CRC/C/ECU/CO/4 6. Basic health and welfare (arts. 6; 18, para. 3; 23; 24; 26; and 27, paras. 1-3, of the Convention) Children with disabilities 56. While welcoming the constitutional guarantees (arts. 50 and 53) of full social integration and equal opportunities for children with disabilities, the Ecuador without Barriers Programme (Programa Ecuador sin Barreras), and the fact that children with disabilities have been included in mainstream education, the Committee is concerned at the lack of support provided to the families and the high cost for the family of treating children with disabilities. 57. In light of article 23 of the Convention, the Committee’s general comment No. 9 (2006) on the rights of children with disabilities and the Convention on the Rights of Persons with Disabilities, the Committee recommends that the State party take all necessary measures to protect and promote the rights of children with disabilities, including access to education and providing adequate resources in order for parents to be able to care properly for their children. It further recommends the collection of data disaggregated by age, sex, ethnic origin and socioeconomic background and increased cooperation with civil society. Health and health services 58. The Committee welcomes the adoption in 2006 of the Health Act and the renewed political and financial support to the plans on maternal and infant death, adolescent pregnancy, child malnutrition and free maternity and attention to children. Noting that infant mortality and chronic malnutrition (affecting one in five children under 5) continue to be the most pressing health problems of children, the Committee is particularly concerned that despite recent efforts to expand services such as immunization and prenatal and healthy child services, large segments of the rural and peri-urban population still lack access to and/or face poor quality or culturally non-sensitive services and must pay for medicines in most cases. Also, the Committee is concerned at reports of a lowering of exclusive breastfeeding. 59. While noting more recent information by the State party that infant mortality has decreased and that poverty maps are helping the distribution of food through the school system, the Committee urges the State party to continue expanding maternal and child health services and nutritional surveillance and support including to more remote areas, in a gender and culturally sensitive manner and with an emphasis on prevention and promotion. The Committee further recommends that the International Code of Marketing Breast-milk Substitutes be disseminated. It further recommends that coordination with other actors of the Integral Protection System and teamwork be improved. The Committee also urges the State party to continue to increase public allocations to health, as required in the Constitution. Adolescent health 60. While welcoming the National Plan for the Prevention of Adolescent Pregnancies as a response to one of the most pressing health problems faced by adolescents, the Committee shares the concern expressed by the Committee on the Elimination of Discrimination against Women in 2008 (CEDAW/C/ECU/CO/7, para. 38) at the high rate of pregnancy among teenage girls, especially among indigenous and Afro-Ecuadorian girls (one in five deliveries is by girls between 15 and 18 years of age). In this regard, the Committee is concerned at the insufficient sex and reproductive health education and the absence of information on and access to contraceptives despite the recent Constitution’s explicit 12

Select target paragraph3