National Report

on Ukraine’s progress toward goals established at the World Summit for Children

А. Introduction. Background.

In 1990 Ukrainewas a part of the Union of Soviet Socialist Republics. In 1991 Ukraine proclaimed its independence – the factor that determined change in its social policy, including policy for children. In February 1991 Ukraine ratified the UN Convention on the Rights of the Child, became a signatory to the World Declaration on Ensuring Survival, Protection and Development of Children and the action plan for its implementation.

Historically, Ukraine embarked on implementing the provisions stipulated by the UN Convention on the Rights of the Child at the time when social restructuring got under way, with economic and political reforms of the early 1990s bringing about dramatic deterioration in family, and, consequently, children’s status.

The Constitution of Ukraine adopted on June 28, 1996 maintains that the state defines and guarantees human rights and freedoms in accordance with generally recognized international norms. The new Fundamental Law meets international legal standards in the domain of human rights, in particular, UN Convention on the Rights of the Child. Given current circumstances, social policies concerning children should be aimed primarily at reducing the adverse effects of negative factors engendered by societal reforms.

The National Program “Children of Ukraine” (1996) was independent Ukraine’s first fundamental document intended to improve children’s social protection. It mapped out major areas of the government’s social policies in the sphere of childhood protection. The Program’s first-priority tasks implied efficient tackling of children’s problems and meeting the requirements stipulated by the UN Convention on the Rights of the Child.

In 1996 the Ministry of Ukraine for Family and Youth was set up. Its tasks included designing state policies for improving the status of family, women, youth and children, as well as demographic situation; for encouraging childbirth; for securing healthy and all-round development for young people and children; for their humanistic upbringing; and for complying with conclusions made by the UN Committee on the Rights of the Child. At the same time Departments for Family and Youth were set up in local governments charged with the task to implement government policies for family, women, youth and children, and for mother and child protection.

In March 1999 the Ministry was restructured into the State Committee for Family and Youth. The administrative reform in early 2000 resulted in charging the Ukraine’s State Committee for youth policies, sports and tourism with implementing government policies concerning family, women, youth and children. This restructuring proved inadequate, and at the moment the government is considering the formation of the State Department for Government Family Policy, Childhood Protection and Securing Equal Rights and Opportunities for Women.

Th Interdepartmental Commission for Childhood Protection was formed in Ukraine in order to coordinate the activities undertaken by Ministries and other central executive bodies. The Commission’s main tasks include addressing issues calling for interagency coordination, preparing proposals on complying with the UN Convention on the Rights of the Child and other international legal instruments. Vice-Premier of Ukraine heads the Commission.

In addition to its key tasks, the Commission analyzes children’s sustenance and development, as well as the ways they are affected by socio-economic policies; coordinates activities implemented by central and local executive bodies for children; approves and submits to the President of Ukraine in due order annual National Statement on Children’s Status in Ukraine; takes part in drafting proposals on acceding to international agreements (treaties), and ratifying conventions aimed at improving children’s status.

Starting 1996 annual reports on children’s status in Ukraine were initiated at the national level. Reports summarizing the results achieved in 1996, 1997, and 1998 contain detailed analyses of main yearly indicators characterizing children’s status, as well as basic recommendations as to its improvement, and reflect progress toward implementing the National Program “Children of Ukraine”.

1999 National Report on children’s status in Ukraine is the first thematic report on social protection of orphans and children devoid of parental care. The report contains a detailed analysis of the status of orphans and children devoid of parental care, together with a list of activities undertaken by the government over the year under account and aimed at protecting rights and interests of children belonging in this category.

In order to create conditions for ensuring each child’s right to be born healthy, to survive and to have conditions for comprehensive development, as well as to enjoy reliable social and psychological protection, proposals for the National Program “Children of Ukraine” for years 2001-2005 were developed in 2000. Addressing children’s status improvement issues is stipulated in Cabinet of Ministers’ Action Program “Reforms for Welfare”.

Government bodies in Ukraine enhance their attention to childhood’s social problems both at the political and legislative levels. Over 1992–2000 regulatory and legal framework for ensuring children’s rights and interests has been subject to improvement; government structures involved in children’s issues have expanded their presence; these years have seen increase in the number of state agencies and institutions providing social, rehabilitation and psychological assistance to children in need of it; the network of foundations and organizations has extended.

Scholars also pay considerable attention to identifying priorities in government policy for children. They have conducted extensive research aimed at studying and solving various issues related to improving children’s health care and their physical and mental health. Progress was made in Ukraine’s integration into global cooperation – close links have been established with United Nations Children Fund (UNICEF), and other international organizations.

In the context of preparatory activities for UN General Assembly for Children focusing on reviewing progress toward implementing goals set by the World Summit for Children, Cabinet of Ministers of Ukraine has adopted Directive on drafting action plan for participating in UN General Assembly Special Session (year 2001). Within preparation framework the achievements have been locally analyzed, analytical reports have been compiled and steps have been taken to provide for their public discussions in the regions involving non-governmental organizations and mass media.

Ukraine’s National Report on progress toward implementing goals established by the World Summit for Children is based on analytical materials provided by the Ministry of Education and Science of Ukraine, Health Ministry of Ukraine, Ministry of Interior of Ukraine, Ministry of Labor and Social Policy of Ukraine, Ministry of Justice of Ukraine, Ministry of Ukraine for Emergencies and Population Protection from Chornobyl Disaster Aftermath, Ministry of Agrarian Policy of Ukraine, State Statistics Committee of Ukraine, State Committee for Youth Policy, Sports and Tourism of Ukraine, State Committee for Information Policy, Tele- and Radio Broadcasting of Ukraine, State Department of Ukraine for Enforcing Criminal Penalties, Academy of Medical Sciences of Ukraine, Council of Ministers of the Autonomous Republic of Crimea, oblast state administrations, Kyiv and Sevastopol city state administrations, as well as official statistical data.

А).

To meet the provisions of Article 42 of the UN Convention on the Rights of the Child stating that “States Parties undertake to make the principles and provisions of the Convention widely known, by appropriate and active means, to adults and children alike”, the UN Convention on the Rights of the Child has been published in Ukraine in Ukrainian and Russian languages. The publication was facilitated by public and government structures and technically supported by UNICEF. 300,000 copies of posters “UN Convention on the Rights of the Child” have been printed and distributed among children and adults free of charge. A special class centering on the Convention and its study was held in the schools of Ukraine to celebrate the Convention’s tenth anniversary.

In accordance with Article 44 of the UN Convention on the Rights of the Child Ukraine prepared and submitted for consideration National Reports on the implementation of the UN Convention on the Rights of the Child in 1993 and 1998. In 1994 the UN Committee on the Rights of the Child submitted its conclusions on implementing recommendations designed by the Committee on the Rights of the Childafter the first report. Measures towards implementing recommendations designed by the Committee on the Rights of the Child have been taken on the government level.

Over the past five years mass media in Ukraine have become much more active in making the UN Convention widely known. To provide for media coverage of issues pertaining to rights of children, their social protection and guarantees for all-round development, the Government of Ukraine facilitated registration and publication of youth periodicals, educational journals, children’s newspapers and magazines. Initiatives aimed at establishing children’s and youth pages, supplements, and special columns in “adult” publications have found support, too.

Improving children’s social status in Ukraine is continuously highlighted by government-controlled electronic mass media. A special order of February, 2000 initiated mandatory children and teenagers program series, particularly, legally oriented, in the state TV and radio broadcasting networks.

B, D).

Article 49 of the Constitution of Ukraine sets forth that every individual has a right to health care, medical assistance and medical insurance. Section VII in the Fundamental Lawof Ukraine on Health Careregulates incentives for child birth, establishes guarantees concerning mother and child health care, medical assistance to pregnant women and new-born infants, strengthening and protecting children’s and adolescents’ health, providing health care to children and adolescents, child nutrition issues.

Under the law of Ukraine children are entitled to free health care. One of the first priorities is developing primary medical and sanitary support, first and foremost, for children population. In accordance with Cabinet of Ministers Decree of July 17, 1998 # 1303 children aged under three (children with disabilities aged under 16) receive doctor-prescribed medicationsfree of charge in case of outpatient treatment.Children between three and six years old have to pay for 50% of medications’ costs.This Decree approves a list of diseases, medications for which are also administered free in case of outpatient treatment (oncology diseases, hematology disorders, sugar diabetes, tuberculosis, AIDS, etc.). Home industries are putting out basic medications sold at reasonable prices.

Nevertheless, inadequate funding and organizational drawbacks hold back further progress of both primary medical and sanitary aid and specialized services, which, in its turn, has adverse effect on children’s health.

Congenital and acquired pathologies in children resulted in a number of disorders (deficiency of mental and physical development leading to reduced or limited life activity forms appropriate for the child’s age, and in the gravest cases – to disabilities and social disadaptation).

Regrettably, this state of affairs accounts for substantial increase in disability rate among children. Since 1993 рокуthe number of disabled children in Ukraine has grown by 28.5 thousand with overall decrease in children population by over 1.4 million. It means that the share of disabled children in the population has increased from 1.1 to 1.6%.

The overall number of children with disabilities according to 1999 data constitutes 150.3 thousand, or 156.4 per 10,000 children. There have been no major changes in the structure of children’s disability causes over the recent years; still, nervous system disorders have taken the lead.

Taking into account aggravated demographic situation and the need to change it for the better, and implementing President’s instruction, the Concept for early social rehabilitation of disabled children in Ukraine has been adopted. Putting in place early social rehabilitation system for disabled children that involves professional, medical and social rehabilitation for individuals with limited physical and mental capabilities will make it possible to complete integral rehabilitation system, and will reduce the layer of socially disadapted children, will teach them self-service and involve them, as much as possible, into socially useful labor.

7,947 thousand children are institutionalized in 58 boarding schools run by the Ministry of Labor and Social Policy of Ukraine; 68,664 thousandchildren are maintained in 401 secondary educational establishments run by the Ministry of Education and Science of Ukraine for children with mental or physical disabilities. These institutions focus mainly on maximum possible correction of mental and physical disabilities, social and quotidian adaptation of disabled children in inpatient environment aimed at renovating their social status.

In accordance with Articles 22 and 24 of the Law of Ukraine “On Fundamentals of Disabled Persons’ Social Protection in Ukraine” inmates with physical disabilities and adequate intellectual level irrespective of their age, who have completed nine general school years or received secondary education, are referred for employment or studies at other educational establishments. A portion of disabled children are vocationally trained at five vocational technical boarding schools for disabled and at technical colleges for disabled integrated into social protection system. Upon completing their studies they work in the national economy system. Inmates with profound mental retardation (imbecility or idiocy degree), bed-ridden patients reaching the age of 18, are transferred to appropriate institutionor, if such a desire is expressed by parents (caretakers, relatives), into their care.

Medical and organizational issues related to preventing children’s morbidity and disability call for enhanced level of prevention activities among healthy children, for better medical aid to afflicted children, and for developing specialized children care system. The Health Ministry of Ukraine is working on prevention activities standards for outpatient clinics, schools and preschool establishments aimed at reducing the number of examinations by specialists and at enhancing the role played by pediatricians and nurses in identifying diseases and their follow-up.

Infectious diseases that have social causes and require special attention and changed approaches to health care provided to diagnosed contingents include tuberculosis, HIV/AIDS and venereal diseases.

Almost 25 thousand of tuberculosis cases are recorded annually in Ukraine, with approximately 800 children under 14 among them. Since 1990 this disease prevalence rate in children has increased 1.7 times. Tuberculosis prevalence rate in children has somewhat stabilized in 1999;tuberculosis mortality rate has also decreased. This stabilization, however, is unsteady given high morbidity rates in adults. Afflicted adults provide the major tuberculosis infection source for children, with 30 to 70% being chronic alcohol and drug addicts who refuse to undergo treatment, have no permanent duties or place of residence, and migrate from one oblast to another.

The numbers of HIV-positive cases throughout Ukraine are growing dramatically. 35.0 thousand HIV-positive cases have been recorded since 1987, 1.8 thousand children among them, with most of them detected in 1999. There have been 58 AIDS cases among children, 42 children died. The most common case is children being infected by HIV-positive mothers.

The Supreme Rada of Ukraine passed the Law on March 3,1998 “On introducing amendments to the Law of Ukraine “On preventing AIDS and social protection of population”. Medical examination rules aimed at identifying HIV infection, and at keeping records of HIV-positive and AIDS individuals and their medical supervision have been approved by Cabinet of Ministers Decree of December 18, 1998 # 2026 “Issues pertaining to preventing and protecting population from HIV and AIDS”.

Cabinet of Ministers Decree of July 10, 1998 # 1051 is in force in Ukraine “On the amount of monthly state support for children under 16 infected with human immunodeficiency virus or living with AIDS”, as well asthe Health Ministry order of July 31, 1998 # 265 “On the procedure for paying out monthly state support for children under 16 infected with human immunodeficiency virus or living with AIDS”. In accordance with Cabinet of Ministers Decree of March 9, 1999 # 341 “On AIDS and drug addiction prevention program for 1999-2000” the Health Ministry issued the order ofApril13, 1999 #83 “On approving Health Ministry of Ukraine Action Plan on AIDS and drug addiction prevention for1999 - 2000”.

Assessing the state of children’s health, women’s and female adolescents’ health indicators should not be overlooked, in particular, their reproductive system.

Female adolescents’ morbidity rates (per 10,000 population)

Disease / 1991 / 1995 / 1999 / + (times)
Anemies / 8,5 / 34,0 / 58,9 / + 6,9
Menstrual cycle disorders / 62,3 / 120,9 / 218,4 / + 3,5
Urinogenital system diseases / 194,1 / 447,4 / 747,5 / + 3,8
Total / 5269,2 / 6403,4 / 8277,3 / + 57

Female adolescents’ and pregnant women’ health dynamics is characterized by extremely negative tendencies. Over the past ten years urinogenital diseases prevalence rate in Ukraine’s female adolescents has increased almost twice; menstrual dysfunction prevalence rate – 1.5 times. These diseases directly affect potential mothers’ reproductive health.

With the view to improve specialized medical care provided to young girls the Health Ministry of Ukraine passed the order “On improving children and adolescent gynecology service” (1996) initiating the development of children and adolescent gynecology consulting rooms network.

Mother and child care agencies and institutions focused their efforts on implementing major government and national strategic programs and specific mother and child care activities having crucial impact on basic health indicators: “On activities aimed at implementing Main Social Policy Guidelines”, “National Family Planning Program”, “Targeted Comprehensive Genetic Monitoring Program in Ukraine for 1999–2003”, “Comprehensive Disability Program”, “Immunoprevention Program for Population of Ukraine until year 2000 ”, National Program “Children of Ukraine".

Implemented activities and programs enabled the following achievements:

  • Keeping in place children and women medical care system, with it prevention-oriented character;
  • Facilitating progress of services, such as medical genetics and prenatal diagnostics, organizing rehabilitation centers network for children with organically afflicted nervous system, as well as medical/social rehabilitation centers for alcohol- and drug-addicted children and adolescents;
  • Setting up efficient family planning centers network, disseminating family planning principles and methods, extending periods of mother and child stay in maternity inpatient clinics. Prior to 1990 the annual number of abortions in Ukraine constituted over 1 million, while in 1999 the number decreased to 440 thousand. The number of abortions in all oblasts of Ukraine has diminished almost by half;
  • Opening newly-born infants’ wards currently operating in each administrative region. In 22 oblasts of Ukraine, Autonomous Republic of Crimea and in the city of Kyivanesthesiology and intensive therapy wards for newly-born infants have been put in place reducing early neonatal mortality rates;
  • Reducing mortality rates in first year infants – this was made possible due to early diagnostics and adequate treatment for pregnancy complications and neonatal diseases;
  • Stabilizing mortality rates in children aged 0-14 that in 1999 amounted to 10.4 per 10,000 children.The rate has been steadily decreasing since 1995, primarily at the expense of accidents, injuries and poisonings mortality rates;
  • Improving specific reproductive health indicators, particularly, stabilizing mother mortality rate;
  • Keeping up high level of children population’s coverage with vaccination – ranging from 93% to 98%, bringing down infectious diseases prevalence ratethrough immunopreventive measures: diphtheria prevalence ratehas decreased as compared to 1998 by 53%, measles - by 60%, whooping-cough - by 29%, epidemicmumps - by 54%. Sanitary and epidemic service institutions survey infectious diseases prevalence rates irrespective ofsource of infection, its transmission channels and factors, including water transmission.

Programs aimed at improving mother and child health care system in Ukraine have been implemented with financial support provided by UNDP, UNICEF, WHO and US Agency for International Development. These include, in particular, “Ukrainian Health Care Initiative”, “Women, Infants and Children Mortality Control Program”, “The Rights of the Child Program”, “Iodine Deficiency Disorders Elimination Program”, “Child-Friendly Clinic Initiative”, “Chornobyl Humanitarian Assistance and Rehabilitation Project”, “Hope Project – pilot initiative for tuberculosis treatment”, “Youth Health Care and Development Program”, UNESCO-Chornobyl Program (project#64 “Setting up socio-psychological assistance centers for population afflicted by Chornobyl disaster”), to name but a few.