A/81/133 D. Exclusion from participation in public life 16. Older women are generally excluded from policymaking, including voting. 35 It is usually assumed that their views are represented by family members. 36 Older women, particularly Indigenous women, are also not meaningfully consulted in development and governance processes, which fail to recognize their knowledge and role in sustaining community and environmental systems. 37 E. Lack of access to targeted essential services 17. Services addressing violence against women are often embedded within sexual and reproductive health frameworks designed primarily for those of reproductive age . 38 According to one analysis, only 0.1% of “gender equality”-focused spending specifically includes older women. 39 The situation is compounded by the severe shortage of non-governmental organizations dedicated specifically to addressing older women’s needs. 40 18. Older women have specific health needs that are often insufficiently addressed, such as incontinence, menopause, cancer screening and HIV and other sexually transmitted infection prevention. 41 Clinical trials rarely include older women, and those over the age of 70 are often excluded from breast cancer prevention programmes – and sometimes from treatment altogether. 42 The situation is exacerbated by the tendency for care providers for older persons to receive low wages and inadequate training. 43 19. When healthcare for older women, including psychological and end-of-life care, is neglected, they might see no positive alternatives and feel pressured to agree more frequently to physician-assisted suicide or euthanasia, 44 the normalization of which may institutionalize harmful assumptions about the value of those who need additional care. 45 Studies further indicate that, even though pain can now be medically controlled in up to 98% of cases, most cancer patients still die in pain. The availability of euthanasia and assisted suicide might decrease incentives for training in pain management. 46 20. For many older women, spending the final stage of life at home is deeply important, yet adequate support to facilitate that is often unavailable. 47 Shelters and affordable public housing for older women can often be unequally distributed throughout the country 48 and are underfunded. Accommodation for women escaping violence prioritizes those with minor children, and older women may be denied access __________________ 35 See https://www.cambridge.org/core/journals/ageing-and-society/article/abs/older-and-stillvoting-a-mixedmethods-study-of-voting-amongst-the-older-old-in-europe-and-in-the-northwestof-england/96AB777A88E5C691482AEB322936E4C9. 36 Submission by Komnas Perempuan. 37 Ibid. 38 Submission by Kathryn Falb. 39 See https://www.helpage.org/wp-content/uploads/2024/09/Investing-in-Equality.pdf, p. 5. 40 Submission by HelpAge International España. 41 Ibid. 42 Submission by the Older Women Network Europe. 43 Submission by Australian Feminists for Women’s Rights. 44 Submission by Fondation Jérome Lejeune. 45 See communication CAN 2/2021. All communications mentioned in the present report are available from https://spcommreports.ohchr.org/TMsearch/TMDocuments. 46 Joint submission by Alliance Defending Freedom (ADF International) and others. 47 See https://pmc.ncbi.nlm.nih.gov/articles/PMC12409080/. 48 Submission by the Slovak National Centre for Human Rights. 6/26 26-09992