E/2009/27 E/CN.6/2009/15 belonging to vulnerable groups such as minority or rural women. Experience indicated that women’s out-of-pocket health expenditures were in general higher than men’s; their contribution to and benefits received from social security schemes were lower; and comprehensive packages of services and entitlements did not always cover women’s specific health needs. Universal coverage as well as a gender-specific approach were critical in overcoming health inequities for women. 5. Service delivery reform in primary health care could have a positive impact on women’s right to health. Reforms should include a culturally and gender-sensitive approach that responded to the different health-seeking behaviours of women and men. Women’s input in decisions affecting their health was crucial and had to be enhanced. 6. The need to focus on capacity- and skill-building of health workers, through enhanced gender-sensitivity training, was recognized. It was noted that the majority of health workers were women and that much of the unpaid care work in households and communities was also performed by women. Service delivery should aim to enhance access to primary health care for women, as well as to reduce their unpaid caregiving responsibilities. There was also a need to focus, in a gender-sensitive manner, on effective community participation, raise awareness about people’s right to health, and encourage participation of vulnerable groups in health provision. A rights-based approach that emphasized providers’ obligations and care seekers’ rights should be applied, and training of health providers should focus on eliminating any stigmatizing attitudes or discrimination towards any person seeking care. 7. Participants stressed the role of public health literacy for health promotion and prevention of ill health, and noted that health education should be part of basic primary health-care packages. The importance of gendersensitivity in health education for enhancing women’s health was stressed, as was the urgency of targeting health messages to the needs and priorities of women and girls in a gender-responsive manner. Consideration should be given to the choice of medium for delivering health messages and ways to take into account the barriers that women faced in accessing means of mass communication, including newspapers and the radio, as well as positive experiences with the use of interpersonal communication. The frequency and timing of such communication opportunities was critical to ensuring that women could take full advantage of those opportunities. 8. Participants called for gender-responsive health systems that provided sexual and reproductive health services for all women and girls. Less progress had been made towards achieving Millennium Development Goal 5, on improving maternal health, than any other Goal. At the global level, maternal mortality decreased by less than 1 per cent per year from 1990 to 2005, far below the 5.5 per cent annual improvement needed to reach the target. Maternal mortality represented one of the largest inequities in health, reflecting a lack of access to sexual and reproductive health care as well as the failure of the health system to adequately address the particular needs of women and girls. The consequences of failing to improve access to and the quality of sexual and reproductive health care included maternal morbidity and mortality, infertility and unintended pregnancies, fistula, sexually transmitted 09-28398 11