And causing the need for his social. Social insufficiency

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A disabled person is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a limitation of life and necessitating his social security.

Disability - social insufficiency due to a violation of health with persistent disorders of body functions, leading to a limitation of life and the need for social protection.

Social insufficiency - the social consequences of a health disorder, leading to a violation of a person's life and the need for his social protection.

ability to self-service;

ability to move independently;

ability to learn;

ability to labor activity;

ability to orientate in time and space;

the ability to communicate (establishing contacts between people, processing and transferring information);

the ability to control one's behavior.

Recognition of a person as a disabled person is carried out by the State Medical Service. social expertise. The procedure and conditions for recognizing a person as disabled are established by the Government of the Russian Federation.

Disability is a social phenomenon from which no society is free. As they say, no one is immune from disability. A civilized society must do everything possible to enable people with severe disabilities to participate in economic and social life. This is a matter of fundamental human rights, which are the duty of society, the state and legislation to ensure. The whole question is whether there are enough available economic resources for this.

To a large extent, the effectiveness of the relevant policy also depends on the extent of disability in the country, which is due to many factors. These are the state of health of the nation, the level of healthcare, socio-economic development, the quality of the ecological environment, historical heritage, participation in wars and armed conflicts, etc. In Russia, all of the above factors have a pronounced negative vector, which predetermines high rates of disability in society. Currently, the number of disabled people is approaching 10 million people. (about 7% of the population) and continues to grow.

The social vulnerability of the disabled as a specific group of the population is clearly seen in all social indicators. In comparison with the rest of the population (non-disabled), their income at the age of 20 and older is 1.7 times lower, employment at working age is 5.5 times lower, the level of education is significantly lower, the share of singles (living separately), widowed, divorced (divorced) and never married.

The degree of social infringement of a disabled person largely depends on age. The general pattern recorded by the last population census is that social inequality between the disabled and the rest of the population manifests itself especially clearly at the age of 20-40, then gradually weakens and disappears at older ages, and sometimes even turns into a certain advantage of the disabled.

Disability is one of the mediating mechanisms of social differentiation of mortality. Numerous studies of social inequality in mortality show that the survival rate of socially vulnerable groups of the population is significantly lower, especially in pre-retirement ages. From studies of mortality, the "protective" function of a high educational qualification and marital status is well known.

From the point of view of marital status, the differences between the disabled and the rest of the population are greatest at young marriageable ages, and disappear by old age. No less contrasting are the differences between the disabled and non-disabled in terms of the level of education. At the age of 20 to 40, the proportion of people without education is more than 200 times, and the proportion of people with primary and incomplete secondary education among the disabled is 2 times higher than among non-disabled people, the illiterate, as the census data show, almost entirely consists of disabled people. The trend towards leveling differences with age is even more pronounced in education than in marital status. The gap in income levels is also maximum at working age (especially at 20-39 years old), and starting from 65 years old it decreases.

The gradual weakening of the social differentiation of disability with age can be explained by a "selective" effect and a change in the heterogeneity of the population. Early disability can be seen as both a cause and a sign of social disadvantage. In the specific conditions of Russia in the 1990s. disability at older ages can be considered to some extent as adaptive behavior.

The peculiarity of Russian selectivity is manifested in the availability of the status of a disabled person, including awareness of the possibility of obtaining a disability and the benefits associated with this, the availability of medical facilities.

Chapter 1.: General provisions of the social protection of the Russian Federation

In Russian legislation, the definition of disability is based on the model of disability recognized by the state.

In Soviet times, the concepts of "disabled" and "disability" were defined based on the economic model. So, according to Art. 18 of the Law of the USSR "On State Pensions" of 1956, disability is a permanent or prolonged loss of ability to work.

In the 1990s, the definition of disability in the legislation changed due to the influence of the medical and social model of disability. The definition of the concept of "disabled" was enshrined in the Law of the USSR "On the basic principles of social protection of disabled people in the USSR" (Article 2): "a disabled person is a person who, due to the restriction of life due to the presence of physical or mental disabilities, needs social assistance and protection" .

The development of the medical and social model in Russia was influenced by a review published in 1993 by M.V. Korobov " International classification disorders, disability and social insufficiency and the possibility of its use in practical medical and social expertise”, in which the author proposed to use this classification to clarify the criteria for disability, determine the needs of people with disabilities in rehabilitation measures and evaluate the effectiveness of its results.

Finally, the medical and social approach in the definition of the concept

"disabled person" was enshrined in the Federal Law "On the Social Protection of the Disabled in the Russian Federation". In accordance with Art. 1 of this Law, a disabled person is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection. According to the same article, disability is a complete or partial loss by a person of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities.

In 1997, by the Decree of the Ministry of Labor and social development The Russian Federation and the Order of the Ministry of Health of the Russian Federation approve the Classifications and time criteria used in the

medical and social expertise, which became the basic document serving the Decree of the Government of the Russian Federation of August 13, 1996 No. 965 “On the procedure for recognizing citizens as disabled.”161 These Classifications were based on the International Nomenclature of Violations, Restrictions and Social insufficiency.162 Currently, there are Classifications and criteria used in the implementation of medical and social expertise, which were approved in 2009163 (Classifications and criteria). They are based on the same principles and approaches as the previous Classifications. Thus, Russian legislation is based on scientifically developed and accepted by the international community medical and social models of disability.

After the adoption of the Federal Law "On the Social Protection of the Disabled in the Russian Federation", a new definition of the concept of "disability" was introduced, contained in the Classifications and temporary criteria adopted in 1997 used in the implementation of medical and social expertise. According to clause 1.1.2. of these Classifications, disability is a social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and the need for social protection.

630, these Classifications were canceled, there is currently no legal definition of the concept of "disability" in Russian legislation.

Definition of disability in modern legislation can only be identified through a consistent analysis of legal norms. From paragraph 4 of Art. 3 of the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation” dated December 10, 1995 No. 195-FZ, it follows that disability is a difficult life situation, objectively disrupting the life of a citizen, which he cannot overcome on his own. However, this definition does not capture the essence of disability.

The concept of “disabled person” currently enshrined in legislation corresponded to the international documents that existed at the time of its introduction, since the general methodological basis for defining this concept both in the Federal Law “On the Social Protection of Disabled Persons in the Russian Federation” and in the World Program of Action for Disabled Persons and in the Standard Rules for Ensuring Equal Opportunities for Persons with Disabilities was the MCS adopted in 1980. However, after the adoption of the ICF in 2001 and the Convention on the Rights of Persons with Disabilities in 2006, the definition of the concept of “disabled person” contained in Russian legislation is outdated and no longer corresponds to modern international acts, since it does not indicate such an element of disability as the inability to adapt the external environment to a disabled person. In this regard, the development of a new definition is currently very relevant.

Considering the issue of introducing a new concept into the legislation

"disabled", it is necessary first of all to dwell on the terminology used. In Russia, the Latin word “invalid” is used to designate persons with significant health impairments, which means “unfit” in translation. In Russian, this word appeared in the 18th century. in relation to military personnel who, as a result of injuries, did not allow them to support and serve themselves. In the 19th century All persons who have lost the ability to support and serve themselves due to a health disorder began to be classified as disabled.

In modern scientific and socio-political literature, there is a tendency not to use the term "disabled" to refer to people with health problems, explaining this with ethical considerations. There is an opinion that this word offends dignity, discriminates against rights, inspires the idea of ​​one's own inferiority and thus hinders the normal formation of personality. The term “disabled person” is intensively replaced by the terms “person with disabilities” (sometimes “…health” is added), “person with disabilities”, “person with visual impairments (or other impairments)”, etc. For example, the First International Festival of Young Disabled People, held in Moscow in 1992, proposed the term

“disabled person” should be replaced by the concept of “disturbed condition”, since there are no people called disabled, but there are people with various physical, mental, etc. states.

The debate about replacing the word "disabled" with other terms is not new. In the 1930s, the Soviet medical community discussed the question of whether this term should be used, and such names as “limitedly able-bodied”, “persistently disabled”, etc. were proposed.

Since this trend can be reflected in legislation, it is necessary to dwell in more detail on the use of relevant terms.

The term "person with disabilities" is a Russian translation from of English language North American term "people with disabilities". This term does not reflect the specifics of the state of a citizen, because it does not determine in what area of ​​life a given person has limited opportunities (in health, commercial activities, creativity, opportunities for prestigious recreation, etc.).

The terms "person with disabilities", "person with disabilities", "person with visual (hearing, etc.) impairments" reflect the specifics of the state of a citizen, but the Latin term

"disabled" allows you to form a generalizing noun - disability, which is impossible when using the above terms.

The term "disabled person" most clearly conveys the essence of the phenomenon in comparison with other terms in the Russian language. Therefore, its replacement is especially unacceptable in the legislation, since legal technique requires clarity and uniformity of the terminology used.

The proposal by Yu.V. Ivanchina to exclude the term “disabled person” from the circulation of the Labor Code of the Russian Federation and replace it with the terms “capacity for work” and “incapacity for work.” Firstly, such an innovation would contradict the rule on the use in labor law of the concepts of other branches of law in the same meaning that they are given “ parent industries.

Secondly, the concept of "disabled" is broader than the concept of "disabled", since it covers both temporarily disabled persons and persons with permanent disability. The Labor Code of the Russian Federation171 (Labor Code of the Russian Federation) provides for a number of benefits directly for disabled people (who can conditionally be classified as persons with permanent disability) (Articles 92, 94, 96, 99, 113, 128, 179, 224). Usage general concept"disabled" will not allow to single out this category and additional definitions will have to be introduced (temporarily disabled, permanently disabled, etc.).

Thirdly, as noted above, it is wrong to equate disability and incapacity for work. Not every disabled person can be recognized as disabled. In the Classifications and criteria used in the implementation of medical and social examination of citizens by federal government agencies medical and social examination, three degrees of limitation of the ability to work are established (subparagraphs "g" of paragraph 6):

I degree - the ability to perform labor activities in normal working conditions with a decrease in qualifications, severity, tension and (or) a decrease in the volume of work, the inability to continue working in the main profession while maintaining the ability to perform labor activities of a lower qualification under normal working conditions;

II degree - the ability to perform labor activities in specially created conditions using auxiliary technical means;

III degree - the ability to perform labor activity with significant assistance from other persons or the impossibility (contraindication) of its implementation due to existing limitations of life.

As an example, consider the case of determining the degree of working capacity of a disabled person with no lower extremities who is a programmer. This disabled person can work full time at home or in the office and does not require specially created working conditions. Therefore, he cannot be recognized as limited for work, based on the specified Classifications and criteria, although he is undoubtedly a disabled person.

Thus, labor legislation should contain special legal norms that ensure the exercise by disabled people of their right to work (rules on limiting the involvement of disabled people in night work and overtime work, the preferential right to remain at work when the number or staff of employees is reduced, etc. ). Based on the analysis carried out, it is not possible to differentiate the legal regulation of the labor of disabled people without using the term "disabled person".

The concepts "disabled" and "disability" cannot be regarded as equivalent due to the fact that "one of them characterizes the subject, personality, and the second - a special state of health or even a social category." Thus, both concepts should be defined in the legislation.

In order to bring Russian legislation into line with the Convention on the Rights of Persons with Disabilities, in March 2014, amendments were prepared to the Law on the Social Protection of Persons with Disabilities, according to which the definition of the term “disabled person” is supposed to be reworded: “a disabled person is a person who has health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects, disorders anatomical structure organism, its organs and systems, leading to a limitation of life and causing the need for its social

protection." However, the proposed changes, in our opinion, do not solve

the problem of compliance of the considered international documents. The new legal concept of "disabled person" must meet the following requirements:

1. The definition must use the terms contained in the ICF.

2. The definition should indicate that the impairment of a person's health entails both a limitation of his opportunities and the social limitations that this person faces. It is advisable to define the limitation of opportunities with the help of the phrase "limitation of life activity", and social limitations - with the help of the phrase "reduced adaptability to the social environment", the use of which indicates the need to adapt to the disabled environment.

3. Since, from the point of view of law, a person becomes disabled after being recognized as such by competent specialists, this should also be recorded in the definition. The need to reflect this circumstance in the definition, in particular, is indicated by S.Yu. Golovin 174 and V.S. Tkachenko.

In view of the foregoing, the following definition can be given: a disabled person is a person who has a change in health established by the conclusion of a medical and social examination due to a persistent violation of the functions and systems of the body, leading to a limitation of life, expressed in a complete or partial loss of the ability to independently carry out domestic, social and professional activity, as well as to reduce adaptability to the social environment and causing the need for its social protection.

The concept of "disabled" defines a person with certain properties. The concept of "disability" should reflect the properties of a person defined as a disabled person. Therefore, based on the formulated definition of "disabled person" for fixing in regulatory legal acts

the following definition of "disability" can be proposed: disability is a change in human health due to a persistent impairment of the functions and systems of the body, leading to a limitation of life, expressed in the complete or partial loss of the ability to independently carry out household, social and professional activities, as well as to reduce adaptability to social environment and causing the need for its social protection.

Ability to self-service 3rd degree (inability to self-service, the need for constant outside help and complete dependence on other people);

Ability to move 3 degrees (inability to move independently and needing the constant help of other people);

Orientation abilities of the 3rd degree (disorientation and need for constant help and (or) supervision of other persons);

Ability to communicate 3 degrees (inability to communicate and the need for constant help from others);

The ability to control one's behavior of the 3rd degree (inability to control one's behavior, the impossibility of correcting it, the need for constant help (supervision) of other persons).

Criteria for determining Group II disability is a violation of the health of a person with a persistent disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to the restriction of one of the following categories of life activity or their combination and causing the need for his social protection:

Ability to self-service 2nd degree (ability to self-service with regular partial assistance from other persons using, if necessary, auxiliary technical means);

Ability to move 2nd degree (ability to move independently with regular partial assistance of other persons using, if necessary, auxiliary technical means);

Orientation abilities of the 2nd degree (orientation ability with regular partial help of other persons, using auxiliary technical means, if necessary);

Ability to communicate 2nd degree (ability to communicate with regular partial assistance of other persons using, if necessary, auxiliary technical means);

Ability to control one's behavior of the 2nd degree (permanent reduction in criticism of one's behavior and the environment with the possibility of partial correction only with the regular help of other persons);

Ability to learn 3 and 2 degrees (inability to learn or ability to learn only in special (correctional) educational institutions for students, pupils with developmental disabilities or at home according to special programs using, if necessary, auxiliary technical means and technologies);

Ability to work 3 and 2 degrees (inability to work or the impossibility (contraindication) of work or the ability to perform work in specially created working conditions, using auxiliary technical means and (or) with the help of other persons).

Criteria for determining Group III disability is a violation of human health with a persistent moderate disorder of body functions, caused by diseases, consequences of injuries or defects, leading to a limitation of the ability to work I degree or limitation of the following categories of life in their various combinations and causing the need for social protection:

Ability to self-service of the 1st degree (ability to self-service with a longer expenditure of time, fragmentation of its implementation, reduction in volume, using auxiliary technical means if necessary);

Ability to move I degree (the ability to move independently with a longer expenditure of time, fragmentation of performance and reduction of distance using, if necessary, auxiliary technical means);

Orientation abilities of the 1st degree (ability to orientate only in a familiar situation independently and (or) with the help of auxiliary technical means);

Ability to communicate I degree (ability to communicate with a decrease in the rate and volume of receiving and transmitting information; use, if necessary, auxiliary technical means of assistance);

Ability to control one's behavior of the 1st degree (periodically occurring limitation of the ability to control one's behavior in difficult life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction);

Ability to learn I degree (ability to learn, as well as to receive education at a certain level within the framework of state educational standards in general educational institutions using special methods training, a special training mode, using, if necessary, auxiliary technical means and technologies).

Category "disabled child" is determined in the presence of disability of any category and any of the three degrees of severity (which are assessed in accordance with the age norm), causing the need for social protection.

6. 36 Organization of obstetric and gynecological care in Kazakhstan. Measures to combat abortion.

Obstetric and gynecological care is provided in the following APOs:

1) organizations of primary health care (hereinafter referred to as PHC):

polyclinic (city, district, rural);

medical outpatient clinic, feldsher-obstetric station, medical center;

2) healthcare organizations providing consultative and diagnostic assistance (hereinafter referred to as CDP):

consultative and diagnostic centers / polyclinics.

In PHC healthcare organizations, pre-medical and qualified medical care without round-the-clock medical supervision for the protection of women's reproductive health is provided by doctors general practice, primary care physicians/pediatricians, feldshers, obstetricians and nurses.

In healthcare organizations of the KDP, specialized medical care without round-the-clock medical supervision for the protection of women's reproductive health is provided by obstetrician-gynecologists and other specialists.

The mode of operation of state and non-state APOs that provide a guaranteed amount of free medical care established in accordance with applicable law.

Obstetric and gynecological departments (offices) as part of PHC and CDP healthcare organizations organize obstetric and gynecological care for women outside and during pregnancy, in the postpartum period, provide family planning and reproductive health services, as well as prevention, diagnosis and treatment of gynecological diseases reproductive system by:

1) dispensary observation of pregnant women in order to prevent and early detection complications of pregnancy, childbirth and the postpartum period with the allocation of women "by risk factors";

2) identification of pregnant women in need of timely hospitalization in day hospitals, pregnancy pathology departments of maternity hospitals, specialized medical institutions with extragenital pathology, in compliance with the principles of regionalization of perinatal care;

3) referral of pregnant women, women in childbirth, puerperas to receive specialized and highly specialized medical care in medical organizations of the republican level;

4) conducting prenatal training for pregnant women in preparation for childbirth, including for partner childbirth, providing an opportunity for pregnant women to visit a maternity facility where childbirth is planned, informing pregnant women about alarming signs, about effective perinatal technologies, the principles of safe motherhood, breastfeeding and perinatal care;

5) conducting patronage of pregnant women and puerperas;

6) counseling and provision of services on family planning and reproductive health;

7) examination of women of childbearing age with the appointment, if necessary, of an in-depth examination using additional methods and the involvement of narrow specialists for the timely detection of extragenital, gynecological pathology and taking them to the dispensary;

8) depending on the level of reproductive and somatic health, women are included in dynamic observation groups for timely preparation for a planned pregnancy in order to improve pregnancy outcomes for mother and child;

9) organization and conduct preventive examinations the female population for the purpose of early detection of extragenital diseases;

10) examination and treatment of gynecological patients using modern medical technologies, including in hospital-replacing conditions;

11) identifying and examining gynecological patients to prepare for hospitalization in specialized medical organizations;

12) clinical examination of gynecological patients, including rehabilitation and sanatorium treatment;

13) performing minor gynecological operations using modern medical technologies;

14) ensuring the continuity of interaction in the examination and treatment of pregnant women, puerperas, gynecological patients;

15) conducting an examination of temporary disability due to pregnancy, childbirth and gynecological diseases, determining the need for and terms of temporary or permanent transfer of an employee for health reasons to another job, referring women with signs of permanent disability to medical and social examination in the prescribed manner;

16) provision of medical and social, legal and psychological help;

17) advanced training of doctors and paramedical personnel in accordance with the current legislation of the Republic of Kazakhstan;

18) introduction into practice of modern safe diagnostic and treatment technologies, measures for the prevention and rehabilitation of patients, taking into account the principles evidence-based medicine;

19) implementation of sanitary and anti-epidemic (preventive) measures to ensure the safety of personnel and patients, prevent the spread of infection;

20) carrying out activities in the field of informing and improving the sanitary culture of the population on various aspects healthy lifestyle life, preservation of women's reproductive health, preparation for motherhood, breastfeeding, family planning, prevention of abortion and sexually transmitted infections, including HIV infection and other socially significant diseases;

21) analysis of performance indicators of obstetric and gynecological units (office), statistical accounting, evaluation of the effectiveness and quality of medical care, development of proposals for improving obstetric and gynecological care;

22) conducting educational work with the population, doctors and midwives in the following forms: individual and group conversations, lectures, stained-glass windows, publications in print and electronic media (television, radio and the Internet). Educational work is carried out jointly with the centers for the formation of a healthy lifestyle. Accounting for the work done is kept in the register of information and educational work medical organization according to the form 038-1 / y, approved by the order of acting. Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 "On approval of forms of primary medical records healthcare organizations, registered in the Register state registration normative legal acts No. 6697.

The first place should be given to sanitary and educational work among the population (male and female) using its various forms (lectures, conversations, films, radio, television, print, exhibitions, posters, brochures, leaflets, memos, evenings of questions and answers and etc.).

OK Nikonchik points out that for a number of years the percentage of primigravida and nulliparous among the total number of women resorting to abortion has remained the same (about 10%). In her opinion, this fact testifies to the insufficient effectiveness of the sanitary-educational work of women's clinics.

Providing the population with effective contraceptives is of great importance in reducing the number of abortions. In fact, they are available, but either they are not used in sufficient volume, or they are ineptly used. This is indicated by the above data of O. E. Cherpetsky, according to which 52% of women going for an abortion did not use them, and 40% used them ineptly or resorted to ineffective, even harmful methods (coitus interruptus). Based on the materials of O.K. Nikonchik, 30-35% of women who have a regular sexual life do not protect themselves from pregnancy. In this regard, the organization of special receptions on this issue in women's consultations and the sale of contraceptives are useful.

An important role should be played by well-placed social and legal assistance in women's consultations, especially in combination with patronage of pregnant women at home, which makes it possible to clarify the conditions of their life and family relations. Improving the living conditions of pregnant women is also one of the tasks of antenatal clinics.

Particular attention should be paid to primigravidas and women who often resort to abortions, as well as to persons who have resorted to criminal interventions for the purpose of abortion.

Practice has shown that the best results in reducing the number of abortions were achieved where the public was involved in this work and where the fight against abortion was supported by the implementation of the outlined plans for the construction of children's institutions, maternity hospitals, gynecological departments, etc.

Komsomol and trade union organizations of institutions, industrial enterprises and educational institutions should be involved in the fight against abortion. Vigorous work is needed to identify and bring to justice those involved in criminal abortions.

OK Nikonchik gives interesting data concerning new proposals introduced into practice in some regions of the country and aimed at reducing the number of abortions. These include the organization of people's universities for newlyweds (Syzran), dispensary observation women who often resort to abortions (Kuibyshev region), the establishment of a marriage hygiene consultation at the registry office (Voronezh region), a lecture hall for men (Sevastopol), the organization of a university of health for women (Tula region).

Of great importance in the fight against abortion will be the further rise in the well-being of the population, the implementation of state measures to encourage motherhood, the further growth of housing construction, children's institutions and the raising of the cultural level of the Soviet people.

1. 37Main types of institutions for the protection of motherhood and childhood. Their functions.

Women's consultations - dispensary-type medical and preventive institutions that provide all types of preventive and curative care to pregnant women and gynecological patients, as well as taking the necessary measures to protect and improve women's health. They can exist both as independent institutions and as part of maternity hospitals, polyclinics, medical and sanitary units of industrial enterprises or other medical institutions.

Consultations provide medical obstetric and gynecological care to women of the assigned territory, are engaged in the implementation of modern methods diagnostics and treatment, advanced forms and methods of outpatient obstetric and gynecological care, carry out sanitary and educational work among the population, provide assistance to women in matters of legal protection in accordance with the legislation on the protection of motherhood and childhood, conduct preventive actions aimed at preventing complications of pregnancy, childbirth, the postpartum period, gynecological diseases; provide continuity and communication in the examination and treatment of pregnant and sick women with other medical institutions (maternity hospitals, ambulance stations, children's clinics).

As part of each independent antenatal clinic, there are: obstetric and gynecological medical rooms, specialist doctors (therapist, dentist), procedural rooms, for psychoprophylactic preparation of pregnant women for childbirth, for mothers' school, for the prevention of pregnancy, a social and legal worker, an operating room with a rest room for patients, etc. If the consultation is part of another medical institution, then some of his offices are used to serve women.

The work of the antenatal clinic is based on the territorial-district principle, according to which the entire territory served by the consultation is divided into medical sections. The site is served by an obstetrician-gynecologist and a midwife. Reception in consultations is held daily at a convenient time for the population (optimal hours are from 8 to 20). Usually, each district doctor conducts alternating morning and evening appointments, which makes it possible for a woman to contact “her” doctor at a convenient time for her. An appointment for an appointment for all days of the week, a doctor's house call is made by phone or directly through the consultation registry.

The patronage work of antenatal clinics consists in visiting pregnant women (mainly by a midwife or a doctor), puerperas and gynecological patients in order to familiarize themselves with their living conditions, monitor the patient's compliance with the doctor's prescriptions and adherence to the recommended regimen, and establish the health status of women who did not appear at the appointment. a doctor or not hospitalized in a hospital, teaching women the rules of personal hygiene, etc.

You can always get advice from the legal adviser of the antenatal clinic on issues of maternal and child health, work, leisure, etc.

Medical and sanitary units (MSCh) serve workers directly at industrial enterprises and belong to medical and preventive institutions of the outpatient-polyclinic type. They include polyclinics, hospitals, workshop health centers, as well as dispensaries, nurseries, diet tables. Many medical units have a antenatal clinic and an obstetric-gynecological department in a hospital and thus provide the entire volume of obstetric and gynecological care to workers. In addition to serving the workers of their enterprise, many medical units also provide assistance to the population living in the area of ​​their location.

Women's consultations as part of the medical unit are created and work on the shop principle. The duties of obstetrician-gynecologists working in the medical unit include: studying the working conditions of women; selection of pregnant women to be rehabilitated in sanatoriums; recommendations on dietary nutrition of pregnant women in the canteen of the enterprise; examination of temporary disability; development of health-improving measures for the prevention and reduction of temporary disability of women; employment of workers who have undergone gynecological diseases or operations, who are often and for a long time ill; participation in medical examinations of female employees (mandatory preliminary upon admission to work and periodic); organization of a sanitary asset on its site; participation in the development and implementation of activities carried out by the administration of an industrial enterprise and public organizations on labor protection and women's health. To prevent gynecological morbidity, each industrial enterprise creates personal hygiene rooms with separate cabins with a rising shower (bidet), shower units and a room for a short rest for workers after hygiene procedures. Personal hygiene rooms are located, as a rule, not far from the place of work of women, and in large enterprises - in each workshop. Where it is impossible to equip stationary personal hygiene rooms, mobile cabins with shower units and warm water tanks are organized.

"Marriage and Family" consultations are a relatively new form of medical care for the population and are designed to provide them with specialized treatment, preventive and advisory assistance on medical aspects of family and marriage relations. They are organized in the capitals of the Union republics, republican, regional (territorial) centers, other cities with a population of over 500 thousand people and are subdivisions of women's consultations. They provide medical assistance to the population for infertility (male and female), conduct in-depth outpatient examinations and treatment of women and men suffering from reproductive dysfunction, provide consultations on the medical aspects of family planning (individual selection of modern contraceptives to prevent unwanted pregnancy for newlyweds, families with increased risk of giving birth to a sick child), on psychological issues of intra-family communication, on sexual disorders (outpatient examination and treatment of married couples suffering from sexual disorders), a medical genetic examination of families with hereditary pathology is being carried out, sanitary and educational work is being carried out on issues of marriage hygiene.

Medico-genetic consultations. There are two types of medical genetic institutions in the Soviet health care system: regional medical genetic offices and republican (interregional) medical genetic consultations.

Medical genetic rooms are usually deployed at the base regional hospitals. The tasks of the regional offices, in addition to the actual medical genetic counseling (assessing the risk of having a child with a particular pathology), include promoting medical genetic knowledge among doctors and the public, as well as helping doctors and families in diagnosing a number of hereditary diseases. Some genetic studies are also carried out in them (determination of the set of chromosomes, simple biochemical analyzes etc.). In necessary cases, families are sent to the republican (interregional) medical genetic consultations.

The tasks of the republican medical genetic consultations are an in-depth examination of patients with a hereditary pathology (or suspicion of it) and the determination of the genetic risk in the most difficult cases, prenatal diagnostics hereditary pathology, organizing and conducting mass examinations of all newborns for phenylketonuria and hypothyroidism.

Medical genetic counseling. A relatively new type of medical care for spouses (or one of them), aimed at preventing the birth of a child with hereditary diseases or congenital malformations.

There are 2 types of medical genetic counseling: prospective, which is carried out before the birth of a child, and retrospective, carried out after the birth of a sick child and is associated with an assessment of the risk of recurrence of the disease.

In what cases is it advisable to contact a medical genetic consultation for prospective counseling? Firstly, it is necessary in the presence of hereditary diseases or congenital defects in one of the spouses or their close relatives. In these cases, it is more expedient to consult a consultation before the onset of pregnancy, in order to plan a pregnancy or refuse it, taking into account the conclusion of a geneticist.

Second, prospective counseling includes counseling for pregnant women. Sometimes a woman in the period immediately preceding pregnancy, or at the beginning of it, without knowing it yet, takes medication, undergoes X-ray or radioisotope examination, suffers from certain diseases. In such cases, it is also advisable to contact a medical genetic consultation to find out if such effects will affect the condition of the fetus.

The third reason for treatment can and should be repeated spontaneous abortions (miscarriages) in the early stages of pregnancy, as well as infertility of spouses. It is known that in more than 50% of cases, miscarriages in the first 3 months of pregnancy are associated precisely with chromosomal pathology, which can be detected in a latent form in one or both spouses. Therefore, for couples where the wife had 2 or more miscarriages in early dates, the study of chromosomes should be one of the elements of their medical examination.

More complicated is the issue of genetic testing for infertility. Those genetic diseases, which can lead to infertility in women, usually manifested by delayed puberty and the absence of menstruation (amenorrhea), and in such cases, genetic counseling and examination are absolutely necessary. If sexual development proceeds normally and there are no violations menstrual cycle, we can firmly believe that the cause of infertility is not associated with chromosome disorders and consultation with a specialist in infertility, and not a geneticist, is necessary.

In men, a manifestation of genetic disorders leading to infertility is aspermia (absence of spermatozoa in the ejaculate). Therefore, if a spouse has a similar anomaly, a genetic examination is highly advisable. In cases of infertility (male or female), a genetic study should be preceded by a consultation with the relevant specialists - a gynecologist or sexologist.

The second type of medical genetic counseling is retrospective, it is carried out when the family already has (or had) a sick child and the spouses are concerned about the probability of birth next child healthy. This type of counseling is more common. The fact is that in most families, young, healthy spouses, in whose relatives there were no similar diseases, usually there are no obvious reasons to turn to genetics and the birth of a sick child is unexpected for them.

Indications for retrospective counseling are: the birth of a child (fetus) with any congenital malformations; delay in his psychomotor or physical development and the presence of convulsions; intolerance to certain foods in a child, repeated vomiting, chronic diarrhea; progressive jaundice of newborns, enlargement of the liver or spleen; chronic bronchopulmonary diseases, death of a newborn child from intestinal obstruction; decreased hearing or vision in a child; change in color and smell of urine; violation of pigmentation of the skin and mucous membranes; paresis and paralysis of unknown origin. Consultation in these cases can be undertaken at the initiative of the family. There are many other indications for referring to a geneticist - for example, the presence of an unclear pathology of the blood system, intolerance to some drugs, etc., but the recommendation to consult a geneticist in these cases is usually given by the attending physician.

In any case, counseling begins with the establishment of an accurate diagnosis in a sick child or in a sick parent, relative, depending on what was the reason for the appeal. To do this, sometimes you have to resort to special genetic methods of examination - analysis of chromosomes, biochemical research, the study of the nature of skin patterns on the palms and fingers, etc., and in some cases to additional methods clinical examination - X-ray, neurological, study of electrocardio- and electroencephalograms. This is due to the difficulty of identifying hereditary diseases, the number of which is very large (only diseases caused by single genes are known to be more than 3500). In addition, many hereditary diseases similar not only to each other, but also to diseases of a non-hereditary nature.

In each case, at the first visit of the family to the medical genetic consultation, detailed information is collected about the development of the disease, living conditions, past diseases, etc., a pedigree of at least 4 generations is compiled, and, if necessary, the tasks of additional research are determined. The consultation usually ends with the issuance of a medical genetic conclusion.

It should be borne in mind that some hereditary diseases are clinically manifested already at the birth of a child, while others - only after a few months or even years. At the same time, the development of the disease can sometimes be prevented. timely treatment. That is why all newborns must be examined to identify some hereditary diseases, the list of which depends on the characteristics of the region.

Decision-making in retrospective counseling about the advisability of having the next child is influenced by both the magnitude of the risk (risk above 10% in genetics is assessed as high) and the nature of the disease. For example, even a 50% risk of having a baby with six fingers cannot be a reason for not planning a pregnancy, since this defect can be easily removed surgically. At the same time, already with a 5-6% risk of having a child with deep mental retardation or with blindness, most spouses prefer to abstain from further childbearing. Of course, the nature of the recommendation is also influenced by the presence of healthy children in the family, the age of the spouses, their socio-cultural level, and other factors.

It is useful to know that if earlier a geneticist ended the consultation by determining the genetic risk and explaining to his family in an accessible form, giving the spouses the right to decide for themselves what to do, now, due to the success of medicine, it has become possible to directly study the intrauterine fetus. Such studies are united by the concept of prenatal (prenatal) diagnosis, the methods of which depend on the type of pathology, gestational age, and a number of other factors. What does prenatal diagnosis of malformations and hereditary diseases give?

Melenchuk Savely Gennadievich

3rd year student, department of social work of the Law Institute of Siberian Federal University, RF, Krasnoyarsk

AT modern world there are many social problems. These problems hinder the development and normal functioning of society. Their solution is possible only through the coordinated activities of the state and society. This activity is carried out in any state, but it is not always effective, according to different reasons such as lack of funding, lack of knowledge about the causes of social inequality and ways to overcome it, and, sometimes, from the unpreparedness of society itself for change.

Thus, one of the most important social problems in Russia at the moment is the problem of childhood disability. Disabled persons constitute a special category of the population. Disability is associated with a persistent health disorder that leads to limited life activity and necessitates social protection. The state policy towards persons with disabilities is aimed at solving problems of this nature. Disability should be considered in the same way as one of the forms of social inequality. This means that society does not perceive disabled people as full-fledged members of society. This fact suggests that the existing social conditions limit the activity of this population group. This, in turn, hinders the integration of children with disabilities into society.

Therefore, despite the fact that Russia is a social state, which guarantees the equality of rights and freedoms of every person and citizen, regardless of any differences, people with disabilities cannot always exercise their constitutional rights. This characterizes childhood disability as one of the most important social problems.

Problem: Can we say that the rights of children with disabilities, guaranteed by the state, are fully realized?

Hypothesis: The rights of children with disabilities guaranteed by the Constitution of the Russian Federation and other laws are not fully implemented in practice.

The object of the study is children with disabilities.

The subject of the study is the situation of children with disabilities and the problems they face in modern Russia.

The goal is to determine to what extent the rights of children with disabilities guaranteed by the state are realized.

Tasks: - describe the concepts of "disabled" and "disabled child";

· consider the list of guaranteed rights of children with disabilities;

· draw up a questionnaire and conduct a survey of children with disabilities;

Determine to what extent the guaranteed rights of children with disabilities are realized.

Research methods: theoretical - analysis, systematization, generalization: empirical - questioning.

In accordance with the Federal Law "On the Social Protection of the Disabled in the Russian Federation": a disabled person is a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection. Therefore, the concept of a disabled person is enshrined in law. And it denotes a category of people with disabilities who need help and social protection.

Depending on the degree of disorder of body functions and limitation of life activity, persons recognized as disabled are assigned a disability group, and persons under the age of 18 are assigned the category of “disabled child”. Disabled child - an individual under the age of 18 inclusive with deviations in physical or mental development having limitations in life due to congenital, hereditary or acquired diseases, the consequences of injuries that necessitate his social protection. Accordingly, children's disability has a certain age range. Thus, children with disabilities constitute a separate group that requires a special approach in the implementation of assistance programs.

The Manual of Medical Occupational Examination defines "disability" in childhood, as "a state of persistent social maladaptation, due to chronic diseases or pathological conditions, sharply limiting the possibility of including the child in age-appropriate educational and pedagogical processes, in connection with which there is a need for constant additional care for him, assistance or supervision. It follows from this that children with disabilities are not adapted to self-integration into public life and need social protection.

According to the Analytical Bulletin of the Federation Council, until 1979, the presence of disabled children eligible for social benefits was not recognized at all in the USSR, since disability was defined as “a persistent violation (decrease or loss) of general or professional working capacity due to illness or injury” . The status of a "child with a disability" was first officially introduced in the USSR during the International Year of the Child, declared by the UN in 1979. Consequently, until 1979, disabled children were not recognized in the USSR, and they were not provided with assistance. Which, in turn, had a negative impact on the condition of children with disabilities, since the rehabilitation of disabled people is the more effective the earlier it begins.

At the moment, according to official data from the Federal State Statistics Service, the number of disabled children receiving social benefits aged 0 to 17 in the Russian Federation in 2012 is 568,000 people.

As I.V. Larikov, today in Russia there is progressive legislation that provides conditions for the integration of children with disabilities into society. It is based on international treaties signed by Russia and other international acts containing generally recognized principles and norms. international law, following the norms of the Constitution of the Russian Federation, which declares the primacy of international law. Thus, Russia adheres to the position of the world community on the issues of providing children with disabilities with acceptable living conditions.

According to article 7 of the Constitution of the Russian Federation, Russia is welfare state, "whose policy is aimed at creating conditions that ensure a decent life and free development of man" . Accordingly, the policy of the Russian Federation is aimed at improving the level and quality of life and providing opportunities for realizing the potential of people.

Obviously, the possibility of self-realization as a full-fledged member of society is an important factor for a child with disabilities that influences his future life. In accordance with the law “On the Fundamentals of Social Services for the Population in the Russian Federation”, social services created in Russia “provide assistance in professional, social, psychological rehabilitation to disabled people, persons with disabilities, juvenile delinquents, other citizens who find themselves in a difficult life situation and need rehabilitation services". This indicates that children with disabilities in the Russian Federation should be assisted in various areas of life.

According to the Law of the Russian Federation "On State Pensions in the Russian Federation", children with disabilities are provided with a social pension and supplements to it. Also, in accordance with Art. 18 of the Law "On Social Protection of Disabled Persons in the Russian Federation" educational institutions, social protection authorities, communication and information institutions, physical culture and sports ensure the continuity of upbringing and education, the social adaptation of disabled children. Moreover, if it is impossible to educate and educate children with disabilities in general or special preschool and general educational institutions, the state undertook to provide them with a full general education or individual program at home. It follows from this that the educational process is aimed both at the rehabilitation of disabled children and at socialization and education. And the state, in turn, must ensure open access for children with disabilities to the education process.

The Town Planning Code of the Russian Federation guarantees the provision of conditions for disabled people to have unhindered access to social and other facilities. In accordance with the Decree of the Government of the Russian Federation, children with disabilities under the age of 16 are provided with medicines by prescription of doctors free of charge, free dispensing of medicines by prescription of doctors and free dispensing of prosthetic and orthopedic products by enterprises and organizations of the Ministry of Labor and Social Development of the Russian Federation. Thus, the state guarantees a wide range of rights and services to children with disabilities.

However, I.V. Larikova believes that the Russian state policy in this area is contrary to the law - both in the field of the family and in the field of education and rehabilitation.

In order to identify the degree of implementation of the guaranteed rights of children with disabilities in 9 localities of the Russian Federation, a survey was conducted through personal and Internet surveys that covered 67 children with disabilities. The gender and age composition of the respondents is represented by 23 boys and 44 girls, of which 11 are aged 11-13, 31 are 14-16 and 25 are aged 17-18.

Analysis of answers to the question “Does the state provide you with assistance?” showed that 87% of disabled children receive state assistance, and 13% of respondents do not receive state assistance. This fact can be explained by the fact that, perhaps, some children with disabilities do not need help or by the fact that the child is not registered with the social protection authorities.

Based on the results of the question “What types of assistance does the state provide you with?” managed to find out that 89% of the surveyed children with disabilities receive material assistance, 30% - sanatorium treatment, 40% receive drug supply and only 18% of respondents receive all of the above as state aid. Accordingly, assistance among needy children with disabilities is unevenly distributed.

In this regard, 77% of respondents note that the assistance provided by the state is not enough for them, and only 23% of disabled children from among those receiving state assistance consider it sufficient. Thus, the problem of insufficient state assistance for children with disabilities is confirmed.

Education is received by 65 children out of 67, which is 93%, respectively, 2 children do not receive education - 3% of the number of respondents.

Analysis by answering the question “How is your training going?” gave the following results: 33 surveyed children with disabilities receive education in a general educational institution, 24 out of 67 surveyed children study in a special educational institution for children with disabilities, and 10 respondents study at home. According to the results this issue, we can say that almost all children with disabilities receive education, to a greater extent in special educational institutions and at home, rather than in general educational institutions, which indicates that inclusive education for children with disabilities in Russia is still inaccessible.

After analyzing the answers to the question regarding the barrier-free movement of children with disabilities through the streets and buildings, it was possible to find out that 39% of the respondents always encounter problems when moving, 18% of the respondents often face, not often 23%, and 20% of the children with disabilities never do not encounter problems when moving on the street and buildings. Judging by the results of the answers to the question, it can be said with a fair degree of certainty that in Russia there is still no complete “barrier-free environment” that would ensure that there are no problems with the movement of children with disabilities and people with disabilities, in general, along the street and buildings.

Disabled children themselves assess the implementation of state policy aimed at supporting children with disabilities in the following way: 19% of respondents believe that state policy is implemented rather in full, 62% of respondents say that the policy is implemented rather not in full, and 19% of respondents % find it difficult to assess. Accordingly, children with disabilities are convinced that the state does not fully realize its potential in protecting the rights, freedoms and interests of children with disabilities. Children with disabilities are either not satisfied with government assistance, or, for the most part, assess their satisfaction as average, which is a problem that needs to be addressed.

Children with disabilities themselves see possible ways The solution to the above problem is to organize an accessible environment, not in words, but in deeds, 42% of respondents think so. The inevitability of a change in public opinion for the greatest assistance and protection of children with disabilities say 28% of respondents. The fact that not only children, but also their parents need help is evidenced by 9% of responses. The need for free sanatorium-and-spa treatment is noted by 16% of the respondents, and 61% of the disabled children note an increase in the amount of material assistance. The option of building special schools and rehabilitation centers was voiced by 28% of the respondents, and 20% of the respondents spoke about the coverage of the problems of children with disabilities in the media.

Thus, children with disabilities see the prevailing importance in providing the greatest assistance and protection for themselves in increasing material assistance, as a universal means by which children with disabilities and their families themselves can purchase the necessary goods and services to improve the process of rehabilitation and life.

And the final question of the questionnaire showed that 8% of the respondents are quite satisfied with their lives, 17% of the respondents are mostly satisfied with their current situation, and 27% of the interviewed children with disabilities are somewhat satisfied with their lives. A large number of respondents, namely 37%, for the most part are not satisfied with their life, but 11% are not at all satisfied with the way they live. Accordingly, there are much more children with disabilities who are not satisfied with their living conditions at the moment than children with disabilities who are satisfied with their life situation. This is due to the combination of the above problems and factors.

Thus, after analyzing the answers to the questionnaire, we can say with a fair degree of certainty that childhood disability in modern Russia is one of the most important social problems. The situation of children with disabilities at the moment is not one of the best.

Through analysis, comparison of legislation and survey results, it was possible to find out that insufficient state assistance, expressed in minimal financial assistance, cannot compensate for the costs of families for the rehabilitation of children. Pervasive negative public opinion also complicates the processes of rehabilitation and socialization of children with disabilities. Underdevelopment of infrastructure, lack of inclusive education and inadequate legislative measures and standards - all this worsens living conditions, making a child with disabilities feel unwanted, segregated from society.

Thus, the hypothesis that the rights of children with disabilities guaranteed by the Constitution of the Russian Federation and other laws are not fully implemented in practice is confirmed.

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