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Baroness Morgan of Drefelin: I am delighted to take part in this important debate and congratulate the noble Baroness, Lady Gould, on initiating our discussion. I should like to focus especially on health and to begin by quoting from the declaration:
"Women have the right to the enjoyment of the highest attainable standard of physical and mental health. The enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology".
The declaration stresses that health and well-being eludes the majority of women and but inequality both between men and women and among women in different geographical regions, social classes and indigenous and ethnic groups is a major barrier to women's achievement of the highest attainable standard of health.
The platform for action calls on the Government to do several things about health, in particular, to,
"design, with women, Health Services that meet the needs of all types of women at all the stages of their lives . . . to train health workers to understand how to provide services which meet women's needs, especially for privacy and respect . . . to do more to prevent diseases such as cervical and breast cancer, osteoporosis, chalmydia . . . ensure access to safe, affordable, effective methods of family planning . . . give women who have unwanted pregnancies ready access to reliable information and compassionate counselling . . . provide sports facilities for women".
So a specific platform of ideas for action was set out in Beijing.
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The question today is what progress our Government are making towards achieving the platform for action. I would not want the debate to go by without mentioning the question of HIV/AIDS and to recognise that that is a catastrophic health challenge in the developing world, especially in Africa. I congratulate the Government on the publication of the Commission for Africa report, which recognises the inter-relationship between health, peace and security and fair trade, and on their commitment to take those recommendations forward to the G8. Although I do not want to talk about that in detail, it would be a shame not to refer to what in this debate.
Looking closer to home and considering women's health in the UK, we are extremely fortunate to benefit from the National Health Service which, in recent years, has had unprecedented investment and modernisation. How far has that gone towards achieving the health aspects of the platform for action? A recent Equal Opportunities Commission report entitled, Promoting Gender Equality in Health, published in 2003, suggested that NHS modernisation has been gender-blind and that there is much room for further improvement in gender mainstreaming. If this were to be achieved not only in the development of services but also in the research underpinning service development, there would be particular benefits for women in this country.
The report made an interesting detailed analysis of a number of national service frameworks for different conditions and focused particularly on coronary heart disease. It identified in detail that the risk profile for women with coronary heart disease is very different to that of men and that by differentiating between men and women in the development of targets it would be possible to achieve further health gains for women.
Women access and experience health services differently because of our biological difference and our experience of life. To use the vernacular, it is a "no brainer". We need to make progress in the teasing out of the different experiences of women. We know that women have a longer life expectancy in this country and yet they report more ill health.
I am pleased to say that these ideas are very much being taken up by the Government. In the recently published public health White Paper we can see these ideas going forward, particularly as we move from the paradigm in which the NHS focuses on illness to one in which we focus on wellness. As I have said, this is evidenced by the government White Paper.
Perhaps I may give an example. The question of breast cancer is an area which, by definition, is a gender-specific health concern. We know that 10 years ago breast cancer was very much a taboo subject which was not discussed easily and openly in the media or among women themselves. In 1995, when the declaration was developed and agreed, breast-screening had only just been introduced in this country and rolled out across the UK. At the same time, women's groups, trade unions and many people who were concerned about breast cancer started to raise awareness of the need to promote early detection.
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This, combined with the implementation of best treatment guidelines, the introduction of multidisciplinary specialist teams and the introduction of new hormone treatments such as tamoxifen, has precipitated a significant reduction in mortality rates for breast cancer of more than 20 per cent over the past 10 years. This has to be celebrated.
As we know, breast cancer remains the most common cancer in women in the UK and is on the increase. There is a debate as to why this is happening. It is the single biggest health concern for women in this country. In 1995, the lifetime risk of a woman developing breast cancer was one in 12; now it is one in nine. While there is much to debate about the nature of that increase, it is extremely important that we note that the risk of breast cancer increases with age. Healthcare for older women was picked up by the platform for action as a key issue.
Young women in this country have a risk of breast cancer of one in 15,000 up to age of 25, whereas older women experience a risk of one in 15 up to the age of 70. It is a very big difference. This is of particular interest because in 2000 the Government published their cancer plan, the first comprehensive plan aimed at reducing cancer mortality. A key aim within the plan was to extend breast screening to women over the age of 65 and to introduce two-view mammography, which is more effective. That has been hugely successful and promises to continue to be so. As a result, the screening service has reported recently that the first indications suggest that 14 per cent more cancers have been detected as a result, and that 42 per cent of those detected were too small to have been otherwise detected by the women themselves.
We have to recognise that the extension of screening to women over the age of 65 as a gender-specific health initiative has made a great contribution to promoting women's health. It has also highlighted the potential for mainstreaming gender issues further into the health policy arena.
5.35 p.m.
Baroness Massey of Darwen: I am delighted that my noble friend Lady Gould has, yet again, secured this timely debate with, I believe, the usual suspects responding on all sides. I shall address the issue of girls' education. Education underpins much of what is feasible in the other goals listed in the Beijing action plan. We all know how important education is in raising the hopes and achievements of all. It is particularly important in raising the aspirations, knowledge and skills of women.
Education for girls and women is not just about literacy and numeracy, important though they are. It concerns rights, careers, education for health and access to technology. I want to ask the Minister what the UK Government are doing to facilitate and support work between governments, non-governmental organisations and donors to enable them to make education for women, particularly in underdeveloped countries, a reality and a priority.
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I was pleased to see the recent DfID report, Girls' Education: towards a better future for all, which was published earlier this year. It is an inspiring and ambitious document. It reflects on the position of women in society, pointing out that women have to overcome obstacles in order to gain education—this is a worldwide issue, not just in underdeveloped countries. Even in the UK, girls often have been directed to unambitious goals and we know that even now, improved academic performance in girls does not necessarily mean equality in earning power and opportunities in employment, as my noble friend Lady Prosser said.
Today, I want to focus mainly on girls and women in developing countries. The millennium development goals aim to achieve universal primary education by 2015 and to promote gender equality and empower women. We know that gender parity in primary education, which was to be achieved by 2005, is falling short. More than 75 countries are likely to miss this goal.
Certain facts are clear. Women with a basic education are much less likely to be poor. Providing girls with one extra year of schooling beyond the average age can boost their eventual wages by between 10 and 20 per cent. A child born to an educated woman is much more likely to survive into adulthood. An educated woman is much more likely to have her children vaccinated against childhood diseases. But education is beyond many families—a good reason for poverty reduction. Some schools are remote and not encouraging to girls. Boys are excluded from schools because they live in countries in conflict.
We also know that many girls are not receiving the education which is their right. There are 23 million girls out of school in sub-Saharan Africa. In Niger, fewer than one-third of all school-aged girls are enrolled in primary school. The picture is not so bleak elsewhere and I shall give some examples. In Bangladesh, equal numbers of girls and boys now enter secondary school. In 1990, there were only half as many girls as boys in secondary education. Nepal has nearly nine girls for every 10 boys enrolled in primary school, compared with seven girls for every 10 in 1990. In Kenya, over 1 million extra children have enrolled in primary school since the removal of school fees in 2003.
Governments need to provide adequate resources for the education of girls, teachers need to be trained and paid regularly and policies on the education of girls need to be in place and made to work. Donors need to support governments in this. Donors can encourage the analysis of what girls face in relation to education and they can help governments do these analyses. Donors must, of course, respect cultures and customs and not impose their own. I have seen that lack of respect happen on numerous occasions in my work on health education in central Asia. That is an unfortunate and unproductive stance which can give rise to maladministration and corruption.
Donors and governments can work with civil societies to benefit the education of girls. Examples such as the Forum for African Women and the Global
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Campaign for Education have played and are playing an important role in promoting education for girls and women, raising funds and publicising the needs of girls and women.
I was interested recently to read the UK Department for Education and Skills' new international strategy, which I believe is its first. The strategy will encourage schools in the UK to link with schools in developing countries and DfID and the DfES have committed themselves to more joined-up work—not just thinking, but also action. That will not only benefit schools in developing countries but enable young people in the UK to get a better grasp of global affairs. It is an initiative which I think we might follow with a good deal of interest.
In his introduction to the DfID strategy on girls' education, the Secretary of State for International Development, Hilary Benn, said:
"We do not need complex international negotiations to help solve the problem of education. We just need to listen to governments, local communities, children, parents and teachers who know what challenges remain. And we need to provide them with enough funding to put their ideas on education into practice".
He points out that in 2005 the UK will hold the presidencies of the G8 and the EU and he affirms that it will use its leadership roles to,
That is all very hopeful and exciting. I know that the Minister is firmly committed to making the education of girls a priority in many contexts. So perhaps I may return to my original question of how the UK will work with governments, civil society and donors to improve education for girls. I know that that is a huge question, but surely the education of women and girls must be high on any agenda for action. I look forward to the Minister's response.
5.41 p.m.
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