the lack of prenatal care;

(d) At the low level of awareness among the population, particularly in rural areas, of the need to use hygienic, sanitary practices;

(e) At the high rate of children dying as a result of accidents, such as drowning, and that little is done by the State party to prevent these deaths;

...

484. The Committee recommends that the State party:

...

(b) Facilitate greater access to free primary health services throughout the country as well as prevent and combat malnutrition, paying particular attention to pre- and antenatal care for both children and their mothers;

(d) Enhance the efforts to educate the population in hygienic, sanitary behaviour, notably through awareness-raising campaigns and programmes;

...

485. The Committee welcomes the adoption of the National Policy for Safe Water Supply and Sanitation. However, the Committee is concerned, despite the measures taken by the State party, about the extent of water contamination, specifically with arsenic, air pollution and the low availability of sanitation facilities which have serious negative consequences for children’s health and development.

486. The Committee urges the State party:

(a) To continue and strengthen its efforts to reduce contamination and pollution of air and water as well as improve sanitation facilities, including by strengthening the implementation of the National Policy for Safe Water Supply and Sanitation;

(b) To intensify awareness-raising campaigns and educational programmes in order to inform children and adults about appropriate behaviours protecting them against risks.

• Indonesia, CRC, CRC/C/137 (2004) 8 at paras. 75 and 77-79.

75. While acknowledging the improvements in budget allocations to the health-care sector, the Committee remains concerned at the high maternal mortality rate, incidence of child malnutrition, proportion of children born with low birth weight and prevalence of infectious and, mosquito-borne diseases, including malaria, the low immunization rate and the lack of access to safe drinking water and sanitation, particularly in conflict-affected areas.

...

77. The Committee recommends that the State party:

...

(b) Prioritize the provision of drinking water and sanitation services;

(c) Strengthen existing efforts to prevent malnutrition, malaria and other mosquito-borne diseases, to immunize as many children and mothers as possible, to make condoms and other contraceptives available throughout the country and to promote breastfeeding, and extend these programmes to all conflict-affected areas;

...

78. The Committee notes the establishment in 1999 of the Commission on Reproductive Health, to deal, inter alia, with the problems of adolescent health, HIV/AIDS prevention and family planning. The Committee is nevertheless concerned that these issues remain a problem for adolescents and that no organized system of reproductive health counselling and services, nor education on HIV/AIDS and sexually transmitted infections (STIs) for youth exists. The Committee is further concerned at the high number of tobacco smokers among adolescents.

79. The Committee recommends that the State party:

...

(c) Promote collaboration between State agencies and NGOs in order to establish a system of formal and informal education on HIV/AIDS and STIs and on sex education;

(d) Take into account the Committee’s general comment No. 3 (2003) on HIV/AIDS and the rights of the child and the updated International Guidelines on HIV/AIDS and Human Rights in order to promote and protect the rights of children infected with and affected by HIV/AIDS;

(e) Ensure access to reproductive health counselling and information and services for all adolescents;

(f) Provide adolescents with accurate and objective information on the harmful consequences of tobacco use and protect them from hurtful misinformation by imposing comprehensive restrictions on tobacco advertising.

• Guyana, CRC, CRC/C/137 (2004) 26 at paras. 156-161.

156. The Committee welcomes the implementation of the Integrated Management of Childhood Illness (IMCI) and the marked improvement in immunization coverage. However, the Committee remained concerned at the high infant and under-5 mortality rates, the high incidence of malaria, especially among the Amerindian children, as well as the high incidence of malnutrition, including iron deficiency anaemia and stunting of growth.

157. The Committee recommends that the State party:

(a) Take all necessary measures to reduce mortality rates by improving prenatal care and preventing communicable diseases;

(b) Continue to combat malaria and address environmental causes and strengthen availability of nets and insecticides, especially in areas where malaria is most prevalent;

(c) Address the issue of malnutrition by education and ensuring availability of adequate nutrition among mothers and children;

(d) Continue to encourage exclusive breastfeeding for six months with appropriate introduction of infant diet thereafter, taking into account the support needed for working mothers.

158. The Committee is concerned at the high rate of teenage pregnancies and drug abuse among adolescents.

159. The Committee recommends that the State party set up adequate services for adolescents, including mental health and reproductive health services. It also recommends that the State party take all necessary measures to prevent drug abuse and provide therapeutic and rehabilitative services for drug abusers.

160. The Committee welcomes the National Strategic Plan HIV/AIDS 2002-2006 and the manufacturing of anti-retroviral drugs in the State party and supplying them free of charge to adults. However, the Committee is concerned about the rapid spread of HIV/AIDS within the State party causing a large number of children to be infected or affected by HIV/AIDS.

161. The Committee recommends that the State party integrate respect for the rights of the child into the development and implementation of its HIV/AIDS policies and strategies on behalf of children infected with and affected by HIV/AIDS, as well as their families, in accordance with the Committee’s general comment No. 3 (2003) on HIV/AIDS and the rights of the child (CRC/GC/2003/3).

• Armenia, CRC, CRC/C/137 (2004) 36 at paras. 222-227, 239 and 240.

222. While welcoming the adoption in March 2003 of a programme to provide free medical care, including dental care, for children up to the age of 15 and free inpatient medical care to children belonging to underprivileged groups up to the age of 18, the Committee reiterates its concern regarding the deterioration in the health system in the State party following cuts in public expenditure on the health system. In this regard, the Committee notes with concern that infant and maternal mortality rates remain high and that an increasing number of children and mothers suffer from malnutrition as a result of rising food prices and poverty. The Committee is also concerned about the continuous growth in tuberculosis morbidity among children...

223. The Committee urges the State party to:

...

(d) Take measures to improve children’s nutrition, including education on proper breastfeeding practices among mothers, and to remedy inequalities in access, availability and affordability of nutritious food;

(e) Take measures to educate the public on healthy eating habits, providing the necessary dietary supplements to reduce the incidence of iron deficiency anaemia among mothers and children;

...

224. The Committee reiterates its concern regarding the high incidence of teenage pregnancies and the consequent high rate of abortions among girls under 18, especially illegal abortions. Furthermore, while the incidence of HIV remains low in the State party, the Committee is concerned about the lack of knowledge about HIV/AIDS among young people. The Committee welcomes, in this regard, the legislative measures taken in the area of reproductive health and HIV/AIDS prevention in 2002, such as the Reproductive Health and Human Reproductive Rights Act, the approval of the National Strategy to Combat HIV/AIDS in 2002, and the establishment of an Inter-Ministerial Council for HIV/AIDS Prevention.

225. The Committee recommends that the State party reinforce its efforts to reduce the number of teenage pregnancies and combat HIV/AIDS and other sexually transmitted diseases, including by ensuring that adolescents are provided with reproductive health education and child-friendly counselling services.

226. The Committee reiterates its concern at the high incidence of environmental threats. In particular, the Committee notes with concern that old water pipes and failures in the water supply system have led to contamination of drinking water and serious outbreaks of infectious diseases.

227. In the light of article 24 (c) of the Convention, the Committee reiterates its recommendation that the State party take all appropriate measures, including international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution and contamination of water supplies. The Committee encourages the State party to collect data on access to clean water and sanitation.

...

239. The Committee reiterates its concern about the increasing use of and traffic in illicit drugs among persons under 18 years...

240. The Committee recommends that the State party develop a national drug control plan, or a Master Plan, with the guidance of the United Nations Drug Control Programme. The Committee encourages the State party to continue its efforts to provide children with accurate and objective information about substance abuse. The Committee urges the State party to ensure that child drug abusers are not criminalized, but treated as victims in need of assistance towards recovery and reintegration, and that the State party develop preventive and reintegration programmes for children who are victims of substance abuse. The Committee recommends cooperation with and assistance from WHO and UNICEF.

• Germany, CRC, CRC/C/137 (2004) 51 at paras. 295 and 296.

295. The Committee is...deeply concerned at the very high incidence of suicide among children and adolescents.

296. The Committee recommends...that the State party strengthen adolescent health services, in particular counselling services and suicide prevention programmes.

• The Netherlands (Netherlands and Aruba), CRC, CRC/C/137 (2004) 63 at paras. 362 and 363.

362. The Committee welcomes the low infant and child mortality rates in all parts of the State party, but is concerned about the relatively low vaccination rates among some religious groups. The Committee is also concerned that HIV/AIDS infection rates for mothers and children are on the rise.

363. The Committee recommends that the State party:

(a) Take all necessary measures, in cooperation with parents and religious leaders, to ensure universal vaccination of children;

(b) Take all necessary measures to reduce mother-to-child transmission of HIV/AIDS, including but not limited to the use of antiretroviral drugs for pregnant mothers who are HIV-positive.

• India, CRC, CRC/C/137 (2004) 75 at paras. 430-433.

430. The Committee notes the numerous national plans and programmes initiated during the 9th and 10th five-year plans to address health issues. Nevertheless, it remains seriously concerned at the unavailability and/or inaccessibility of free, high quality primary health care; the slow decline in infant mortality; the worsening maternal mortality rates, due in part to the high increase of unattended home deliveries; the low immunization rate; the high incidence of low-birth-weight babies; the high number of children with stunting, wasting, or who are underweight; the prevalence of micronutrient deficiencies; and the low rate of exclusive breastfeeding and appropriate introduction of infant diet. The Committee further expresses its concern at the environmental pollution prevalent in some states, specifically arsenic and lead pollution, and at the lack of access to safe drinking water and adequate sanitation by a large percentage of the population...

431. The Committee recommends that the State party reinforce its efforts in developing effective policies and programmes to improve the health situation of children. It also recommends that the State party ensure access for all children to primary, free and quality health services; regulate and monitor traditional and modern medicinal practice; combat malnutrition; promote healthy nutrition habits, including breastfeeding; improve immunization rates; increase access to safe drinking water and adequate sanitation; and address the issue of environmental pollution effectively. Additionally, the Committee encourages the State party to pursue additional avenues of cooperation and assistance for child health improvement with, inter alia, WHO and UNICEF.

432. The Committee welcomes the adoption of the National AIDS Prevention and Control Policy, 2001, aiming at achieving no new infections by 2007. It also welcomes the decision to provide antiretroviral drugs to children and adults free of charge, but remains concerned at the rising number of children infected and/or affected by HIV/AIDS...

433. The Committee recommends that the State party:

...

(b) Strengthen its measures to prevent mother-to-child transmission, inter alia by combining and coordinating them with the activities to reduce maternal mortality, and take adequate measures to address the impact upon children of the HIV/AIDS-related deaths of parents, teachers and others, in terms of children’s reduced access to family life, adoption, emotional care and education;

(c) Strengthen its efforts to raise awareness about HIV/AIDS among adolescents, particularly those belonging to vulnerable groups, and among the population at large, notably in order to reduce discrimination against children infected and/or affected by HIV/AIDS;

(d) Seek further technical assistance from, among others, the Joint United Nations Programme on HIV/AIDS.

• Papua New Guinea, CRC, CRC/C/137 (2004) 94 at paras. 510, 511, 524 and 525.

510. While noting the encouraging downward trend in infant mortality rates and the improvement in vaccination coverage, the Committee is concerned at the high maternal mortality rate due in part to the high number of unattended deliveries, the inaccessible and unsatisfactory health-care facilities, the prevalence of malaria, the high incidence of malnutrition and micronutrient deficiencies among mothers and children, and the limited availability of safe drinking water and adequate sanitation.

511. The Committee recommends that the State party:

(a) Strengthen its efforts to provide all communities with accessible and high-quality health-care facilities;

(b) Improve training efforts of local midwives, thereby promoting safe deliveries;

(c) Address the issue of malnutrition and micronutrient deficiencies through education and promotion of healthy feeding practices, including breastfeeding;

(d) Strengthen its efforts to prevent and treat malaria;

(e) Ensure safe drinking water and adequate sanitation to all.

...

524. While welcoming the establishment of the National Narcotics Bureau to address the problem of substance abuse, the Committee remains concerned at the high incidence of children abusing drugs such as marijuana and home brew. It is also concerned at the lack of adequate legislation and treatment programmes in this regard.

525. The Committee recommends that the State party take action to combat drug abuse by children, including through public education campaigns, and ensure that child drug and substance abusers have access to effective structures and procedures for treatment, counselling, recovery and reintegration.

• Slovenia, CRC, CRC/C/137 (2004) 104 at paras. 577 and 578.

577. The Committee notes with concern the increase in the number of suicides among young people aged between 7 and 19 in the reporting period.

578. The Committee recommends that the State party strengthen its efforts and programmes to prevent suicide among young people. The Committee also recommends that the State party ensure psychosocial counselling for children with mental health problems and for those subjected to various forms of abuse to improve the early detection and prevention of suicide.

• Japan, CRC, CRC/C/137 (2004) 116 at paras. 647 and 648.

647. The Committee is concerned about the prevalence of mental and emotional disorders among adolescents, including stress and depression, and the lack of a comprehensive strategy on adolescent mental health. The Committee is also concerned that sexually transmitted diseases among youth are on the rise and shares the State party’s concern about drug abuse by adolescents in the State party...

648. The Committee recommends that the State party:

(a) Undertake a study of adolescent health with a view to developing a comprehensive adolescent health policy, which includes preventive measures, where appropriate, that addresses mental health, reproductive and sexual health, drug abuse and other related issues;

...

(c) Develop and implement programmes for the prevention of mental and emotional disorders among adolescents and train teachers, social workers and others working with children on how to address adolescent mental health issues in a child-sensitive manner.

• Sao Tome and Principe, CRC, CRC/C/140 (2004) 54 at paras. 282-286.

282. The Committee welcomes the fact that the right to health care is enshrined in the Constitution. The Committee also welcomes the positive result of the expanded programme of immunization. The Committee takes note of the new strategy to combat malaria.

283. However, the Committee is concerned at the lack of access to safe drinking water and sanitation, which is the main cause of the prevalence of diarrhoeal diseases and worms, the high incidence of respiratory diseases and malaria, the high levels of maternal and child mortality, child malnutrition and the high number of children born with low birth weight.

284. The Committee recommends that the State party:

...

(d) Strengthen existing efforts to immunize as many children and mothers as possible;

(e) Strengthen existing efforts to combat malaria, respiratory diseases and diarrhoeal infections, and to take all necessary measures to lower mortality rates;

...

(g) Take measures to improve the nutritional status of children through education and promotion of healthy feeding practices, including breastfeeding;

(h) Continue to cooperate in this matter with, inter alia, WHO and UNICEF.

285. The Committee notes with interest the Reproductive Health Programme. However, the Committee is concerned that:

...

(b) Alcohol, tobacco and drug abuse is affecting an increasing number of young people and that the existing legislation does not provide effective protection for children;

...

286. The Committee recommends that the State party:

...

(b) Promote collaboration between State agencies and NGOs in order to establish a system of formal and informal education on HIV/AIDS and STIs, on sex education and on family planning;

...

(d) Ensure access to reproductive health counselling and information and services for all adolescents;

(e) Provide adolescents with accurate and objective information on the harmful consequences of alcohol, drug and tobacco use, and develop and implement a legislation adequately protecting them from harmful misinformation, including through comprehensive restrictions on alcohol and tobacco advertising;

...

• Myanmar, CRC, CRC/C/140 (2004)81 at paras. 432 and 433.

432. The Committee is concerned that the measures taken by the State party to raise awareness among the Padaung and the Kareni tribes on the potential health hazard of their traditional practice of neck elongation have been insufficient. The practice can result in sudden death or serious damage to the spinal cord if the neck-elongation ring is removed.

433. The Committee recommends that the State party continue and strengthen its awareness-raising activities among the people of the Padaung and the Kareni tribes, in particular women and girl children, on the potential risks of their traditional practice for their physical well-being.

• Dominica, CRC, CRC/C/140 (2004)101 at paras. 501 and 502.

501. The Committee welcomes the existence of the Drug Prevention Unit within the Ministry of Health. However, the Committee is concerned about the sustainability of its activities. The Committee is further concerned at the lack of a minimum age for purchasing alcohol and other controlled substances.

502. The Committee recommends that the State party provide the Drug Prevention Unit with the necessary human and financial resources to ensure continuation of its activities. It further recommends that it set the minimum age for purchasing alcohol and other controlled substances at 18 and take all the necessary measures to fully implement and enforce this minimum age.

• Botswana, CRC, CRC/C/143 (2004) 25 at paras. 151 and 152.

151. While welcoming the establishment of the National AIDS Council, chaired by the president, the National AIDS Coordinating Council, the National Policy on HIV/AIDS, the Prevention of Mother to Child Transmission Programme and the programme for AIDS orphans, the Committee shares the serious concern of the State party at the still exceedingly high prevalence rate of HIV/AIDS, especially among women in their child-bearing years compounded, in part, by inappropriate traditional practices, stigmatization and lack of knowledge on prevention methods.

152. In the light of general comment No. 3 on HIV/AIDS and the rights of children (CRC/GC/2003/3), the Committee urges the State party to strengthen its efforts in combating the spread and effects of HIV/AIDS by, inter alia, training professionals, conducting education campaigns on prevention, improving the prevention of mother to child transmission programme, by providing free and universal antiretroviral medication and improving protection and support for AIDS orphans.

• Croatia, CRC, CRC/C/143 (2004) 36 at paras. 194, 195, 220 and 221.

194. The Committee notes with concern the relatively high number of deaths and injuries among children due to traffic and domestic accidents despite the various measures taken by the State party to address this problem.

195. The Committee recommends that the State party continue and strengthen as much as possible its efforts to prevent traffic and domestic accidents, inter alia by systematic enforcement of existing regulations and by ongoing awareness-raising via educational campaigns.

...

220. The Committee notes the efforts undertaken by the State party with regard to drug abuse by adolescents but remains concerned at the increasing number of cases, the increase in sharing syringes among drug users, the lack of an integrated strategy against drug abuse and the apparent inadequacy of treatment facilities to deal with drug additions. The Committee is also concerned at the increasing alcohol and tobacco consumption by adolescents and the lack of programmes for the prevention of suicide among adolescents. The Committee is also concerned that adolescents have a low perception of the risks of contracting HIV and other STDs.

221. The Committee recommends that the State party:

...

(c) Develop programmes to prevent and combat HIV/AIDS, taking into account the Committee’s general comment No. 3 on HIV/AIDS and the rights of children (2003);

(d) Develop mental health programmes and services for, inter alia, the prevention of drugs and alcohol abuse, and tobacco use, and programmes for the prevention of suicide and to enhance the quality of the treatment facilities;

...

• Kyrgyzstan, CRC, CRC/C/143 (2004) 50 at paras. 290 and 291.

290. The Committee notes with appreciation the efforts made by the State party to work with different specialized agencies of the United Nations as well as with international NGOs to reduce child mortality. It also welcomes the decision of the Government in December 2003 to introduce the WHO live birth definition nationwide. It is, however, concerned at the regional disparities in mortality rates, the inadequate antenatal care, which is not completely free, the inhumane treatment of children in psychiatric hospitals, and the increase in cases of communicable diseases, such as tuberculosis and HIV/AIDS. Exposure to environmental hazards such as mining wastes or unsafe drinking water also worries the Committee.

291. The Committee recommends that the State party undertake more efforts to ensure the highest attainable standard of health for all children, to improve antenatal care programmes, to prevent the spread of contagious diseases such as HIV/AIDS and tuberculosis, to improve psychiatric care so as to ensure that children with psychiatric problems are treated humanely and to explicitly prohibit placing children in adult psychiatric hospitals. International assistance from WHO and UNICEF should be requested, inter alia to address the issue of providing safe drinking water and increased access to sanitation.

• Equatorial Guinea, CRC, CRC/C/143 (2004) 64 at paras. 357, 358, 361 and 362.

357. The Committee notes with appreciation the efforts undertaken by the State party to extend the coverage of the health and basic sanitation services. However, the Committee is very concerned that despite decreases in the infant mortality rate, under-five mortality rate and maternal mortality rate, these rates remain very high. It is further concerned at the high incidence of malnutrition and that significant numbers of poor families lack access to services, including safe drinking water and sanitation facilities, which contributes to the spread of communicable diseases...

358. The Committee recommends that the State party:

...

(b) Strengthen the implementation and coordination of existing health policies and programmes, in particular the National Action Plan (1992-2000), the Expanded Programme of Immunization, and the Drinking Water and Environmental Health programmes;

(c) Facilitate greater access to primary health services; continue to reduce the incidence of maternal, child and infant mortality; prevent and combat malnutrition, especially amongst vulnerable and disadvantaged groups of children; and promote proper breastfeeding practices;

...

361. The Committee welcomes the efforts undertaken by the State party to address the spread of HIV/AIDS, e.g. the National Programme to fight HIV/AIDS, which provides for free and universal antiretroviral medication, but remains very concerned at the increasing prevalence of HIV/AIDS amongst adults (mainly women) and youth and the increasing number of children orphaned by HIV/AIDS...

362. The Committee recommends that the State party:

(a) Increase its efforts to prevent the spread of HIV/AIDS, taking into account the Committee’s general comment No. 3 on HIV/AIDS and the rights of the child and the International Guidelines on HIV/AIDS and Human Rights;

(b) Strengthen its measures to prevent mother-to-child transmission, inter alia through coordination with the activities aimed at reducing maternal mortality;

...

• Angola, CRC, CRC/C/143 (2004) 78 at paras. 419-422.

419. The Committee expresses its deep concern at the alarming levels of mortality among children, with 25 per cent of children dying before they reach the age of 5. It notes that the main causes of child mortality are related to malaria, diarrhoeal diseases, acute respiratory diseases and vaccine-preventable diseases. The Committee is also concerned about the fact that a majority of children do not have access to adequate heath services, the high level of malnutrition among children, the lack of access to safe drinking water and proper sanitation, and inadequate breastfeeding practices among women.

420. The Committee urges the State party to strengthen its efforts to improve the health situation of children in the State party, including through:

...

(b) Strengthening vaccination programmes;

(d) Active promotion of exclusive breastfeeding for six months after birth, with the addition of appropriate infant diet thereafter.

421. The Committee is concerned at the lack of adolescent health services and the large number of teenage pregnancies.

422. The Committee recommends that the State party pay close attention to adolescent health, taking into account the Committee’s general comment No. 4 on adolescent health and development. In particular, the State party should strengthen sexual and reproductive health education for adolescents, including family planning measures, especially in schools and out-of-school programmes, with a view to reducing the incidence of teenage pregnancy, and provide pregnant teenage girls with the necessary assistance and access to health care and education...

• Antigua and Barbuda, CRC, CRC/C/143 (2004) 93 at paras. 503-506, 514 and 515.

503. The Committee welcomes the initiative taken by the State party to make baby products, including medicine, tax free. It further notes the high level of immunization coverage and that health services are free and cover all areas of the country. It also notes the establishment of the AIDS secretariat and welcomes the information that antiretroviral drugs will be provided free of charge to patients with HIV/AIDS. However, the Committee notes that, as recognized by the State party, the social services are under a tremendous resource strain, in particular the health service. The Committee also shares the concern of the State party at the rising incidence of obesity.

504. The Committee recommends that the State party:

...

505. The Committee is concerned that insufficient attention has been given by the State party to adolescent health issues, including developmental, mental and reproductive health concerns. The Committee further notes with concern that the adolescent outreach project focusing on fertility and sexuality funded by the United Nations Population Fund (UNFPA) has not been sustained. The Committee is also concerned that reproductive health education is not part of the official curriculum of primary and secondary education.

506. The Committee recommends that the State party:

(a) Undertake a comprehensive study to assess the nature and extent of adolescent health problems and, with the full participation of adolescents, use this as a basis to formulate adolescent health policies and programmes with a particular focus on the prevention of sexually transmitted diseases (STDs), especially through reproductive health education and child-sensitive counselling services, and taking into account the Committee’s general comment No. 4 (2003) on adolescent health and development in this regard;

(b) Strengthen developmental and mental health counselling services as well as reproductive health counselling and make them known and accessible to adolescents;

(c) Take measures to incorporate reproductive health education in the school curriculum, particularly at the secondary level, in order to fully inform adolescents about their reproductive health rights and the prevention of STDs, including HIV/AIDS, and early pregnancies;

...

514. While noting the programmes and initiatives taken by the State party to eradicate trafficking and the illicit use of drugs, the Committee remains concerned at the growing incidence of substance abuse by children, including the use of crack, cocaine and marijuana. It is also concerned at the lack of specific legislation prohibiting the sale, use and trafficking of controlled substances by children, and also of treatment programmes in this regard. The Committee also notes with concern that alcohol consumption by children is common, especially during festivities.

515. The Committee recommends that the State party take action to combat drug and alcohol abuse by children, including through public education awareness campaigns, and ensure that children who abuse alcohol and/or use drugs and other harmful substances have access to effective structures and procedures for treatment, counselling, recovery and reintegration.

• Sweden, CRC, CRC/C/146 (2005) 8 at paras. 55-58.

55. ...The Committee is concerned, in particular, about the increasing number of school pupils who feel the effects of stress; the increasing incidence of suicide, bulimia, anorexia, overweight and obesity cases, and the lack of programmes on mental health of children.

56. The Committee recommends that the State party take the necessary measures:

(a) To reduce the stress level of school pupils and help them deal with its effects;

(b) To prevent suicide;

(d) To address the issue of overweight and obesity;

(e) To strengthen mental health programmes for children, both preventive and interventional.

57. The Committee welcomes the efforts taken with regard to sex education in schools, drug and tobacco use and alcohol abuse. However, the Committee remains concerned about the sharp increase in 2002 in abortions among teenagers, and about the prevalence of tobacco and drug use, and of alcohol abuse.

58. The Committee recommends that the State party increase its efforts to promote adolescent health policies and strengthen the programme of health education in schools. It further recommends measures, including the allocation of adequate human and financial resources, to evaluate the effectiveness of training programmes in health education, in particular as regards reproductive health, and to develop youth-sensitive and confidential counselling, care and rehabilitation facilities that are accessible without parental consent when this is in the best interests of the child. It also recommends that the State party continue its efforts to prevent and combat the use of tobacco and drugs, and the abuse of alcohol.

• Albania, CRC, CRC/C/146 (2005) 19 at paras. 131, 132, 149 and 150.

131. The Committee welcomes the legislative and other measures taken by the State party to reduce the use of tobacco, in particular among children under 16 years of age. However, the Committee is concerned at the reported rise in suicide rates among children for which sufficient data is not available and considers that, in general, the health services provided, including mental health services, may not be tailored to the needs of adolescents, thus reducing their willingness to access primary health services. It further notes the concern of the State party that abortion may still be used as a family planning method and that the abortion rates are alarmingly high.

132. The Committee recommends that the State party:

(a) Increase its efforts to promote adolescent health policies, introduce legislation and strengthen programmes of health education in schools;

...

(c) Study the occurrence and causes of suicide to enable the appropriate authorities to improve their understanding of this phenomenon and take appropriate measures to reduce the suicide rates, including by improving preventive and interventional mental health services;

(d) Provide access to information on reproductive health and family planning with a view to improving the practice in these areas, including the reduction of recourse to abortion as a method of family planning;

...

149. The Committee is concerned at the increase in drug abuse, in particular among young children, including through the free distribution of drugs by drug dealers with the aim of luring children into drug use, which may occur also in school environments.

150. The Committee encourages the State party to continue and expand its activities in the area of prevention of substance abuse and use of children in the trafficking of such substances, and to support recovery programmes dealing with child victims of drug abuse. The Committee recommends that the State party consider seeking technical assistance from UNICEF and OHCHR.

• Luxembourg, CRC, CRC/C/146 (2005) 36 at paras. 200, 201, 211 and 212.

200. The Committee notes with concern the high number of suicides among adolescents in the State party. While welcoming the information that a child psychiatric unit has been recently established within a country hospital, the Committee is concerned about the information that many children from Luxembourg are treated in institutions offering psychiatric assistance to minors across the border in Germany, France or Belgium, owing to the reported lack of an adequate care system, in particular child and juvenile psychiatry, in Luxembourg.

201. The Committee recommends that the State party use the results of the comprehensive study recently undertaken to address the issue of suicide among the youth as a basis for the formulation of adolescent health policies and programmes. It further recommends that the State party continue to improve the quality and capacity of child and juvenile psychiatry in the country, paying special attention to mental health provisions, both preventive and interventional.

...

211. The Committee is concerned at the high level of use of illicit drugs and substances among adolescents and notes the difficulties confronted by the State party in dealing with this phenomenon.

212. The Committee recommends that the State party undertake a study to carefully analyse the causes and consequences of this phenomenon as well as its possible links with violent behaviour and the high suicide rate among adolescents in the State party. It further recommends that the State party use the outcome of this study to increase its efforts to prevent the use of illicit drugs and substances.

• Austria, CRC, CRC/C/146 (2005) 47 at paras. 263 and 264.

263. While noting the efforts made by the State party, the Committee remains concerned about the health problems faced by adolescents, in particular about drug and tobacco use and alcohol abuse and that the regulation of their consumption by children and adolescents falls within the competence of the Länder. Furthermore, the Committee is concerned at the suicide forums accessible on the Internet where young people can exchange experiences and suicidal thoughts.

264. The Committee recommends that the State party strengthen its efforts to prevent drug and tobacco use and alcohol abuse and to harmonize the different regulations in the various Länder on this matter. The Committee recommends that the State party undertake practical measures to prevent access to information through the Internet inciting suicide.

• Belize, CRC, CRC/C/146 (2005) 59 at paras. 344, 345, 348 and 349.

344. The Committee welcomes the revised and expanded Care and Growth Chart, which provides a detailed and personal health and development record for all children under 5 years of age. While noting with appreciation the State party’s efforts to improve the primary health care, including the establishment of the National Health Insurance Scheme and the School Health and Physical Education Services (SHAPES) programme, the Committee is nevertheless concerned at the regional disparities in accessibility to health services, the high number of infant deaths and regional differences in this respect, and the situation of malnutrition among infants and children. The Committee is also concerned at the lack of access to safe drinking water and sanitation in the rural and most remote areas. Furthermore, the Committee reiterates its concern at the low prevalence of breastfeeding.

345. The Committee recommends that the State party:

...

(b) Continue its efforts to improve prenatal care, including training programmes for midwives and traditional birth attendants, and take all necessary measures to reduce infant mortality rates, especially in rural areas;

(d) Ensure access to safe drinking water and sanitation in all areas of the country;

(e) Strengthen its efforts to implement the National Breastfeeding Policy, adopted in 1998, and encourage exclusive breastfeeding for six months after birth with the addition of an appropriate infant diet thereafter;

(f) Seek international assistance, including from UNICEF and WHO, to that effect.

...

348. The Committee welcomes the National Strategy on HIV/AIDS and free and universal access to voluntary testing, counselling and anti-retroviral drugs. Nevertheless, it remains deeply concerned at the very high incidence of HIV/AIDS in the State party and the adverse consequences suffered by children infected with or affected by HIV/AIDS. The Committee notes with concern the limited availability of preventive programmes and awareness-raising campaigns on HIV/AIDS. The Committee notes that the State party has conducted a rapid assessment of the situation of orphans and vulnerable children in 2004.

349. With reference to the need to implement the Committee’s general comment No. 3 (2003) on HIV/AIDS and the rights of the child (CRC/GC/2003/3) and the Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37, annex I), the Committee recommends, in particular, that the State party:

(a) Strengthen its efforts to combat HIV/AIDS, including through preventive programmes and awareness-raising campaigns, and to prevent discrimination against children infected with and affected by HIV/AIDS;

(b) Undertake a comprehensive study to assess the prevalence of HIV/AIDS, including the number of children infected with and affected by HIV/AIDS, and devise a comprehensive national plan of action for orphans and vulnerable children, including children infected with and affected by HIV/AIDS, using to the extent possible the results of this study and the rapid assessment of the situation of orphans and vulnerable children conducted in 2004;

...

(d) Continue to strengthen its efforts to prevent mother-to-child transmission of HIV;

(e) Seek international assistance from, among others, UNAIDS and UNICEF, to that effect.

• Togo, CRC, CRC/C/146 (2005) 104 at paras. 563-568, 579 and 580.

563. While acknowledging the improvements in the health-care sector, in particular the establishment of clinics in rural areas and the activities implemented to improve the nutrition of children, the Committee is particularly concerned at the increasing infant mortality rate, the high child and maternal mortality rates, the low birth weight, child malnutrition, the low breastfeeding rate, the low rate of immunization, the prevalence of infectious diseases, mosquito-born diseases, including malaria, and the lack of access to safe drinking water and sanitation. The Committee is further concerned about the disparity between the number of health centres in rural and urban areas.

564. The Committee recommends that the State party:

(a) Develop and implement a long-term comprehensive policy with a strong emphasis on early childhood development and community health in which measures will be taken:

(i) To decrease reduce significantly infant and maternal mortality rates;

...

(iv) To prioritize the provision of safe drinking water and sanitation services, especially in rural areas;

(v) To prevent malnutrition, malaria and other mosquito-borne diseases;

(vi) To immunize as many children and mothers as possible;

(vii) To promote exclusive breastfeeding until the age of 6 months;

(b) Seek in this regard technical assistance from, among others, UNICEF.

565. While noting the measures taken to prevent the transmission of HIV/AIDS from mothers to children and the creation of the National Committee on HIV/AIDS Prevention, the Committee is concerned about the prevalence of HIV/AIDS and that no education for youth on HIV/AIDS exists.

566. The Committee recommends that the State party:

(a) Increase its efforts to prevent HIV/AIDS, taking into account, inter alia, the Committee's general comment No. 3 (2003) and the International Guidelines on HIV/AIDS and Human Rights;

(b) Strengthen its measures to prevent mother-to-child transmission, inter alia, by combining and coordinating it with the activities to reduce maternal mortality, and take adequate measures to address the impact on children of the HIV/AIDS-related deaths of parents, teachers and others, in terms of children's reduced access to family life, adoption, emotional care and education;

...

567. While noting the existence of a family planning information programme, the Committee remains concerned at the large number of early pregnancies. The Committee is further concerned that this issue remains a problem for adolescents and that there is no organized system of reproductive health counselling and services, nor education on sexually transmitted infections for youth.

568. The Committee recommends that the State party develop a comprehensive policy on adolescent health that promotes collaboration between State agencies and NGOs in order to establish a system of formal and informal education on HIV/AIDS and sexually transmitted infections, and ensures access to reproductive health counselling and services for all adolescents, even when married.

...

579. The Committee welcomes the adoption on 18 March 1998 of Act No. 98/008 on drugs control and the setting up in 1996 of the National Anti-Drug Committee (CNAD) and in 2000 of the National Anti-Drugs Plan. However, the Committee remains concerned about the large number of children, in particular street children, using and selling drugs.

580. The Committee recommends that the State party:

(a) Provide children with accurate and objective information about substance use, including tobacco use, and protect them from harmful misinformation through comprehensive restrictions on tobacco advertising;

...

• Bolivia, CRC, CRC/C/146 (2005) 121 at paras. 640, 641, 654 and 655.

640. ...The Committee is...concerned that, despite a significant decrease, infant mortality rates remain very high, and well above the regional average. Furthermore, the Committee is deeply concerned at the high levels of malnutrition among children in the State party and at the limited use of breastfeeding. While noting that the prevalence rate of HIV/AIDS is relatively low in the State party, the Committee expresses concern at its considerable increase in recent years.

641. The Committee recommends that the State party continue to strengthen its efforts in improving the health situation of children in the State party and their access to quality health services in all areas of the country, particularly rural areas... Furthermore, the State party should ensure that mothers are encouraged to rely exclusively on breastfeeding for six months after birth, with the addition of appropriate infant diet thereafter. The Committee also recommends that the State party complete and implement the draft law on HIV/AIDS.

...

654. The Committee notes with concern the increasing number of children who use drugs and harmful substances in the State party.

655. The Committee recommends that the State party:

(a) Formulate a rights-based plan of action for the protection of children and adolescents from the dangers of drugs and harmful substances, and involve children in its formulation and implementation;

(b) Provide children with accurate and objective information about the harmful consequences of substance abuse;

...

• Nigeria, CRC, CRC/C/146 (2005) 135 at paras. 712, 713, 716, 717, 731 and 732.

712. The Committee takes note of efforts made by the State party to improve its health system, including the Baby Friendly Hospital Initiative and the Integrated Management for Childhood Illness, as well as the establishment of the National Programme on Immunization Agency. Nevertheless, the Committee remains gravely concerned at the alarmingly high rate of infant, child and maternal mortality, and the high incidence of major illnesses affecting children, including polio, malaria and diarrhoea as well as the low rate of immunization coverage in the country, particularly in the northern regions, and of malnutrition and the low rates of exclusive breastfeeding. The Committee is also concerned at the very low level of knowledge among mothers on basic health issues, such as about the use of oral rehydration solutions (ORS) for diarrhoea. The Committee, while acknowledging the adoption of the new National Water Supply and Sanitation Policy, also remains concerned at the access to safe drinking water and sanitation, particularly in rural areas.

713. The Committee recommends that the State party:

(a) Address, as a matter of urgency, the very high mortality rates among infants, children and mothers, by, inter alia, stepping up the immunization programmes and improving antenatal and post-natal care;

...

(c) Take measures to introduce awareness-raising programmes for women, on the importance of, inter alia, prenatal and post-natal health care, preventive measures and treatment for common illnesses; immunization and balanced diet for the healthy development of children;

...

(e) Ensure universal access to drinking water and sanitation services.

...

716. The Committee welcomes the efforts made by the State party to prevent and control HIV/AIDS including the establishment of the National Action Committee on AIDS, as well as the recent introduction of testing, counselling and PMTCT (Preventing Mother-to-Child Transmission) in some areas. However, it remains concerned about the high incidence of the infection and its wide prevalence in Nigeria, as well as the lack of knowledge especially among women on modes of transmission and prevention of HIV/AIDS...

717. The Committee recommends that the State party continue its efforts in preventing the spread of HIV/AIDS and providing treatment...

...

731. While acknowledging the efforts made by the State party to combat drug abuse, trafficking and drug-related violence, the Committee remains concerned at the high incidence of substance abuse by children in Nigeria, including the use of cannabis, psychotropic substances, heroin, cocaine and volatile organic solvents, as well as abuse of local plants... It is also concerned at the lack of specific legislation prohibiting the sale, the use and the trafficking of controlled substances applying children, and also of treatment programmes in this regard.

732. The Committee recommends that the State party undertake a comprehensive study to assess the nature and extent of drug abuse by children, and to take action to combat the phenomenon, including through general poverty reduction strategies and public education awareness campaigns...

• Saint Lucia, CRC, CRC/C/150 (2005) 10 at paras. 82, 83, 93 and 94.

82. The Committee expresses its concern at the increasing rate of HIV/AIDS and other sexually transmitted diseases among adolescents. It further notes with concern the high rate of teenage pregnancies and the fact that the State party does not pay sufficient attention to adolescent health issues, including developmental, mental and reproductive health concerns.

83. The Committee recommends that the State party:

(a) Undertake a comprehensive study to assess the nature and the extent of adolescent health problems and, with the full participation of adolescents, use this as a basis to formulate adolescent health policies and programmes with particular focus on the prevention of HIV/AIDS and other sexually transmitted diseases, taking into account the Committee’s general comment No. 4 (2003) on adolescent health and development;

(b) Strengthen developmental and mental health counselling services as well as reproductive counselling and make them known and accessible to adolescents;

(c) Ensure the inclusion of reproductive health education in the school curriculum and fully inform adolescents of reproductive health rights, including the prevention of teenage pregnancies and sexually transmitted diseases, including HIV/AIDS;

...

93. While the Committee is encouraged that the State party has taken measures to ensure the school environment remains drug-free for children, it remains concerned that measures for monitoring drug abuse among children as well as their involvement in drug trafficking outside of schools have not been fully developed in the report.

94. The Committee recommends that the State party strengthen its measures to combat drug abuse by children, including through public education awareness-raising campaigns and ensure that children who abuse drugs have proper access to effective structures and procedures for treatment, counselling, recovery and social reintegration.

• Philippines, CRC, CRC/C/150 (2005) 24 at paras. 161, 162, 165-168, 184 and 185.

161. The Committee is encouraged by the progress achieved by the State party in the field of health and health services, particularly with regard to immunization, such as polio eradication and the elimination of neonatal tetanus and it notes with appreciation the Health Sector Reform Agenda.... The low prevalence of breastfeeding, malnutrition among children, including micronutrient malnutrition problems among schoolchildren and in general, children’s limited access to quality health services in the remote areas of the country give cause for serious concern...

162. The Committee recommends that the State party:

...

(e) Strengthen existing efforts to immunize as many children and mothers as possible by effectively implementing immunization programmes;

(f) Encourage exclusive breastfeeding for six months after birth with modifications for an appropriate infant diet thereafter and take measures to improve the nutritional status of children through education and promotion of healthy feeding practices;

...

165. The Committee notes with appreciation the State party’s efforts to promote adolescent health, including through implementation of the Reproductive Health Programme and a joint project on adolescent health in collaboration with the Population Commission and UNFPA. The Committee is concerned about alcohol, tobacco and drug abuse among adolescents, early pregnancies and in this respect adolescents’ limited access to reproductive health counselling and accurate and objective information about, for example contraception. The lack of legislation establishing a minimum age for purchasing and consuming alcohol gives cause for concern. The Committee also shares the State party’s concern about the lack of measures to prevent suicide among adolescents.

166. The Committee recommends to the State party that it:

...

(b) Ensure access to reproductive health counselling and provide all adolescents with accurate and objective information and services in order to prevent teenage pregnancies and related abortions;

(d) Establish by law the minimum age for purchasing and consuming alcohol;

(e) Provide adolescents with information on the harmful consequences of alcohol, drug and tobacco use;

...

(g) Seek technical cooperation with, among others, WHO, the Joint United Nations Programme on HIV/AIDS and UNFPA.

167. The Committee notes the relatively low HIV prevalence rate in the country and welcomes the various efforts being made to address the prevention of transmission and the reduction of HIV/AIDS, including through the implementation of the AIDS Prevention and Control Act (Republic Act No. 8504), adopted in 1998, and the establishment of the National AIDS Prevention and Control Programme in 1998, the Committee is concerned about the presence of risk factors predisposing HIV-infection, such as the high number of sex workers. While noting that the AIDS Prevention and Control Act guarantees access to complete HIV/AIDS information in schools, the Committee expresses its concern about the inadequate level of HIV/AIDS awareness among Philippine adolescents.

168. In the light of the Committee’s general comment No. 3 (2003) on HIV/AIDS and the rights of the child and the International Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37), the Committee recommends that the State party continue to:

(a) Strengthen its efforts to implement the AIDS Prevention and Control Act in order to prevent and treat the effects of HIV/AIDS;

...

184. While noting the State party’s efforts to combat drug trafficking and drug and substance abuse, inter alia, through implementing the Comprehensive Dangerous Drugs Act of 2002 (Republic Act No. 9165), and the increased number of treatment and social reintegration services for children, the Committee is deeply concerned at the massive narcotic trade in the Philippines and its adverse effects on children and adolescents. It shares the State party’s concern about the high incidence of drug and substance abuse, including glue and solvent sniffing among street children...

185. The Committee recommends that the State party continue to strengthen its efforts to:

(a) Combat drug and substance abuse among children and adolescents, for example by effectively implementing the Comprehensive Dangerous Drugs Act of 2002 and secure due process of the law;

(b) Provide children and adolescents with accurate and objective information about drug and substance use, including hard drugs, glue and solvent sniffing, through public school programmes and media campaigns and protect children from harmful misinformation and models;

...

• Bosnia and Herzegovina, CRC, CRC/C/150 (2005) 49 at paras. 249, 251, 254 and 255.

249. The Committee is concerned that the country’s complex political structure and the lack of unified laws and policies make equitable access to health-care services for all children increasingly difficult. Furthermore, the Committee takes note, with concern, that one fifth of children are not fully vaccinated and that exclusive breastfeeding is limited to the first three months and only to a limited number of children...

...

251. The Committee recommends that the State party undertake all necessary measures to ensure that all children enjoy the same access and quality of health services, with special attention to children belonging to vulnerable groups, especially Roma. Furthermore, the Committee recommends that the State party strengthen its efforts in improving the health situation of children in the State party, including through:

...

(b) Strengthening vaccination programmes;

(d) Promoting exclusive breastfeeding for six months after birth with the addition of appropriate infant diet thereafter;

(e) Seeking technical assistance from, among others, UNICEF and WHO in this regard.

...

254. The Committee is concerned that high-risk behaviour among young people - (i.e. injecting drug use and risky sexual behaviour) - may expose the State party to serious HIV/AIDS problems in the future. The Committee also notes that this issue was recognized by the Government only in 2002 - with the creation of the National Advisory Board for the prevention of HIV/AIDS and the development of a “Strategy for Preventing and Combating HIV/AIDS in Bosnia and Herzegovina” - whereas it is still not perceived as a threat by most of the population.

255. The Committee recommends that the State party:

(a) Increase its efforts to prevent the spread of HIV/AIDS, taking into account the Committee’s general comment No. 3 (2003) on HIV/AIDS and the rights of the child and the International Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37);

(b) Launch campaigns and programmes to raise awareness about HIV/AIDS among adolescents, particularly among those belonging to vulnerable groups as well as the population at large, so as to reduce discrimination against children infected and affected by HIV/AIDS;

• Nepal, CRC, CRC/C/150 (2005) 66 at paras. 341 and 343.

341. The Committee welcomes the establishment of a working group to implement the Integrated Management of Childhood Illness strategy in 1997 and commends the State party’s efforts in improving the immunization coverage for children under 5, including the recent completion of the comprehensive measles vaccination campaign. The Committee nevertheless shares the concerns of the State party that the health and social services are under tremendous resource constraints and that the overall quality and availability of health care available to children in the State party is seriously inadequate, in particular among poor families and in rural areas. In particular, the Committee is concerned about:

(a) High rates of infant, under-five mortality and maternal mortality, and the low life expectancy in the State party;

(b) Continuing threats to survival and development of children by preventable childhood diseases, including diarrhoea, malnutrition, anaemia, intestinal infectious diseases; bacterial infection; measles and pneumonia;

...

(d) Inadequate sanitation and access to safe and clean water, in particular in rural areas, which generally suffer from lack of services;

(e) Low awareness about health, hygiene and sanitation, particularly in rural areas and prevalence of traditional practices which could be harmful to the health of children, such as that of consulting witch doctors instead of modern medical facilities and withholding water from children suffering from diarrhoea.

...

343. The Committee recommends that the State party:

...

(b) Continue strengthening its efforts to extend immunization coverage to all parts of the country;

...

(d) Continue strengthening measures to combat childhood illnesses, paying particular attention to the needs of children belonging to high-risk groups;

(e) Engage in awareness-raising efforts to provide the general public, in particular, families, children and health-care providers, including traditional health practitioners, with appropriate knowledge of basic first aid and health care;

...

(g) Pursue additional avenues for cooperation and assistance for the improvement of child health with, among other organizations, WHO and UNICEF.

• Ecuador, CRC, CRC/C/150 (2005) 91 at paras. 439-442.

439. The Committee reiterates the concern raised in its previous concluding observations (CRC/C/15/Add.93) with regard to the damaging effect of oil extraction and the spraying of illegal crops under Plan Colombia on the environment and on the health of children.

440. The Committee recommends that the State party effectively address the problem of pollution and environmental degradation, including by seeking bilateral agreements and international cooperation. It also recommends that the State party strengthen its environmental health education programme.

441. The Committee remains concerned at the increasing number of teenage pregnancies and the number of very young mothers. The Committee is also concerned that adolescents face particular physical health and mental health risks, including violence, drug use and alcohol abuse and sexually transmitted infections (STIs).

442. The Committee recommends that the State party pay particular attention to adolescent health, taking into account the Committee’s general comment No. 4 (2003) on adolescent health and development in the context of the Convention on the Rights of the Child. The Committee recommends that the State party strengthen the existing laws and programmes and in particular:

(a) Undertake measures to reduce the rate of teenage pregnancies, in particular through reproductive health education and child-sensitive counselling services;

(b) Undertake measures to reduce the rate of teenage pregnancies through, inter alia, the effective implementation of the Sex Education and Love Act in a gender- and child-sensitive manner;

(c) Undertake effective measures to prevent sexually transmitted diseases and to combat drug use and alcohol abuse by children, including through public education awareness-raising campaigns and ensure that children who abuse alcohol and/or use drugs have access to effective structures and procedures for treatment, counselling, recovery and reintegration;

(d) Increase its efforts to promote mental health and counselling services, inter alia with a view to addressing suicide among adolescents, and ensuring that such services are accessible to, and appropriate for all adolescents, including indigenous, Afro-Ecuadorian and those living in remote areas.

• Norway, CRC, CRC/C/150 (2005) 105 at paras. 499 and 500.

499. The Committee remains deeply concerned at the high incidence of suicide among adolescents, which accounts for about one out of every four deaths among young women and men.

500. The Committee urges the State party to strengthen the health service resources for people in suicidal crisis and to take measures to prevent suicide among groups that are at risk.

• Mongolia, CRC, CRC/C/150 (2005) 113 at paras. 558-563.

558. While noting with appreciation the State party’s efforts to improve primary health care, in particular the prevention of infectious diseases such as measles, meningitis and diphtheria as a result of the successful implementation of the National Immunization Programme 1993-2000, the Committee is nevertheless concerned at the regional disparities in access to health services, the high rates of both maternal mortality and under-5 mortality and regional differences in this respect, and the prevailing situation of malnutrition among children. The Committee notes with concern that the exclusive breastfeeding rate is declining and that the State party has not yet adopted the International Code of Marketing of Breastmilk Substitutes... The Committee expresses its concern at the poor state of sanitation, environmental pollution problems and the limited access to clean and safe drinking water in the country...

559. The Committee strongly recommends that the State party undertake all necessary measures:

...

(b) To continue its efforts to improve prenatal care and to significantly reduce maternal and under-5 mortality rates, paying particular attention to mothers and children living in remote areas of the country;

(c) To adopt the International Code of Marketing of Breastmilk Substitutes and to encourage exclusive breastfeeding for six months after birth, with the addition of an appropriate infant diet thereafter;

(d) To improve the nutritional status of children, for example through introducing a school nutrition programme, with particular attention to children in rural areas;

(e) To ensure equal access to safe and affordable pharmaceuticals used in the prevention and treatment of a range of health conditions of children and to raise awareness on the use and effects of medicines;

(f) To ensure access to safe and clean drinking water and sanitation in all areas of the country and to protect children from the consequences of environmental pollution;

...

560. The Committee takes note of the State party’s efforts to promote adolescent health and health education in schools by implementing the National Reproductive Programme on Student and Adolescent Health and a campaign on the “health-promoting school”. However, the Committee is concerned at the limited number of school health services, including the lack of regular physical examinations and statistical data on the status of schoolchildren’s health. In addition, the Committee is concerned that insufficient attention has been given to adolescent health in the context of non-communicable diseases related to lifestyle factors, such as tobacco smoking, alcohol consumption and drug abuse.

561. The Committee recommends that the State party pay close attention to adolescent health, taking into account general comment No. 4 (2003) on adolescent health and development in the context of the Convention on the Rights of the Child, and strengthen its efforts to promote adolescent health, including sexual and reproductive health education in schools, and to introduce school health services, including youth-sensitive and confidential counselling and care. The Committee recommends that the State party ensure that adolescents not attending school are provided with the same education, information and services for health. In order to decrease tobacco smoking, alcohol consumption and drug abuse among adolescents, the Committee recommends that the State party initiates campaigns, particularly designed for adolescents, on health-behavioural choices.

562. The Committee notes the relatively low HIV infection rate in the country and is encouraged by the State party’s efforts to prevent and combat HIV/AIDS and sexually transmitted infections (STIs) by implementing, inter alia, the National Strategy to respond to HIV/AIDS, the State Policy on Public Health, the National Reproductive Health Programme, the Law on the Prevention of HIV/AIDS and the National Programme on Communicable Disease. Notwithstanding the positive steps taken by the State party, the Committee expresses its concern about the existing risk factors, such as the growing number of young sex workers, which predispose them to HIV-infection.

563. In the light of the Committee’s general comment No. 3 (2003) on HIV/AIDS and the rights of the child (CRC/GC/2003/3) and the International Guidelines on HIV/AIDS and Human Rights (E/CN.4/1997/37), the Committee recommends that the State party strengthen its efforts to prevent the spread of HIV/AIDS and continue to raise awareness about HIV/AIDS among adolescents, particularly among those belonging to vulnerable groups.

• Nicaragua, CRC, CRC/C/150 (2005) 132 at paras. 638-641, 658 and 659.

638. ...[T]he Committee is concerned that:

(a) Only about two thirds of the population have access to clean drinking water and that there is a huge discrepancy between the rates of urban and rural population having access to clean drinking water;

(b) One out of every three children suffers some degree of chronic malnutrition and that about 10 per cent of them are said to suffer from severe malnutrition;

(c) While the Committee notes the progress made in the reduction of infant and child mortality, including the National Plan for the Reduction of Maternal, Perinatal and Infant Mortality of March 2000, it continues to be concerned at the level of infant and child mortality as well as at the high rate of maternal mortality.

639. The Committee recommends that the State party:

(a) Take all possible actions to reduce poverty and equalize living conditions throughout the country, and ensure access to basic goods and services, such as clean drinking water, especially in remote and rural areas;

(b) Ensure basic health care and services to all children throughout the country and urgently address the problem of malnutrition, with special emphasis on rural and remote areas;

(c) Strengthen its efforts to urgently tackle the grievous issue of infant, child and maternal mortality throughout the country.

640. While the Committee welcomes the enactment of Act No. 238 on the Protection and Defence of Human Rights in the presence of AIDS, as well as the Strategic National Plan against STDs and HIV/AIDS and it is concerned that antiretroviral treatment is not yet guaranteed to the newborn from seropositive mothers and that post-natal care is not provided to the seropositive mother. Furthermore, the Committee is concerned that the presence of HIV/AIDS is particularly high in frontier and harbour zones and that the potential of its spread represents a high, latent risk, despite the fact that official data show a low number of cases.

641. The Committee recommends that the State party:

(b) Strengthen its measures to prevent mother-to-child transmission, inter alia, through coordination with the activities aimed at reducing maternal mortality;

(c) Guarantee antiretroviral treatment to newborns from HIV/AIDS seropositive mothers as well as post-natal monitoring of seropositive women;

...

(e) Strengthen its efforts by conducting campaigns and programmes to raise awareness about HIV/AIDS among adolescents, particularly among those belonging to vulnerable groups as well as the population at large, so as to reduce discrimination against children infected and affected by HIV/AIDS;

(f) Ensure the provision of adequate financial and human resources for the effective implementation of the Strategic National Plan against STDs and HIV/AIDS;

(g) Seek further technical assistance from, inter alia, the United Nations Joint Programme on HIV/AIDS (UNAIDS) and UNICEF.

...

658. The Committee is concerned at the endemic abuse of substances among street children and members of youth gangs (pandillas).

659. The Committee recommends that the State party establish programmes to prevent and combat substance abuse by street children and members of youth gangs (pandillas), including the provision of psychosocial assistance for addicts. The Committee also recommends that the State party seek technical cooperation from, among others, the World Health Organization (WHO) and UNICEF.

• Costa Rica, CRC, CRC/C/150 (2005) 149 at paras. 708, 709, 712 and 713.

708. The Committee notes the steps taken by the State party to strengthen the access to health services and information for children with disabilities, and train professionals working in public health institutions on the rights of disabled children, as well as the efforts to include children with disabilities in regular school, the prenatal and post-natal screening programmes. The Committee remains concerned, however, at the limited coverage of this progress to the economically disadvantaged and rural populations.

709. The Committee recommends that the State party continue to expand programmes for children with disabilities including the prenatal and post-natal screening programmes, and ensure their access, inter alia through mobile clinics, to economically disadvantaged people in rural areas...

...

712. The Committee notes with appreciation the measures taken by the State party to implement its recommendation to develop adolescent-sensitive health policies and strengthen reproductive health education and services in order, inter alia, to prevent and reduce teenage pregnancies, and to enhance the prevention of substance abuse among adolescents. The Committee is concerned however that the number of teenage pregnancies remains significantly high.

713. The Committee recommends that the State party continue to strengthen reproductive health education in secondary schools such as “Young Love” to prevent teenage pregnancies...

• Yemen, CRC, CRC/C/150 (2005) 161 at paras. 785 and 786.

785. The Committee notes the efforts undertaken by the State party in the area of basic health and welfare, such as the immunization programme and control of diarrhoeal diseases, and the consequent improvements such as, inter alia, the decrease in the infant and under-five mortality rates. The Committee also welcomes the adoption of a Strategy for the Integrated Management of Childhood Illnesses (IMCI). However, the Committee is deeply concerned about the health situation and the fact that only 50 per cent of the population has access to health services. Particular matters of concern are:

...

(b) The insufficient focus on preventive health care;

(c) The still-high infant, under-five, and maternal mortality rates, partly due to the weak antenatal and post-natal care and maternal malnutrition;

(d) The high prevalence of malnutrition among children;

...

786. The Committee recommends that the State party:

...

(b) Emphasize the role of preventive health care;

(c) Continue to strengthen the efforts to decrease the infant, under-five, and maternal mortality rates through, inter alia, providing adequate ante- and post-natal care;

...

(e) Improve access to family planning involving both men and women.

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