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Healthcare Field - Case of Albania HEALTHCARE FIELD - CASE OF ALBANIA Submitted to the United Nation's Committee on the Convention on the Elimination of All Forms of Discrimination Against Women February 2016 Published by the Albanian Center for Population and Development (ACPD) Adresa : Bul “ Gjergj Fishta”, Kompleksi “Tirana 2000” Kulla 4, kati 2, Tiranë Web: www.acpd.al.org Supported by The Shadow Report is supported by UNFPA and with the financial support of the Swedish Government and UNFPA. The content of this document is the responsibility of the compiler of the document and in no case shall be considered as the opinion of UNFPA Albania. “SHADOW” REPORT HEALTHCARE FIELD - CASE OF ALBANIA Submitted to the United Nation’s Committee on the Convention on the Elimination of All Forms of Discrimination Against Women February 2016 Submitted by the Albanian Centre for Population and Development (ACPD) and the following Non-Profit Organizations: • Action Plus • Albanian Association of People Living with HIV/AIDS (PLWHA) • Albanian Disability Rights Foundation (ADRF) • Albanian Helsinki Committee (AHC) • Albanian Society for All Ages/ASAG • Albanian Women’s Christian Association/YWCA • Alliance Against Discrimination of LGBT People • Association “ Acli-Ipsia in Albania • Centre for Legal Civic Initiatives (CLCI) • Children’s Human Rights Centre of Albania (CRCA) • Community Development Centre “Today for the Future” (CDC- TFF) • Counselling Line For Women and Girls • Gender Alliance for Development Centre (GADC) • Human Rights in Democracy Centre • National Centre for Social Studies (NCSS) • Psycho-Social Centre “Vatra” (“Vatra” P.S.C) • Observatory for Children’s Rights (Observatory) • PINK Embassy/LGBT Pro Albania • Useful to Albanian Women (UAW) • Women’s Forum of Elbasan 4 “SHADOW” REPORT TABLE OF CONTENTS List of Abbreviations ...................................................................................................................6 I. Part One: Introduction and Summary ..................................................................................7 A. Acknowledgements .....................................................................................................7 B. Methodology ................................................................................................................7 C. Introduction ..................................................................................................................8 D. Summary and recommendations of the report ..........................................................9 II. Part Two: Analysis of non-discrimination standards in matters of healthcare. ............... 18 A. Legal approaches to the standards of CEDAW in the field of healthcare. ................ 18 1. Applicable legal framework - the need for alignment with the standards of Article 12 et al of CEDAW and the General Recommendation 24 ..................... of the CEDAW Committee. .................................................................................. 18 2. Administrative structures at central and local level related to health care. ....23 3. The role of NPOs in issues related to women’s health. .................................... 26 B. Practical approaches to CEDAW standards in the field of healthcare ..................... 29 1. General information on women’s health ........................................................... 29 2. Access to services and awareness of women .................................................. 30 3. Health and nutrition of mother and child ........................................................... 31 4. Sexual and reproductive health: Family planning and contraception ................32 5. Provision of family planning services ...............................................................33 6. Termination of pregnancy ..................................................................................34 7. Sexually transmitted infections, STIs and HIV/AIDS ..........................................35 8. Provision of service for vulnerable groups ........................................................37 9. Tumours of the reproductive system: Breast and cervix cancer ..................... 38 10. The health of women victims of domestic violence ......................................... 39 11. Victims of trafficking (VT/PVT) and addressing health problems ....................43 12. Health care for women in rural areas ................................................................45 13. Women with disabilities ..................................................................................... 46 14. Women from Roma and Egyptian communities ............................................... 48 15. The health of LGBTI and women LBT ................................................................ 50 16. The health of older women ................................................................................ 51 17. Women serving a prison sentence .....................................................................52 18. Work relations and specific issues of women’s health ......................................53 19. The role of education and school curricula related to health and health services .............................................................................................54 ANNEXES ............................................................................................................................55 Annex 1 List of NPOs ..........................................................................................................55 Annex 2 Questionnaire ...................................................................................................... 56 Annex 2 Selected Bibliography ......................................................................................... 58 HEALTHCARE FIELD - CASE OF ALBANIA 5 List of Abbreviations CEDAW Convention on the Elimination of Discrimination against Women DV Domestic Violence PHI State Labour Inspectorate/Public Health Institute SHI State Health Inspectorate SII Social Insurance Institute INSTAT Institute of Statistics STI Sexually Transmitted Infections CC Civil Code LC Labour Code FC Family Code CPD Commissioner for Protection from Discrimination PHC Primary Health Care LGE Law on Gender Equality in Society LGBT Lesbian, Gay, Bisexual, Transgender and Intersex MoH Ministry of Health MoSWY Ministry of Social Welfare and Youth SAA Stabilisation and Association Agreement with EU NPO Non-Profit Organization ILO International Labour Organization WHO World Health Organization PWD Persons with Disabilities NCCP National Program of Cancer Control SHR Shadow Report RA Republic of Albania DHSA Demographic and Health Survey in Albania NSGEEDV National Strategy for Gender Equality and Domestic Violence NES National Employment Service RH Reproductive Health SRH Sexual and Reproductive Health SSS State Social Service THB Trafficking of Human Beings ATTT Anti-Trafficking Technical Table PO Protection Order UN Women United Nations Entity for Gender Equality and the empowerment of women DDM Decision of the Council of Ministers VT/PVT Victims of Trafficking/Potential Victims of Trafficking 6 “SHADOW” REPORT PART ONE A. ACKNOWLEDGEMENTS This Shadow Report (hereinafter referred to as the “SHR”) regarding the protection of women’s rights in the area of health against CEDAW standards was prepared by the Albanian Centre for Population and Development (ACPD) in cooperation with 20 non-profit organizations, a full list of which is found in Annex 1. We would like to thank all the non -profit organizations that responded positively to this initiative and contributed to the collection of the necessary information by filling in the questionnaires, conducting interviews, participating in consultations, etc. ACPD would like to thank the UNFPA for the financial support in drafting this Shadow Report on CEDAW standards and their de facto and de jure status in Albania. In addition, we would also like to thank the Commissioner for Protection from Discrimination, Ms. Irma Baraku, who met with the team of experts, gave her opinions and made relevant comments. We would also like to thank all the people, representatives of central and local institutions, representatives of various communities and interest groups who cooperated by providing information and opinions about the areas covered in this report. ACPD wishes to thank in particular the team of experts who contributed to the drafting of the report: Prof. Dr. Arta Mandro–Balili, Dr. Ditila Doracaj and Dr. Irida Agolli-Nasufi. This study would have not been possible without the valuable contribution of the ACPD staff, who worked during the entire time under the guidance of experts to collect primary data and prepare the information, based on which the analysis of the report is made. B. METHODOLOGY 1. The Structure: The SHR is made of two parts: Part One, which contains introductory and summary information, including the recommendations of the report, and Part Two, which dwells on the analysis of healthcare non-discrimination standards in the legal and factual field. Apart from the legal analysis, the most dynamic parts of the SHR are the facts obtained on women’s health situation and the discrimination against them. By legal basis we do not just mean the law, but also the international documents ratified, by-laws, strategic documents, protocols and so on, that impose obligations. 2. The axis of analysis: The working group has carefully analysed CEDAW’s Article 12 components, and the meaning given in the
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