Strengthening comprehensive health care for women

Ensuring good quality, comprehensive health services that meet women's needs and are accessible to all women.

Development and enhancement of reproductive health programmes and services would reduce maternal and infant mortality from all causes and enable women and men to fulfil their personal aspirations in terms of family size, consistent with their freedom and dignity and personally held values.

The total worldwide annual cost of better reproductive health care is about $17 billion, less than one week of the world's expenditure on armaments.

This strategy features in the framework of Agenda 21 as formulated at UNCED (Rio de Janeiro, 1992), now coordinated by the United Nations Commission on Sustainable Development and implemented through national and local authorities. It also formed part of the Platform for Action of the UN Fourth World Conference for Women (Beijing, 1995). Women's groups should be involved in decision-making at the national and community levels to identify health risks and incorporate health issues in national action programmes on women and development.

Agenda 21 suggests that governments should take active steps to implement programmes to establish and strengthen preventative and curative health facilities which include women-centred, women-managed, safe and effective reproductive health care and affordable, accessible services as appropriate for the responsible planning of family size, in keeping with freedom, dignity and personally held values, taking into account ethical and cultural considerations. Programmes should focus on providing comprehensive health care, including pre-natal care, education and information on health and responsible parenthood and should provide the opportunity for all women to fully breast feed at least during the first four months post-partum. Programmes should fully support women's productive and reproductive roles and well being, with special attention to the need to provide equal and improved health care for all children and to reduce the risk of maternal and child mortality and sickness.

As a matter of urgency, and in accordance with country specific conditions and legal systems, measures should be implemented to ensure that women and men have the same right to decide freely and responsibly on the number and spacing of their children, to have access to the information, education and means, as appropriate, to enable them to exercise this right in keeping with their freedom, dignity and personally held values taking into account ethical and cultural considerations.

WHO has programmes specifically aimed at improving the health of women. Disaggregated mortality, morbidity and health-related data are collected. A programme on maternal and child health, including family planning, addresses the needs of women by means of a multi-faceted approach that aims at: ensuring that pregnant women receive adequate antenatal care and have access to essential obstetric and gynaecological care provided by trained health workers; ensuring that most births are attended by trained health workers; that the health infrastructure provides for access to family-planning; and that there is intersectoral action to enhance the role and status of women. WHO supports 90 developing countries with specific maternal and child health/family planning programmes and collaborates with UNFPA in this regard. A strategy has been launched to reduce maternal mortality and morbidity. A major part of UNFPA-supported activities are in the areas of maternal and child health and family planning services. UNICEF's strategy can be seen as partly concerned with means of eliminating sex disparities from birth and of increasing the access of both girls and young women to health and educational services. FAO country nutrition profile emphasizes the needs of pregnant and lactating women. Participation of women in supplementary feeding programmes is encouraged. A significant proportion of the projects assisted by the WFP are explicitly focused on improving the health and nutritional status of nutritionally vulnerable groups including women.

Action by governments to address this objective might include providing adequate financing to ensure the availability of primary health services to all by the year 2000, with a review of women s health needs in establishing programmes. Steps might be taken to provide universal family-planning services, as well as accessible information available in the area of sexual health, particularly measures to prevent the spread of HIV/AIDS among women. Measures might also be taken to ensure that free health educational materials and health services are available in all educational institutions.

Action by non-governmental organizations might include non-formal health education and advisory services for women and girls at the community level, giving particular emphasis to women's traditional health knowledge and providing outreach to the urban poor and rural women who do not have access to government services.

Action by organizations of the UN system might include an increase in the proportion of assistance in the area of health, which has recently stagnated, with particular focus on the health of women and girls and by promoting the training of more female health workers.