Sexual and Reproductive Health and Rights in Europe

Transcription

1 ASTRA is a regional network of NGOs and individuals advocating in a collective voice for women s sexual and reproductive heal and rights in Central and Eastern Europe. Presently ASTRA consists of members. ASTRA works for e advancement of sexual and reproductive heal and rights as fundamental human rights and advocates for eir observance, prioritization and implementation on e international, regional and national agendas. ASTRA strives to increase awareness about ese issues and to ensure at e specific reality of women's sexual and reproductive rights and heal in Central and Eastern Europe receive e highest attention and are treated wi adequate priority on international, regional and national agendas. These include e anticipated accession of many of e countries of e region to e European Union and our participation in e United Nations and in e Council of Europe. ASTRA strategies include: Advocacy for Sexual and Reproductive Heal and Rights (SRHR) as e equality and human rights issue in e context of international and regional agreements Monitoring and reporting on e status of implementation of SRHR and gender-related policies Promoting e best legal, policy and service provision standards in SRHR Building partnerships wi NGOs and relevant institutions including UN agencies and EU bodies The report was written by Christina Zampas, Legal Adviser for Europe (Center for Reproductive Rights) in consultation wi Wanda Nowicka (Polish Federation for Women and Family Planning), wi assistance of ASTRA member organizations who helped in providing information to eir country. Contributions from: ARMENIA - Women's Rights Center BULGARIA - Bulgarian Family Planning and Sexual Heal Association; Bulgarian Gender Research Foundation; Gender Education, Research and Technologies CROATIA - Be Active Be Emancipated (B.A.B.E.); CESI - Center for Education and Counseling and Research; Women's Room - Women's Center for Sexuality and e Prevention, Research and Combating of Sexual Violence GEORGIA - Women's Center HUNGARY - Habeas Corpus Working Group LATVIA - Family Planning and Sexual Heal Association of Latvia LITHUANIA - Family Planning and Sexual Heal Association of Liuania POLAND - Polish Federation for Women and Family Planning ROMANIA - AnA: Romanian Society for Feminist Analysis; IPAS; The East European Institute for Reproductive Heal RUSSIA - Novgorod Gender Center SLOVAKIA - NGO Pro-Choice January 00 Astra Secretariat: Federation for Women and Family Planning Nowolipie /, 00- Warsaw, Poland Ph/fax:.. info@astra.org.pl; ISBN --0- Sexual and Reproductive Heal and Rights in Europe Report to e European Union

2 The ability of women to control eir own fertility is absolutely fundamental to women's empowerment and equality. When a woman can plan her family, she can plan e rest of her life. When she is healy, she can be more productive. And when her reproductive rights...are promoted and protected, she has freedom to participate more fully and equally in society. Reproductive rights are essential to women's advancement. - Thoraya A. Obaid, UNFPA Executive Director [G]ender equality cannot be achieved wiout guaranteeing women's sexual and reproductive heal and rights, at expanding access to sexual and reproductive heal information and heal services are essential for achieving e Beijing Platform for Action, e Cairo Program of Action and e Millennium Development Goals. - Declaration of e (European Union) Conference of Ministers of Gender Equality, Luxembourg, February 00 e following are critical components of a comprehensive and evidence based response [to HIV prevention]: Universal access to sexual and reproductive heal information and services for women, men and young people, including people living wi HIV and AIDS, to ensure at ey have access to a full range of reproductive choices in accordance wi e Cairo/ICPD Agenda Universal access to education and provision of life-skills and sexuality education and action to promote increased safety in schools for all children, to increase protection against abuse, rape, unintended pregnancy and sexually transmitted infections including HIV; - European Union Statement on HIV Prevention for an AIDS Free Generation November 00 Reproductive heal problems are e leading cause of women's ill heal and dea worldwide. When bo women and men are taken into account, reproductive heal conditions are e second-highest cause of ill heal globally, after communicable diseases. These figures mask huge disparities, bo among and wiin countries, including countries in Europe. The reproductive heal situation in new member states of and accession countries to e European Union, as well as neighboring countries are similar. For instance, in many countries of e Central and East European (CEE) region, due to limited contraceptive services and information, abortion is used as e primary meod of fertility control. Still many women are denied access to modern contraceptive meods because of financial inaccessibility, lack of information or because ey receive misleading information. In addition, attempts to curb women's access to safe and legal abortion are leaving many women in vulnerable situations which reaten eir life and heal. Accurate and scientifically-based sexuality education and access to reproductive heal services is also limited due to growing influence of conservative forces, including e Caolic Church. Moreover, sexually transmitted infections (STIs) - including HIV/AIDS - rates have dramatically risen, especially amongst adolescents and women, in some countries of e region and experts predict at is crisis will likely spread to oer CEE countries if ere are no strong rights-based prevention programs in place. Because reproductive heal status depends so heavily on income and gender, addressing is issue becomes a matter of gender equality and human rights. It is important to note at e European Union is founded on e principles of democracy, human rights, gender equality and e rule of law. Thus, while e European Union plays a critical role in addressing ese issues in its development policy and should continue to do so, it should also strengen and expand such policies to its existing and future borders, most particularly addressing e grave situation facing people in Central and Eastern Europe. Reproductive Rights are Human Rights The s was a key decade in articulating e links between e provisions set out in existing human rights treaties and women's reproductive rights. Widespread recognition of e legal foundations for reproductive rights is a critical step toward achieving human rights for all women. Reproductive rights were a major topic at two international conferences, e United Nations International Conference on Population and Development (ICPD) and e United Nations Four World Conference on Women (Beijing). The consensus documents from ose meetings affirmed e centrality of ese rights to international human rights and described e panoply of rights at are included in e reproductive rights framework. As stated in Paragraph. of e ICPD Programme of Action: [R]eproductive rights embrace certain human rights at are already recognized in national laws, international human rights documents and oer consensus documents. These rights rest on e recognition of e basic right of all couples and individuals to decide freely and responsibly e number, spacing and timing of eir children and to have e information and means to do so, and e right to attain e highest standard of sexual and reproductive heal. It also includes eir right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents. The Application of Gender Equality and Human Rights to Sexual and Reproductive Heal Issues Human rights related to sexual and reproductive heal include e right to life, e right to liberty and security, e right to information, e right to heal, e right to education, e right to a private and family life, e right to be free from inhumane and degrading treatment, and e right to be free from discrimination, to name a few. All of ese rights are also included in e European Charter on Fundamental Rights. International human rights bodies around e world, including United Nations, e Council of Europe and e Inter-American human rights system, have all applied gender equality and human rights principles to sexual and reproductive heal issues. The United Nations Treaty Monitoring bodies, which monitor state compliance wi e six major United Nations human treaties, have addressed sexual and reproductive heal and rights issues wiin e context of state obligations under various treaty provisions, including e right to bodily integrity, liberty and security, privacy, information, life, heal, education and right to be free from discrimination. In its General Recommendation, e CEDAW Committee explicitly acknowledges e discriminatory impact denial of reproductive heal care has on women, [I]t is discriminatory for a State party to refuse to provide legally for e performance of certain reproductive heal services for women. The jurisprudence of e European Commission of Human Rights and e European Court of Human Rights have also recognized at reproductive rights are protected by e European Convention on Human Rights and Fundamental Freedoms and have decided most of ese cases on e basis of Articles,, and of e Convention. The European Union on SRHR issues The EU has recognized in several documents governing its international development policy, at an effective approach to sexual and reproductive heal and rights (SRHR) is needed in order to reduce poverty and maternal and child mortality rates, to prevent sexually transmitted infections (STIs), including HIV/AIDS, and to promote women's rights. Despite its mandate on human rights and gender equality, progressive SRHR language and policies already in place at e European Union's international development policy level have been generally missing in internal European Union programmes and policies concerning Member States. However, ere has been some recognition by e EU on SRHR problems wiin its borders, but almost no effective policies or programmes have been developed. For example, in its recent Statement on HIV Prevention for an AIDS-Free Generation, e EU has acknowledged at growing epidemics in Eastern Europe highlight e needs for evidence - based HIV prevention and notes at access to sexual and reproductive heal information and services, including sexuality education, is key to fighting e spread of HIV/AIDS wiin e Union. In addition, in 00, Anne Van Lancker's (MEP) report on SRHR was adopted by e European Parliament which calls on e European Union to take more concerted action in is field. The starting point for Ms. Van Lancker's report focuses on e commitments made by e EU to e Cairo and Beijing conferences and outlines some of e challenges faced in EU Member States and in CEE countries on SRHR. It calls for EU member states, for example, to ensure safe and legal access to abortion, provide comprehensive and scientifically based sexuality education programs and to make contraceptives more accessible to vulnerable groups by offering subsidies. Reducing inequalities between citizens of new and old EU member states, between e EU and its CEE neighbors and between men and women will require a concerted effort by e EU to address sexual and reproductive heal and rights issues, if it fails to do so e EU's guarantee of equality and human rights will not be met. This paper first sets for recommendations to e European Union, including e European Parliament, relevant European Commission bodies, including e DG on Equality and e DG on Public Heal, and to e EU Network of Independent Experts on Fundamental Rights, on addressing SRHR issues. It en provides country reports which briefly summarize some of e sexual and reproductive heal challenges and violations people are facing in select new EU Member states, in accession countries and in neighboring countries. The country reports focus on four issues: family planning, abortion, HIV/AIDS, and SRHR challenges faced by adolescents. Each country report includes an example of a recommendation by a United Nations treaty monitoring body to at country which highlights some of e SRHR violations recognized by ese UN bodies and illustrates how sexual and reproductive heal issues are incorporated into eir understanding of human rights. Recommendations Given at gender equality and human rights are two fundamental foundations of e European Union, bo in membership to e European Union and in external policies, reproductive and sexual rights issues must be addressed by e Union. Reproductive and sexual rights are comprised of intersecting and overlapping rights found in all of e principle human rights treaties and recognized by all e United Nations Treaty Monitoring Bodies as human rights issues, including gender equality issues. Therefore, a consolidated approach by all international bodies at have a mandate to address human rights, including e European Union, to recognizing and addressing such rights is imperative. Implement all European Union policy and programme commitments to SRHR, including ose commitments to e ICPD Programme of Action, Beijing Platform for Action, HIV/AIDS, Millennium Development Goals, etc., in European Member States and in neighbouring countries in Central and Eastern Europe; Follow-up on e progress made on issues set for in Anne Van Lancker's report on SRHR, which was adopted by e European Parliament in 00. Develop closer collaboration wi member states and neighbouring Central and East European countries and allocate necessary resources to promote rights-based sexual and reproductive heal policies and programmes and to prevent sexual and reproductive heal violations; In e face of growing opposition to SRHR and e ICPD Programme of Action, continue to build and strengen a rightsbased approach to SRHR issues in Europe and around e world, including supporting projects and organizations working for e promotion of an evidence and rights-based approach to sexual and reproductive heal issues. For furer recommendations see ASTRA's two previous reports on e European Union: Sexual and Reproductive Heal and Rights in e European Union: Present Status and Potential Directions for Advancement and Closing e Gap on Sexual and Reproductive Heal and Rights in e Enlarged European Union ( For detailed information on programmes and policies wiin e EU at address SRHR issues and gaps in EU policy and law on is issue, see ASTRA reports: Sexual and Reproductive Heal and Rights in e European Union: Present Status and Potential Directions for Advancement (00) and Closing e Gap on Sexual and Reproductive Heal and Rights in e Enlarged European Union (00) ( For example Regulation (EC) No /00 of e European Parliament and of e Council of July 00 on aid to fight poverty diseases (HIV/AIDS, tuberculosis and malaria) in developing countries; Regulation (EC) No /00 of e European Parliament and of e Council of July 00 on aid for policies and actions on reproductive and sexual heal and rights in developing countries; European Parliament resolution on population and development: years after e UN Conference in Cairo (00/(INI) Committee on Development and Cooperation. EU/DEVELOPMENT: Valkenberg Informal calls upon EU to commit to achievement of Millennium Development objectives, Press release, Agence Europe, Brussels, October, 00; See also Regulation (EC) No /00 of e European Parliament and of e Council of July 00 on aid to fight poverty diseases (HIV/AIDS, tuberculosis and malaria) in developing countries. ASTRA Network: Sexual and Reproductive Heal and Rights in e European Union (EU): Present Status and Potential Directions for Advancement, 00. European Union, World AIDS Day Statement on HIV Prevention for and AIDS Free Generation, General Secretariat, November 00, /0, Devgen Report on Sexual and Reproductive Heal and Rights, European Parliament Committee on Women's Rights and Equal Opportunities ( June 00), A-0/00. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

3 The first HIV infection in Armenia was reported in. Until, e primary means of transmission was sexual transmission. Recently, ere has been a considerable increase in e number of infections resulting from intravenous drug use. Approximately,00 adults and children - 00 of whom are women aged - - are currently living wi HIV/AIDS in Armenia. Modern contraceptive use is low in Armenia. A UNICEF survey indicates at % of women use contraception. However, reports by international aid agencies show at only.% of all women use modern contraception and only % of married women. Contraception can be purchased from pharmacies or ordered from family planning departments, but may be too costly for some women. The low rates of modern contraceptive use are ascribed to lack of information about and access to family planning services and lack of state subsidies for contraceptives. The Armenian government has taken steps to increase access to family planning services. As of 000, e For Family and Heal Armenian Association (AFHA) had established ree family planning/sexual and reproductive heal clinics in Yerevan city and six in e regions of Armenia. In 00, e government passed e RA Law on Reproductive Heal and Reproductive Rights of Human Beings (RH&RR), which recognizes each woman's right to safe moerhood and to effective contraception to prevent pregnancy. Though AFHA's clinics and e RH&RR law are considerable advancements, rates of modern contraceptive use remain low and access to family planning services is still limited. In rural areas and in some urban areas, family planning services continue to be unavailable, and women must travel for reproductive heal services. Women wiout e financial means to travel continue to use unreliable, contraceptive meods and to carry pregnancies to term wiout necessary heal services. There are no state subsidies for contraceptives and heal care providers are not trained in contraceptive use. Armenia has made some effort to confront e HIV/AIDS pandemic. In, e government adopted e RA Law on Prevention of HIV/AIDS Disease, which articulates e government's strategy for prevention, diagnosis, and control of HIV/AIDS and which recognizes some rights of individuals living wi e disease. The law does not meet international standards completely, however, because it mandates testing and medical examinations for specific populations - including persons in prisons and pregnant women and it does not provide social security for persons living wi HIV/AIDS. Currently, 0 amendments are being devised to address ese problems. Furer, e lack of meaningful sexuality education and e low rates of modern contraceptive use raise concerns about prevention and transmission. Increased access to modern contraception and to comprehensive sexuality education is needed to enable individuals to inform and to protect emselves. Low rates of modern contraceptive use and limited access to you friendly and confidential family planning services affect adolescents and result in pregnancy, abortion, and sexually transmitted infections. Approximately % of women aged - give bir to live infants each year. Furermore, in 00, ere were abortions performed for adolescent women, of which were for women under and of which were for women under. Adolescents under years of age can have abortions only wi eir parents' written permission. The government has exhibited an increasing commitment to promoting e sexual and reproductive heal of adolescents. Article of e RH&RR law focuses on adolescents' right to you-friendly sexual and reproductive heal services and to sexuality education. But sexuality education programs in schools have not been officially or systematically introduced by e government. Sexuality education programs at do exist are usually provided by non-governmental organizations. Abortion is legal in Armenia. A woman can terminate a pregnancy during e first weeks of gestation on request. Between and weeks, however, a woman can have an abortion only for medical or prescribed social reasons. Abortions after weeks are permitted only by approval by a commission. Abortion is e primary meod of bir control in Armenia. A 000 survey indicated at % of respondents have had at least abortion, % have had -, % have had -, and.% have had. The average woman erefore has more an two abortions in her lifetime. The high rate of abortion is e result of lack of access to reproductive and sexual heal information and education and to family planning services. In spite of e high abortion rates, women still face obstacles to accessing safe abortion. In e past years, e cost of abortion has increased significantly. Officially, abortions cost between $-. Doctors' salary for e procedure is $ - $0, however, so ey often charge far more an e official price. Given at e average monly income is approximately $ 0 is can be prohibitively expensive for some women. Furer, abortions must be provided by gynecologists in gynecological wards, maternity hospitals, or specialized heal centers. Because of ese requirements, abortion services are not provided in rural areas and in some urban areas. Women who cannot afford to travel to undergo e procedure risk unwanted pregnancies and illegal and unsafe abortions. e Committee is alarmed by e fact at abortion remains e most commonly used means of family planning in e country owing, in particular, to inadequate education and e high cost of contraceptives. The Committee recommends at family planning programmes be set up for women, in particular to decrease e incidence of abortion, along wi programmes for e prevention and treatment of cancer. Furermore, e Committee requests e Government to take measures which will promote employment for women and eir greater participation in public life. UNICEF, information by country, (lat visited December 00). See for example, USAID, Country Heal Statistical Report, Armenia ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), available at Id. ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). R. Abrahamyan & G. Avagyan, Demographic and Heal Survey, Armenia 000 as cited in Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. NATIONAL STATISTICAL SERVICE, MINISTRY OF HEALTH, AND ORC MACRO, ARMENIA DEMOGRAPHIC AND HEALTH SURVEY 000, at 0 (Dec. 00), available at (last visited Nov., 00). Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), supra note. ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). 0 United Nations Development Program in Armenia, (last visited December, 00). International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). UNAIDS, Armenia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, available at (last visited July, 00). UNAIDS, Armenia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, available at (last visited July, 00). UNAIDS, Armenia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, available at (last visited July, 00). UNAIDS, Armenia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, available at (last visited July, 00). Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. 0 Women's Rights Center, The Gender Analysis of e Legislation of e Republic of Armenia on Reproductive and Sexual Heal Rights (00) at. International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). ASTRA, Reproductive Heal Services in Armenia: Country Report, available at (last visited July, 00). International Planned Parenood Federation (IPPF), Country Profiles: Armenia, available at (last visited July, 00). ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

4 As of 00, fewer an 00 adults and children are living wi HIV/AIDS in Bulgaria. Men account for % of HIV infections, and e dominant meod of transmission is rough sexual relations. UNAIDS reports at all men living wi HIV in Bulgaria are over years of age, and all women living wi HIV are over. 0 Use of modern meods of contraception remains low in Bulgaria. A 00 report indicated at only % of married women use any meod of contraception and at % use modern meods of contraception. Wi respect to specific modern meods of contraception,.% of Bulgarian women use condoms,.0% use oral contraceptives, and.% use an IUD. There are no age restrictions on access to contraception. And while all types of contraception officially require prescriptions, e reality is at contraception can usually be purchased wiout a prescription at most points of sale. As suggested by usage rates, modern contraception is not widely accessible, due to lack of affordability. The government does not provide or subsidize contraception, nor do insurance plans cover contraceptives. The Bulgarian Family Planning Association, an NGO, provides subsidized or free contraception, including oral contraceptives, IUDs, and condoms. Oer heal and you oriented NGOs also distribute condoms. In 00, e Council of Ministers adopted a national heal strategy, which includes reproductive heal in ree of its five key areas. Prior efforts include e introduction of e National Family Planning Programme in, a two year program which introduced family planning into medical curricula to train heal professionals, us bringing services to university hospitals. The rate of abortion in Bulgaria is high; as of 00 ere were approximately. abortions per 00 live birs in Bulgaria. Current law permits abortions upon request to e week of pregnancy, as long as e abortion does not endanger e woman's heal. Abortions are permitted between and weeks only if, as determined by a special medical commission, e moer has a proven, documented disease at might endanger her life or e fetus' life. Abortions after e 0 week of pregnancy are permitted only in cases of severe fetal impairment or if e woman's life is in danger. Current law also requires at women under e age of have e written consent of a parent and at abortions be performed by obstetrician/gynecologists in specialized obstetric/gynecological clinics or hospitals. The relatively high rates of abortions illuminate e need for increased access to contraception and to family planning services for Bulgarian women. But pre and post abortion counseling on prevention of unwanted pregnancy is not common practice and medical professionals lack e sills to provide contraceptive counseling. Additionally, women are unable to choose freely between abortion procedures, as medical abortion is still in e process of approval in Bulgaria. Medical abortion is a safe and early non-invasive alternative to surgical abortion. A woman can have a medical abortion as soon as her pregnancy is confirmed, and e treatment is generally % effective for terminating pregnancies up to days. The failure to make medical abortion available denies women e ability to have earlier, and erefore safer, abortions. This, in turn, reduces women's access to safe abortion services and increases abortion-related mortality and morbidity. In its latest concluding observation from CEDAW to Bulgaria e Committee expressed alarm at abortion appears to be used as a meod of family planning. Alough e delegation provides some additional information in its oral presentation, e Committee remains concerned about e measures taken to ensure at women have proper access to contraceptives. Though rates of HIV infection are low, ere is a moderate to high risk at Bulgaria's HIV epidemic will grow. Low usage rates of condoms at protect against sexually transmitted infections as well as lack of sexuality education and failure to provide confidential testing raises serious concerns about prevention and transmission. Furer, significant sexual risks in minority populations and current patterns of drug use-wi approximately 0,000 injecting drug users in Bulgaria-increase e likelihood at Bulgaria's epidemic will grow. A final concern is e lack of access to antiretroviral (ARV) medication: as of 00, ARV treatment was available only in Sofia, e capital, leaving 0% of individuals in need of e medication wiout access to treatment. Approximately % of women between - years of age give bir each year. In 00, ere were. abortions per 00 live birs for women under 0. Though, as a group, adolescents do not currently suffer from HIV/AIDS, drug use and sexual activity trends among yous suggest at e epidemic may soon spread to adolescents. Adolescents do not receive adequate sexuality education necessary to inform and protect emselves. Sexuality education is not required in schools. Though heal education classes may include sexuality education information, ese classes are not held regularly and are taught by untrained teachers who fail to prioritize topics related to sexuality. Recently, governmental ministries and NGOs have devised and are testing a comprehensive sexuality education package for students between and years of age. Population Reference Bureau, Women of Our World (00), available at Population Reference Bureau, Family Planning Worldwide 00 Data Sheet: Data and estimates of contraceptive use and related reproductive heal indicators for e countries and regions of e world (00), available at ASTRA NETWORK, Reproductive Heal Services in Bulgaria: Country Report, available at Id. Id. Id. Id. Id. World Heal Organization Regional Office for Europe, European heal for all database (HFA-DB) (00), available at United Nations Population Division Department of Economic and Social Affairs, Abortion Policies: A Global Review (00), available at Id. Id. ASTRA NETWORK, supra note. United Nations Population Division Department of Economic and Social Affairs, supra note. ASTRA NETWORK, supra note. Rachel K. Jones & Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, PERSP. ON SEXUAL AND REPROD. HEALTH (00). Mitchell D. Creinin, Medical Abortion Regimens: Historical Context and Overview, AM. J. OBSTETRICS AND GYNECOLOGY S, S (000) UNAIDS, Bulgaria: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at Id. 0 Id. Id. Id. Id. Susheela Singh and Jacqueline E. Darroch, Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries, FAMILY PLANNING PERSPECTIVES NO. (000), available at World Heal Organization Regional Office for Europe, supra note. Executive Board of e United Nations Development Programme and of e United Nations Population Fund, Second country cooperation framework for Bulgaria (00-00), available at ASTRA NETWORK, supra note. Id. Id. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

5 The government provides reproductive heal services rough state heal care facilities. Bo e maternal mortality ratio and e infant mortality rate are low: maternal deas per 0,000 live birs (in 000) and. infant deas per,000 live birs (in 00). However, contraceptive prevalence is still low and resorting to abortion remains a principal means of fertility regulation. Though citizens of Croatia are guaranteed e right to use contraception, a full range of contraceptive products are not available in pharmacies. In addition to requiring a doctor's prescription, e government fully covers e costs of just one kind of contraceptive pill. All oers are paid for in full by e individual. As a result, e prevalence of e contraception in general population is low, for example just % of women of fertile age use oral contraceptives and only % of women visit gynaecologists wi e purpose of consultation on family planning. Condoms, on e oer hand, are more widely available and affordable. Emergency contraception, ough legal and available, is not widely publicized and is too expensive for most people to afford. The Caolic Church, which influences attitudes relating to contraception, only endorses natural family planning. Despite increasing numbers of HIV infections, institutionalized education greatly neglects heal education, particularly sexual education. In fact, many adolescents report at e media is eir main source of information, alough ey are aware at media images of men and women embody largely stereotyped gender roles and relations. Bo boys and girls have stated e need for information and advice on sexuality. Noneeless, e number of counseling centers dealing wi family planning has been reduced. Such low levels of knowledge expose adolescents to risks of sexual behavior, such as 0 STIs, unwanted pregnancies, and sexual exploitation. The figures show e impact: e Share of young girls up to years of age who undergo abortion has increased from % in 000 to. in 00 and ere is a growing incidence of STIs, primarily infections caused by Chlamydia and HPV. The Ministry of Science, Education and Sports has a program called Teenstar, which is conducted by a caolic nongovernmental organisation, on its approved list of sexual education curricula. While is program is not funded by e state, it still remains on is Ministry list, despite e fact at e program includes gender stereotyped roles and information based on religious and moral values of e Caolic Church, not scientific evidence. The lack of accurate sexual education has resulted in an incomplete understanding of sexual behaviour, under-developed communication skills and fragmented knowledge of sexuality and SRHR issues. The last investigation among e college and secondary school students showed at young persons have inadequate knowledge concerning sexuality and reproduction. Strong prejudices against oral contraceptives still exist in general population, as well as among teenagers. More en 0% of young people wrongly believe at oral contraceptives have negative repercussions on e heal and appearance of young women. There is not sustained effort wiin e medical profession or in e school system to address e existing prejudices. For young people, is means greater exposure to risky sexual behaviour, unrealistic expectations and distorted view of one's own sexuality. The number of legal abortions performed in Croatia has been decreasing over e years. For example, notifications of,0 abortions in 000 indicated a.% decrease from. During 00, official statistics show at, abortions were performed, a.% drop from 00 - wi, (0.%) artificial abortions representing e largest percentage. The most common age group of women having abortions performed is women between and years old.in addition, many women who seek an abortion already have oer children. Thus, abortion continues to be used as a meod of bir control. Abortion rights are regulated by e Family Planning Law, which was passed on April,. Under is law, termination of pregnancy may be performed up to weeks of pregnancy, on request. After at period, e procedure is allowed only wi e approval of a special commission. Abortions are permitted in hospitals wi gynecology and obstetrics wards. Despite such legislation still existing, abortion rights in Croatia have been limited over e past ten years due mainly to influence and lobbying of e Caolic Church. Gynecologists in many hospitals have refused to perform abortions, justifying it by conscientious objection. Thus, it is impossible to obtain abortion even in some hospitals at are legally obliged to provide such services. Inaddition, due to e collapse of Croatia's heal care system, abortion was e first heal service removed from free of charge services. The price for abortion is very high, ranging from EUR to 0EUR depending on e hospital stance regarding reproductive rights. All of ese factors have led to increasing amounts of illegal abortions at are not registered; as a result, e low official abortion rates are misleading. Until e end of 00, e prevalence rate of state reported HIV/AIDS-related cases was fairly low: HIV infections; AIDS cases; and 0 AIDS-related deas. The majority of cases are attributed to male homosexual sex, wi % of e total cases being male. Less an % of HIV infections were spread rough intravenous drug use (IDU). And among heterosexual cases, over 0% of men were infected outside of Croatia, while e majority of heterosexual women had high-risk male partners. The highest number of registered HIV cases is in e capital city Zagreb, wi prevalence highest in e urban centers on e Adriatic coast. Risks of HIV outbreaks are estimated as moderate, partly due to many years of efforts at primary and secondary prevention. But e country is experiencing rapid social changes, economic crisis, and increased injecting drug use, all which are factors at facilitate e rapid spread of HIV. To address is concern, e Ministry of Heal and Social Welfare is implementing a. million USD program called Scaling Up National HIV/AIDS Response. The main objectives of e program include: increasing responsible sexual behavior among young people; decreasing HIV/AIDS infection among high risk groups; and improving e HIV/AIDS surveillance system. The Committee is concerned about e persistence of sex stereotyping in educational curricula and in textbooks. It is also concerned at girls and women in secondary schools and universities continue to choose study areas traditionally seen as female areas and at ey are underrepresented in e sciences. The Committee encourages e State party to intensify its efforts to eliminate gender stereotyping and to strengen e mainstreaming of gender perspectives in curricula and textbooks. It also requests e State party to enhance e training of teaching staff in regard to gender equality issues. It calls on e State party to furer encourage diversification of e educational choices of boys and girls and, at e tertiary level, to attract more women to e field of science and technology, including rough temporary special measures in accordance wi article, paragraph, of e Convention. It also urges e State party to encourage a public dialogue on e educational choices girls and women make and eir subsequent opportunities and chances in e labour market UNFPA, Global Reach: Indicators, Croatia Overview, available at Id. CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD (WOW), EAST CENTRAL EUROPE: Croatia (000). See presentation by Sanja Cesar of CESI Center for Education, Counselling and Research, titled Recent Threats to SRHR in Croatia, presented in Brussels, April, 00. On file wi ASTRA. CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD (WOW), EAST CENTRAL EUROPE: Croatia (000). ASTRA Network, Reproductive Heal Services in Croatia: Country Report (00), available at See presentation by Sanja Cesar of CESI Center for Education, Counselling and Research, titled Recent Threats to SRHR in Croatia, presented in Brussels, April, 00. On file wi ASTRA. ASTRA Network, Reproductive Heal Services in Croatia: Country Report (00), available at Id. Id. See presentation by Sanja Cesar of CESI Center for Education, Counselling and Research, titled Recent Threats to SRHR in Croatia, presented in Brussels, April, 00. On file wi ASTRA. ASTRA Network, Reproductive Heal Services in Croatia: Country Report (00), available at See presentation by Sanja Cesar of CESI Center for Education, Counselling and Research, titled Recent Threats to SRHR in Croatia, presented in Brussels, April, 00. On file wi ASTRA. UNAIDS, Croatia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at Id. Id. UNFPA, Global Reach: Indicators, Croatia Overview, supra note. ASTRA Network, Reproductive Heal Services in Croatia: Country Report (00), supra note. AMIR HODžIæ AND NATAšA BIJELIæ, THE SIGNIFICANCE OF GENDER IN THE ATTITUDES AND SEXUAL BEHAVIOUR OF CROATIAN ADOLESCENTS: REPORT OF THE FINDINGS OF THE URGENTLY CLAIMING THE FUTURE: FOCUS ON GENDER FOR SAFER SEXUAL RELATIONSHIPS RESEARCH PROJECT (CESI 00). 0 ASTRA Network, Reproductive Heal Services in Croatia: Country Report (00), supra note. See presentation by Sanja Cesar of CESI Center for Education, Counselling and Research, titled Recent Threats to SRHR in Croatia, presented in Brussels, April, 00. On file wi ASTRA. See presentation by Sanja Cesar of CESI Center for Education, Counselling and Research, titled Recent Threats to SRHR in Croatia, presented in Brussels, April, 00. On file wi ASTRA ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

6 Modern contraceptive use remains low in Georgia. As of 00, e contraceptive prevalence rate among married women between - years of age was % for any meod of contraception and 0% for modern meods of contraception. Wi a.% prevalence rate among is population, widrawal is e most common meod of contraception. Prevalence rates for modern meods of contraception are as follows:.% of married women use IUDs,.% use condoms,.% rely upon sterilization, and.0% use oral contraceptives. Civil and military conflict, political instability, and social and economic hardship have left quality heal care largely inaccessible for individuals living in rural areas and individuals unable to afford private doctors. Georgians' heal has subsequently deteriorated, and women have been particularly disadvantaged. A survey reported at only 0% of women have had a gynecological exam in e previous mons and at only % of sexually active women have ever had such an exam. Inadequate access to family planning services and high costs of contraceptives are considerable barriers to widespread use of modern meods of contraception. Additionally, maternal and infant mortality rates have increased considerably in Georgia, providing furer evidence of e limited access to heal care for women. There are abortions per live bir in Georgia. Georgian women marry early and us, achieve eir desired number of children early in eir lives, and, as a result, abortions are concentrated in women between - and 0- years of age. The law permits abortions upon request during e first weeks of pregnancy and for a range of medical and social reasons between e and weeks of pregnancy. These grounds include, for example, e divorce or e dea of e husband during e pregnancy, e imprisonment of e woman or her husband during e pregnancy, or pregnancy at results from rape. In addition, abortions between and weeks are permitted for oer reasons upon e approval of a commission of local physicians. Despite is, only per cent of abortions in e country are legal (Women reproductive heal survey, Georgia -000, Tbilisi, 00). As a result, post abortion complications are very high at % and pregnancy related morbidity and mortality are much higher an in most European countries (). More an ree quarters of all abortions falls at women aged 0 to. Due to e poor accessibility of contraceptive information and services, abortion remains e main meod of fertility control. The low level of awareness of reproductive heal issues, poor availability of family planning services and high cost of contraceptives, continue to be barriers to e increasing move from controlling fertility rough abortion to contraceptives. As of 00, approximately,000 adults and children were living wi HIV/AIDS in Georgia. In 00, fewer an 00 adults and children died of AIDS. Intravenous drug use is e primary meod of transmission and, as such, accounts for % of infections. Heterosexual transmission follows, accounting for % of infections. Despite e relatively low prevalence rates of HIV/AIDS, UNAIDS reports at Georgia has e fastest growing HIV infection rate in e Caucasus. Risky sexual practices and a considerable increase in e number of intravenous drug users indicate at HIV infection rates are likely to grow. Furer, low rates of modern contraceptive use - particularly of dual meods, such as e condom, at protect against sexually transmitted infections and pregnancy - and inadequate sexuality education raise concerns about HIV/AIDS prevention and transmission. Though a UNICEF program began providing information related to reproductive heal, family planning, and HIV/AIDS in 00, ere are no systematic sexuality education programs at schools or universities. Lack of you-sensitive services, including confidential counseling and care wiout parental consent, including parental consent for young women under e age of to undergo an abortion, contributes to e lack of awareness among you of how to prevent transmission of STIs, to e low rates of modern contraceptive use, high rates of illegal abortion, and growing prevalence of HIV/AIDS amongst adolescents in Georgia. The Committee notes wi concern e increasing incidence of sexually transmitted diseases and at existing heal services may not be tailored to e needs of adolescents, us reducing eir willingness to access primary heal services. The Committee recommends at e State party increase its efforts to promote adolescent heal policies and strengen e programme of heal education in schools. It furer recommends measures, including e allocation of adequate human and financial resources, to evaluate e effectiveness of training programmes in heal education, in particular as regards reproductive heal, and to develop child- and you-sensitive confidential counselling, care and recovery facilities at are accessible wiout parental consent when is is in e best interests of e child. The State party could consider seeking technical cooperation and advice from UNICEF and e World Heal Organization (WHO). UNFPA, State of e World Population (00), available at (last visited August, 00). Population Reference Bureau, DataFinder database, available at (last visited at August, 00). Population Reference Bureau, DataFinder database, available at (last visited at August, 00). ASTRA, Reproductive Heal Services in Georgia: Country Report, available at (last visited August, 00). ASTRA, Reproductive Heal Services in Georgia: Country Report, available at (last visited August, 00). ASTRA, Reproductive Heal Services in Georgia: Country Report, available at (last visited August, 00). ASTRA, Reproductive Heal Services in Georgia: Country Report, available at (last visited August, 00). ASTRA, Reproductive Heal Services in Georgia: Country Report, available at (last visited August, 00). United Nations Population Division Department of Economic and Social Affairs, Abortion Policies: A Global Review (00), available at (last visited August, 00). United Nations Population Division Department of Economic and Social Affairs, Abortion Policies: A Global Review (00), available at (last visited August, 00). United Nations Population Division Department of Economic and Social Affairs, Abortion Policies: A Global Review (00), available at (last visited August, 00). Report on Reproductive Heal in from Georgia Women's Center, 00, Dr. Ia Verulaishvili, Tbilisi, Georgia UNAIDS, Georgia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at (last visited August, 00). UNAIDS, Georgia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at (last visited August, 00). UNAIDS, Georgia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at (last visited August, 00). UNAIDS, Georgia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at (last visited August, 00). UNAIDS, Georgia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at (last visited August, 00). UNAIDS, Georgia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at (last visited August, 00). ASTRA, Reproductive Heal Services in Georgia: Country Report, available at (last visited August, 00). ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

7 The contraceptive prevalence for any meod (traditional, medical, barrier, natural) is estimated at %, and at % for modern meods. In, e maternal mortality ratio was to 0,000 and infant mortality was at per,000 live birs. In its response to a 00 United Nations inquiry, e Hungarian Government indicated at it views its maternal and infant mortality levels as unacceptably high. While e country does not have an explicit population policy, incentives and compensations are given to married couples to promote childbearing. Programs include, inter alia, protecting pregnant women and supporting em after giving bir rough family and support services. In addition,hungarian families receive some preferential treatment, while families wi ree or more children receive certain material benefits. Family planning services are integrated into national heal services and focus on prenatal and postnatal care and counselling, as well as on reducing e number of abortions. While a full range of modern contraceptives is widely available in pharmacies and clinics, e government does not subsidize contraceptives, erefore, many individuals do not have easy access to high-quality sexual and reproductive heal services at will prevent unwanted pregnancies and reduce reliance on abortion as a meod of family planning. HIV/AIDS is considered a major concern by e Government. The Minister of Welfare established e National AIDS Committee in to coordinate efforts against AIDS by, inter alia, working out general guidelines, preparing and evaluating actions, and funding different programs. It is estimated at,00 people are living wi HIV/AIDS in Hungary. By mid-00, Hungary reported a cumulative total of,0 cases of HIV infection, AIDS cases, and deas. In 00, rates of syphilis had increased to. per 0,000 persons. In,,0 of,0 new patients wi venereal diseases were diagnosed wi gonorrhea. The majority of reported HIV infections are among homosexual and bisexual men. In 00-00, % of heterosexual cases were imported cases from countries wi generalized HIV epidemics. Prostitution and trafficking in women are growing problems, and it is unlikely at women involved in prostitution who are infected wi HIV/AIDS are accounted for in e statistics. Furermore, public awareness of HIV transmission is low, while many people avoid being screened out of fear at testing is not anonymous. In order to address many of ese problems, Hungary needs to create a coherent policy for prevention and treatment. While noting at abortion rates have fallen in e reporting period, e Committee remains concerned about e high rate of abortion among women, including young women wiout children, and e possible connection to difficulties in accessing family planning meods and e prohibitive cost of contraceptives, particularly for women wi low incomes. Abortion The Committee draws attention to its general recommendation on women and heal and recommends at comprehensive research be undertaken into e specific heal needs of women, including reproductive heal, HIV/AIDS, e financial and organizational strengening of family planning programmes addressed to women and men and e provision of wide access to contraceptives for all women. The Committee urges e State party to reinforce programmes on sexual education for bo girls and boys. The Committee calls on e State party to take all appropriate measures to foster responsible sexual behaviour and take all appropriate steps to stop e use of abortion as a means of bir control.... Abortion rates had been relatively stable, but began decreasing around. Until, an average of,000 abortions per year was officially recorded, and e number recorded in was down to,00 abortions. Before, abortion was regulated administratively and permitted for a range of medical and social reasons. But in, Parliament enacted and implemented Act LXXIX of on e Protection of Fetal Life (e Abortion Law). The Abortion Law provides at an abortion may be performed until e week of pregnancy if e woman's heal is severely reatened; e fetus is likely to suffer severe malformation or a severe deficiency; e pregnancy resulted from a crime; or e woman is in a severe crisis. Officially, ere are no religious restrictions on abortion. The Constitutional Court has stated at as long as doctors could conscientiously object to carrying out e procedure, regulations permitting abortion is not in contradiction wi religious convictions. Hungary's overall goal is to reduce e total number of abortions as much as possible. Policies regarding abortions are reflected in bo e legal regulations and in e commentaries and rulings of e Constitutional Court. The Court expressed e view at prohibition and criminalization of abortion would not be as effective as providing correct information and education on meods of contraception. Noneeless, e procedure for obtaining an abortion has become increasingly formal over time. In 000, e Abortion Act was amended, imposing onerous and biased counseling requirements and restricting funding for abortion to procedures performed based on medical indications and in cases of rape. 0 In, ere were birs per,000 women aged -. Various surveys have concluded differing numbers of teenage pregnancies each year, ranging from less an % of women under age to %. The statistics vary so greatly since adolescent women often hide eir pregnancies and seek abortions eier in a very early stage or in an unofficial way. In, according to official statistics, girls under age amounted to about.% of women who obtained abortions at year, whereas e number of live birs to girls under age accounted for about.% of all live birs. Hungary does not have a general overall policy, or a unified practice, regarding sex education for adolescents. The National Public Education Program sets for e minimal requirements for heal education in school, which includes family planning education. In addition, welfare officers and district nurses on school duty are required under a ministerial decree to participate in heal education classes covering family planning and contraceptive meods. CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD (WOW), EAST CENTRAL EUROPE: Hungary (000). Id. UNFPA, Global Reach: Indicators, Hungary Overview, available at WOW: Hungary, supra note, at. UNFPA, Global Reach: Hungary Overview, supra note. WOW: Hungary, supra note, at 0. Id. INT'L HELSINKI FEDERATION FOR HUMAN RIGHTS (IHF), WOMEN 000: AN INVESTIGATION INTO THE STATUS OF WOMEN'S RIGHTS IN CENTRAL AND SOUTH-EASTERN EUROPE AND THE NEWLY INDEPENDENT STATES, Hungary:. Reproductive Rights and Access to e Healcare System (000). WOW: Hungary, supra note, at. Id. Hungary, Act LXXXVII of 000 on e Amendment of Act LXXIX on e Protection of Fetal Life (000), CENTER FOR REPRODUCTIVE RIGHTS, GOVERNMENTS IN ACTION, February 00. UNAIDS, Hungary: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at WOW: Hungary, supra note, at. UNAIDS, Hungary: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), supra note. WOW: Hungary, supra note, at. UNAIDS Epidemic Update December 00, p. (last visited December, 00) Id. WOW: Hungary, supra note, at -. Id. at. 0 Id. at. Id. at. Id. Id. Id. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

8 As of, heal care in Latvia was in a poor state. It was estimated at only % of women used hormonal contraceptives or IUDs, while anoer % used condoms. Instead, e majority of women did not use modern contraception, and relied only on widrawal or e calendar meod. Compared to a study in, many improvements had been made in relation to self-assessment of heal in 00. However, contraception is still often left aside or being used incorrectly. There is no unified family and bir promotion policy in Latvia. However, in 00, e Secretariat of e Minister for Special Assignments for Children and Family Affairs proposed planning additional measures for bir promotion. The use of hormonal contraceptives has been inhibited by two causes. First, hormonal meods are too expensive for many. Second, doctors have promoted baseless fears at such meods are harmful to women's heal. But in February, Latvia's Association for Family Planning and Sexual Heal was founded to educate e public; e Association published e country's first comprehensive pamphlet on contraception in May. In addition, e Law on Sexual and Reproductive Heal was adopted by e parliament on January, 00, and entered into force on July, 00. The law determines e grounds for e termination of pregnancy, as well as e legal basis for delivery assistance, treatment procedures in cases of STIs, as well as procedures for bir regulation. Emergency contraception has been available over-e-counter since 00. Furermore, hormonal contraception is available wi a prescription only under e Law, ereby eliminating uncontrolled use. Though continuously declining, abortion rates are still very high at 0. per,000 women of reproductive age in 00 and per,000 in 00. Abortions are legal upon request up to weeks of pregnancy, and up to weeks of pregnancy for special medical or social conditions. Abortions must be performed in government medical centers or private medical centers at have contracted for heal insurance. Before recent adoption of e Law on Sexual and Reproductive Heal, abortion had never been defined in any laws. In 00, e Ministry of Heal began working on disseminating information on abortion. According to e Family Planning and Sexual Heal Association, e Ministry developed a frightening information kit at raer an providing information on access and availability of services, is kit simply stresses e risks of abortion and lists possible complications. In addition, churches in Latvia are active in pro-life campaigns. As a result, % percent of men and % of women misleadingly ink abortion is harmful for women's heal. However, views on harmfulness do not necessarily impact e decisions made regarding abortion; % of women and % of men ought abortion was a normal bir control meod. While noting a steady decrease in e number of abortions, e Committee is concerned at e abortion rate remains high. The Committee recommends at furer measures be taken to guarantee effective access of women to heal-care information and services, particularly regarding sexual and reproductive heal, in order to prevent recourse to abortion and protect women from its negative heal effects. It furer recommends at programmes and policies be adopted to increase e knowledge of and access to contraceptive meods wi e understanding at family planning is e responsibility of bo partners. The Committee is concerned at e spread of HIV/AIDS, e increase in e infection rates of women and e absence of a strategic national plan to address e issue of HIV/AIDS and how it affects women. The Committee urges e State party to take comprehensive measures to combat e spread of HIV/AIDS, to take strong preventive measures and to ensure at women and girls infected wi HIV/AIDS are not discriminated against and are given appropriate assistance. The Committee also recommends at sex education, particularly targeting adolescents, be made widely available, wi special attention to e prevention and furer control of HIV/AIDS. According to UNAIDS latest report, Latvia has seen a steady rise in e total number of HIV cases, which by mid-00 was more an six times higher an it had been in (, compared wi ). However, ere are signs at e epidemic's pace is slowing in Latvia, wi new reported HIV infections decreasing consistently since 00. It is important to note at women are increasingly affected (comprising % of new infections in 00) and e epidemic is concentrated largely among people younger an 0 years. Strikingly, some % of HIV diagnoses in Latvia have been in teenagers (- years). Until e end of, HIV in Latvia was transmitted solely rough sexual contacts, usually male homosexuals, and until is time, e incidence of infection was very low, wi a total of HIV infected individuals. But in November and December of, e first five HIV infected intravenous drug users were registered. Since en, e main mode of HIV transmission has become IDU, responsible for % of e HIV infections reported in 00. Because many IDUs are arrested, 0% of newly diagnosed HIV-positive individuals were diagnosed in prisons in 00. Due to e establishment of harm reduction programs, rates of HIV infection among IDU have decreased, while e spread of infection via (hetero)sexual contact remains high. HIV testing and counseling is available rough all doctors in e country and is free of charge and women are recommended to undergo HIV testing during pregnancy. However, lack of a strategic national plan to address e issue of HIV/AIDS, including e increasing infection rates of women and young people hinders progress in is area. Consistent wi e overall abortion rates of e country, e abortion rate for pregnant adolescents is quite high. In, e 0 pregnancy rate was. per,000 women aged -. However, e birrate was only. per,000, while e abortion rate was.0 per,000. In most countries, younger adolescents are much more likely to choose an abortion an are older teenage girls. However, in Latvia, e abortion ratio for older adolescents is still above 0 abortions per 0 pregnancies. The first you heal centers in Latvia were established in, following an order from e Minister of Heal at granted bo municipal and national funding for is purpose. However, state funding was discontinued, and only a few of e centers still operate. In 00, e Ministry of Education and Science stated heal education is required for students in e and grades, and a subject of choice for high school students. However, sexual education in Latvian schools is not adequate; only one or two lessons a year in heal education are devoted to reproductive heal issues. Therefore, NGOs have stepped in to assist. For example, Latvia's Association for Family Planning and Sexual Heal's Sex Education Working Group has focused on implementing sexual education into general school curriculum. Noneeless, young people in Latvia lack sufficient knowledge and ey have misconceived understandings on various sexual and reproductive heal issues. D. Vjatere, Family Planning in Latvia: A Blossoming Flower, () PLAN PARENT EUR. - (). Aivita Putnina, LAFPSH Papardes zieds, Reproductive Heal of e Population: Study on e situation in Latvia (-00), at - (00). Id. at. D. Vjatere, supra note. Id. IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), available at Aivita Putnina, LAFPSH Papardes zieds, supra note, at. Id. Id. IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), available at IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), supra note. Aivita Putnina, LAFPSH Papardes zieds, supra note, at. ASTRA NETWORK, REPORT ON THE ASTRA STRATEGY PLANNING SESSION AND THE ADVOCACY WORKSHOP, 0- September 00, Sofia, Bulgaria, available at Aivita Putnina, LAFPSH Papardes zieds, supra note, at. UNAIDS Epidemic Update December 00, p. (last visited December, 00). UNAIDS, Latvia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at Id. Aivita Putnina, LAFPSH Papardes zieds, supra note, at. UNAIDS, Latvia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, supra note. 0 Susheela Singh and Jacqueline E. Darroch, Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries, FAMILY PLANNING PERSPECTIVES NO. (000), available at Id. Aivita Putnina, LAFPSH Papardes zieds, supra note, at -. Id. at. D. Vjatere, supra note. Aivita Putnina, LAFPSH Papardes zieds, supra note, at. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

9 In its most recent concluding observation to Liuania, e Human Rights Committee expressed its...concern at e high rate of unwanted pregnancies and abortions among young women between e ages of and, and e high number of ese women contracting HIV/AIDS, wi consequent risks to eir life and heal, which implicates Article of e ICCPR. Rates of modern contraceptive use are low in Liuania. Alough half of Liuanian women between e ages of - have experienced at least one unintended pregnancy, e rate of modern contraceptive use is only % and e rate for all meods is %. The low usage rates are due, in part, to limited contraceptive availability caused by e government's failure to provide affordable contraception. Oral contraceptives can cost up to $0 a year, which is more an ree times e cost of a medical abortion. Specialized reproductive heal services are provided only in e State Family Planning Center, where patients receive care on a fee-for-service basis in accordance wi prices set by e Ministry of Heal. The Liuanian government has failed to prioritize family planning and recently chose not to ensure access to family planning services for its citizens. There is no legislation regulating family planning services, and, in July 00, e government failed to approve e Draft Reproductive Heal Law, stating at international agreements do not absolutely establish reproductive rights. The Draft Law would have provided free or subsidized contraception for low-income persons, and it would have legalized sterilization and all meods of abortion. The government's continual refusal to recognize reproductive rights and to ensure access to contraception compromises women's ability to participate equally in society. It also jeopardizes women's heal by increasing rates of unwanted pregnancies, abortion, and maternal mortality. Abortion is very common in Liuania. Alough abortion is generally not considered a meod of contraception, e high rates of abortion indicate at it is one of e principal meods of family planning for women. Three times as many abortions take place in Liuania as compared to oer Norern European countries. Out of every,000 women in Liuania,. have undergone an abortion, and one ird of adolescent pregnancies end in abortion. The high rates of abortion are ascribed, in part, to e low cost of abortion in comparison to oer contraceptive meods. Whereas oral contraceptives may cost up to $0 each year, non-surgical abortions cost approximately $.0 and in-patient, clinic abortions $.0. Abortions necessary for medical reasons are performed for free. The right to legal abortion is currently under attack in Liuania. In April 00, a draft law was registered at bans abortion in all cases except when e woman's or fetus' life is in danger and when e pregnancy is e result of a crime. While is draft law was recently defeated, it is only one example of continuing attempts to curb women's right to access safe and legal abortion. An additional concern regarding safe abortion is e inability of women to choose freely between abortion procedures. Though abortion is currently legal rough e first trimester, only surgical abortion is permitted. Women do not have access to medical abortion, which e Liuanian National Committee on Biomedical Eics refused to approve and which e Ministry of Heal agreed to. Medical abortion is a safe and early non-invasive alternative to surgical abortion: it can be given as soon as a pregnancy is confirmed and is generally % effective for terminating pregnancies up to days. The lack of access to medical abortion denies women e ability to have earlier, and erefore safer, abortions. This, in turn, reduces women's access to safe abortion services and increases abortion-related mortality and morbidity. As of 00, approximately,00 adults and children - of which fewer an 00 are women aged - - are living wi HIV in 0 Liuania. The majority of people living wi HIV are under 0 years of age. The first HIV case was reported in, and rates of HIV infection have increased steadily since en, wi a five-fold surge of infections in 00, e majority attributable to injecting drug use. Rates of HIV/AIDS infection are relatively low. However, low rates of modern contraceptive use and inadequate sexuality education raise concerns about transmission and prevention. Increased access to modern contraceptives and to comprehensive sexuality education is needed to enable citizens to inform and to protect emselves. The Human Rights Committee recommends at Liuania take furer measures to help young women avoid unwanted pregnancies and HIV/AIDS, including strengening its family planning and sex education programmes. Adolescents face numerous reproductive heal problems. Rates of unwanted pregnancies and abortions in adolescents are high. In 00, an average of out of,000 women aged - gave bir, which is two to ree times more women an in oer Western European Countries. In,.% of abortions were performed for women under years of age. Furer, rates of HIV in you, particularly in young women, are increasing:.% of women infected wi HIV are between - years of age. Inadequate sexuality education leaves adolescents ill equipped to confront such reats to eir reproductive heal and lives. Sexuality education is not provided systematically at schools. The education at is offered is incorporated into different disciplines and does not provide adequate information on contraception, protection from sexually transmitted infections, and equal gender relations. Furer, untrained teachers teach sexuality education, and e manuals used exhibit stereotypical gender roles and attitudes towards sexuality. The Ministry of Education and Science has recently refused to support a Baltic states project on training of teachers on HIV/AIDS prevention, and Government support of a voluntary sex education plan whose aim was to provide you in schools wi unbiased, balanced information, was widrawn in 00 due to a campaign at distorted e facts about is project and manipulated e public and politicians on e dangers of sexuality education. This situation has left most you wi little knowledge and tools to protect emselves from unwanted pregnancy and sexually transmitted infections. This is a serious setback for Liuanian yous and eir parents who need support in ensuring at young women do not face unwanted pregnancies and at you can protect emselves from HIV/AIDS. An NGO, e Family Planning and Sexual Heal Association, has founded Adolescent Heal Promotion Centers in several towns to inform adolescents about sexual and reproductive heal issues. The government, however, no longer provides funding for ese centers. To enable adolescents to inform and protect emselves from pregnancy and sexually transmitted infections, e government must promote and support sexuality education. Family Planning and Sexual Heal Association, Unintended Pregnancy and Emergency Contraception Information for Women, available at United Nations Population Fund (UNFPA), THE STATE OF THE WORLD POPULATION 00, at, (00). Developing Effective Laws and Policies in Liuania, MAKING THE CONNECTION: NEWS AND VIEWS ON SEXUALITY: EDUCATION, HEALTH AND RIGHTS (SIECUS), Winter 00/00, available at INT'L HELSINKI FEDERATION FOR HUMAN RIGHTS, WOMEN 000 AN INVESTIGATION INTO THE STATUS OF WOMEN'S RIGHTS IN CENTRAL AND SOUTHEASTERN-EUROPE AND THE NEWLY INDEPENDENT STATES, Nov. 000, at, available at CENTER FOR REPRODUCTIVE RIGHTS, WOMEN'S REPRODUCTIVE RIGHTS IN LITHUANIA: A SHADOW REPORT TO THE CEDAW COMMITTEE (000). Decision of Government of July 00, Nr.IXP-. See CENTER FOR REPRODUCTIVE RIGHTS & UNIVERSITY OF TORONTO INT'L PROGRAMME ON REPRODUCTIVE AND SEXUAL HEALTH LAW, BRINGING RIGHTS TO BEAR: AN ANALYSIS OF THE WORK OF UN TREATY MONITORING BODIES ON REPRODUCTIVE AND SEXUAL RIGHTS n.00 (00). See id. Statement by H.E. Dr. Gediminas Serksnys to United Nations General Assembly Session, Committee on Population and Development Session, Reproductive Rights and Reproductive Heal, Wi Special Attention to Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), April 00, Developing Effective Laws and Policies in Liuania, supra note. You-Peer, Liuania Country Overview, available at Developing Effective Laws and Policies in Liuania, supra note. INT'L HELSINKI FEDERATION FOR HUMAN RIGHTS, supra note. Id. ASTRA, CEE Bulletin on Sexual and Reproductive Rights, No () 00, available at (last visited July, 00). Letter dated February 00 No. (..-) 0 to e Liuanian Family Planning Association and e Opinion of e States Medicines Control Agency (SMCA) regarding e safety and efficacy of medical on file wi e Family Planning and Sexual Heal Association of Liuania. Rachel K. Jones & Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, PERSP. ON SEXUAL AND REPROD. HEALTH (00). Mitchell D. Creinin, Medical Abortion Regimens: Historical Context and Overview, AM. J. OBSTETRICS AND GYNECOLOGY S, S (000) UNAIDS, 00 Report on e global AIDS epidemic (00), available at (last visited July, 00). 0 UNAIDS, Liuania: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, available at (last visited July, 00). UNAIDS Epidemic Update December 00, p. (last visited December, 00) UNFPA, STATE OF WORLD POPULATION 00, at (00). For example, in France, e average number of birs per,000 women aged was in 00. Id. CENTER FOR REPRODUCTIVE RIGHTS, A SHADOW REPORT, supra note, at n.. See Liuanian AIDS Centre, Preliminari Situacija Apie Situacija Lietuvoje (on file wi e Center for Reproductive Rights). Jeffrey V. Lazarus, Sex, Lies and Liuania: A Misinformation Campaign by Anti-choice Advocates Threatens Common Sense Heal Reforms, CONSCIENCE MAGAZINE, Spring 00, at -. CENTER FOR REPRODUCTIVE RIGHTS, A SHADOW REPORT, supra note, at -0. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

10 Poland's public heal care system lacks family planning programs and services, and citizens have limited access to modern contraception. Accordingly, data indicate at rates of modern contraceptive use are low. In 00, e majority of Poles (.%) surveyed eier did not use any contraception or used a meod considered ineffective:.% did not using any meod, % used widrawal,.% used a calendar-based meod. In terms of modern contraceptive use, 0.% used condoms,.% used bir-control pills. Voluntary sterilization continues to be illegal. Sixty-nine percent of Polish citizens inks at modern contraceptives should be partially subsidized, and one ird of ose polled (%) ink at ey should be fully subsidized. Numerous political, social, and economic barriers prevent women from accessing modern meods of contraception. Though e Family Planning, Protection of e Human Fetus and Conditions for Termination of Pregnancy Act of (e Anti-Abortion Act) requires full access to contraception for citizens, government policies have prevented, raer an secured, such access. Between and 00, for example, e public heal care system promoted natural family planning and ignored modern contraceptive meods. Furer, primary heal care services do not include contraceptive counseling, and many women are left wi e only option of prohibitively expensive private gynecological visits. In some cases, doctors may require monly visits to prescribe contraception, may impose religious biases on women, or may be ignorant of modern meods of contraception, all of which reduce access to such meods. Many women who wish to obtain prescriptions for oral contraceptives are unable to afford em, as e average oral contraceptive costs approximately Euros per mon. The government partially subsidizes only hormonal contraceptives, having widrawn subsidies for oers in, and oral contraceptives are erefore very expensive. These factors prevent women from accessing contraception and controlling eir reproductive lives. In, e Anti-Abortion Act severely restricted e right to legal abortion. The law permits abortion only if a woman's life or heal is in danger, if e fetus is irreparably damaged or has an incurable, life reatening illness, or if e pregnancy results from a criminal act, such as rape or incest. Raer an eliminating e practice of abortion, e Anti-Abortion Act has pushed e practice underground. It is estimated at between 0,000 and 00,000 illegal abortions are performed each year, some in very unsafe conditions which lead to needless deas. Illegal abortions are expensive, costing an average of 000 PLN (0 Euros). This prevents economically constrained women from accessing abortion services. Additionally, since e Anti-Abortion Act was passed, e number of legal abortions has dropped considerably, from in to in 00. The statistics indicate at, in addition to creating an abortion underground, e Anti-Abortion Act has substantially restricted e availability of legal abortion. In Poland, a woman is legally entitled to undergo an abortion if her life or heal is in danger or if e pregnancy is a result of rape or if fetus has impairment. Women entitled to abortion by law are frequently unable to exercise eir right. Many hospitals no longer provide abortions. Furer, doctors interpret exceptions to e abortion ban narrowly, refusing, for example, to acknowledge reats to a woman's heal if she is likely to live rough delivery. Doctors refuse to certify cases to allow abortions to proceed and fail to provide referrals to doctors willing to perform e procedure. The effects of such restrictive abortion practices are felt roughout e heal care system and society. Women's access to oer reproductive heal services is restricted: in public healcare facilities, pregnant women often cannot receive prenatal tests because heal care professionals fear ey will lead to abortion. Women in difficult socio-economic situations, even adolescents, forced to give bir have no social support system and are frequently unable to care for eir children and 0 emselves. Women undergoing underground abortions face injury and even dea. The Committee reiterates its deep concern about restrictive abortion laws in Poland, which may incite women to seek unsafe, illegal abortions, wi attendant risks to eir life and heal. It is also concerned at e unavailability of abortion in practice even when e law permits it, for example in cases of pregnancy resulting from rape, and by e lack of information on e use of e conscientious objection clause by medical practitioners who refuse to carry out legal abortions. The Committee furer regrets e lack of information on e extent of illegal abortions and eir consequences for e women concerned (art. ). The State party should liberalize its legislation and practice on abortion. It should provide furer information on e use of e conscientious objection clause by doctors, and, so far as possible, on e number of illegal abortions at take place in Poland. These recommendations should be taken into account when e draft Law on Parental Awareness is discussed in Parliament. The Committee also reiterates its concern about family planning regulations adopted by e State party. The high cost of contraception, e reduction in e number of refundable oral contraceptives, e lack of free family planning services and e nature of sexual education are also of concern to e Committee (art. ). The State party should assure e availability of contraceptives and free access to family planning services and meods. The Ministry of Education should ensure at schools include accurate and objective sexual education in eir curricula. Poland's AIDS epidemic began in e mid-'s and is driven largely by injecting drug use, but increasingly by sexual activity. New HIV cases peaked at 0 in, decreased for ree years, and have increased slowly since en. According to e latest UNAIDS report, new infections in Poland have been increasing gradually each year since 00, reaching in 00 (EuroHIV, 00). For a long time e dominant factor in Poland's epidemic, injecting drug use now accounts for under one ird of new infections and has been overtaken by unprotected sex - heterosexual and between men - as e main route of HIV transmission. Women now comprise more an 0% of people living wi HIV in Poland. Currently, e HIV prevalence rate is 0.% for persons between and years of age, and approximately,000 people aged - are living wi HIV. These are official statistics but NGOs place e numbers as much as ree times higher. While rates of HIV/AIDS infection are relatively low, rates of modern contraceptive use - specifically of dual meods like e male condom at prevent bo pregnancy and e transmission of sexually transmitted infections - and inadequate sexuality education raise concerns about transmission and prevention. As in oer countries, women are more vulnerable because of eir status in society and because of e taboos around sexuality. Increased access to modern contraceptives and to comprehensive, unbiased sexuality education is needed to enable citizens to inform and to protect emselves. Adolescents face unique obstacles to reproductive autonomy. Approximately % of women giving bir are adolescent moers. It is estimated at, adolescent girls between and years of age gave bir in 00. Despite such high rates of teenage pregnancy, e government has failed to treat adolescent sexual and reproductive heal as a serious issue. In particular, adolescents face inadequate and limited access to information, counselling and services. Parental consent requirements for access to heal services, including contraception and inaccurate and biased sexuality education have created formidable barriers to e improvement of adolescent heal. Wi respect to contraception, cultural and religious norms often result in denied access to contraceptives for adolescents. Doctors are not obliged to provide contraception, and ey often refuse to write 0 prescriptions or to provide contraceptives to adolescent girls. Furer, e high cost of oral contraceptives is likely to be more prohibitive for younger members of e population, who may be wiout financial resources of eir own. Moreover, inadequate and biased sexuality education seriously inhibits adolescents from leading informed, healy reproductive lives. There is no compulsory national sexuality education program in schools. Though % of Poles surveyed in wanted sexuality education in schools to discuss unwanted pregnancy and sexually transmitted infections, e required preparation for family life programs focus on preparation for marriage and family raer an on sexual and reproductive heal. Heavily influenced by e Caolic Church, ese programs reflect traditional gender stereotypes, promote natural family planning, and discourage and provide misinformation about modern contraception. Schools at want to introduce sexuality education programs are faced wi unqualified teachers, parental disagreement, and inadequate financial resources. Accurate and comprehensive sexuality education is necessary to decrease teenage pregnancy rates, to help adolescents avoid sexually transmitted infections, and to enable adolescents to live healy sexual and reproductive lives. Zbigniew Izdebski, Pro heal and sexual behaviors in an aspect of HIV/AIDS in Poland (), as cited in Federation for Women and Family Planning, The Anti-Abortion Law In Poland: The Functioning, Social Effects, Attitudes and Behaviors (000), available at Federation for Women and Family Planning, Sexual and Reproductive Heal and Rights: Independent Report Submitted to e United Nations Human Rights Committee (00), available at CBOS (Public Opinion Research Center), poll: "Current problems and events. The Funding of Contraceptives, May 00. in: Women's Reproductive Heal, Poland, 00, Izabela Mielczarek. Office of e Plenipotentiary for Gender Equality, Warsaw 00. Id. Id. Id. Id. Id. Federation for Women and Family Planning, supra note. Federation for Women and Family Planning, supra note. Federation for Women and Family Planning, supra note. Federation for Women and Family Planning, supra note. Id. Id. Report of e Council of Ministers for e Realization of e Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy Act (), as cited in Federation for Women and Family Planning, supra note. ASTRA Network, Reproductive Heal Services in Poland: Country Report (00), available at Federation for Women and Family Planning, supra note. Id. Id. 0 Id. Id. UNAIDS, Poland: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at Id. UNAIDS Epidemic Update December 00, p. (last visited December, 00) UNAIDS, 00 Report on e global AIDS epidemic (00), available at Central Statistics Office, as cited in ASTRA, supra note 0. Federation for Women and Family Planning, supra note. Id. Id. 0 Id. Id. Zbigniew Izdebski, Selected Aspects of Evaluation of e National HIV/AIDS Prevention Program, UNDP (00), as cited in Federation for Women and Family Planning, supra note. Federation for Women and Family Planning, supra note. Id. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

11 While e prevalence rate for modern contraception has tripled since, it is still low in Romania. The contraceptive prevalence rate for any meod is estimated at.%, but only.% for modern meods. Almost 0% of women living in union have an unmet need for modern contraceptives. Most modern contraception is imported from oer countries. There are no accurate sources of information about emergency contraception, which is not readily available in e country. The main problem is e lack of bo modern contraceptives and sexual and reproductive heal services available outside e main cities. Almost all obstetrics and gynaecology departments, private abortion clinics, and family planning clinics are located in urban areas. In e early 's, heal policymakers began to lift restrictions on women's access to contraception and abortion and to develop e first national family planning program. In, e Ministry of Heal established e Family Planning and Sex Education Unit; and ere are currently about 0 family planning and reproductive heal clinics run by e state. Then, in, family planning was integrated into e basic package of services provided to e population under e primary heal care reform initiated by e Ministry of Heal in. In March 00, e Ministry of Heal and Family drafted a document of a strategic planning process aimed at improving e heal status of e Romanian population in e field of sexual and reproductive heal. This strategy was e first reproductive heal policy of its kind in Romania. Alough e abortion rate has lowered due to e increase in contraceptive prevalence, it remains high compared to oer countries in e region. Estimates are as high as ree abortions per one live bir. Abortion has been legal and available on request in Romania since. Once legalized, Romania had e highest number of abortions in e region, leaping from,00 in to,00 in. However, e number of abortions performed has been steadily decreasing since en. Most abortions are performed on women between e ages of 0 and. As a result of e liberalization of e abortion law, e registered number of maternal deas caused by abortion declined from in (out of a total of maternal deas at year) to in, leading to a drop of percent in e maternal mortality rate. But because of such a big caseload under limited time and lack of availability in rural areas, e quality of abortion care is sometimes low. Very few hospitals provide post abortion counseling and contraceptive services. To date, two Post Abortion Care projects are underway rough two Romanian NGOs, namely e Society for Education in Contraception and Sexuality (SECS) and e East European Institute for Reproductive Heal (EEIRH). By e end of 00, e HIV/AIDS incidence rate in Romania was. per 0,000 persons. The overall number of HIV/AIDS cases was,, wi, people living wi HIV/AIDS. Currently, e main means of HIV transmission is rough heterosexual sex, but intravenous drug use is an emerging risk factor among you. The steady increase in e HIV/AIDS incidence rate among adults relates mainly to ese two meods of transmission of e virus. Similarly, is correlates wi e growing incidence of STIs, particularly syphilis. Romania has e highest number of HIV infections in e sub-region of Sou-Eastern Europe. Many of e new HIV/AIDS infections are seen in patients who were born between and and were infected rough unscreened blood and blood 0 products and e repeated use of contaminated needles. However, new infections are attributable to unsafe sex, most of it heterosexual. Children and adolescents in Romania have suffered greatly due to political and economic transition. There are approximately,000 orphans in state institutions, according to official statistics, a number at has increased by 0% since. In, ere were birs per,000 women aged -. Data show rates of abortions per,000 women aged 0 to, and abortions per,000 women aged to. These figures (compared to e absolute number of women in each age category) are less an ose for e age groups to and 0 to. However, considering e percentage of women who are sexually active in each age group, e frequency of abortions reported per,000 women is comparable between women aged to and women aged to, where e frequency of abortions is e highest. Despite ese high numbers, ere are only a few you-friendly family planning services for adolescents: eight pilot projects implemented by e You for You Foundation (YFY) and e Society for Education in Contraception and Sexuality (SECS) and one YFY you-friendly center. Young people have fears about eir privacy being violated given e public location of most clinics and lack of availability of you- friendly services, us ey avoid such services and rely mostly on eir peers and media for information on sex and STIs. Most alarmingly, Romania has 0% of Europe's total population of HIV/AIDS infected children. In, e UNFPA and e Ministry of Heal approved e national NGO You for You Foundation's Reproductive Heal and Sexuality Education for Adolescents. An agreement is in place signed by e Ministry of Heal and e Ministry of Education in 0 00 to introduce heal education, including family life skills into grades I-XII starting in 00. However, is program is not provided roughout e country and you still lack access to information on preventing unwanted pregnancies and STIs. The Committee is concerned at: The high number of young moers and of abortions among teenage girls; The high rate of sexually transmitted diseases; The Committee recommends at e State party: Provide for adolescents' access to medical counselling and advice wiout parental consent, taking into consideration e evolving capacities of e child; Establish comprehensive family planning programmes, as well as undertake measures to ensure at abortion is neier perceived nor practiced as a meod of contraception, such as rough campaigns to raise awareness of e importance of contraceptive use to reduce e number of unwanted pregnancies; The draft Law on Reproductive Heal and Assisted Human Reproduction began as anti-abortion legislation but due to advocacy efforts by many stakeholders, it has become, in part, sensitive to adolescent needs; it mandates adolescents' free access to reproductive heal services, including abortion, wiout parental consent. By e end of 00 it has still not yet been promulgated by e president. REPRODUCTIVE HEALTH SURVEY, ROMANIA 00, Summary report, May 00 p., Romanian Ministry of Heal, World Bank, UNFPA, USAID, UNICEF; See also UNFPA, Global Reach: Indicators, Romania Overview, available at REPRODUCTIVE HEALTH SURVEY, ROMANIA 00, Summary report, May 00 pp. and, Romanian Ministry of Heal, World Bank, UNFPA, USAID, UNICEF. Id. IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), available at WHO, Abortion and contraception in Romania A strategic assessment of policy, programme and research issues ASTRA Network, Reproductive Heal Services in Romania: Country Report (00), available at WOW: Romania, supra note, at. ASTRA Network, Reproductive Heal Services in Romania: Country Report (00), supra note. UNFPA, Global Reach: Indicators, Romania Overview, supra note ;See also REPRODUCTIVE HEALTH SURVEY, ROMANIA 00, Summary report, May 00 pp. 0-, Romanian Ministry of Heal, World Bank, UNFPA, USAID, UNICEF ASTRA Network, Reproductive Heal Services in Romania: Country Report (00), supra note. WOW: Romania, supra note, at. ASTRA Network, Reproductive Heal Services in Romania: Country Report (00), supra note. International Child Development Centre, UNICEF, Women in Transition p. tbl.. ().. WOW: Romania, supra note, at. ASTRA Network, Reproductive Heal Services in Romania: Country Report (00), supra note. WHO, Abortion and contraception in Romania A strategic assessment of policy, programme and research issues,p Id. UNFPA, Global Reach: Indicators, Romania Overview, supra note. UNAIDS, Romania: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at 0 Id. UNAIDS Epidemic Update December 00, p. (last visited December, 00) WOW: Romania, supra note, at. WOW: Romania, supra note, at. WHO, Abortion and contraception in Romania A strategic assessment of policy, programme and research issues,p 0 WOW: Romania, supra note, at. Romanian Family Heal Initiative Technical Fact Sheet: Reproductive Heal Policy Development, available at WHO, Abortion and contraception in Romania A strategic assessment of policy, programme and research issues, p 0 UNFPA, Global Reach: Indicators, Romania Overview, supra note. ASTRA Network, Reproductive Heal Services in Romania: Country Report (00), supra note. 0 Romanian Family Heal Initiative Technical Fact Sheet: Adolescent Reproductive Heal in Romania available at 0 ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

12 Modern contraceptive use is not widespread in Russia. The contraceptive prevalence rate for modern meods is at a reported %. The quality of available contraception is questionable, and many individuals engage in unprotected sexual intercourse. Women's centers and hospitals deliver family planning services. Modern contraception remains largely unavailable because e Russian government does not provide affordable contraception and because existing family planning centers do not adequately meet demand for family planning services. Contraceptives are typically imported, resulting in prohibitively high costs. Accordingly, oral contraceptives and condoms cost much more an abortions: on average, oral contraceptives cost $ per year and condoms cost $, whereas an abortion costs $. Women us rely principally upon abortion to control eir fertility. In addition, ere are few family planning centers to meet e needs of Russian women, leaving an estimated. million women wi unmet needs for contraception. The government has made no effort to provide affordable contraception, to ensure universal access to contraception, or to increase e provision of family planning services. Raer, its has undermined such efforts, cutting, for example, family planning Children of Russia programs from state budgets in. The lack of access to contraception and to family planning services results in high rates of unwanted pregnancies, abortions, and sexually transmitted infections such as HIV/AIDS. The sexual and reproductive heal of Russian adolescents is in jeopardy. Adolescents become sexually active early - girls being. and boys. years old on average at first intercourse - and wi is burgeoning sexuality come high rates of STIs, particularly HIV/AIDS, pregnancies, and abortions in adolescents. Adolescents are contracting HIV faster an any oer segment of e Russian population: at e end of 00, 0% of e approximately 0,000 individuals living wi HIV/AIDS were between - years old. The teenage pregnancy rate - pregnancies per,000 pregnancies - is higher an in any Western European country. Furer, wi an estimated / of adolescent pregnancies ending in abortion, e abortion rate for adolescents is also among e highest in developed countries. A recent study indicated at women under 0 years of age have e majority of abortions performed after weeks, and at young and adolescent girls account for e highest grow 0 of gynecological morbidity. Lack of sexuality education largely accounts for adolescents' sexual and reproductive heal problems. Adolescents report not knowing enough about sex, and misinformation amongst adolescents abounds: for example, % of students surveyed believed at only persons wi multiple partners were at risk for HIV. In spite of e serious heal problems experienced by adolescents, e government does not require sexuality education in schools and has not worked to educate its adolescents. Raer, in response to a vocal conservative group, e government halted e introduction of comprehensive sexuality education programs in schools in. To save e heal and lives of its adolescents, e Russian government must educate em on all aspects of sexuality, including contraception, STIs, and pregnancy. Abortion is e primary meod of fertility control in Russia. Approximately 0% of pregnancies end in abortion, placing Russia second behind Romania for e country wi e most abortions per capita. Limited contraceptive availability and e low cost of abortion relative to contraception account for ese high rates. Russian law legalizes abortion for e first weeks of gestation upon request. It permits abortion at later stages only to save a woman's life, to preserve her mental or physical heal, for social reasons, or if e fetus is impaired. Adolescents under years of age must have parental consent to obtain an abortion. Though abortion rates are high in Russia, widespread access to safe abortion is not a reality. Unsafe abortion is e primary cause of maternal mortality, and e government has not worked to ensure at all abortions take place under medical care and in sanitary conditions. Furer, e right to abortion is currently reatened. A 00 decree restricted e permissible social grounds for abortion between and weeks of pregnancy from reasons to. These reasons are: ) a court ruling depriving or restricting one's parental rights; ) pregnancy resulting from rape; ) incarceration in a detention center; and ) severe disability or dea of a woman's husband at time of pregnancy. This decree limits e ability of women to secure safe abortions. In particular, it hurts vulnerable populations such as adolescents who tend to wait until after e week of pregnancy to seek medical attention. Russia has e largest HIV epidemic in Europe and e fastest growing rate of HIV infection in e world. Wi approximately 0,000 adults and children - of which 0,000 are women - years old - living wi HIV/AIDS, Russia accounts for 0% of all HIV infections officially registered in Central Asia and Eastern Europe. Though % of newly registered cases in 00 were associated wi intravenous drug use, e epidemic appears to be shifting to e general population. Newly registered cases 0 associated wi heterosexual transmission increased from.% in 00 to % in 00. And young people are bearing e brunt of new HIV infections. Each year, more an ree quarters of new diagnoses are in people aged - years. Despite high rates of HIV/AIDS, e Russian government has failed to systematically confront e pandemic. The few current programs at exist focus on curative care and do not give adequate attention to prevention. Accordingly, e government has not made contraception - specifically dual meods like e condom at protect against bo pregnancy and sexually transmitted infections - affordable and widely available. There is also little public education on HIV/AIDS: few adolescents receive sexuality education, and, in 00, public awareness programs for HIV/AIDS received less an 0% of e AIDS budget. Generally, e HIV/AIDS programs at do exist have fallen victim to spending cutbacks on heal and social programs, which have slowed e grow and execution of treatment and prevention services. The Committee is also concerned at e insufficient information concerning adolescen heal, in particular wi regard to reproductive heal. The Committee is also concerned at contraceptives are not wiin financial reach of all, us limiting eir usage in e State party and at ere is a high incidence of teenage pregnancies and abortions. The Committee recommends at e State party pay close attention to adolescent heal, taking into account General Comment No. (00) on adolescent heal and development in e context of e Convention on e Rights of e Child, and strengen its efforts to promote adolescent heal, including sexual and reproductive heal education in schools, and to introduce school heal services, including you-sensitive and confidential counselling and care. UNFPA State of e World Population Report 00 (last visited December, 00). CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD: LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVESEAST CENTRAL EUROPE (000). CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD: LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVESEAST CENTRAL EUROPE (000). POPULATION COUNCIL, FRONTIERS, RUSSIA: POSTABORTION FAMILY PLANNING COUNSELING AND SERVICES LEAD TO INCREASED CONTRACEPTIVE USE (00), (May 00), citing IRINA SAVELIEVA, POSTABORTION FAMILY PLANNING OPERATIONS RESEARCH STUDY IN PERM, RUSSIA (00). John A. Ross & William L. Winfrey, Unmet need for contraception in e Developing World and e Former Soviet Union: An Updated Estimate, INT'L FAM. PLAN. PERSP. (00). See Obraschenie v. Sovet bezopasnosti Rossiiskoi Federatsii obshchestvennost I spetsialistov v oblastiokhrany reproduktivnogo zdorov'is [An address to e Securiy Council of Russian Federation of Public Specialists in Reproductive Heal], PLANIROVANIE SEM'I [FAMILY PLANNING] (). from e Russian Family Planning Association (May, 00), citing GOSKOMSTAT (RUSSIAN FEDERATION), RUSSIAN STATISTICAL ANNUAL (00). See also In Russia, six out of every pregnancies end in abortion, ASSOCIATED PRESS WORLDSTREAM, Oct., 00; THE ALAN GUTTMACHER INSTITUTE, FACTS IN BRIEF, TEENAGER'S SEXUAL AND REPRODUCTIVE HEALTH, DEVELOPED COUNTRIES (00). In Russia, six out of every pregnancies end in abortion, ASSOCIATED PRESS WORLDSTREAM, Oct., 00. Fundamentals of e Legislation on Public Heal Care, N -, Ved. V.S.,, no., Item, art.. Russian Federation, Decree of e Government of e Russian Federation # on e List of Social Indications for Induced Termination of Pregnancy, Aug., 00. Fundamentals of e Legislation on Public Heal Care, N -, Ved. V.S.,, no., Item, art. (). Concluding Observations of e Committee on Economic, Social and Cultural Rights: Russian Federation, U.N. Committee on Economic, Social and st Cultural Rights (CESCR), Sess., mtg., paras.,, U.N. Doc. E/C.//Add. (00). Russian Federation, Decree of e Government of e Russian Federation # on e List of Social Indications for Induced Termination of Pregnancy, Aug., 00. S.V. ZAKHAROV ET AL., ADOLESCENT REPRODUCTIVE BEHAVIOR AND HEALTH IN RUSSIA: AN ANALYTIC REVIEW (000). THE JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS) & WORLD HEALTH ORGANIZATION (WHO), AIDS EPIDEMIC UPDATE, DECEMBER 00, at (00). Russia's Registered HIV Cases Have Tripled Over Last Year, KAISER DAILY HIV/AIDS REPORT, Apr., 00. UNAIDS, Russian Federation: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections at, available at (last visited July, 00). THE JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS) & WORLD HEALTH ORGANIZATION (WHO), AIDS EPIDEMIC UPDATE, DECEMBER 00, at (00). UNAIDS, Russian Federation: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections at, available at (last visited July, 00). 0 UNAIDS, Russian Federation: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections at, available at (last visited July, 00). UNAIDS Epidemic Update December 00, p. (last visited December, 00) Stephen Massey, Russia's Maternal & Child Heal Crisis: Socio-Economic Implications and e Pa Forward, EASTWEST INSTITUTE POLICY BRIEF, Dec. 00, at. Sarah Grisin & Celeste Wallander, Russia's HIV/AIDS Crisis: Confronting e Present and Facing e Future (00), citing UNAIDS, Report on e Global HIV/AIDS Epidemic (00); CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD: LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVESEAST CENTRAL EUROPE (000). Sergei Blagov, HealRussia: Disastrous Rise in HIV Among You, INTER PRESS SERVICE, June 0, 00. CENTER FOR REPRODUCTIVE RIGHTS, TRENDS IN REPRODUCTIVE RIGHTS: EAST CENTRAL EUROPE (00). THE JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS) & WORLD HEALTH ORGANIZATION (WHO), AIDS EPIDEMIC UPDATE, DECEMBER 00, at (00). THE ALAN GUTTMACHER INSTITUTE, FACTS IN BRIEF, TEENAGER'S SEXUAL AND REPRODUCTIVE HEALTH, DEVELOPED COUNTRIES (00). Russian U.N. Country Team, MDG+ Agenda in Russia: Translating Economic Grow Into Sustainable Human Development wi Human Rights (00), (Dec. 00). S.V. ZAKHAROV ET AL., ADOLESCENT REPRODUCTIVE BEHAVIOR AND HEALTH IN RUSSIA: AN ANALYTIC REVIEW (000). 0 Russian U.N. Country Team, MDG+ Agenda in Russia: Translating Economic Grow Into Sustainable Human Development wi Human Rights (00), (Dec. 00). Sexuality Education and Information Council of e United States (SEICUS), Russia: Study looks at you sexuality knowledge and sexuality education, MAKING THE CONNECTIONNEWS AND VIEWS ON SEXUALITY: EDUCATION, HEALTH AND RIGHTS (000). Yuri A. Amirkhanian et al., Risk Factors for HIV and Oer Sexually Transmitted Diseases Among Adolescents in St. Petersburg, Russia, FAM. PLAN. PERSP., (00). See CENTER FOR REPRODUCTIVE RIGHTS & OPEN DIALOGUE FOR REPRODUCTIVE RIGHTS (ODRR), WOMEN'S REPRODUCTIVE RIGHTS OF YOUNG GIRLS AND ADOLESCENTS IN RUSSIA: A SHADOW REPORT (), citing Russian Federation, Ministry of Heal, Ordinance No. of May,, on e Improvement of Medical Care for Adolescents. See CENTER FOR REPRODUCTIVE RIGHTS & OPEN DIALOGUE FOR REPRODUCTIVE RIGHTS (ODRR), WOMEN'S REPRODUCTIVE RIGHTS OF YOUNG GIRLS AND ADOLESCENTS IN RUSSIA: A SHADOW REPORT (), citing Information Center of e Independent Women's Forum cited in WOMEN'S ENVIRONMENT AND DEVELOPMENT ORGANIZATION'S, RISKS, RIGHTS AND REFORMS (). ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

13 Slovakia is among e European countries wi e most positive development in e number of abortions, dropping by 0% over e last years. There are. abortions per,000 women in fertile age (,000 per year), which is approximately every four pregnancy. The biggest segments are women wi two children. The cost of abortion doubled in 00 to EU and must be paid full by women; is is almost half of e average salary in Slovakia. While e rate of modern contraceptive use has grown in Slovakia, it is still quite low compared to oer EU countries. The number of women using hormonal contraception has grown from % at e time of collapse of e previous regime to almost % recently. % of Slovak women use some form of modern contraception, and e prevalence rate for any meod is about %. Though hormonal contraception is an object of medical prescription, it is not covered by medical insurance at all. Since May 00, emergency contraception (EC) has had over-e-counter status and could be purchased wiout prescription. However, e Ministry of Heal just released a statement asking e Drug Agency to change eir May decision, which would make EC an object of medical prescription once again. Present law in Slovakia is quite liberal, allowing artificial abortion up to e week of pregnancy wiout need to specify e reason. In addition, a regulation of e Ministry of Heal permits abortions between and weeks of pregnancy in cases of fetus damage or heal-risk reasons. The significant decrease in e number of abortions is, in part, e result of better access to contraception and broader choice of contraceptives. At e same time, access to safe abortion has been reduced, despite e law, due to attacks by anti-choice caolic groups. Because of ese campaigns, even supportive gynecologists have taken an anti-choice position, relying on e conscientious objection clause. Not only is e issue of abortion on request a topic of debate, but abortion for medical reasons has also become a current issue of political and legal dispute. For example, ere is a Constitutional Court case pending which claims at Slovakia's abortion law violates e fetus' constitutionally protected right to life. Overall, reproductive rights in Slovakia are being oversimplified to e right of abortion. The efforts of conservative political forces to demonize reproductive rights are not limited to e ban of abortions, but extend to all forms of contraception, sexual education, and access of you to objective information. In recent years, several measures have been taken (or have tried) to restrict access to family planning services. In particular, a proposal about a conscientious objectors treaty wi e Holy See is being drafted by e Ministry of Justice. The treaty would, for example, allow doctors to refuse to perform abortions and judges to refuse to take on divorce cases. Furermore, e current Ministry of Heal regulation governing assisted reproduction is discriminatory in at it does not allow such procedures to be performed if e woman is single or if she is not in a traditional marital or oer state-acknowledged relationship. Thus, not only are single women discriminated against but also gay women. Furermore, only women under e age of are eligible for subsidies which cover e extremely expensive costs of assisted reproduction procedures. Thus, women who are older and unable to bear children are, in effect, unable to access such services. In addition, while reports of forced or coerced sterilization of Romani women in Slovakia has led to stricter legal requirements on ensuring heal care providers obtain e informed consent of patients, e state has still refused to fairly investigate e reports and has to date not provided any effective remedies, despite recommendations from e Council of Europe Commissioner for Human Rights and e UN Human Rights Committee. HIV/AIDS occurrence in Slovakia is substantially low compared to oer countries in e European Union, wi high estimates being less an 00 people living wi HIV/AIDS as of e end of 00. The number of new HIV/AIDS cases has been getting reported since. At e end of June 00, Slovakia had registered HIV infections, predominantly transmitted rough homosexual and bisexual sex. A total of AIDS cases and AIDS deas in Slovakia were reported at is time. While HIV/AIDS rates have remained low, syphilis rates have significantly increased over recent years. In, e prevalence rate of syphilis was lower an average in e EU. But by 00, e figures reached approximately four times e standard EU level. Well-designed national HIV/AIDS programs are ought to have contributed to low prevalence among intravenous drug users (IDUs) and low incidence in non-injecting populations. For example, a syringe exchange program has been operating in Bratislava since, where e prevalence of HIV in IDUs in e city is only 0.0%. Noneeless, Slovakia's lack of public awareness and responsibility campaigns could hinder is country's ability to continue to maintain its low prevalence of HIV/AIDS. The state is responsible for e contents and implementation of sexual heal education as part of preparing children and you for marriage and parenood. In basic and secondary schools, is preparation is included in e mandatory curriculum of eier eical education or religious education. Thus, parents and students are given a choice in selecting education in accordance wi eir worldview. TheCommittee expressed regret at State party's failure to clearly deny or admit breaches of e principle of full and informed consent but asserts at an investigation related to maternity wards and gynecology departments of hospitals did not result in findings of infringements of "medical indication" of sterilization after e oral consideration of e report. The Committee furer expressed regret at e reference made, in e same submission, to "e fact at not all administrative acts were fulfilled in every case" appears to amount to an implicit admission of breaches of e requirement of informed consent (art.,). The committee proceeded to recommend at e State party should adopt all necessary measures to investigate all alleged cases of coerced or forced sterilization, publicize e findings, provide effective remedies to victims and prevent any instances of sterilization wiout full and informed consent. However, e sexual education included in religious education is very conservative and subjective. The only meod of contraception taught to pupils is abstinence before marriage and natural family planning. The pupils do not receive objective information about family planning and modern contraceptives. Furermore, ere is no minimum standard for knowledge required to teach sexual education presented in eical education; instead, such instruction depends on e teacher's 0 approach. Modern and student-friendly sexual education materials are not available. ASTRA Network, Reproductive Heal Services in Slovakia: Country Report (00), available at Id. Id. Id. Záväzné opatrenie MZ SR o podmienkach umelého oplodnenia è. Z 00/-D- (The Binding Order of Ministry of Heal regarding e Conditions for Artificial Fertilisation Nr. Z Z 00/-D-) Recommendation of e Commissioner for Human Rights Concerning Certain Aspects of Law and Practice Relating to Sterilization of Women in e Slovak Republic, October 00 CommDH (00). Id. Olga Pietruchova, Slovak Family Planning Association, Sexual and Reproductive Heal and Rights in Slovakia, August 00. ASTRA Network, supra note. Id. IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), available at Olga Pietruchova, Slovak Family Planning Association, supra note. UNAIDS, Slovakia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections (00), available at Id. Olga Pietruchova, Slovak Family Planning Association, supra note. UNAIDS, Slovakia: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, supra note. See Id. ASTRA Network, supra note. Id. 0 Olga Pietruchova, Slovak Family Planning Association, supra note. ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights

14 United Nations Committee on e Rights of e Child Concluding Observations to Ukraine October 00 Wi regard to adolescent heal The Committee expresses concern about e lack of access, wiout parental consent, to medical counselling and advice. The Committee is also concerned about e large number of teenage abortions, is being e principal cause of maternal mortality. Reproductive heal is an important area of heal care in Ukraine. Reproductive heal/family planning centers have been established in each of e regions of Ukraine. As e result of national programs on family planning, recent years have led to positive changes in e prevalence of contraception. As of 000,.% of married couples reported using condoms, while.% relied on oral contraceptives, and 0.% used vaginal tablets. During e 's, Ukraine's population drastically decreased, due to a decreasing bir rate and rising mortality. However, e rate of population decline slowed for e first time in 00. In addition, e maternal mortality rate dropped from. maternal deas per 0,000 live birs in down to. per 0,000 live birs in 00. Under Ukrainian law, abortion is legal up to e week of gestation upon request, or up to e week of pregnancy under medical conditions. The number of abortions in Ukraine has considerably decreased over e past decade. In, out of every,000 women of childbearing age had undergone an abortion, compared to. per,000 women in 00. Abortion has been e basic meod of regulating unwanted pregnancies for decades, and unsafe abortion remains e main cause of maternal mortality, infertility, and complications during pregnancy and delivery. It is estimated at over - % of abortions are performed illegally outside medical institutions. Abortion tourism from oer countries, particularly Poland, is present, but difficult to investigate. While noting e State party's efforts in e area of HIV/AIDS, e Committee remains concerned at:(a) The growing number of cases of HIV/AIDS among e you;(b) The very serious impact of HIV/AIDS on e cultural, economic, political, social and civil rights and freedoms of children infected wi or affected by HIV/AIDS, including e Convention's general principles, in particular non-discrimination, heal 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 e efficiency of e State party's HIV/AIDS prevention programmes and e lack of uniform standards regulating care, treatment, medical services and social assistance for people and families living wi HIV; (d) Insufficient counselling services provided to people wi HIV/AIDS, especially adolescents The Committee recommends at e State party: (a) Take e necessary measures to provide adolescents wi access to medical counselling and advice wiout parental consent, taking into consideration e evolving capacities of e child; (b) Ensure at adolescents have access to and are provided wi education on reproductive heal and oer adolescent heal issues, including mental heal, as well as wi child-sensitive and confidential counselling services; (c) Undertake a comprehensive and multidisciplinary study to assess e nature and extent of adolescent heal problems, including e negative impact of sexually transmitted diseases and HIV/AIDS and, wi e full participation of adolescents, use is as a basis to formulate adolescent heal policies and programmes; (d) Integrate respect for e rights of e child into e development and implementation of its HIV/AIDS policies and strategies on behalf of children infected wi and affected by HIV/AIDS, as well as eir families, including by making use of e International Guidelines on HIV/AIDS and Human Rights (E/CN.//, annex I) and wi particular reference to children's rights to be protected from discrimination and to heal, education, food and housing, as well as e rights to information and freedom of expression; According to UNAIDS, Ukraine, wi estimated adult HIV prevalence of.%, remains e worst-affected country in Europe. Fuelled by unsafe injecting drug use and unprotected sex, its epidemic shows no signs of abating. The annual number of newly reported HIV cases continues to rise and exceeded 00 in 00, almost % more an e 000 cases diagnosed in 00 and almost double e number diagnosed in 000. These figures understate e actual size of e epidemic by a wide margin since ey only reflect infections among people who have been in direct contact wi official testing centers. Intravenous drug use remains e most common source of infection, contributing to % of officially registered HIV cases among adults. However, in 00, 0% or more of all new reported HIV infections, were due to unprotected sex. Increasing numbers of women are being affected, many of em acquiring HIV from male partners who became infected when injecting drugs. Throughout Europe, Ukraine has one of e highest birrates among adolescents. Rates are estimated at 0 or more birs per,000 adolescents per year. Children and adolescents in e Ukraine receive medical assistance for reproductive heal rough family planning centers and centers for adolescents. Sexual education centers for adolescents are established in fourteen oblasts of Ukraine, and ree adolescent family planning centers are you-family clinics. Unfortunately, ese sexual education and family planning centers are still not enough, as STI rates and e HIV/AIDS epidemic continue to dramatically increase. There is no comprehensive sexuality education program in schools at teach adolescents, for example, how to protect emselves against HIV/AIDS transmission and to prevent unwanted pregnancy. In addition, e policy of requiring parental consent for medical services undertaken by minors violates adolescent's privacy and confidentiality, making e limited HIV/AIDS services at are available, inaccessible. UNFPA, Global Reach: Indicators, Ukraine Overview, available at ASTRA Network, Reproductive Heal Services in Ukraine: Country Report (00), available at Id. Id. Id. Id. Id. IPPF EUROPEAN NETWORK, ABORTION LEGISLATION IN EUROPE (updated Feb. 00), available at UNAIDS Epidemic Update December 00, p. (last visited December, 00) Id. Id. Susheela Singh and Jacqueline E. Darroch, Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries, FAMILY PLANNING PERSPECTIVES NO. (000), available at ASTRA Network, Reproductive Heal Services in Ukraine: Country Report (00), supra note. Id. AND REFORMS (). ASTRA - Central and Eastern European Women's Network for Sexual and Reproductive Heal and Rights