TEXTBOOK OF PEDIATRIC GYNECOLOGY - 2013

Chapter 1. INTERNATIONAL, NATIONAL AND BIOETHICAL FOUNDATIONS OF A PEDIATRIC GYNECOLOGIST'S PRACTICE

INTERNATIONAL AND NATIONAL INSTRUMENTS REGARDING THE RIGHTS OF A SICK CHILD

The successful development of pediatric gynecology is a prime example of our state's commitment to fulfilling high socio-ethical obligations in maternal and child healthcare, as well as fostering international integration. It is a vital component of the measures implementing the Law of Ukraine "On the National Program 'National Action Plan for the Structure/175.html">Implementation of the UN Convention on the Rights of the Child for the Period up to 2016'".

Article 24 of the Convention on the Rights of the Child (UN, 1989) enshrines "the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the Treatment of illness and rehabilitation of health." To put this right into practice, the Convention provides for taking necessary measures to reduce infant and child mortality; ensuring the provision of necessary medical assistance and healthcare to all children, with primary focus on The Development of primary healthcare; combating disease and malnutrition; providing expectant and postnatal mothers with appropriate healthcare services; ensuring that all segments of society, particularly parents and children, are informed, have access to education, and are supported in The Use of basic child health and Nutrition, the advantages of breastfeeding, environmental sanitation, and the Prevention of accidents; and developing preventive healthcare education and family planning services.

The UN Convention on the Rights of the Child is a landmark international instrument that safeguards a child's rights from the perspective of fundamental human rights proclaimed in the Universal Declaration of Human Rights (UN, 1948). Fundamental personal rights—such as the right to life, personal integrity, freedom, justice, education, and healthcare—are not forfeited when a child falls ill, nor do they depend on the severity or prognosis of the disease. The dignity of human life remains unchanged by deteriorating health and is not contingent on the quality of life. Moreover, a sick person or a sick child must be surrounded by extra care and attention beyond standard human rights boundaries. The protection of a sick child's rights should facilitate overcoming difficulties, physical and mental suffering, and ensure a high quality of life under conditions of dependency (medical-technical, medico-social, and medico-economic) caused by illness.

The International Conference on Primary Health Care, jointly organized by WHO and UNICEF in Alma-Ata (1978), proclaimed the principles and guarantees of primary healthcare for all peoples of the world. Specifically, this Declaration states that health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity; it is a fundamental human right, and the attainment of the highest possible level of health is a most important worldwide social goal whose realization requires the action of many other social and economic sectors In addition to the health sector.

Other instruments focusing on specific rights of sick individuals and children include: the Council of Europe's "Recommendation on the Rights of the Sick and Dying" (1976), the Council of Europe's "Charter of the Hospitalized Patient" (1979), the World Medical Association's "Declaration of Lisbon on the Rights of the Patient" (1981), the European Parliament's "European Charter of Patients' Rights" (1982), and the WHO "Declaration on the Promotion of Patients' Rights in Europe" (1994). The aforementioned documents protect dignity and integrity, and guarantee respect for a sick child from the moment they enter into a relationship with a healthcare institution. These documents aim to ensure humane treatment for all patients, especially the most vulnerable, such as children.

The Convention on the Rights of the Child (UN, 1989) entered into force in Ukraine on September 27, 1991. Its core provisions are as follows:

— States Parties recognize that every child has the inherent right to life;

— States Parties shall ensure to the maximum extent possible the survival and healthy Development of the child (Article 6);

— the child shall be registered immediately after birth and shall have the right from birth to a name, the right to acquire a nationality and, as far as possible, the right to know and be cared for by his or her parents;

— States Parties shall ensure the implementation of these rights in accordance with their national law and their obligations under the relevant international instruments in this field, in particular where the child would otherwise be stateless (Article 7);

— States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful Interference;

— where a child is illegally deprived of some or all of the elements of his or her identity, States Parties shall provide appropriate assistance and protection, with a view to speedily re-establishing his or her identity (Article 8);

— States Parties shall ensure that a child shall not be separated from his or her parents against their will;

— States Parties shall respect the right of the child who is separated from one or both parents to maintain personal relations and direct contact with both parents on a regular basis, except if it is contrary to the child's best interests (Article 9);

— States Parties shall take measures to combat the illicit transfer and non-return of children abroad (Article 11);

— the child shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of the child's choice (Article 13);

— States Parties shall respect the right of the child to freedom of thought, conscience and religion;

— States Parties shall respect the rights and duties of the parents and, when applicable, legal guardians, to provide direction to the child in the exercise of his or her right in a manner consistent with the evolving capacities of the child;

— freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health or morals or the fundamental rights and freedoms of others (Article 14).

The human (child) right to health can only be realized when it is regulated by law. Upon gaining independence, Ukraine proclaimed the priority of human interests and rights regarding healthcare, a safe environment, and social protection, as declared by the fundamental law of Ukraine — the Constitution.

The Constitution — the Fundamental Law of Ukraine — contains essential provisions. The child, his or her life and health, honor and dignity, inviolability and safety are recognized in Ukraine as the highest social value. Equality of rights for young women is ensured by special measures for the protection of women's labor and health; the establishment of pension benefits; the creation of conditions that enable women to combine work with motherhood; legal protection, material and moral support for motherhood and childhood, including the provision of paid leave and other benefits to pregnant women and mothers. The employment of young women and minors in jobs hazardous to their health is prohibited.

Everyone has the right to health protection, medical care, and medical insurance. Healthcare is ensured by state funding of relevant socio-economic, medical-sanitary, and preventive health programs. The state creates conditions for effective and accessible medical services for all young citizens. In state and municipal healthcare institutions, medical care is provided free of charge, and the network of existing institutions cannot be reduced.

Children are equal in their rights regardless of their origin, as well as whether they are born within or outside of marriage. Child abuse and exploitation are punishable by law. The maintenance and upbringing of orphans and children deprived of parental care are the responsibility of the state. The family, childhood, motherhood, and fatherhood are protected by the state.

Motherhood in Ukraine is protected and encouraged by the state. Maternal and child healthcare is ensured through the Organization of a wide network of women's Medical and Genetic consultations, maternity hospitals, sanatoriums and rest homes for pregnant women and mothers with children, nurseries, kindergartens, and other childcare institutions; the provision of paid maternity leave funded by social insurance and the establishment of nursing breaks during working hours; the payment of childbirth benefits and childcare benefits for sick children in accordance with established Procedures; the prohibition of employing young women in heavy work and hazardous industries, The transfer of pregnant women to lighter work while maintaining their average earnings; health improvement and the enhancement of working and living conditions; the mitigation of negative environmental factors; state and public support for families, and other measures stipulated by the legislation of Ukraine.

Issues concerning the health of children and adolescents are the subject of constant attention and care by the Verkhovna Rada, the President, and the Government of Ukraine, as well as local state authorities and self-government bodies. Improving child healthcare is one of the priority directions of social policy.

The formation of the regulatory and legal framework for healthcare in Ukraine is influenced by numerous factors, such as the Specifics of the initial legal environment, the development of sovereign Ukrainian statehood, socio-economic characteristics, the urgent needs of the healthcare system, the occurrence of emergency situations, and the expansion of international cooperation. These factors determine the directions and intensity of the law-making activities of legislative and executive authorities.

To further develop the provisions of the Basic principles of Legislation of Ukraine on Healthcare concerning "Maternal and Child Healthcare," A number of resolutions of the Cabinet of Ministers of Ukraine have been adopted, addressing the social protection of families raising children with disabilities, social guarantees for low-income families with sick children, and the enhancement of social protection and material support for orphans and children left without parental care.

Resolutions of the Cabinet of Ministers of Ukraine have approved national programs aimed at improving the status of women, their households, families, maternity and childcare, and family planning.

Orders of the Ministry of Health of Ukraine, adopted to implement the aforementioned regulatory legal acts, concern the organization of various medical services, The regulation of medical care for various categories of children, social assistance to children and mothers, etc.

Healthcare institutions must ensure that every young female patient receives qualified medical supervision during Pregnancy, inpatient medical care during childbirth, and therapeutic and preventive care for both the mother and the newborn.

The Law of Ukraine "On State Assistance to Families with Children" dated November 21, 1992, defines the categories of women eligible for maternity benefits.

The types of earnings subject to inclusion when calculating The amount of maternity benefits are determined in accordance with the Procedure established by the Cabinet of Ministers of Ukraine.

The Law of Ukraine "On State Social Assistance to Persons with Disabilities from Childhood and Disabled Children", in accordance with the Constitution of Ukraine, guarantees persons with disabilities from childhood and disabled children the right to financial support funded by the State Budget of Ukraine and ensures their social protection through the establishment of state social assistance at the level of the subsistence minimum. Persons with disabilities from childhood who are eligible for both state assistance and a pension are granted social assistance of their choice. The Law also specifies: the period for which state social assistance is granted; the terms of payment of state social assistance upon A change in disability group; the conditions for the reinstatement of state social assistance payments; the procedure for applying for state social assistance and relevant information; as well as the procedure and deadlines for granting such assistance.

The Law of Ukraine "On Child Protection" defines child protection in Ukraine as a strategic nationwide priority and establishes the fundamental principles of state policy in this area to ensure the realization of a child's rights to life, healthcare, education, social protection, and comprehensive development. The Law defines the following terms: "Child means a person under the age of 18 (majority), unless, pursuant to the law applicable to him/her, he/she attains majority earlier. Childhood means the period of Human Development prior to the attainment of majority." Definitions of other terms are also provided. Child protection legislation is based on the guarantees of the Constitution of Ukraine, the provisions of the UN Convention on the Rights of the Child, international treaties, and other regulatory legal acts governing public relations in this sphere. The task of child protection legislation is to expand the socio-legal guarantees for children, ensure the physical, intellectual, and cultural development of the younger generation, and establish socio-economic and legal institutions to protect the rights and interests of children in Ukraine. The Law defines the fundamental principles of child protection, The system of child protection measures, the organization of child protection, and outlines the rights and freedoms of the child—including the right to life and health, a name and nationality, an adequate standard of living, the right of the child to freely express opinions and receive information, and the right to protection from all forms of violence. The articles of the Law specify the rights, duties, and responsibilities of parents regarding the upbringing and development of the child, the child's right to education, etc.

The Law of Ukraine "On Amendments to the Law of Ukraine 'On State Assistance to Families with Children'" guarantees that the right to child benefits for single mothers is granted to single mothers and single adoptive parents (who are not married) if the child's birth certificate lacks an entry about the father or if the entry about the father was made in the established manner upon the mother's instruction. Widows and widowers with children who do not receive a survivor's pension or social pension for them also have the right to child benefits for single mothers. The allowance is paid in the amount of 10% of the subsistence minimum per child under 16 years of age (or under 18 years of age for students). The allowance is granted for each child.

The Law of Ukraine "On Prevention of Domestic Violence" defines the legal and organizational frameworks for the prevention of domestic violence, as well as the bodies and institutions entrusted with implementing measures to prevent it. Domestic violence refers to any intentional acts of a physical, sexual, psychological, or economic nature committed by one family member against another, if these acts violate the constitutional rights and freedoms of the family member as a human being and citizen and cause moral damage, or harm to their physical or mental health. The Law establishes the grounds for taking measures to prevent domestic violence, special measures for violence prevention, and liability for committing domestic violence.

Decree of the President of Ukraine "On Additional Measures to Ensure the Implementation of the National Program 'Children of Ukraine' for the Period up to 2005." The National Program "Children of Ukraine" is a comprehensive document that, in accordance with the provisions of the UN Convention on the Rights of the Child ratified by Ukraine, outlines the Morphology/3.html">MAIN DIRECTIONS OF state policy regarding children and the measures for its implementation by central and local executive authorities, local self-government bodies, institutions, organizations, and public institutions.

Protecting individuals during their childhood—when the spiritual, moral, and physical Formation of the personality takes place, when national and universal cultural values are assimilated, and when temporary hardships and adults' mistakes can cause harm and deform their development—must be one of the main tasks in shaping our state's development strategy.

The purpose and MAIN OBJECTIVES OF the "Children of Ukraine" program are:

— creating conditions for the physical, intellectual, and spiritual development of children, ensuring their social protection and proper upbringing based on the achievements of Ukrainian national and world cultural and historical development;

— further improving legislation concerning the social protection of children;

— enhancing mechanisms of social support for children who find themselves in difficult and emergency situations;

— developing the network and increasing the operational efficiency of specialized child social protection institutions and services;

— improving maternal and child health, preventing disabilities, and creating conditions for the integration of children with developmental disorders into society;

— improving family-type upbringing forms for orphans and children deprived of parental care, such as family-type orphanages and foster families;

— timely identification of functionally dysfunctional families and ensuring the healthy development of children raised in them;

— regulating child labor and establishing effective mechanisms to monitor compliance with child labor laws.

Resolution of the Cabinet of Ministers of Ukraine No. 66 dated February 8, 1994, “On Additional Social Guarantees for Low-Income Families with Sick Children and Children in their First and Second Years of Life,” introduces compensatory payments to families with sick children when referred for consultation or treatment to state specialized medical institutions in Ukraine to cover travel expenses for the sick child and one of the parents; it also provides free distribution of dairy, dried, canned, and other specialized baby foods for infants and toddlers from low-income families.

Resolution of the Cabinet of Ministers of Ukraine No. 226 dated April 8, 1994, “On Improving the Upbringing, Education, Social Protection, and Material Support of Orphans and Children Deprived of Parental Care,” stipulates that the state protects orphanages from repurposing, sale, and privatization. It establishes that personnel working in infant homes, orphanages, and boarding schools for orphans must demonstrate empathy, kindness, and a high sense of responsibility for their duties. Annual health improvement measures for these children must be organized in sanatoriums, recreational camps, and sports camps. The Ministry of Healthcare is required to ensure medical care for orphans, conduct medical examinations twice a year, place them under dispensary observation when necessary, provide continuous medical supervision and timely treatment, and prioritize the supply of necessary medications, medical apparatus and equipment, and physical development correction tools to educational institutions. It is established that orphans and children deprived of parental care, except for those under guardianship, are fully maintained by the state.

Order of the Ministry of Healthcare of Ukraine No. 77 dated April 14, 1993, “On the Status and Measures for the Further Development of Medical and Genetic Care in Ukraine,” states that genetically determined pathologies account for a significant share of the morbidity STRUCTURE OF THE Ukrainian population with temporary and permanent disability, which, combined with the harmful IMPACT OF ENVIRONMENTAL factors, causes adverse changes in approximately 60% of the population. Marriages between individuals with hereditary pathologies and Congenital Malformations negatively affect their offspring and, overall, population health and labor resources. Hereditary and Congenital diseases are a leading cause of high infant mortality. Perinatal mortality in Ukraine is caused by hereditary pathology in 25% of cases. Environmental pollution continues to significantly influence The Emergence of this pathology. Medical science and practical healthcare currently pay attention, to the extent of their capabilities, to the prevention of hereditary pathologies and congenital malformations. The purpose of the order is to further develop medical genetics in Ukraine. The order contains provisions on the medical and genetic service of Ukraine; recommendations regarding the network of interdistrict medical and genetic offices; staffing standards for medical personnel in genetic centers; a list of congenital malformations in newborns subject to mandatory registration; a list of chromosomal and hereditary pathologies registered outside the neonatal period; and a list of research institutes and medical universities providing consultative, diagnostic, and therapeutic care to sick children with hereditary and congenital pathologies.

Order of the Ministry of Healthcare of Ukraine No. 276 dated October 31, 2000, “On the Procedure for Conducting Preventive Vaccinations in Ukraine,” provides the schedule of preventive vaccinations along with indications and contraindications for their administration. The schedule includes three sections: age-based vaccinations, vaccinations conducted in endemic and enzootic areas and according to epidemiological indications, and recommended vaccinations. The age-based vaccination schedule contains two alternative regimens for hepatitis B vaccination. Vaccination regimens for HIV-infected children and children with AIDS are provided. The Order defines provisions for organizing and conducting preventive vaccinations, provides a list of medical contraindications for preventive vaccinations, and establishes the reporting form for adverse events (complications) following the administration of IMMUNOBIOLOGICAL PRODUCTS.

Order of the Ministry of Healthcare of Ukraine No. 482 dated December 4, 2001, “On Approval of the Procedure for Issuing a Medical Certificate for a Disabled Child Under 16 Years of Age,” and Orders No. 471 and 516 dated November 8, 2001, “On Approval of the List of Medical Indications Entitling to State Social Assistance for Disabled Children Under 16 Years of Age,” contain medical indications that grant the right to receive state social assistance for disabled children under 16 years of age for terms of 2, 5, and 16 years in accordance with the International Statistical Classification of Diseases (ICD-10), and also define the procedure for issuing the medical certificate for a disabled child.

Joint Order of the Ministry of Healthcare of Ukraine, the Ministry of Education and Science of Ukraine, the Ministry of Ukraine for Family, Youth and Sports, and the State Department of Corrections No. 740/1030/4154/312/614 dated November 23, 2007, “On Measures for Organizing the Prevention of Mother-to-Child HIV Transmission, Medical Care, and Social Support for HIV-Infected Children and Their Families,” contains instructions on the procedure for preventing mother-to-child HIV transmission in medical facilities and institutions of the State Penitentiary Service of Ukraine, on the procedure for providing medical and social care to HIV-infected children, as well as a model regulation on the interdisciplinary team for providing medical and social care to HIV-infected children and their families.

Order of the Ministry of Healthcare of Ukraine No. 540 dated August 4, 2006, “On Approval of Breastfeeding Principles, Criteria, and Procedures for Assessing Health Care Facilities for Compliance with the ‘Baby-Friendly Hospital’ Status,” contains breastfeeding support principles that comply with the WHO/UNICEF Global Strategy for Infant and Young Child Feeding, along with criteria and procedures for assessing healthcare facilities for compliance with the “Baby-Friendly Hospital” status.

Order of the Ministry of Healthcare of Ukraine No. 716 dated November 14, 2007, “On Approval of the Clinical Protocol for Obstetric Care ‘Prevention of Mother-to-Child HIV Transmission,’” contains recommendations regarding HIV testing for pregnant women, antiretroviral prophylaxis, Management of Labor in HIV-infected women, and measures to prevent HIV transmission in their infants.

The following national and sectoral programs contribute to improving health, creating conditions for childbirth and child rearing, social protection, combating HIV/AIDS, and raising the quality of education:

— National Program “Children of Ukraine”;

— “School Bus” Program;

— State Program “Reproductive Health of the Nation through 2015”;

— State Program for Overcoming Child Homelessness and Neglect for 2006–2010;

— Intersectoral Comprehensive Program “Health of the Nation for 2002–2011”;

— Demographic Development Strategy through 2015;

— National Program for Ensuring HIV Prevention, Care, and Treatment for HIV-Infected and AIDS Patients for 2004–2008;

— Program for Implementing State Policy in the Field of Combating Illicit Trafficking in Narcotic Drugs, Psychotropic Substances, and Precursors for 2003–2010.

An integrative, practically oriented document was Order of the Ministry of Healthcare of Ukraine and the National Academy of Medical Sciences of Ukraine No. 500/71 dated August 11, 2011, “On Approval of Measures by the Ministry of Healthcare of Ukraine and the National Academy of Medical Sciences of Ukraine to Implement the National Program ‘National Action Plan for the Implementation of the UN Convention on the Rights of the Child through 2016.’” It aims to improve the quality and increase the volume of medical services provided to children, prevent childhood disability, create a safe environment for child development, and preserve children's health and lives.