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(c) Undertake a comprehensive survey on all children deprived of a family environment and create a national register of all such children;
(d) Amend the Consolidated Law on Immigration with a view to explicitly specifying the right to family reunification and its application to all foreigners with this right, including families formed in Italy;
(e) Ensure the proper selection, training and supervision of foster families and provide them with adequate financial support and status;
(f) Take into account the Guidelines for the Alternative Care of Children (General Assembly resolution 64/142, annex).
41. The Committee welcomes the mandatory provisions on the need to listen to the views and opinions of the child in domestic and intercountry adoptions. However, the Committee, noting the practice since 2003 of “open adoption”, expresses concern at the lack of a firm and coherent legal basis for such adoptions and the risks of indeterminate placement in foster families. Furthermore, the Committee reiterates its concern that intercountry adoptions are continuing with non-States parties to the Hague Convention on Protection of Children and Cooperation in respect of Intercountry Adoption, despite the absence of bilateral agreements. While noting the measures taken by the the Commission on Intercountry Adoption, the Committee remains concerned with the large number of private adoption agencies, the inadequate monitoring system and the reports of financial gains of some parties in the adoption process.
42. The Committee recommends that the State party:
(a) Introduce the principle of the best interests of the child as a paramount consideration in legislation, including Acts No. 184/1983 and No. 149/2001, and procedures governing adoption;
(b) Conclude bilateral agreements with all sending countries that have not yet ratified the 1993 Hague Convention;
(c) In compliance with the Hague Convention and article 21 (d) of the Convention on the Rights of the Child, ensure effective and systematic monitoring of all private adoption agencies, consider options to manage or limit the large number of private adoption agencies, and ensure that adoption processes do not provide financial gains to any party;
(d) Ensure systematic follow-up on the well-being of children adopted during the previous years and on the causes and consequences of the breakdown of adoption.
Violence against children, including abuse and neglect of children
43. The Committee is seriously concerned at the absence of a nationwide common system and framework for the protection and prevention of children from all forms of physical and mental violence and a corresponding monitoring and coordinating body for implementation. In this regard, it notes with serious concern results from a survey indicating that the majority of children aged 14-17 years, mostly in northern and central Italy, have experienced or witnessed child ill-treatment. In particular, while encouraged by positive experiences in some regions with respect to data collection (Piemonte and Veneto) and prevention (Emilia Romagna), the Committee is concerned at:
(a) The lack of a comprehensive national data collection system and register on all forms of violence against children;
(b) Regional disparities in terms of the existence and implementation of guidelines on violence against children, and with respect to prevention, treatment and eradication of violence;
(c) The abandonment of children by mothers in difficult situations.
44. The Committee reiterates its previous concerns and concluding observations (CRC/C/15/Add.198, paras. 37 and 38) and, drawing its attention to general comment No. 13, recommends that the State party:
(a) Prioritize the elimination of all forms of violence against children, including by ensuring the implementation of the recommendations of the United Nations study on violence against children (A/61/299), taking into account the outcome and recommendations of the Regional Consultations for Europe and Central Asia (held in Ljubljana, Slovenia, 5-7 July 2005), and paying particular attention to gender;
(b) Provide information concerning the implementation by the State party of the recommendations of the above-mentioned study in its next periodic report, particularly those highlighted by the Special Representative of the Secretary-General on violence against children, in particular:
(i) The development of a national comprehensive strategy to prevent and address all forms of violence and ill-treatment against children;
(ii) The introduction of an explicit national legal ban on all forms of violence against children in all settings;
(iii) The consolidation of a national system of data collection, analysis and dissemination, and a research agenda on violence and ill-treatment against children.
E. Disability, basic health and welfare (arts. 6, 18 (para. 3), 23, 24, 26, 27 (paras. 1-3) and 33 of the Convention)
Children with disabilities
45. The Committee regrets the limited information in the State party’s report on children with disabilities. While welcoming efforts to integrate children with disabilities in the school system, the Committee is concerned that disability is still conceptualized as a “handicap” rather than approached with the aim of ensuring the social inclusion of children with disabilities, and that there are regional disparities in the provision of specialist teachers in schools. The Committee is further concerned at inadequacies and delays with respect to ensuring special care for children with disabilities in early childhood and the lack of statistical data for children with disabilities in the age group of 0-6 years.
46. The Committee recommends that the State party review existing policies and programmes to ensure a rights-based approach in relation to children with disabilities, and consider information and training initiatives to ensure that relevant Government officials and community at large are sensitized in this respect. The Committee also recommends that the State party provide sufficient numbers of specialist teachers to all schools so that all children with disabilities can enjoy access to high-quality inclusive education. Furthermore, the Committee recommends that the State party gather specific and disaggregated data on children with disabilities, including the age group of 0-6 years, to adapt policies and programmes according to such needs. The Committee encourages the State Party to take into account the Committee’s general comment No. 9 (2006) on the rights of children with disabilities in this respect.
Health and health services
47. The Committee notes with concern the absence of defined essential levels of health care (Livelli Essenziali di Assistenza – LEA) in combination with the devolution of health-care powers to the regional level, which has resulted in discrepancies in the quality and efficiency of the health-care system between southern and northern regions of the State party, affecting the right of children to the highest attainable standard of health. The high, and growing, rate of child obesity, and the significant number of children suffering from allergic and/or respiratory diseases, are also a matter of concern to the Committee. The Committee is further concerned that, compared to their Italian counterparts, foreign mothers experience higher rates of stillbirths and perinatal mortality, and are more likely to need treatment in emergency departments or hospitals; this is due, in part, to the fact that undocumented foreign mothers do not undergo the necessary obstetric treatment and tests prior to and during pregnancy, given the criminalization of undocumented foreigners.
48. The Committee recommends that the State party take immediate steps to promote common standards in health-care services for all children in all regions, and:
(a) Undertake an analysis of the implementation of the 2006-2008 National Health Plan with respect to children’s right to health and, on this basis, allocate adequate health-care expenditure for children;
(b) Define the essential levels of health care (LEA) without delay;
(c) Improve training programmes for all health professionals in conformity with the rights of the child;
(d) Undertake advocacy and awareness-raising programmes targeting schools and families, emphasizing the importance of physical exercise, healthy eating practices and lifestyles, including the effective implementation of the National Prevention Plan 2010-2012, and increase the hours and improve the quality of physical education in the curricula of primary and secondary schools;
(e) Develop and implement an information and awareness-raising campaign on the right to health care of all children, including those of foreign origin, targeting in particular health-care facilities that are accessed by foreign communities. This should include addressing the higher rates of stillbirths and perinatal mortality among foreign mothers.
49. The Committee is concerned at the low rate of exclusive breastfeeding for the first six months, and the practice of providing complementary foods to infants from the age of four months. The Committee is further concerned at the unregulated marketing of food for infants, young children and adolescents, and inadequacies in the monitoring of the marketing of breast-milk substitutes.
50. The Committee recommends that the State party take action to improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures including campaigns, information and training for relevant Government officials, particularly staff working in maternity units, and parents. The Committee further recommends that the State party strengthen the monitoring of existing marketing regulations relating to food for children and regulations relating to the marketing of breast-milk substitutes, including bottles and teats, and ensure that such regulations are monitored on a regular basis and action is taken against those who violate the code.
51. The Committee is concerned at the absence of a comprehensive national strategy or system to assess and monitor the situation of mental health among children, in particular adolescents. It regrets, in this regard, that the National Guidelines on Mental Health of 2008 have yet to be implemented. The Committee is further concerned that inadequate resources have prevented local health authorities and the Child and Adolescent Neuropsychiatric Services from putting in place multidisciplinary teams to address mental health problems among children from a socio-psychological approach. It is also of concern to the Committee that some psychopharmaceuticals used by children have the side effect of increased suicidal tendencies. The Committee is also concerned over the prevalence of depression, which may lead to suicides among children.
52. The Committee, referring to its general comment No. 4 (2003) on adolescent health and development, recommends that the State party strengthen available and quality services and programmes for mental health, and in particular:
(a) Implement and monitor the National Guidelines on Mental Health without delay;
(b) Develop a comprehensive national mental health policy with a clear focus on the mental health of adolescents, and ensure its effective implementation by allocating adequate public funding and resources and developing and implementing a monitoring system;
(c) Implement a multidisciplinary approach to the treatment of psychological and psychosocial ill-health and disorders among children by establishing an integrated system of child mental-health care that involves the parents, family and school, as relevant.
Drug and substance abuse
53. The Committee is deeply concerned at the increase in use of illicit drugs, in particular amphetamines, among adolescents in the State party. The Committee notes with concern that such drugs are often used to improve school performance and to fight depression. Further, the Committee is concerned at the high levels of alcohol consumption and tobacco use among children, and the negative influence of advertisements, through direct advertising or through the mass media in general.
54. The Committee, referring to its general comment No. 4, recommends that the State party take relevant measures to eliminate the use of illicit drugs by children, through communication programmes and campaigns, the provision of life-skills education to adolescents, and the training of teachers, social workers and other relevant officials. This must include programmes on promoting healthy lifestyles among adolescents to prevent the use of alcohol and tobacco and the enforcement of regulations on the advertising of such products to children. The Committee encourages the State party to present information on such efforts and data on the use of illicit drugs by children in its next periodic report to the Committee.
Children of incarcerated parents
55. While the Committee welcomes the adoption of Act No. 62/2011 on the protection of the relationship between mothers in prison and their minor children, it is concerned at the high number of children separated from one or both parents who are imprisoned, the situation of babies who are living in prisons with their mothers, and cases where children risk being separated from their mothers if the mother does not meet the requirement for house arrest.
56. The Committee recommends that the State party undertake a study on the situation regarding the rights of children with parents in prison to a family environment, with a view to ensuring personal relations, adequate services and appropriate support in line with article 9 of the Convention.
Standard of living
57. The Committee is deeply concerned at the high number of children living in poverty in the State party and at the disproportional concentration of child poverty in southern Italy. The Committee is also concerned to note that the State party has the second-lowest employment rate among women in the European Union (below 50 per cent), in particular given that that child poverty is closely linked with unemployment among women. While appreciating recent policy interventions in 2008-2009 for low-income families (the Bonus Famiglia and the Social Card), the Committee is concerned that such programmes only marginally reduce inequalities and poverty. The Committee notes with concern that the programmes of the State party seem to focus on income measures and have limited consideration of social, cultural, geographic and other such structural determinants of poverty reduction.
58. The Committee urges the State party to intensify its efforts to address and eradicate poverty and inequality, especially of children, and:
(a) To consider systematic reform of current policies and programmes to effectively address child poverty in a sustainable manner, using a multidisciplinary approach that considers social, cultural, and geographic determinants of poverty reduction;
(b) To evaluate the result of current programmes on poverty alleviation and ensure that subsequent policies and plans contain relevant indicators and a monitoring framework;
(c) To increase the participation of women in the labour market and promote flexible working arrangements for both parents, including by increasing the provision of childcare;
(d) To increase and sustain income support for low-income families with children and ensure that such support is extended to families of foreign origin.