21. The Committee notes with concern that clandestine abortions are a major cause of death among women, and the high level of maternal and infant mortality. 22. While noting the increase in the budget of the psychiatric hospital of Paraguay, the Committee is concerned about the situation of patients in psychiatric institutions, especially women and children, and the lack of adequate procedural safeguards for persons committed to such institutions. The Committee is particularly concerned about the abuses suffered by some patients held in solitary confinement. E. Suggestions and recommendations 23. The Committee calls upon the State party to address the specific subjects of concern already expressed with respect to its initial report, and reiterates that the State party should implement the Committee’s suggestions and recommendations in this regard. In particular: (a) The Committee calls upon the State party to take all necessary measures to reduce extreme poverty and to improve its social development strategies, including coordination measures among the various institutions, as well as evaluations to assess the impact of plans and identify their shortcomings. The State party should also adopt additional fiscal measures aimed at improving the distribution of wealth throughout the population in both rural and urban areas. In this respect, the Committee invites the State party to take into consideration its statement on “Poverty and the International Covenant on Economic, Social and Cultural Rights”, adopted on 4 May 2001 (Official Records of the Economic and Social Council, 2002, Supplement No. 2 [E/2002/22 E/C.12/2001/17], annex VII). The Committee requests that the State party, in its next report, include disaggregated and comparative data, and indicators, on the number of persons living in poverty and extreme poverty, as well as on progress made in efforts to combat poverty and extreme poverty; (b) The Committee recommends that the State party increase its efforts to speed up the demarcation of ancestral lands and territories and their return to the indigenous peoples, following up the distribution of land to farmers with measures such as technical assistance, inputs, tools, microcredit, training and infrastructure, as well as irrigation and electricity systems. The State party must ensure that the budget allocated to agrarian reform is not diverted; (c) The Committee recommends that the State party take the necessary measures to ensure equal working conditions for men and women, including equal pay for equal work. The State party should adopt, as soon as possible, the law on equal pay that is being discussed in the Senate, and ensure that it is fully in line with the Covenant; (d) The State party should step up its efforts to eliminate domestic violence and consider amending its criminal legislation on domestic violence to increase the penalty for this offence; (e) The Committee urges the State party to take effective measures to reduce the unemployment rate and regularize the informal economy; and to guarantee that workers are able to exercise their labour rights, including the right to social security; (f) The Committee recommends that the State party ensure that the Ministry of Justice and Labour carries out trade union registration procedures with due diligence. The State party should adopt strong measures to protect unionized workers and their leaders from acts of intimidation, including through investigation, legal proceedings and the imposition of penalties on those responsible for such acts; (g) The Committee requests the State party to adopt effective measures to ensure parity in the minimum wage paid to public and private sector workers, ensuring that the minimum wage allows all families to enjoy an adequate standard of living; (h) The Committee encourages the State party to redouble its efforts to eliminate child labour, particularly in domestic service, taking all appropriate measures. It requests the State party to investigate all cases of exploitation and sexual abuse of child workers, and bring to trial and punish those responsible; (i) The Committee recommends that the State party step up its efforts in the area of health, and invites it to establish a global health policy enabling the poorest sectors to have access to free, high quality primary health care. The Committee requests the State party, in its next report, to provide detailed and updated information, including disaggregated statistical data and indicators, in order to assess the level of progress achieved in that area. 24. The Committee requests the State party to ensure the equality of men and women in all spheres of life, in particular by taking effective measures to combat discrimination in the education of girls and young women, in access to employment and in workingconditions. The Committee recommends that the State party adopt a law on equal opportunities for men and women and ensure that the activities of the Secretariat for Women have a real impact on women’s lives. 25. The Committee recommends that the State party take whatever positive measures are necessary to eliminate discrimination suffered by women in vulnerable situations, such as women in rural areas, including the elaboration of a comprehensive public policy to combat trafficking in persons and to provide protection and assistance to victims. 26. The Committee recommends that the State party amend the articles of the Labour Code that establish discriminatory conditions for domestic work, and increase the number of labour inspections in that sector. 27. The Committee urges the State party to adopt urgent measures to ensure that soybean cultivation does not undermine the ability of the population to exercise the rights recognized by the Covenant. Apart from ensuring compliance with the law on toxic agro chemicals, the State party should establish an effective legal framework for protection against the use of toxic agro chemicals and carry out effective and frequent inspections.