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INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT HELD AT CARIO, 5-13 SEPTEMBER 1994
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CENTER FOR REPRODUCTIVE LAW & POLICY • INTERNATIONAL PROGRAM
The Cairo Conference
A Programme of Action for Reproductive Rights?
The 1994 International Conference on Population and Development (the “ICPD”) was a watershed event.
Representatives from over 180 nations met in Cairo and agreed to the centrality of women in all discussions of
population and development. Although the conference ii'as characterized by opposition from certain religious
coalitions and a continued concern with high population growth rates, it is the first United Nations population
conference that endorsed “reproductive rights.” The success of the ICPD Programme of Action, measured in terms
of improving women’s lives, will depend upon the actions taken by governments and non-governmental
organizations (“NCO’s”) in the years to come. NGO’s must devise strategies to hold governments accountable
and to ensure that the promises of reproductive rights and empowerment do not ring hollow. An understanding of
those portions of the ICPD Programme of Action that represent important advances for women willfacilitate the
development of such strategies.
International Human Rights
Population policies seek to influence the most intimate and profound decisions of an individual’s life.
All United Nations population conference documents, therefore, have called for respecting human
rights. The ICPD Programme of Action, however, is notable for its endorsement of a range of
human rights. The document not only recommends that national population policies respect
international human rights norms, it also endorses a host of rights — such as the right to
development, the right to health, the right to health care, the right to education, and the right to
decide the number and spacing of children — that are applicable to a broad range of development
policies. The opening paragraph of the introductory chapter, entitled “Principles,” reflects the
increasing importance of international human rights and the political compromises crafted to
maintain consensus.
The implementation of the recommendations contained in the ICPD Programme of Action is the
sovereign right of each country', consistent ivith national laws and development priorities, with full
respect for the various religious and ethical values and cultural backgrounds of its people, and in
conformity with universally recognized international human rights.
Because human rights principles elevate women’s need for dignity, equality, and respect to the level
of a right, most womens health advocates have enthusiastically supported the call to integrate
4
i
international human rights principles into the ICPD document. Hence the call for governments to *
exercise their sovereignty consistent with international human rights. Yet certain countries opposed
to the universal application of international human rights have argued for the sovereign right to
enact laws, regardless of their human rights implications, so long as such laws respect religious and
other values. For example, Iran registered its reservations to all language in the chapter entitled
“Principles” which dealt with sexual relationships outside of marriage and other acts not consistent
with Islam. In an attempt to balance these perspectives, the ICPD Programme of Action declares
that its recommendations must be implemented consistent with national law and international
human rights and with respect for the diversity of religious and ethical values. But what occurs
when a government seeks to implement the ICPD Programme of Actions recommendations by
enacting policies that are consistent with national laws but inconsistent with international human
rights law? The ICPD document does not wrestle with this problem.
Empowerment of Women
The ICPD Programme of Action has been heralded for articulating and reflecting a dramatic shift
in global population policy through its recognition of the pivotal role of women. The document
approaches womens empowerment holistically by acknowledging the multi-faceted nature —
economic, cultural, social, and legal — of the policies that must be employed to improve womens
lives. The key paragraph of the ICPD Programme of Action regarding womens empowerment is as
follows:
4.1 The empowerment and autonomy of women and the improvement of their political, social,
economic and health status is a highly important end in itself In addition, it is essential for the
achievement of sustainable development. The full participation and partnership of both women
and men is required in productive and reproductive life, including shared responsibilities for the care
and nurturing of children and the maintenance of the household. In all parts of the world,
women are facing threats to their lives, health and well-being as a result of being overburdened
with work and of their lack of power and infuence. In most regions of the world, women receive
less formal education than men, and at the same time, women's own knowledge, abilities and
coping mechanisms often go unrecognized. The power relations that impede women's attainment
of healthy and fulfilling lives operate at many levels of society, from the most personal to the highly
public. Achieving change requires policy and programme actions that will improve women's access
to secure livelihoods and economic resources, alleviate their extreme responsibilities with regard to
housework, remove legal impediments to their participation in public life, and raise social awareness
through effective programmes of education and mass communication.
Based upon these principles, the ICPD Programme of Action strongly recommends government
actions that support womens empowerment. The vast majority of ICPD participants endorsed this
perspective. However, a minority of Islamic nations indicated a degree of discomfort with such
strong language on womens rights. For instance, Libya expressed a reservation to all sections of the
chapter entitled “Gender Equality, Equity and Empowerment of Women” to the extent that they
contradicted Islamic law, particularly as it relates to inheritance rights and sexual behavior.
Nonetheless, the ICPD document does not bow to regressive minority views on womens equality
and empowerment.
2
Reproductive Health
A necessary prerequisite to the empowerment of women is the provision of health services and,
particularly, reproductive health care. To date, many population programs have focused on the
provision of a narrow range of contraceptive services in die context of family planning clinics. Such
programs thus respond only to one of womens many health needs. The ICPD Programme of
Action acknowledges the need for a broader approach to health as it relates to population and
development policies. The document also endorses a modified version of the World Health
Organizations (the “WHO”) definition of the term “reproductive health.”
72. Reproductive health is a state of complete physical, mental and social wr1!-being and not
merely the absence of disease or infirmity, in all matters relating to the reproductive system and to
its Junctions and processes. Reproductive health therefore implies that people are able to have a
satisfying and safe sex life and that they have the capability to reproduce and the freedom to
decide if when and how often to do so. Implicit in this last condition are the right of men and
women to be informed and to have access to safe, effective, affordable and acceptable methods of
family planning of their choice, as well as other methods of their choice for regulation offertility
which are not against the law, and the right of access to appropriate health-carr services that will
enable women to go safely through pregnancy and childbirth and provide couples with the best
chance of having a healthy infant. In line with the above definition of reproductive health,
reproductive health care is defined as the constellation of methods, techniques and services that
contribute to reproductive health and well-being through preventing and solving reproductive health
problems. It also includes sexual health, the purpose of which is the enhancement of life and
personal relations, and not merely counselling and care related to reproduction and sexually
transmitted diseases.
The ICPD Programme of Actions endorsement of a reproductive health approach is a major success
for womens health advocates. Paragraph 7.6 of the document urges governments to provide women
and men with a host of services such as pre- and post-natal care, safe delivery, and treatment of
infertility, reproductive tract infections, and sexually transmitted diseases. As to abortion services,
paragraph 7.6 suggests that services be limited in the manner specified in paragraph 8.25, the key
abortion paragraph that is discussed below. This shift toward a reproducti'7^ health perspective was
achieved despite opposition from a handful of participants. The Holy See expressed reservations to
the entire chapter entitled “Reproductive Rights and Reproductive Health.” Malta registered
reservations to this chapters title. Several Islamic nations — Afghanistan, Brunei, Djibouti, Kuwait,
Libya, and Yemen — also reserved on terminology that they regarded as being in contradiction to
Islamic law. These conservative forces served to dilute references to sexual health and sexual rights
throughout the entire ICPD Programme of Action. They also forced all references to “fertility
regulation” — a phrase defined by the WHO to include certain abortion-related services — to be
replaced by “regulation of fertility,” a phrase that has no pre-determined definition. Moreover, in
paragraph 7.2, the scope of the term “regulation of fertility” is further circumscribed. Women and
men are to regulate their fertility only by methods that are “not against the law.” Nonetheless, the
ICPD Programme of Action remains unequivocal in its support for a broad-based reproductive
health approach.
3
Reproductive Rights
One of the singular accomplishments of the ICPD Programme of Action is its support for
“reproductive rights.” The ICPD Programme of Action is also the first United Nations population
conference document that begins to delineate the core elements of this right:
73. Bearing in mind the above definition, reproductive rights embrace certain human rights that
are already recognized in national laivs, international human rights documents and other relevant
United Nations consensus documents. These rights rest on the recognition of the basic right of all
couples and individuals to decide freely and responsibly the number, spacing and timing of their
children and to have the information and means to do so, and the right to attain the highest
standard of sexual and reproductive health. It also includes the right of all to make decisions
concerning reproduction free of discrimination, coercion and violence as expressed in human rights
documents. In the exercise of this right, they should take into account the needs of their living and
future children and their responsibilities towards the community. The promotion of the responsible
exercise of these rights for all people should be the fundamental basis for government- and
community-supported policies and programmes in the area of reproductive health, including family
planning. As part of their commitment, full attention should be given to the promotion of
mutually respectful and equitable gender relations and particularly to meeting the educational and
service needs of adolescents to enable them to deal in a positive and responsible way with their
sexuality.
Given the importance of reproductive rights to a woman-centered approach to population issues, it
is not surprising that this section of the ICPD document served as a lightening rod for opponents of
change. Conservative religious forces led by the Holy See questioned the validity of the very
concept of “reproductive rights.” Not only did they regard this right as one not previously
recognized by the United Nations, but they also argued that the phrase includes a right to abortion
on demand. Nicaragua and the Dominican Republic specifically registered a reservation to the
phrase “reproductive rights” on the basis that they regarded life as beginning at conception. Several
governments also expressed concerns about who would have the “right” to make reproductive
decisions. Governments intensely debated whether “couples and individuals” or just couples had
the right to decide the number and spacing of children. Nations such as Egypt, El Salvador, and
the Dominican Republic supported conferring reproductive choice exclusively upon couples in a
marital context. Once again, in an attempt to balance divergent views, the ICPD Programme of
Action incorporates compromise language. It recognizes that “couples and individuals should make
reproductive decisions, but such decisions “should take into account . . . [peoples] responsibilities
towards the community.” In fact, the concept of responsible decision-making is mentioned no less
than four times in this one paragraph. These references reflect a covert attempt to set parameters on
reproductive choice. Although most people regard reproductive decisions as profoundly personal,
the ICPD document suggests that people consider the social and economic consequences to “the
community”of their decision to bear children. Despite ideological attacks, however, the ICPD
Programme of Action endorses the principle of reproductive rights and the right of “couples and
individuals” to determine the number and spacing of their children.
4
Family Planning
Given the many controversies relating to womens empowerment and reproductive rights, family
planning was relatively uncontroversial at the ICPD. Although the Holy See had sought to
jeopardize the concept of family planning by claiming that such services include abortion, it failed
to mobilize support for its position. The ICPD Programme of Action thus states:
7.12. The aim offamily-planning programmes must be to enable couples and individuals to
decide freely and responsibly the number and spacing of their children and to have the information
and means to do so and to ensure informed choice and make available a full rmge of safe and
effective methods. The success ofpopulation education and family-planning programmes in a
variety of settings demonstrates that informed individuals everywhere can and w:1l act responsibly
in the light of their own needs and those of theirfamilies and communities. 1 he principle of
informed fee choice is essential to the long-term success offamily-planning programmes. Any
form of coercion has no part to play. In every society there are many social and economic
incentives and disincentives, in order to lower or raise fertility. Most such schemes have had only
marginal impact on fertility and in some cases have been counterproductive. Governmental goals
forfamily planning should be defined in terms of unmet needs for information and services.
Demographic goals, while legitimately the subject ofgovernment development strategies, should not
be imposed on family-planning providers in the form of targets or quotas for the recruitment of
clients.
The ICPD Programme of Action recognizes the centrality of informed choice to family planning
programs. Coercion and abuse is rejected, as are incentives that seek to influence family size. The
documents position on demographic targets, however, is unclear. On the one hand, the ICPD
Programme of Action states that quantitative measures are “legitimately the subject of government
development strategies.” On the other hand, it recognizes that quantitative goals “should not be
imposed upon family planning providers in the form of targets or quotas for the recruitment of
clients.” Does this mean that nations that attempt to achieve broad fertility targets are acting in
accordance with the ICPD Programme of Action? Can nations impose targets or quotas relating to
the retention or treatment — as opposed to the “recruitment” — of clients? The ICPD document
does not explicitly answer these important questions.
Safe Motherhood
During the preparatory meetings of the ICPD, Safe Motherhood programs were attacked by the
Holy See and its allies on the ground that such programs were a subterfuge for abortion rights.
This assault failed. The ICPD Programme of Action states:
8.19. Maternal deaths have very serious consequences within the family, given the crucial role of
the motherfor her children’s health and welfare. Tie death of the mother increases the risk to the
survival of her young children, especially if the family is not able to provide a substitute for the
maternal role. Greater attention to the reproductive health needs offemale adolescents and young
women could prevent the major share of maternal morbidity and mortality through prevention of
unwanted pregnancies and any subsequent poorly managed abortion. Safe motherhood has been
accepted in many countries as a strategy to reduce maternal morbidity and mortality. 1
5
t
e ICPD document thus recognizes the toll that unplanned motherhood may have on womens
lives. However, because of the politicization of all issues perceived as abortion-related, the
document falls short of strongly endorsing the need for safe motherhood policies. The ICPD
rogramme of Action merely states tliat safe motherhood “has been accepted by many countries” as
one strategy by which to combat maternal morbidity. It does not recommend that govermnents
support or expand these programs.
Abortion
Abortion was the most contentious issue at tthe
’__ 2272.
J
ICPD Perhaps unfortunately,
the conflict over
abortion thus received the greatest media coverage. The carefully crafted paragraph
i in the ICPD
Programme of Action regarding abortion states:
8.25.
In no case should abortion be promoted as a method offamily planning. All
Governments and relevant intergovernmental and non-governmental organizations are urged to
strengthen their commitment to women's health, to deal with the health impact of unsafe
abortion^^/ as a major public health concern and to reduce the recourse to abortion through
expanded and improved family planning services. Prevention of unwanted pregnancies must
always be given the highest priority and all attempts should be made to eliminate the needfor
abortion. Women who have unwanted pregnancies should have ready access to reliable
information and compassionate counselling. Any measures or changes related to abortion within
the health system can only be determined at the national or local level according to the national
legislative process. In circumstances in which abortion is not against the law, such abortion should
be safe. In all cases women should have access to quality services for the management of
complications arising from abortion. Post-abortion counselling, education andfamily planning
services should be offered promptly which will also help to avoid repeat abortions.
***/ Unsafe abortion is defined as a procedure fer terminating an unwanted
pregnancy either by persons lacking necessary skills or in an environment
lacking the minimal medical standards or both. (WHO/MSM792.5).
This paragraph raises several important issues, including the use of the terms “unsafe abortion” and
abortions that arc “not against the law.” Anti-choice forces, represented by the Holy See, Malta,
Ecuador, and Argentina, argued that all abortions were unsafe for the fetus. The phrase “unsafe
abortion, they argued, was thus redundant. The majority view is that there are indeed abortions
that are safe for a woman seeking to end her unwanted or health-threatening pregnancy. The
WHO definition of unsafe abortion” was incorporated into the document to clarify this issue. The
paragraph also strongly endorses the sovereignty of the national legislative process in abortionrelated matters. This endorsement appears to reject the role of national courts and appropriate
human rights forums in dealing with abortion laws. It is also noteworthy that paragraph 8.25 does
not refer to “legal abortions.” It refers to abortions that are “not against the law.” The two or three
nations in the world with the most stringent abortion laws declared that they could not be asked to
recommend legalizing abortion. Malta expressed a reservation to the phrase “abortion is not against
the law” in paragraph 8.25. A positive aspect of the ICPD document is its acceptance of the
importance of post-abortion counselling and care. Nations such as Bangladesh, Cyprus, Canada,
Zambia, and Zimbabwe were strong supporters of this principle. Thus, although the ICPD
Programme of Action does not contain abortion rights language, it does recognize unsafe abortions
as a public health crisis and does call for greater safety and compassion for women obtaining
abortions.
6
1
Conclusion
It remains to be seen whether the ICPD Programme of Action will enhance reproductive health
and rights. Because the document continues to express a concern with high global population
growth rates, it can be regarded as espousing a utilitarian perspective — women should be
empowered and educated because doing so will reduce fertility rates. The goal of population and
development policies should be to promote egalitarian policies that enhance the quality of life for
all, particularly, the reproductive health, socio-economic status, and equality of women. Moreover,
although the ICPD Programme of Action articulates a paradigm shift toward a broader reproductive
health approach, the financial commitments to making these services available do not even come
close to matching those for family planning programs. The total cost of implementing the
programs suggested by the ICPD document is estimated to be $21.7 billion by the year 2015. Of
this amount, $13.8 billion is committed to family planning programs, $6.1 billion to reproductive
health, and $1.5 billion to HIV/AIDS prevention. Nonetheless, the ICPD document is an
important beginning. The promises contained within the ICPD Programme of Action, if
implemented, would indeed transform womens lives and set the stage for true reproductive dignity
and freedom.
Please note: This publication contains quotations front the unedited version of the Programme of Action, dated
September 19, 1994, which was distributed immediately after the ICPD.
October 28, 1994
Forfurther information on these issues, contact Rachael N. Pine, Director of International Programs, Anika
Rahman, Staff Attorney, or Rebecca Casanova, Associate.
7
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CENTER FOR REPRODUCTIVE LAW & POLICY • INTERNATIONAL PROGRAM
The Cairo Conference
A Programme of Action for Reproductive Rights?
The '1994 International Conference on Population and Development (the aICPD”) mas a matershed event.
Representatives from over 180 nations met in Cairo and agreed to the centrality of momen in all discussions of
population and development. Although the conference ivas characterized by opposition from certain religious
coalitions and a continued concern mith high population gromth rates, it is the first United Nations population
conference that endorsed reproductive rights.” The success of the ICPD Programme of Action, measured in terms
of improving momens lives, mill depend upon the actions taken by governments and non-governmental
organizations (^NGO’s”) in the years to come. NGO's must devise strategies to hold governments accountable
and to ensure that the promises of reproductive rights and empomennent do not ring hollow. An understanding of
those portions of the ICPD Programme of Action that represent important advances for women will facilitate the
development of such strategies.
International Human Rights
Population policies seek to influence the most intimate and profound decisions of an individual’s life.
All United Nations population conference documents, therefore, have called for respecting human
rights. The ICPD Programme of Action, however, is notable for its endorsement of a range of
human rights. The document not only recommends that national population policies respect
international human rights norms, it also endorses a host of rights — such as the right to
development, the right to health, the right to health care, the right to education, and the right to
decide the number and spacing of children — that are applicable to a broad range of development
policies. The opening paragraph of the introductory chapter, entitled “Principles,” reflects the
increasing importance of international human rights and the political compromises crafted to
maintain consensus.
The implementation of the recommendations contained in the ICPD Programme of Action is the
sovereign right of each country, consistent with national laws and development priorities, with frill
respect for the various religious and ethical values and cultural backgrounds of its people, and in
conformity with universally recognized international human rights.
Because human rights principles elevate womens need for dignity, equality, and respect to the level
of a right, most womens health advocates have enthusiastically supported the call to integrate
international human rights principles into the ICPD document. Hence the call for govermnents to
exercise their sovereignty consistent with international human rights. Yet certain countries opposed
to the universal application of international human rights have argued for the sovereign right to
enact laws, regardless of their human rights implications, so long as such laws respect religious and
other values. For example, Iran registered its reservations to all language in the chapter entitled
“Principles” which dealt with sexual relationships outside of marriage and other acts not consistent
with Islam. In an attempt to balance these perspectives, the ICPD Programme of Action declares
that its recommendations must be implemented consistent with national law and international
human rights and with respect for the diversity of religious and ethical values. But what occurs
when a government seeks to implement the ICPD Programme of Actions recommendations by
enacting policies that are consistent with national laws but inconsistent with international human
rights law? The ICPD document does not wrestle with this problem.
Empowerment of Women
The 1CPD Programme of Action has been heralded for articulating and reflecting a dramatic shift
in global population policy through its recognition of the pivotal role of women. The document
approaches womens empowerment holistically by acknowledging the multi-faceted nature —
economic, cultural, social, and legal — of the policies that must be employed to improve womens
lives. The key paragraph of the ICPD Programme of Action regarding womens empowerment is as
follows:
4.1 The empowerment and autonomy of women and the improvement of their political, social,
economic and health status is a highly important end in itself In addition, it is essential for the
achievement of sustainable development. The full participation and partnership of both women
and men is required in productive and reproductive life, including shared responsibilities for the care
and nurturing of children and the maintenance of the household. In all parts of the world,
women are facing threats to their lives, health and well-being as a result of being overburdened
with work and of their lack of power and influence. In most regions of the world, women receive
less formal education than men, and at the same time, women’s own knowledge, abilities and
coping mechanisms often go unrecognized. The power relations that impede women’s attainment
of healthy and fulfilling lives operate at many levels of society, from the most personal to the highly
public. Achieving change requires policy and programme actions that will improve women’s access
to secure livelihoods and economic resources, alleviate their extreme responsibilities with regard to
housework, remove legal impediments to their participation in public life, and raise social awareness
through effective programmes of education and mass communication.
Based upon these principles, the ICPD Programme of Action strongly recommends government
actions that support womens empowerment. The vast majority of ICPD participants endorsed this
perspective. However, a minority of Islamic nations indicated a degree of discomfort with such
strong language on womens rights. For instance, Libya expressed a reservation to all sections of the
chapter entitled “Gender Equality, Equity and Empowerment of Women” to the extent that they
contradicted Islamic law, particularly as it relates to inheritance rights and sexual behavior.
Nonetheless, the ICPD document does not bow to regressive minority views on womens equality
and empowerment.
2
Reproductive Health
A necessary prerequisite to the empowerment of women is the provision of health services and,
particularly, reproductive health care. To date, many population programs have focused on the
provision of a narrow range of contraceptive services in die context of family planning clinics. Such
programs thus respond only to one of womens many health needs. The ICPD Programme of
Action acknowledges the need for a broader approach to health as it relates to population and
development policies. The document also endorses a modified version of the World Health
Organizations (the “WHO”) definition of the term “reproductive health.”
72. Reproductive health is a state of complete physical, mental and social
-being and not
merely the absence of disease or infirmity, in all matters relating to the reproductive system and to
its Junctions and processes. Reproductive health therefore implies that people are able to have a
satisfying and safe sex life and that they have the capability to reproduce and the freedom to
decide if, when and how often to do so. Implicit in this last condition are the right of men and
women to be informed and to have access to safe, effective, affordable and acceptable methods of
family planning of their choice, as well as other methods of their choice for regulation offertility
which are not against the law, and the right of access to appropriate health-carr services that will
enable women to go safely through pregnancy and childbirth and provide couples with the best
chance of having a healthy infant. In line with the above definition of reproductive health,
reproductive health care is defined as the constellation of methods, techniques and services that
contribute to reproductive health and well-being through preventing and solving reproductive health
problems. It also includes sexual health, the purpose of which is the enhancement of life and
personal relations, and not merely counselling and care related to reproduction and sexually
transmitted diseases.
The ICPD Programme of Actions endorsement of a reproductive health approach is a major success
for womens health advocates. Paragraph 7.6 of the document urges governments to provide women
and men with a host of services such as pre- and post-natal care, safe delivery, and treatment of
infertility, reproductive tract infections, and sexually transmitted diseases. As to abortion services,
paragraph 7.6 suggests that services be limited in the manner specified in paragraph 8.25, the key
abortion paragraph that is discussed below. This shift toward a reproductb70 health perspective was
achieved despite opposition from a handful of participants. The Holy See expressed reservations to
the entire chapter entitled “Reproductive Rights and Reproductive Health.” Malta registered
reservations to this chapters title. Several Islamic nations — Afghanistan, Brunei, Djibouti, Kuwait,
Libya, and Yemen — also reserved on terminology that they regarded as being in contradiction to
Islamic law. These conservative forces served to dilute references to sexual health and sexual rights
throughout the entire ICPD Programme of Action. They also forced all references to “fertility
regulation” — a phrase defined by the WHO to include certain abortion-related services — to be
replaced by “regulation of fertility,” a phrase that has no pre-determined definition. Moreover, in
paragraph 7.2, the scope of the term “regulation of fertility” is further circumscribed. Women and
men are to regulate their fertility only by methods that are “not against the law.” Nonetheless, the
ICPD Programme of Action remains unequivocal in its support for a broad-based reproductive
health approach.
3
Reproductive Rights
One of the singular accomplishments of the ICPD Programme of Action is its support for
“reproductive rights.” The ICPD Programme of Action is also the first United Nations population
conference document that, begins to delineate the core elements of this right:
73. Bearing in mind the above definition, reproductive rights embrace certain human rights that
are already recognized in national laws, international human rights documents and other relevant
United Nations consensus documents. These rights rest on the recognition of the basic right of all
couples and individuals to decide freely and responsibly the number, spacing and timing of their
children and to have the information and means to do so, and the right to attain the highest
standard of sexual and reproductive health. It also includes the right of all to make decisions
concerning reproduction free of discrimination, coercion and violence as expressed in human rights
documents. In the exercise of this right, they should take into account the needs of their living and
future children and their responsibilities towards the community. The promotion of the responsible
exercise of these rights for all people should be the fundamental basis for government- and
community-supported policies and programmes in the area of reproductive health, including family
planning. As part of their commitment, full attention should be given to the promotion of
mutually respectful and equitable gender relations and particularly to meeting the educational and
service needs of adolescents to enable them to deal in a positive and responsible way with their
sexuality.
Given the importance of reproductive rights to a woman-centered approach to population issues, it
is not surprising that this section of the ICPD document served as a lightening rod for opponents of
change. Conservative religious forces led by the Holy See questioned the validity of the very
concept of “reproductive rights.” Not only did they regard this right as one not previously
recognized by the United Nations, but they also argued that the phrase includes a right to abortion
on demand. Nicaragua and the Dominican Republic specifically registered a reservation to the
phrase “reproductive rights” on the basis that they regarded life as beginning at conception. Several
governments also expressed concerns about who would have the “right” to make reproductive
decisions. Governments intensely debated whether “couples and individuals” or just “couples had
the right to decide the number and spacing of children. Nations such as Egypt, El Salvador, and
the Dominican Republic supported conferring reproductive choice exclusively upon couples in a
marital context. Once again, in an attempt to balance divergent views, the ICPD Programme of
Action incorporates compromise language. It recognizes that “couples and individuals should make
reproductive decisions, but such decisions “should take into account . . . [peoples] responsibilities
towards the community.” In fact, the concept of responsible decision-making is mentioned no less
than four times in this one paragraph. These references reflect a covert attempt to set parameters on
reproductive choice. Although most people regard reproductive decisions as profoundly personal,
the ICPD document suggests that people consider the social and economic consequences to the
community”of their decision to bear children. Despite ideological attacks, however, the ICPD
Programme of Action endorses the principle of reproductive rights and the right of couples and
individuals” to determine the number and spacing of their children.
4
Family Planning
Given the many controversies relating to womens empowerment and reproductive rights, family
planning was relatively uncontroversial at the ICPD. Although the Holy See had sought to
jeopardize the concept of family planning by claiming that such services include abortion, it failed
to mobilize support for its position. The ICPD Programme of Action thus states:
7.12. The aim offamily-planning programmes must be to enable couples and individuals to
decide freely and responsibly the number and spacing of their children and to have the information
and means to do so and to ensure informed choice and make available a full nnge of safe and
effective methods. The success ofpopulation education andfamily-planning programmes in a
variety1 of settings demonstrates that informed individuals everywhere can and wdl act responsibly
in the light of their own needs and those of theirfamilies and communities. 1 he principle of
informedfree choice is essential to the long-term success offamily-planning programmes. Any
form of coercion has no part to play. In every society there are many social and economic
incentives and disincentives, in order to lower or raise fertility. Most such schemes have had only
marginal impact on fertility and in some cases have been counterproductive. Governmental goals
forfamily planning should be defined in terms of unmet needs for information and services.
Demographic goals, while legitimately the subject ofgovernment development strategies, should not
be imposed on family-planning providers in the form of targets or quotas for the recruitment of
clients.
The ICPD Programme of Action recognizes the centrality of informed choice to family planning
programs. Coercion and abuse is rejected, as are incentives that seek to influence family size. The
documents position on demographic targets, however, is unclear. On the one hand, the ICPD
Programme of Action states that quantitative measures are “legitimately the subject of government
development strategies.” On the other hand, it recognizes that quantitative goals “should not be
imposed upon family planning providers in the form of targets or quotas for the recruitment of
clients.” Does this mean that nations that attempt to achieve broad fertility targets are acting in
accordance with the ICPD Programme of Action? Can nations impose targets or quotas relating to
the retention or treatment — as opposed to the “recruitment” — of clients? The ICPD document
does not explicitly answer these important questions.
Safe Motherhood
During the preparatory meetings of the ICPD, Safe Motherhood programs were attacked by the
Holy See and its allies on the ground that such programs were a subterfuge for abortion rights.
This assault failed. The ICPD Programme of Action states:
8.19. Maternal deaths have very serious consequenees within the family, given the crucial role of
the mother for her children’s health and welfare. The death of the mother increases the risk to the
survival of her young children, especially if the family is not able to provide a substitute for the
maternal role. Greater attention to the reproductive health needs offemale adolescents and young
women could prevent the major share of maternal morbidity and mortality through prevention of
unwanted pregnancies and any subsequent poorly managed abortion. Safe motherhood has been
accepted in many countries as a strategy to reduce maternal morbidity and mortality. 1
5
The ICPD document thus recognizes the toll that unplanned motherhood may have on womens
ives. However, because of the politicization of all issues perceived as abortion-related, the
document falls short of strongly endorsing the need for safe motherhood policies. The ICPD
Programme of Action merely states that safe motherhood “has been accepted by many countries”
as
one strategy by which to combat maternal morbidity It does not recommend that governments
support or expand these programs.
Abortion
Abortion was the most contentious issue at fthe ZZZZ.
J
ICPD Perhaps unfortunately,
the conflict over
abortion thus received the greatest media coverage. The carefully crafted paragraphl in the ICPD
Programme of Action regarding abortion states:
8.25.
In no case should abortion be promoted as a method offamily planning. All
Governments and relevant intergovernmental and non-governmental organizations are urged to
strengthen their commitment to tvomen’s health, to deal udth the health impact of unsafe
abortion***/ as a major public health concern and to reduce the recourse to abortion through
expanded and improved family planning services. Prevention of unwanted pregnancies must
always be given the highest priority and all attempts should be made to eliminate the needfor
abortion. Idtimen who have unwanted pregnancies should have ready access to reliable
information and compassionate counselling. Any measures or changes related to abortion within
the health system can only be determined at the national or local level according to the national
legislative process. In circumstances in which abortion is not against the law, such abortion should
be safe. In all cases women should have access to quality services for the management of
complications arising from abortion. Post-abortion counselling, education and family planning
services should be offered promptly which will also help to avoid repeat abortions.
Unsafe abortion is deftied as a procedure for terminating an unwanted
pregnancy either by persons lacking necessary skills or in an environment
lacking the minimal medical standards or both. (WHOZMSMZ92.5).
This paragraph raises several important issues, including the use of the terms “unsafe abortion” and
abortions that are not against the law.” Anti-choice forces, represented by the Holy See, Malta,
Ecuador, and Argentina, argued that all abortions were unsafe for the fetus. The phrase “unsafe
abortion, they argued, was thus redundant. The majority view is that there are indeed abortions
that are safe for a woman seeking to end her unwanted or health-threatening pregnancy. The
WHO definition of unsafe abortion” was incorporated into the document to clarify this issue. The
paragraph also strongly endorses the sovereignty of the national legislative process in abortionrelated matters. This endorsement appears to reject the role of national courts and appropriate
human rights forums in dealing with abortion laws. It is also noteworthy that paragraph 8.25 does
not refer to legal abortions.” It refers to abortions that are “not against the law.” The two or three
nations in the world with the most stringent abortion laws declared that they could not be asked to
recommend legalizing abortion. Malta expressed a reservation to the phrase “abortion is not against
the law in paragraph 8.25. A positive aspect of the ICPD document is its acceptance of the
importance of post-abortion counselling and care. Nations such as Bangladesh', Cyprus, Canada,
Zambia, and Zimbabwe were strong supporters of this principle. Thus, although the ICPD
I rogramme of Action does not contain abortion rights language, it does recognize unsafe abortions
as a public health crisis and does call for greater safety and compassion for women obtaining
abortions.
6
Conclusion
It remains to be seen whether the ICPD Programme of Action will enhance reproductive health
and rights. Because the document continues to express a concern with high global population
growth rates, it can be regarded as espousing a utilitarian perspective — women should be
empowered and educated because doing so will reduce fertility rates. The goal of population and
development policies should be to promote egalitarian policies that enhance the quality of life for
all, particularly, the reproductive health, socio-economic status, and equality of women. Moreover,
although the ICPD Programme of Action articulates a paradigm shift toward a broader reproductive
health approach, the financial commitments to making these services available do not even come
close to matching those for family planning programs. The total cost of implementing the
programs suggested by the ICPD document is estimated to be $21.7 billion by the year 2015. Of
this amount, $13.8 billion is committed to family planning programs, $6.1 billion to reproductive
health, and $1.5 billion to HIV/AIDS prevention. Nonetheless, the ICPD document is an
important beginning. The promises contained within the ICPD Programme of Action, if
implemented, would indeed transform womens lives and set the stage for true reproductive dignity
and freedom.
Please note: This publication contains quotations jrom the unedited version of the Programme of Action, dated
September 19, 1994, which was distributed immediately after the ICPD.
October 28, 1994
Forfurther information on these issues, contact Rachael N. Pine, Director of International Programs, Anika
Rahman, Staff Attorney, or Rebecca Casanova, Associate.
7
y
' f
September 26,
1994
Repor t
on
the
International
Conference
Development, Cairo, September 5 - 13, 1994
on
Popu1 ation
and
Gita Sen
DAWN (Development Alternatives with Women for a New Era)
This
report on the
ICPD focusses on the Programme■
of Action
adopted by
the countries attending the Conference, <and sets it
in the context of
the larger
global debate on population
and
development
issues. Understanding the
context and the intense
debates of
the last
two years
is essential
to grasping
the
full implications of the document itself.
Context
Population policy has always been contentious, Clashes
between
different
perspectives and
points of
view
occurred both
at
Bucharest
in 1974 and
in Mexico
City in 1904.
Never before,
however, have there been
so many sets of actors in
the public
arena.
These include,
in addition
to the
usual Northern and
Southern country groupings
(European Union, USA etc versus
G—
77),
the
traditional
family
planning
establishment,
environmenta lists,
religious
fundamentalists,
and
women's
organizations. The
resulting transformation
of public
debate
has been profound.
North-South
disagreements
over
the relative contribution of
population growth
versus unsustainable consumption to
global
envi ronmenta1
problems surfaced in a major way during UNCED in
Rio in
1992. It
was
in Rio
that
the
Holy See
put
itself
forward as a champion
of the South, arguing that poverty
and
inequality were greater
problems than
population growth
per
se.
Clear even then was the effort by the Holy See to use the
North-South divide to
attack
family planning
programmes and
thereby the availability of both contraception
and abortion in
the South. The continuing
and unresolved North-South
strugg 1 e
over
global
equity
in
trade,
debt
and
other
economic
relationships
provides fertile ground for
such attempts, even
though there are few Southern
governments at the
present time
that would agree with the Holy See's views on popu1 ation.
It was <a 1 so
during UNCED, that women's organizations,
working
in the NGO Forum and under the umbrella of the Women's
1arge1y
to define women's positions on popu1 a t i on
Caucus, began to try
and
in
a
manner
that would
articulate
women's
interests,
safeguard
them from
becoming pawns
in the power
games among
other
actors. In
In
particular,
considerable
time
women spent
wi th
Northern
environmentalists
debating
the
need
to
1
>
-.
... -J.. . ... .
acknowledge
both
the
right
to
development,
and
women's
concerns
about
population
policies
and
programmes.3This
process
of clarification and
articulation has continued since
UNCED, and particularly in the preparations for the ICPD.
<
’i
1
1
The last
two
years
have seen touch public
debate
at
both
and
national
levels
(in
many
but
not all
Internationa 1
countries)
between environmentalists,
the
f ami ly y planning
establishment and women's organizations.
Atjtimes, the debate
has
been
difficult
and
acrimonious
as
women
tried
to
articulate
a
position
that affirmed
the
right
to control
fertility and
to. <: have
access to, health, while,
at the same
time, being
I
critical of the approaches and methods of. existing
populationi
policies and
programmes. In
the
process of/, this
debate,
however, a new
paradigm
for population
policy
has
emerged w one
that shifts
the objectives of
policy
away
from
|
the control
of numbers per se towards the provision of broadly
defined
reproductive health services, and
that
acknowledges
women's
reproductive
rights
as well
as
their
need
for
empowerment.
Women s strategies - dilemmas and dangers
,
I
i
i
i
i
Women's attempts
to define positions have
been fraught with
difficult
conceptual and
political choices
and dilemmas.
In
the
context of ICPD women have had to
thread their way among
three
sets
of
actors
the s traditional
population
establishment,
the fundamentalist
patriarchs,
and
the donor
community particularly the Bretton Woods institutions.
of
the
On
the one
hand,
women
have
long
been
critical
resources
population establishment which Ihas had control over
including
and
programmes
and
the
direction
of
policies
long to
reproductive technologies
but has been wedded for too
an approach which
has subordinated women's reproductive health
needs
to the control
of numbers.
For over a
decade, women s
been critizal
of
the
organizations
and networks
have
alsoi
and of
and development,
directions of
contraceptive research
the
same
family
planning
programmes. At
the
abuses within
time, women's
women's
health
organizations
strongly
affirm
to have
rights
to
plan and
manage
their own
fertility and
access to decent
right
health services, including through the
to
secure livelihoods
and
productive resources,
One dilemma
for
women s
to be
organizations has
been
to work
out
how
existing programmes
without
effeetive
in their
criticism of
NGO treaty
1 One concrete result of
this process was the
on population that was developed at the Forum during UNCED.
a
rapid
growth
of
newi
literature
3
There
is now
Dixon-Mue11er (1993),
Sen, IGermain
and
reflecting
this. See
the new journal,
Reproductive
Chen (1994),
Correa (1994) and
Health Matters as examples.
falling into
the g^me
of fundamenta 1ist
patriarchs who
a 1 so
criticize
family
planning programmes
but
from
an
entirely
different perspective - one that denies women's rights*
This has
been rendered difficult by the Holy See's espousal of
6-77
positions
in
the
North—South
debates.
While
women,
particularly from South
organizations, have
of
been critical
their
own
governments,
the>( strongly
affirm
the
right
to
development as
a fundamental
aspect of
human rights
without
which all other
rights become
inaccessible to many. And
they
challenge the
North's domination of
and imposition of
highly
inequitable international
economic arrangements.
In the
ICFD
contex t,
the
shadowy
role of
the
Bretton
Woods
and
some
bi 1atera1
aid
institutions which
increasingly
speak
the
1anguage
of reproductive
health and rights
while
espousing
population
conditionalities
in lending
programmes,
and
the
attempts
by some members
of the European Union to
tone down
1anguage
i
on the
right
to
development meant a
second dilemma
How to
for women.
affirm women's reproductive
rights without
fa 11ing
into
the
8ret ton
Bretton
Moods
definitions of
development
prior it ies
and methods, and,
and, on the other
hand, to affirm and
support
the right to
development without
downplaying women's
reproductive
health
and
rights
concerns
as
many
G-77
governments appeared happy to do?
A
third
problem
for
women
has
been
the
attempt
by
fundamentalist patriarchs
to wrap themselves
in -the mantle of
cultural
sovereignty
and
anti-imperial ism.
At a
conceptual
level, and at
the level
<of open
public debate,
this is
the
easiest
for
women
to
<address,
since
the
fundamentalist
representation
of culture
is
so unabashedly
patriarchal, as
became
obvious during the
ICPD debates,
But, at the national
1 eve 1,
in
many
countries,
it
is
the
most
dangerous
and
difficult force for
women to contend with, since it
un1eashes
political forces
and processes that
operate outside the realm
of civilized
discourse.
For
women, the
extent
of time
and
respect accorded at ICPD to
very thinly disguised
attempts to
keep women disempowered, were a sobering reminder
of the road
ahead.
all these dilemmas and
Whi 1 e
dangers came to a
<
head at ICPD,
they
-for
have been
visible
and building
for
at least
the last
dec ade. Women's
strategies for
dealing with them
I
have
become
increasingly sophisticated
and
careful
during the
two
1 ast
years. These strategies have had four aspects:
- to clarify positions and bottom-line non-negoti^bjes - to
affirm
health
and
rights
reproductive
I
in
the context
of
strategies;
to
equitable
developmen t
be
critical
of
past
popu1 ation
polie ies
and programmes,
including
technologies,
without throwing the
baby out with the bath-water. Soon
after
early
attempt
by
a
UNCED
there
was an
number of
women's
i
organizations and
networks to
define
a bottom-line
(Women's
Voices '94). This r an into criticism from a number of iwomen
as
being uriclear a to ou t the broader development context. Ai clearer
3
statement which affirmed
common ground
across
aff i rmed
a
range
of
women s organizations,
while
acknowledging the
whi le
existence -of
differences,
was
negotiated at
the meeting
on "Reproductive
Health and Justice:
Cairo 1994" that brought together
members
of over 200 organizations in Rio in January 1994.
I
I
I
acknowledge the multiple role^s
that women's organizations
have to play at
this juncture - North
South and ideological
divisions ( as
well as
personality clashes
and ego
prob1ems)
have been as
present in the
in ternationa1 women's movement as
in
other
social movemen ts.
Furthermore,
globa1
politics is
itself
in
a
process
of flux
some of
this is
strong 1 y
positive,
since spaces
are
opening
up for
new
methods
of
citizen action,
as well
as ways of linking
international and
national level
politics. Women
have had
to learn,
sometimes
painfully, how
to move
between positions
of pure
opposition
and
positions of negotiation
with those
in power. How
to do
the
latter without compromising on
fundamental positions, and
with
transparency and accountability,, and how to do the former
with a
degree of
responsibility and without
hoiier—than-thou
posturing
have■
been
difficult
lessons,
but
many women's
organizations
are learning
them. Again,
the
Rio meeting
on
"Reproductive Health and Justice"
was an
important milestone
in the process
of resolving tensions, As
a result, women were
able to
be extraordinarily
effective in
their advocacy
both
during
Prepcom
HI,
and
under
the
logistically
more
challenging conditions of the ICPD itself.
■
“ to increase information flows, communication,
and planning advocacy
networks
exchanged
a
great
deal
of
information,
some times
faster than governments,
during the process leading
up
to
ICPD.
The
role
of
WEDO
(Women's
Environment
and
Development Organization)
in facilitating
the Women's
Caucus
and mobilizing women's energies during the
negotiations of the
draft Programme
of Action
during Prepcom
III were
critical,
Women were
thereby able significantly
to influence the draft
to
stronger
make
it stronaer
in
terms of
the right
to development,
reproductive health
and rights, and
resources, New skills
of
working
together
across
national
boundaries
under
intense
pressure,
of
negotiating
and lobbying
with
governments and
internationa1 agencies, and
of working inside delegations
and
in the corridors, have been 1earned.
The sheer logistics
of ICPD made it
difficult for the Women's
Caucus
to function in
Cairo as
it had in
New York; while it
continued to
play the rol e
of communicat ion, and
information
dissemination, the actual
lobbying became the task of
sma11er
and more flexible, informal networks.
produce carefully
researched material_ that could
be the
...of
the new paradigm
A wealth
of new imateria 1 has begun
to be
published, as
earl ie r:
mentioned earlier:
new• r esearch
agendas
are
oeing
defined,
as
well
as
new
material
f or
popu1 ar
- to
4
c ommun i
I
!
I
!
I
i
ion.3
How effective women's strategies have been can
(
be seen from
the. fact that the international
populationi debate has been
transformed.
Thfe ICPD's Programme of Action has become a
metaphor for power - from an initial outline that was entirely
set within the traditional demographic control
mode,
its
transformation into a <document that pays central attention
to
women's rights and health has tJeen a< concrete result. The fury
of
the fundamentalist patriarchs is■ a signal of how profoundly
threatening
they find this
change.
Perhaps the simplest
example of
this was the
attempt to
delete the
word
” individuals*’ from the phrase ’’couples and individuals” in the
context of
the right to
plan reproduction
freely
and
responsibly.
“Couples and
individuals” has been
accepted
language in population policy documents for the last 20 years.
As a woman said at the end of the Conference, ’’the
patriarchs
were never bothered by individual s until they began
to imagine
individuals as possibly having a female gender”!
i
3 An example is
the summary of the DAWN platform document
(Correa, 1994) which is already available in English,
French,
Spanish, Portuguese and Arabic.
5
Report on the ICPD document
the Draft Programme of Action
The
Draft Programme of
Action (POA)
is the main
document of
the
International
Conference
on^ Population
and Development,
one
that has
been
developed
and negotiated
by
governments
through
three meetings
of
the
Preparatory Committee
Committee,,
and
finally ICPD itself.
to be
It was adopted at the
ICPD and is
approved by the General Assembly during its current session.
i
The Politics
The initial outline of
the POA
produced almost two years
ago
by the ICPD Secretariat (under
UNFPA) was set
almost entirely
within
the
traditional
demographic
<control
mode.
Women's
organizations,
fresh
from
UNCED,
andI
very
aware of
the
pressures
from
both
Nor them
and
environmentalist
fundamentalist
lobbies
recognized
the
need
for
<greater
^activism.
At
the
time,
tension
time,
between
the
population
establishment and
the Northern
on the
environmentalist lobby
one hand, and women's organizations on the other,
were running
high.
i
i
i
i
i
Women's
organizations, in networks
spanning South
<
and
North,
began
a
period
and
of intense
at
both
focussed
lobbyingl
international and
national levels to
transform the
awareness
of influential
policy makers, and to affect the POA itself, In
this
they
were
not. alone.
Many
influential
academics
and
policy makers,
private foundations, as
well as key. bilateral
aid
agencies were
convinced of the validity
of the arguments
being
made by
women's
organizations,
and provided
critical
support.
By the
time of
PrepCom III
in April
1.994 in
New York,
the
women's lobby
had become
and
both articulate
and effective,
the draft document
itself had
changed significantly.
PrepCom
III witnessed the first
major clash
between the Holy See
and
women, as
the former tried to
"square bracket"4 all
language
relating to reproductive
rights and health. Their support
for
this was,
at the time, relatively thin, coming mainly from the
small
countries
of
Central
America
and
Francophone
West
Africa.
Hue h,
however ,
includ ing
the
was
also
accomp1i shed
PrepCom
during
III,
of
quite
1anguage
on
inc 1usion
progressive
** Putt ting something
not
been
agreed
upon,
negotiation.
in
square brackets means that it has
and
must
be
subject
to
further
6
ii
—.re.
the old outside the reproductive age-groups. A great deal
of
the language produced by the Women's Caucus was incorporated
into the draft POA. But one source of disquiet to many women's
organizations was that
the population establishment maintained
a relatively 1ow profi1 e durinc/ this time - as one observer
put it,
it was as if
the women were being allowed to tire
themselves out battling the Holy See,, so that family-planningas-usual could prevail in the end.
i
Islamic fundamentalists played almost no role
during PrepCom
111 But in the months between New York and
Cairo,
the Holy
See engaged in intense lobbying
in
Islamic states,
most
importantly Iran, Islamic fundamentalists
within
Egypt
itself
had
long been opposed
--J to the ICPD, largely because i t wou1d
give the government greater international prestige.
Combined
with the Holy Sees attempts at i
making common cause with
Islamic patriarchs, this generated considerable
weeks before ICPD. There was serious distortion ferment in the
of the POA in
thZ PAfUJar "’edia’ made easier by the fact that the quality of
the
a ic translation of the document was extraordinarily
poor. Under intense pressure from Islamic fundamentalists, the
Islamic
Centre for Population®
at Al
Azhar University
reputed to be the oldest university still in existence, issued
a statement that, while admitting
admitting that the PDA
POA had some good
points,
generally condemned
it
.as
promoting abortion,
homosexuality and adolescent sexuality.
Some
sexuality.
Some g
governments,
notably Saudi Arabia,
withdrew from the conference, while two
heads of state declined to attend.
!
t
I
I
I
ICPD began,
therefore,
amid considerable nervousness
even
among governments supporting the PDA. At
the
same
time,
many
governments also began to see very’ clearly
what women's
organizations have known all
along - the extent to which
fundamentalist patriarchs wi11
go when they feel
their
authority
to control
basic
aspects of women's 1 ives being
questioned.A
Women' s networks that had had the experience of rgrappling with
the Holy See during PrepCom III,
had carefully
/ worked out
° Ironically,
the Islamic Centre for Population was set
up in the mid-1970's with funding from UNFPA and
donors
to expand population research and education in the other
region.
On
the
other hand,
the
alliance between
the
patriarchies of two religionsi was
weak
from
the
start
because
was weak from the
Islam is not intrinsically opposed to abortion in the way that
the Holy See is. Attitudes
to female sexuality also are
considerably different
in the two religions.
And the actua1
behaviour of
practising Catholics in
the matter of
both
contraception and abortion diverge very considerably from
the
preaching of the Church' s conservative hierarchy.
7
strategies
for
nursing
the
PDA through
the
long
hours of
negotiation
in the
Main
Committee
and its
various
working
groups and informal
groups, in such
a way
as. to protect
its
core concepts and
language. Women were also confident that
it
would be impossible in the end for ^anyone to
extract key parts
of the
text without
iunravelling the
whole; the
latter would
have very major political
costs for the "unraveller” since the
text contains
a great deal that
is new but
uncontroversia11y
good for
Ihealth and well-being.
Still, the informal
lobbying
networks had
— their
---- • hands
full to
prevent major damage to
the
POA.
One casualty of
the intensity of women's
and
women's lobbying efforts
the amount
of time
involved, combined with the
difficulty of
access from the NGO
Forum to the ICPD
itself,
i tself t was the extent
of communication of the
r ‘
’
details
of what was actually happening
at the main
Conference to those in
the NGO Forum, Frustration
about
the
amount of
time spent on arguing
about
abortion
fuelled
fears
that
development
issues were
somehow
being
short-changed in
the process.
Those familiar
process.
with the draft
POA were aware that
many of
the key development concerns
had
already been
negotiated during PrepCom III, and much of it was
favourable to
the South.
But not many
of those at
the Forum
were in fact familiar with the document itself.
It was difficult for
those at
a distance
to appreciate the
intensity
of the struggle
being waged. Behind the struggle to
get clear acknowledgement of
of the
the realities
realities of
of unsafe
unsafe
abortion
for
women in alj parts of the world stood the carefully worked
out and
negotiated framework
of
women's empowerment,
gender
equality, and reproductive
health and rights. All of this
had
been framed
primarily with the realities of the lives of women
of
the
South
in
mind,
and
represented
the
first such
achievement in a major internationa1 population document.
Politic® in the Main Committee
On the
floor of the Main Committee
and in its working groups,
the political alignments started out with a combination of
the
Holy See
and Islamic
governments. The
former opposed
(as it
had
during PrepCom
III) abortion
under
any conditions,
the
entire framework of reproductive and sexual
health and rights,
the
acknowledgement
of
different
types
of
fami 1ies,
and
education
and
services
for
adolescents,
Many
Is1amic
governments,
on the
other
hand,
appeared
to be
much
more
nervous about women's empowerment and
rights such as the right
of girls
to equal inheritance than
about abortion, But,
like
the
Holy
See,
they
were
also
for
opposed
to
privacy
ado 1escen ts,
support for different
forms of
fami 1ies, sexual
families,
i
8
)
I
health
and sexual
rights.This
political alignment
•f ina 1 1 y
broke up only after protracted
negotiation of the
language on
abortion, and the dropping of sexual rights from the POA.
Ranged
on the
other
side
was the
European
Union, the
US,
Canada,
Brazi1, South Africa,
and a
large number of Southern
countries which
took strongly pro-women
stands on the
above.
The US was
c1 ear 1y a strong supporter of the POA but unwilling
to
be
very
vocal
because
of
internal
domestic
politics
relating
to
the Clinton
administration.*
In working
groups
and informal
the
US
groups,
delegation worked extremely
hard
to
put
through
the
POA.
The
US was
in
this
forum
more
PDA.
progressive than some
members of the EU on
issues such as the
right to development.
G-77 countries had agreed to ac t
together on issues
affecting
North-South relations, and resources, but to act
independently
on
all
other
matters
including
reproductive
health
and
rights
On the right
to development,
the EU spoke
with one
voice but
there was
clearly
a
difference between
the
more
progressive
position
of
the
Nordics
versus
for
example
Germany.
India
had
al ready
intervened
strongly
on
North-South
relations,
technology, and
resources during
PrepCom
III. At
ICPD India worked
on these issues largely
through G—77 as had
been
agreed. On
women's empowerment,
violence against
women
and
girls, and reproductive health and rights, India made some
excel lent
statements
on
the floor
of
the
Main
Committee.
Sexual rights was finally dropped from
the POA because
of intense pressure from Iran and Pakistan
even though country
^fter country
explained that, in
the presence of
wide-spread
sexual violence and abuse against
women and children,
sexua1
rights imply the right to
succour and support rather
than, as
the
Holy See
had
chosen
to
represent
it,
the
right
to
promiscuity.
• A point to be
noted is that primary
responsibility for
the ICPD in
the US
lay with the Dept
of State which
has had
many disagreements with USAID
as the main
implementer of
US
population assistance programmes.
The latter is far more
tied
to
the
old
demographic
control
paradigm,
and
its
future
actions bear close monitoring and scrutiny.
This
agreement should
have meant
that the
first two
c hapters,
the Preamble, and the Principles, of the POA, should
have been left
to countries to handle independently since they
include
a
great
deal
that
is
germane
to
the
succeeding
chapters
on
reproductive
rights
and
women's
empowerment,
Instead Algeria (as chair
of G-77) chose
to speak for all .of
the G-77
during the
negotiations on
the first
two chapters,
This went
unchallenged. Consequently,
the G-77 “position”
on
chap ters
1
and
2 was
tilted
heavily
towards
the
Islamic
count ries.
9
However geopolitical
concerns, including
possibly the desire
not to upset
Islamic government^, made India
adopt a low risk
and low profile strategy during
key working group and informal
negotiations.
1
The Programme of Action
t
Why is
the POA important? Principally because it sets the tone
and scope
of population
related policies
and programmes
for
the next 20
years. Although it is
not binding on governments,
it provides an overall perspective both
to national programmes
and to
Although
international assistance. The
latter is key.
donor assistance accounts at
al 1
only 20 -257. of
present for
in
leverage
population
expenditures,
it
has
considerable
The POA
determining
the
direction
of
national
programmes.
a
opens up the
possibility of monitoring donor assistance vis
vis stated committments to women's empowerment and health.
The
POA
is
also
important
because
it
is
an
“enabling”
document,
one
that
gives
activists
a
basis
for
moving
programmes in particular directions. While few
governments may
automatically do
what they
have agreed
in the
POA is worth
doing,
at
least they
will
have to
justify both
action and
inaction in
terms of the POA.
How much happens
will depend a
great deal on the mechanisms for
monitoring and accountability
that are put in place at the national level.
important
for
women
In
addition,
particularly
the
POA is
outside conferences
because
it
represents
the
first
time ,
(which quickly
1become largely women's
specifically
for women
d irectiona1
affairs) that the world community has made a major
supported by
change
in policy
that
has
been initiated
and
that,
Population
and that can
work
in women's
interests.
women,
women's
number of very active
policy has been the
focus of a
and the POA
represents the
a decade,
organizations ^for over
culmination of
one phase of women s attempts to move policy in
better directions.
does this
the PDA in fact
To understand the
extent to which
raised about
questions that were
and
to examine some
of the
important
and about finances, it is
the development framework
to look carefully at the document itself.1®
The document has 16 chapters:
2
(c hs
1 and
2 on
overa 11 tone
Preamble
and
Prine i ples)
set
the
are
based
on
the Eng 1i sh
T he
comments
foil owing
of the
in the
Main Committee
version of
the POA
as amended
the
in the
final
Plenary;
ICPD and
accepted
by
consensus
the
the Secretariat during
amendments were
made available by
or
finally
edited
not been
Plenary;
the version
used
had
thoroughly checked for ac c uracy.
10
1
5
<
4
2
1
1
4
The
I
I
I
I
I
(ch 3) - the general development context
(c hs
4-8)
core
section
on
women's
empowermen t,
fami 1ies,
underserved
groups,
groups,
reproductive
and
sexual
Health and rigtits
(chs 9-10) - migration
(ch 11) - education
(ch 12) - technology and research and development
(chs
13-16)
national 4 and
international
act ion,
f inances, relationship to NGOs.
tone:
The tone of a
document is usually set in its initial chapters.
Previous population documents
usually started with demographic
information
as
a
basis for
action,
defined
the
princ i pa 1
objective as control
of numbers, and moved to family
planning
programmes
as the
action required to meet
the objective. The
POA
on the other
hand starts
with very moderate
language on
population growth, acknowledges the problem of
numbers without
using
scare
tactics,
places unsustainable
production
and
consumption
earlier in
the
list
than population
growth
in
terms
of environmental
effects, and
refers
to the
problems
caused by the
unfavourable international economic environment,
The Preamble then gives
central place
to the need to
empower
women and
to the
“new comprehensive
concept of
reproductive
health”. Some governments
and many women might have
preferred
to
drop
all
demographic
justification
and
to
derive
reproductive health programmes directly from the
assessment of
the health
needs of individuals,
individuals,
especially women, But,
even
as it
stands, the Preamble, with
its softening of
Maithusian
language, moves a long way in this direction.
The
opening
paragraph
(the
“chapeau ”)
of
the
chapter
on
Principles took
a great deal of time to negotiate. In the end,
like “couples and individuals” and “freely
and responsibly” in
sets the
earlier population
documents, it
framework for
the
POA's principles
as a careful
balance between the
importance
recognized
of
internationally
human
rights,
and
the
sovereignty
of nations
as represented
by
national laws,
as
well as development
priorities, various religious and
ethical
backgrounds.
values,
and
cultural
backgrounds.
While
supporters
of
reproductive health and rights lost the
overriding affirmation
gave up the
of internationa1
human rights, opponents
attempt
which could be used to justify
to
include traditional customs
range of
violent
and
abusive
the status
quo
for
a
whole
practices against women and children.
Holy
The chapter in
its final version also
managed to foil a
See led
attempt
to smuggle
in anti-abortion language
through
1 ed
<
of
use
of
the
third
article
the
Universal
se1ec tive
guaran tees
of
Human
Rights which
guarantees
“the right
to
Declaration
i
and security
of the
person”. The
rest of
the
life, 1i her ty
are
unexceptionable,
setting
a
whole
range
of
pr inc i p1es
within
a
general
context
of
internationa
1
human
pr inc ip1es
speaking
out
against
violence
and
coercion,
rights.
11
acknowledgingj
the
right
to
development,
to
education, ,and the multiplicity of family forms.
health,
to
The enabling environment
During
the Conference
there
was
some complaint
in
the NGO
Forum that development
issues wer^e1 being short-changed by
the
battle over
abortion.11 I n
fact, as
mentioned earlier,
much
of
chapter 3
had already
been negotiated during
PrepCom III
and
contained a
good
deal
favourable to
the South and
to
women. What was pending for ICPD was an EU-led
attempt to hold
favourable languager on
North-South relations
hostage to
the
inclusion of some
<mention of the need
for good governance, to
reduce corruption etc.
Once compromise language was found
the
chapter was over.
Chapter
3 acknowleges the
right to development as a universal
and inalienable right
and as
an integral part of
fundamental
human
rights,
argues
that "structural
adjustment programmes
-.(be)
so
designed and
implemented as
to
be
responsive to
social and environmental
concerns”, and that the North should
lead
in
sustainable
consumption
and
effective
waste
management.12
It
T
*
speaks
strong 1y
to
the
problems
of
inequality within and
between nations. and
the needs
of poor
women everywhere, Its section on sustainabi1i ty
defines as its
objective
the need
to
reduce unsustainable
consumption
and
production. It argues
in favour of
investment in human beings
and the need to strengthen food security.
Chapters
9
and
10 on
migration
were generally
acceptable
except for a protracted North-South squabble
over the “rights”
of international
---- 1
migrants
to family
reunification. In
fact,
since international nigrationi occurs within the
South as well,
there were
many Southern
governments that
were uneasy
about
such
a
’’right”. This
was
resolved
by changing
“right”
to
’’vital
importance ”
and
calling for
a world
conference
on
migration.
xx
In
fact
the
struggle over
abortion
was
no
more
<
abortion
protracted in actual fact than the
negotiation over migration,
but
this was not highlighted by
media coverage.
It was more
than ironic that
some South-based journalists and others
were
willing
to
dichotomize
women's
health
and
rights
die hotomize
health
and
from
development, perhaps without
realizing
realizing that
that they
they were
falling
thereby into the Holy See's world—view?
A2
There is
much in chapter
3 that
those interested in
soc ia1 and economic equity can support.
For instance, minority
women f rom
the US were delighted when, as a result of informal
advocacy,
the
US
amended
para
3.16,
which
def ines
the
objec tive
of raising
the quality
of
life,
to include
poor
women in both
deve1 oped and developing countries as
deserving
of special attention.
12
1
T he4 Co re
Chapters 4-8
constitute the core
of the
PDA. Together
these
chapters acknowledge
the realities of
women's lives in
terms
of
lack of
power, economic
insecurity,
abuse, violence
and
coercion,
unrecognized
and
unmet
health
needs,
and
poor
quality or no
services. They also
recognize the
realities of
of children and adolescents
the 1ives
and their needs
along
with older
people, the indigenous,
and disabled, for
quality
services.
How should
policies address
these realities? These
chapters develop
the concepts of
women's empowerment , and
of
reproductive and sexual health, as well
as reproductive rights
to provide a
frame for policies. It is
the first time thereby
that an internationa1
document on population affirms the
need
of individuals
for health
and well-being
as its
fundamental
guiding principle.
!
I
I
I
I
women's
Chapter
4 on women's
empowerment abandons the old and neutral
language
of
women's
women's
status
for
a
more
proactive
acknowledgement
of
power
relations.
It
It contains
strong
i' s
sections on women's
empowerment including economic
rights, on
the girl child including opposition to
son-preference and sex
selection,
against
female genital
mutilation,
infanticide,
trafficking
and
child prostitution
and
pornography, and
in
favour of
programmes to educate
men towards more
responsible
behaviour.
I
I
Chapter 5
on the family starts by acknowledging the variety of
family forms and
defines the objectives as
being to
support
families, to provide social security for
chi 1d-rearing, and to
protect
the rights of
women
and children
within
families,
Recognizing the
worsening conditions of
to
poor families due
declining social
expenditures (consequent on
cuts),, it
budget cuts)
argues
for
for
special
support
especially
single-parent
households .
Chapter 6
similarly addresses.
the
needs of
the
underserved
elderly
children and
youth,
the
elderly,,
indigenous
people, and the disabled.
Chapter
7 on
reproductive health
and
rights occasioned
the
most protracted negotiation,
and the strongest attempt by
the
Holy See to weaken
the thrust
of the document. Starting
with
WHO
definitions
of
reproductive
and
sexual
health3-"3
the
chapter goes on
to define reproductive rights
as the right to
make reproduction
decisions free
of discrimination, coercion,
and
violence.
It
def ines
governments'
duty
to
base
all
policies and
programmes inc 1 tiding
family planning
programmes
on these
rights, and
to promote
equitable gender
relations.
The chapter
states
that
reproduc tive
hea1 th
services
(including sexual health and family planning)
should be linked
to the
primary health
care system, and should
include making
abortion
safe (where
it
is
not against
the
1 aw), treating
The
definition
of
sexual
abbrev i ated
in
the final
version
objections of Iran and Pakistan.
13
hea1 th
of
the
was
POA
considerably
to meet
the
♦
reproductive tract
infections, sexually transmitted
diseases,
and
infertility, in
addition
to maternal and
child
hea1 th
services and counselling
men and youth for responsible
sexua1
behavlour.
The
chapter
supports
the decentra
decentralization
1ization
of
services,
improvement
of
quality
in
family
planning
programmes, and
has a
strong
statement against
any form of
coercion
in
family
planning
programmes
including
targets,
inc lading
quotas, incentives►
and disincentives, It
defines the role
of
NGOs
to
<
monitor
programs and calls
for
putting
in
place
systems to>
detect and control abuses.
abuses. The chapter has a strong
section on the health needs of adolescents.
Chapter VIII
on
health was relatively uncontroversial
barring
para
8.25 on
abortion. Although
this
para was considerably
watered
down
from
its
initial
versions,
its
major
accomplishment is
that it
acknowledges unsafe
abortion as
a
major public healthi concern, and states that
women should have
access
to
services
to manage
complications
under
all
circumstances.
It
also
contains
an
enabling
statement
requiring abortion to
be safe in circumstances
in which it is
not against the law.
i
.
I
i
I
Over al 1 , this
section of
strong framework
the POA provides a
that is in touch
with reality, that
acknowledges health needs
and concerns, and
that bases actions
on strong
|principles of
human
rights.
Al though
the
Islamic countries
managed
to
include
an
opening
sentence
to
state
that
chapter
7
specially
the
1 inked
to
the
chapeau
of
chapter
2
on
Principles,
i .e. ,
the
rights
by
qualification
of
human
reference to national
and
1 aws, religious and ethical values,
clear,
cultural
backgrounds,
backgrounds,
the
chapter's contents
are
strong, and
persuasive enough
to transcend this, In
the end,
what
happens by way
of action
can never go
against national
laws; what is important is that the world community in a
large
majority
agreed with the
of a
POA while
accepting the right
small minority to dissent.
Technology
Chapter
12 on technology
and R&D
is another
strong chapter
f rom
a
to
gender
for
adhering
perspec t ive.
It
argues
i nternat iona1
for
research,
and
ethical
standards
in
continuous surveillance
i n which
women s organizations should
play
a significant
greater
effort
to
It
calls
for
role.
methods to
protect
develop barrier methods
of contraception,
against STD's, and more male methods.
It al so
calls f o r research to develop better indicators of the
qu a 1 j t y
new
of care
in family
planning programmes,
and for
par t nerships
and
between
governments,
the
private
sector
women's groups. It
abortion,
also calls
for more research on
on natural methods,
on mortality and
morbidity differentials.
14
I-
I
)
and
research
that
incorporates
disempowered groups in society.
the
perspectives
of
Resources
What are the resources required, for this programme of action?
Initial estimates produced by the Secretariat at the start of
PrepCom
only had data for
family planning.
General
dissatisfaction among countries and strong
lobbying by women
led to the generation of a new set of estimates including the
broader reproductive health agenda.
i
I
The Amsterdam Declaration
of
1989 estimated
the family
planning resource requirements for the year 2000 as US 9
billion (in 1980)
dollars. In 1993 dollars, this estimate is
now $10.2 b.
F
Reproductive health excepting family planning
is
estimated at S 5.0,
HIV/AIDS at 1.3,
and
1.3,
and research, data
collection (including decennial censuses),
censuses), and
and
policy analysis
at $ 0^5 b. Overall,
about 657. of the
the total
total of
of $ 17.0 b would
go towards the delivery system. This total
would increase by
the year 2015 to $ 21.7 b.. The share of external finance would
rise from its current figure of abodt 207. to roughly one-third
of the total.
These estimates are admittedly rough ,
and reflect more a
political
target than accurate data.
In this sense they are
important
because fully 1/3 of the total is for new areas of
reproductive health beyond what is provided
by family planning
programmes.
This must
be acknowledged and represents an
important achievement for any development agenda that
is
responsive to women's needs.
A valid point that
has been raised, however, by UNICEF among
others is that resource needs for broad primary health care,
child survival,
primary education,
and for other aspects of
women *s empowerment remain unspecified,
Pressure on these
fronts has to be imounted both in terms of the forthcoming
Social
Summit and
the
UN Secretary-General's Agenda for
Development.
Where will the money come from for the POA? In the year 2000,
$ 5.7 b should come from external
donors and
the rest from
domestic resources. In countries like India where the bulk of
current expenditures comes from domestic sources, resources
will have to generated partly by improving the efficiency of
the existing delivery system, by making a stronger budgetary
committment
to primary hea1th care,
and by using external
funds for
innovative prog rammes.
In countries with weaker
inf rastrue ture,
donor
assistance will
be critical.
C1 ear
signals of nat iona1
political
will
to back
the POA will
probably play a significant role in being able to access such
resources. Compared to the * 600 b resource estimate generated
by UNCED, $ 17.5 b is mere peanuts!
15
.6 .
The road ahead
t
From
the
perspective of
the international
women s movement;,
women's
the signal
achievement of
the ICPD
was the
ability to
make
governments respond
to women
as clear
political agents,
not
simply appealing to the
good will of
governments or agencies,
but acting politically
with strategic thinking,
planning, and
thinking.
coordinated action. The next step is clearly implementation.
Of the greatest urgency
is the setting up
of effective
and
flexible
structures for monitoring and
accountability at both
the international
and national
levels. National
governments,
and
donors
bilateral and
multilateral
have
to
begin
seriously implementing
the POA. In
the process they will have
to work
out new ways of incorporating women's organizations in
the monitoring, evaluation and planning stages.
A
second
critical step
is
to channel
political energy
and
resources towards
reviving primary
health care systems. Much
of the current POA is
predicated on a system of primary health
care, which
in many countries
is practically non-existent
or
has been
seriously eroded by
either reliance on
bureaucratic
management systems or by structural adjustment programmes.
A third
step is to strengthen actions and pressure to increase
resources
tor
an
for
enabling
social and
economic
deve1opment
agenda, including
support
for
women
empowering
themselves .
This will require
carrying
the Cairo
agenda fc. ward
to the
Social Summit and to Beijing.
There are pitfalls
and dangers as we
move ahead either
if we
rest on our laurels, or if
underestimate the dangers of the
id i ist
for
patriarchs.
We
should
expect
and
plan
attacks both in
the preparations for the
Social Summit and in
the World Conference
But this is perhaps
on Women at Beijing.
the unavoidable
price for success at Cairo, or for success any
time that women
affirm their capability to exercise
political
power.
16
VOICES
ova*, (j.r.G3
An
extract
from the report of the Internationa 1
Conference
Popu1 a tion and Development held at Cairo, 5—13 September,
on
REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTH
i
Rep roduc t i v e
health is a state of complete physical, mental
and
soc i a1
well-being and not merely the absence of disease
or
in —
f i rmi ty,
in all matters relating to the reproductive system
and
to
its functions and processes.
Reproductive
health
the re fore
imp lies
that people are able to have a satisfying and
safe
sex
life
and
that
they have the capability to
reproduce
and
the
freedom
to decide if, when and how often to do so.
Implicit
in
this last condition are the right of men and women to be informed
and
to have access to safe, effective,affordable and
acceptable
me thods
of family planning of thei r choice, as well as the
1 aw ,
and the right of access to appropriate health-care services
that
will
enab1e women to 9° safely through pregnancy and
ch iIdb i rth
and
provide
couples with the best chance of
having
a
healthy
infant.
In
line
with the
above
def in i tion
of
reproduct ive
heal th , reproductive health care is defined as the
conste11 at ion
of methods, techniques and services that contribute to
rep roduc —
t i v e health and we 11-being by preventing and solving reproductive
health probl ems.
It also includes sexual health,
health- the purpose
of
which is the enhancement of life and personal relations, and
not
merely counselling and care related to reproduction and
sexually
transmitted diseases.
Bearing in mind the above definition, reproductive rights emb race
certain
human
rights that are already
recognised
in
n a t i on a 1
1 aws,
in ternat ional human rights documents and
other
consensus
documents.
These
rights rest on the recognition of
the
b as ic
right of all couples and individuals to decide freely and respon—
s ib 1 y
the
number, spacing and timing of their children
and
to
have the information and means to do so, and the right to
attain
the highest standard of sexual and reproductive health.
It
also
includes
t h e i r right to make decisions
concerning
rep roduct ion
free
o f disc rimination, coercion and violence, as
expressed
in
human
rights
docu.men ts .
I n the exercise of
this
r ight ,
they
should
t ak e
into account th - needs of their living
and
future
chi 1d r en
and their responsibi1ities towards the community.
The
promo tion
of
the responsible exercise of these rights
for
all
p eop 1e shou. 1 d be the fundamental
fund amen ta I basis for government-and commun—
ity—supported policies and programmes in the area of reproductive
health, inc1ud ing family plan nin g.
their
As part of their
commitment,
ful 1
a 11 e n tion
should
be given to the
promotion
of
o romot i on
mu tua11y
resp
tfu1
and
e q u i t a b 1 e g e n d e r relations and
particularly
to
mee t in«j
the
education al
arid service needs
o
off
adolescents
to
enable them to deal Hl a pos1t1v e and responsible w a y w i t h
their
sexual it y.
VOICES
Reproductive health eludes many
of the world's people
because
of
such factors as: inadequate levels of knowledge
about
human
sexuali ty
and inappropriate or poor-quality reproductive
heal th
in format ion
and
services; the prevalence
of
high-risk
sexua1
behavlour;
discriminatory social practices;
negative
att i tudes
towards
women
and girls; and the limited power many
women
and
girls have over their sexual and reproductive lives,
Adolescents
are particularly vulnerable because of their lack of
information
and
access to relevant services in most countries.
Older worne n
and men have distinct reproductive and sexual health issues which
are often inadequately addressed.
The
implementation of the present Programme of Action is
to be
guided
by
the above comprehensive definition
of
reproductive—
health, which includes sexual health.
R) H
(l
*
I
i,
Materials from the New York
PREPCOMM meeting
May 1993
I
I
f
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USUN Press Release #63-(93)
May 11, 1993
Statement by The Honorable Timothy E. Wirth, United States Representative L
to the Second Preparatory Committee for the International Conference on
Population and Development, at the Preparatory Meeting, May 11, 1993
Mr. Chairman, Madame Secretary-General, and distinguished delegates,
it is an honor for me to be here today to represent the United States at this
second preparatory meeting for the 1994 International Conference on
Population and Development in Cairo.
First, I want to congratulate Dr. Fred Sai on his election to the
chairmanship. We look forward to his able leadership. I also want to
congratulate the UN organizers for the groundwork that has now been laid for
productive deliberations at this meeting and the remaining meetings before
Cairo. We have much work to do in the next 15 months, but important
progress has been made. It is a special pleasure for us to work with Dr. Nafis
Sadik and the able Secretariat, and I hope my comments today are as
comprehensive and compelling as her speech opening the Prepcom yesterday.
I also would like to recognize the critical role of non-governmental
organizations and experts in preparations for Cairo. NGOs made outstanding
contributions during the Earth Summit process, and we must encourage that
kind of participation on the road to Cairo. Their ideas, energy,
z
gy, experience,
and |
connections to real people in every corner of the world have helped
help us come this
far. They will give life to our deliberations in Cairo and beyond.
Today, I would like to share with you the new policy developments in the
United States since President Clinton took office. These developments reflect
our determination to help lead and be a part of a renewed global effort to
address population problems. Even more important, we are committed to help
promote international consensus around the goal of stabilizing world
population growth through a comprehensive approach to the rights and needs
of women, to the environment and to development. These elements are the
underpinnings of a new partnership among nations, men and women, and the
natural world. Only as innovative and engaged partners can we rise to this
urgent global challenge.
-2A Broader Perspective in U.S, Policy
President Clinton is deeply committed to moving population to the
forefront of America’s international priorities. He understands the cost of
excessive population growth to the health of women, to the natural
environment and to our hopes for alleviating poverty. He believes that
America cannot stand aside as the world confronts one of the largest challenges
of this century and the next.
Since taking office, President Clinton has taken steps to revitalize U.S.
efforts. The President has reversed the so-called Mexico City Policy, lifting
restrictions that prohibited some family planning organizations from receiving
U.S. funding because of abortion-related activities. He has mandated a
reorganization of the State Department to reflect the greater priority we are
giving to population as a major global issue. He has called for a restructuring ,
of our foreign aid programs to promote development more effectively. And, he I
has requested a $100 million increase in population assistance for Fiscal Year f
These actions have clearly established the importance that the U.S. gives
to the issues of international population. An additional step will be taken by
the U.S. government. I am pleased today to reconfirm the Clinton
Administration s intention to contribute to the United Nations Fund for
)
Population Activities. We are close to a final decision on conditions for our
y
contribution and the level of funding.
Finally, under the direction of President Clinton, the United States is
developing a comprehensive and far-reaching new approach to international
population issues. It will expand the scope of our activities and harmonize
them better with collective international efforts. The key elements of our
approach are:
o
ensuring that couples and individuals have the ability to exercise their
right to determine freely and responsibly the size of their families;
o
promoting access to the full range of quality reproductive health care,
including women-centered, women-managed services;
o
stressing the need for governments and public and private organizations to
commit themselves to quality of care in family planning services;
o
supporting the empowerment of women so that all societies may move
toward full gender equality in all aspects of decision-making concerning
economic and social development;
o
ensuring access to primary health care, with an emphasis on child survival;
o
preserving the endangered natural environment of our globe; and
o
ensuring that our population policy supports the world’s priority for
sustainable development.
*
-3 -
Women's Health and Status
i a A3 ue PrePar,eiffr Cairo, we must recognize that women are taking
leadership around the world on their own behalf and for the benefit of their
ar.TJk8’ their/Tomm^yties, and their countries. They know what they need
and they must be equal partners in programs and policies.
V0?16.11 are all too often victims of poverty, discrimination, and actual
d faience. Without nutrition, without health, without control over
«nJz^2kg’+Wfmen+Cani1^ empower themselves to achieve their full potential
and contribute to sustainable development. Unacceptably high levels of
Per.sist in many countries. Inadequate access to
health,care, contraception, and safe abortion leaves more than
TZiOmenjdead ft°AI^oeve^ta¥e’ Pregnancy-related causes each year.
SX"7 tr“smitted
thataSiTite proje? S
is “■«>
,“th0<i " ““
»are
We f111131 ta^e a,broader approach to sexual and reproductive
nrArnnii^r111^ rac0^lze that advancing women’s rights and health and
fJnTamentSw «lFhann-ng “kreinforcing objectives. Even more
lundamentally, all barriers which deprive women of equal opportunity must be
removed. Universal educational opportunities, especially for girls and women
are an essential precondition for economic empowerment.
’
Population and Environment
L f+k Second> ti16 world and U.S. policy, have moved past the misconcention
V *hatPopulatl?n growth is a "neutral phenomenon." Its effect on economic
IW development is not neutral. Neither is its linkage with the environment
'I Xmces^eutral 6 C°nneCtlOn between Population and consumption of
Citizens of developed nations must recognize that our current nonulation
T^n™eChi°10gr and coosmnption patterns give our nations a major and
d sproportionate impact on the global environment. Representing less than
one quarter of the world’s population, developed nations consume 75 percent of
all raw materials and create a similar percentage of all solid Xte
-4Under President Clinton, America is now addressing these issues more
actively. For example, the U.S. will sign the Biodiversity Treaty and is
committed to reducing our emissions of greenhouse gases to their 1990 level by
the year 2000. The long-term budget strategy presented by the President
includes investments in pollution prevention, energy efficiency, renewable
energy, environmental restoration and water treatment. The U.S. takes the
points raised in Agenda 21 very seriously and is actively formulating a
sustainable development plan for implementing it. And we will act on the
Agenda 21 objectives calling for further research on population/environment
relationships and for integration of demographic considerations into
environmental planning at all levels.
Migration
A third major issue in the population equation is international migration.
Uncontrolled migration is fueled by demographic pressures, those same
pressures which are challenging our ability to live in peace with our
environment. The Cairo process should reaffirm the priority we place on
improving the conditions which force people to move — impoverishment,
persecution, and conflict.
people should have the right to remain in their homes in safety and
dignity. In those cases where individuals have resettled permanently,
governments should make every effort to bring them fully into the social and
political life of their new homes.
New Opportunities: The Cairo Conference
The Cairo conference, and the process leading up to it, will provide new
opportunities to agree on actionable recommendations for the issues I have just
discussed. The secretariat for the conference has provided us with a well
thought out conceptual framework, built around the central theme of "choices
and responsibilities. We must consider carefully the responsibilities that men
and women have to one another, the responsibilities that governments have to
people within their borders, and the responsibilities of all to the world
community. By doing so, we can ensure that individuals do have choices.
In addition, the U.S. looks forward to working with the international
conmiunity to develop consensus around priority, long-term, and quantitative
goals for stabilizing world population, just as we work to preserve the global
environment, improve health, and meet other development objectives.
We also encourage the development of regional fertility and population
growth goals, as agreed at the Bali and Dakar regional conferences. At the
same time, these goals should not be confused with targets and quotas which
apply penalties to failure; this is a self-defeating approach. The adoption of
reasonable goals can help us to estimate resources required and evaluate what
we have achieved.
-5-
now and the Cairo conference, the U.S. government supports the
need to develop new estimates of the resources required for population and
reproductive health programs. Resource estimates should also be made for
improving child health, providing universal access to basic education and
reducing infant and maternal mortality.
As a world community we need to speak with one voice in respecting all
peoples rights and standing up to those who engage in coercive activities. A
<}jeiStlfn^Or the mt™tional community to consider is how governments
should be held accoimtable. A government which is violating basic human
>
rights should not hide behind the defense of sovereignty.
/
Difficult as it is, we must also discuss thoroughly the issue of abortion
Recent international meetings have drawn attention to the human tragedv of t
illegal and unsafe abortion. It is estimated that as many as a quarter of
maternal deaths, ranging from 50,000 to 200,000 annually, are due to this
cause, almost all m developing countries.
International consensus has yet to be developed on the proper and feasible
roie of governments and public policy in this area. The abortion issue should
be addressed directly with tolerance and compassion rather than officially
ignored while women, especially poor women, and their families suffer. The
U.b. government believes the Cairo conference would be remiss if it did not
develop recommendations and guidance with regard to abortion. Our position
is to support reproductive choice, including access to safe abortion.
Mr. Chairman, Madame Secretary-General and fellow delegates, many of
you have heard me talk about the profound effect the Earth Summit in Rio had
onpeople m the United States, and on me personally. It gave us - politicians,
NGOs and every day citizens - a new energy and dedication to meet
complicated and urgent problems head on, to make the necessary changes in
our own country - both in policies and individual behavior - to be better
partners m the struggle to save our global environment. The Cairo conference
can be the same kind of turning point for all of us. No issue will leave a
greater mark on fiiture generations than the population issue. I pledge the
fullest measure of American effort to meet this challenge in a wav that
safeguards the rights, the welfare and the future of human beings the world
ovez*•
Thank you, Mr. Chairman.
* * ** *
£
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Press Release USUN #71-(93)
May 17, 1993
Statement by Ambassador Warren Zimmermann, United States Alternate
Representative to the Second Preparatory Committee for International
Conference on Population and Development, on Item 5, Proposed Conceptual
Framework of the Draft Recommendations of the Conference, May 17, 1993
Mr. Chairman and distinguished delegates, I am pleased to have the
opportunity to present the views of the United States concerning the
document which will be adopted at the Cairo Conference.
In preparing our comments, the U.S. delegation benefitted greatly from the
interventions and statements prepared b}r the other delegations, as well as
the excellent speech given by tne Secretary General on Friday.
The U.S. delegation fully agrees that the decisions of the Cairo Conference
should be reflected in a new consensus document. This new document should
build on the Bucharest World Population Plan of Action and the Mexico City
Declaration and Recommendations, not attempt to revise them. The new plan
of action should respond to the dramatic changes which have taken place in
the past two decades, as well as anticipate the needs of the next century. We
believe the new plan should be as concise and action-oriented as possible,
given the scope and pressing importance of its subject matter.
We also support the suggestion of the Secretary General that the present
framework should include separate and prominent attention to specific goals
we in the international community share. These goals will provide a standard
for evaluating our efforts and holding us accountable in the future. A 20-year
time-frame seems quite appropriate.
In addition to deciding the type of document to come out of Cairo, the
Secretary General also called on us to agree on the specific issues to be
addressed by the document and the interrelationships among them. We are
- 2-
impressed by the considerable convergence of views emerging, as exemplified
in the statements by the representative of the EC, the representative of the
Group of 77, the delegation of India and the Non-Governmental Organization
iN'
fNGO) community.
I would like to reiterate a few of the common themes at this PrepCom which
the U.S. delegation hopes to see as part of the new plan of action:
o
| the centrality of the individual and human rights in all matters of
I population policy. As the Secretary General stated in her speech,
coercion, whether physical or moral, has no place” in population
policies and policies;
o
the empowerment of women and gender equality, as well as the
obligations of men;
o
the reaffirmation of a full range of reproductive rights as human
rights;
0
the strengthening of family planning programs in the context of a
more comprehensive approach to women’s reproductive health;
0
the reduction of disparities among peoples in quality of life;
o
the assurance of a healthy and sustainable environment for current
and future generations; and
0
a commitment to a comprehensive approach to population issues
that integrates population, consumption, environment and
development.
We and other delegations have already circulated suggestions about the
organization of the conceptual framework and the major headings and
Subheadings. Further discussion on these questions will be taking place in
informal sessions. However, generally speaking, we reaffirm the importance
of considering all the major themes of this conference: interrelationships
among population, environment, consumption and development; fertility,
reproductive rights and health; general health and mortality; aging and
family formation; and international and internal migration.
With regard to essential principles, the European Community has advanced
our thinking significantly by proposing a clustering of principles, which we
endorse, that will clarify and consolidate our work. We would like emphasize
»___________________________ 1
__________ -J_____ 4-1______ I
,
i .
that ___
women
’s concerns and gender
■ considerations
be• recog
recognized as
integral
to
each of these principles. Further, special attention should be given to
indigenous people, refugees, marginalized peoples, people with disabilities
and the underserved.
We would retitle Chapter 1 ‘Interrelationships among Population,
Consumption» Environment and Development;1 to emphasize the cumulative
effects of these combined factors on individuals, communities and the globe.
The Secretaiy General requested guidance on the relative emphasis to place
on the consequences and specific causes of environmental degradation. We
urge that the document identify the root causes and
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- 3focus on solutions through a fully integrated set of population, consumption,
environment, and development policies. Economic growth is of importance to
people in all nations. The challenge is to achieve that growth within the
context of environmental sustainability, addressing both peculation growth
and resource consumption. Our recommendations must reflect the global
community’s determination to develop environmentally sensitive technologies,
fair trade arrangements, and sustainable development strategies that will
help ensure a healthy community for all.
We believe Chapter II should be retitled to incorporate the concepts of gender
equality And equity along with women’s empowerment- We support the focus
on women’s empowerment, not simply roles and status, which nas emerged
during this PrepCom. We suggest special attention be paid to the fact that
opportunities for women are shaped from the moment of birth by adding a
subchapter B on TheGirjjQhild. The serious neglect and/in many cases,
outright abuse an d vToIencecLLr ec te d at girl children can no longer be ignored
or tolerated. Finally, we also suggest adding a subchapter C on men’s
i
responsibilities to support gender equality throughout society and to ensure
the well-being of their partners and their children — responsibilities which
depend importantly on men’s sexual behavior and use of appropriate male
methods to prevent unwanted pregnancies and STDs.
Chapter III on population growth and structure, including attention to family
formation, children and youth, and ageing, addresses universal, demographic
and social concerns for both developed and developing countries. In
1 particular, the goals, policies and programs that we develop need to recognize
^he variety of_family forms that exist m the world today and the fact that the
needs of the elderly are posing increasing challenges fofall societies as life
expectancy increases and family structures change.
Chapter IV, recognizes the importance of the interrelationships among
rfim’oductiye rights^reproductive health, and family planningr and the need to
develop policies and programs that enhance these interrelationships. First, a
subchapter on reproductive health and reproductive,rights would incorporate
safe abortion as well as maternal health care and STD/AIDS prevention
(areas that the Secretariat had proposed for Chapter V on overall health and
mortality). Second, family planning as a separate subchapter would reaffirm
the importance we all accord to access to good quality services. We would add
a third subchapter on adolescent sexuality and fertility. These issues have
been addressed in our previous statement. The recommendations of the
Bangalore and Botswana expert meetings provide excellent guidance on these
themes. There should also be a subtitle in this chapter concerned with human
' ScyualitY_an.d.gender relations. While many may see human sexuality as a
private realm beyond the proper scope of attention of intergovernmental
resolutions, we consider it essential for governments to legitimize serious
public discussion and promote knowledge and education in these areas.
In addition to the specific chapter addressing reproductive health, a chapter
on overall health and mortality would be appropriate. Among other things,
this chapter would draw attention to two critical health
:S12/27
- 4concerns closely related to fertility and reproductive health objectives: the
need to continue efforts aimed at reducing infant and child mortality and the
need to invest more in the infrastructure to meet basic socioeconomic needs
and to provide both preventive and curative health programs. We note the
special challenges posed by the needs of those who are homeless and hungry.
With regard^to the chapters on international and internal migration, we
believe our deliberations should reinforce emerging
international
a
------------ —1 norms
Cuuceming the rights of individual migrants and refugees, with particular
pf
concerning
attention to the special vulnerabilities of women and children, tni addition,
we must underscore the need for further examination by governments of the
longer-term
ger-term economic and political causes and consequences of migration,
including
luding the roles of population pressures, poverty and environmental
degradation.
A series of chapters remain which address critical matters of
implementation: information, education, and communication;
capacity-building; technology and research; national and international action;
and partnerships with non-governmental groups. From our perspective, the
arrangement and grouping of these sections could be modified in the final set
of recommendations, and we will provide additional comments on these to the
Secretariat. However, I would like to highlight here a few key points:
First, the commitment we have stated to the centrality of women in
population, environment and development concerns must be reflected in all
aspects of implementation of the conference recommendations and goals.
Gender considerations and women’s direct participation must figure
\
prominently in education, training, research agendas, and resource allocation.
Second, legal _and regulatory barriers, which often impede progress toward
population and sustainable development objectives, should be specifically
addressed. In particular, laws and policies which discriminate.against women
and constrain the roles of the private, voluntary and commercial sectors must
be reexamined.
Third, capacity-building should give high priority to investments in the
knowledge .base that supports our endeavors, including basic data collection
and analysis, biomedical research, social and behavioral research, and policy
; and program research and evaluation. Those who are affected by policies and
I programs, especially women, must be involved in decision-making in all
I stages of research. Further, they must have access to data and research
i findings which are the basis for informed decisions by individuals and for
[ monitoring program performance.
Fourth, the ability of individuals to exercise their indhddual human rights
and act responsibly requires awareness, knowledge and information.
Therefore, we underscore our belief in tne need for a renewed emphasis on
information, education and communication in virtually every area of activity
addressed by the Cairo conference. We would also emphasize the urgent need
to reduce sex role stereotypes in public information as a major means to
enhance gender equality.
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- 5Lastly, we need to focus on estimating the resources required to meet the
population and reproductive health goals we set for the year 2015. We urge
the Secretariat to prepare estimates to be considered at PrepCom 3, along
with a proposed sharing of responsibility among donors, national governments
and the private sector.
Before I close my remarks, I want to suggest that we agree during this
PrepCom on procedures for information exchange and feedback between now
and the thira PrepCom scheduled for next April. Wc suggest the Secretariat
circulate, well in advance of PrepCom 3, a set of draft documents including
recommendations to ensure that comments from government and
non-governmental organizations can be incorporated in a revised draft to be
considered at the PrepCom. These comments by governments and NGOs
could be communicated both directly and through informal intersessional
consultations conducted by the Secretary-General. NGOs should have the
opportunity to participate fully in all intersessional activities. A revised draft
should then be made available to governments in all official languages well
ahead of PrepCom 3.
Mr. Chairman, we very much look forward to working with you and the
Conference Secretariat through the remainder of this Prep Com and the
preparations for Cairo. Thank you, Mr. Chairman.
* * * * *
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USUN Press Release 74-(93)
May#, 1993
Statement by The Honorable Timothy E. Wirth United States Representative
to the Second Session Preparatory Committee for the International
Conference on Population and Development, Closing Statement, May 21, 1993
Mr. Chairman, thank you for allowing me this opportunity to make a few
concluding remarks. On behalf of my delegation, I must start by saying how
privileged we feel to have been able to participate in this preparatory
meeting. We would like to express our particular thanks to the UN
Secretary-General. Mr. Boutros-Ghali, for providing such a welcoming
framework for the conference. We must also express our appreciation to you,
Dr. Sai, to Secretary-General Nafis Sadik, to the chairman of the working
groups, Mr, Biegman and Mr. Kaaria, and to all who have worked to make
this a successful PrepCom.
I want to congi’atulate the Chairman on the excellent draft summary he
has prepared of our proceedings. It reveals that much has been accomplished
over the past two weeks by all delegations and by the assemblage of NGO
representatives who have so enriched our deliberations. We have clearly
recognized the importance of providing family planning services in the context
of reproductive health and rights. Together, I believe we have developed a
appreciation for the close and complex interrelationships of papulation,
the environment, consumption, development, and migration.
We have also been reminded of the need to consider these broad societal
issues from the standpoint of individuals - especially women - as the
particular group most affected. In addition, participants have affirmed the
need to better understand families, in all their diversity^nd to find ways to
strengthen them as they face new pressures. They have recognized:
That men and women must be responsible to one another and give each
other mutual support;
The basic human right of all couples and individuals to decide freely and
responsibly the number and spacing of their children to have access to the
necessary education, information, and quality family planning and
reproductive health services;
And that all of us must share responsibility for nurturing the next
generation and caring for the ageing - those who gave birth to us.
- 2Since the first international population conference in Bucharest 20 years
ago, we have achieved simificant and remarkable changes. Even before then
many in this room had already emerged as leaders on these issues. We salute
your efforts and your example. Family planning and other reproductive
vv■ slV’vlces are ^ow much more widely available around the world and
both birth and death rates have come down in most regions. We who are
assembled here are now ready to take the next steps, and to demonstrate
again, thau by working together we can make a difference. And we must,
Twenty years frorn now another generation will take our seats in this
hall to prepare for the Fifth World Conference on Population. Delegates to
t i
j™
be asliinS wliat we did and how well we met the goals
established in Cairo.
They will be asking whether we have undertaken the hard work and
careful planning required to translate our good intentions into real changes in
programs. They will be asking whether all of us -- developed and developing
country governments, international agencies, and NGOs - have made the
longterm commitment of resources necessary to increase the reproductive
choices and quality of life for people around the world - and whether we did
I so m time to make a difference.
The United States believes that the Cairo Conference will be a milestone,
le key will be to engage people - both women and men - from all walks of
life within our countries and across the globe. To help maintain momentum
and participation, we strongly support recommendations for a systematic
progi-am of intersessional consultations. For its part, the United States
intends to continue the momentum from here.
During this time, to support our words with deeds, we will accelerate
h 0Ur le^s aftlve branfh fulfill President Clinton’s commitment to
broaden our support for reproductive health, family planning and other
population programs in our foreign assistance budget. The United States is
student0 andtS1kte
this challenge as a global partner, as a willing
tE 3 S<enSe °f ur^cy- Together we have much to learn and
much to do if we are to successfully translate our vision into concrete
programmatic strategies.
vou and
me reit*rate
thanks and appreciation to
you and to all participants in this constructive dialogue. Together, we will
nte a new history for our world. Thank you, Mr. Chairman.
* * 4 * *
Parliamentarians
for
Global Action
<3
Parliamentary Declaration
on Population and Development
Presented to the Second Meeting
of the Preparatory Committee
to the 1994 International Conference
on Population and Development
May 16, 1993.
New York.
parliamentary DECLARATION
ON POPULATION AND DEVELOPMENT
tlie u?dersi9ned members of Parliamentarians for
Global Action, met in New York on 15-16 May 1993, to
consider the issues of population and development/ We
represent 19.1 million citizens of Earth, from 24
countries and all regions.
The peoples we represent
reflect the full variety of the world: extreme affluence
and absolute poverty, high and low literacy, small and
large families.
Together, we stand united in our
determination that the Cairo International Conference on
Population and Development in 1994 will be a milestone in
the effort to create a sustainable planet for all
peoples, of both the present and future generations,
where human rights for all are fully respected. The
empowerment of women is fundamental to the achievement of
these goals.
The Population Challenge
The population of the Earth is increasing by a quarter of
a million each day. in the absence of wise management,
the population increase will cause irreparable depletion
of the planet's resources and environmental degradation,
to the serious detriment of human civilisation.
The
civilisation.
human family must come to terms with the need to match
population size with the capacity of the Earth to sustain
an optimal number of its own species.
Political Will
The population . and development challenge can be met.
Addressing as it does individual rights and societal
responsibilities, it is a question of political will.
Critical
decisions,
with
appropriate
national
obligations, r
” st‘ be made
‘ within
*
??
this decade to meet the
chaHenge. Failure to act after Cairo would mean failure
of a fundamental nature for the planet., for all time.
The people, whom we represent and who hold us
accountable,
want immediate action.
Among our
constituents, sufficient political will exists for change
to occur. It is our task, as their representatives, to
translate that will into political action. We call upon
the governments and other influential organizations and
institutions of the world to match us in that endeavour.
Population and Development
The problem is not purely one of numbers. T1
The essential
problem is the link between population size.r economic
growth, and the provision of services to meet the basic
needs of all people. Poverty, including unemployment and
appalling working conditions, results in large family
size: it removes the opportunity for couples to decide
for themselves. Some 95% of the population growth will
occur in the developing world.
The. population and development challenge is both a
societal responsibility and a question of human rights.
The solution is not state coercion, but rather freedom of
choice for responsible family planning.
Concern for
human rights requires that the solution be found through
the
free . exercise
of
individual
choice
and
responsibility.
With sufficient political will, the
attainment of a stable optimal population for Earth will
be compatible with the full exercise of individual
rights.
The true carrying capacity of the Earth is not known, It
could perhaps be expanded through investment in
friendly technology. It is clear that at
current
°f technology the carrying capacity' of
many parts of the Earth are being exceeded. Our estimates
of carrying capacity depend upon assumptions that reflect
national diversity among contemporary societies which
therefore, make a global consensus difficult to achieve.
But the circumstances demand that progress toward such a
consensus be made. We call upon governments to undertake
studies on the national carrying capacity of their
And
countries.
And . we call upon the United Nations to
undertake a similar study on the economic carrying
capacity of the planet, which would address the national
studies and the interrelationship between them.
Population and Consumption
The present situation is a crisis of both human numbers
and human
behaviour,
--- If human numbers are to be managed,
so too must human behaviour,
If the developing world
must contain the expansion of its population, the
developed world must contain the profligacy of
<
its
lifestyle.
The richest 20
percent of the world
population consume 80 percent of the resources,
The
underlying issues of consumption patterns in the
developed world must be addressed in a :meaningful way.
In short, peoples of the North must eliminatet ever
over
consumption and unnecessary waste if the population and
development crisis is to be resolved.
Extreme inequalities of wealth and opportunities in poor
countries must also be addressed. There must be a more
equitable distribution of wealth and improved access to
services for social stability
and a better quality of
.
life for all.
It is essential that the final document from Cairo accord
responsibility equitably between the developed and the
developing world for meeting the challenge.
Global
problems, even if approached locally, can be resolved
only from a truly global perspective, one which eschews
regional or national bias, The interests of the planet
must be identified from that perspective, and the
national interests of all Me
mber• States be seen to be
---compatible with that broader interest.
Population and the Environment
Experience shows that underdevelopment, through poverty
and
population
.3
pressures, environmental
causes
<
degradation:
in
water
quality,
soil
depletion,
desertification.
sanitation
and
local
pollution,
Environmental
consequences
then
adversely
affect
development prospects.
Sound economic development
policies will ease population pressure, and mitigate
environmental degradation.
They who live in extreme
poverty cannot be stewards of the Earth when daily
survival is at stake.
Population and Trade
The key to development prospects is fairer terms of
trade. No amount of development assistance, no finelytuned
structural adjustment policy,
will
enable
developing countries to resolve their problems when their
resource base remains strangled by restrictive trade
policies. The developing world must have fair access to
world markets and technologies in order to generate its
own development. The population and development crisis
will not be resolved until this problem is addressed.
The rich countries should not use their power to damage
the economic prospects of poorer countries.
Population and Debt
We urge, the World Bank, IMF and other financial
institutions to ensure that structural adjustment
Programmes and other obligations do not damage healthi and
education services as some have in the past, because
these are crucial to real economic and social
development.
Until the debt problem is resolved, c,
: will be
governments
unable to break free of the cycle of populationl pressure,
poverty and slow or negative rates of development.
Policies of debt alleviation by creditor agencies; and
countries is a precondition to national progress in
economic and social development, and attaining an optimal
population commensurate with that development.
Population and Migration
While some level of voluntary migration is normal,
poverty and population pressures, political conflict and
human rights abuses cause mass migration problems and
social unrest which threaten both stability and security
among nations. Economic disparities between urban and
rural areas and other causes of migration must be
redressed with greater emphasis on decentralisation of
population.
Over the long term, progress in economic
development will remove the compulsion for citizens to
leave their own country, even if conditions in the
developed world remain relatively attractive. We urge
the international community to take the necessary
measures to remove the causes which give rise to mass
local and international migrations.
It is also
imperative that a charter be drafted without delay to
protect the rights and ameliorate the economic and social
injustices to migrants.
The Rights and Role of Women
Progress in promoting the role of women in contemporary
society is a central feature of the population and
development challenge. The rights and responsibilities
of women, especially in the developing world and
particularly in rural areas, have been neglected and must
be asserted.
The political rights of women must be realised through a
greater participation in public and political life in all
countries. . The Convention against all Forms of
Discrimination against Women must be ratified and fully
observed by all UN Member States before 1995.
More attention needs to be given to the rights of women
to have greater economic power.
This must also be
accompanied by redress of the present social injustice to
women — in the area of sexual harassment and equality of
opportunity — including supportive family leave
policies.
Fundamentalism in all forms is confined
neither to specific religions nor specific societies: its
common victims are innocent citizens everywhere and in
particular women.
Access to education for girls and women must be quickly
improved. A correlation exists between education levels
and smaller family size. No better economic investment
return can be made by the international community than on
education for girls, to bring them to the same level as
their male counterparts.
reproductive ‘“health
made “ ESrcise°V1It°n the
haters
a.- ffOrd?ble and accessible contraception, fewer
abortions will result.
Experience shows that, when
combined with better education, the provision of these
s?1??0®3 reST’?.lbS in smaHer family size through freedom
of choice. With sound economic investment policies the
exercise of individual rights will significantly reduce
current concern over global population trends.
Governments should be challenged to combine policies of
smaller family size with reduced infant mortality,, and to
this end, surpass the minimum goals agreed
agreed by
b
WHO,
UNICEF, UNDP and UNFPA of:
*
reducing maternal mortality by 50% by the year
2000;
*
reducing mortality rates for infants and for
children under 5 by one-third, c_
or to 250 and 70
respectively per 1,000 live births, whichever
is less.
Family Planning
Familyplanning is a joint
joint responsibility
responsibility and all
countries need to focus on the education of both men and
women to fully
i
af:ceP^ their mutual obligations as
parents, .including financial responsibility for children.
Family planning must be integrated into community-based
ealth services, with a focus on the quality of health
care provided.
^ecia! attention must be given to the needs of
adolescents, particularly with regard to family planning.
Sex education programmes must be made available, oriented
to adolescents and their parents.
Failure in this
respect within this decade will have a major effect on
rates in the next century.
Financing the Solution
No solution to the population and development crisis will
be found without a major financial contribution from the
developed world.
A 3% reduction in current military expenditure worldwide
would meet the costs of implementing Agenda 21 for
environmental clean-up and poverty elimination, and
should be a minimum objective for all governments.
We call upon all OECD countries to achieve what some
countries have done during the 1980's: the attainment of
the 0.7% target for official development assistance and
target for total financial flows to the developing
world, prescribed for the world community by the Pearson
Commission three decades ago. We parliamentarians eschew
any notion of "aid fatigue" and call upon the developed
world to do what should have been done twenty years ago,
and provide sufficient aid that genuinely contribute to
development and does not return to donor countries in
undue proportions; this in the full knowledge that aid by
itself will not be sufficient.
It is a question of
political will, resting on enlightened self-interest and
human solidarity.
What is morally right will, in
retrospect, prove to have been politically right.
We call also upon governments to allocate 4% of their
official development assistance programmes to population
activities by 2000. 'The recent decisions by the United
States in this respect are highly encouraging, and a
challenge to the rest of the developed world.
jts *_____________________ _____
•.
.
•
Resources for population and family planning activities
must
must,, :in time, be found equally between the developed and
the developing world.
The need for transparency to
ensure that financial transfers are not wasted through
inefficient administration and corruption is selfevident, and is acknowledged alike by parliamentarians
from the developing as well as the developed world.
Progress . in. this
respect
requires
a
greater
decentralisation of authority and the administration of
such funds to regional and local municipalities, and a
greater popular participation in the development planning
and administration in the developing countries. Where
development assistance is to be expended on women's
issues, the planning, administration and financial
control, with full transparency and accountability, of
such funds should have the full involvement and support
of women and women's groups.
The Cairo Conference
The 1994 Cairo Conference must be a springboard to
generating political will that ensures that the related
issues of. population and development are at the top of
the political agenda of world leaders for the remainder
of the decade.
Parliamentarian Action
We hereby pledge our personal commitment to undertaking
P°iiticai action, in our national parliaments and
elsewhere as appropriate,
to promote the above
prescriptive policies and goals.
In particular, we
undertake to ensure parliamentary participation in the
following:
* Establishment of national committees on population and
development, where they do not yet exist, for preparation
for the Cairo Conference;
* Provision of national reports by our member countries
for the preparatory process, and parliamentary review of
them before they are submitted;
* Initiation of parliamentary mechanisms on population
and development, to ensure that national activity after
the Cairo Conference is maintained at the same level of
political will
as that which is generated at the Conference;
* Observation of World Population Day on 11 July through
activities to focus the attention of governments and
communities of the importance of population an
development issues;
*
Parliamentarian involvement in the Cairo Conference;
* Delegations, as appropriate, to ministers of our
governments, and institutions to convey acceptance of
this declaration.
Senadora Silvia Herndndez (Mexico);
International President
Participants in the Parliamentary Workshop on Population
and Development:
Mr. Murli Deora, MP; (India) Parliamentary Convener
Senator Margaret Reynolds, MP;
(Australia)
Chair
Parliamentary Workshop on Population and Development
Senator Olu Alabi (Nigeria)
Ms. Phoebe Asiyo, MP (Kenya)
Mr. Karl-Goran Biorsmark, MP (Sweden)
Ms. Ingeborg Botnem, MP (Norway)
Dep. Benedita da Silva (Brazil)
Dip. Maria Angelica Cristi (Chile)
Dip. Sara Cruz Olvera (Mexico)
Senador Jaime Ferndndez Mirabal (Dominican Republic)
Ms. Daisy Fuentes, MP (Philippines)
Mr. Gopi Nath Gajapathi, MP (India)
Dep. Gary Guiteau (Haiti)
Ms. Houda Kanoun, MP (Tunisia)
Mr. Moses Katjiuongua, MP (Namibia)
Mr. Abdul Moyeen Khan, MP (Bangladesh)
Prof. Mona Makram-Ebeid, MP (Egypt)
Senador Ricardo Monreal Avila (Mexico)
Mr. Lesedi Mothibamele, MP (Botswana)
Dip. Karen Olsen Beck de Figueres (Costa Rica)
Senator Noor Jehan Panezai (Pakistan)
Mr. Longin Pastusiak, MP (Poland)
Dr. Irma Alasyah Putra, MP (Indonesia)
Charm Oppah Rushesha, MP (Zimbabwe)
Dep. Francesco Rutelli, MP (Italy)
Dip. Florencio Salazar Adami (Mexico)
Ms. Nerissa Corazon Soon Ruiz, MP (Philippines)
Dr. Mrs. W.M.R. Sudjoko, MP (Indonesia)
Mr. Richard Ulfvengren, MP (Sweden)
Mr. Tony Worthington, MP (United Kingdom)
U.S. DELEGATION
INTERVENTION REGARDING GOALS
PREPCOM II
May 19, 1993
The United States supports, in principle, the goals enunciated by
the Secretary General in her Friday presentation and in the
Secretariat non-paper.
These goals call for — over a twenty year period — major
reductions in infant and maternal mortality, substantial
improvements in longevity, meeting the unmet need for family
planning services, the universal availability of primary school
education — with an emphasis on the equalization of opportunity
for girls — and finally, for the slowing of the rate of
population growth. Many of these goals reflect already adopted
regional and national goals ad can only be met with the
participation and commitment of individual countries and regions.
We would suggest, furthermore, that three additional goals be
taken into consideration.
o The first is to redress a fundamental inequity in the
treatment of boy and girl children under five which is reflected,
in many areas, by the fact that by age five a disproportionate
number of girls do not survive — either as a result of sex
selection, infanticide or because of inadequate nutrition or care.
o The second represents an extension or subset of the goal to
reduce maternal mortality — that is, we propose that a goal be
set as well for the proportion of maternal mortality which is due
to unsafe abortion.
o The third goal we suggest addresses many of the concerns
expressed at this conference — whether the health of children,
the empowerment of girls and women or the well being of the
family. We speak here of a reduction in the proportion of births
that occur among teenage girls and particularly the very young
girls in that age span.
We hope that these additional goals will be considered and that
they will be quantified — along with those suggested by the
Secretary and the Secretariat using the best available data — by
the third Prep-Com
-2-
rwlize that there are many worthy and important goals |isted
tbrnnahout all the preparatory documents which unfortunately, o
r
of information and «. suggest that attention ^, given to the
information in the future.
development of such
i--- --the ICPD should not be
We want to emphasize that goals adopted by as
commitments we make
viewed as external, arbitrary
steps toward
fXd^f^l^Sr'p^^
groups that, in all societies, are di^dv^^^do^yot?er
lack of education, family ethnicity, disability or other
conditions.
30361
or
Dr. Hans Fleisch
18
1993
Germany will have the presedency of the EC during the ICPD
1994. Therefore Germany will play a key role an the part of
the Europeans in the forthcoming ICPD 1994-decisions.
There is only one German institution specificly concerned
with world population issues, the Deutsche Stiftung
Weltbevoelkerung (DSW).
In Germany the ICPD 1994 is being prepared by a national
commission. Because of my media- and PR-work as managing
director of the DSW the federal governement of Germany has
appointed me to this commission with the specific brief to
further public awareness of world population issues and the
ICPD 1994. I have not been allocated any funds or whatever
for this task.
Furthermore I have been invited by the Bundespraesident and
leading people of serveral political parties to inform them
about ICPD 1994 following the Prepcom 2.
Further I have agreed with the secretary general of Deutsche
Welthungerhilfe for me to outline and implement a common
campain of awareness of world population issues for
decisionmakers. (Members of the Welthungerhilfe are the
Bundestagspraesidentin, chief whips of the Bundestag and all
major associations of Germany).
-Secretary of state REPNIK, probable future minster for
forein affairs and a personal friend of Helmut Kohl, told me
that he is prepared to increase the percentage of the German
ODA that ist need for family planning etc. provided that
certain politicians to support this.
My above mentioned activities and those I shall outline
below will have to be curtailed without any other sources of
finance be made available to DSW. However a major German
foundation (Bosch-Stiftung) have offered to be CO-funder
provided that another donor can be found.
In may opinion it is crucial that I am able to undertake the
following:
- preparation of mainly English language publicatons for
distribution to opinionmakers
-a "Happy-Christmas"-campain for all German members of
parlament (together with Welthungerhilfe)
-a "Happy-New Year"-campain for decision makers in NGOs,
business and finance (together with other NGOs)
-mailshots and ICPD-newsletters for journalists.
These activities will cost DM 63.000 (42000 US/Dollar) in
1993 and DM 90.000 (60.000 US-Dollar) in 1994 of which about
the half could be funded by the Bosch-Stiftung.
THE GROUP OF 77
New York
Office of the Chairman
STATEMENT BY COLOMBIA ON BEHALF OF THE GROUP OF 77
AT THE SECOND SESSION OF THE PREPARATORY COMMITTEE
OF THE INTERNATIONAL CONFERENCE
ON POPULATION AND DEVELOPMENT
New York, 11 May 1993
P.O. BOX 20 • NEW YORK, N.Y. 10017 U.SA • TELEPHONE (212) 758-7577 . (212) 963-3816 • TELEX 377-0000 . FAX (212) 758-7580
J
Mr. Chairman:
At the outset, allow me to congratulate you, on behalf of the Group of 77,
on the occasion of your election to guide our discussions during this crucial
meeting. We are proud that a representative of the developing world, with such an
outstanding background on population issues, will lead our deliberations during this
Second Preparatory Committee of the International Conference on Population and
Development
Mr. Chairman:
The G-77 would like to address item 4 on our agenda by commenting on
the reports of the six expert group meetings and by proposing some operative
arrangements dealing with the preparation of the Cairo Conference.
With regard to the expert group meetings, we believe that the substantive
debate on their recommendations should be under agenda item 5. On this
understanding, we would like to submit three comments that could improve the
methodological treatment of the expert group reports as inputs for the Conference.
1.
The G-77 believes that a more profound and concrete consideration of
the financing of international cooperation for population activities must be
undertaken. Although some of the expert recommendations incidentally touch on
this matter, none of them has offered a thorough analysis of this crucial aspect of
the Cairo Conference. Without a systematic reflection on the possibilities and
constraints of the future availability of resources for the developing world in this
field, most of the other inputs may prove useless.
2.
A more systematic work in the formulation of the recommendations is
needed. At the present stage the recommendations included in the six reports
often overlap each other and mix the strategy, policy and operational levels. The
Secretariat should ensure that these recommendations clearly identify the "added
value to the current status on each specific field, taking into account the appraisals
of the implementation of the World Population Plan of Action. On the other
hand, a systematic approach should clearly build upon related multilateral policy
guidelines like the International Strategy for the Fourth Development Decade and
Agenda 21.
However, it is of the highest importance to maintain the specific population
focus in the recommendations formulated. Although issues like social policy,
environment, poverty eradication and promotion of women are essential, all the
recommendations should address explicitly their population aspects.
Bearing this in mind, the recommendations should take into account relevant
coordination mechanisms, especially at the field level, among relevant U.N bodies
2
and agencies like WHO, UNESCO, UNICEF, UNDP and the World Bank. Such
an approach would allow the integral treatment of specific issues like international
migration, which has gained increasing importance for the developing world.
3.
The recommendations should identify priorities among the ways and
means to achieve the agreed population goals. If a "shopping list" approach is
avoided, the formulation of priorities can help Member States define their own
population policies. Ultimately, each Member State has the responsibility to decide
about the implementation criteria to cope with its particular needs.
Mr. Chairman:
Finally, the G-77 would like to submit two operative proposals in order to
ensure that the Cairo Conference is prepared at the adequate political level:
1.
Given the obvious importance of this process, a substantive increase in
the resources devoted to it must be considered, both for intergovernmental and
secretariat work.
2.
The proposed duration of the Third Preparatory Committee may be
short in view of the substantive work that must be done at that late stage before
going to Cairo. We hope this PrepCom will agree on a longer duration for the
Third PrepCom, bearing in mind the schedule of other important U.N. meetings.
Mr. Chairman:
You can count on the full cooperation of the G-77 to achieve the specific
goals of this Second Preparatory Committee.
Thank you.
PERMANENT
MISSION OF
DENMARK
TEL. (212) 308-7009
TO THE UNITED NATIONS - 2 UNITED NATIONS PLAZA. NEW YORK. N.Y- >0017 -
PREPARATORY COMMITTEE FOR
THE INTERNATIONAL CONFERENCE
ON POPULATION AND DEVELOPMENT
SECOND SESSION
10 - 21 MAY, 1993
STATEMENT
BY
THE REPRESENTATIVE OF
DENMARK
ON BEHALF OF THE EUROPEAN COMMUNITY
AND ITS MEMBER STATES
AGENDA ITEM 5:
PROPOSED CONCEPTUAL FRAMEWORK OF THE
DRAFT RECOMMENDATIONS OF THE CONFERENCE
Friday, 14 May, 1993
Check against delivery
Mr. Chairman,
behalf of the European Community
I have the honour to speak on
and its Member States.
thank the Secretary-Genera! of the Conference for
Let me first
the Proposed Conceptual Framework of the Draft
the document on
of the conference (Document E/CONF.84/PC/ll). The
Recommendations
a good basis for the discussions of the
document provides
it contains the major elements of the substance of
Committee, as
However, we regret the late distribution or the
the Conference,
nave made the preparations for this meeting
document which
would urge the Secretariat to ensure that all
difficult. We
distributed 'well in advance of the next
relevant documents are
itself to ensure thorough
preparatory meeting and the Conference
preparations.
Conference we agree
Concerning the format of the outcome of the
to let the decisions of the
with the Secretary-General *s proposal
a new Plan of Action.
Conference be reflected in one document,
results of the World population
This document must build on the
and the Mexico-Declaration, but the Cairo
Plan of Action
documents,
should not attempt a revision of these
Conference
We recognize the
milestones in their own right,
which are
United Nations Conference on
importance of the outcome of the
Environment and Development in the preparation for this Conferen-
ce.
as foreseen
The new document from the Cairo Conference shoul ,
in the Secretary-General's proposal, be based on the results and
common understandings that have developed over the
t.._ last decades
action in a practical
and present the recommendations for future
believe that the document should be
and action-oriented way. We
roles of governments and other actors
manageable and identify the
locally, nationally, regionally and
at various levels of action
2
internationally,
required.
including actions to be taken and resources
It is our understanding that the review and appraisal of progress
made in the implementation of the World Population Plan of Action
will be background documentation for the Conference.
Mr. Chairman,
The Secretary-General has proposed that the preamble for the
document should reflect the major intergovernmental commitments
relating to population, economic and social development, and
sustainability. We basically agree with this proposal but we find
that the preamble should equally stress the commitment to respect
basic human and reproductive rights and improving the quality of
life for all.
We agree that the heart of
the conceptual
framework is the
guiding principles outlined in Part One, paragraph 15. Our main
concern here is with the organization of these principles. At the
moment the list of headlines lacks structure and several of the
items overlap. We feel that the number of headline themes needs
to be kept small and that the many further issues should be
explicitly identified and grouped under these themes.
We identify four key areas for organizing the guiding principles:
1.
Human Rights
and
Population:
Recognizing
obligations
and
responsibilities.
2. Human Development and Population: Increasing choices and
opportunities.
3. Sustainable Development and Population: Matching resource
consumption and growth.
4. Partnership in Population: Moving from commitment to action.
Under the theme of "Human Rights and Population” there should be
explicit attention to the extension and protection of rights and
the obligations and responsibilities of individuals, families,
3
groups and nations. Important sub-themes concern rights of women
and gender equality, obligations of men, protection of vulnerable
groups, sexual and reproductive rights and opposition to
coercion.
Under the theme of "Human Development and Population" issues of
quality of life, education, health and reproductive choice, and
intergenerational equity need explicit identification. Special
needs to provide a full range of choices and opportunities for
women and adolescents must be acknowledged.
Under the theme of '’Sustainable Development and Population" the
whole range of issues concerning the interrelationship of
population, environment, 'resource consumption and sustainable
development would be addressed.
An
important addition to the guiding principles currently
addressed in paragraph 15 is our suggestion of the theme of
"Partnership in Population". This theme concerns the translation
of commitment into action at individual, group, national and
international levels. We believe that this theme should also form
the basis for a separate Part Three, to underline the importance
of future action.
We also believe that the Chapters of Part Two should be reordered
and partially restructured to reflect these four areas for
organizing the guiding principles. In order to comment on the
issues in Part Two we will for the time being revert to the
structure as outlined in the document.
Mr. Chairman,
While we agree in general with the proposed content of chapter
I of Part Two, we find that in order to reflect better the
content of the chapter the title should read: "Relations between
population and sustainable development". It is important that the
perspective in this chapter should be the population-related
4
aspects of developmental and environmental problems, as stated
in the document. Encroachment on ongoing negotiations in other
fora dealing with environmental issues should be avoided. The
population questions merit separate discussion and should not
drown in a general debate on all development related issues.
It is of great importance that the document focuses on gender
aspects and the rights and empowerment of women in connection
with population. Chapter II on the role and status of women
should also include a discussion of the changing roles and
responsibilities of men. Consequently we would suggest the
following title for the chapter: "Gender equality, equity, and
empowerment of women". The content of this chapter should be
further developed. The results of the expert group on women and
development could serve as a substantial input. In this connec
tion we would like to emphasize the importance of giving high
priority to universal literacy and education at all levels especially for women and girls.
In Chapter III on population growth and structure we agree with
the view that it is important to recognize the variations in
population development at regional and at country level, The
causes as well as the consequences of variations must be analyzed
and appropriate measures developed to deal with the different
situations. In this context an assessment of the impact of the
AIDS pandemic would be of interest. We agree that the changing
patterns of family formation and the profound changes taking
place in family sizes, forms and structures demand new measures.
Such measures must be targeted to all members of the family.
We would like to see Chapter IV deal with the broader issue of
sexual and reproductive health including responsibilities towards
one's partner, transmission of sexually transmitted diseases and
HIV/AIDS. This chapter must also address the important issue of
abortion. Consequently the title of the chapter should be changed
to: "Reproductive rights, sexual and reproductive health and
family planning". Section B, "Family planning", is a very
5
important section in its own right. Furthermore, a section
called: "Reproductive health information and services" should be
added to reflect the broader perspective on the health of
parents, adolescents and children.
f
Section C of Chapter IV should be titled: "Adolescent sexuality
and fertility". As mentioned in my statement Monday the special
needs of the adolescent population must be recognized, Young
people - men and women - must have access to reproductive health
services and confidential counselling without prejudice to their
age or marital status, and to appropriate family planning
services.
Information and education on sexuality, sexual
behaviour, reproduction and sexually transmitted diseases,
including AIDS, and the consequences of early childbearing must
be an integrated part of the educational system.
Chapter V on health and mortality should assess gender and socio
economic differentials regarding health and mortality issues m
both developed and developing countries. A section on sexual
transmitted diseases, prevention and impact, should be included.
The title of Section C in this chapter should be changed to
"Maternal morbidity and mortality”, and should discuss infertility problems as well, The health issues should in general
be viewed in the context of Health for All by the Year 2000.
In Chapter VI on international migration it would be as important
and more in line with the themes of the Cairo Conference to focus
on the causes of migration, whether they are political or
economical by nature. The recommendations from the European
Population Conference address both the causes and consequences
of international migration as well as the issue of integration
of migrants and could be used as an inspiration for this chapter.
The problem of south-south migration should also be dealt with
in this chapter.
Chapter VII on population distribution and internal migration
should stress the importance of rural development and look at the
6
possibilities of planning urban development with a view to
support for development of smaller cities as an alternative to
the troubled megacities of both developing and developed
countries.
The experience over the last decades has clearly shown the
importance of creating awareness of population issues, We
therefore attach great importance to further action to strengthen
information, education and communication, as indicated in Chapter
VIII.
To ensure that commitments are developed into action it is
essential to develop and strengthen capacity-building, especial
ly in developing countries. Such capacity—building shall help to
develop appropriate national population-related programmes and
policies as part of overall national plans as well as to
strengthen the ability to manage population programmer.
programmes, The
recommendations on international cooperation from the European
Population Conference can serve as useful input for Chapter IX.
Chapter X on technology and research should also include
substantive research on the determinants of fertility decline,
international migration and levels and patterns of mortality, and
on the interrelationships between population growth and sustai
nable development.
We agree with the focus in Chapter XI on national responsibilities, but the commitment of both developed and developing countries
to common action in the population field should be stressed,
Encouraging cooperation between
between the
the developing countries in
confronting problems in this area could provide for new solu-
tions. The international community should give special attention
to the African region,
where population-related problems
are
particularly serious.
We finally agree with acknowledging the contribution of NGO's,
community groups and the private sector, but prefer the title of
«
7
Chapter XII to be changed to: ’’Cooperation with groups outside
governments".
Mr. Chairman,
We would like to see the outcome of the Conference on Population
and Development in a global perspective. The need for a balance
between population, sustained economic growth and sustainable
development and environment is the responsibility of all
governments. A comprehensive partnership in population, as
mentioned earlier, is required to transform the commitment of the
Conference into action at individual, group, national and
international levels. We encourage UNFPA to take an active role
in implementing the envisaged Cairo Plan of Action. As regards
the monitoring of the implementation we believe that no new
institutions should be established. We would therefore see the
Population Commission as the relevant UN forum - as has been the
case after the Mexico and Bucharest Conferences.
Finally, Mr. Chairman,
As mentioned in the beginning of my intervention we believe that
a good basis for further deliberations at this preparatory
committee and beyond has been established through the Conceptual
Framework as presented by the Secretary-General. The comments and
suggestions that
I
have
put
forward here
on
behalf
of
the
European Community and its Member States should be seen in that
context.
Thank you, Mr. Chairman.
I'
U.S. DELEGATION WORKING PAPER - MAY 19, 1993
CLUSTER 5: RESOURCE ALLOCATION, RESOURCE MOBILIZATION, THE ROLE
OF GOVERNMENTS AND OTHER SECTORS.
1. The Secretariat did well to cluster Chapters 11, 12 and 13 so
as to combine the discussion of the responsibilities of
governments and the non-government sector, at both the national
and international levels, with the mobilization and allocation of
resources. Furthermore, we support and encourage further
collaboration among the various relevant UN agencies concerned
with population and development.
Re:
National laws and policies affecting family planning:
2. Countries should review legal and regulatory barriers
impeding progress on gender concerns and a broad range of such
additional issues as including access to reproductive health and
family planning information and services.
3. Governments should review tax, trade and tariff policies
relating to advertising and promotion restrictions on
contraception, patent and trademark law, pricing policies and
restrictions on fees charged by not-for-profit organizations.
4. Governments should take all possible steps to strengthen
linkages between public and private institutions in the provision
of reproductive health and family planning services. They should
encourage private services that are cost-effective,•of good
quality, and affordable to the population being served,
recognizing the responsibility of the public sector to assure
that all segments of the society are well served.
Re:
Resource Mobilization
5. When referring to resources applied to population, attention
must be given to resources that affect the full range of
socio-economic determinants of population change (e.g.,
education, health services, as well as direct or proximate
determinants (e.g., reproductive health and family planning
services, child survival programs). In this regard, we note the
post-cold war opportunity to invest more substantially in the
social sectors.
-26. The analysis on which the Amsterdam Declaration estimate of
expenditure on population programs was based should be .
strengthened and updated before PREPCOM 3. This analysis should
include the following:
total donor transfers in support of population programs;
country budgetary outlays for reproductive health and
family planning services and information, demographic
data collection and socio-economic analysis and
research, biomedical research, and communication/mass
media programs;
——
private sector and NGO outlays for contraceptive and
related reproductive health services;
expenditures by individuals for reproductive health and
family planning services.
—
investments needed to ensure necessary contraceptive
research and development (including methods that protect
against STD's) and population-based monitoring for
safety.
7. Based on the above analysis, we endorse the suggestion of the
G-77 that the cost of providing reproductive health and family
planning services, as well as the costs of various support and
allied activities, should be calculated on a per capita basis,
and these costs, adjusted for inflation, should form the basis of
a global estimate of achieving a global population goal of the
sort proposed by the Secretary—General. Critical to.this
estimate is an updated global estimate of contraceptive
requirements by the UNFPA's special unit that deals with this
subject.
8. The resulting figure should form part of the agenda of the
ICPD, along with a proposed sharing of costs among the four
categories of actors: donor governments, recipient governments,
private and non-governmental institutions, and individuals
9. We wish particularly to emphasize the importance of
re-engaging the worldwide private pharmaceutical industry in
contraceptive research and development, including
women-controlled methods.
30363
CHAIRMAN'S SUMMARY ON CONCEPTUAL FRAMEWORK
1. The purpose; of the Present ^ary
fu
on its third session,,based on^^ois session of the preparatory Committee
jjame^or^^harroik'place^at the
t of the document took place in a subgroup of
The
discussions
on
the
structure
if
’
the
whole and led to agreement on the following
2.
the informal consultations
structure:
preamble
PRINCIPLES/FUNDAMENTAL CONSIDERATIONS
CHOICES AND RESPONSIBILITIES
Chapter I.
Chapter II.
Chapter III.
Chapter IV.
SWEW*’1"
, SUSTAINED ECONOMIC
GENDER EQUALITY AND EMPOWERMENT OF WOMEN
POPULATION GROWTH AND STRUCTURE
THE FAMILY, ITS ROLE AND COMPOSITION
REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH AHO FAMILY PLANHIHG
Chapter V.
Chapter VI.
Chapter VII.
Chapter VIII.
HEALTH AND MORTALITY
POPULATION DISTRIBUTION, URBANIZATION and internal migration
INTERNATIONAL MIGRATION
MEANS OF IMPLEMENTATION
Chapter IX.
PROMOTION OF
COMMUNICATION
Chapter X.
CAPACITY-BUILDING
Chapter XI.
POPULATION
INFORMATION,
EDUCATION
TECHNOLOGY, RESEARCH AND DEVELOPMENT
PARTNERSHIP IN POPULATION - ACTORS AM) RESOURCES
Chapter XII.
NATIONAL ACTION
AND
page 2
Chapter XIII.
INTERNATIONAL COOPERATION
Chapter XIV.
PARTNERSHIPS WITH NON-GOVERNMENTAL SECTORS
FROM COmiTMENT TO ACTION
Chapter XV.
FOLLOW-UP TO THE CONFERENCE
3. The discussions, both in the plenary and in the informal consultations of the
whole, on the content of the document covered the entire range of topics proposed
in the conceptual framework (E/C0NF.84/PC/U) , as well as the issue of goals for
2015 proposed by the Secretary-General of the Conference. Those discussions are
summarized as follows:
4. Several delegations spoke on the importance of the preamble to set the
context of the Conference document and to convey to a broader public the vision
and purpose of the Conference. It was suggested that the preamble should cover,
in addition to the items contained in paragraph 13 of the conceptual framework,
reference to past experiences with population policies and programmes; the
demographic data should be strenghtened and focused on the 20-year framework;
reference to action necessary to attain population objectives in the context of
sustained economic growth and sustainable development, with emphasis on human
rights and giving special attention to the developing countries, particularly the
least developed countries. The preamble should draw attention to the magnitude
of resources required for implementing the Cairo commitments. The list of
instruments mentioned in paragraph 14 of the conceptual framework should be
expanded for balance and coverage and include key regional documents.
5. All delegations agreed that principles were an essential part of any document
emanating from Cairo. They would form the basis for the new plan of action.
That section of the document should ensure that the plan of action was actionoriented and would form the basis for international consensus.
While
circumstances would change and priorities vary, the principles would provide the
guiding philosophy well into the twenty-first century.
6. Most delegations stressed that the principles should built as much as
possible on agreed international instruments including the World Population Plan
of Action, the Mexico City Conference recommendations, the Amsterdam Declaration
on a Better Life for Future Generations, the Rio Declaration and Agenda 21. Many
delegations considered that the right to development was an essential principle
as well as the sovereignty of nations.
7. Numerous delegations favoured a group of principles in which the importance
of human rights was fundamental and the main point of departure. It was hoped
that the principles would be concise and easily readable so as to have maximum
public appeal.
8. It was generally agreed that the International Conference on Population and
8.
Development should concentrate on its overall theme of population, sustained
page 3
economic growth and sustainable development. Issues and recommendations relating
to this theme should be forward-looking, operational and pragmatic.
9. Many delegations mentioned the new climate of agreement and the spirit of
cooperation regarding population issues. They also noted the lack of major
differences between the approaches of the developing and the developed regions
on substantive issues and the broad consensus on the need to examine population
matters in the context of development. They also stressed the centrality of the
human being in all questions of population and development and the need for
population policies and programmes to be based on the fundamental rights and
freedoms of individuals and couples.
10. While building on the important achievements of the 1974 and 1984 population
conferences, many delegations endorsed the suggestion of the Secretary-General
of the Conference for a new plan of action, which would be free-standing and
operational in nature. They also stressed the importance of ensuring that the
recommendations were formulated in a manner that clearly identified their
innovative aspects and priorities. In addition, the recommendations of the
regional conferences and expert group meetings should be fully taken into account
in the document for Cairo.
11. Many delegations emphasized the need for recommendations to reflect the
considerable demographic, social and economic diversity that existed among and
within countries. Traditional classifications of development were considered
inadequate, given the social and economic changes of recent years. The economies
in transition of Europe, for example, had very complex demographic and socio
economic problems that differed markedly from the more developed European
countries.
Recommendations for action should take into account regional
diversity and country-specific conditions.
12. All delegations agreed that population, environment and development were
inextricably interrelated.
Many delegations stressed, however, that the
Conference should not run the risk of being too diffuse in its deliberations, but
rather should focus most particularly on population-related issues while taking
note of complementary issues.
In this regard, it was recognized that the
Conference should build on existing international agreements, including
especially the 1992 United Nations Conference on Environment and Development and
Agenda 21. It would serve no purpose to renegotiate those agreements
13. Many delegations strongly emphasized that sustained economic growth and
socio-economic development were fundamental factors influencing population
factors. Highest priority must therefore be accorded to improving the quality
of life for all people, notably through alleviation of poverty, employment
creation, the guarantee of human rights, the improvement of health, education and
housing, and economic opportunities, particularly for women.
14. In order to promote sustained economic growth and sustainable development,
many delegations stressed the importance of a supportive international economic
environment. The debt burden of poorer countries remained a major constraint to
their socio-economic development. Restrictive trade policies inhibited economic
growth and led to inefficient patterns of production and resource use.
Structural adjustment programmes could have the effect of weakening social
page 4
services, placing added stress on vulnerable groups, including women and
children, and encouraging overexploitation of natural resources and environmental
degradation.
Emphasis was also placed on science and technology and the
development of relevant new technologies and their accessibility to countries in
need. Building domestic capacities and strengthening of institutions to meet the
challenges of demographic change were further priorities.
15 Many pointed out that achieving the objectives of sustained economic growth,
sustainable development and effective population policies would require
mobilization of substantial additional financial resources from the international
community as well as within countries.
It would not be useful to adopt
objectives without considering the means of implementation and the resources
required. In this regard, the model provided by Agenda 21 could be considered.
16. There was general agreement that population factors had significant impacts
on, and were in turn influenced by continued widespread poverty and inequality
of wealth between and within nations as well as by wasteful
patterns
of
production and consumption, by unsustainable use of natural resources and
environmental degradation, and by serious social and gender inequalities.
17 An important priority, it was pointed out, was the development of adaptive
strategies to address the implications for sustainable development and the
environment resulting from the inevitable increases in population numbers and
changes in concentration and distribution, particularly in ecologically
vulnerable areas and urban agglomerations. Related to this were strategies to
minimize dislocations of populations due to environmental factors and natural
disasters.
disasters. Such policies would need to address the underlying causes, promote
emergency preparedness and establish mechanisms to aid the victims, both within
and outside their own country.
18. Several delegations noted the importance of maintaining balance between
18.
human needs and aspirations on the one hand, and the natural resource base and
environmental conditions on the other. It was recognized that inefficient and
unsustainable use of natural resources and environmental degradation, whether
caused by rapid population growth, poverty, or unsustainable consumption
patterns, could constrain prospects for socio-economic development. In this
connection, some delegations underscored the importance of changing values, human
patterns of behaviour, and the distribution of power within society.
19. Social and economic factors can influence the impact of population on both
local and global environmental problems. Many delegations referred to increasing
demographic-related pressures on the environment and natural resources, whether
associated with numbers, urban concentrations, migration or consumption patterns.
Concern was expressed over effects on natural life support capacities in
different ecological zones.
20. It was considered important to promote more effective partnerships between
Governments and the private sector in addressing population and development
issues. Greater involvement and participation in the process of both policymaking and implementation by local communities, industry, non-governmental
organizations and indigenous groups, should be stimulated.
page 5
21. There was unanimous consensus that the empowerment of women was an essential
factor in achieving population objectives, sustained economic growth and
sustainable development. Existing gender inequalities and barriers to women
should be eliminated and their participation in all levels of policy-making and
implementation should be increased. Opportunities should be enhanced for
leadership roles and for greater access to education, jobs and improved health
services, including sexual and reproductive health and family planning. The role
and responsibility of men in bringing about gender equity, policy and value
changes was repeatedly emphasized.
22. Delegates expected that in the Cairo document issues of gender equality,
equality.
equity and rights that were specific to particular chapters would be addressed
in those chapters. Gender issues (such as achieving gender equality in education
and training; enactment and/or enforcement of laws pertaining to minimum age at
marriage; proposals concerning women's opportunities for productive and
remunerative employment; and women's rights, health and advancement at the
workplace) which cut across many of the chapters, and could not be adequately
dealt with under any single heading such as health or reproduction, should be
addressed under chapter II of the document, to be titled "Gender equality and
empowerment of women".
Many delegates emphasized the need to present the
recommendations in a systematic manner and a suggestion was made to structure
them according to four categories: legal, economic, education and cultural
aspects. Some delegations called attention to some issues such as power-sharing
in decision-making in the family, violence against women, prostitution and the
special needs of women for protection in times of war. Genital mutilation, which
some delegations saw as both a health issue and a rights issue, also needed to
be addressed in the Conference document. In general, it was felt that the
document should emphasize more the comprehensive relationship between women's
empowerment, development and population.
23. Some delegations emphasized that the document should not merely reiterate
already-accepted general principles, but make an advance over the wording in
earlier agreements - by means of concrete proposals for action that would lead
towards those accepted goals, or by elaborating or extending earlier language
regarding rights and responsibilities pertaining to gender issues, as they were
linked to population and development. It was also felt that there was need to
develop indicators to monitor progress in this area. Specific suggestions were
made in some areas - for instance, goals for achieving gender equality in
education, as well as for achieving universal primary education for both girls
and boys. Delegates also emphasized the need to include concrete steps to improve
women's access to productive and remunerative employment and measures to
eliminate negative stereotypes against women.
24. While many delegations emphasized the importance of rapid population growth
as one of the main challenges faced by the world community, it was also
recognized that there existed considerable variation in population growth rates
among regions and countries. Consequently, any recommendations concerning
population growth should take this diversity into account and be formulated
accordingly.
Some delegations noted that the importance of achieving
stabilization of population was increasingly receiving an international
consensus. A few delegations suggested that specific demographic targets be set
including for population growth.
page 6
25. Trends in population growth and structure, many agreed, should be clearly
brought out in the final document as they provided the necessary background
against which population and development relationships interacted. In this
regard, a number of delegations stressed the special situation in the least
developed countries which needed special attention. Also, mention was made of
the importance of future levels of population in relation to consumption and
production.
26. Many delegates noted that population growth and poverty were closely related
but that any simplistic cause and effect notions should be avoided. Many socio
economic variables affected population growth in particular gender equality and
human resources development, including education, health, family planning and
employment. These linkages should be brought out in the final document.
27. While the discussion on population structure covered all age groups, many
delegations focused particularly on population ageing. Many agreed that the
consequences of ageing required close scrutiny. The issue of ageing was of
particular immediate concern in a number of the developed countries, but it was
pointed out that problems of ageing could become overwhelmingly large in the
developing countries where the bulk of the elderly would be living.
28. Rapidly ageing populations was a new phenomenon in human history that
required urgent attention particularly when viewed over a longer time
perspective. It was pointed out that women would make up a disproportional share
of the elderly making it all the more crucial to integrate women in the
development process.
29. Several delegations expressed the need for the document to take into account
the perspective of particular population groups, such as indigenous peoples and
the disabled, whose needs concerning, inter alia, sexual and reproductive health
including family planning services should be recognized. It was also suggested
that the Conference document should address the specific forms of discrimination
which disabled people may face with regard to international migration.
30. Many delegations requested that there should be a separate chapter on the
family, bringing out the central role families. Delegations emphasized the
importance of addressing within this issue the diversity of families and their
varying experiences.
31. Many delegations suggested that the Cairo document should recognize that
women, regardless of age, marital status, sexual orientation and other social
conditions have the right to have access to information, education and services
to exercise their reproductive and sexual rights.
32. The reproductive rights of couples and individuals to decide freely and
responsibly the number and spacing of their children, as stated in the World
Population Plan of Action, was reaffirmed by a large majority of delegations.
A few speakers suggested some modification of the rights to make them apply to
couples only, to individuals only or to women only.
33. In relation to sexual and reproductive health, many delegations reiterated
that reproductive health programmes should protect women of all ages. Such
/
page 7
programmes should have a client-centred approach, Some delegations recommended
the inclusion of proper prevention, ttreatment
—"k— and referral of sexually
transmitted diseases and infertility.
34. Family planning services were widely recognized as a means to fulfil
reproductive rights as well as to promote maternal and child health. Such
services, it was strongly recommended, should be voluntary, accessible,
acceptable and affordable. Improving the quality of services and choice of
available methods was also recognized as an important priority. Many delegates
reiterated the need to promote research and development on both male and female
family planning methods. The role that men can play in family planning practice
was also suggested as an important topic of attention. Many participants
recommended a special mention of the need to remove legal barriers to the
provision of family planning methods that affect a wider social marketing
distribution.
35. Human sexuality and sexual behaviour was recognized as a neglected area that
.
_r
‘ attention.
■' . In this respect, it was recommended
----- 1- to 1 treat
requires
special
sexuality and gender relationships as closely interrelated and as factors that
affect sexual health and reproductive behaviour. Many delegations suggested
specific actions covering a wide range of activities, such as behavioural
research, sex education for boys and girls, counselling, as well as the
consideration of parents as a major channel for ensuring responsible parenthood.
36.
Adolescents also received particular attention.
Many delegations
recommended the inclusion in the Cairo document of specific actions aimed at
facilitating informed decisions regarding their sexual behaviour, sexual health,
prevention of sexually transmitted diseases, as well as the removal of barriers
to the access to reproductive health care services.
37. It was pointed out that among the issues that the Conference needed to
address were the unacceptably high levels of maternal mortality and morbidity in
many developing countries. Unsafe and illegal abortion, which in many countries
is an important cause of maternal morbidity and mortality, constitutes one of the
most neglected problems affecting women's lives. It was seen by most delegations
as a major public health issue which the Conference needed to recognize and
address as such. While many delegations suggested that all women should have
access to safe abortion, others suggested that the best way to eliminate
abortions was provision of effective, modern contraception information and
services; a few delegates reiterated that abortion should not be promoted as a
method of family planning.
38. Several delegates emphasized the importance of primary health care in
combatting infant, child and maternal mortality and expressed concern about the
reduction of social investment on health as a result of structural adjustment
progranmes.
It was reconinended that with respect to child survival, the
Conference should take into account the strategies and goals agreed upon at the
World Suimit for Children. The situation prevailing in the countries in economic
transition regarding mortality levels and trends, especially adult male
mortality, preoccupied several delegations and should also be addressed in the
final document.
i
page 8
39. Many delegations stressed the need for the Conference document to give
particular attention to those issues that had come into light since the
International Conference on Population (1984), such as the acquired
immunodeficiency syndrome (AIDS) pandemic. The Cairo document was seen as a
unique opportunity to articulate a consensus on strategies for the prevention of
human immunodeficiency virus (HIV) infection. In this respect, it was noted that
information, education and communication campaigns were vital for preventing the
spread of AIDS and information about the prevention of HIV/AIDS infection should
be included as an element in family planning programmes.
The issue of
international cooperation on research on drugs to treat and prevent AIDS should
receive adequate attention.
40. With respect to the themes related to population distribution and internal
migration, delegates supported the need for decentralization and the
strengthening of local government. Some support was also expressed for the
elimination of generalized subsidies in urban areas, the adoption of appropriate
pricing policies for services and agricultural goods, and the introduction of
cost-recovery schemes. Subsidies had to be directed only to the urban poor,
whose productivity had to be enhanced as part of any poverty-alleviation
strategy. Inclusion of environmental issues related to population distribution
was welcomed. The need to promote balanced urban and rural development, and to
create jobs in rural areas was supported. Redirecting migration from large to
small or medium-si zed urban centres as a means of achieving a balanced population
distribution was endorsed. Some delegates suggested that recommendations to
enhance data sources on internal migration were needed as well as studies on the
causes of internal migration.
41. With respect to international migration, several delegations stressed the
need to consider different types of migrants. It was important to use the
appropriate terminology, especially in the area of rights. With respect to
migrant workers, mention of the relevant ILO conventions and recommendations was
suggested, although caution had to be exercised in citing international
instruments that had not yet been ratified. Delegates from the developed
countries underscored the relevance of the recommendations on international
migration made by the European Population Conference, whose language represented
already the broad consensus of ECE members.
42. The generally positive tone used to discuss international migration was
welcomed. It was pointed out that in many circumstances migration was beneficial
to both the countries of origin and the receiving countries. The challenge was
to reduce pressures for uncontrolled migration. Several delegates pointed out
the difficulty of the task, particularly because the development process was
likely to increase migration pressures in the short term. A few delegations
noted that strong migratory pressures could be generated in the economies in
transition if their serious demographic problems in conjunction with job
creation were not solved.
It was suggested that a special subsection on
international migration and development be included. That subsection would
contain recommendations regarding the causes of migration, particularly relative
to those areas where economic growth and sustainable development could be
fostered by international cooperation. Some delegates stressed the need for
bilateral or multilateral negotiations and agreements regarding particular
aspects of international migration, such as the treatment of migrant workers and
page 9
their families, or the migration of skilled personnel, The need to protect
female migrant workers from exploitation was underscored.
43.
Several delegates noted that it was important to prevent racism and
xenophobia not only with respect to long-term migrants but rather with respect
to all migrants. The integration of long-term migrants was to be pursued while
at the same time respecting their cultural background.
44. The need to improve statistics on both migrants and their remittances was
stressed by a number of delegates. The interchange of information between the
sending and the receiving countries had to be fostered. Further studies on the
causes of international migration were suggested as well as on the effects of
remittances.
45.
With respect to refugees, delegates indicated that the relevant
international instruments should be mentioned and that it was important to
reiterate the international consensus on protection. Mention should be made of
the right to seek asylum and not to the right to asylum. It was stressed that
refugee assistance was needed both in the developing countries and in the
countries that are in economic transition. The provision of adequate health and
sexual and reproductive health services for female refugees was suggested.
46. Many speakers emphasized the major role of population information, education
and communication and motivational activities in bringing a diverse cross-section
of policy makers, planners, programme managers, administrators, field workers and
the general public to new levels of awareness about the implications of emerging
population issues. In order to achieve responsible choices in all aspects of
population, including fertility and migration, better communication was needed
to reach all segments of the population. Individuals, families and communities
should know what choices are available to them and how best to make them. At the
same time, Governments should recognize their responsibility at every level to
avoid coercion and to promote informed choice. With the wide variety of
information forms and communication channels available for awareness creation and
the delivery of motivational messages, it was pointed out. Governments should
carefully examine their information, education and communication programmes to
ensure that they employ appropriate information-processing and repackaging
techniques to achieve maximum results with their specific target audiences.
47. Mere awareness was no longer sufficient. It would be appropriate to move
from awareness to action. It was therefore appropriate to spell out specific
options and opportunities for the 1990s in the field of information, education
and communication that would enhance individual, family, community and national
choices.
48.
The importance of timely dissemination of reliable and up-to-date
information in appropriate formats for the formulation of effective population
policies and the implementation of efficient programmes should be stressed in the
Conference document. It should emphasize that the development of national
population information systems was an effective means of organizing the data and
information that constituted the knowledge-base on population. The document
should recommend that the use of modern information-handling technologies be
promoted to develop databases, facilitate the processing and analysis of
page 10
population data and improve the exchange of information.
XSaX:he f
;
emohasized as an essential ingredient of population and development efforts. In
addition, research should give proper attention to gender issues and
considerations of special population groups, such as indigenous peoples and the
disabled.
50 Several delegations pointed out the need to give greater emphasis to datageneration, training, including research training,and research in
area of
population. In many developing countries, the paucity of P0P“1at10n '
insufficiency of research capabilities had adversely affected the possibility of
meaningfully integrating population perspectives into development plans and
strategies.
51. A number of speakers stressed the importance of research and technology in
responding to the population and development issues, particularly with regard to
cont?acejtion, infant and child survival disability and environmenta
degradation. The Cairo document should reflect the Vlta\c1°.nt.rib^1°n.5
technology and research can make in improving human lives and living conditions.
52 There was a broad consensus among delegations that strong emphasis needed
to be placed in the Cairo document on the need for broadened national action
aimed at social development. More resources, both national and J"1®™**™"®!’
should be assigned to social programmes. Several delegations endorsed the view
of the Secretary-General of the' Conference that the share of total national
expenditure going to the social sectors should rise to at least 20 per cent. It
was underscored that, within social-sector expenditure, the population sector
should be given high priority, commensurate with the crucial linkages between
that sector and socio-economic development.
53. National action in population-related matters concerned both developing and
developed countries alike. The theme of the Conference, population, sustained
economic growth and sustainable development, made it clear that a reciprocity of
actions was needed, with the North reexamining its lifestyles and unsustainable
consumption patterns as the South acted to bring population growth downi to a
level compatible with sustainable development. Many delegations highlighted the
necessity of including in the Cairo document this broad perspective of population
and development.
54 Delegations suggested a broadening of the scope of resource mobilization
beyond family planning to encompass sexual and reproductiveIJ'ea1th “J"®Further, many delegations were of the opinion that an even broader message had
to come out of the Cairo conference, namely that reproductive health and family
planning were linked to other factors such as education and women s status which
were equally important for the achievement of socio-economic development.
55. On the matter of increased allocation of national resources for population
delegations were in broad agreement. None the less, increased allocations should
page 11
be made within the constraints of overall resource avallabijity and perceived
national development priorities.
International bl1^e;a1l anod.
assistance, which had been declining in recent years, had played an important
part in facilitating national action in population.
In the view of many
deleoations, assistance for population should be increased in line with an
overall increase in the overseas development assistance to 0.7 per cent of the
gross national product.
56. Delegations broadly supported the need for a Partnership for nationalI action
on oooulation between Governments, non-governmental organizations (NGOs) and
oJhei? organizations outside government, as well as the private sector. NGOs were
seen not as substitutes for Government action, but as partners acting as
catalysts ?or change, setting quality standards for population programmes and
developing innovative approaches.
57 Delegations also considered it important for the Cairo document to address
the islul of adequate and reliable funding for NGO activities. Both Governments
and donor agencies should develop mechanisms for assuring a regular. flow
resources to NGOs. In the view of some delegations, this policy should include
increasingly direct reliance on national NGOs, to profit from their knowledge of
local socio-cultural conditions.
58 Similarly the complementary role of the private sector in the population
area should be clearly spelled out in the Cairo document Legal and regulatory
barriers impeding full access to reproductive health and family planning services
should be reviewed. The contribution of services supplied by the private sector
U promotincj cost effectiveness in reproductive health care and other social
sectors should be given full recognition.
59
Many delegations noted the need for updated estimates for resource
respect so as to provide the Cairo Conference with more precise estimatesof the
resources reouired over the next decade. In this connection, various delegations
suggested that relevant recommendations from the European Population Conference
regarding resource mobilization be consulted.
An
The anneal to increase resources for population activities could be
60
ctrenathened by emphasizing the developmental successes achieved by investments
iSveXitV.Vh^WtWnl noted thlt pool'd wlr^cumstances presented
the opportunity to substantially increase investments in social sectors, inc
ing the population sector.
61. The need for international cooperation for technjcalassistance to^help
special needs of the
resolve various population issues was underscored.
i--- was noted The
and
it was suggested that
economies in transition for such cooperation European Population
Conference be
the corresponding recommendations of the
consulted.
page 12
62. There
genera, support X^propos^of
“S me^to account
luaiested that the proposed time frame of
63
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$
should be monitored
The point was made by many '‘ele9at’ons “urnlt'ionaVfo™^ TheSnmist be
economic goals.
the Cairo document should also include
34
Some
delegations
suggested
that
64.
qualitative goals and objectives.
65 Additional resources wou1^ b® ^heSecretariatVaVnTinto account current
S0C’al SeCt“r'
66.
several
t t
mare
on^th^Ut' ^“at^Tconrerence
adequate provision
V’th- review and appraisal of the Pr09r®” ™?iois tlso
J"he’ WH-ta^foT the “^ec^ ^We^recoSndationT on institution.,
^nt%rXW-iX
““
°f aCt’OT'
H 11 - G (JS
t
Summary of DAWN’s Platform for ICPD
POPULATION
AND
Reproductive
RIGHTS
J
Feminist Perspectives
from
THE SOUTH
Summary by Sia Nowrojee
Based on the text by Sonia Correa
in collaboration with Rebecca Reichmann
Development Alternatives with Women for a New Era (DAWN)
1994
Published by:
Development Alternatives with Women
for a New Era (DAWN),
c/o Women and Development Unit (WAND)
University of the West Indies
School of Continuing Studies
Pinelands, St. Michael
BARBADOS, West Indies
Layout:
Kurlyne Alleyne
Printed by:
Coles Printery, Wildey, St. Michael, Barbados
The original text for this document was published by ZED Press in
association with Development Alternatives with Women for a New Era
(DAWN).
-•<
Introduction
In 1987, following the United Nations Decade for Women, the
Development Alternatives with Women for a New Era (DAWN)
network published Development, Crises and Alternative Visions: ’
Third World Women’s Perspectives. The publication presented an
alternative vision for development based on the participation of women
as agents, not objects, in the development process. In 1994, in
preparation for the International Conference on Population and
Development (ICPD) in Cairo, DAWN has produced a similar
visionary agenda for women’s health advocates and population
professionals on population, development and sexual and reproductive
health and rights.
DAWN is committed to encouraging women to share their
experiences, disseminate information and apply strategies that have
worked in very diverse Southern realities. Throughout 1992-1994,
DAWN organized a series of regional meetings on reproductive rights
and population. One hundred and forty women attended these
meetings from 54 countries in the Caribbean, Latin America, the
Pacific, South Asia, South-east Asia, the Middle East and Africa.
While each regional agenda had its own emphasis, priorities and
opportunities, the meetings provided participants with the opportunity
to grapple with some of the difficult overarching issues facing both the
population establishment and the international women’s movement,
and to envision strategies for action. Out of these meetings came a
comprehensive publication on population and sexual and reproductive
health and rights.
Population and Reproductive Rights: Feminist Perspectives from
the South describes and analyses the history and contradictions of the
.***
population field’s past and present policies; presents a comprehensive
framework on sexual and reproductive health and rights; examines the
barriers to implementing this framework; and offers forward-looking
strategies for Cairo and beyond. What follows is a summary of the
I publication. To obtain a copy of the book, please contact:
Zed Press
7 Cynthia Street
London, NI 9JF
UNITED KINGDOM
Telephone:
Fax:
44-71-837-4014
44-71-833-3960
or:
DAWN Secretariat
c/o Women and Development Unit (WAND)
University of the West Indies
"School of Continuing Studies
Pinelands, St. Michael
BARBADOS, West Indies
Telephone:
Fax:
(809) 426-9288, 436-6312/3
(809) 426-3006
2 ♦ $
Fertility Management Policies: Past, Present,
and Challenges for the Future
jr n most cultures, people have always used fertility regulatory
practices to balance their community size with available resources.
Through the ages, women have regulated their own fertility, sometimes
at great risk to themselves. Therefore, the basic tenet of current
international and population programmes, fertility regulation, is not an
anomaly. What requires critical examination however are the scope of
population interventions in the last few decades; the forces that create,
contradict and challenge these policies and programmes; and the direction
of future policy, programmes and advocacy.
Throughout the last 30 years, fertility control has been used as a strategy
to address a slew of political and economic questions by international
agencies and national governments, rather than as a means to enable and
enhance women’s reproductive health and rights. Economic development
and scarce resources have long been a rationale for fertility control
policy, preventing an analysis of existing structural and interpersonal
inequities. Population conditionalities have often been imposed on
international economic assistance to Southern countries. Additionally,
since the Mexico Population Conference in 1984, the free market
economy has guided contraceptive development and distribution,
providing new international incentives for fertility control policies.
Political agendas, based on nationalist or eugenic policies, have guided
the population policies of governments ranging from fascist Europe in the
2
• Population and Reproductive Rights • SUMMARY
1930s, to post-colonial Africa in the 1960s and 1970s, to recent US
health and legal practices against communities of colour. Today,
environmental concerns are cited as being an urgent reason to control
fertility in the South, while Northern consumption has not been
adequately addressed as a cause of environmental degradation.
In spite of contradictions and changes in population policies, it is possible
to identify six broad approaches to population policy (see Box 1).
However, through the decades. Southern feminists and Northern
minorities have recognized familiar strains of population control,
privatization (both at the economic and household level) and political
agendas that maintain systemic and interpersonal inequities in the explicit
and implicit agendas of population policies.
Fertility management policies have thus had a questionable effect on
women’s health and well-being around the world. In addition to
population programmes coercion, discrimination and poor quality
services, data on contraceptive prevalence, maternal mortality, unsafe
abortion and STD and HIV prevalence provide empirical evidence of
persistent gender biases in programme implementation. The burdens of
fertility control and related political agendas, whether biological or
social, have always fallen on the shoulders of women. At the same time,
international and government investments fail to provide supportive
programmes and services, and individual male behaviour remains
unquestioned.
A brief examination of the three world conferences on population
provides additional insight into some of the key players, issues and
contradictions in the population field. In 1974, the first population
conference was held in Bucharest. There, a North-South political conflict
prevailed with Southern governments resisting the imposition of Northern
demographic imperatives. However, Northern investment increased and,
♦
• Fertility Management Policies •
3
in spite of their stand in Bucharest, many Southern governments
expanded their internationally funded public family planning programmes
and adopted clear fertility control measures.
I
The document emerging from the Mexico Conference of 1984 could be
interpreted as a North-South agreement of neo-Malthusian or population
xjntrol principles. This was somewhat overshadowed by the US position^
in alliance with the Vatican, proposing that international aid for
population activities be reduced and fertility management be handled as
a private matter for each household. However, fertility control remained
the informing principle of the major international institutions (the World
Bank, UNFPA and USAID) and national population guidelines. The
result of the 1984 Conference was not a retreat from population control/
but rather a trend toward privatization, both of services and of the
inequities existing in gender relations.
I
Preparations for the 1994ICPD have thrown up a similar range of issues
and contradictions. Once again there were early attempts to focus the
conference on environmental responsibility rather than on existing
socioeconomic and interpersonal inequities. Additionally, the Vatican and.
its allies have tried to thwart attempts to place family planning in the
context of comprehensive reproductive and sexual health initiatives.
However, the role of women’s organizations in the ICPD process in
transforming the debate remains unprecedented and signals a change ini
the field.
Thus, the history of the last three decades does not portray a linear
evolution of demographic policies at the international, regional and
national levels. International and State economic and political interests,
as well as the advocacy and resistance of some governments and
communities, have all shaped these policies. Even when policies maintain
a consistent set of goals, the design and scope of interventions change
4
• Population and Reproductive Rights
• SUMMARY
over time. Recognizing this instability allows us to de-construct the
notion that policies are immutable.
International and national policies are subject to transformation whenever
social relations and cultural norms are challenged from the grassroots.
In uncovering the contradictions inherent in population policies,
participants in the DAWN regional meetings emphasized the possibili.
for positive change and formulated a framework through which we can
implement this change. Our task is to sustain women s struggles to
restructure and ’engender’ household dynamics (or the so-called private
domain’) while simultaneously confronting the social, political and
economic (or public) environments that reinforce oppressive gender
systems and inhibit reproductive and sexual health and rights.
Box 1
EXISTING APPROACHES TO POPULATION POLICY:
CHARACTERISTICS & CONTRADICTIONS
1. Fully Established State-Led Policies: are characterized by the
distribution of long-lasting or permanent provider-dependent
contraception, coercion or incentives. Women are seen as wholly
responsible for fertility regulation, while their health and rights are
ignored, and demographic goals are the priority. These policies have
been commonly implemented throughout Asia and in some Latin
American countries.
2. Incomplete Policies: refer to the incomplete implementation by States
of formal policies advocated by the international population
establishment. Incomplete policies are often characterized by co
existence with contradicting policies. For example, they may co-exist
with pro-natalist policies in post-colonial Africa, Islamic family laws,
or most recently, structural adjustment policies, which impede the
provision of comprehensive and good quality family planning and
reproductive health programmes.
• Fertility Management Policies •
3. Combined Policies: exist when there is no explicit population policy or
perhaps a mild policy, often where economic development has
progressed. In countries like Brazil, Columbia and Korea, however,
economic development has not proved to be the best contraceptive.
While women’s economic status may improve over time, many factors
affecting fertility trends continue to endanger women’s reproductive
health and rights. Instead of addressing systemic and interpersonal
inequalities that lead to high fertility, medical approaches to fertility
regulation are highly relied on, resulting in high rates of sterilization,
hysterectomies and illegal abortions.
4. Pro-Natalism: is related to cultural and religious values, and political
and economic conditions. Nation building or religious values, as
evidenced by the role of the Vatican in the ICPD process, dominate the
debate rather than a concern for women’s repipductive health and rights
and men’s reproductive behaviour.
5. Double-standard Policies: target certain racial, ethnic, economic and
social groups for population control, to maintain inequalities between
groups. Based on eugenic and genocidal tenets, these policies result in
programmes that are rife with abuses. The best examples of these
policies are formal apartheid in South Africa and informal apartheid in
the US, which resulted in different services and policies to communities
of colour and minorities than to white or majority groups.
6. Basic Needs Approach: to development includes fertility management
without costs to women’s health, rights and well-being, and has existed
in Sri Lanka, Cuba, Kerala State in India and Costa Rica. Family
r
planning is placed in the context of other basic needs and health care.
However, structural adjustment and other international economic and
political policies currently endanger these systems.
5
Sexual and Reproductive Rights and Health:
the Southern Feminist Approach
TT istorically. States and political movements around the world have
attempted to manipulate women’s reproductive and sexual health
and behaviour for political purposes, under the guise of population
control. DAWN believes that women’s reproductive health must be
placed within a comprehensive human development framework that
promotes all people’s well-being and women’s full citizenship.
In the last few decades, women have built an internationally recognized
international framework for the universal defence of women’s autonomy,
bodily integrity and personhood. DAWN has interpreted and expanded
the framework to more fully reflect Southern women’s concerns.
DAWN’s Reproductive Health and Rights Framework draws on human
rights principles to remove women’s reproduction from its isolation and
place it in the larger context of equitable development policies to provide
for basic social and material needs, including freedom from
comprehensive health services, education, employment and freedom from
gender-based abuse (see Box 2).
Challenges to the Reproductive Health and Rights Framework
The international women’s movement and the population field face
considerable challenges implementing the Reproductive Health and Rights
Framework. Primarily, these challenges come from cultural factors, the
• Sexual and Reproductive Health and Rights •
7
Box 2
THE DAWN REPRODUCTIVE HEALTH
AND RIGHTS FRAMEWORK
DAWN views reproductive health as inextricably intertwined with
women’s human rights. Therefore, DAWN’s framework for women’s
reproductive rights and health incorporates attention to women’s
economically productive and cultural roles in addition to their biological
reproductive functions. In the biological context, DAWN’s definition of
reproductive health services includes not only access to contraceptive
information and methods and legal abortion, but also STD and cancer
prevention and treatment, prenatal care and mental health services, all
within the context of comprehensive preventive health services. A
further element of the DAWN perspective on reproductive health is
respect for traditional health knowledge, much of which is gradually
being destroyed by imposed medical technologies.
st
DAWN’s comprehensive reproductive health and rights policy would
guarantaa women access to housing, education, employment, property
rights and legal equality in all spheres. It would also secure women’s
freedom from abuse, harassment, genital mutilation and all forms of
gender-based violence.
DAWN’s insistence upon a holistic analysis reveals our bias toward
comprehensive health services as a key component of our proposal for
social policies and infrastructure designed to meet people’s (especially
women’s) basic needs. In Southern countries, we recognize an alarming
trend away from State responsibility for basic needs, in which market
forces increasingly have been employed to mobilize and distribute health
resources that should be widely available to the public. Based on
structural adjustment policies, this tendency towards privatizing the
health sector isolates it from the other basic services (which, in many
cases, are also being privatized) and limits even further poor women’s
access to health care.
s
8
• Population and Reproductive Rights
• SUMMARY
State and the role of the marketplace in the population field. DAWN has
tried to identify some of the key issues and contradictions inherent in
these challenges and offer analysis, critiques and solutions.
A.
Cultural Challenges to the Reproductive Health and Rights
Framework
Many Southern activists and researchers assert that the human rig.
paradigm that forms the basis of the Reproductive Health and Rights
Framework is culturally problematic for the following reasons:
• It posits the individual ’ownership’ of the female body and
autonomous control over reproductive functions which is grounded in
Western capitalist assumptions of private property.
• It ignores differences in cultural and moral patterns, and supports
universal international human rights standards which is a form of
imperialism. DAWN researchers from Asia, Africa and Latin America
have all, however, criticized state-sanctioned ’cultural’ norms and
practices hostile to women’s freedom and equality, which are often
defended in the name of national and cultural sovereignty.
• These issues raise a number of dilemmas for Southern feminists ai
the population field: How can we balance individual rights of women
with community well-being? How can Southern feminist values be
combined with cultural identity and resisting imperialism?
DA WN Response
DAWN affirms that the ’self reaches far beyond the notion of bodily
integrity and must be understood in the context of all significant family,
cultural, social and economic relationships, and the conditions that
determine the choices, reproductive and otherwise, available to women.
4
f
• Sexual and Reproductive Health and Rights •
9
Acknowledging the concept of a relational ’self would strengthen the
relevance of the Health and Rights Framework in diverse cultural
contexts. However, the decision-making self and bodily integrity must
remain at the core of reproductive rights, and our challenge now is to
expand the Framework without demolishing this conceptual cornerstone.
I
A Southern women’s perspective remains sensitive to cultural diversity
and national sovereignty, and respects the consolidation of traditions that
enhance and preserve cultural identity. DAWN affirms the crucial
importance of cultural integrity and supports women s roles in family and
community daily rituals that both reinforce and renew cultural identity.
However, when cultural practices only consolidate women’s
subordination, damage women’s physical integrity or their freedom to
make decisions about their own lives, we must question those practices
from a health and rights perspective.
Furthermore, DAWN researchers from Africa remind us that traditions
are not static, but historical processes. As traditional beliefs and practices
evolve, new patterns replace the old. Women’s changing roles must be
viewed in this context to transform and consolidate new forms of cultural
identity that value women’s intellectual, spiritual and material
contributions to their societies.
Stole Challenges to the Reproductive Health and Rights
Framework
Existing State and legal systems continue to undermine the
implementation of the Reproductive Health and Rights Framework:
B.
• Practices that are harmful to girls and women, such as female genital
mutilation or child marriages, are often justified or protected through
customary codes.
w
• Population and Reproductive Rights
• SUMMARY
• Contradictions between statutory legal systems that protect women’s
rights and customary codes that justify violations against women often
undermine Southern feminists’ attempts to challenge such practices.
• States often do not foster the basic conditions which enable women to
exercise their rights. Women are unable to fully exercise their human
rights whenever their livelihood is endangered, public health ana
education systems are inadequate, and cultural diversity is not
respected.
DAWN Response
States must reform their legal frameworks in order to protect women’s
basic rights and provide adequate services. States must bring customary
and statutory law into alignment and improve enforcement mechanisms.
Both statutory and customary legal systems must be held accountable for
violations of women’s human rights.
Conditions that enable women to exercise their rights and ensure their
health are imperative. International agencies, as well as governments,
must be responsible for the provision of comprehensive reproductive
health services and the protection of socioeconomic, or ’enabling,’ rights
(see Box 3).
c.
Marketplace Challenges to the Reproductive Health and Rights
Framework
In Southern countries, DAWN recognizes an alarming trend away from
State responsibility for basic needs and a growing employment of market
forces to mobilize and distribute health resources that should be widely
*
• Sexual and Reproductive Health and Rights •
11
Box 3
DAWN’S RECOMMENDATIONS FOR REPRODUCTIVE
HEALTH SERVICES
Reproductive health services should include:
• Quality of care in contraceptive services: choice among a range of
contraceptive methods, availability of full information about all methods
and their side effects, providers’ technical competence combined with
interpersonal skills, structural interventions for maintaining availability
of an appropriate constellation of services.
In addition to contraceptive services and quality of care, the following
services should be provided:
• Pre- and post-natal care, full gynecological services, cervical and breast
cancer screening, STD/RTI prevention (with special attention to
HIV/AIDS), safe abortion services (or at the minimum, adequate
treatment for women who have suffered an incomplete abortion),
assistance to adolescents and women during menopause, mental and
occupational health services, services to address sexuality and gender,
rape and other forms of gender violence.
Enabling conditions should include:
• Guaranteed minimum nutritional intake, child-care centres, basic
education, conditions that make maternity and breast-feeding viable for
working mothers, and public services to facilitate household
maintenance.
available to the public. This poses a number of challenges to tl|e
Reproductive Health and Rights Framework:
• Based on structural adjustment policies, privatizing the health sector
isolates it from other basic services and limits even further poor
women’s access to health care.
12
• Population and Reproductive Rights • SUMMARY
• The private sector’s aggressive testing and marketing of new medical
technologies has resulted in the appropriation of control over women s
bodies and their health knowledge. This is evidenced in excessive use
of medical interventions, such as Caesarean sections; the development
of new, sometimes suspect, reproductive technologies; and the testing
of these technologies extensively in the South and among marginalized
groups in the North.
DAWN Response
DAWN questions the neo-liberal ideology that promotes the marketplace
as the provider for basic human needs.
DAWN recognizes that medical technology offers women a great deal
and must not be rejected wholesale. However, women must be involved
in the development and distribution of medical technology, especially
reproductive technology, and multinational and national firms must be
held accountable to internationally accepted ethical practices.
In sum, the DAWN Reproductive Health and Rights Framework stands
for all women’s freedom to make life choices - unchecked by cultural
restrictions, legal or economic barriers - allowing them to realize their
full humanity in all of the diverse ways that women may envision it.
The ICPD and Challenges Ahead
As a result of many years of women’s organizing internationally, the
population field will never again be the same. Women s advocacy
throughout the ICPD process has resulted in a draft ICPD document that
actually reflects the DAWN Reproductive Health and Rights Framework
(see Box 4). However, a long road lies ahead. Much of the document
still contains bracketed language to be contested in Cairo. Regardless of
whether the document is approved as it stands, our next challenge will
• Sexual and Reproductive Health and Rights •
13
then be to organize women to forcefully support the draft document’s
integrated approach to reproductive health and rights at national levels.
Now that reproductive health and rights have been debated and adopted
by official institutions, DAWN recognizes the risk that feminist discourse
may be appropriated and manipulated by the population, development
and scientific communities. We call for Southern women to critically
distinguish institutional discourse from substantive policies and
interventions that do protect women’s health, rights and well-being.
There is a need for careful strategizing beyond Cairo.
Box 4
THE 1CPD DRAFT PROGRAMME OF ACTION
Chapter VII:
Reproductive Rights, Sexual and Reproductive Health
and Family Planning
The ICPD document defines reproductive health as physical, mental and
social well-being (not just the absence of disease), and the ability to
exercise one’s human sexuality without health risks.
Sexual health is defined as the integration of physical, emotional,
intellectual and social aspects of sexual being, and the objective of sexual
health sendees should be to encourage personal relationships and individual
development, not just the treatment of reproductive health problems and
sexually transmitted diseases.
j
The document declares that sexual and reproductive rights include certain
human rights that are already officially recognized: basic rights of
j.
individuals and couples to decide on the number and spacing of their
children, and rights to information and accessible services to that end; the
right to respect for the security of the person and physical integrity of the
human body; and the rights to non-discrimination and freedom from
violence.
Forward Looking Strategies: Beyond Cairo
A ctivists all over the world are reshaping the purposes of world
bodies and investing then with renewed authority to monitor and
censure government complicity with gender and ethnic violence,
structural inequality and other policies or practices that negatively affect
women. As a Southern feminist network, DAWN has identified strategies
to strengthen and further enable the international women’s movement to
continue to do this kind of advocacy, as well as specific strategies to
overcome the cultural, State and market-based challenges to the
Reproductive Health and Rights Framework.
Strengthening the International Women’s Movement
In the 1990s, the international women’s movement has finally achieved
organizational maturity, incorporating mechanisms for clear division of
responsibilities, broader participation and increasingly accessing
sophisticated global communications technologies. The UN Conferences
in the last five years demonstrate the political legitimacy of the
international women’s community. Women’s concerns are now
recognized and incorporated into international development agendas.
Additionally, women’s organizations and networks have established
alliances with human rights and development agencies, indigenous and
gay and lesbian movements and, in some cases, have engaged in ongoing
dialogue with governmental sectors.
• Forward Looking Strategies •
15
However, there is still a long way to go to assure implementation and
enforcement of our proposals. In order to move forward and implement
the strategies discussed above, there is a need to continue to strengthen
the women’s movement through critical examination of the movement,
dialogue within and beyond the movement, as well as concrete
strategizing and advocacy.
. ...u.
I.’l
A. A Critical Look at the International Women Movement
()
Some feminists fear that acknowledging the diversity in the women’s
movement could divide us. DAWN believes that a clear priority beyond
Cairo is to articulate how the richly diverse makeup of the international
women’s movement can become a means of strengthening our political
legitimacy.
■ . . idoZ
•: .
hi tHlJ
Some feminists support the notion of radically opposed male-female
identities. DAWN believes that this separatist tendency polarizes feminist
initiatives; limits our ability to explore potential alliances beyond the
borders of the women’s movement; and increases the risk of isolating the
movement as it takes the principal of autonomy to the extreme.
Activists’ attempts to influence population policies have i renewed
controversy as to whether women should pursue a strategy of structural
change versus the incremental transformation of institutions and social
practices. Some feminists feel that the population and reproductive health
approaches are too distinct to reach consensus on reform of population
policies; the power imbalance between the population establishment and
the women’s movement does not bode well for feminist gains; and that
there is a need to consolidate a consensual feminist perspective before
engaging in power struggles with the population establishment. DAWN
has decided to struggle to gather the forces necessary to exert power
16
• Population and Reproductive Rights • SUMMARY
where power lies. A decision not to intervene in this way leaves the
control of power in the hands of others.
Crucial Conversations: Dialogue Within and Beyond the Women’s
Movement
Political strategies for the women’s movement must be developed ana
undertaken through dialogue within the movement, and guided by clear
ground rules, including democratic decision-making processes, clear
division of labour between those operating from within and those
exerting pressures from outside dominant political systems and
transparency and trust among ourselves (see Box 5).
B.
Southern feminists cannot evade involvement with States if we are to see
the implementation of gender-sensitive programmes, universal services,
legal reforms and if we are to hold States accountable. Through dialogue
with international agencies and States, women must organize to hold
agencies and governments accountable for the design and implementation
of policies affecting women. The Reproductive Health and Justice:
International Women’s Health Conference for Cairo ’94 identified
accountability mechanisms that women can use in this process. Through
such dialogue, women’s organizations can consolidate and broaden their
participation in public life at local, national and international levels.
• Forward Looking Strategies •
17
Box 5
SUMMARY OF THE WORKING GROUP
ON POLITICAL PROCESS
Reproductive Health and Justice:
International Women’s Health Conference for Cairo ’94
1. Linkages: Who, What and How
Who:
We must build linkages within the women’s movement; between
the movement and the government; between the movement and
society at large; and among international networks.
What:
Reproductive rights are not an isolated issue, but are intrinsically
linked to macro-development models.
How:
We need to ensure the link between strengthening the movement
internally (through information flow, transparency in actions,
feedback and monitoring) and extemafwork (by creating
alternatives, advocating and lobbying policy-makers). To stress
the inter-connectedness of issues requires solidarity jn support of
each other’s actions.
2. Mobilization for Reproductive Rights and Justice
Reproductive rights activists should not limit themselves to working
with the women’s movement, but should link up with other social
movements locally, nationally and internationally.
3. Working Inside and Outside the Official ICPD Process
Outsiders have less power and need allies inside; insiders cannot do
their work properly if they have no backing from outsiders in the
movement. Distinguish among those outside because they are
uninformed, and those outside for tactical reasons. Work inside if
you are able to maintain your own agenda, terms of reference and
avoid cooptation. Act with confidence and force: BOTH are
i
required.
18 ' • Population and Reproductive Rights • SUMMARY
4.
Dialogue and Working with Population Institutions
‘Dialoguers’ and ’workers within* have to be explicit about their own
women’s movement-backed agenda.
5.
Commitment and Accountability within the Movement
Privileged political actors should take care to related openly with
women at the grassroots level in the community, provide information
and encourage articulation of local needs and demands, and translate
these into more general political demands at the national and
international level.
6.
Representation
Actors at any level have to be responsible and accountable to the
women whose interests they represent. It is not acceptable that
powerful international bodies appoint (top-down) so-called experts
and women’s representatives.
7.
Women and the State
NGOs have to hold governments accountable for promises they have
made or conventions they have signed. This requires a public
monitoring process.
8.
Donors
Distinguish between donors with their own agenda (making
instrumental use of women) and donors willing to fund work as
defined by women themselves.
9.
Transparency
Transparency means acknowledging and working with power
differences, and it leads to cooperation in clearly defined, public and
agreed-upon terms.
• Forward Looking Strategies •
19
■i
10.
11.
Importance of Vision and Collectively Developing a Global
Conceptual and Analytic Framework for Local, Specific
Strategies and Action
L
V
To build the strength of the movement or of alliances, the time and
energy-consuming process of sharing experience and vision cannot
be skipped.
. Assessment of Our Strength as a Movement
f
On our various routes to Cairo, the movement-building and alliance
making process is going on. We know that advocacy will only be y
successful if there are solid local organizing efforts. We must have
unity in our vision, and solidarity in our strategies. We will have
political impact: our power-tools are diversity and subversion.
•
-’.I'-
Strategies for the International Women’s Movement to OvercQine
Challenges to the Reproductive Health and Rights Framework
A. Strategies to Overcome Cultural Challenges
In all cultures, gender arrangements transform biological differences and
sexuality into human power relations and agency. Transforming these
cultural systems that oppress women may be the women’s movement
most challenging task ahead.
,
Through research and action, women must sustain and refine our critique
of gender arrangements; change public attitudes about female sexuality
and the ’ideal’ family structure; secure women’s rights to social benefits;
and advocate for the recognition of women’s contributions in the home,
in local and national economies and in public community life.
We must strengthen and support all aspects of cultural transformation and
continuity that respect women’s integrity without falling into cultural
I
20
• Population and Reproductive Rights • SUMMARY
relativism. DAWN urges Southern women to recognize that claims of
cultural relativism or moral supremacy, often in the name of preserving
cultural or national sovereignty or religion, may weaken women’s
position to defend their universally recognized rights.
B, Strategies to Overcome State Challenges
The women’s health movement must work to hold States accountable for
the design and implementation of policies affecting reproductive rights.
Women must advocate for the integration of women’s rights, including
reproductive rights within the UN Human Rights Charter as a critical
next step in modifying the standard concept of universal human rights.
Women must advocate for the international monitoring committee
established by the Convention to End Discrimination Against Women
(CEDAW) to be authorized to investigate complaints and bring action
against governments that condone abuses or do not comply with the
Convention.
In compliance with international political and socioeconomic human
rights principles, governments must be held responsible to provide
comprehensive health services; develop and implement measures to
combat all forms of violence against women and girls; and provid
policies and programmes to educate and encourage men to take
responsibility for their reproductive behaviour, transmission of STDs and
the well-being of their children.
When governments are not responsive to advocacy, women should appeal
to international regulatory standards and legal mechanisms to hold States
accountable to their citizens, through world bodies such as the World
Health Organization, the United Nations Centre for Human Rights and
the International Court at the Hague.
• Forward Looking Strategies •
21
International agencies and donors should expand their own programme
and funding categories to promote this forward looking agenda.
C. Strategies to Overcome Market Challenges
The worldwide economic crisis has demonstrated that a balance must be
struck between state-managed social and economic development and
private initiatives. There is no single blueprint, but any approach must
adopt a basic framework of food security, employment and income
opportunities and basic services guaranteed through participatory
processes.
Women should monitor and call attention to reduced State allocations to
social sectors and services. We must organize against an emphasis on
export promotion at the expense of production for local consumption and
sustainability.
Women should engage in more research and piloting of public-private
partnerships to meet basic needs. South-to-South information exchange
on effective mechanisms should be encouraged.
Through consumer advocacy, women should be involved in the
development and distribution of reproductive health technologies, and
hold multinational and national firms involved in technology development
accountable for internationally accepted ethical practices.
If private companies are not responsive to public pressures, women
should appeal to international regulatory standards and legal mechanisms
through world bodies such as the World Health Organization, the United
Nations Centre for Human Rights and the International Court at the
Hague.
IL €-6
'■I
I
United States Department of State
A
I'lie Counselor
II ashin^ton, D.C. 20320
August 3, 1993
TO:
FROM:
Interested parties in population policies
Timothy E. Wirth<^
SUBJECT: U.S. policy recommendations to ICPD Secretariat
Because of your involvement in international population
policies, I thought you would be interested in reviewing the
documents recently forwarded by the U.S. Delegation for PrepCom
II of International Conference on Population and Development to
the Secretariat. Attached is a copy of the transmittal letter,
our working paper on goals to be established at the ICPD and
our recommendations to the framework for the ICPD.
These are consensus recommendations from our diverse
delegation, which'included members from five government
departments or agencies and 11 non-governmental organizations
representing a variety of views. These recommendations do not
reflect the final negotiating position of the United States -we would like additional input before finalizing the positions
we will be advocating at the third Preparatory Committee and in
Cairo.
We hope to have your help and input as we work to promote a new
policy agenda and to provide a budget to support these goals.
I encourage you to provide feedback and guidance on the
enclosed documents to either me or Ellen Marshall on my staff
(2401 E Street, NW, RP/Room 1284, Washington, DC 20522,
202/663-1064) .
THE COUNSELOR
DEPARTMENT OF STATE
WASH I NGTON
July 30,
1993
Dear Dr. Sadik :
Attached are revised comments and :suggestions from the U.S.
delegation on the conceptual framework for the International
Conference on Population and Development (ICPD), including the
Preamble and Essential Principles. These are consensus
recommendations ffrom our diverse delegation which included
members from five government departments or agencies and 11
non-governmental organizations representing a variety of views.
In regard to the goals to be set at the ICPD, I have
attached a wor/.ing paper developed by the delegation that
reflects some of our recommendations. The U.S. supports, i n
principle, the goals enunciated by the Secretariat during
PrepCom II. We would suggest that four additional goals, which
are further described in the attached paper, be taken into
consideration.
All the preparatory documents contain many worthy and
important goals, some of which unfortunately do not lend
themselves to quantification. Others, such as quality of care,
could be quantified in the future, given a better base of
information, c^.z vjq suggest that attention be given to the
development of such information in the future.
We want tc emphasize that goals adopted by the ICPD should
not be viewed as external, arbitrary targets, but as
commitments we ...ake to ourselves — anc to others
tto take
measurable steps toward improving the quality of life,, the
health and wel^ being, and the freedom of all our peoples. We
cannot restate >ften enough, or strong.y enough, our opposition
to coercion in cny form, even when coercive measures appear to
be well intentioned or when they result from lack of attention
or sensitivity to individuals or groups that, in all societies,
are disadvantaged by age, sex, lack of.education, family
ethnicity, disability or other conditions.
Dr . Nafis Sadi?.
Execu ive director.
United Nations Population Fund,
220 E. 42nd Street, 18th Floor,
New York, New York 10017
United States Department of State
If (ls/i inpt on, 1). C.
20520
WORKING PAPER ON GOALS
U.S. DELEGATION
PREPCOM II
For the goals to be established at the International
Conference on Population and Development, the U.S. supports, in
principle, those enunciated by the Secretariat during PrepCom
II. These goals call for, during a 20-year period, major
reductions in infant and maternal mortality, substantial
improvements in longevity, meeting the unmet need for family
planning services, the universal availability of primary school
education — with an emphasis on the equalization of
opportunity for girls, and slowing the rate of population
growth. Many of these goals reflect already adopted regional
and national goals and can only be met with the participation
and political commitment of individual countries.
We would suggest that four additional goals be taken into
consideration:
o
Redress a fundamental inequity in the treatment of boy and
girl children under five which is reflected, in many areas, in
the fact that by age five a disproportionate number of girls do
not survive — either as a result of sex selection, infanticide
or because of inadequate nutrition or care. Goals should be
established both to eliminate gender differentials in infant
mortality and for the sex ratio at birth not to exceed 105
males per 100 females.
o
As an extension of the goals to reduce maternal mortality,
a goal should be set to reduce the proportion of maternal
mortality which is due to unsafe abortion.
Reduce age-specific birth rates for those less than 20
o
years of age, particularly the very young girls in that age
span.
I
o
Provide universal sex education in formal and non-formal
educational settings, including information on methods to
regulate fertility and prevents AIDS and other STDs.
We hope that these additional goals will be considered and
that they will be quantified before PrepCom III, along with
those suggested by the Secretariate, using the best available
data.
Individual regions and individual countries should
strive to meet all or some of the goals sooner than the 20-year
time frame and we recommend that some intermediate, measurable
goals be set worldwide as well.
j
-2-
I hope that you find our recommendations useful in the
redrafting of the framework. While these recommendations
reflect a consensus developed by our delegation, they are not
the final negotiating position of the United States. The
roundtables and other activities may provide additional
information that we will want to include in our positions.
I thank you in advance for your consideration and look
forward to our continued work together.
With best wishes,
S i naeffely^you r s (T
\Jl\M Cult
Timothy E. Wirth
Enclosures:
As stated
United States Department of State'
AWT
;W
-
I'lir Counselor
'*•
H ashin^tori. !).('. 20o2()
August 3, 1993
TO:
FROM:
Interested parties in population policies
Timothy E. WirthCT^
SUBJECT: U.S. policy recommendations to ICPD Secretariat
Because of your involvement in international population
policies, I thought you would be interested in reviewing the
documents recently forwarded by the U.S. Delegation for PrepCom
II of International Conference on Population and Development to
the Secretariat. Attached is a copy of the transmittal letter,
our working paper on goals to be established at the ICPD and
our recommendations to the framework for the ICPD.
These are consensus recommendations from our diverse
delegation, which included members from five government
departments or agencies and 11 non-governmental organizations
representing a variety of views. These recommendations do not
reflect the final negotiating position of the United States -we would like additional input before finalizing the positions
we will be advocating at the third Preparatory Committee and in
Cairo.
We hope to have your help and input as we work to promote a new
policy agenda and to provide a budget to support these goals.
I encourage you to provide feedback and guidance on the
enclosed documents to either me or Ellen Marshall on my staff
(2401 E Street, NW, RP/Room 1284, Washington, DC 20522,
202/663-1064).
4
-2All the preparatory documents contain many worthy and
important goals, some of which unfortunately do not lend
themselves to quantification. Others, such as quality of ca re,
could be quantified in the future, given a better base of
information, and we suggest that attention be given to the
development of such information in the future.
We want to emphasize that goals adopted by the ICPD should
not be viewed as external, arbitrary targets, but as
commitments we make to ourselves -- and to others — to take
measurable steps toward improving the quality of life, the
health and well being, and the freedom of all our peoples, We
cannot restate often enough, or strongly enough, our opposition
to coercion in any form, even when coercive measures appear to
be well intentioned or when they result from lack of attention
or sensitivity to individuals or groups that, in all societies,
are disadvantaged by age, sex, lack of education, family
ethnicity, disability or other conditions.
July 30, 1993
j
THE COUNSELOR
DEPARTMENT OF
STATE
WAS HIN GTO N
Jyly 30,
1 993
Dea r Dr. Sadi k:
Attached are revised comments and suggestions from the U.S.
delegation on the conceptual framework for the International
Conference on Population and Development (ICPD), including the
’ '
. These are consensus
Preamble and Essential Principles,
diverse
delegation which i ncluded
recommendations from our c_
-members from five government departments or agencies and 11
non-governmental organizations representing a variety of views.
In regard to the goals to be set at the ICPD, I have
attached a working paper developed by the delegation that
reflects some of our recommendations. The U.S. supports, i n
principle, the goals enunciated by the Secretariat during
We would suggest that four additional goals, wh i ch
PrepCom II.
further described in the attached paper, be taken into
consideration.
All the preparatory documents contain many worthy and
important goals, some of which unfortunately do not lend
themselves to quantification. Others, such as quality of care,
could be quantified in the future, given a better base of
information, and we suggest that attention be given to the
development of such information in the future.
We want to emphasize that goals adopted by the ICPD should
not be viewed as external, arbitrary targets, but as
commitments we make to ourselves — and to others -- to take
measurable steps toward improving the quality of life, the
health and well being, and the freedom of all our peoples. We
cannot restate often enough, or strongly enough, our opposition
to coercion in any form, even when coercive measures appear to
be well intentioned or when they result from lack of attention
or sensitivity to individuals or groups that, in all societies,
are disadvantaged by age, sex, lack of education, family
ethnicity, disability or other conditions.
Dr . Nafis Sadik
Executive Director,
United Nations Population Fund,
220 E. 42nd Street, 18th Floor,
New York, New York 10017
k
♦
-2-
I hope that you find our recommendations useful in the
redrafting of the framework. While these recommendations
reflect a consensus developed by our delegation, they are not
the final negotiating position of the United States. The
roundtables and other activities may provide additional
information that we will want to include in our positions.
I thank you in advance for your consideration and look
forward to our continued work together.
With best wishes.
Sinoerfely^yours C
\J|\m MUUb
Timothy E. Wirth
Enclosures:
As stated
' !
1
United States Department of State
Irtishin^ton^ !)■( ■
^0520
WORKING PAPER ON GOALS
PREPCOM 11
U.S. DELEGATION —
the ,0.1. to oe -tsbllshed
st the
the I„ter„stion31tts.
■ - 1 at
For
and
a"\Development,
D
feTJetariat during PrepCom
Conference on Population
enunciated
by the
those
period, major
principle
These, goals call for.
for, during
J• L/substantial
II.
T-_in infant and Vernal mortality,
reductions
in longevity,, meeting the
th^.
o£ primary school
improvements i
universal
avalthe univers on the equalization
of
planning services,
equalization
_ with an emphasis
emphasis on-th^q^e
population
education - for girls, and Slowing the
already adopted regional
opportunity
Many of these goals reflec
be
met
with the participation
growth.
national goals and can only
individual countries.
and i—
and political commitment or -additional goals be taken into
We would suggest that four
consideration.
in the treatment of boy and
fundamental inequity reflected, in many areas, in
o
Redress a
under five which is
number of girls.do
girl r children
that iby age five
five aa disproportionate
selection
, infanticide
y
_
result of sex l--the ffact that - oyeither
,
a
resuxu
Goals
as
<
not survive -care. <---- should be
_
;
nutrition
jentials in infant
of
inadequate
i
differentials
or because
eliminate
gen
.
rt
_
h
not
t0 exceed 105
e stablished both to <---- ratio ar birth not to c..
and
for
the
sex
mortality
males per 100 females.
'j to reduce maternal mortality,
extension of the goals
As
an
proportion of maternal
o
set to reduce the
t
goal
should
be
unsafe abortion.
a
mortality which is due to i--" : those less than 20
for
Reduce age-specific birth rates young
girls in that ago
o
the very I
of
age,
particularly
years
span.
provide universal sex
'
• l in formal and non
o ducaiional^ettrngs.^nel^^g information
other STDS.
e
AIDS
regulate
that these additional go 1,1s will
oill^e
be eensidered^d
We hope
■ - will be quantified before
P
available
that they
suggested by the ^^“^hualCountries should
those individual regions and indi
sooner than the 20-year
data .
• , meet all or
of the goals 300^.^^ measurable
strive to
frame and ^e recommend that some
time
goals be set worldwide as well.
’f
:!
-2-
All the preparatory documents contain many worthy and
ALnl Goals some of which unfortunately do not lend
?0 qlartiflcatxon. Others. such as quality of care,
themse
tified in the future, given a better base of
information, and we suggest that attention be given to the
development of such information in the future.
emphasize that goals
commitments we make tc’ ourselves ^^to.o er
measurable steps toward
towaman/the fyreedom of an our peoples. We
health and well being,
restate often enough, or strongly enough, our opposition
cannot r~--form, even when coercive measures appear to
to coercion in any 2
be well intentioned or: when they result from lack of attention
individuals or groups that, in all societies,
or sensitivity to i-are disadvantaged by age, sex, lack of education, family
ethnicity, disability or other conditions.
July 30,
1993
U.S. DELEGATION'S SUGGESTED CHANGES
TO THE PROPOSED FRAMEWORK DOCUMENT (PC 11)
FOR THE UNITED NATIONS INTERNATIONAL CONFERENCE
ON POPULATION AND DEVELOPMENT
July 30, 1993
NOTE- This draft combines into one document selected language from the U.N. s
proposed framework document (PC 11), recommendations from Expert Group
Meetings, and changes and additions suggested by the U.S. Delegation Italic text
signals UN and, where indicated. Expert Group Meeting language, while plain text,
including bold-face where inserted into pre-existing language, represents additions or
changes suggested by the U.S. Delegation. Indented text between two slashes—/ /
indicates how the Delegation wishes its suggestions to be incorporated.
PREAMBLE
The Preamble would seek to define clearly the objectives and goals that need to be pursued by
Governments, non-governmental organizations and the international community to improve
prospects for accelerated economic growth, to reduce high rates of population growth and to
produce conditions under which the development process could be maintained and promoted on a
sustained and sustainable basis.
//The U.S. Delegation suggests that the following points be included in the
preamble://
.
An assessment of population policies and programs over the past 25 years
should serve as a critical foundation for developing goals and strategies for the future.
The context of population policy-making is changing, including democratization in
many countries, increasing political participation of women, and respect for human
rights, including women's rights. There is a need for more comprehensive policies,
broad-based participation in policy development, and reexamination of the appropn
roles and responsibilities of governments from the central to the local levels. Also, mor
governments have adopted population policies and programs that are now at the
implementation stage.
.
Pressure is increasing from the interaction of several phenomena: global
economic crisis and increased poverty; over-consumption of resources by wealthier
countries and people; mass migrations to mega-city slums; growth of refugee camps,
with women and children comprising 80 percent of their populations; severe economic
and social disparities within all countries; inappropriate and ineffective economic
policies and development models, especially as they affect economic growth, weaken
basic social services and infrastructure, and increase debt; rapid population growth and
unprecedented population size; and unsustainable use of natural resources and the
production and disposal of toxic wastes.
1
r^-
*
Other relevant issues include the global pandemic of ITIV/AIDS and other
STDs; changing patterns of sexual and family relationships; degradation and loss of
subsistence economies and indigenous knowledge; all forms of violence from armed
conflict to violence against individuals, including rape and forcible impregnation as
well as coercive abortion and compulsory sterilization; and denial of food, health
services, and basic rights to girl children and adolescents.
•
Key contextual factors are families. The family is the basic unit of society,
the setting in which—for most people around the world—births and deaths occur and
health care is delivered. The roles of families to nurture, teach, provide support for their
members, and care for those unable to care for themselves are usually carried out by
members related by blood or marriage and increasingly through other ties. Around the
world and across time, families show great variability, strengths, resilience, and
fragility. At all stages of life, families are ultimately tied to the development of positive
health behaviors as well as care of the dependent young and elderly. Population and
development strategies must take into account how the social and economic changes
experienced in a country affect the abilities of families to function in these critical roles,
especially the growing phenomenon of single parent families usually headed by
women.
•
Another key contextual factor is environmentally sustainable
development. Taking care of people's basic needs and improving their quality of life
require economic growth and reallocation of resources within the framework of
environmentally sustainable development. Environmentally sustainable development
requires improving the quality of life while preserving environmental potential for the
future, and applying this principle evenly and equitably in both the North and South.
•
Several other goals should be noted. In order to be just, humane, and
effective, population and development policies and programs should enhance social
and economic justice, include popular participation^ incorporate women equally in all
levels of planning, decision-making, and implementation; respect human rights; protect
women's rights and reproductive rights, including safe, voluntary abortion;
significantly reduce maternal and infant morbidity and mortality rates,;and address the
root causes of poverty and environmental degradation.
•
Because of women's biological function in reproduction and the
persistence of gender inequality and discimination, the Preamble and all other sections
of the document should consider women’s perspectives and assess the impacts on
women.
//The U.S. Delegation suggests that existing paragraph 13 read as follows (note
:• - • - -that the goals and projections have been changed from 2025 to 2015): //
In its work on population projections, the Population Division of the Department of
Economic and Social Development of the United Nations Secretariat has prepared three
2
■'V
scenarios of population growth The
jX’by MsZderih/Tow
world population of 6.2 bil ion y e y <
ybiUion by 2015, while under the
variant projection, the wor popuha ky^
scenarioS/ billions of
high variant, it may .reach a higl
.93^,
educated, and employed by
additional people will need
aiipViate conditions of abject poverty under
2015. There is also the impera ive need
|n °ddition, the basic needs of the
which hundreds of millions o pcop> e
Y
t also be met Taking
.........
//The U.S. Delegation suggests that existing paragraph 14 read as follows,/ /
..i,
bc aPPr^r ihr
rdaling K, populalion
relevant international ^stru^tsar^
World Population Conference in 19 ,
adopted by the ^tematl0^1^
Pl,.„ ofAel.^, adopted by tbe
reco/!,mendationS for its further implementation,
irL 3934 Also relevant are the
Generations; the International Development
Aidant
Decade; tbe rcco^endatons of the
Strategy for the Fourth Unitea n
e
.■ Agenda 21; and the Nairobi
United Nations Conference on
The document must
Forward Looking Slrateg.es tor the Adv.n ament of Women.
I
I
I
reflect the applicable Pro^s‘onJ
Pontical Rights; the International Covenant on
International C°ve^n^
fhe Convention on the Elimination of Racial
Social, Economic and Ci
g
Piimination of All Forms of Discrimination
a^ZSZ^:^'Sghts of the Child. Cons^tfon
Agassi Wome,
Monships ofthe 2994 Conference to subsequent
Mer"sovenl,,.ftal conferences on issues related to population and development.
PART ONE: PRINCIPLES/FUNDAMENTAL CONSIDERATIONS
i
Part one
action on population and dcvelopmen .
ri0.hts anj responsibilities and gender
—-
lSO";tuUsnpm^inauzed people, people w.lh disabilities, and the
under-served.
//The following clusterings are those suggested by the EC and endorsed, wrth
modifications, by the U.S.:/1
3
/
A.
Human Rights, Reproductive Rights, and Population: Recognizing Obligatioiys
and Responsibilities
•
The preeminence of human rights for all should be a fundamental concern
in reproductive health and family planning programs and policies. Individuals should
be protected against discrimination based on gender, class, race, disability, ethnicity,
age, or sexual orientation should be protected.
•
Coercion or intimidation must never be used in family planning and
reproductive health programs.
•
Women and girls are the subjects, not the objects, of population policies
and have the right to determine whether, when, why, with whom, and how to express
their sexuality; they have the right to determine when and whom to marry; they have
the right and responsibility to decide whether, how, and when to have children.
•
While women’s health and reproductive health services are essential,
reproductive health services for men, including male sexual, reproductive health ,and
family planning services are also important to protect their own health, and the health
and well-being of women and children.
B.
The Responsibility of Society for Human Development, Reproductive Health.
and Family Planning: Ensuring Choices and Opportunities
•
Governments and inter-governmental organizations should create the
necessary social, environmental, legal, cultural, and political conditions to reduce
poverty and enhance quality of life.
•
Gender equity and empowerment of women must be pursued in all
domains, public and private.
•
It is necessary to provide a full range of good quality family planning and
reproductive health services for women, men, and adolescents, regardless of age or
marital status, that are responsive to their needs. Every women should have the right to
safe abortion and complete, unbiased information on all fertility regulation methods.
•
Governments and intergovernmental organizations should meet the needs
of vulnerable groups, including the disabled, indigenous people, the displaced,
refugees, the aged, children, and the homeless.
•
Popular participation, including especially women, must be central in all
phases of development, implementation, and monitoring of policies, programs, and
services.
4
•
Families are basic units of society; policies and programs should recognize
and support the various family formations that exist, but not discriminate against
individuals.
C.
. Sustainable Development: Linking Population, Consumption, ond Environment
•
The integration of policies concerned with population growth, resource
consumption, environmental degradation, and quality of life should be pursued and
emphasized throughout program and policy development, implementation, and
monitoring, using as a guide the documents listed in paragraph 14 of PC/11, with the
modifications proposed by the U S. Delegation.
•
National and local population goals and policies must include
consideration of natural resource use, production of waste, food supplies, and quality of
the environment together with economic and social factors.
•
Sustainable development requires actions which address the needs of the
present generation without compromising the ability of future generations to meet their
own needs.
•
While economic growth is important to all nations, programs and policies
should focus on growth and economic development programs that can be achieved
within the context of environmental sustainability and equity.
•
Particular attention should be given to the rights, constraints, and roles of
groups discriminated against on the basis of gender, class, race, disability, ethnicity, or
age.
D.
Partnership in Population: Moving from Commitment to Action
•
A clear set of international standards should be developed for both
quantitative and qualitative measurement and monitoring of progress, impacts, and
unintended consequences at national and global levels.
•
Responsibility to generate resources and mobilize action requires
enhanced participation by, and appropriate cooperation among, concerned individuals,
NGOs, private commercial enterprises, national governments, and international
agencies, including multilateral banks.
•
Commitments to action should take into account that some of the most
innovative solutions come from the local and community level; hence every effort
should be made to learn from actors at all levels, including community leaders, non
governmental organizations, women's groups, indigenous peoples, and the private
commercial sector.
5
•
Expanding knowledge, information, and communication is integral to
population and development programs.
PART TWO: CHOICES AND RESPONSIBILITIES
Part Two of the document will address, on a sectoral basis, issues relating to population,
sustained economic growth and environmentally sustainable development.
CHAPTER I: THE INTERRELATIONSHIPS BETWEEN POPULATION, SUSTAINED
ECONOMIC GROWTH, AND SUSTAINABLE DEVELOPMENT
A.
Population in the Context of Sustainable Development
and Sustainable Livelihoods
International understanding of the concept of sustainable development continues to evolve. At
the same time there is growing appreciation of the diverse interlinkages of population concerns
with both economic activity and environmental conditions. It is seen as important that this
process gain due recognition and support both at the international and at national levels.
//The United States endorses the recommendations of the Expert Group Meeting
on Population, Environment and Development, with particular emphasis on
Recommendation 1 which states://
Because there are strong linkages between population, development and the environment,
Governments are urged to establish or strengthen mechanisms to coordinate policies and
programmes and give unified direction for integrating environmental and population concerns
into development policy-making and planning. In particular, Governments are urged, when
formulating their social and economic policies, plans and programmes in any sector, to take fully
into account the implications of projected demographic trends as well as of patterns of production
and consumption, for the protection of the environment and the conservation of natural
resources.
//The U.S. Delegation suggests that the document://
•
Recognize the linkages among population growth, resource consumption,
environmental degradation, poverty and quality of life; and consider population factors
as an integral part of any environmentally sustainable development policy and /or
program.
•
Recognize that environmental degradation over the long term can impede
economic growth and efforts to eliminate poverty.
6
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•
Challenge the world to impiove the quality of life for today's citizens
without compromising that of future generations by achieving a balance between
human needs and aspirations and the natural resource base and environment, and by
intervening in the cycle of environmental degradation, whether fed by poverty and
rapid population growth or affluence and unsustainable resource consumption.
. ......... //The U.S. Delegation suggests that the document encourage governments to://
•
Develop strategies to accommodate inevitable population growth that
promote improvement in the quality of life and the prevention and alleviation of
negative environmental impacts, including policies and programs to increase the use of
environmentally-friendly technologies in both new and existing production and
processes.
•
Support and promote increasing economic and social status of women and
give full recognition of the fact that the full participation of women in all government
and non-government policy-making contributes to human rights, environmentally
sustainable development, and sound population policies.
•
Reallocate national and international resources to support human
I development, eliminate the burden of structural adjustments on women, and reduce
■ disparities between the rich and the poo:>r.
I
B.
Population and Socioeconomic Development
Perspectives and experiences differ on the relationship between population size and growth and
socio-economic progress. Actions aiming at integrating population concerns into development
should give particular attention to improving the quality of life, alleviating poverty and reaching
other goals specified in the International Development Strategy for the Fourth United Nations
Development Decade.
//The U.S. Delegation suggests that the document://
•
Recognize rapid population growth and the consequent changes in
demographic structure and population distribution as crucial factors that impose
pressures and constraints on economic and social development efforts, and the
environment and natural resources.
.
Emphasize population as a dynamic variable requiring policy intervention
in all environmental and socioeconomic development strategies.
•
Promote actions aimed at integrating population concerns into
development, giving particular attention to improving the quality of life, achieving
equity in social relationships, providing basic infrastructure and social welfare services,
alleviating poverty, and promoting gender equality.
7
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b
c.
Populotion, Consumption, ond the Environment
The United Nations Conference on Environment and Development served to Id^hli^ht the
impact of current human activity on the natural environment. Relatively little attention,
homever, has been paid to the projected consequences offuture population levels and related
patterns of consumption and production. It will be important for the Conference to build on the
understanding reached at the United Nations Conference on Environment and Development,
while avoiding encroachment on ongoing negotiations relating to environment issues.
//The U.S. Delegation suggests that the document://
Recognize the critical nature of environmental degradation associated
with and flowing from current patterns of development and consumption and from the
rapidly changing size and distribution of the population.
Recognize demographic pressures on natural resources and the
environment, locally and globally, and set up safeguards for natural life support
capacities in different ecological zones as well as measures to protect these ecosystems
including habitat protection.
7
CHAPTER II: GENDER EQUALITY AND EMPOWERMENT OF WOMEN
Achieving genuine gender equality has an important impact on the status of women and the role
they are able to play in all aspects of socio-economic development.
A-
Empowerment and Status of Women
//The United States endorses Recommendations 16 and 17 of the Expert Group
Meeting on Population and Women which state://
Governments and non-governmental organizations are urged to make special efforts to improve
and equalize the school enrollment and attendance of girls and boys in all levels of education.
Recognizing the difficulty of some families in permitting daughters or sons to attend school,
innovative strategies need to be devised which respond to existing socioeconomic and familial
constraints. There is also a need for increased sensitivity to young women's reasons for
dropping out offormal education, whether as a result of early marriage, pregnancy or economic
need. Policies and programmes must be adopted which will enable them to continue their
education.
Governments and non-governmental organizations should make efforts to ensure that women of
all ages who have little or no formal schooling are provided with special non-formal education
that would assist them to gain access to remunerative employment, knowledge of their legal
rights, information on family and child health, nutrition and fertility regulation and information
8
on services for which they are e
schooling.
This should complement ruther Hum substitute for formul
//The U.S. Delegation suggests that the document:/ /
•
Recognize that empowerment is essential to improving the status and
roles of women; is critical to achieving universal human rights, including the
elimination of gender-based violence; and is a key factor in achieving environmentally
sustainable development and population stabilization.
//The U.S. Delegation suggests that the document encourage governments to.//
•
Accelerate efforts to eliminate social, cultural, educational, political, and
economic barriers which perpetuate gender discrimination in society and in sexual
relationships.
•
Ensure full access to a wide range of methods of fertility regulation and
obstetrical, gynecological, and health care services.
•
Expand women's access to information on their legal rights and their
access to courts of law, along with necessary legislation to eliminate discrimination on
the basis of gender.
•
Recognize and enhance women's economic contribution to family and
national productivity; remove barriers to credit, landholding, and inheritance; and
eliminate gender discrimination in employment.
•
Educate women and men on cultural and social barriers to women s full
participation in development and the negative impacts that inequitable sex-role
socialization can have on children and societies.
Work with NGOs to examine policies and programs in all sectors using
formulate plans and targets to address gender inequities; assure
gender anailysis;
y
’ ’ ' on progress at all levels of
women's reproductive rights, and report regularly
implementation.
[
|
B.
The Girl Child
I/The U.S. Delegation suggests that the document://
•
Recognize that the basis for empowerment is investment in the
development of the child and encourage equal access to adequate nutrition, health care,
including reproductive health services, education, formal and informal training, and
other basic social goods.
9
4
t
i
//The U.S. Delegation suggests that the document encourage governments to://
*
Prevent victmuzahon by such practices as infanticide, child marriages
sexual bondage, and other forms of exploitation such as sexual abuse and genital’ '
mutilation.
5
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Promote positive images of women's economic productivity through
*
parents.
’
Encourage mterministerial collaboration to retain girls in school through
the secondary level and provide in-school helath services and sexual education.
c.
Male Responsibility and Participation
//The United States endorses Recommendation 12
18 of the Expert Group on
Family Planning, Health and Family Well-being which states-//
Governments, donors and non-governmental organizations should encourage increased
mvolvement in and responsibility for family planning on the part of men, through research on
male attiudesand motivation, messages specifically tailored for men, strategies to encourage
responsible fatherhood, sharing of responsibilities between men and women, research on male
methods of contraception, and innovative clinical services adapted to the needs of men.
//The U.S. Delegation suggests that the document://
throughout
mm Sh0U'd
resPonsibility
S“PP« gender equality
//The U.S. Delegation suggests that the document encourage governments to://
Recognize men as clients for contraceptive information and services
increase research for development of new male contraceptives, and promote the use of
condoms and vasectomy through innovative services and information campaigns,
b f ii’
E?CrOUrtSe HirV??1'6 resPonsibility for their children and participate in
the full range of family and child care responsibilities, not just wage earning.
.
*
Support men through education and services to protect themselves and
their partners from sexually transmitted diseases.
10
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CHAPTER III: POPULATION GROWTH AND STRUCTURE
A.
Diversity of Fertility, Mortality and Population Growth Rates
Although global patterns show that the world population is in a process of demographic
transition, important variations exist at the regional level and within regions and countries.
Many countries seem to converge to a pattern of low population growth but at different speeds
and at rates that are becoming increasingly diverse. Others have yet to begin such a process.
Equally noteworthy is the contrast between the decline in population growth rates and the
absolute increase of population. As up to 95 percent of the population growth in the coming
decade will occur in developing countries, the rate offertility decline in those countries will be a
critical determinant offuture world population size. Measures designed to assist countries in
addressing the consequences of demographic trends at different transition should be elaborated.
//The U.S. Delegation suggests that the document://
•
Support the reduction of rapid global population growth with the long
term goal of achieving a stable world population of under ten billion people as soon as
possible.
•
Advocate achievement of replacement-level fertility as a reasonable and
attainable long-term goal at the national level.
•
Advocate reducing disparities between racial, ethnic, and class groups in
fertility, mortality, and population growth rates which result from disparities in access
to primary and reproductive health care services, including family planning.
B.
Children and Youth
Due to the persistence of high fertility levels, a large number of developing countries have, within
their overall populations, substantial proportions of children and young people. Some countries,
as a consequence of an increase in their levels offertility, have also increased the proportion of
children and youth, thus producing a phenomenon called "juvenation.H The challenges created
by such situations both in economic and social terms should be addressed.
//The U.S. Delegation suggests that the document should encourage
governments to://
•
Invest in all dimensions of human development for children and youth,
including their physical, social, economic, mental, and educational development.
•
Eliminate persisting gender inequalities in nutrition, education, and
socialization of children.
11
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•
Provide education to school-age children and youths on population,
environment, gender relationships, family life, reproductive health, and sexuality.
•
Lower the incidence of early pregnancy and childbearing to reduce
maternal mortality and morbidity, prevent disruption of schooling, facilitate
employment, and encourage the stability of unions.
C.
Aging Populations
The steady increase of older age groups in national populations has significant implications for
many countries, both developed and developing. The economic and social impact of the "ageing of
populations" needs to be recognized both as an opportunity and a challenge.
//The U.S. Delegation suggests that the document encourage governments to://
•
Identify options to allow older people to work and live independently in
their own communities long as possible.
•
Establish a safety net for the elderly in countries where social security and
pension systems are inadequate.
•
Respond to the physical, social, economic, and mental needs of all the
elderly, and eliminate gender inequities in the provision of social support services.
•
Address the fact that women are and will make up a disproportionate
share of the elderly, making it all the more crucial that women be fully integrated
socially and economically.
CHAPTER IV: THE EAMILY, ITS ROLE AND COMPOSITION
A.
Family Formation and Structure
As part of the processes of rapid demographic and accelerated social change both in the developed
and the developing countries, the patterns offamily formation are undergoing considerable
change and the composition and structure offamilies are also being altered. The implications of
such changes for demographic processes and the formulation of responsive policies and programs
should be addressed.
//The U.S. Delegation suggests that the document encourage governments to://
•
Adopt laws and policies which recognize and support the plurality of
family forms, with particular attention to households headed by women.
12
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•
Examine further the relationships between social and economic
development, natural resources management, and family formation/structure.
Eliminate coercive policies related to marriage and childbearing.
Enact and/or enforce laws pertaining to the minimum age of marriage.
•
Adopt policies that encourage power sharing and shared decision -making
within the family.
CHAPTER V: REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH
AND FAMILY PLANNING
A.
Human Sexuality and Gender Relations
//The Chairman's Summary on the Conceptual Framework, from the second
session of the Preparatory Committee for the International conference on
Population and Development, noted that://
Humin sexuality and sexual behaviour [is] recognized as a neglected area that require[s] special
attention. In this respect, it [is] recommended that sexuality and gender relationships be treated
as closely interrelated and as factors that affect sexual health and reproductive
behaviour....Adolescents also [require] special attention.
//The U.S. Delegation suggests that the document add a section under this
heading, which will://
•
Recognize that sexiuality and gender relationships underlie the
empowerment of women, as well11 as the well-being and development of children and
adolescents, especially girls.
Recognize that sexuality and gender relationships are closely interrelated
and together affect the ability of men and women to achieve sexual health use
contraception and prevent STDs and control their fertility-in particular how they affect
the practice of family planning and the transmission of STDs, and make this recognition
central to programs to modify risk behaviors.
//The U.S. Delegation suggests that this s< 'tion encourage governments to:/ /
Develop formal and informal sex and gender education programs.
r.
*
Encourage the mass media and authors of text books, family planning
rebhonships^1
ClJuCatlonal materials to promote equitable and responsible sexual
13
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B.
Reproductive Health and Reproductive Rights
//The United States endorses Recommendations b and 7 of the Expert Group on
Family Planning, Health, and Family Well-being which state://
Governments, intergovernmental and non-governmental organizations are urged to recognize
that abortion is a major public health concern and one of the most neglected problems affecting
women's lives. V^omen everywhere should have access to sensitive [non-directive] and safe
abortion services.
Given the high prevalence of sexually transmitted diseases (STDs) and the AIDS pandemic
which threaten the well-being of men, women and children, family planning programmes need to
widen their scope to include reproductive health care including STD/HIV education and
prevention.
I/The U.S. Delegation suggests that the document encourage governments to://
•
Provide family planning and STD/HIV services which are mutually
supportive because they deal with shared behaviors and interventions.
•
Prevent threats to reproductive health over the life cycle, including,
among others, genital mutilation, poorly managed pregnancy and childbirth, and STDs,
all of which have health and fertility effects.
•
Ensure access to antenatal, delivery, and post partum care, including
emergency services, to reduce maternal morbidity and mortality.
•
Assess the demographic and development impacts of the global pandemic
of STDs and AIDS (HIV), and the contribution that population-related programs,
including family planning, can make to prevention and control.
C.
Family Planning
Family planning programmes respond to two basic concerns:
(a) To guarantee the exercise of the rights of couples and individuals to decide the number
and the spacing of their children; and
(b) To promote the health of women, children and the family
Family planning programmes are also an important component of population programmes and
development strategies.
I/The United States endorses Recommendation 14 from the Expert Meeting, on
Family Planning, Health and Family Well-being as follows://
14
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Governments and non-governmental organizations are urged to improve the quality offamily
planning services by incorporating the user's perspective and respect for the dignity and privacy
of the client. Programmes should provide the broadest possible range of contraceptive methods;
thorough and accurate information to enable clients to make informed choices; systematic follow
up; easy availability of and accessibility to services; and technically competent service providers
who receive proper training and supervision, with additional emphasis on communication and
counseling skills. Unnecessary medical and regulatory barriers restricting access to services I
should be removed. Strategies should be carefully designed and tailored according to local
I
conditions, and the cost of services and contraceptives should be subsidized for people who
cannot afford the full cost.
I/The U.S. Delegation suggests that the document://
•
Reaffirm that family planning is a basic human right, saves lives, and is
cost effective; and that access to family planning empowers women and can help them
to improve their status.
//The U.S. Delegation suggests that the document encourage governments to://
•
Ensure that family planning services are free of coercion, facilitate
voluntary choice by individuals and couples by the provision of complete and unbiased
information on all fertility regulation methods, and demonstrate respect for individuals’
privacy and dignity.
•
Oppose all eugenic policies and practices that promote selective breeding
and sterilization on the basis of sex, class, race, and disability.
•
Encourage comprehensive approaches to the provision of fertility
regulation and other reproductive health services, with emphasis on quality of care and
responsiveness to users' perceived needs.
Design programs to be geographically accessible, affordable, and costeffective.
•
Increase women's involvement in designing, managing, and monitoring
family planning and reproductive health services.
•
Include men as well as women as clients, and show special concern for the
young, marginalized people, and other under-served groups.
♦
Provide family planning services through multiple channels to extend
their outreach.
•
Reduce contraceptive failure rates through better information, services,
and methods, while recognizing that contraceptive failure is likely to remain a
substantial issue for the foreseeable future.
15
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•
Assure that supplies of contraceptives, adequate for all current and
expected future users of family planning services, are allocated to service sites in the
public and private sectors based on standards for storage and utilization recommended
by government and manufacturers; and assess future needs based on client preferences
for methods, rather than a pre-determined goal of method utilization.
D.
Adolescents
//The United States endorses Recommendation 16 from the Expert Group on
Family Planning, Health and Family Well-being which states://
GouemmCTifs arc urged to recognize the special needs of the young and adolescent population
and to strengthen programmes to minimize the incidence of high-risk and unwanted pregnancies
and STD/HIV infection. Special efforts need to be made to reach this target population with
information, education and motivational campaigns through formal and informal channels,
including the involvement of young people themselves. In view of the fact that adolescents tend
to avoid or underutilize MCH/FP and STD services, often with disastrous consequences, it is
important that service providers be trained to be more receptive to adolescents Programmes
should provide confidential services to adolescent men and women without regard to marital
status or age. Young people should be involved in the planning, implementation and evaluation
of programmes designed to serve them in order for services to be sensitive to their needs.
//The U.S. Delegation suggests that the document include the following/ /
•
Recognize that adolescents are increasingly engaged in sexual activity, are
especially under pressure from changing social and economic circumstances, are
increasingly vulnerable to STDs, forced sex, unwanted pregnancy, and other problems
which seriously threaten their health and well-being.
•
Urge investment in special efforts to increase adolescents access to
appropriate information and services for reproductive health and fertility regulation.
•
Urge the development of special programs to prevent sexual exploitation
of and violence against adolescents.
CHAPTER VI: HEALTH AND MORTALITY
A.
Infant and Child Mortality
I/The United States endorses Recommendation 4 of the Expert Group on Family
Planning, Health and Family Well being which states://
16
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To save the lives of [women], children and adolescents and to improve their general health,
Governments and the international community are ur^ed to improve their investment in family
planning, reproductive and maternal and child health (MCH) services. Governments are also
urged to monitor the progress in safer motherhood and child survival and to take the necessary
actions to enhance the effectiveness of the interventions.
I/The U.S. Delegation suggests that the document:/ /
•
Reaffirm commitment to international efforts to improve child survival.
•
Advocate that health services-including safe and effective womencentered and managed reproductive health care and family planning services-be
strengthened and made more accessible.
•
Recognize that comprehensive health care should include prenatal care,
provide information on maternal and child health and responsible parenthood, and
provide mothers the opportunity to breast-feed their infants for at least the first four
months of life.
•
Promote expansion of infant and child health care services, including
immunization coverage, prevention and management of childhood disease, and
nutrition counseling.
B.
General Health and Mortality
Existing goals and targets for health and mortality issues at global, regional, and national levels
need to be reflected and, where appropriate, updated; appropriate objectives should be formulated
in light of recent socio-economic, epidemiological, and technological developments.
//The U.S. Delegation suggests that the document://
•
Recognize that the objective is positive health, not just the avoidance of
specific illnesses.
•
Reaffirm the importance of preventive health care and health promotion
to decrease disability, and improve the quality of life for all age and racial groups.
•
Recognize the need to reduce environmental and other causes of
morbidity and mortality, such as polluted water and air, poor sanitation, toxic waste
"t disposal, violence, dangerous life style choices, and infectious diseases such as
tuberculosis.
17
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CHAPTER VII: POPULATION DISTRIBUTION, URBANIZATION,
AND INTERNAL MIGRATION
//The United States recognizes the validity of the opening statement in the
Preamble to the recommendations of the Expert Group Meeting on Population,
Environment and Development which states://
The problems associated with and flowing from patterns of development, environmental
degradation and population growth and distribution are in many parts of the world reaching
critical proportions. The need to address these problems is, therefore, urgent.
A.
Population Distribution and Sustainable Development
Measures that foster sustainable development by taking account of the positive and negative
impacts of population distribution and migration should be considered.
//The U.S. Delegation suggests that the document encourage governments to://
•
Make better use of existing and/or new data to monitor and analyze
trends and patterns in population distribution, internal migration, and natural resource
use.
•
Promote the development of economic opportunities in more rural areas
as a means of better balancing population distribution between rural and urban areas.
Such opportunities should promote gender equity in land rights, credit, and services, as
well as in employment, hiring, and promotions, and in policy and decision making
positions in both the private and public sector.
•
Encourage rural centers of commerce and development in order to reduce
the necessity for rural to urban migration.
•
Identify areas, such as arid lands, tropical forests, watersheds, coasts, and
coastal waters subject to acute population pressures, and institute integrated population
and development policies that will alleviate the pressure on the environment.
•
Minimize hazards to the environment and human health and safety by
such means as land-use planning.
B.
Population Distribution Policies and Development Policies
Measures leading to a better integration of spatial considerations in development strategies
should be prepared.
//The U.S. Delegation suggests that the document://
18
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■/
•
Encourage the establishment of small and medium growth centers with
full economic and social services.
•
Advocate safeguarding the basic human rights of individuals in
formulating and implementing transmigration policies.
•
Encourage the development of durable solutions to problems related to
displaced persons, including the provision of support and assistance to receiving
regions and countries to work towards eliminating the root causes of those problems.
•
Encourage special attention to population pressures on buffer areas
around ecologically fragile areas.
c.
Population Growth in Large Urban Agglomerations
Measures to meet the diverse challenges posed by the continued growth of large urban
agglomerations should be developed with particular emphasis on the needs of poor urban
dwellers.
//The U.S. Delegation suggests that the document encourage governments to://
•
Establish systems of planning for urban areas to aid in the anticipation
and provision of adequate social services, including health and family planning.
•
Pay special attention to the need to minimize air and water pollution in
urban settings, especially in mega-cities.
•
Promote economic development and job formation in cities where
unem ployment and underemployment are high.
•
Provide additional resources to local authorities for the management of
cities particularly those which are experiencing rapid population growth, and for
adequate training in municipal management, including the provision of environmental
services.
CHAPTER VIII: INTERNATIONAL MIGRATION
A.
Documented Migrants
On the basis of existing international instruments and taking account ofchanging concerns
regarding migration, measures to protect the rights of migrants and to ensure that the positive
consequences of migration are realized in both countries of origin and destination will be
proposed.
I
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//The U.S. Delegation suggests that the document://
•
Recognize the value of developing channels for orderly legal migration.
•
Support cultural and social pluralism through information and education
programs, and the promotion of tolerance.
•
Accept that "where legal migration has proved to be of a long-term nature,
naturalization should normally be available, especially for second-generation
immigrants; civil and political rights and responsibilities should be extended to long
term legal immigrants, as appropriate." (European Population Conference
recommentation no. 44)
B.
Undocumented Migrants
In accordance with the provisions of international instruments, measures to protect the rights of
undocumented migrants and to prevent their exploitation while at the same time combatting
those who facilitate undocumented migration will be presented.
//The U.S. Delegation suggests that the document://
Recognize the right of each nation to control access to its territory.
•
Encourage cooperation between countries of origin and destination to
prevent uncontrolled migration.
•
Make potential migrants aware of the legal conditions for entry,
employment and stay in host countries through information activities in the country of
origin, making use of the facilities of international organizations where appropriate.
Governments should also take action against traffickers and employers of illegal
immigrants. (European Population Conference Recommendation no. 41)
Limit the misuse of asylum privileges by economic migrants.
•
Recognize the obligation of countries of origin to facilitate the return of
irregular migrants.
C.
Refugees
The increasing numbers of refugees and asylum-seekers are a growing issue in many regions.
The need to address the root causes of refugee flows should be stressed, the right to asylum should
be reaffirmed and measures to protect and assist refugees and repatriated refugees should be
proposed.
20
• »Sit.
//The U.S. Delegations suggests that the document encourage governments
to://
•
Recommend accession to the 1951 Convention and the 1967 Protocol for
those countries that have not already done so.
•
Reiterate the international consensus on the protection of persons facing
persecution or having a well-founded fear of persecution on account of race, religion,
nationality, social group or political opinion.
•
Highlight the special protection needs of refugee women and children,
especially adequate health and social services, which should include family planning
and reproductive health services.
•
Seek to ameliorate the root causes of refugee movements.
•
Recommend accession to the 1951 Convention and the 1967 Protocol for
those countries which have not already done so.
CHAPTER IX: PROMOTION OF POPULATION INFORMATION, EDUCATION AND
COMMUNICATION
Ensuring the widespread dissemination of relevant information on population and development
should be an important aspect of the objectives of the Conference. Education at all levels will be
needed to increase awareness of the interrelationship between population issues, economic and
social decisions and sustainability. In addition to identifying appropriate messages dealing with
those issues, it will be necessary to address the means of conveying them effectively to target
audiences..'..It is proposed that the central focus of this chapter should be the key message of the
1994 Conference: information and education should emphasize "choices and responsibilities.
/ /The United States endorses Recommendation 19 of the Expert Group on
Family Planning, Health and Family Well-being which states://
Governments and non-governmental organizations are encouraged to support information,
education and communication (IEC) activities in order to increase awareness about the benefits
offamily planning for both individuals and the larger community, through comprehensive
education efforts utilizing a wide variety of communications channels. Such programmes have
played a crucial role in bringing about the transformation of traditional attitudes and social
behavior necessary for the adoption of modem contraception. Public education programmes
should develop a clear communications strategy based on empirical research on social values and
reproductive behavior.
//The U.S. Delegation suggests that the document://
21
■r
/
I
I
?
EmPhasize that access to accurate and adequate information on family
planning and reproductive health services in particular is a prerequisite for individuals
to be able to exercise their right, and their social responsibility, todec de Xther how
.:“drcn and how ma"y “—■
//The U.S. Delegation suggests that the document encourage governments to://
•
Develop national, research-based, multimedia, and culturally approoriate
XXTactwities3'^165' 3nd m°nitOr 3nd eValU3te
impaCt °f -f—ation and
h w *
SuPPort education about sexuaiity, family life, and gender relations for
dren, adolescents, and adults, through enhanced use of mass media, outreach
programs and local communication networks. This education should emphasize
choices and responsibilities in regard to sexuality, STDs, child-bearing, and gender
relations to achieve good health and stabilize global population growth.
•
Work to change gender stereotypes in the media and in school curricula to
combat sexual inequality and violence of all kinds.
Support the use of entertainment and popular role models in
communicating population and reproductive health messages, especially for youth.
.
’ . Increase education at aH levels about the relationships among population
issues, environmental concerns, poverty, and economic and social development.
•
Improve the quality of communication and counseling by health and
family planning providers to assure informed choice and healthy behaviors.
CHAPTER X: CAPACITY BUILDING
Development of effective, integrated programmes addressing population issues,particularly
family planning, within the context of sustainable economic activity requires the participation of
appropriately trained personnel working within effective institutional arrangements
D^lopment of these necessary human resources, especially in developing countries, should be
a^r^d to ensure better programme/projcct design, the establishment or implementation of
sewwe?^
eVaUatt°'‘ sxJstems' mprovement of supervision, service delivery, and quality of
//The U.S. Delegation suggests that the document://
ho im *
E"COU,ra8e and suPPort capacity building for population, reproductive
nealm and family planning programs.
22
/
I
•
Encourage donors to continue supporting capacity-building for
population, reproductive health, and family planning programs.
//The U.S. Delegation suggests that the document encourage governments to.//
•
Provide management and technical training to population specialists and
family planning and reproductive health professionals, with emphasis on training
women for greater leadership roles.
•
Eliminate gender discrimination in institutions which are held in public
trust, including barriers to women's advancement to senior-level decision-making and
policy positions.
®
Encourage collaboration among ministries of finance, environment, health,
and other social welfare sectors in developing and implemen ting the recommendations
of this plan of action.
•
Require public and private sector agencies to be accountable to women,
communities and national level bodies for resources and results.
•
Require that data collection and comparative analysis performed by
governments and private sector agencies be based on cost, user satisfaction, geographic
coverage, and interrelationships with environmental conditions and economic
development.
CHAPTER XI: TECHNOLOGY, RESEARCH
Research must respect the rights of human subjects, and involve those who are affected
by programs and policies in all stages of research.
A.
Basic Data Collection and Analysis
T/i£ need to formulate guidelines to facilitate the complementary use of population censuses, civil
registration systems and socio-demographic surveys requires recognition, as does the promotion
of the analysis and dissemination of the results of such research.
//The U.S. Delegation suggests that the document://
•
Call for improving the quality of basic data about vital processes
(including the use of Geographic Information Systems).
//The U.S. Delegation suggests that the document encourage governments to://
23
'•■ttnsii
•
Ensure data collection on a timely basis; make data accessible, and analyze
and distribute them in a timely manner;.
•
Analyze and disseminate data for policy decisions and improved program
planning and implementation.
B.
Biomedical Research
The need to encourage and. support both basic and operational research, particularly in the area
of human reproduction, should be addressed. Particular attention should be given to the
development of safe and effective contraceptive technologies for men and womem
/ /The United States endorses the '/Declaration of the International Symposium
on Contraceptive Research and Development for the Year 2000 and Beyond" as
the basis for points to be covered.
The United States endorses Recommendation 30 of the Expert Group on Family
Planning, Health and Family Well-being. //
Governments and donors are urged to increase support for research on improving existing
contraceptive technology as well as developing new technology that will be affordable in
developing countries, focusing on methods which may have additional benefits in the prevention
of STD/A1DS, male methods to increase men's involvement in family planning, and methods
appropriate for breast-feeding women. Efforts should be made to remove constraints hindering
progress in this field, including inappropriate litigation practices and unjustified regulatory
requirements, and to enhance the involvement of private industry in this effort.
//The U.S. Delegation suggests that the document://
•
Recognize the need to include women in all stages of research and
development of all fertility regulation methods.
•
Recognize the urgent need for increased investment in developing
improved and new methods of contraception that are effective and safe for both men
and women, including, among others, long-acting, post-ovulatory, post-coital, male
-controlled methods, woman-controlled methods, and barrier methods.
•
Take into account t..e need for protection from STDs both with and
without protection from pregnancy.
•
Call for continued surveillance of contraceptive safety and side effects.
•
Encourage private industry to increase its investment in new fertility
regulation technology.
24
c.
Social and Behavioral Research
Greater understanding of social and behavioral processes , and accurate,
culturally relevant knowledge of the people served, are essential to achieving
many of the goals of population stabilization, reproductive health,
environmentally sustainable development, and the management of fertility and
sexuality.
/ /In this context, the United States endorses Recommendation 31 of the Expert
Group on Family Planning, Health, and Family Well-being.//
Governments and donors are encouraged to support social science research on human sexuality
and sexual behavior in different cultural settings to provide information useful in intervention
programmes to prevent umvanted pregnancies and STD/H1V infections.
//The U.S. Delegation suggests that the document encourage governments and
the research community to://
•
Increase interdisciplinary social and behavioral research on the
determinants and consequences of changes in fertility, mortality, age structure, family
formation, migration, and distribution
•
Give priority to research on the relationships between population growth
and environmentally sustainable development, interactions between women's status
and population change, the environmental and social consequences of urbanization,
and the causes and consequences of international migration.
•
Give particular attention to research on individual attitudes and behavior
in population-related areas, including social science research on human sexuality, and
reproductive and sexual behavior in different cultural settings.
D.
Policy and Program Research
//The United States endorses Recommendations 33 and 34 of the Expert Group
meeting on Family Planning, Health, and Family Well-being which state://
Governments, non-governmental organizations and donors are urged to support ongoing applied
research efforts in family planning. Special emphasis should be given to evolve definition,
standards and indicators of quality of service in the description, monitoring and evaluation of
family planning programmes, [and more research on quality of care and cost
effectiveness of different service delivery approaches].
25
/
bi view of the importance attached to the role offamily planning programmes in enabling
individuals to achieve their reproductive goals, Governments and donors should support research
efforts to develop indicators of programme performance to capture this crucial dimension.
//The U. S. Delegation suggests that the document://
•
Recognize the urgent need to increase investment in research essential to
design and monitor programs and policies, to assess program costs, to improve quality,
and to ensure access to services.
•
Urge governments to assure that the program and policy research agenda
responds to the needs of women, marginalized, and under-served people and is
respectful of their rights.
CHAPTER XU: NATIONAL ACTION
Decisions taken and implemented at the national level are recognized as the most significant in
terms both of quality of life and impact on global population levels. Measures to recognize the
imperative of the full integration of population-related policies into national socio-economic
development strategies should be addressed.
//The U.S. Delegation suggests that the document encourage governments to://
•
Commit adequate human and financial resources to national economic
development programs and social programs that emphasize education for all citizens
and to national reproductive health, population, and maternal and child health
programs.
•
Establish national indicators for improvements in individual livelihoods
and well-being, population stabilization, environmental stability, and economic
progress.
•
Develop national policies and local initiatives which include the full
integration of population, consumption-related issues, environmental change, health,
and gender considerations into socioeconomic development strategies.
•
Review legal and regulatory barriers impeding progress toward gender
equity and a broad range of related issues, including access to reproductive health and
family planning information and services.
•
Review tax and importation policies, advertising and promotion
restrictions, patent and trademark laws, pricing policies, and restrictions on fees
charged by non-profit organizations that inhibit provision of family planning and
reproductive health services.
26
I
I
7
u
I
CHAPTER XIH: INTERNATIONAL COOPERATION
The existing spectrum of intergoverntpental cooperation relating to population issues requires
recommendations for its further development. Attention should be given to cooperation between
the developing countries as well as to assistance by the developed countries to their developing
country partners. It is proposed that this section also address the interrelationship between
assistance directed to population-related activities and international cooperation connected to the
broader areas of socio-economic development and sustainability..
//The United States endorses Recommendation 29 of the Expert Group on
Family Planning, Health, and Family Well-being which states://
Governments of developed and developing countries and intergovernmental organizations are
thus urged to increase significantly their proportions of development assistance for family
planning to meet resource requirements. In so doing, it should be noted that costs of
programmes and sources offinancing will vary by such factors as social and economic setting,
programme maturity, programme coverage and delivery modes including the extent of
involvement of the private and non-governmental sectors.
//The U.S. Delegation suggests that the document://
•
Emphasize that global population stabilization, environmental stability,
and economic justice together form the basis for environmentally sustainable
development.
•
Support intergovernmental cooperation as essential to the achievement of
long-term planetary security.
•
Urge donors and policy-makers to make the major resource commitment
necessary from both the public and private sectors to achieve population stabilization
and reproductive health and rights.
CHAPTER XIV: PARTNERSHIPS WITH NON-GOVERNMENTAL SECTORS
There is growing acceptance in many countries of the positive contribution which non
governmental groups can make to the development and implementation of population-related
activities. It is proposed that the contribution of community groups, non-governmental
organizations, the private sector and other relevant participants be acknowledged.
//The United States endorses Recommendations 21 and 22 of the Expert Group
on Family Planning, Health, and Family Well-being which state://
Governments and international organizations are urged to increase
their support to non-governmental organizations working in family planning, particularly in
two ways. First, by facilitating the development of access to family planning services. Second,
27
i
?
by supporting these organizations to address in innovative ways such important issues as
reproductive health of adolescents, womens empowerment, community participation, broader
reproductive health services, quality of care and outreach to marginalized groups. Once shown
to be effective and acceptable, new approaches can then be integrated into wider national family
planning programmes.
^on-govemmental organizations are encouraged to coordinate their activities at national and
international levels and to continue to emphasize their areas of comparative advantage, including
voicing to policy makers the concerns and needs of women and local communities regarding
sexual and reproductive health.
//The U.S. Delegation suggests that the document include the following
goals://
•
Recognize the positive contributions of non-governmental groups,
especially women's groups, community groups, and other members of the private
sector, as a major national and international resource, and encourage them to fully
participate in the conceptualization, innovation, implementation, and evaluation of
population and development programs and policies.
•
Strengthen linkages between public and private institutions in the
provision of reproductive health and family planning services at the community level.
•
Assure adequate financial and technical resources for the participation of
non-governmental organizations in programs and policies.
•
Encourage NGOs to work with intergovernmental agencies to assure a
broad base of supporting services such as female education, primary health care, credit
and income generation, and women's health services to under-served communities.
•
Ensure that in all national, regional, and international follow-up
mechanisms agreed-upon as a result of the International Conference on Population and
Development that non-governmental organizations are included as partners, and
participation in such bodies should be representative of those concerned.
•
Strengthen NGO capacity through training and allocation of resources to
expand their outreach and play a greater role in the partnership with government
//The U.S. Delegation suggests that the document should encourage
governments to://
•
Incorporate NGOs into the planning, implementation, and evaluation of
population, family planning, and women’s reproductive health programs at the
national, regional, and local levels.
28
Determine, with NGOs, the highest quality-of-care standards and agree to
‘mprove criteria in both the public and private sectors.
//The U.S. Delegation suggests that the document encourage NGOs to://
•
Mobilize and educate communities about existing services, and encourage
the utilization of government-provided services in promoting women's and children's
health, such as immunization, family planning, and women’s reproductive health care,
including safe delivery.
•
Contribute to the national debate on population policies and take a
leading role in representing the interests of minorities and women.
•
Network with regional and international NGOs to broaden their
experience base in replicating innovative approaches to advocacy and action in the
population health and development sectors.
•
Disseminate program approaches and results so that successes may be
incorporated into government programs.
29
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THE CAIRO CONFERENCE.
I - What happened in New York
The nnsl ^sion ot tne Preparatory Committee for the Cairo Lnterriadonal ’
t
Conference on Pop-uiation and Development concluded in New York late on Friday
The New York .T.eenng had before it an S2 page document, with 16 different
chapters, covennga very' oread senes nf topics on population policy in general. < inly
■ pages were dedicaied to the theme of development.
On muv.. of whai was presented Uierc was ^ciicrdl
or dt least
enough agnxmtnc to am-,c ac formulations around which atnerai cuneus could be
amved- Tlicre 'Ams however no dgraeuicii era a mimbei’ of essential areas, some of
which of very special concern to the Church, and indrrd, to persons of ail religions
and none.
s
Before moving on to deal in some detail with those areas, it might be helpful
to draw attention to some aspects of the draft programme of the Cotiferer.es which
have m... received as much aasndon as they deserve.
me rlrat is money. The United Nations draft document cads for flramatic
increases m the amount of international development funding which should be earmarKcr. tor population acavirics. It asked that population directed funds should be
h...-rased from 1.4% of all dcveiupjnsnt funds to at least 4%. that is an increase frum
USS 5 biiliua to at least USS 13 biUion by the year 2000. Much of this money would
come from merrased donations, especially from the United States of America and
- apan. out a great acai wouid have to come from'cutting back spending on other areas
at aevelopm.ent, ir. -.he areas of education, health care, industrial caveiopment and
disaster relief.
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In ^ooiuon .c suer, an unprecedented increase in the funds
might become
available, the resu;:: of the Preparatory Committee constitute a real change in the
—
basic philosophy which will inspire such a missive intervention.
ion yeirs i^o, it the Mexico City Population Conference, die doomsday
nmnhwties of uncontrolled populate, growth and the threat that it proposes to the
eanh s resnurerts are :ts county were dominant themes. The answers were indicated
*n SOYeminent-centre^ pm^rammes of population edux-ation, and Ln reaching certain
larges and goals for the provision of family planning services. The Holy See was
almost alone In stressing the tact thai the decisions tn he mane concerning the number
uid spacing of births belong to married couples, responsibly ^ermsir.g rheJr vocation,
— and twi'in the first place to governments.
Now ten years Later, the paoriues of population policies have changed. At
New York there was hardly any mention of die doomsday vulvas and even some
criticism or the former .ovcrnmcavccntred policies, considered as coei’clvc and
demeaning to women, just as the Holy Sec had been saying for some time.
That does no: unfortunately mean that the preparation for the Cairo Conference
has come around to positions closer to those of he Holy Sec: far from it. The New
York meeting m?d?. it abundantly clear that the Cairo Conference will , be a
Cnm>.rp.nc« about life-styles, rather than about numbers or abour development as
more traditionally unriexsrrYYi.
It will
a. Conference on Ilfe*sr. it .tuarting nut. from a very specific vision.
At the Cpnukmon uf the New York meeting, for example, the Secretary General of
-re Conrcrerrec sale mat die work was a »1cujiy fur ijidlYiduab •and for the right of
individuals tn make cr.ciccs. It would be wrong to think that the word individual Ui
this cose was just synonym for the person or for man or the human being.^What is
at stake ts - philosophical vision, linked especially to views of some Northern
r.uropean counrrres md the United Scius, based on an exaggerated individualism,
Wttich co'nurs every i<;per.t of the text and leaves the. way open to broadly libertarian
*
•
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interpreuLsca or its proposes. \
_J
In tiic discussions on (lie theme of the fauiilv. for insuumc, many delegations
wished not to rerer to the family as the fundamental mut of society, as the Universal
Dcdaraiian of Human Rights docs. One delegate said that his socic^ is now marked
by an ntnmiymian and an individuolisnu, the result of which was that his society could
no longer identify itself with the Universal Declaration. The questica is, what right
----
has any International Conference to export such visions and impose them on soc:etias
where the family and the community are greatly respected and in fact constitute the
guarantee of stability and cohesion for society?
Cine, of the. new concepts proposes tor approval by the Cairo Conference, is
that cnilen reprndnc.tive. health, with the consequent reproductive, rights. These
terms are so new that there is no satisfactory translation for them. Tney crutld of
course be considered in a positive way, If they were orier.taied to helping women to
4
exercise their vocation to maternity in optimal health conditions, providing education,
primary health care, emergency services and posi-narai care tier mo (her and child. But
—
they arc interpreted in fact in an
Aa u -*1. they refer lu prerugatives
of individuals without any reference tc/marriagc. \
Abortion is included as one of the essential parts of the definition of
reproductive health. The 12nn repiooucdve rights is interpreted by many tn terms or
a radical rtpro-choice*’ position, in which the woman would be assigned the exclusive
right to maxe the decision to-terminate her pxegnar..
The consequences of such new concepts are of especial interest m the Church
in Africa, -where (he Church is In fact a major - in some cases the only - supplier of
the health cacc services, especially at gruss rwh level and diuuug die poor. The
Delegation of the Holy See made it very clear that it would block any suggestion
which would moke more difficult or compromise this work of the Church by the
'.nciusion in any national health care agendas of measures which the Church-based
services cannot endorse.
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(Jn rhe specific ’’nefr.e nf jborJoQ, (he Conference
divides '.mo dircc
groupings:
• Cae. found in the Secretariat text, ^trased. the sciiuus problem of the Ganger
to women’s iicaltli caused by the cornolicadons of abortions, but ±cn asked
^ovcoiLiieais to leexaminc legislation on abortion, and to move towards the atnrmation
of an exclusive right of women to make decisions about their pregnancies. In practice,
aboroon on demand.
- A ices radical solution stressed simply that in the circumstances where
abortion is legal, it should be medically safe.
- The Holy Sec and others stressed that ill efforts should be made to assist
u/omen to avoid ibordon, but that the Legalization of abortion does not resolve the
problems.
In any caieT all the references concerning abortion in the documents have
remained ’in brackets’. 'ITiis is a procedural mrfhod tn show that the preparatory
meeting enuid come to no agreement and ±c question will be rcdlscussed n Cairo.
Some reports affirm that mis conmmmd “a defeat of the Holy SeeM. Such repuxb do
not take into account that it was the clear iuicuiiuii of ^uuic delegations to have
^Ixj rd tn serial rd lexis aopiovcd already in New York, aionwidc the other approved
texts. Acd this did not occur 1
On a number of occasions, those who propose that abortion be included as a
generalized component of population policy, stressed that abortion is already legalized
in some way in most ataur and that therefore the International Community should
recognize this as a reality. Such afnrmauons are based on a superficial interpretation
of statistics and take no account nr the tact mat even in enuntres where abortion is
legalized, there is no national consensus of the citizens on the question, and very
often the majenty of citizens does not want to see abortion as a family planting
means and much icth
cu> pari uf •dcveluoinciu aid pro^i*ajnines.
A mo tv .lienLive examination 'o me statistics; cviacr.ee ovaiiabld would
.r.ciaer.ca of miLcmai 'loath ■oar. ae ccrreiaiec. "O'. •.a the
indicate '.bat a
,
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presentee. Being ag=;n:t such '.;fcs:yics was equates with being against jiOxi cis. 3uc
such a form of progress is not shared ey so many people in every pan o: the world
and of all beliefs.
What ii rxippaning in tie preparations for the Cairo meeting is something
which concerns the future of humanity. It concerns institutions such as marriage and
the. family which have, been recogruxed as central to society since Its very origins.
What is involved is the sacred character nf human Life and the enormous responsibility
and dignity assigned to parents xs stewards nf its transmission. Lt involves the future
Scability of our socisties and of the very values which so many families throughout
the world are struggling to Transmit and defend.
I was greatly stniuk by Uic fact that al the New York meeting dealing with
family and women’s issues, with the questions of the uansinissiun of life, the
rcsponsibiliuea of adolescents, there was much talk of gender equity and equality, of
<
reproductive rights, ar.d of individual choices, but two words were completely absent.
One was marriage, an institution which seems sadly have beer, put aside as irrelevant
or emarginated. The other was love: love Is the most central concept, co be
rediscovered, to be protected xnd fostered, if the family is to carry out its mission,
as 2 true comnun;:y of life and ’ove. A closed, exaggerated individualism, on the
other hand, can only extinguish love.
fa overcome this onesidenness, ;( is important that \e viewpoint of the. vast
majority of the population of Africa, as wdl as nf other continents, .ne made. more,
evident. The Church has a special interest, as I have said, in seeing that ..s enormous
contribution in the health care and educational sectors not be compjutilised. But it has
a deeper concern: a concern for the defence of humanity, for the authentic values of
the various cultures and for ’tic entire Christian heritage.
Cor.crstfity, tnc Church should work or. four fronts:
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availability ar not of legalized aconiuii, uul to the complex or factors me. jded tn me
;3
Human Development incex. which concern me overall level of health, aducctionax and
development Ldciori in i country. The problem of women’s health will be best
resolved through uivcstmcat in. improving health services tor women, not by the
further promotion of ibordon.
Starisdcs presented to the Committee showed that it is also naive tn suggest
that the number of abordons will be reduced simply by making a wide range 01 family
planning services available. The stadstics tor-the ’Jnueo States for example indicate
that it has a very’ high rate of what is called ’'contraceptive prevalence" and at ’Jk.
same rims one of the highest abortion rate, in the world.
Finally, the individualistic philosophy of the Conference is noticeable i the
attemprs rn extend the availabiliiy of all repiuductivc Iiealth care and ramify planning
services to adolescents and to children, and to assure absolute confidentiality tor
young people, on the basis that “sexuai-activity* is not . mpLy a fact but almost a
personal or individual light for ah young people.
The Holy See, fought hard to reciftnr. and guarantee the rights and
rcsponsibilitiw of parentu, as recognised already ir. international documents. V» i reas
it '*'as not possible to arrive .al finalized terminology of this question, the pressure
from African and ’.siarr.ic countries is so strong that a favourable solution 4/ill
hopefully be found.
U
vhat can he. done?
Only a few monttis remain before die Cairo Conference begins, the first of the
major popuiaiion conferences io be held in Africa. What car. be done in these months
id lead?
One of the dominating .repressions that 1 had during the New York meeting
as that on?/ one side of ’he picture was emerging. only one life style was being
15:50
*
05/20/94
15/,p2/94
15:13 : ^Z0^12^o9J. 4903
QPR-29-r99'1
Xi,:30
_® 008/008
— ^NFPA N Y-
U.S. GMEGSSY UOT1CPN
39 G G3e21S9
o.ll
3
7
In me firs: pUcz, ::s sgr.ncms snauiri he mnrr. famiiiAr with '-’har :s heing
elaborated. naiionaJly as regards nopuiarion aad health policies, also ih.nugn actively
intervening writ: the appropriate atuhoriucs of their countries io guarantee that such
procedures arc not left exclusively to interested groups. Sumcduici tlx behest
authorities arc unaware of what is being done in their name or in the name of their
nation.
In the second place, there should be greater dialogue with the leaders of other
Christian communities as well as with the leaders of other groat religions, who
certainly share our concerns especially with regard to the future hfe-stylcs -T the
vounger generanons.
The Church has a leadership role and a responrihihry to enlighten society, iQ
draw anenrion through an the means at aur disposal tn what is at .stake in these issues,
so that politicians and aiher leaders are ooi tempted to overlook the deeper questions
concerning the f. turc of humanity, which are at stake in the period of preparation for
tlie Cairo conference.
Finally, die Church must use these coming months to develop a more intense
effor of prayxr and witness, especially of married couples and families themselves.
Perhaps the intemarional community surrenders too easily to compromise positions
because it has lost heart and confidence. The Church, with the strengths that ore its
own, must be in the forefront in renewing confidence in the family and in showing
(hat, with the. help of the Almighty, families in all pans of the wortd are willing and
idle io face the challenges that sre. posed to them.
Magr. Diarmuid Martin
28 April L994
^otcc
. ii
MH i-6
«■■
€
CCI FAX
436-3859-008-475
! 3
J-r o m: UNITED NATION POPULATION FUNDS
To :
FAX 011-91-114627612
FAX
\PR
UNFPA Representatives
UNFPA Country Directors
FROM :
Stirling D. Scruggs,
Chief, Information and E x r. e. r n a 1
19 94
RE:
Abortion .
ICPD and
PAGE
1
OF
ACTIO.N COPY
1
TO :
1 3 Apri1
22 03 GMT
Tlx. 7607883
IN TWO PARTS
PART
DATE :
19 9m
1 4 APR 1994
Re]a t i o
s Division
f\
jo.•>»-.
N
the V a r. i c a n
A
You may have seen some o f the recent coverage in the media
of
the above-me ci. oned i s s u e s
You ma v b e asked to comment.
- . Sad ik had
private audience with Pope John Paul TI at
Vatican on 18 March, Her purpose was to discuss areas of common
concern, particularly in preparation for the International
Conference on Population and Development.
,A
1
the
Dr. Sadik reports that their meeting was cordial. She discussed with the
Pope ijhe situation of women, particularly poor women, and explained that the
Conference draft Programme of Action is based on i
respect for human rights,
including the human right to family planning (adopted
1 at the 1974 World
Population Conference in Bucharest and further
strengthened.at _the, 1984
Conference in Mexico City), His Holiness said the Church- could only support
"natural" family planning.
They agreed that population issues are o f major importance in today's
world, and that "human-centred" development i s
essential. •They concurred on
the need for responsible parenthood and birth
spacing. As you,know, all of
these points are noted in the draft Programme of Action.
(
Since the meeting on 18 March and (1 ui mg t lie
early stages of PrepCom
III, the Vatican has spoken out forcefully against
family planning,
reproductive rights and health, and abortion.
In order_4ox. yoiL._LQ_±iilT.y.-un4^w up ' ■ '
cur ren t situation and UNFPA' s
position, I have attached several documents:
- UNFPA's Perspective on Abortion
- Abortion Facts
- Abortion and the draft ICPD Programme of A c t i o n
WHO s Definition of Reproductive Health
- Abstract of "Reproductive H-vilth: A Global P(: r s pee t i v e
- Dr
Sadik s3 press statement on the f i r s t d a v of P r e p«"o ir ; ’ I
Please study these d o c u m it: .
a n d the cuirent wording of the 11 a 1 L
vo u
in c
Progi?mme o i
: v r e pre j e n t
A <. l i o n
■> u r
We will be pouching a set of :> i t c- f i n g notes
within the nv :. t
that wil 1 include several populac i o n a n d
U N F P A - r e 1 a c e d subject..
UNFPA ' S
i
I
I
I
I
position
t e u we e k s
PERSPECTIVE ON ARC TION
UNFPA d^es not provide
'■» i
for abortions 'M
j bor t ior. :elated
activities ar. ywnere in the world
'■is is i n accordance with
he
recommendation of che 1984
1 984 International Conferenc e on Popularion
held
\
M
r
t
FAX 436 - 3859-008—4 7 5
APR 1994
_ com;; UNITED NATION POPULATION
FUNDS
To :
FAX
in-ZF5T7612
22 03 GMT
Tlx
7607883
PAGE 2 OF 4
Mexico City, which was “affirmed by
the UNFPA Gwcming
Governing council
Council in 1985
Council's decision states that it
the policy Of the
not to The
-- i Fund
Fund .
provide assistance fd? abortion
abort.on
services
or
abortion-re
la ted
equipment and supplies as a method
0* family planning".
The provision of maternal
and child health and v - '
services and information- is
voluntary family plannin
u n q u e s r. j o n a b 1 y the most effective rneans Qf
&
preventing abortions. The
greater part of UNFPA 's as si s tance
projects in these areals . UNFPA s goal is
goes towards
to eliminate the need for abortions.
Although most abortions are
preventable by Che p--- ■
family plan* mg services
provision of quality
women will
Ill continue to seek abortion
cases of con-t r a c e p t i v e fail
services in
ure or human error.
a social reality, in j15
— 8 -7 ,
Abortion is, and wi11 remain,
an estimated 36 million to
were performed world-wide' Between 26
53 million abortions
million and 31 million of
1e g a 1 , and 10 mill j. on to 22 mi lli on
these were
c 1 a n de stine.
Abortion is a major health issue. The WHO has
o* rhe
the 500,000 maternal deaths that occur
developing countries, of these, 25 to
33 per cent
of unsafe abortions, Abortion should
be safe, and result from complications
not result in the death.;’ of women,
the lack of services should
■ a c a ?. e r: o f
unsafe abortions!, women
should have access to services for
t h e mana genie n r. o f
compli cation s.
It is important for all
countries to address the issues
major health risk to women and
to document its incidence and of abortion as a
causes.
STATEMENTS BY THE UNFPA EXECUTIVE
DIRECTOR:
"Ti^re
very large measure
countries.
developing
-2 is
place every year. All of
that take
prevented rather than i
to have
interrupted their pregnancies. Thi*
to adolescents, for whom
applies
especially
pregnancy carries special risks.
York, ICPD PrepCorn II)
(14 May 1993, Neu
Prevention of unwanted j—
pregnancies must always be given
priority and all attempts should
--J
be made to eliminate the ‘need the highest
(A April 1394, New York,
for abortion . "
ICPD PrepCorn III)
i,
abortion facts
In most developed countries,
about half of the abort!
young, unmarried r--women with no children, while in Eastern ons are obtained by .
developing countries
Europe and the
- -s abor t ion is much more .prevalent
two or more children.
among married women with
The United Nations FPopulation Division,
grounds on which abortionn is permitted:
1 . To save the life of the
woman;
2 .
pi-cocvo phjol^ol Lc
1 th,
3 . to preserve mental health;
4 . rape or incest;
5 . foetal impairment;
6 . economical or social
reasons. a n ci
7 . on request.
recognizes s e v e n
In 17s of the 190
the life of the woman, countries i/i the WO r 1 d i abortion is permitted to save
In 119 c o u n c r i e r; i t
health; to preserve rmental
■
health, a b o r t i o n i- s permitted to prest.• t ve physical
A b o r t i o n i r* permi r. tedd . n c a s e o f
is permitted in 95 countries.
rape and incest in 8 1
countri-.
and in
\
rtfCI FAX
436-.j59-OO8-475
13
From: UNITED NATION POPULATION FUNDS
To:
FAX 011-91-114627612
. j94
22:03 GMT
Tlx: 7607883
PAGE 3GFZ,
of foetal impairment in 7
countries . Abor r. i on is available
for economic o f
social reasons in 56 countries and abortion i s
available on request in 41
countries.
.-J
Interpietations of laws are often as important as
the statutes
themselves in determining the availability of abortions,
In many countries
where women can in principle get an abortion on
on demand
they find it
difficult to exercise this legal right for a variety of
reasons, including
stricter than—usual medical requirements, 1 ack of public
funds for services,
lack of information or referral networks, lack of
trained providers, extreme
centralization of services, and local opposition
or reluctance to enforce
nat ional 1aws.
It is a myth that abortions are
a r e most common where they are most easily
available. On the contrary, more women
w o m e n resort to
b o r t i o n where the
availability and quality of family planning services and sex
and sex education are
poor. The Netherlands, with Europe s most liberal abortion law,
has an
abortion rate of five for
for every
every 1,000 women, compared to the Western European
average of 14. In Latin America, where abortion is almost
completely illega’
the rate is between 30 to 60 per 1,000 women. Restrictive abortion
-------- i laws
do not prevent, abortion but force women to seek back-street techniques
.at
account for a significant proportion of all ma t e r n a 1 d e a t h s.
i
In 1987; an es t i rna ted 3 6 mi 11 ion
to 53 million abortions were performed
world-wide. Between 26 million and 3 1
million of these were legal, and 10
million to 22 million clandestine, A > i
e.-.timated 400 — 500 women die every day
due to the consequences of unsafe aborti
ons. It is very difficult to find
specific data on abortion and abortion complication
s . As far as illegal
abortion is concerned, data comes from
secondary sources, such as hospitals
and clinics Treating women for the complications of
unsafe abortions.
ABORTION AND TCPD DRAFT PROGRAMME ‘OF ACTION
Unsafe abortion is a leading cause of
maternal deaths world-wide. There
jis a growing recognition among Governments
that this reality needs to be
dealt with "openly and forthrightly . . as
a major public health concern", in
the words of the ICPD drift Programme of Action.
The draft Programme -- based largely on the views articulated by
Governments at the second session of the ICPD Preparatory Committee, regional
and subregional population conferences and
the forty-eighth UN General
Assembly -- stresses the health con.
uences of unsafe abortion, and urges
that the issue be addressed on th.
isis. It states, "Mortality resulting
from complications of poorly perfor’iv- I abortions accounts for a significant
proportion
(as much as half in some countries) of the estimated 500,000
annual maternal deaths, "particularly in countries where abortions are unsafe
and illegal
Objective 8.16 of the draft Programme is
' to achieve a rapid and
substantial reduction of maternal m o r h i d i t
and mortality" and "to eliminate
all deaths from unsafe abortions .
To meet this goal, countries are called on
to take measures necessary t o ' e 1 i m i n a t e all. unuanced
births and u n s a r
abortion"
In action paragraph 8.21,
Gov elnments are urged to assess the h e a 11 h
impact of • i n s a f e abort, i o n
to reduct: tr. he
J i e need
n e e d f o r abortion through expand e i
and improved family planning s e r v i c - . aand
n d ttoo frame abortion laws and policies
on the basis of a commitment to women s health and
well-being rat he r t h a n
criminal codes and pur.it v e me a ur
i
i/-r^z=Er
,1 FAX 436-4353-009-996
14 APR 1 9 94
?rom: UNITED NATION POPULATION FUNDS
To:
FAX 011-91-114627612
0:03 GMT
Tlx: 76078U3
1 OF A
FAX IN TWO PARTS
.3
PART 2
TO :
UNFPA Representatives
UNFPA Country Directors
FROM:
DATE :
Stirling D. Scruggs
Chief, Information and External Relations
Division
13 April 1994
RE :
Abortion,
ICPD and the Vatican
WHO'S DEFINITION OF REPRODUCTIVE
HEALTH x
<
(
The expression "reproductive health"
appears to have been
formally used for the first time in 1988
in resolution WHA 41.9.
In view of the foregoing and ta k ing
into account note 89/14
dated 15 December 1989
1989 and
and entitled "Reproductive Health,
Reproductive Technology", from WHO's
Technical Terminology Service,
WHOTERM, reproductive health can be defined
as follows.
REPRODUCTIVE HEALTH iiss a state ofc■’
physical, mental and
social well-being, and not merely complete
the abs en c e of disease or
in1 rmity, in all matter relating to the
reproductive system and to
i\t~ function and processes
5
Reproductive heath r
’
therefore
impli ss that people are able
to
have a satisfying and safe
-2 sex life and that they have the
capability to reproduce and the freedom
to decide if, when and how
often to do so. Implicit in this
this last condition are the right of
men and women to have access to
safe
to
effective,
affordable and
.cceptabie methods of fertility regulation
r
-.1
of
their
choice, and the
iont of access to health car- serviced that will
provide
them with
the best chance of realizing nei
t'„
ha v o a h o. a 1 r. h y c h i 1 d .
REPRODUCTIVE HEALTH-CARE0-!s .defines Of reproductive health
the constellation of
methods, techniques and services that
contribute
to reproductive
health and well-being through prevent)
: solving reproductive
health problems.
■«*
* Quoted from Reproductive Health Activities
requested by Sixth Meeting of the
lV1Cie“ in WHO. A report
Policy
and Coordination
committee, WHO/UNDP/UNFPA/World Bank
Special
Programme on
Juneai993 DeVelopment and Research Twining
in Human Reproduction.
Abs trac t :
REPRODUCTIVE HEALTH: A GLOBAL PERSPECTIVE
By M.F. Fathalia
Director, S p e c i a 1 Programme of Re;;ea:-.h,
Training, World Health 0 r g a n i z a c i o n . Development and Research
Geneva, Switzerland
....
FA£
436-4353-009-996
14 APR I 9‘J 4
POPULATION FUNDS
FAX 011-91-114627612
ohh—UillTEDr NATION
To:
0:03 GMT
Tlx: 7607883
31
Reproductive health implies C
that people have the ability to
reproduce, to regulate their fertility’ and to practise and enjoy
sexual relationships. It further implies that reproduction is
carried to a successful outcome through infant
infant and
and child
child survival,
growth and healthy development. It finally implies that
women can
go safely through pregnancy and childbirth, that fertility
regulation can bo achiovad without health hazard?, and that paoplq
are safe m having sex.
Globa] indicators or reproductive health pose major challenges
to the health and scientific community:
There are between 60 million and BO million infertile
couple s
world-wide.
The world has witnessed a major expansion in contraceptive use
in the past few decades. United Nations estimates of
prevalence of contraceptive use among currently married women
of reproductive age are 51 per cent for the world as a whole,
46 per cent for less developed regionss and
and 70
70 per cent for
more developed regions. Between 40 million
mil 1ion and
and 60 mill ion
induced abortions take place in the world each year. Of these,
25 to 40 per cent are performed illegally.
Female circumcision i s still practised
-H-J
in around 40 countries.
It is estimated that about 9.8 million
infants and about 5
million children aged 1 to 4, a total of about 15 million,
died annually in the world during the period
1985-1990.
many parts of the world,
levels as low as 2
other part of the world, rates up tc 1,100 per 100,000 live
births are still encountered,
encountered. WHO global estimates indicate
that about half a million women die each year due to
complications related to pregnancy and childbirth. All' but
about 6,000 of these deaths take place in developing
countries.
H 6
Communicable diseases that are transmitted predominantly by
sexual contact (STDs) are now the most common group of
notifiable diseases in most countries. Although reliable data
on worId-wide incidence of STDs are not available, WHO minimal
estimates for yearly incidence are 80 million for bacterial
STDs, 50 million for viral STDs (other than HIV) and 120
million for trichomoniasis. Most bacterial and viral STDs can
rb!°.
transmitted from mothei to foetus, thereby aggravating
their impact on reproductive health
6
§
During the 1980s, women constituted about 25 per cent of AIDS
cases, the percentage will approach
per cent in the 1 9 90.s.
According to WHO forecasts, in 1930 ana .99
.9911 alone, more women
will develop AIDS than during rhe whole of
o f the 1980s decade.
With a risk of perinatal transmission of 20 to 40 per cent,
the magnitude of the problem for children is
i s clear.
STATEMENT OF DR.
NAFIS SADIK SEGRETARY-GENERAL INTERNATIONAL
A
PAGE 2 OF 4
..
u^1-11462761Z
•
/ o t> d
CONFERENCE ON POPULATION
AND development
f RFt—F3 9 4AT A UN PRESS
conferencej
Ladies and Gentlemen,
thank you for
c o in i n g .
The ,, Third r
and final imeeting
-- of the rPreparatory Committe
the International
-1
Conference
will take place
e for
Population
(
over the next three weeks, and Development (ICPD)
culmination of an
exhaus tive three-yea r rroIhiS rneet:inK is the
conferences, nat iona1
Process of regional
tables on a variety of activities, expert group meetings, round
related subject''
by
Government: s
and NGOs throughout th? and a lot of hard work
world.
K
We meet ata
at a time when
driven by
human numbers and
and wasteful
unprecedented growth in
consumption,
resources upon which future
,llany of the basic
“•pi-." generations
“ill depend for their
when environmental
intensifying and when widesbread
inequality persists.
iaesPrea<i poverty and -I pollution is
social and economic
However, we also
meet during a time of
a
ut the importance
“idespread agreement
of
Population
the individual and on
and about the need tto focus on
and
individual choice a s
balancing P
peculation
r- ou 1 ation and
the keystone to
resource s . There
consensus that we
r: should inves
is now
now an
an jinternational
t in people.
and 1
them make
especially in-i women,
t
be
choices
about family size
with]'
' quality family
1
high
‘i-j by
Providing them
Planning
eliminate hundred
prog
r
animes.
Thi
-.is of thousands of
— s approach will
the same time
it will slow the ]— maternal deaths eacn
each year.
year.
At
making it difficult'
rapid population
Lt for many devel
growth
that
is
-loping countries
ttieir growing numbers
-_^s with food, shelter,
to
provide
and health.
employment,
education
The efforts of
al ready met with
in ternational
community have
developing countries,
nates in
occurring
a t i on growth is
have declined from
1960s to 3
.
n C° 4 today.
t:oday ■
Currently about 55 7 children in the
currently,
and individuals
in (4 '
countries use per cent of couples
planning, a nearly developing
five-fold
--1 increase since some method of fami 1y
(
the mid-1960s.
However, there is
stil
much to do .
is 5.7 billion,
World population
It win reach eith
billion by the ’—
er 7.27 billion or 7.92 today
year 2015, depending
two decades, Tha t '’ s a
on what we do over the next
difference of 660‘
equivalent to the
million people, nearly
current population
of Africa.
The Prepcom has
before it a draft
contains a set of 2QErogramme of Action
year goals.
that
These So a 1 s
mortality reduction and
are in the areas of
universal aval la bi 1i
to
ty of and
information and
at 1ea s t p
services,
What
"7-tion, especially for
optimistic
girls.
next 20
are tha
e„ss X Cman-e-aCCOr'1pll£hed over
the SUCC
successes\ha'are the
successes
the
expanding
ccess to ceproductiv..
ceproductivhealth
hea\ t h < ■
' 3 S haVe ™ade in
V
•.
rates, 1stinging family f’
wealth c7 a r e , lou’erinS death
Planning irformar
“ ^.format ion
on and services and
raising education and
income level
-i-, iincluding
n c 1 u d i n g among women.
Howeve r
u 1 1 range of
the frun
mode rn family p’
ctill remains
P'anning methods
unavailable t o a t least
3 5 0 mi ] n j
qp
couples .
a , •»•- :;.0n"rr0o£p‘"iiity
:-Trs='.
16
Ujh n.6.8 IL
ICED PREECOM III
Sonia
PROCESS AND RESULTS
Correa ( DAWN Research Coordinator on Population and
Reproductive Rights)
BACKGROUND
in New York April 4 Any evaluation of the PrepCom III, held
impasses. The
22,
cannot be restricted to its processes and
ICPD
of
the
last
political consequences
meaning
and
to
related
negotiation
round before Cairo are directly
held in
agreements reached at preparatory regional meetings,
the assessment should take into account
1992-1993.
Also,
informal debates or. specific themes and diplomatic activities
in the May 1993 — April 1994
by the Secretariat
carried out
this analysis should
include in several
Above all,
period.
aspects the concrete results of the mobilization efforts made
the national,
by the women's movement since PrepCom II, at
regional and international levels.
that in the
For example, it is fundamental to bear in mind
Conference held in Mexico,
a document
Apri 1
1993 Regional
the Latin American Consensus was approved. This text
known as
rights
terminology,
identifies
reproductive
adopts
the
health issue,
and recommends that
abortion as a public
governments should
inc rease funding for research and programs
health hazards associated
with
geared to
reducing
the
During PrepCom III, the Mexico Consensus
clandestine abortion.
the twelve Pacific countries,
was often
recalled; similarly,
referred most of their positions to the
which acted en bloc,
PortoVilla Declaration, an agreement reached at their regional
conferei ce.
by the
Among
the several informal consultations initiated
highlighted
.
table
on
Ethics
should
be
the
round
Secretariat,
sponsored by the
in early March in New York,
It was held
with the
International Law Department,
Co1umbia University
Jacqueline
them,
Dr.
presence of several
feminists, among
Pi tanguy.
The resulting publication was broadly circulated at
the past year, Dr.
Nafis
PrepCom III. At other
1evel, during
of
UNFPA
—
carried
out
Sadik — ICPD president and director
the regional
numerous diplomatic visits and participated in
meetings, in search of support for the Annotated Draft for the
world action plan to he discussed at PrepCom III.
effort 1 , the formal visit to
In Dr. Sadik s intense visiting effort
should be
the Vatican, three weeks prior to the PrepCom III
This dialogue
resulted in
immediate Vatican
highlighted.
reaction to the PrepCom III
document.
Ambassadors to the
Vatican were summoned to get acquainted with the critique of
the Catholic Church, presented in a document of over 50 pages,
The differences of opinion
between Dr.
Sadik and Pope John
Paul II
were covered
by the International
press, which m de
her March 7 -12 trip to Brazil quite significant. In Brazil in
addi t ion
to her
contacts with national
authorities,
she?
addressed
t he L a t i n Arne r i c an min i ste r s gat he red a t t he R i o
G r o u p m e e t i n g o n the ICPD.
several
Regardinghe women's
a.. veren t .there were also
women's
initiatives. For Latin America a regional conference was held
in Oaxtepec,
Mexico. National networks were established in
Nicaragua
Peru, Colombia,
several countries
(Brazil, Mexico,
(Brazil,
and Chile),
and specific events were carried out to influence
in most cases had a direct
national positions. Those actions,
and positive impact on the position of official delegates, A1
the international level, the intense mobilization of the 1993to open a dialogue among
above all
1994 period had sought,
to establish a
inside the movement, and
different positions
Among the numerous
for political consensus,
minimum basis
the conference on
meetings on this agenda,
internationa1
in Rio de Janeiro,
Reproductive Health and Justice, held
January 1994, was possibly the most significant given its
representativeness and quality of its final document.
THE F’REPCOM PROCESS
:
COMPOSITION AND RULES
together national
PrepCom meetings for UN conferences pull
voting
rights
at plenary
state delegations with speaking and
example,
the
status
varies.
For
sessions. However, delegation
with
only
the
Vatican has the status of a permanent observer,
at plenary sessions.
Presently only some
right to speak -at
as
Switzerland
and
the
PLO delegation are
observer countries
the
African National
Until
recently
in a similar situation.
with
the end of
However
«,
Congress had also this status.
it
is expected
process
,
Apartheid, and the democratization
at
the Cairo
rights
that South Africa,
will enjoy
full
when
the UN
not
approved
conference. The Vatican status was
of the
in
the
context
was founded.,
it dates from the 60's,
geopolitical tensions of a bipolar world.
Countries will intervene either individually or en bloc. Among
the
latter we find the "economic bloc " G “77, representing
130 developing countric
and the European Union, which speaks
issues.
through one spokesperson on all
issues.
Eastern European
countries, arc also increasingly acting in a concerted way.
differences,
Despite existing
intraregional
differences,
it is expected
fashion. The existence
that regions will act in a coordinated
fashion.
preven t
of
the
blocs,
however,
does not
prevent
individual
negotiations of an informal character.
religious
organizations and
A vast array of nongovernmental
only the UN
recently,
groups follows the debates. Until
accredited
ECOSOC
Social
Council
Economic
and
in the debates and had the
organisations could participate
at the occasions
right to intervene in the plenary sessions,
ECOSOC accreditation is
defined by the session president, Now,
reviewed; in practice any NGO accredited
being criticized and
to the preparatory meetings has access to the p1enaries.
is, undoubtedly
undoubtedly the growing NGO
Another important_ novelty is,
presence in the official delegations.
Un like PrepCom I I, when only the developed countries had NGOs
their delegations,
in April this was clearly seen am^ng
in
The Brazilian delegation, for
Southern delegations.
severs1
having also the
examp1e was headed by Ambassador Mauro Couto,
presence of First Secretary Ernesto Rubarth, but was also
accompanied by Dr.
Neide Patarra,
F'atarra, who participated in writing
of the National Report,
and by two representatives of the
Brazilian Association of Population Studies -- Dr. Elza Berquo
second week of
the PrepCom,
In the U-__ and Prof. Donald Sawyer■
(Pernambuco
state
Correia
Pedro
Federal
Deputy
the
social
Security
Committee
a member of
representative),
Also, the ABEFP - Brazilian
spent a day at the meeting.
Association of Family Planning Organizations - representative
Dr. Marcos Paulo, attended delegation works for some days.
9
In addition to Brazil, NGOs participated in the delegations of
Bang 1adesh and the
Argentina, Mexico, Peru, Bolivia,
Bangladesh
Chile,
Phi 1ippines.
composition most countries were
plenary sessions,
Regarding
Comparing with the May 1993
at
PrepCom
III.
represented
and
greater presence
the
was
remarkable
meeting,
it
m
and
economies
"
transi
tion
with
the
countries
visibility of
more
fdelegations were
In general
Islands;
the Paclf c
was
the
composition
In
terms
'
“
of
NGOs
and
vocal
.
substantial
of
a
clear
majority
as
in
PrepCom
II,
that
is,
the same
or
and
very
few
development
women's family planning NGOs,
environmental NGOs, especially form the South. Women's NGOs
and
were in larger numbers, had a very efficient intervention,
in
the
space
reserved
the
debate
assumed clear leadership of
for the NGOs.
texts
and approves
amends,
The committee basically reads,
are
plenary
sessions
presented by the Secretariat.The first
the
ones to allow for freer manifestation on the part of
to
feel
the
atmosphere
delegates. This is when it is possible
of the coming debates. Then, the plenary session is split into
the
At PreCom III,
groups to discuss the specific chapters.
Draft
were
read
sixteen chapters of the Annotated Action Plan
The third reading was done at the
at two working groups.
plenary in the last two days of the gathering (April 21 - 22).
there were informal
formal
sessions
Simultaneous with the
negotiations to “overcome impasses and arrive at a common
With
wording, where not always the NGOs presence is allowed.
reproduced
in
the
be
little variation,
this format will
the Cairo conference
preparation of other events and in
itself. Unlike the PrepCom
,
however, NGOs access to the
debates and negotiations will certainly be more restricted
during the official debates in Cairo.
Al though the right to vote is guaranteed the guiding principle
plenary sessions working group meetings and informal
at
for consensus." Any delegation can
sessions is the "search
observers„ as
including the permanent observers,
raise a disagreement,
there is no consensus on specific terms, or
the Vatican. When
in
even on paragraphs or whole chapters, they are enclosed
is
reached,
the so-called
brackets until
a new wording
compromise wording.
The English term
"brackets" was likely the most used word and
heard word during the last week of debates and negotiations at
the ICPD PrepCum III.
WHAT NGOs (WOMEN'S AND OTHERS) DO AT A FREPCOM MEETING..There is a lot to do at ~the such a meeting: get to know the
process of debate in the UN context, meet people and establish
promote
negotiate with funding agencies,
political linkages,
parallel activities, meet friends.
However,
if one intends to pi ioritize in the formal debate
process in such a way as to influence the conference results,
the following tasks should be absolute priorities :
the official documents to propose new
*
Read and criticize
wording. This critical review is repeated at every new reading
of the documents by the official delegations.
t
All sessions should be monitored in order to know the
position of each country and blocy-as well as their evolution
during the process.
*
It's necessary to establish a dialogue with official
delegations to explain our proposals and have them defended at
delegates
tan
the
sessions.
Actually,
only
official
consolidate positions in the final document.
*
NGO regional networking efforts are
greater political impact on delegations.
needed
to
assure
*
When the
debate development goes contrary
to NGOs'
perspectives,
it is possible and necessary to put forward
alternatives documents.
They can be circulated or presented
orally at sessions, provided the president authorises it.
these activities have been
In the
case of women NGOs'
coordinated, in an increasingly efficient way , by the Women's
Caucus under the responsibi1ity of WEDO — Women, Environment
and Development Organization.
FROM PREPCOM II TO PREPCOM III
: OLD IMPASSES AND NEW ISSUES
impasses were focused on four main issues. First as
PrepCom II
which
we know the forceful Vatican position against abortion,
marked the two weeks of negotiation. Despite that insistence,
Dr. Fred Sai, the committee's president, acknowledged in his
summary of the debates the existence of conflicting positions
Similarly the Annotated Action Plan Draft whose
on abortion,
in September 1993 and the second in
first draft circulated
January 1994,, has maintained a clear wording in relation to
this issue.
fundamental
reflected the
The
second
line
of tension
perspective and the so—ca11ed
difference between the feminist
pressures to
It was manifested in
population establishment.
The
family
planning.
broaden the conventional terminology of
that
the
greatest
April 1994 discussions clearly demonstrated
was to, have
impact of the women's movement on PrepCom
II
Planning
and
changed
the Chapter VII
t tie from
'Family
Reproductive
Reproductive Rights"
to " Reproduction Health ,
Rights and Family Planning."
Since last year contraceptive activities were subordinated —
programmatically —
to broader
health
conceptually jand
safeguard
by respect tQ.;.. fundamental rights. This
directives,
i
-- - of a political
agreement limits the risks that , il^^- context
deadlock, negotiation might be again^pniBhed back to the» narrow
In
and conventional demographic matrix Of family planners,
1993, feminists also managed to change the title of Chapter IV
from Status of Women to Gender Equity and Women Empowerment.
The other two areas of conflicts showed a clear split between
North and South, During the discussions on Chapter V — on the
, supported by the U.S.,
family — the Nordic countries
to indicate the
defended the use of the term "families"
and
changes
in
the contemporary
family
heterogeneity
fact that the Vatican kept silent on this issue
structure. The
was counterba 1anced by the G-77 position of support for the
H
original title — "The family and its role.
NGOs particularly the feminist ones had
limited
In May 1993,
and
its
national
delegations.
As
a
result
access to the G-77
of
the
instrumentalization
of
developing
the mere expression
However in the Annotated Draft,
countries by the Holy See .
solved
in
a skilful way.
Family in the
this conflict was
remained
in
the
title
but
the
chapter's
wording and
singular
the
plural
character
and
the
heterogeneity
content preserved
of the family forms.
in the
Another aspect of the North-South tension was clear
development
(Chapter
III),
rekindling
debate of sustainable
On the
other hand the
American
the EC0'92
conflicts,
ECO'92
relation
to
the
criticism
of
reservations
in
delegation had
supported
the
conventional
the Northern consumer patterns and
environmenta 1
degradation
to
that
correlates
analysis
hand
the
G-77
countries,
growth.
On
the
other
population
the
particularly China expressed their reservations against
is,
against
concept.
that
development"
conuept,
"sustainable
incorporatii >g the environmental cost of development advocating
the terminology of sustained economic growth.
Under those circumstances political resistancejto the Vatican
developed countries , whicrh—expressed
was concentrated in the
i.
towards
broader
themes for
the debate
on
reservations
NGOs
were
involved
development . Therefore
, Southern women's
in several
fronts of conflicts: the immediate battle against
they
the background
the "control1istas" and the Holy See; in
macroeconomic
on
had differences with developing countries
issues;
regarding the impasse on family andI sustainable
development, they were at odds with the G-77.
Those criss crossing controversies would be also present at
undoubtedly
the PrepCom
III.
In some
cases they were
addition
In
exacerbated, in others they were fairly diluted,
detai
led)
complete
and
the reading of the new document (
the
especially:
regarding
resulted in
new disagreements
and
governments
criteria
between
NGOs
relationship
and
the
structures needed to assure follow-up and monitoring of
allocation
to
, and the crucial aspect of resource
Action Flan
implement it.
»
PREPCOM III: A NEW GEOGRAPHY
Vatican :
the "amplified reaction "
the
in PrepCom II
Considering the several lines of tension
in
the
central
focus
conflict with the Vatican was certainly
plenary
first
In
its
1994
negotia ions,
the
April
refusedI the concept of
the ^Vatican flatly
intervention
reproductive rights claiming that it was a new justification
the North
. Instumentai ising
for popular control
.programs
_
delegation
—
inspired
by
South cleavage the
the document
that the
published
in Rome two weeks before — maintained
perspective of " reproductive rights"
supported by the women
the
was egotistical
and individualistic,
thus shirking
fundamental —debate on the inequalities of global development.
Following the same reasoning the delegation suggested that the
Draft Document lacked "minimum
basis," an affirmation
minimum ethical
that provoked immediate► and irritated reaction from Session
President Dr. Fred Sal.
In sum in this new stage of negotiations, the Holy See does
but calls into question
not limit itself to reject abortion,
the entire new conceptual and programmatic matrices with which
population debate. Since the
each one tries to transform the
by a small group of
beginning
this position was supported
countries that despite being a minority were extremely vocal.
They were the Vatican's shock troops: Honduras, Guatemala and
Ecuador,
for Central America;
Nicaragua which initially spoke
and
the
Malta,
Cameroon,
Benin
Venezuela
Argentina,
Venezuela,
the
Latin
Philippines at the start of the meeting. Regarding
Countries their positions were openly contrary to the Mexico
this pro-Vatican group
, however,
consensus. Over the weeks
Salvador and Panama started to
suffered some defections. El
its
and Venezuela ceased
different position
present a
intervention. Regarding the Phi lippines the arrival of the
pro-Vatican
the original
Manila delegation radically altered
stance.
At any rate this small group of delegations was able to
that might have
systematica11y enclose in brackets any word
reproductive
rights,,
rights
including
any relation to health and
adopted by
international
those previously
approved and
Includes in
conferences by the World health Organisation.
their
list are the following s sexual and reproductive health,
reproductive rights, fertility regulation, safe maternity, and
even family planning.The logic behind this obstruction is the
the
assertion,
that abortion might be implicit in any of
article,
terms.
Bella Abzug.
in her daily Earth Times
if
those
premises
were
maintained
ironically remarked that
"pregnancy" and "women " should also be inclosed in brackets.
brackets caused great
The enclosing of "family planning" in
fami 1y
and
among delegations
and irritation
annoyance
with
the
as such expression had been negotiated
planners,
Vatican since 1974. In this case, the obstruction results from
in the Cairo document is
the fact that "family planning"
r.
sexual and rwpnpductive health programs,
considered' part of as a whole
Vatican. Had the origina
prev.
fSiy’ Pining,
.1 th
-J
which are opposed
formulation
it might have been possible to preserve
Reproductive Rights
the former term to the detriment of the others.
As a result , the Draft Plan of Action to be approved in Cairo
VIII,
is pervaded by brackets, especially in
c Chapters VII and to the
Obstruction
which directly deal with these issues.
rights ?
to individual
"reproductive "
themes are extended
families."
In
adolescents' autonomy,
and of course? to the “ of systematic
the third reading of Chapter V as a consequence
again called into
obstruction,
the plural
wording was once
The
word "condom"
question, sending us back
to 1991-. impasse,
when the
minute
,
was also kept in. brackets until
the last
always a
there
was
Holy See admitted their removal, provided
provided
reference to abstinence.
The Southern Countries
The qualitative leap
be viewed as victory
Vatican'£ reaction at PrepCom III cannot
j under seige? because- <
? but as an expression of a pcrsition
it seems that
'92
and PrepCom II
' .
unlike the• situation at ECO
related
to
the
North and South i
the difference between
rapidly
are being
reproductive rights
controversy over
this
discourse is not
overcome. Therefore to the extent that
Nortnern
monopoly
?
space for
any longer perceived as a Northern
benefit
Vatican maneuvering? as mediator for global issues in
of its own agenda, is reduced.
context.
At the
------- , favour this new
Two distinct processes
emphasize
at
the
Cairo
77 has decided to
official level, 1the
-- G—
’’
j
nature, focusing on chapters dealing
with
debate its economic
resource
mechanisms?
and
development? funding and monitoring
internal
allocation. This makes it possible ■o avoid facing
is,
for
issues
—
there
differences regarding reproductive
positionsand
Argentina's
example, a huge gap between India's
stances.
delegations to assume individual
- freeing national
official
influence
on
At the level of society and of the
the consistent and
positions the shift results above all from
efficient*work of the women's movements.
negotiations ? numerous developing
During the three weeks of
This is not surprising
the Vatican.
countries challenged
<
India? China? Bangladesh and
coming from Asian nations? like
have no reason
Nepal? which implement demographic policiesand
,
this
is
not
necessarily .
However,
to submit to Catholic values,
African
countries
such as
true of the Pacific
Islands, or
In
the
same
context
the
Malawi?
Botswana,
and
Zimbabwe,
Botswana,
Islamic
governments,
as
Turkey
support from more 1ay-oriented
and Tunisia? was of fundamental importance.
in Latin America,
However, the more s ignificant shift occurred not even partially?
Peru, Brazil,
and Mexico did not go along? obstruction. On
the
with the Vatican's strategy of systematic
supporting
the
new
contrary,
there were positive and vocal in
continental
the
fundamentally
on
perspectives,
based
directly
those
positions were
we
know,
consensus.
,
and
above
all,
national debates,
influenced by the preparatory
feministsin
the
they were guaranteed by
t . the presence of
the
with
similar
situation
occurred
delegations.
A
delegations, it goes without say ig, have
Philippines. Those
been and still are pressured by the Holy See.
than mere resistance to the
This qualitatively means more
the Action Plan wording was
Vatican's obstruction, As a whole,
of "friendly delegations",
improved,
thanks to the support
bracket proposed by the shock
from North and South*- For each
In this manner the term
troops a new concept was introduced. reproductive healthi <-nd
previous
sexual
was added to the
physical
concepts
, as the right to
final
rights formulation. New
security was-> incorporated to the
integrity and personal
guarantees
the classical formulation that
document, enriching
individuals and couples to
(since Bucharest) the right of they wish to have.
decide on the number of children
The "silent control 1istas"
f-y
between
clear tension
was expressed
During the PrepCom 111
.there
tr'j
was^
both
in the
expressed
both
11 was
feminists and family p
-Hinn
and
and also
also in
in the
the many
wording and
battles over the document wording
also^
had
This
conflict
■ i the Women's Caucus,
The
pro-file
in April
1994.
when
presence
,
institutions had
they^po^^they'dlMo^in
politically^^^^^h^n9Ua9e' 11 was
in politically
women
with
the links
dfrectli^lnvolvZ^^n proClding^'family
services in
in providing
Southern counties. They
They fully col laborated with feminists,
the critique of
and most of them had thoroughly incorporated
global
inequalities.
structurally adjustment programs and of <
plained by three factors,
This new political cuii'-t.-.t
context can be ex and convergence between
Actually,
since 1993,
the dialogue
On the other hand
,
segments'of the two camps have d^ned.
( family
planners)
history .teaches us that "control 1istas
the conservative
never have faced
faced,,
openly and radically,
doing. In PrepCom III
forces as the women
women's movement has been
the debate ,
it was
to the extent that feminists
lead
them. Finally , we should take
impossible to merely disqualify
on these sectors of the open support
into account the impact
to
government (
and other donor countries)
given by the U.S.
t
perspective.
the broader feminists
f—i-it could
conflict did not vanish rnd
the hints
However _±,he
most varied circumstances. On April 1-' the New
be seen in-ttie
lysis of PrepCom
York Times,
published on its front page an anal, compared with
the feminist approach was
III.
In this article
Usinc
i of population control.
those of
the renowned. defenders
those people
accused
the
women
of
lack
people accused
objective arguments
, as they
consider
that
in
a
context
of
they consider
t
of
political realism,international
resources,it should not
be
increasingly scarce
broader health programs.
signed in Cairo commitments to
remained intact in some
The population control approach also
section, of the Draft
Dr.ft Plan
Pl.n of
o, Action.
For
, Structure. and Demographic
’^r.phlc tore..
Th.
VIII ,
were
-formulated
tn
strictly
aem
«
P
^formal
formulated in
actions
several
in
the
terminology
involved
Rra’ilian
termino
1ogy
the
change
the B •>
con.ult.tion.,, which
which h.d
participation of th.
1 Chapter
XI, ^a. totally
P.Lpation. The
Th. same ‘hhhhh-^.r^n
^"h
Communication
which
Education, and
Information, Education,
reformulated in the process of debate.
approach—WjElF: abQye_.all—, , evident in the
— The same conventional
Chapter XIII)- when
— . — — allocation (
sec tior» dealing with resource
the
future
Action Plan
,
estimating the budget to implement unmet contraceptive
•‘ » needs,
the Secretariat only included the
2010, and adding small amount
proj ecting the expenses to Year
account the area of
funding to take into
of additional
was called
into
This basis of estimate
reproductive> health.
countries,
and
GU.S., Nordic
question Iby, the European Union,
action
of
the
objectives
and
to
77, as it did not correspond
the plan under debate.
in the final
the section was entirely rewritten;
As a result
increased and allocation was also
version , total funding was
heal th
the favour of the sexual and reproductive
altered in
was not
the
proposed
budget
as the structure of
area. However,
in Cairo,
does not end
changed
,
the dispute
radically
from
the
strictly
,Actually
_____ ,
it
seems to
have shifted
funding
.
Therefore
ideological sphere to the hard dispute? over
the challenge for the women's movement is to utilize the Plan
,
guaranteeing
of Action as
as a
a guideline to set priorities
investments
at
regional
and
national
levels.
adequate
Perhaps the
Vatican can celebrate a temporary victory in
the Vatican
PrepCom
III.
The same cannot be said of
the population
III .
establishment that does not have any
longer
the dominant
influence on the process.
process. Under those circumstances, hardline
"controllistas" maybe
tempted to
resort to-insidious
maneuvers. For example
, they could strike a bargain with the
Holy See to exchange the feminists' reproductive rights for a
return to conventional
formulations, already internationa11y
accepted , as it is the case of family planning and
rights of
individuals and couples.
Given
these risks,
it is yery
important to carefully monitor the political movements of
the
population establishment in the next few months before Cairo.
Are we talking about development or not?
to prioritize the
The decision by several women's organisation
in the processes
reproductive health and rights
approach of
leading up to Cairo was widely criticized during 1993. Among
the most frequent one was that Southern
the criticisms
question
global
globa1 1 development
had
ceased
to
feminists
the
condi t ions, and in so doing they had become prisoners of
This criticism
logic
in
the population camp.
prevai1ing
the movement,
and
later it was
original 1y developed within
involved in
the
ICPD
supported by
some Southern NGOs
preparatory process. Recently as we mentioned earlier , it was
its traditional
skill at the
taken up by the Vatican, with
ICFD
divide-and-rule game. Considering the current stage of
debate
.
to resume the
, it ‘seems appropriate
preparations
process
PrepCom 111
the
reasons because
Among
other
in
many
aspects.
illuminates this debate
and
ref lection
the
in
,
Durin
the
1992-1994 period
movement
the women s
c it
by
mobilizations carried
the
debate
on
health and
countries
5
particularly in Southern
linked to the broader
reproductive rights has always been
equity
,
that is
life with
of
perspective
of goality
sustainable human development. This approach is quite clear in
the final document of the con_feren< e on Reproductive Health
and Justice
in the context of current development. Above all,
several
internationa1
networks directly
involved
in the
process have reiterated that the debate does not end in Cairo,
but should unfold
in the Social
Development Summit and in
Beij ing.
Similarly during the three weeks of PrepCom III negotiations ,
,
negotiated and
the Women's Caucus proposed amendments
sessions
related
to
the
macro debates,
carefully monitored all
was
of
"
progressive
”
wording
on
development
A good -deal
the
direct
influence
of
the
Caucus
or
through
introduced by
sustainable
term
the
case
of
as in
the
women's NGOs,
, the
Especially
development,
included in several chapters.
to
the
new
approach
Caucus work had a direct impact on the
relationship between NGOs and governments.
the document restricted the NGOs role to
The first draft of
several
activities.
During
the
debates
implementation
countries
)
China,
India,
Iran
and
some
African
delegations (
autonomous
opposed the recognition of
NGOs as
strongly
reasserts
the
The
final
document however
,
partners.
implementation
,
design
,
importance of NGO contribution to the
another
the actions resulting from ICPD. At
and monitoring of
heal th
in
ternationa1
funding
for
level,
the increase of
internationa
if we keep in mind women's basic
programs is not relevant,
needs especially the poorest ones.
Caucus monitoring iwork also allowed mapping out important
opposition
shifts regarding the• debate's global context. U.S.
to include the issue of consumption in the developed countries
the
in the first sessions,
when Timothy Wirth,
was removed
meeting.
Later
first addressed the
delegation spokesperson,
consul tations betwe?en G-77 and the U.S. delegation
informal
impasse over section C of
made it possible to overcome the
Sustainable Development)
,
dealing with the
Chapter
III(
Reactions
environment,
correlation between population and
come
fromi the
language” did not
against the new "compromise
A new
India
and
Morocco.
North , but from China , along with
severa
1
session
because
in the plenary
impasse was avoided
sk
i
1
f
u
1
in
,
were
very
the Brazilian
delegations , including
neutralizing the Chinese position.
the Canadian delegation
During the third week of work
negotiations
conducted
informal
to solve the problems of
Chapter XVI
(Action Plan Follow-up) and also the additional
impasses of Chapter III. Perhaps these efforts would have been
had not been
successful if PrepCom's whole atmosphereobstruction .
In
contaminated
by the Vatican's systematic
many
left
fo.
Cairo
,
addition to some fundamental differences
unsolved.
other impasses remained
i
principles as
, what happened with human rights by China
For example
as
opposed
the Plan,
to monitoring
reference
good
of
the
premises
The same can be said of
expected.
defended
and fight against corruption
government, democracy,
G-77.
In
in brackets the
European Union and enclosed
by the
'-- -paragraph
the fol lowing
opposed
Jg
(—
Ul I LJ
> •—
—
f- |
Europeans
retaliation
commitment not to reduce
the
developed
countries'
dealing with
the
we witnessed
both cases
,
In
development funding.
to
the
conditional.
conflict related
c lassiaal—North - South
rules.
international
theme of
However it was worth noting that the
not
arise any
’ f explosive, did
deemed potentially
migrations,
were
substantive
great controversy, -The two reading sessions
document, the only bracket
and difficult, but in the final reunification,” defended by
refers to the "right to family
ways by
the U.S.
and the
Turkey,
and refuted in different
European Union.
it is
prepCom III,
Taking as reference the ECO'92 and the have established a
possible to state that the april debates
for the conflicts . If the north-South gap seems
new geography
L
- .
asoects
, in others it remains frozen,
to narrow in some aspects
are evident
evident,, among them
Simultaneously, new zohes of tension
, as
for becoming
the tension surrounding the Chinese bid
the
same
In
quickly as possible, the new great world power.
the bloc of
context
, it is worth noting the constitution of
"transition
economies."
Among
other
reasons
the so-called
was an open conflict
because in all debates on funding there
economic grouping.
between the G-77 countries and_t±LLs new
tTiore
FROM NEW YORK TO CAIRO: CHALLENGES AND TASKS
Cairo will
ago ,
Contrary to what was predicted a few months approve
documents
not be
a'formal conference designed to
characterized by difficult
already agreedI upon, but a forum
the may~Sept period
negotiations and subject to impasse. In
bilateral and
involving
take place
many negotiations will
monitored and
to
be
multilateral
activitit .
They
have
be
rapidly
shou1d
critically
analyzed..
Their results
analyzed
disseminated.
of
impac t
the
to reduce
Regarding specific strategies
1
11
present at F’repCom
Vatican's obstruction, women's NGOs
f o r international circulation, In Brazi1,
produced an document
the
signatures, by
for
this document will be circulated
the
■‘ > Rights. At
Reproductive
Network of Health and
National
the Brazilian
‘ 1 to
‘support
.
nationa1 level,it is also fundamental
the
the
plural
character
of
position and strive to guarantee f
Cairo official delegation.
For NGOs
and
the
women's
movements
5»
the
final
stage
of
er
negotiations from now until September has many implications
it is impossible to abandon
Among them , the certainty that
so
far
It is also critical
the approach that has brought us
impact as to effect th*to enlarge the analysis and policy
document
,
and particularly
the
components
of
development
democratic
institutions,
to
referr ing
those aspects
development
resources.
This
corrup ion and the allocation of
commitment
to
the
work
of
the
past
approach will guarantee the
the
path
that
will
take
us
to
decade and it also shows
Copenhagen and Beijing.
H
»G ■-cl
li ’
Reproductive Health and Justice:
International Women's Health Conference for Cairo '94
i
A,'-.<-W
ATT
r
-
-r
•
'▲X^ZAX'V'ZZtf
January 24-2H • 1994 • Kio de Janeiro
THE RIO STATEMENT OF
MREPRQDUCTIVE HEALTH AND JUSTICE;
INTERNATIONAL WOMENZS HEALTH CONFERENCE
FOR CAIRO 1994”
Oryaru/mq Committee
Memtxi •»
reqay Anfroous
Aomen a<»>> L>"»rx’twwm i n«
U <*»D
t. aHbta An
\mparo C!aro
v-*un vmerx
^nu l ^nbOcan
A omen » rtrAMh
Sonia Correa
■\joofui rrm«nM iw-Aim And
Kmjk*
Branl
uermain
Adrie r
INtnuiH*'* A.imrn » IVMH
COAHlJOn I AIM
Lcyla <juI< ur
Aomen l..>nu I rvlrr
Bene t.. Madunaqu
A I**
nom<-n «n
Florence w xianqu\u
-IcOKAJ W>w’*n<»
SsMK ur«>n
Aiexandnna B. Marcelo
tkonunfwm fhAppmo
Rosalind Fetch esky
Intrnvauon^i IW|voc1mcdv« KJqTO
During the period January 24-28, 1994, 227 women from 79
countries participated in "Reproductive Health and Justice:
International Women's Health Conference for 1 airo ,94” held
in Rio de Janeiro.
The conference brought together
representatives of women's and other non-governmental
organizations and networks active in the fields of health,
human rights, development, environment, and population. The
main objective of the conference was for women to prepare
to
participate
in
the
International
Conference
on
Population and Development to be held in Cairo in September
1994 , and to provide a forum where women could search for*
and identify commonalities on reproductive health and
justice, while recognizing the diversities emanating from
different economic,
social,
political,
and cultural*
backgrounds. The conference also aimed at developing tools
and strategies to be used before, during and after the
Cairo conference.
At lKwt <rouO ilNUtAUi
Jacqueline Htanquy
CiU/rnMup
XclAArt •< m*- ’''Vi
Julia Scott
'UOoriM
IVM * Womrn « rV^A
rtOfCCJ .•'6* IP* I SA
Gila Sen
Development UrmAht* w«n
Women tor j Vv tn <DAW**>
Beatnjs Stcmcrcinq
Women » UioCMi "Vimxx lor
Repaxlurtivr Mjqncs 'WCiAKXi
U*jnJinjt«>n inftr r
Mona Zulfkar
Women
Impmvcment
KMlXiMIOn
The participants strongly voiced their opposition to
popul tion policies intended to control the fertility of
women and that do not address their basic right to secure
livelihood, freedom from poverty and oppression, or do not
respect their rights to free informed choice or to adequate
health care; that whether such policies are pro- or antinatalist, they are often coercive, treat women as objects
not subjects, and that in the context of such policies, low
fertility does not result in alleviation of poverty.
In
fact, a significant number of the participants opposed
population policies as being inherently coercive.
There
was unanimous opposition to designing fertility control
measures or population policies specifically targeted at
Southern countries, indigenous peoples or marginalized
groups within both Southern and Northern countries, whether
by race, class, ethnicity, religion, or other basis.
There was also significant criticism of pressure by donors
and efforts to
link development aid or structural
adjustment
programs
to
the
institution
and/or
implementation of population control policies and a
•**1
Secretariat.
International Women 5 rtealth Coalition ilWMC)
24 Last 21 Street, flew >o»h. rtY 10010
Tel: 212-979-8500 Tele 1 424064
Fax: 212 979-9009
Secretariat: ,
Citizenship. Studies. In’onnatlon. Action tCLFIA)
Hua do Russel 694/2 undar. Gloria
Klo de Janeiro 22210 KJ brazil
Tel/Fax. 55-21-225 6115
■
suggestion that donor countr ies should not promote in other
countries what they do not support for the majority of their own
people.
It was agreed that:
1.
Inequitable development models’and strategies constitute the
underlying basis of growing poverty and marginalization of women,
environmental degradation,
growing numbers of migrants and
refugees, and the rise of fundamentalism everywhere.
For women,
these problems (and their presumed solutions through economic
programs for structural adjustment which promote export production
at
the expense of
local
needs)
have particularly severe
consequences:
growing work-burdens and responsibilities
female-headed households or otherwise);
(whether
in
spiralling prices and worsened access to food, education,
health services and other, ba'sic rights;
greater economic pressures to earn incomes;
growing victimization through violence,
wars,
and
fundamentalist attempts to control and subordinate women
sexually and in a number of other ways.
2.
Externa'
debt t
debt,
structural
adjustment
programs,
and
international terms of trade sustain Northern domination, increase
inequalities between rich anc| poor in all countries, aggravate
civil strife, encourage the corruption of government leaders, and
erode the already meager resources for basic services.
I
T
3.
Environmental degradation was seen to be closely related to
inequality in resources and consumption/ profit-driven production
systems, and the role of the military as a major polluter and user
of resources; hence, there is a close relationship between the
violence and poverty that bedevil people's, particularly women's,
lives and environmental problems. Focussing on women's fertility
as a major cause of the current environmental crisis diverts
attention from root causes including exploitative economic systems,
unsustainable elite consumption patterns and militarism. Women in
the conference urged governments to diminish military expenditures
in fav r of social programs.
The participants also urged the
Northern governments and donors to stop supporting and financing
military and undemocratic regimes in the South.
2
4.
There was particular concern about the situation of women
migrants who are heads of households, domestic servants, migrant
workers, entertainers and other service workers.
It was agreed
that while the movement of people should not be constrained by
discriminatory and restrictive immigration policies which operate
in contexts where migration is often forced by economic hardship,
civil strife, war and political persecution, efforts should be made
to address the brutality and violence faced by women and children
who are victims of trafficking and sexual exploitation.
5.
Alternative development strategies must be identified.
In
doing so, there is no single blueprint for development strategies
but a multiplicity of approaches within a basic framework of food
security, adequate employment and incomes, and good quality basic
services which can be guaranteed through democratic people-centered
and participatory processes.
6.
The "sustainable and human development models" that are
currently being proposed in the official documents of governments
and international organ zations,, need to be based on investments
and social policies that guarantee th
quality of life and wellbeing of all people.
7.
There was general agreement on the need t_
to design social
development policies starting from the concerns and priorities of
vomen. These include:
the need to redistribute resources in an equitable and
just manner without discrimination against women,
women, to
remove poverty, and to improve the quality of life of
all;
the need to design development strategies so that they do
.“not
.ct disempower and marginalize people,
people, particularly
women;
to restore and strengthen basic services (for health,
education, nousing, etc.) that have been eroded by
macroeconomic policies;
to provide health services that are cof' good quality,
_ 1
accessible, comprehensive, -and - address the■’ireprodu'? J. /e
health needs of women and men of all ages;
to address reproductive health and rights needs and
concerns (including the right to free and informed
choice)
within the context of social and economic
justice;
3
to strengthen women's participation and empowerment in
po1i tica 1 and policy-making processes and institutions
with the goal of achieving gender balance in all such
processes and inst i tut ions;
to build accountability
policies.
processes
and mechanisms
into
8.
The discussion of fundamentalism brought strong agreement
that, whatever its origins or religious 'claims,
its aim is
political.
Central to fundamentalist attempts to gain political
power is the control of women's lives and in particular of female
sexuality,
including
the
right to self-determination and
reproductive decisions.
There was criticism of the role of major
Northern countries in supporting fundamentalist groups for their
own political ends. Fundamentalists use religion, culture, and
ethnicity in their pursuit of power; such movements represent a new
form of war against women and an aggressive attempt to mutilate
their human rights.
A major site of the fundamentalist war against women is over
the meaning of '•families0. The participant
at the conference
agreed that a definition of family which is limited to a model wi^h
a male "head0 of household, wife and children, does not reflect the
^fe s^uation of 311 of the world's people. Instead it was agreed
that all those who voluntarily come together and define themselves
as a family, accepting a commitment to each other's well being,
should be respected, supported, and affirmed as such.
10.
.All members of the family have rights.
especially to justice
and human dignity. Physic 1, emotional, psychological or sexual
abuse towards women, young girls and children within families
constitute a serious violation of basic human rights under the
Universal Declaration of Human Rights. Women's rights within the
family include access
to resources
resources,, participation
making, bodily integrity and security. Women have in decision
a right to
participate
in public
life,
to social benefits and social
insurance, and to have their unpaid work inside and
outside the
home recognized and shared by: all members of the family.
11.
Comprehensive <and‘ high quality health services for women,
women,
including for reproductive health,
, are a primary responsibility of
governments. They should be available, accessible and affordable to
>rder to reduce maternal 'mortality
morbidity, child
mortality and unsafe abortion, within a broad
women's health
approach that addresses women's needs across the life
cycle.
Qualitative
(as well as quantitative)
indicators need to be
developed to assess services, and users
need to be involved in
this.
4
r*
*
12.
There was clear agreement that quality reproductive health
services are a key right for women. However, existing family
planning programs cannot simply be redefined as programs of
reproductive health. Reproductive health services should include
prenatal, childbirth and postpartum care including nutritional and
lactation programs; safe contraception and safe non-compulsory
abortion; prevention, early diagnosis and treatment of sexually
transmitted diseases, and breast, cervical and other women's
cancers as well as the prevention and treatment of HIV/AIDS, and
treatment of infertility; all with the informed consent of women.
These services should be women-centered and women-controlled and
every effort should be made to prevent the maltreatment and abuse
of wonen users by the nodical staff.
The UN and other donors and
governments should recognize the right to safe and legal abortion
as an intrinsic part of women's rights, and governments should
change legislation and implement policies to reflect such a
recognition.
13.
In the area of contraceptive technology, resources should be
redirected from provider-controlled and potentially high risk
methods, like the vaccine, to barrier methods.
A significant
proportion of the participants also felt strongly that Norplant or
other long-term hormonal contraceptives should be explicitly
mentioned as high-risk methods from which resources should be
r directed.
Female f controlled
methods
that
provide
both
contraception and protection from sexually transmitted diseases,
including HIV, as well as male methods, should receive the highest
priority
in contraceptive research and development.
Women's
organizations are entitled to independently monitor contraceptive
trials and ensure women's free informed consent to enter the trial,
Trial results must be available for women's organizations at the
different stages of such trials, including the very early stages.
14.
Better health services are one element of women's human
rights, In addition, sexuality and gender power relationships must
be addressed
as a
central
aspect of
reproductive rights,
Reproductive
rights are
inalienable human rights which are
inseparable from other basic rights such as the right to food,
shelter, health, security, livelihood, education and political
empowerment. Therefore, the design and implementation of policies
affecting reproductive rights and health should conform to
international human rights standards.
15.
Women are entitled to bodily integrity.
Within this
integrity.
principle, violence against women; forced early
early mar iage; and
harmful -practices;-especiaily-feniale^geftitai^.uutilation,
..lutilat ion, must be
recognized as a major reproductive rights, health and development
1SjU6u Governments should take measures to combat such practices
and should be held accountable for failure to do so.
5
-
------ their sexuality with pleasure
16.
Women have a right to express
and without tear ot abuse and risk of diseases or discrimination on
Social and
^he basis of their sexual orientation or disability.
powerlessness;
oppressive cultural,
traditional
and
economic
religious norms and practices; 1nequ i ta'‘ ’1e laws; fundamentalism and
fear of male violence are impediments to women's own sense of
ent’tlement and should be challenged.
17.
Women, especially girls, must have equal access to e.ducation
Such education should not be gender discriminatory in
in general.
Quality sex education with a
its objectives, methods and content.
gender perspective should be made available to women and men of all
ages, in order to create the conditions for equity in social roles
enable them
control
and empowerment of women in order
<---- to
-- --------- to
_ ---- their
own fertility.
IS.
For women to be able to empower themselves and fully exercise
their rights of citizenship,
c1tizenship, the underlying inequities in gender
relationships must be eliminated.
In particular, policies and
family
programs
should
educate
and encourage men to share
their
responsibility
responsibilities,
including
the
responsibility
for
reproductive behavior and for the prevention of STDs.
Participants at the conference were
oncerned that women and
19.
women's organizations should be involved in the decision making
process locally, nationally and internationally where any laws or
policies affecting their rights and health are designed and
implemented.
Governments,
the UN,
and c-her
international
institutions should be held accountable for the design and
implementation of social and development policies that guarantee
women's Reproductive rights and health. Mechanisms for monitoring
and regular evaluation should be established, and should provide
for participation of women's organize ions.
Donors and governments should also be held accountable and
20.
their concern for women's health and development should be
Donors and
reflected in their resource allocation and priorities.
governments should revise their funding categories so as to promote
comprehensive womien's health programs, rather than narrowly defined
programs for family planning.
A major requirement is that womencentered programs must have access to a fair share of the financial
resources available for reproductive health.
21.
The participants recommended a UN commission on women's
reproductive rights whose composition should be gender balanced,
^Tid'^trerHcb^ake u*-vUnt of geographic, ethnic, racial and other
balances.
The said commission should be interdisciplinary and
should include NGOs, especially women’s human rights organizations,
tach government should oe held responsible to establish a similar
commission at the national level.
6
i
Q jc co
nh h
41
I
Sissela Bok
May 16, 1993
NEW PERSPECTIVES ON ETHICS AND POPULATION POLICY
Revised Draft Outline,
INTRODUCTION
Professionals in the population field sometimes conduct their
research, their policy debates, and their planning of programs at
a level so abstract as to obscure the felt experience of the
people who are the subjects of all these activities.
Populations
are by definition multitudes, or people in the aggregate. But
"population" can also be taken in the active sense of "peopling a
place or region" or the increase in the number of people. [See
box, with O.E.D. definitions of population.]
Experts who focus
too single-mindedly on people in the aggregate and on their
increasing or decreasing in number risk ignoring the impact of
policies on the actual lives of the individual human beings —
of
the women, men, and children in cities and villages the world over
— whose activities make up the population statistics.
The result has all too often been that the fundamental
ethical issues at stake in policy debates about matters as central
to human lives as procreation, sexuality, and family life, have
been sorely neglected.
For decades, ethical problems concerning,
for instance, the just sharing of burdens and responsibilities of
birth control or the human rights of those — mostly women —
whose lives are directly and often intimately affected by
I
2
different population policies, have been given short shrift.
When
these problems have not been left out of policy debates alto
gether, they have frequently been dealt with by means of
uncritical cost benefit analyses or vacuous moral rhetoric.
In recent years, however, ethical issues have come to the
forefront, in large part because many of those with most at stake
personally in the population debate have succeeded in making their
voices heard as never before.
Women's groups, including
members
of the growing women's health movement, human rights advocates.
environmentalists, representatives of labor, business, and
farming organizations, and grass roots activists in every region - all have brought new, at times clashing, arguments to bear to
the debate over population policy.
The resulting debates have brought searing moral conflicts
into the open and, while hardly resolving them, at least succeeded
in delineating them more sharply than in the past.
The stakes are
seen as great: witness the past years' debates about international
funding for population programs in China. And while moral rhetoric
still resounds on every side of such conflicts, it no longer
drowns out the voices of those with most at stake in the outcomes.
As a result, it has become impossible for policy analysts or
agency representatives simply to ignore or to downplay the impact
of population policies on human lives, or to make do with cost
benefit calculations about this impact in the abstract.
3
CONTEXTS OF MORAL CHOICE REGARDING POPULATION ISSUES
Ethical conflicts over population policies concern not only
the goals that we should pursue, singly and collectively, but also
the means that can legitimately be employed, and that are most
desirable, in the course of this pursuit. The choices concerning
ends and means when it comes to sexuality, family planning, and
child-bearing take place at every level, from the individual all
the way to the international level, in contexts of extreme
economic, social, and political diversity, involving gender.
class, ethnicity, and religion, with wide variations in what
individuals are able to do depending on the power relationships in
which they stand. But at all these levels and in all the contexts,
no matter how varied, in which such choices are made, it is
important to recognize that the resulting policies often place the
largest burden on women and that it is they who have been most
often at risk from of errors in, or abuses of, the resulting
policies, customs, and rules.
Works of literature have conveyed women’s experiences in this
regard mgnificently, from Homer’s Iliad to Thomas Hardy’s Tess of
the D'Urbervilles; from the seventeenth-century True Relation of
My Birth, Breeding, and Life, by Margaret Cavendish to Tolstoy's
Anna Karenina; and from The Confessions of Lady Nijo, written in
fourteenth-century Japan, across the world to Sigrid Undset’s
account, in Kristin Lavransdater, of a Norwegian woman’s life in
i
4
medieval Norway.
[Possible box with short excerpts from one or
more of these.]
No matter how diverse the circumstances of the
women1s lives depicted in these works, their responses to
pregnancy and childbirth are strikingly similar: the intensity of
exhileration, longing, fear or dejection associated with thoughts
of becoming pregnant, depending on the circumstances? the
desperate furtiveness often associated with extramarital
pregnancies; the bonding with a newborn baby or at times its
rejection? the anguish about the survival of one born too early or
in poor health, and the blending of love and suffering when the
birth of a child is welcomed by one parent but not the other.
Our century has seen the advent of striking technological
innovations in the areas of contraception, sterilization, safe
abortion, in vitro fertilization, surrogate pregnancy, fetal
monitoring and therapy, and premature deliveries. These new
technologies have greatly increased procreative choice for many,
while also generating new ethical dilemmas.
But the fundamentals
of the experiences of pregnancy and childbirth have not shifted
for most vast majority of women.
The personal and social
pressures associated with these experiences result not only from
community and interpersonal attitudes toward sexuality, courtship,
marriage and family life, but also, since early times. from
population policies of a sort, often rooted in particular
religious doctrines or expansionist political programs.
5
While such policies are still common today, the major
consideration driving population policy during the past four
decades has turned out to be a global one, responding to concern
over the unprecedented rate of growth of the world’s population in
the course of our century.
Like the more long-standing attitudes
and policies, however, current population policies still affect
for better or worse
women
as powerfully as in the past in
the most intimate sphere of their lives.
And the choices made
regarding procreation, whether by governments, agencies,
communities or individuals, affect many others — not only those
most directly affected but, cumulatively, persons in larger and
larger contexts including that of future generations.
Such choices can be looked at from many perspectives —
statistical, for example, or historical or political — other than
a moral one. But the moral perspective is inescapable as soon as
the choices in question are evaluated on normative grounds. When
people point to something — say a woman's choosing to interrupt
or continue her pregnancy, or the state's pressuring her to do one
or the other — as being right or wrong, good or bad, admirable or
reprehensible, just or unjust, they are making a moral claim.
They
are bringing to bear, implicitly or explicitly, one or more moral
principles such as that of compassion or justice taken to be due
1
The word "moral,” used in this sense, merely notes the
presence of normative aspects of the claims being made,
however much one may disagree with the claims
themselves? it should be distinguished from "moral” in
the sense of "morally right," or "praiseworthy."
6
to persons out of respect for their worth or dignity. And they
regard individuals who perceive nothing serious or morally
problematic in denying others such respect as morally obtuse.
Contemporary debates over population policies increasingly
stress the lack of such respect for individuals — women, men, and
children — whose procreative practices are affected, sometimes
coercively, by pro-or-anti-natalist policies in many nations or by
members of some one community or culture or power sphere; or the
lack of respect, more generally, by haves for have-nots, by the
public at large for experts in the field, or, finally, the lack of
forethought, and thus respect, on the part of peoples presently
alive when it comes to future generations.
Advocates of competing policies about population issues,
furthermore, increasingly appeal to moral principles, rights,
responsibilities, and to corresponding prohibitions or
obligations, as if such appeals render further argumentation
unnecessary. And yet both accusations of obtuseness and
unsupported moral invocations, while doubtless at times to the
point, often conceal a failure to recognize the complexity and the
interrelatedness of the definitional, structural, empirical, and
moral issues in choices about population policy. They are rarely
such that there is one and only one legitimate way to go, one so
clearly right that all who do not agree must be obtuse if not
downright ill-willed.
7
Adversaries in policy debates too rarely articulate the ways
in which they define the moral and other terms they use. As a
result, they often attach
differing meanings to terms such as
"person," "justice," "equity," "family values," "empowerment,"
"stewardship, "and "procreative rights." To the extent that these
differences are not set forth and taken into account, any debate
is undermined from the outset.
In addition, adversaries do not always attend to the
structure and possible weaknesses of the conflicting arguments
leading to their own conclusions and those of their opponents. As
a result, the areas of possible agreement and those in need of
further debate remain undifferentiated.
These debates are further hampered by fundamental
disagreements about the nature of the empirical data on which to
base policy choices; and in turn about the predictions that can be
based upon these data: the
add to the
conflicting assessments that result
difficulty of reaching consensus about the moral
issues involved. Thus the empirical data available, concerning,
for example, population growth or numbers of unwanted pregnancies
in a community or nation, are of differing reliability. They may
be sketchy, subject to various biases,
unintentionally inaccurate
or outright fraudulent. And projections for the future concerning
such figures, the consequences of different population policies,
or the reversibility of adverse developments are even more open to
8
bias and unintentional error.
Such projections are, as a result.
even less likely than existing empirical data to offer solid
ground on the basis of which to debate about desirable goals and
acceptable means, unless carefully compared and tested.
Projections of this nature are sometimes cavalierly expressed,
unaccompanied by estimates of levels of risk should they turn out
to be erroneous. Yet policies based on miscalculations in this
realm could engender immense, possibly irreversible, suffering and
devastation.
MAIN AREAS OF MORAL CONFLICT CONCERNING POPULATION
Greater attention to the definitional, structural, and
empirical aspects of the population debate will help remove
needless causes of disagreement.
In turn, this will make it
possible to delineate the moral dimensions of the remaining
conflicts more sharply: ones concerning, most prominently, aims,
means, rights, and responsibilities, all intricately linked in
practice.
A. Aims.
In theory, the aims of population policy could
concern any factor or set of factors that would count as
improvements for any group of human beings seen in the aggregate.
In practice, however, population policy has increasingly come to
concern two central and often conflicting aims.
The first of
these aims concerns population in the sense of ’’peopling” or
9
procreation: it is the aim of stemming the growth of the world’s
population before it exhausts the resources needed by this and
coming generations and comes to pose possibly irreversible threats
to all living beings and the earth’s environment. The second aim
advocated for population policy is that of focusing first of all
on overcoming the poor health, lack of reproductive choice,
subjugation, and poverty of so many members of the world’s present
population.
[Cross-references to the Introduction to this volume
and other chapters).
For those who see the first aim as primary, methods of
contraception, sterilization, and abortion have long constituted
the primary available means. Accordingly, family planning programs
the world over have concentrated on these methods.
More recently,
it has become clear that socioeconomic factors, especially women’s
access to health care and education, and a concern for human
rights, including reproductive rights, play an important role in
fertility regulation as well.
Those who stress the second aim,
however, regard these factors not merely as means to population
control but above all as worth achieving in their own right. They
are divided, however, as to whether the first aim is worth
pursuing as a byproduct of the necessary socioeconomic reforms or
whether, on the contrary, it should be set aside as
beside the
point so long as these reforms are achieved, possibly even
counterproductive.
[Cross-references to later chapters]
10
High on the agenda in current discussions of family planning
is the question of whether there can be consensus among the
holders of the two aims to pursue them both, at least where the
two overlap: agreement in practice to provide as widely as
possible for access to education, health care and means of
voluntary family planning, without seeking any corresponding
agreement regarding the underlying question of which of the two
aims aim is primary and which secondary.
Even where agreement is
achieved about practical aims to pursue, however, conflicts remain
concerning areas where the overlap between the two aims is less
clearcut or non-existent.
At what individual or societal costs
should either end be pursued without concern for the other?
Should the reproductive freedom stressed by proponents of the
second aim pose limits to procreation by persons with AIDS, for
instance. or addicted to drugs?
And what priorities should be set
when it comes to the distribution and financing of, say,
educational versus family planning services?
The question that may be most divisive, in this regard, is
that of the different, perhaps incompatible views held with
respect to the scope envisaged for the benefits to be achieved
from population policies and the costs that will have to be
imposed.
These differences in scope extend in both space and time
and both, at bottom, have to do with justice as between different
groups of human beings.
In space, the differences are regional
ones, as well as dividing poorer from richer nations, developing
11
from developed ones, These differences, often encapsulated as
North/South differences, concern the justice of the costs imposed
by population policies.
How do justice and expected utility
balance out in deciding whether to give priority to cutting back
on resource usage by richer nations or on population growth in
poorer nations?
The temporal dimension of the differences in scope concerns
the degree to which the needs, interests, and possibly the rights
of future generations ought to be taken into account in addition
to those of people presently alive.
As increasing numbers of
people put greater pressure on the environment and on nonrenewable resources, how will this affect their children and those
coming after them?
It is in this context that questions
of
stewardship have come to the fore, concerning the justice and the
wisdom of failing to consider the long-term consequences of
present practices.
[More on this score to be added.]
[In the next draft of my chapter, I plan, further, to
consider certain limitations of scope that I take to be
unacceptable both from a moral and from a purely practical point
of view:
the "lifeboat ethics" formulated by Garrett Hardin and
others, according to which wealthier peoples
should simply
let nations incapable of controlling their populations "sink”
12
in order to preserve
adequate resources for their
descendants
the "do what is right though the heavens may fall” ideologies
so intent on achieving their goals or ruling out certain
means as to refuse to consider any possible consequences for
humanity.
B. Means.
Conflicts over the various means employed to attain the
aims of population policy, such as different methods of
contraception, sterilization, and abortion, concern both their
practical usefulness in achieving the intended aims and their
moral legitimacy [cross-references to later chapters]:
From the point of view of practical usefulness, the various
methods have been compared with respect to the degree to which
they have achieved the stated goals under different circumstances.
Thus comparisons are made between the levels of success or failure
of family planning programs in different communities; whether
coercive methods of population control such as those used in China
have been more successful in practice than the less coercive ones
employed in India; and whether the indirect route of stressing
economic development and education, especially the education and
access to health care of women, has done so better than a focus on
family planning.
13
Debates about the moral legitimacy of different means of
achieving the aims of population policy center around three sorts
of questions:
first, whether the means in question are morally
illegitimate in their own right, regardless of how voluntarily
they may be employed (contraceptives, sterilization, and abortion,
for example, are prohibited by the Catholic Church as being
contrary to Natural Law and thus morally illegitimate, yet
accepted as legitimate by a great many practicing Catholics);
second, whether such means are voluntarily employed by individuals
or coercively or manipulatively imposed upon them; and third,
whether the funds provided to pay for the various means are
appropriately used or siphoned off, either for personal gain
or to pay for, say, armaments purchases.
In evaluating the degree to which different means are
coercively or manipulatively imposed upon individuals, information
and socio-economic context plays an important role.
Middle-class
women in industrialized democracies who have access to, and are
adequately informed about, a number of reproductive technologies
are clearly less likely to find themselves coerced or manipulated
than poorer women without such access, information, and freedom to
choose.
As a result, reproductive technologies must be evaluated,
from a moral point of view, with sensitivity to their potential
for abuse under different sets of circumstances.
The same is true
of the many forms of incentives and disincentives employed by
governments, agencies, and community groups to achieve such goals.
14
[More in next draft, including: a discussion of
the so-called ’’dirty hands" argument appealed to by
persons wishing to legitimate means they know to be immoral on
grounds that the ends for which these means are employed are so
important as to justify their use.
— moral arguments, especially Kantian and utilitarian ones,
espoused in our time by Gandhi, King, and a number of theologians
and philosophers, to the effect that immoral and inhumane means
inevitably condition and corrupt the hoped-for ends, however
desirable in their own right.
C.
Rights (cross-ref’s to articles in rights section)
In this section, I shall define rights (giving references),
consider the relationships between rights, liberties, interests,
and needs, and the special role of human rights in controversies
concerning population policy; I shall also
take up certain
conflicts concerning rights:
Which sets of rights might be considered as fundamental and
what sorts of priorities are argued for among them; about
conflicts of rights between individuals and, for instance,
North/South; the role of the rights of women in the context of
choice about procreation and population policy more generally;
15
the neglected role of rights of adolescents and their needs when
it comes to choices regarding sexuality and procreation (cross
reference) and the rights of children; whether members of future
can be thought of as possessing rights much like those we grant
presently living beings; and, if not, how their interests might
nevertheless be made to count in the choices we make. A
considerable philosophical literature exists on this score; I plan
to weigh its relevance to the present debates.]
Responsibilities
In this section, I shall define responsibilities in
connection with duties and obligations; and consider the different
views regarding responsibilities: ways in which rights tie in with
responsibilities or duties; the question over who, or what groups
or nations have primary responsibility for helping to achieve the
intended goals; for whom responsibility might be exercized and on
the part of whom; what is meant by responsibility with respect to
reproductive choices;, including the neglected role of
responsibilities for men in
this respect; how responsibility
affects decisions concerning stewardship; whether responsibility
requires, at times, the recourse to illegitimate means to secure
ends thought desirable.
16
DEBATING THE ETHICS OF POPULATION POLICIES
In this section, I plan to distinguish two approaches in such
debates along and to weigh the advantages and drawbacks of each
from the point of view of examining the ethical issues involved
and guiding policy.
The two approaches are:
setting forward one’s ideal position, as completely developed
as possible, in opposition to competing views, whether or not
one intends to compromise later;
and stressing the basics of what one’s position might already
have in common with other positions, whether or not one
intends to explore potential differences later.
Both positions are familiar in political as in philosophical
and religious debates.
Both, but especially the first, are used
in the population debate.
Each in its own way can seek to inspire
as well as to persuade; but the first is concerned primarily with
its own side winning, the second with achieving a baseline
consensus with proponents of all sides, on the basis of which to
facilitate further debate.
The main drawback of the first is that
proponents will refuse all compromise and adhere to their
developed position, "come what may"; and of the second, that the
consensus found will be too limited to allow much progress to be
made.
[Examples from the population debate to illustrate each}
*
ft
17
I shall argue that both approaches will benefit from
addressing the difficulties (discussed above, pp. 6-8) that stand
in the way of the articulate debate now so clearly needed in the
debate over population issues.
Doing so will already help make
the arguments clearer — not only their definitional, structural,
and empirical underpinnings but also their moral configurations.
For this reason, every effort should be made (and will be, in
the present volume) to be clear about the definitions of terms
used but also aware of alternative interpretations; to attend to
the structure of arguments, one's own and those of others, in
order to lay bare the region of agreement or overlap; to scan for
misleading or needlessly vague empirical data and for biased or
unfaounded projections for the future.
While this will help, however, it will hardly resolve a
number of remaining conflicts about population policy of a serious
and substantive nature. While the first approach is already in
frequent use in the population debate, I suggest that it will be
helpful to supplement it by means of the second.
Existing efforts
will only be strengthened, for purposes of arriving at collective
strategies, if it is possible to arrive at a shared basis of
widely shared assumptions.
The debate can then proceed both from
the top down, bargaining on the basis of fully delineated
positions, and from the bottom up, moving forward on the basis of
shared premises.
4
18
what would a search for consensus call for with respect to
aims, means, rights, and responsibilities?
- As for aims, few would quarrel with that of survival as
fundamental to population policies, even though disagreement is
rife about whose survival is at issue and how it should be
achieved. In addition, certain aims for population policy can be
ruled out as illegitimate: e.g. ones clearly proclaiming the need
for racial, ethnic, or religious "cleansing" or, on the contrary,
domination. From such a basis. it may then be easier to take up
equally coercive but less overtly violent methods
to achieve
class or national or cultural dominance.
— Although the debate over means covers a broad spectrum, at
the very least there might be near-general agreement that
voluntary efforts on the part of women and men to plan for only
wanted births is uncontroverted and far preferable to others; and,
except for opposition by clergy of a few denominations,
increasingly disregarded by parishioners), that voluntary
contraception must be included in such efforts.
At the other end
of the gestation cycle, most would agree that infanticide
constitutes murder and is unacceptable,
(though here again.
definitional questions arise as to exactly what is to count as
infanticide); likewise, on a larger scale, wide consensus exists
to the effect that any policy of intentional neglect of epidemics
and famines for purposes of population control is illegitimate.
i’
<
19
[Parts to be added:
— on minimalist consensus regarding
rights and responsibilities
in connection with procreation.
- and a conclusion, possibly setting forth where the authors of
the book stand with respect to a number of the ethical issues
presented in the chapter.]
i Ufs
i
I Q| u
203 P02
A
I
MAY 19 >93
3
2
Population and Development Theories
and their
Implications for Population Policies
(Summary)
Section 1,
The debate in a new environment
1.1 Sgcent
:_____________
important intellectual changes in social
sciences in
general
and their
-- — - role in policy making.
Attention will, be drawn - in schematic fashion - to recent
developments in the social sciences which are especially
relevant to the contents of the proposed volume
Specifically they are the following:
Renewed interest in the balance between qualitative and
quantitative research (example: Levine: full recognition of
the role of ambiguity in social sciences, views of Debreu,
Leontiev in regard to formal-mathematical models in
economics and other social sciences).
- Renewed efforts to interlink economics and sociology
(examples are Hanovetter
rs studies on the importance of
Hanovetter's
social networks in economic processes, growing importance of
institutional analysis and its rebirth in modern economic
terms, Becker's theories of household economics; uand
suggested modifications, the rationality paradigm as a
common approach in sociology and economics - See e.g.
Coleman's Foundations of Social Theory)
Increasing efforts to articulate linkages between macro
and micro-levels of analysis (See e.g. the volume on the
macro-micro link by Alexander, Giesen, Munch and Smelser)
- Feminist orientations in the social sciences (feminist
orientations and methods in social research - e.g,
c.^,. Shulamit
Reinharz, Lorraine Code, the problematic of feminist
epistemologies - e.g. Fox-Keller, Harding)
7 Search for more attention to ethical aspects and the
importance of community in economics and in social sciences
m general (Sen, Etzioni), efforts to define basic needs in
an objective way (Doyal, Gough), equity and superfairness
(Baumol).
01:31
r in i
x
ci i:
I
3
1
We are at the crossroad of new orientations in
development policies.
Again attention will be drawn in schematic fashion to
important recent developments and their ramifications for
the situation of women:
Demise of central planning (Heilbronner, Prezeworski,
Kornai) and crisis of once popular theories such as modes of
production and dependency theories (Taiwan, Peru).
- Global interest in genuine democracy and possible
obstacles.
- Discussions of the role of markets, their advantages,
problems caused by markets and problems impossible to solve
through market mechanisms.
Emergence of NICzs and their implications for development
and population policies.
- New emphasis on decentralization and regionalization in
development policies.
Recent important changes .in demographic patterns and
relationships with development policies and performance.
Reference will be made to countries where fertility and
other demographic variables have changed dramatically in the
recent period, and to the causes of these demographic
changes (including the role of family planning programs, of
social programs and of the spread of the idea that couples
can autonomously influence demographic variables).
These situations will be contrasted with others where change
has been much less impressive. Attention will also be drawn
to the fact that the world population growth rate after a
period of decline has unexpectedly started to increase
again.
Some paragraphs should be reserved for the issues of ruralurban migration (including urban settlement patterns) and of
international migration, the role of women within these
migration experiences and the consequences of migration
dynamics for women and their families.
4
Section 2.
Characteristics. ..Q.f the current debate
The main theme of this section is the assertion that several
developments which occurred during the last decade are creating a
context where the population debate can be conducted in an
atmosphere with more opportunities for agreement than in the
past. Care, however, will be exercised in giving the impression
that perfect agreement exists (or is even needed) in this domain.
This will be done by referring to population debates around
environmental (as exemplified by discussions at and in the
aftermath of the Rio Conference on Environment and Development)
and around other issues including to some brought up by some
feminist strings of thinking
Elements, creating more room for agreement and interchange are
the following:
2.1 The declining role of grand ideology i.n the population
debate. The debate on the interrelations between population
and economics..cannot be neatly, divided along grand
ideological lines. The perception that Western,
neoclassical, non-marxist, non-dependency economics
automatically favored population growth reduction policies
while the other camp had a consistently negative attitude
towards such policies, is too simplistic. It will be argued
that the emergence of several neoclassical economists who
deny that rapid population growth (Bauer, Hayek, Simon)
constitutes a problem, that the acceptance of population
policies by governments which claim to be marxist and that
the higher prominence given by some neo-marxists to the
importance of population and the modes of reproduction all
point to a more complex environment for the debate.
2.2 The growing awareness that the interaction.between
population dynamics and economic dynamics is
multidimensional . The diagnosis of specific population
problems recognizes that the interaction between population
dynamics and economic dynamics must be situated
contextually, that it needs to be embedded in the complexity
of the social and economic system, that it should be linked
to the set of complex changes represented by the demographic
transition (health transition, reproductive transition,
family transition etc.) and that population dynamics can
never be viewed in isolation from other factors which affect
development and social welfare.
3.3 The growing acknowledgment of the relevance of values_iji
the population debate
Reference to the need for ethical
perspectives in the debate refers both to the basic
objectives of social and economic development and to the
5
instrumentalities incorporated in population policies and
programs- This topic, since it is expected to be covered in
other chapters of the book, does not need to be elaborated
in detail.
Section 3.
Main contents of the current debate
This section does not intend to give a full-fledged overview
of the current debate (as was done in the paper on
population Growth and Economic Development). Rather the
most crucial points of the debate will be distilled because
something must be said about the strength and weaknesses of
recent theories which have challenged the thesis of possible
negative effects of rapid population growth (especially
those of Simon and Boserup). The policy implications of the
so-called populationist theories and their relevance for
developing countries and for reproductive health and women's
rights will also briefly be discussed.
Section. 4.
Elements for a new synthesis for the interrelations
between population dynamics and economic development
I personally think that the time is not yet ripe for the
full fledged architecture of a renewed synthesis on the
interrelations between population dynamics and socioeconomic
development. Furthermore, I feel that the proposed book
should make it clear that it will represent only a step,
albeit, potentially an important step, in the direction of
such a synthesis.
The purpose of this section will be to provide building
blocks for this synthesis. Attention will be directed to
three areas where rapid population growth can impact
negatively on development. Consideration of these
problematic areas will give raise to three perspectives
relevant for population policy making: the human capital
investment perspective, the demographic equity perspective,
and the ecological perspective. Within each of these
perspectives consideration will be given to women's
empowerment and reproductive health.
4.1 Demographic inequity in the provision of family
planning services and resulting differences in fertility,
together with other social and economic inequities, have the
consequence that certain unfavorable consequences of rapid
population growth will fall more heavily on certain social
groups and on women within these social groups. Population
growth impact studies tend to be predominantly macroeconomic
and macrosocial in their orientation. How rapid population
growth and large family size create special problems for
specific subgroups of the population and are instrumental in
producing further demographic and more general social and
I
6
economic inequities is much less well known and deserves far
more attention in research and in policy-making to reduce
societal inequities. For example there are important
proportions of births which are undesired and these
proportions tend to be higher among women at the lower end
of the income distribution, especially among rural poor
women. Birth rates, in fact are higher in rural areas and
in the poorest segments of society. In many poor countries
the majority share of natural increase occurs among the
poorest groups of society and is obtained in the most
inefficient fashion through a high number of infant and
childhood deaths compensated by an even higher number of
births. Abortion research shows that most illegal abortions
occur among poor urban women who are not using
contraceptives. This situation thus confronts us with
demographic inequity at two levels. First in regard to
accessibility of contraceptives for poor urban women.
Second in regard to health for the same women who, because
of the unfortunate consequences of abortion practiced
without the assistance of qualified medical assistance, will
have to be hospitalized in emergency situations with
concomitant risks of maternal mortality.
4.2 ( Population dynamics is far more important to human
capital investment than to physical capital accumulation.
Human capital investment theory shows that deemphasizing
population quantity in favor of population quality will
benefit economic development. Education in its many forms
and health improvements are undoubtedly the two most
important components of human capital investment. The
creation of human capital investment opportunities for
women, is especially crucial and will be favored very much
by lower fertility both on the micro and macrosocial level.
More rapidly declining birth rates could translate into more
resources for improvements in MCH and in general health and
social services. Therefore the reduction in fertility which
often.is solely justified in terms of personal health
benefits for mothers and children, can also easily be
justified on the macro-level because of the improvements in
population quality which will have important macro-effects
on human capital investment and thus on development goals
themselves. In addition, better educated and healthier
women more fully utilize contraceptive services and other
opportunities to increase the quality of the children they
give birth to. The benefits of human capital investment
therefore, through one step, can stretch over several
generations.
1
7
4<3 .As regards population-environment relationsT their
implications for women issues have been less intensively
explored. Detailing these issues therefore is a challenge
which should be confronted. By taking a broad view of the
environment, including for example urban sanitation and
water supply, it is possible to discover many linkages with
women issues. In the hope of identifying more of such
linkages,.! consulted in recent days some publications on
’’ecofeminism". On the whole these publications have
disappointed me!
By way of conclusion it will be stressed that population policies
should support the two basic objectives of development:
enhancement of the productive capacities of society and the
distribution of its benefits in an equitable manner which will
lead to the general enhancement of quality of life for all
members of society: women, men and children.
u h i \. i o
Section I, Chapter
DRWT/May 21, 1993
CHALLENGES TO POPULATION POLICY: THE RISE OF THE WOMEN'S HEALTH
MOVEMENT
by
for
Volume
SIDA
Claudia Garcia-Moreno and Amparo Claro
Human
Rights r
Women's
Empowerment
and
Reproductive Health; Population Policies Reconsidered. edited by
Sen G.r Germain A. and Chen L.
introduction
The women's health movement has played an important role
in
reshaping the discourse. and in some cases even the practice, of
population and family planning policies and programs. This chapter
will outline the recent history of the movement: the changes in its
thinking.
and
in
its
population debate.
relationships with
other actors
in the
will briefly explain some of the regional
developments, but will focus on the global or international level,
highlighting the contributions of the experience and thinking of
women's health organizations to the population and family planning
fields. (Specific case studies/country or regional examples will be
used where possible).
1
cv
Description of tft^ Women's Health Movement,
This section will consider the movement in a broad way, to include:
- formally articulated networks
- a wide range of women's health groups and non governmental
organizations
- feminists/activists working in 'establishment' institutions
- women in other political and human rights movements,legal
organizations, and others who are concerned with reproductive
health/rights.
Quantitative description: how many groups, where are they based♦
The number of organizations from each region that are involved in
two international networks -Boston Women's Health Book Collective
and the Global Network of Reproductive Rights will be used as a
The numbers of groups in some specific countries, eg.
Nigeria, India, Philippines, or regional networks like the Latin
proxy.
America and Caribbean Women
Health Network will be given as
examples. (The choice of country will depend on the availability of
data).
Qualitative description: an overview of the types of activities
that the groups within the women's movement are engaged in.
Also a description of some of the key networks such as:
— internationally Isis International, Women's Global Network
2
for Reproductive Rights, IWHC, Catholics for a Free Choice
regionally:
example.
for
Latin American and
Caribbean
Women's Health Network (Isis International),
-nationally:
Network
Philippines
(in
formation),
Women's
Medical Associations in Africa, Reproductive Rights Network in
Brazil, Forum for Reproductive Health in Chile.
Boxes describing the Latin American and Caribbean Women's Health
Network and the Global Network for Reproductive Rights (GNRR).
2, Aotivltley of women's health organizations.
2.1 Information sharing.
The movement has been interested in assessing information about
women's health from their own perspective. demedicalizing it and
making it more accessible to womenorganizations, as well as in
sharing
of
information
about
their
dissemination of this information has
own
experiences.
The
been through meetings, and
various books, journals, newsletters and other publications. Some
groups have concentrated almost exclusively on this activity. For
example,
Health Share
in
Canada,
Boston Women's
Health
Book
Collective, the Women's Institute in Spain, [Box with a sample of
one of the newsletters]♦
3
SENT BY:.1HHC
; 5-25-83 ; 4:22PM : 1NTL HOMEYS HEAL1H-4955416
5/12
2.2 Service provision (Cross reference with MCH and Reproductive
Health chapter)♦
The practical experience of trying to address women's health issues
under serious economic and other resource constraints has
been an
important element in shaping the thinking of the women's health
movement. It has highlighted the failures, limitations and abuses
of many population and family planning programs.
Women's health organizations have taken different approaches to
address this:
a) Development of 'alternative' models of service provision. This
section would describe the main elements of these models and use
examples to illustrate different types of
service provision:
Colectivo de Sexualidade y Salud in Brazil, post- abortion services
(Colombia)9
Bangladesh
Women's
Health
Coalition,
Peru:
Flora
Tristan and Manuela Ramos work with urban poor
women, eg on
cervical cancer detection [develop two of these as case studies).
b) Influencing and changing attitudes and approach of health care
providers in existing services (from outside and inside) . This has
been done by raising awareness of service providers through gender
awareness and other training of service providers♦
4
SENT BYHtfHC
; 5-25-93 ; 4:23PM : 1NTL hOMEA d HEALin-43554io
Issues to discuss: How has this experience been systematized and
documented? How widely has it been shared? What impact has this
had. both on shaping the thinking of women's health groups, and on
other policy makers and service providers? (Cross reference with
MCH and reproductive health chapters)
2.3 Advocacy and activism. Describe briefly some of the different
approaches, and regional variations in concerns and strategies.
a) Campaigns: for example international day of action on women's
health, maternal morbidity and mortality campaign. Give examples of
regiona1 concerns,
such as abortion campaign in Latin America,
genital mutilation and WF in Africa,
b) Dialogues with scientists, for example Geneva, Brazil, Mexico
(cross-reference with section 3.2).
c) Links with donors.
d) International declarations/statements: Women's Declaration on
Population Policies, Boston Collective Declaration, FP groups such
as IPPF, CEDPA.
5
• rr Q;
2«4 Research and policy development.
Some ngos have done local research on various
particularly to service provision,
issues related
women's perceptions,
gender
aspects of health care use. In addition, feminists within the large
population/family
planning
organizations
have
introduced
new
concerns to the research agenda and policy development.
Tracing the discourse and the relationships of the women's
health movement with other actors in the population and family
planning- field
(researchers
and
scientists.
policy
makers,
governments, donors, service providers),
3.1 A very brief mention will be made of the background of the FP
movement in the early XXc. But the section will emphasize the last
15 years.
years,
developing a chronology of the key events
such as
formation of networks. international meetings, etc. that underpin
changes in the thinking as well. (Cross-reference with Reproductive
health chapter). [Box of chronology with key dates].
3.2 How has it evolved? At global level and in some regions the
women's
health
movement
initially
focused
its
work
on
the
legalization of abortion. This expanded to include other concerns
such as the abuse of sterilization and a critique of population
control policies, with a focus on reproductive rights. The thinking
6
»
then developed towards a concept of reproductive and sexual health,
and more recently.
sexuality
and
comprehensive model
to a more
development,
particularly
given
of health.
the
impact
of
HIV/AIDS and increasing awareness of the impact of RTIs on women♦
These changes have also been reflected in different relationships
with other actors in the population and family planning fields:
from antagonism to the identification of common ground.
3.3 This section will identify the most important changes in the
thinking
of
the
identify
the
critical
international
health movement,
women's
turning points.
For
example.
when
and
did
feminists start going into some of the mainstream organizations?
When did they begin to acknowledge that
it was
important to
initiate dialogue/negotiations with 'the establishment'?
What has
been the role of feminists working within the system in the health
and population fields (IPPF, Pop Council, HRP). (If space allows,
include here feminist influence on demography).
We will argue that efforts to create a dialogue between women's
health movement or
feminists and
other bodies
has played
an
important role in moving women's concerns forward and ensuring they
are part of the agenda.
Important meetings to facilitate this
dialogue have been:
7
«
1986
IWHC/ Pop Council
Quality
of
Care
Contraceptive
and
the
Development
Process;
1988
IWHC
Second Tietze Symposium on the
Impact of Unwanted Pregnancy
1990
HRP WHO /IWHC
Women *s
Perspectives
on
the
Selection and Introduction of
Regulation
Technologies
1992
HRP
Philippines:a * Vaccine meeting;
b. Asian dialogue;
1992
Pop Council
Day of Dialogue on Population
and Feminist Perspectives
1993
HRP/MoH Mexico
Contraceptive Technology
1993
ICED PrepCom
Women'6 Caucus (compare content
with
womenrs
declaration
1984 Mexico meeting).
8
of
t
Future strategies to ensure that the discourse is translated into
policy and programmes may involve
reaching beyond the population
and family planning establishment/ ie broadening the constituency;
presence
increasing
the
increasing
public
inside
awareness,
policy
and
capabilities♦
11
making
institutions;
strengthening
its
own
• □-z-j-uk) • 4-^orM »
d ruLAi_im4uoo-iio
• -1 U; 1_
We will specifically consider what has been the outcome of this
increased dialogue on research and program policies, strategies and
implementation, and what the risks are, particularly the co-option
of language without the necessary changes.
4. What are th^ specific contributions of feminists to the debate?
This
will
be
discussed
fully in the reproductive
health
and
reproductive rights chapters, but we still think it needs to be
highlighted here. It can be presented briefly under the following
headings:
conceptual and policy
(reproductive and sexual health,
Women's Declaration on Population Policies, gender equity)
service
provision
(quality
of
care.
women-centered
perspective, awareness of coercion. safe abortion)
contraceptive research and development
methods,
involvement of womens groups
introduction
of
new
methods,
(women-controlled
in development and
safe
male
methods,
abortifacients, protection vs infection)
[Cross-reference with Reproductive Health and Reproductive Rights
chapter].
9
Di■inno
□ -4.0
• 4.01 .h
1 . \ A 1—
1
~—F^^sejxt—thinkincr and vision for the future; towards a united
voice?
6.1 summarize where things are at for the women's health movement,
including the Womenfi Caucus at the recent Prepcom of the ICED.
6.2 The women's health movement is not monolithic, and clearly
there are regional and other variations, Some of the controversies
and divergence within the movement are specifically centered around
issues of population, contraceptive technology and reproductive
rights and health. We will outline some of these differences and
explore whether a majority position/common themes
emerge. Here we
will refer specifically to the Women's Declaration on Population
Policies and Women's Alliance. We will mention other
groups, such
as many of the 'family planning'
organizations which would not
consider themselves part of the women's movement.
yet whose work
takes them in the same direction.
6.3 What are the constraints now facing the womens movement and
what are the challenges. Constraints include the resistance of the
FP establishment and others to change,
financial constraints,
institutional constraints (regional variations for example between
Africa and Latin America), sectoral bias present in allocation of
resources.
10
hh h. LioGJ
Section I, Chapter 4)
DRAFT/May 21, 1993
CHALLENGES TO POPULATION POLICY: THE RISE OF THE WOMEN'S HEALTH
MOVEMENT
by
for
Volume
SIDA
Claudia Garcia-Moreno and Amparo Claro
Human
Rights r
jfomen1 s
Empowerment
Reproductive Health: population Policies Reconsidered
7
and
edited by
Sen G., Germain A. and Chen L.
Introduction
The women's health movement has played an important role
in
reshaping the discourse, and in some cases even the practice, of
population and family planning policies and programs. This chapter
will outline the recent history of the movement* the changes in its
thinking.
and
in
its
relationships with other
actors
in the
population debate.
will briefly explain some of the regional
developments, but will
focus on the global or international level,
highlighting the contributions of the experience and thinking of
women's health organizations to the population and family planning
fields. (Specific case studies/country or regional examples will be
used where possible).
1
i IU4\_
l^Description of tb$ Women's Health Movements
This section will consider the movement in a broad way, to include:
- formally articulated networks
a wide range of women's health groups and non governmental
organizations
- feminists/activists working in 'establishment' institutions
women in other political and human rights movements,legal
organizations, and others who are concerned with reproductive
health/rights .
Quantitative description: how many groups, where are they based.
The number of organizations from each region that are involved in
two international networks -Boston Women's Health Book Collective
and the Global Network of Reproductive Rights will be used as a
proxy. The numbers of groups in some specific countries, eg.
Nigeria, India, Philippines, or regional networks like the Latin
America and Caribbean Women
Health Network will be given as
examples. (The choice of country will depend on the availability of
data).
Qualitative description: an overview of the types of activities
that the groups within the women's movement are engaged in.
Also a description of some of the key networks such as:
— internationally Isis International, Women's Global Network
2
for Reproductive Rights, IWHC, Catholics for a Free Choice
regionally:
for
example.
Latin American and
Caribbean
Women's Health Network (Isis International),
-nationally:
Philippines
Network
(in
formation),
Women's
Medical Associations in Africa, Reproductive Rights Network in
Brazil, Forum for Reproductive Health in Chile,
Boxes describing the Latin American and Caribbean Women's Health
Network and the Global Network for Reproductive Rights (GNRR).
.2- Activities of women's health organisations.
2*1 Information sharing.
The movement has been interested in assessing information about
women's health from their own perspective. demedicalizing it and
making it more accessible to womenorganizations, as well as in
sharing
of
information
about
their
dissemination of this information has
own
experiences.
The
been through meetings, and
various books, journals, newsletters and other publications. Some
groups have concentrated almost exclusively on this activity. For
example,
Health
Share
in
Canada,
Boston Women's
Health
Book
Collective, the Women's Institute in Spain, [Box with a sample of
one of the newsletters]♦
3
; 0-25-83 ; 4:22PM : IML HoMEN
SENT BYUWHC
HEALIH-4855410
5/12
2.2 Service prevision (Cross reference with MCH and Reproductive
Health chapter).
The practical experience of trying to address women's health issues
under serious economic and other resource constraints has been
an
important element in shaping the thinking of the women's health
movement. It has highlighted the failures, limitations and abuses
of many population and family planning programs.
Women's health organizations have taken different approaches to
address this:
a) Development of 'alternative' models of service provision. This
section would describe the main elements of these models and use
examples
to
illustrate different types
of
service
provision:
Colectivo de Sexualidade y Salud in Brazil, post- abortion services
(Colombia),
Bangladesh
Women's
Health
Coalition,
Peru:
Flora
Tristan and Manuela Ramos work with urban poor
women, eg on
cervical cancer detection [develop two of these as case studies].
b) Influencing and changing attitudes and approach of health care
providers in existing services (from outside and inside). This has
been done by raising awareness of service providers through gender
awareness and other training of service providers.
4
SENT BYHWHC
; 5-25-93 ; 4:23PM ; 1ML WME.\'hlalin-4355-iio
Issues to discuss: How has this experience been systematized and
documented? How widely has it been shared? What impact has this
had. both on shaping the thinking of women's health groups, and on
other policy makers and service providers? (Cross reference with
MCH and reproductive health chapters)
2.3 Advocacy and activism. Describe briefly some of the different
approaches, and regional variations in concerns and strategies.
a) Campaigns: for example international day of action on women's
health, maternal morbidity and mortality campaign. Give examples of
regiona1 concerns,
such as abortion campaign in Latin America,
genital mutilation and WF in Africa,
b) Dialogues with scientists, for example Geneva, Brazil, Mexico
(cross-reference with section 3.2).
c) Links with donors.
d) International declarations/statements: Women's Declaration on
Population Policies, Boston Collective Declaration, FP groups such
as IPPF, CEDPA.
5
1-
2«4 Research and policy development.
Some ngos have done local research on various issues related
particularly to service provision,
gender
women's perceptions,
aspects of health care use. In addition, feminists within the large
population/family
planning
organizations
have
introduced
new
concerns to the research agenda and policy development.
Ijl
Traoinq the discoyrae and the relationships of the women's
health movement with other actors in the population and family
planning field
(researchers
and
scientists.
policy
makers t
governments, donors, service providers).
3.1 A very brief mention will be made of the background of the FP
movement in the early XXc, But the section will emphasize the last
years.
15 years,
developing a chronology of the key events
such as
formation of networks. international meetings, etc, that underpin
changes in the thinking as well. (Cross-reference with Reproductive
health chapter). [Box of chronology with key dates),
3.2 How has it evolved? At global level and in some regions the
women's
health
movement
initially
focused
its
work
on
the
legalization of abortion. This expanded to include other concerns
such as the abuse of sterilization and a critique of population
control policies, with a focus on reproductive rights. The thinking
6
then developed towards a concept of reproductive and sexual health,
and more recently.
sexuality
and
to a more couipr ehens ive model
development,
particularly
given
of health.
the
impact
of
HIV/AIDS and increasing awareness of the impact of RTIs on women.
These changes have also been reflected in different relationships
with other actors in the population and family planning fields:
from antagonism to the identification of common ground.
3.3 This section will identify the most important changes in the
of
the
identify
the
critical turning points,
international
health
women's
thinking
For
movement,
and
when
did
example.
feminists start going into some of the mainstream organizations?
When did they begin to acknowledge that
it was
important to
initiate dialogue/negotiations with 'the establishment'?
What has
been the role of feminists working within the system in the health
and population fields (IPPF, Pop Council, HRP). (If space allows,
include here feminist influence on demography).
We will argue that efforts to create a dialogue between women's
health movement or
feminists and
other
bodies
has played
an
important role in moving women's concerns forward and ensuring they
are part of the agenda.
Important meetings to facilitate this
dialogue have been:
7
1986
IWHC/ Pop Council
Quality
of
Care
Contraceptive
and
the
Development
Process;
1988
IWHC
Second Tietze Symposium on the
Impact of Unwanted Pregnancy
1990
HRP WHO /IWHC
Women's
Perspectives
on
the
Selection and Introduction of
Regulation
Technologies
1992
HRP
Philippines:a♦ Vaccine meeting;
b. Asian dialogue;
1992
Pop Council
Day of Dialogue on Population
and Feminist Perspectives
1993
HRP/MoH Mexico
Contraceptive Technology
1993
ICED PrepCom
Women's Caucus (compare content
with
women's
declaration
1984 Mexico meeting).
8
of
. □-ko-do •
nUAiHA d nrAi-irr^iJoo^io
J rr X U ; X —
V
We will specifically consider what has been the outcome of this
increased dialogue on research and program policies, strategies and
implementation, and what the risks are, particularly the co-option
of language without the necessary changes.
4. What are the specific contributions of feminists to the debate?
This will be
discussed
fully
in the reproductive health
and
reproductive rights chapters, but we still think it needs to be
highlighted here. It can be presented briefly under the following
headings:
conceptual and policy
(reproductive and sexual health,
Women's Declaration on Population Policies, gender equity)
service
provision
(quality
of
care.
women-centered
perspective, awareness of coercion, safe abortion)
contraceptive research and development
methods,
involvement of womens groups
introduction
of
new
methods,
(women-controlled
in development and
safe
male
methods,
abortifacients, protection vs infection)
[Cross-reference with Reproductive Health and Reproductive Rights
chapter].
9
Di • 1 HBL
1 • *_U1 .h
9
£■. Present thinking and vision for ■fche future.1 towards a united
voice?
6.1 summarize where things are at for the women's health movement,
including the Womens Caucus at the recent PrepCom of the ICED.
6.2 The women's health movement is not monolithic,
and clearly
there are regional and other variations. Some of the controversies
and divergence within the movement are specifically centered around
issues of population, contraceptive technology and
reproductive
rights and health. We will outline some of these differences and
explore whether a majority position/common themes
emerge. Here we
will refer specifically to the Women's Declaration
on Population
Policies and Women's Alliance. We will mention other
groups, such
as many of the 'family planning'
organizations which would not
consider themselves part of the women's movement,
yet whose work
takes them in the same direction.
6.3 What are the constraints now facing the womens movement and
what are the challenges. Constraints include the resistance of the
FP establishment and others to change,
financial constraints,
institutional constraints (regional variations for example between
Africa and Latin America), sectoral bias present in allocation of
resources.
10
J
*
Future strategies to ensure that the discourse is translated into
policy and programmes may involve
reaching beyond the population
and family planning establishment, ie broadening the constituency;
presence
increasing
the
increasing
public
ins ide
awareness,
policy
and
capabilities♦
11
making
institutions;
strengthening
its
own
I
(
fa)
/-■'H li C joQ j
I. INTRODUCTION-SYNOPSIS
The issue of human rights has gained increasing prominence in recent years in a number of contexts. The
field of population and, in particular, population policy is no exception to this trend. Most current documents
dealing with population policy contain provisions on human rights or reproductive rights. Examples include
the draft conceptual framework for the 1994 Cairo population conference, the World Population Plan of
Action, the China white paper on human rights, and the UNFPA statement on human rights, etc. Despite the
presence of such provisions in these documents, there is a curious nature about the discussion of human
rights. It is often undeveloped, truncated, incomplete or simply inadequate. It suggests that more is being
left out than stated-that part of agenda is to give "lip-service" to human rights, but ultimately to reject them
as having major importance in population policy. This approach has developed in part because of the narrow
concept of population policies held by most donor organizations as well as many countries that have adopted
strong population policies. It is also the product of the historical nature of the human rights debate, which has
focussed on civil and political rights and excluded or downplayed social and economic rights and women’s
rights. The undervaluing of these rights has led to excesses in the implementation of population policies and
the widespread violation of human rights. Indeed, it may have played a significant role in the lack of success
of many population policies. An alternative approach would be to place human rights at the center of
population policies and to emphasize, in particular, social and economic rights, the empowerment of women,
and full sexual and reproductive rights for women. Such an approach could transform the essential nature of
population policies, shifting the emphasis away from lowering population growth rates by provision of
contraception toward improving the social welfare and quality of life of the whole population.
II. HUMAN RIGHTS IN EXISTING POPULATION POLICIES
A) subordinate role in many documents
B) ambiguous language-rights to choose "freely and responsibly" is limited right-further qualification by
emphasis on family and couples-cross reference to chapter on documents or treaties.
C) when a clear right asserted, it is incomplete right-only the right to use contraceptives, not the right to have
children, right to abortion, right to assisted reproduction technologies, or right to continuing care with respect
to contraceptives.
D) or rights stated in terms of long-term economic and social welfare rights, rights of future generations,
stewardship of resources-justification for denying individual rights in favor of people who do not existassumption that individual choices cannot lead to greater social welfare-subordination of concern for
immediate social welfare.
E) recent version is population rate of growth must be lowered in order to preserve the environment.
F) or use of the argument that context is all important-different religions and cultures have different
concepts of human rights-excuse for denying rights-assumes that women in some countries are less
concerned with control over their bodies as women in other countries.
G) assertion of new right, that of fetus or embryo to life—again rights of not yet existing persons are given
priority over rights of women—part of strategy of religious right, which is opposed to granting women full
sexual and reproductive rights.
III. SOURCES OF THIS APPROACH TO HUMAN RIGHTS
A) history of population policy movement-donors and countries imposing strong policies tended to view issue
in fairly narrow fashion-emphasis on family planning and contraception to lower birth rate in order to bring
about greater economic growth and improved social welfare-human rights issues peripheral to this and may,
perhaps, need to be subordinated to family planing concerns, except in so far as they converge with desire to
use contraception—in 1968 Teheran statement right is only an instrument of family planning—resort to use of
incentives and disincentives—extreme manifestation is making family planning an end in itself.
B) history of human rights debate—from the beginning a dichotomy between civil and political rights and
economic and social rights—later women rights, although in part, civil and political, also undervalued-why?—
in part conceptual, civil and political rights require no government action, social and economic do (although
can be questioned)—difference between public and private—women’s rights viewed largely as social and
economic-in part because persons creating rights documents and implementing them are men-debate also
sidetracked into east-west political struggle—question of power—cross reference to chapter of documents and
treaties.
IV. RESULTS OF THIS APPROACH TO HUMAN RIGHTS AND POPULATION POLICY
A) difference between articulation and fact—even minimal reproductive rights supposedly guaranteed are
violated-example of Population Conference in Romania held during time of extreme pro-natalist policies
B) human rights excesses of all sorts-women became instrument of population policy-violation of bodily
integrity-forced sterilizations and abortions-abuse of incentives-psychological coercion.
C) also reinforces authoritarian and non-democratic view of society-individuals cannot be trusted-women as
subordinate—maintains status quo-exploration of proposition of whether even if successful in achieving social
and economic welfare, is it worth the price.
D) moreover, many population policies embodying this approach have not had great success-in many places
not much modification of population growth rate-also insufficient realization of long term economic and
social development goals-impoverishment of many developing countries, despite some lowering of birth
rate-India as example.
E) exploration of possibility that this approach to human rights has in fact significantly contributed to the
failure of population policies.
V. ALTERNATIVE WAY OF VIEWING HUMAN RIGHTS IN POPULATION POLICY
A) Is there some way that enlarged concept of human rights could be incorporated into population policy to
avoid these outcomes-way in which human rights in fact transforms whole concept of population policy?
B) emphasis on real and full reproductive rights for women.
1) right not to have children—includes safe abortion services—wide range of contraceptive choice—information
and education-no coercion of any kind-no incentives-right not to be experimented on with respect to new
technologies, without informed consent—treatment for complications from contraception—no subordination
to interests of others.
2) right not to be prevented from having children—access to assisted reproduction and fertility treatment.
C) sexual rights—comprehensive sexual and reproductive health care—right to treatment for and protection
from sexually transmitted diseases—right to be free from sexual and domestic violence—right to free
expression of sexuality.
D) other social and economic rights for women—education—marriage—relations with children—property—
n
i
social security—maternity benefits—employment—housing, etc.
E) attention more on alleviating problems of poverty-unequal distribution of material and social resources-
F) rights in immigration-fact that women's issues ignored in dealing with immigrants and refugees.
G) source documents are CEDAW and women's statement on population policies.
H) benefits of this approach-tries to bridge gap between social and economic rights and political and civil
rights-doesn't devalue the individual at the expense of society as a whole, yet sees the individual asserting
own rights as contributing to general welfare-democratic and unauthoritarian-focuses directly on the end
results improved economic and social welfare, rather than as means to those ends-is in itself a good-avoids
all the excesses of narrow efforts on family planning-makes the idea of population much more than affecting
fertility, expands to idea of quality of life and social well-being .
I) also, if one accepts the premise that lowering the rate of population growth does lead to improved social
and economic welfare, there is some evidence that adopting this approach leads to lowered fertility-examples
of women's education, Sri Lanka, Kerala.
V. IMPLEMENTATION AND ENFORCEMENT
A) difficulties—intractable vested.interests-requires governments to act on a broad spectrum of issues-men
are largely in control and have little interest in moving on women's issues-opposed by prevailing
international phenomena of "structural adjustment," social conservatism, religious fundamentalism,
patriarchal notions of the family
B) strategies, use CEDAW, although difficulties here because of lack of enforcement mechanisms.
C) efforts at organization-feminist community-sympathetic governments such as in Scandinavia-creation of
human rights groups specifically concerned with this issue, i.e. Center for reproductive Rights-influencing
mainline human rights organizations about women's issues and reproductive rights
D) law as instrument of change-enforcement of legislation, including constitutions, that guarantee women
equal rights
4
//
.rvy
. I
DRAFT/MAY 18, 1993
’’Population Re-Considered: Health, Empowerment and Rights II
edited by Gita Sen, Adrienne Germain and Lincoln Chen
Rethinking the Concept of Reproductive Health
or
Setting a New Agenda:
Expanding the Concept of Reproductive Health
or
a title that includes Sexual Health?
by
Adrienne Germain, Sia Nowrojee and Hnin Hnin Pyne
OUTLINE
la
INTRODUCTION
A.
The conditions we face:
1.
Broad Context of Social Relations & Social Policy: Women are
not always able to control the circumstances under which
they have sex in their intimate relationships, and are not
supported by existing social institutions.
Gender power
imbalances are a health hazard and an infringement of human
rights.
Discrimination against women and girls (including a
mention/analysis of class and race). Cross reference:
empowerment and rights papers.
2.
Services: Fragmented health programs that do not address
women's needs well enough, by their nature do not attract
men, and fail to address the complexities of sexuality and
gender.
Cross-reference: Iain Aitkins paper.
1
B.
Purpose of Papar/Map
This paper will explore the necessity/ possibilities and ways of
shifting to support women's rights and enhance male
responsibility, in order to achieve mutually caring, respectful
and responsible sexual relationships.
We will do this through a
description and analysis of the current state of women's
reproductive health, as well as a discussion of the impact of
gender prescribed behaviors and institutions on women's health;
an analysis of how the population field has defined and responded
to reproductive health challenges; a description of recent
efforts to broaden the scope of the field and responses to those
efforts; and finally we will conclude with our recommendations/
vision for the field.
II.
CURRENT STATE OF WOMEN'S REPRODUCTIVE HEALTH <& MEN'S?)
A.
The Problom/Quantitative Picture:
1.
General sexual and reproductive health statistics (all
ages, range of issues).
Be explicit aabout
lack/inadequacies in data.
2.
General data on sex differentials in:
access to health care (eg. Bangladesh case study)
investment in research (eg. contraceptive research has
an unbalanced focus on women, AIDS and cancer research
have an unbalanced focus on men).
2
, □-10-J6 ;i2-idr.M ; i.ml nv.viiL.\ d ntALin-
oc_\i oi’innc
017 4hJO 0227;- 6/14
Develop tables for this section?
B.
Social Relations & Social Policy: How women's sexuality is
controlled and their health endangered by;
1.
Men they have relationships with;
2.
The power relations implicit in male-dominated
institutions which do not see or act according to
women's realities.
(Male behavior, violence, harmful
practices - which women also participate in - including
the kind of sexual encounter),
Cross reference: Rights
paper and Adams/Castle (power relationships between
women).
To make the case that gender and sexuality must be addressed as
central to reproductive and sexual health, this section will
address the following kinds of questions:
How does gender-based behavior (such as violence or control
over decision-making) affect contraceptive choice and use?
What impact do these behaviors have on protective efficacy
of methods?
How much do male behavior and cultural norms related to
sexuality and gender place women at risk of infection?
How much do cultural practices and norms around sexuality
affect women's sexuality and health?
3
- •
Case Study: to give this section a human face/"How gender impacts
Women's Health,,?
III. APPROACHES TO POPULATION & HEALTH POLICIES TO DATS
A.
How the field has defined the problems and solutions:
1.
1950's-60's! defined too many people as the problem.
2.
1960's-70's: created technology which targeted women's
fertility (but not their health), and circumvented male
behavior and responsibility.
3.
1970'5*80'3:
built family planning delivery systems (= women's
fertility control) primarily for married women of
reproductive age;
Emphasis on numbers: concepts of "acceptors,” "unmet
need," "high risk," "couple-year-protection, " "births
averted" restrict program ability to meet reproductive
health needs (cross reference Jain and Bruce paper);
B.
Ralated health policies (1970's-fiO's):
STD programs for sex workers and men. not women in the
general population;
MCH programs that ignore mothers.
4
LJ 1 • l
IL.
IV.
BROADENING THE FIELD: EFFORTS TO ADDRESS REPRODUCTIVE HEALTH
A-
While many of the above ideas continue to determine how
population policies and programs are developed, in recent
years there have been efforts to more broadly define the
problem and the solutions in terms of reproductive, and aven
sexual/ health.
(NB: This section will be augmented by our
list of examples/case studies regarding each topic).
1-
Improving Family Planning Services
1980
Bruce: user perspective
1986
Germain paper for Conference on Better Health for
Women & Children through FP (first draft of what
became BTS)
2.
1987
Ebert program established
1989
Quality of Care
1991
Creating Common Ground
1992
World Bank Best Practices paper on Family planning
1993
Mexico City contraception meeting; HRP
Reproductive Health vs. Fertility Control
1980
Bangladesh Women's Health Coalition founded
1987
Balancing the Scales (IWHC)
1980's
PAISM proposed in Brazil
1991
Reproductive Health: A Strategy for the 1990's
(Ford Foundation)
5
1993
World Bank Best Practices paper on Women & Health;
Papers submitted by delegations to 2nd Prep Com
for ICPD
3.
Beproductive and Sexual Health (inclading gender)
1992
IWHC Barbados consultation on RTIs, sexuality &
gender; IPPF Vision 2000 broadens agenda to focus
on ’’sexual health"
1992
PAHO begins incorporating gender as a variable
into health and development projects
1993
Women's Declaration. Cross reference: GarciaMoreno and Claro.
4.
Safe Motherhood Initiative (1987)
Refined to include morbidity, not just mortality
(Royston)
5.
Incorporating STDs/AIDS Prevention into Family Planning
1988
IPPF, AIDS Prevention Unit, begins integrating
STD/AIDS in FP programs and addressing sexuality.
1990
WHO World AIDS Day: Women and AIDS. Advocacy on
women and AIDS begins or begins to get attention
from the field.
1991-2
IWHC Bellagio conference on RTIs and Plenum book
Others
PAHO, CPO, CFPC and others' experiences with
integrating services; Marie Stopes AIDS programes
6
SENT BYHIVHC
; 5-18-93 ;12:15PM ; INTL WOMEN ’S HEALTH-
617 496 3227:# 9/14
in 7 countries.
6.
Broadening recipient base (men, adolescents)•
1986
Men: A New focus for Family Planning Programs,
Population Reports, November/December.
1987
Marie Stopes male involvement FP/STD education and
service program in Swaziland.
1988
IPPF begins working with youth and men; Thailand.
1990
Condoms: Now More than Ever, Population Reports,
September
1991
IPPF 8 country program review of male
participation in family planning in Africa
1992
IPPF youth program review (Kenya, Ethiopia);
vasectomy: New Opportunities, Population Reports,
March; Marie Stopes projects with youth/men in
Malawi, sierra Leone and Kenya; ECOS discussions
with young men; AVSC.
1993
Nordic seminar on reproductive health of
adolescents.
These strategies defined by parameters set by existing services,
budgets and personnel.
7
B,
Responses - Resistance and Advocacy:
1.
Resistance from population Field; Too expensive, cumbersome
(staff training, overload, etc), medical barriers to
contraceptive access, ’’diverts" population resources, vs.
Jain on continuation rates, contraceptive choice.
Cross
reference: Bruce & Jain paper; Zeidenstein, 1979 (on file).
2.
Rhetoric and Reality: Use of ’’reproductive health” concept
and language, without necessarily changing practices.
Cross-reference: finance paper - compare language (more of a
focus on ’’reproductive health”) and expenditures (usually
biased towards family planning).
3.
Advocacy:
Rise of women's health movement (cross-reference:
Claro and Garcia Moreno), growing documentation of gender
based violence (Heise, Germain, Pitanguy). Contraceptive
development, Progress in appointing/incorporating women.
This advocacy also contributed to many of the changes
described in the section above. (Examine 1974 and 1984 World
Plans of Action?)
4.
Government positions: in 2nd Prep Com for ICPD
8
4
V.
SETTING A NEW AGENDA FOR THE FUTURE
In order to change the balance from male entitlement and women's
responsibility to mutual responsibility and respect, we must
promote women's rights and male responsibility.
Given both
momentum for change implied in recent experience, as well as
seemingly intractable problems (maternal death, botched
abortions, AIDS), a broader definition and strategies are needed
to ensure reproductive health, wellbeing and rights, through:
1.
Improved and integrated services (but no cookie cutter):
This requires going beyond the specific reproductive health
strategies described in Section IV, to focus on sexuality
and gender as central issues in women' s health (and develop,
replicate, augment - depends what we find out about existing
w
programs).
2.
Additionally, we need to create a context in which
reproductive and sexual health services can exist and be
successful.
This means going beyond services to address
social relations & social policy and empowerment: Women's
entitlement, male responsibility.
There are efforts being
made in these> directions (include 2nd Prep Com statements).
Also address discrimination (cross reference
empowerment/rights section) and human rights (cross
reference rights papers).
9
I • 1 Hl 1\_
Specifically, we already know that the field needs to address the
following issues:
The difficulties/dilemmas/resistance encountered in
implementing existing health and population programs and
policies that are trying to improve services (eg. BWHC,
IPPF, PATSM, talk to Judith Holzner, look into Tanzania
project, other papers from NGO form panels at 2nd Prep Com) .
Existing and new male programs (to involve men in health
services which impact women, like STD services; male
responsibility and support for women' s health services and
practices; emphasis in FP programs on condoms and vasectomy)
must begin to address gender.
Adolescents programs should address the sexual and
reproductive health needs of adolescents through sexuality
and gender education, and services (Cross-reference: Kirstan
Hawkins).
STD/AIDS prevention should focus on the health and wellbeing
of individuals rather than on technological fixes.
transmission of virus from ’’high risk” groups to general
population, etc.
safe motherhood and related programs, should be improved to
10
i
focus on women and include safe abortion.
The Vision:
Mutually pleasurable, equitable, caring, responsible and healthy
sexual and gender relationships.
We aspire to redefine the
provision and outcome of population programs to include
comprehensive reproductive and sexual health services that
address/provide the following:
Health counseling and education on all services.
Fully voluntary birth control by individuals (a full
range of contraceptive methods and safe abortion)}
services related to pregnancy (pre- and post-natal
care, nutrition, safe birthing, child health);
RTI prevention, screening and diagnosis and treatment;
GYN care (screening, pap smears, breast and cervical
cancer)
Services that address the changing needs of women
throughout the lifecycle (adolescents, women of
11 reproductive age” and beyond, married and unmarried
women, etc.)
11
I
Sexuality and gender information, education and
counseling and other actions to address a broad range
of issues ranging from violence to consciousness
raising and support for women and men.
Referral systems for other health problems.
This approach differs from most existing services/systems that
address reproductive health, in that it is comprehensive (both in
services and in reach), and includes sexuality and gender as
central issues.
Cross-reference: Iain Aitkin (life cycle
approach) and Kirstan Hawkins (sexuality and gender are central).
While ambitious, it is ultimately necessary to ensure the health
and rights of women and men.
Achievement of this comprehensive
agenda will necessarily be pursued in different ways depending on
local circumstances, etc.
12
X
Paper Outline 23/5/1993
i vi h h : G .■ \ i
SEDA Volume: Human Rights, Women’s Emoowi
it and Reproductive Health; Population
I,
edited
by
Sen
G.
,
Germain
A.
,and Chen L.
Policies Reconsid
Adolescent Sexual and Reproductive Health
Programme and policy implications
by
Kirstan Hawkins (Meshesha B, Todsai J, Aguilar, J. to be confirmed)
I
Introduction
In this paper adolescents or youth are addressed as a specific group regarding sexual and
reproductive health needs. Ideally specific needs according to age or social circumstance
should be addressed as part of the life cycle of human sexual and reproductive health. The
paper does not seek to find a universal definition of "adolescence", but rather address the
needs of young people in the context of their exclusion from current sendees and the complex
of social contradictions surrounding young people and sexuality.
The issue of adolescent sexuality is highly controversial and complex. In many societies it can
be argued that a period of adolescence does not exist with young people passing from a state
of childhood to adulthood marked only by rites of passage. However for many young people
the traditional means of education and initiation into sexual relations has been fragmented or
eroded due to changing social structures, especially through rapid urbanisation. At the same
time many young people find themselves in a semi-autonomous state often separated from the
traditional support structures of family or kin (either geographically or through conflicting
value systems), and yet without the means or opportunities to achieve true autonomy or
independence. This paper therefore focuses on the sexual and reproductive health needs of
young people caught in processes of economic, social and cultural conflict.
The first section of the paper provides a critical overview of how family planning
programmes have viewed and dealt with the issue of young people and liexuality. The section
looks briefly at the failing of family planning services, and educational programmes such as
Family Life Education (FLE) and Population Education to meet the real needs of youth.
Where the needs of young people have been addressed they have largely been defined from
the outside, focusing on negative demographic, epidemiological and social consequences of
adolescent fertility and early child bearing. The consequences of failing to provide the right
kind on information and services is that many young people are entering their first sexual
initiation in situations of high risk, including, unprotected sex and abusive and exploitative
relations.
The second section provides an analysis of some of the socio-cultural and political contexts
within which young people become initiated into their first sexual contacts. This section raises
the question of how young people themselves are defining and experiencing the issues and
problems, and the section argues that the central concerns of young people themselves are
framed within the expression of gender and power relations in their own experiences of
sexuality.
1
Section three focuses on experiences from the field to discuss how some programmes are
focusing on working with young people through sexuality education and the provision of
sexual and reproductive health care services. One of the main lessons learned from these
programmes is that providing young people with the means to explore and understand their
own feelings and experiences around sexuality does not increase sexual activity. Rather it
appears to have the reverse effect in enabling young people to determine their own relations
and ultimately have positive and safer sexual experience.
The fourth section briefly summarises some of the main elements of successful programmatic
approaches, and the final section draws out some of the policy implications of these
experiences.
II
Critical review of how the issue has been dealt with within the population and
family planning field.
This section provides a critical overview of some of the approaches to adolescent sexual and
reproductive health in the field of population and family planning. The section will begin by
critically reviewing the term "family planning" in relation to the needs of the young and
unmarried. Within the family planning field there has been a gradual shift in discourse away
from "population targets" to addressing the rights of all people (regardless of culture, class,
age and gender) to sexual and reproductive health care.
Despite this many young people are denied access to services either on the basis of negative
national policy or the policy of service providers themselves, often with a proviso that a
young, unmarried, sexually active women will only be provided with contraceptive services
once she has proven her fertility. The exclusion of young men and women from services on
these grounds should now be addressed as a human rights issue within the framework of
sexual and reproductive rights (cross reference Reed Boland paper).
Where youth have been addressed in education programmes those approaches that have been
deemed acceptable have largely ignored the underlying issues and concerns of youth
themselves. The two main approaches have been:
Family Life Education: This has largely been taught through the formal school sector at
secondary level. Many young people tn developing countries will have already dropped out
of the school system by the time the FLE curricula is taught. Even for those remaining in
school there is no evidence that FLE has any impact on attitudes or behaviour relating to
sexuality. Rather, most FLE programmes are aimed at imparting a moral view on young
people and is integrated into subject areas such as home economics and biology which
reinforce current gender stereotypes and "normative values", which do not however reflect
the actual experiences of many young people themselves.
Population Education which has been supported by bi-lateral agencies such as UNESCO and
UNFPA. Population education is largely integrated in subject areas such as geography,
biology and environmental studies, aimed at raising awareness of students to issues
concerning population, without addressing any issues related to sexuality and individual
emotion and experience.
2
m
^alysis of socio-cultural dimensions of adolescent sexuality within the context
or gender and power relations.
their initiation into sexual knowledge and experience.This section will begin by raising
questions around normative statements concerning culture, youth and sexuality, and highlight
the contradictory nature of the messages received by young people concerning sexuality In
many cultures early sexual activity is still sanctioned through early marriage, with legitimate
sexual initiation occurring at puberty. However sexual activity outside marriage is often
denied and the provision of sexual education to young people is seen as a threat to a moral
order, and seen to encourage unsanctioned sexual activity.
The section will argue that the dominant ideology of cultural norm relating to sexuality does
not necessarily reflect the lived reality of many sections of society. Many young people
receive most of their sexual education through knowledge imparted from peers and from the
media. These include conflicting images such as the ideal of romantic love, at the same time
as portraying and legitimising exploitative and abusive relations in pornographic media which
is easily accessible to youth in most cultures. Youth are not just passive recipients of culture
and social meaning, but rather through the creation of youth popular culture, young people
give their own legitimation to feelings and desires of sexuality which may not be sanctioned
by traditional cultural practices and structures. At the same time the moral statements of
parents and teachers concerning sexuality, conflict with the reality of sexual culture as young
people expenence it around them. Conflicting messages include examples such as; fathers
initiating sons into sexual experience through sex with prostitutes, young women’s sexual
initiation through exploitation of sugar daddies, rape or incest. In these contexts sexuality
becomes inseparable from the underlying gender and power relations. In their own attitudes
and sub-culture young people may reflect back to each other societal and gender
contradictions, for example with the pressure among peers to enter sexual relations, and for
young women to prove their fertility at the same time as a high value being placed on a
woman’s virginity until marriage. Although the AIDS crisis has provided an opening for
education programmes to youth and HIV education has increased young people’s awareness
of condoms this lies in contradiction to the lack of available services and information on
sexual health. These negative social attitudes feed into negative meanings that young people
themselves create around condom use, for example, young men may see condoms as means
to protect themselves against HIV and thus categorise women into "girl friends" and therefore
safe, and "prostitutes" and therefore unsafe. Young women, alternatively, may feel that if
a young man uses a condom with her he is treating her as if she were a prostitute.
BOXES; This section will use some boxes for relevant quotes and field examples.
The family planning field has on the whole failed to address these central issues of gender,
power and control in relation to young people’s sexuality. Exploring these issues with young
people themselves may raise some of the very contradictory attitudes and statements on which
the balance of gender and power relations are based. Addressing the issue of individual
control over sexuality therefore challenges many deeper layers of societal control in gender,
class and economic relations.
3
IV
Programme examples of innovative programmes addressing sexual health needs
of young people.
However, there are innovative programmes in the field which are addressing these issues with
young people through providing programmes which have a central focus on sexuality
education and the provision of sexual and reproductive health care services. Exploring
feelings and attitudes towards sexuality from the perspective and experience of young people
themselves is the core of these adolescent programmes.
Programme Examples
BOX 1- MEXFAM / Community based peer education programme, with a focus on
participatory education. Peer to peer distribution of condoms and education, parent/youth
discussion groups.
BOX 2- ETHIOPIA reproductive health and youth counselling services.
School based programme.
Youth counselling and clinic services
Other examples: Guatemala, Colombia, Kenya, Zimbabwe, and Tanzania,
This section will consider some of the major strengths and constraints faced by these
programmes. It will also look at questions such as; who should convey information, parental
involvement, where should services be located, age at which sex education has effectively
been introduced, emphasis on sex and gender education (cross reference Germain et al), and
examples of positive effects of early sex education programmes.
V
eIemeDtS °f Pr°eranunes addressing youth sexual and reproductive
This section will look at the issues of replication and expansion of successful programmes.
Although responsiveness to the specific socio-cultural environment is crucial, successful
programmes are often those that challenge the existing statements concerning cultural norms
whilst reflecting and responding to the underlying cultural realities of sexuality.
Although there is no blueprint or formula for a model programme that can be replicated in
all environments, there are certain key elements that can be seen to be essential for successful
programmes. These elements will be discussed and it will be argued that these should form
the basis for programme development, as well as funding and evaluation criteria. These
include:
-Youth participation at all stages of programme development
-Listening to young people’s concerns
-Responsiveness to the needs of youth: especially gender related needs.
-Provision of contraceptive services with education and counselling to ensure
quality of care.
-Thorough understanding of the actual means through which young people learn about
sexuality
4
J
51
>
-Ensuring the provision of options that will be followed up with the appropriate
service and care.
-^rtici^tory education starting from the reality of young people’s experiences
-Non-judgemental attitudes of staff
-Training of youth workers based on understanding their own attitudes to sexuality
-Flexibility and adaptability in programme approaches.
-Outreach approaches to enable programmes to meet young people on their own
terms.
-Adequate referral networks to ensure young people have access to services they
need, e.g menstrual regulation, post-coital contraception etc.
Policy implications of analysis and lessons from the field.
This section will look at some of the main policy implications of these experiences from the
field:
*
At the level of international and donor agencies the main question raised is how policy
relating to young people’s sexual and reproductive health needs will be translated into
action at the programme level. This raises the major question of the accountability of
agencies to demonstrate that discourse is reflected in practice. (Cross reference
Germain paper)
Major donors and bilateral agencies should be placing an emphasis on sexuality
(including gender) awareness in policy formation. This should be reflected in
education programmes and health care services, as opposed to concentrating on
approaches such as population education.
There is a need for the systematic documentation and evaluation of programme efforts
in the field of youth. One of the main questions raised here will be what are the
desired outcomes and how should they be evaluated? Outcomes of youth programmes
based on the elements reviewed in the previous section need to be evaluated by a
wider set of qualitative criteria, than the standard quantitative measures of family
planning programmes. In order to adequately document and evaluate projects
programme objectives need to be well specified. Outcomes need to be formulated
along new criteria pertaining to equitable, non-expioitative relations and safer sexual
practice.
*
*
Donor agencies need to develop specific funding criteria for programmes in the field
of youth based on the experiences of those programmes which are directly addressing
the needs of young people and that young people should be involved at all stages of
programme development.
The question of programme sustainability and continuity is crucial in the field of
youth programming. Donor agencies need to look at the means for sustaining pilot
programmes beyond a three year pilot funding stage to enable successfully piloted
approaches to achieve their potential coverage and impact.
5
T
v'vnf~'aS~a conteiibei rot uivrupSin the state administration
I
remained a mere formality.
| li, Lakshadweep an'
’ondicheny.
•I-
————■
54 •F
3
•Ttp
0
r nv VaHcMii cross swords over' abortion[
bv health personnel who say if the Vatican
'B1.
Mexico Cits in 1984. the final’declaration
^idabomon should not be promoted as af
method of family planning
i
........... ......................
by Chitra Subramaniam
GENEVA
, ^ weekly addres ,i St Peter’s Square in
r
HE quarrel between the United
'
Nationsand the Vatican over birth
. . control has come out into the open
as the world body prepares for the
population conference to be held in fair
next September
Rome
The Vatican, backed by several Latin
American states, has blocked an
agreement at a preparatory meeting in
New York. The meeting, which was to
agree on key points of this plan, was the
last before the Cairo conference on
‘ The Vatican has taken very
objection to proposals - backed y
United States - which will include
TSSSSSSS
Il ^HEDONIST’' CULTURE: Pope John
I iWnhascni.: >ed the plan saymg
^rtinn was a threat to family life. It is
'ggg.V.n ever to reactagamst^
reproductive health care services,
10 ThlTeco^ disagreement is over the
concept of safe motherhood - shoul^^al
include safe abortion when a woman hf
Out of the 189 countries headin<for
( -liro 172 allow abortion in some form
'bni because of the Vancan's opposition
power in the world, clauses referring
rondoms. family planning and salt ,
motherhood have been "bracketed meaning there is no ^reement on them.
^Vatican's nght to "impose on the
secular world its religious dogma on
Contraception and family planning. We
denounce position that contee: dogma
faith and religion with politics, health an
human rights,” said the groups
^presenting NGOs from
Latin Amenca. Europe and the U
Guatemala, CosmR.ca, Ecuador and to a
“SSXSSft
abort.on
PRoma°n„ etholic
Cathobc Church opposes ap.
as well as artificial means of birth control.
As the controversy gains in
sss?«gr
outh^ng^mn un
famUy
planning to married couples.
At the last population conference in
Ue k;ut t.f Aorld population p^-. ^me,
that included promotion of abortion.
The Clinton administration has reverse^
that position and announced it will spend
5x7million this vear for population issues,
an iXse of 50% over lastjyear. One of
th.- coals of the US administration is to
.ns Severs -o.nan has access to safe
X lepuon by rhe turn of th>s century
Ibemmof the Cairo conference >s to
formulate a 20-year
57
concerted
, the L by the m.ddleofof
mc “ase toaction
12.5 billion
(he next century
: .
1S Andfoally, alarm bells have been rung
1 -
E st
% p-
cr ipi
r
fe-’
i
I
‘■"Pact Anahsis of the Women’s Caucus at ICPD
f
HepCoin III on the Draft Final Document of the ( onferenu
r
Prepared by
Enyuon.ne,,, and I^elop.nent Organaudon (WEIX),
^fuy, 1994
t
nan ach^ement^ but also to highlight parts of the Women’s Caucus agenda h^re
'
nU'
Ti,‘U‘On preSen!ed
^Ito Women s Caucus pa^E nd J ^e^
'• h^‘l
of us tn Cairo and beyond. This document should be used in r„,d
,/fws"^ effective strategies for the critical work that lies ahead
o.
erM T,„ ofll„
„ra/, Fml /4ram,(
!
-.....
| >
Introductory Notes.
XZk'aS'o.^’“h'CaUC“S a'"e"d“lc,1,s
nicy appear (or would appear).
r
d,„|utb
Jq
DocuniuiH paragiaph in vdnJi
C olumn 2 provides the amendment as suggested by the Wom<-n\ r,
4 Nd.™
F I'
& ;
<o the Draft t otal
f i
<•
mic„d,„e,^^ .....
' .... ..
I Drat. Contptlauott of Poised Revisions (prior to PrepCtmt III)
-> > nortty Amendments (first days of PrepCom III)
■J Amendments to the Chairman's Draft (throughout PrepCom III)
4) ( omments on the Draft Final Document Ilan- PrepCom III)
< oluinn 3 describes the status ol the amendment: exnet
language i.ikun, conccpi taken, HI'I l.ikcll, Clt
(Ituins not taken" arc suggestive ol the limits ol the
curieiii political situation.)
Column 4 shows the status ol the negotiations wheihri it
. . ,
"..ndinc t.i. it i.tKcn, has been agreed upon oi
whcilici ii will lx- discussed hntlici n ih • C ’
mussed Imthei at the Cairo mctimg and currently exists as-bracketed text
B
i
E
%
1
ia
i
U-
os
CP
f
HI
VJ
>15-
I
Impact Analysis of (lie Women’s
/
aicus at It PI) PrepCoin III on the Draft . .aal Doc uinent of the t’oiifci viicc
!
II
Chapter I
■
PREAMB1J-.
Paiagraph in
Draft 1’inal Doc
Women s Caucus Suggested Amendmem*
Status in the Di.th
Pinal Document
IJ
(delete: unprecedented growth in human numbers, widespread and |)cisis(ciii poverty...)1 ’
not taken
...within and between nations which result from unsustainable growth models of development and
inequitable trading atrangements; and which give rise to...and unsustainable patterns of production.. 1
not taken
H'5
1.8
(delete; reproductive health care) family planning services and contraceptive supplies
112
Structural adjustment programs have led to severe reductions in and deterioration ol services most critical !
to human welfare-including important health, education and socio-economic inlrastruciure-and have had |
particularly adverse consequences on women. International commitment is necessary to ensure the
|
12
allocation of the proceeds of demilitarization toward human development.12
i
II
Status »•! the
Segolialh >ns
not taken
!
I
I
concept taken, but
very weak i "• • nl\
designed stiuviutal
adjustment
programs.. “)
1.14
Everywhere, many women sutler from overwork, the oppressive burden of gender relations, and
inadequate recognition ot their work burdens, or of their economic and stxjial contributions to households,
communities and nations.12
not taken
1.15
■ ■.poverty, sex discrimination and violence against women...and inequitable distribution...1,2
not taken
1.18
.. .comprehensive...12
not taken
1.9
. ..must emphasize male responsibility for family planning and prevention of STDs and AIDS, must
promote women’s effective access to fertility regulation and their ability to negotiate xuality,
reproductive health, and prevention of STDs and AIDs with their partners..
not taken
JgI Cud
ii
•J
ir
g--
•Source:
- Women's Caucus Drati Compilation ol Proposed Revisions on (he Draft Programme ol Action of the ICPD
- Women's Caucus Priority A"iendinents to the Drati Programme ot Action ot the ICPD
" - Women's Caucus Amendments to the Chairman’s Draft of Working Groups I A 2
- WornerTs Caucus Commcni£_on_Drafi Emal Ddcument ol the Conference
'■
Impact /Knulysis ot (lie Wonn- C
aliens al K 1'1) 1'iepCoin III on the Dra(
i
I'inal Document of the Conference
-
Chapter IJ
PRINCIPLES
y Paragraph m '
I Draft I'inal Doe
-J--------------------------
_
»• 1.'*
.Minus in the Di. It
Iflnat Document
Status nt the
Advancing gender equity and c
empowerment of women is a corner >stone ot development and
populatioibrelated programs. Women
- ....J and
men have the equal right
l to participate fully in policy and
decision making at all levels.I-M
ejact language taken
.1 greed
Care should be taken to
t ‘include at all levels and stages women experienced in the gender dimension of
policies and closely linked
-J to women who are affected by such programs.1 J4
I
npt taken
Principle 4
...and is subject to international human rights and other standards.'•J
nl( taken
Principle 5
Sustainable development as a means to ensure human well-being.. .
Principle 3
■ I
1
tv
• y
Women's Caucus Suggested AiNcndineiit*
I
! II
\cgi •nations
II
iii
-
npt taken
.equitably shared by all people today and in the future..."
ctinccpt taken
1' '
in brackets
uQt taken
Principle 6
-...... --- —
Principle 7
■F
not taken
hveryone has the right to liberty n-d security of person.'
exact language taken
agreed
exact language taken
agreed
exact language taken
agreed
all couples and individuals...
..and to have the information, education, and means to do so...1
that men and women share equally the...'
not taken
• t*
J
> i;
^Source:
- Women’s Caucus Draft Compilation <of Proposed Revisions on the Draft Programme of Action of the ICPD
' - Women’s Caucus Priority AmendmentsS to the Dr-I’l Programme of Action of the ICPD
- Women's Caucus Amendments m the Chairman’s Draft ot Working Group- ' & 2
Women’s Caucus Comments on Draft I'inal Document ot the ('onferencc
•,:l
! i
i
:
I 21
Ycl millions ol people will remain unable io assume (his responsibility as long
as they ale dcr.icd
livelihoods and basic human lights. Policy initiatives need to be based on a i
coinniiiinctit io cquilablc
economic and social development, environmental sustainability, aikl the objective
ol democracy and liumaii
lights tor till women and men...1 '
I
|
:
■
!
’f|
noi lakcii
i i
I
li
I
i
I-
.i
Ui
li
I hi. li i idll II
4.
il
•Source
> ‘
t
|||
11 te
oinen s < aucus Pratt Compilation of Proposed Revisions on the Draft Programme ol Action ol the ICPD
Women's Caucus Priority Amendments to the Draff Programme of Action of the ICPD
Women’s Caucus Amendments to the Chairman’s Draft of Working Groups I A 2
Women’s Caucus Comments on Draft Final Document of the (' 'iiference
-7
!
I
pl!
r
Pl llkiplc 9
Principle .5
a-—-
'f
and to adequately take mm .ccount the intericlatlonship of population
issues with respeci io people
and theii well being ‘
in>i Liken
Women and men have the light to the lullest possible range of rcproduciive health, information.
and
services
concept taken
•Wd ac.ess (O (he wulcM possible range
services, including sale allordahle aborrurns and
I icvciition and ticaimcni of sexually tiansmiiied diseases including IIIV/AIDS
not taken
I
l abilities and seivicc.s lot women should be wonicn-centercd,
women-managed, and women
coiHiolled.:
I t
not taken
in all ns divcisc fonus.
.U
not taken
All rncn and worncir have dre rrglu n> benctn from advances in leclmology and knowledge. Research
technology and knowledge
and developmem of reproductive health te oologies should be directed to methods which advance
women s health and control as well as male use and responsibility, and intjrnded users should be
integrated as policymakers at every stage of the design, development, and testing process. '
Principle Hl
i in bravkelsi
■ P>
concept taken in
modified form i "while
vai ious concepts of the
family exist” i
If*
agiced
(delete: which is the natural)
Principle I I
agreed
(delete: b\ both parents)1 2
■ all forms of abuse including...violence...12
Principle 13
lite guiding principle of population and development activities with icspect to indigenous comnmmiies
must be lull recognition of the perspectives and needs
indigenous |>eoples receive population and
development-related seivices which they deem socially and culturally appropriate 1
!
i
•Source:
Women’s Caucus Draft Compilation of Proposed Revisions on the Draft Programme of A
Women’s Caucus Priority Amendments to the Draft Programme ol Auinm of the ICPD
Women s Caucus Amendments to the Chairman’s Draft of Working Croups I & 2
Women’s Caucus Comments on Draft Final Document of the Conference
ion of the K’Pl)
taken
agreed
concept taken
agreed
concept taken
agreed
_____
Principle i >
n,L ‘ ‘•""••"‘'■.n ........ Slums .
mtciuaiioiial uommiiniciits and icsolvc
.,ln| lhc ,c|.lled p, 1|llul|s
as major expressions ol
but must not discinmnaie on the basis ol gcndci. marital status sexual
oiiciii.mon,
ichgion
paiticulaily women and girls
■.
Insert new paid
LOliuCpI l.tklll
pi
4
Jlld ^'"det based discrimmalioit
as aa basis tor seeking asylum. '
m must
must be
he tegatdud
legaidcd as
Universal ratification, removal of inconsistent rese^anons and implementation ot the Convention oi.
the Elimination of All Forms ol IDiscrimination Against Women is essential to ensuring gender
equality and the empowerment otI women and to the success ol population and development progb.m,.
noi
lakcn
noi
lakcn
1
•
•
i
:■
i
not taken
not taken
u",UNCn grLSl. WO"‘CI,1 ii> ‘‘
womeirs human rights and dignity. States should implement
the UN Declaration on the Elimination of Violence Against Women.
not taken
Imertutimtal and ttammal actions should address the needs lor households fuel, clean ...Her sanitation
and child care tacihlies wheie appropriate to alleviate women's special burdens.
not taken
* Soul >_c.
i
Women’s Caucus Draft Compilation ot Proposed Revisions on (’
the Dralt Programme o| Anion ot the i('PI)
Women's Caucus Priority Amendments io (he Dr.ifi Programme ol Action oTthv |( p|i
Women s Caucus Amendments to iliv ('liairman's
.................. ' Draft ol Working Croups I A
WtwttiVt-’tttrrwr Vommrtns
Dtyrlt Fi n.d Dovumcni oCthc^ContcTence^
I .o’iced
1
Li
■-1
liiipuct Analvsis ot the Womei
c aucus at ICPI) PrepCom III on the DriSl’inal !)<.<mneiit of the Conference
If i | w
Chapter III
A
g
i
• hi
............ SSffiHs ...........
Paiagtaph in Draft
Final Dot
Women’s Caucu.s Suggcsicd Amcndmuiu*
rule
ldelete; SUST/MNliD hCONOMIC GROW I H). .FNVIRONMI N P.. EQUITABLE
I
1
Status m the Df.tH
Hnal Document
i
Status ol the
Negotiations
#
not [akun
|
■■
|
inequitable distnbu(i<>n of resources...unfair global trade‘
V2
iuh taken
3.7
(delete p^ras 3.2
r?)’
not taken
3.B Subtitle. .<15
3 16
(delete: sustained economic growth) equitable sustainable development1 ’
not taken
3.H
j
If’
.and children
J..
1
1'1
'r
taken
agreed
aS
h
M’
i
:I
'’I®'.1
. : . HA
*SoUIec
Women s Caucus Draft CoinpHatmn of Proposed Revisions on the Draft Pofgrammr of Action ot the ICPD
omen s Cautus I norny Amendments to the Draft Programme of Action oCthe ICPD
women > ( .meus Amendment.., to the Chmnmm’.s l),.m ol Working Groups 1 A •
'Aomen'S Caueus Comments on Dmli l inal D<>. umenl ol Um Conference
• , .'J .J
11 ' .
i
i
• I
3 13
inequality that icsulis in.
IK >1 ( lk<_ II
*.oin[x>uiKkd by lack ot ;ucu'»s i«> cducaiion
IK)| (.ikfll
and hi he i sovial
s.<>iiecpi lakcii
I
Fl
i c.J
IikIi is iikuinbciii on (h>\ciiiiiicius h» pmcide
III»( Like 11
i
cxaucibaicd by die niuquuable access in land and oihei.
toilucpl laken
unsustainable production and
drice.
I .iCI..d
Hisuinpiiihi paiieins and giowih driven dcvulopinciii paradigms dial.
n<>l laken
cquiiy-drivun sustainable economic development
nol taken
.exposed to enviiomnental hazards...1
i
concept taken
3.15
.increased social sector invcstm.Li and access to high quality family planning and reproductive and
sexual health services that lead K ..'
I agiced
nol taken
i
Living wage employment..J
nol laken
. democratic and...
not taken
reduction of militarism...1
nol taken
I ML and World Bank imposed structural adjustment programmes...1
I
not taken
3.16
. and children...1
not taken
.. accessible, high quality family planning and reproductive health services...1
3.17
(delete: By slowing down population growth, many countries have bi light nioic lime to adjust lot luiuie
population inc leases. I his has increased their ability to attack poverty repair the environment, and
build the base tor tuiure sustainable development. Even a ditteience ol a single decade in the transition
to stabilization levels of fertility can have considerable positive iinpacl on quality ol life.)1 1
in brackets
taken
agreed
■
I
...ihat is not gender-biased . 1
* Source:
- Women's Caucus Dratl Compilation ol Proposed Revisions on U. Draft Programme ol Action of the ICPD
‘ - Women's Caucus Priority Amendments m ihc Drali Programme ol Action of the ICPD
’ - Women’s Caucus Amendments to the ('hairman’s Draft of Working Groups I
2
• Women’s Caucus Communis on Drali bmal Document ol ihu Conference
concept taken
nol taken
I
■pi
:
*
3.18
IKCC^ h. lie mg uage e||||.h>)„lclli. umK-tslup t)l lalld, alH| rj^l,,
„,|lclll plll|K.rly
LOlICCpi Idkcll
3.19
Governments must au to improve the labout productivity ot agricultural producers, intormd sectot
workers, and small ,kale prodiKimn workers, especially women, ami to promote labour-mteosise tathcr
(han
(Han tapiial
capital inicnsiv
nuensise technologies thai exacerbate un- and under employmeni
W
i
<21
w
(delete Private secto, job oc.ilion in die industrial, agricultural, and service sectors should he laminated
by national Governments ilmtugh creation ot more favourable climates lor expanded trade and
investment. I Ins will require supporting democratic' institutions, curtailing corruption and rcdirecimg
domestic budget pnontic.s to the social sectors and human resource development.'
3.22
removing protectionist barriers to their products . '
3.C Subtitle
■ cqgj table
i
...gender incquity/inequality
3.24
(delete: growing) (delete: in the context ot population growth)3
3.26
not taken
LoiiLcpt taken
in bi.ukeK
3
(delete: Serious demographic nressures on the environment may be manifested through rapid populatioo
growth in ecologically fragile areas, human concentrations and through migration.)1
j
3.27
no( (akcii
not taken
3 23
...among specific groups, such as women and indigenous peoples.
:r
.li'ictd
improvements in women’s educational and social status, sexual and...1
not taken
not taken
not taken
u
i'i
not taken
..e.g., comm uni ties, women’s groups and other stake-holders..?
3.29(b)
3.29(d)
...witli particular emphasis on women?
This implies reassessing and changing agricultural, industrial,
economic and energy policies, i lucing
unsustainable resource consumption and production?
not taken
concept taken
agreed
■
S'
3.29(e)
...size,...immigration..?
distribution...and concvntu ion...1
not taken
exacClanguage
taken
L
agteed
—
•Source:
- Women s (.aucus Draft Compilation ot Proposed Revisions
on the Draft Programme ot Action of the K’PI)
* - Women’s Caucus Priority Amendments to
to t.,v
the Draft Programme of Action of'the l(.'PI)
- Women’s Caucus Amendments to the Chairman’s Draft ot
« Working Groups I & 2
■ Women’s Caucus Comments on Draft Final Document of the Conference
—1
' I- '
Impact Analysis of tin
A
en's C aucus at PiepCom III on the Drat
inal Document of C'onlei encv
Chapter IV
GENDER EQUAE1TY, EQUITY AND EMPOWERMENT OE WOMEN
Paragraph in
Draft Final Doc
4.1
Women s ( aucus Suggested Amendment *
..sexuality, reproduction...1
I he power relations that impede women’s attainment of healthy and lullilling lives operate al many
levels of society from the most personal io the highly public, achieving change requires policy and
program actions that will improve women’s access to secure livelihoods and economic resources,
alleviate then extreme resiamsibilities and drudgery in household wotk, and raise social awareness
through effective programmes of education and mass communication
Status in the Drali I -nal
I )ou unient
Si.hijs nl the
‘s. guliathilH
not taken
exact language taken
| agreed
exact language taken
I agreed
sexuality and reproduciion.. .'
I
4.2
...and the Convention for the Elimination of All Forms of-Discrimination
Against women emphasizes
women s rights to education on a basis of equality with men.1
4.3
.equality and equity. .4
4.4(a)
4.4(c)
..and articulation by women themselves of their concerns and needs 2
...and cultural .
...including those that relate to secual and reptoductive health...
4 4(d)
..in their own name and on theit own behalf1
4.4(f)
Govcrnmcnis should take steps to eliminate discriminatory practices by employers against women,
such as those based on contraceptive use. fertility and pregnancy status.1
not taken
concept and exae
language taken
agreed
concept taken
agreed
not taken
exact language taken
in brai kets
not takeh
. uunccpt taken < "tcrtiliis
status" not taken)
F'
•Source.
Women s ( aucus Draft Compilation of Proposed Revisions on (. Draft Programme ol Action o! Hie ICPD
‘ - Women’s ('aucus Priority Amendments to the Draft Programme ol Action of the ICPD
Women's Caucus Amendments to the Chairman's Draft of Working Groups I X' 2
Women’s Caucus Comments on Draft Final Document of the Conference
agreed
1
•4 5
I
laiil'icauon
-Ik e )| Liken
Itlioiil icscix alion and.
■ii'lccd
fl
lot taken
4.9
doniesik violence. . .exploitation.. . within families
b> societies and b\ the state. .'
4.13
;i>ikcpi i.ikcn
| ---------■ agiecd
JNikcpi lakcii
dgreed
Loikcpt (aken
i dgleed
1
h. elnmnate inlantieide and lhe praciice ol prenatal sex selection for non-medical indications,
4.15
the practice of prenatal sex selection together with/ ’
causing the diminution of the
female population..‘
‘
p<>( laken
4.17
exact language taken
I agreed
- “■ -........ =
l"hcr“a"cc nb’,lls •tti'tl l» treat gitls equally in all social, political and
economic spheres.1 •’
4.20;
. and sexual health..1
4.21
..promote and...that raise...io !8 years old..1
4.22
...religious insututions. 1
4.25
...share power with women in reproductive decision making and...1
4.26
... family leave for men and women...1
4.27
■ ■sexual and reproductive health and behavior...4
4.28
...IO ensure men’s fituncial suppon for their children and families, while protecting the safety of
women m abusive relationship..1-’-’
1
y 1
!l
•Source:
- Wu*nen’s ('aucus Draft Compilation ol Proposed Revisions
on the Dial! Programme ol Action of the K PI)
- Women's C,aucus
Priority
to LJlhe Draft Programme of Action of the KTD
j
.........................
••••• Amendments
., (1/ IIIU
- Women’s Caucus Amendments to the Chairman
.......i s Draft of V\ king (iroups I <v 2
- Women’s Cducus Comments on Draft l-inal Doci ment of the c onference
vumiiiviii
WiUL..
conccpi laken
.ii'ieed
exact language taken
in brackets
-
Concept taken, hut no
specified age
agiced
agreed
not taken
exact language taken
agreed
exact language taken
in bracket'.
concept taken
agreed
,
I
‘T
I
pminjapioj ptp J() iunuinn(>G |HUI^ ||i?Jq
HO sniPtinuoj snont’j sjiauio^ c V I sdnojf) ^ut^joy^ jo ijpjq stuEiujipq3
<»1
I sniduipuauiy snnnEj S'liamo^y UdJI »ip jo ..oipv jo mnuipjflojj urjG mn oi SHiauipuauiv Xmjouj snnnEj s.uauio^ - *
CJdJI =>111 io uonav |<) 3uilIIKj3oJf) iihjq mp u<>
pasod.>Jd j
in uooEiidiuoj i|RjG snnnR3 s.timuo^ - r
i
: 33jntt$t
■•’J"
HHI
•ii.uuom Xq XpiKiionjtxlojdsip ua)p>uapiin Xpuajjn.v ■
p33J??R
n ’ Xeuj oi|M tump uiiptM S|EnpiAiput Pip pup -
_ _________
pxjjfc
W
aftEn hiEj
or?
nn^Ej n^En ?iie|
ri sni|iun’| uiipiM nmuoM jo snjpjs pup ppy mp no pup
OS
tinjfri loll
n spioiiasnoq pjpp31|-3|Rlli3| |(, J3Mlllnu SuiamuS p»g 33JR| mi,
8S
,
pxijnr
p^jjir
siionipnon muiouonn-oimis pln> poiHuxl Xq
pwnpunj sai|iurer
U.^E] idnjllOA
-----p33jj?r
XSS SP JO ”
i,,-'»jp|llp
Z.S
ion
•S
rri" ^J’l^nxps
il^^E) Hb.iitn
t ri'' P”* afouJEiu joj afc p>$fo| --
I .Mliu,. |O pE^SIII
u-^ri ..Pinoip,
u^vi 3iiEnauv|
i__
------------lia^El Kb.inn
II^E) )oii
.
S S‘
Xinuajpui pird- -isnui- •
rs
n ’ PSLPJ H>u
•^nas mxnnpvn .
3A!, )ou S3()p llo,lnind(H| s p|j(w 3ip |() %()j
he *pi’j u|
tir^E) pon
■ iii03R|dsip JO smnvn tmpo pup XuaAod •jem
. i
|<> ll»HJEJ3|||O|(] 3||]
rv
iii.">iiin^oq |eiii.|
"»ip !<• KniriK;
■M|) in ^ni’is
♦ Hnuipuniuv poisons ^n.^nrj sjiniuoV
HHn.LJflHlS QNV NOI.l.ISOdJAIOD ‘SH1OM S.1J
il
i
1
1
~
11^*1 )(HI
pnnj^r
!
i
33ii.Yiapio ) ,ii|j jo jumuiijoq |nni,j
*H>(! inn.I
HILL
A JoldiniQ
’j(l OI|J IK) ]||
(kU| )t.
otp jo Ms<p*uv j^rduij
in t|(lvi.i»’ivc|
9 r -'
•
Impact Analysis of the Women’s
uctis at
ICI’D PiepCoin HI on the Draft
I
.al Document of the Conference
Chapter VI
POPULATION GROWTH AND STRUCTURE
Paragraph in
Draft Final Doc
AdnicJi s ( auciis Suggested Auicndiucnt*
6.6
...homelessness. . ‘
Statu,s in the I )ij||
l ilial Dovuincni
1
Status ol the
Ncgi math »ns
2.
*
not taken
*
.govcnunenis, bilateral and multilateral agencies. ‘
I
not taken
.. sustainable..?
not taken
6.7(c)
-
•t:olllillue lllcir eJ^ation tor their personal, social and economic adv .neement.
This will reduce..?
6.9
I
1
6.10
...labour..?
6.11
In addition govertu.tents should repeal laws which discriminate against young pregnant women/
6 14
I
6.1'
6.21
1
6.2
concept taken
agreed
exact languai’e
taken
agreed
concept taken
agreed
concept taken
(widKiut "repeal
laws’;
agreed
exact language
tai. n
agreed
ci.j-tcept taken, but
wakened
"sexual and
reproductive
health" in brackets
c-x®.( language
taJttru
agreed
...rape and incest,2
u>,1,eir quali y of 2 ZZ 222
ice?s to^r
ad,i,l<;si;c"‘s n>ust .safeguard (heir rights to confidentiality, privacy and
access to all [sexual and reproductive healdi| services, including safe abortion,-’
P
*
• support systems and
and to eliminate violence and discrimination uginnst them.2
Si
...torced assimilation into the non-indigenous dominant culture?
0
r#-
no taken
B
f ‘ | j‘- ^Wien's
~
Women’s Caucus
Caucus Draft
Draft Compthttion
Coinpilad of Pioposed Revisions on t' ~
of Ar Hon nf ihe K’PD
lb4 J . wILnen's p‘"U<'US P"1"'"* Amendments to the Draft ProgrammetheofDraft
ActionProgramme
of the U PD
Is
< w
. ?UCUS A,,,c,'d‘n':l>l» <» >l>e Chuirtnan s Draft of Workmg Groups I & 2
p ; i ■ Women
WunwnSs Caucus Comments
Conuneiits on Draft Final.Document of the Conference
r'R- ■■'
I
-
TV
H
*fe!
I
i
indigenous pc<»pk-|s|
6.22
6.23
6 24
6.25
i
6.27
;exact language
taken ilirouglnmt
gtowth dtiven exploitation ol natutal lesoutccs. and to unsustainabli • kvclopinciK projects
implemented without lull consultation, and documented permission
in braukcls
—
mn taken
inc hiding sell-determination. ’
iK)l taken
'les into the decision-making, design, implementation, monitoring and evaluation ol
p 'ics
population, environment and development programs.. 1
exact laiiguijc
taken
agreed
concept take i
agreed
i ‘ ncept taket
agreed
Legal and tnstiiutionalizcd disciimination against indigenous peoples should he eliminated.
.enableindigenous peoples to own, manage and.../’
!•
'
I
I
k
I
I
: I
i
L
3
|
Ii
' r■.bx:,'#,;
■
♦Source:
• Women s C aucus Draft Compilation of Proposed Revisions on the Draft Program
of Action ol the ICPD
- Women s Caucus Priority Amendments to the Draft Programme ol Action of the k'PD
* - Women’s Caucus Amendments to the Chairman’s Draft of Working Groups I <k 2
- Women’s Caucus Comments on Draft Final Document of the Conference
,
1
-1
i
/>
!
r th.
'.yv'< ■
i
•
impact Analysis of the WomeD
Caucus at ICPD PrepCom III on the Dr:
1 inal Document of the ( inference
Chapter VII
RKPRODUr TIVh RIGHTS, (SEXUAL AND REPRODUCTIVE HEALTH I
AND FAMILY PLANNING
Paragraph m
□rail Final Doc
Women s Caucus Suggested Amendment*
rille
• .Sexual and...
7.2,3(a.c).4,5.7.
S.9.15.18.19,23,
24.28,30,42.43.
44.45,46.
...sexual and /and sexual ...(used interchangeably)12 U
7.4,1014,16. IS,
21,23.24.28.31,
33.34.39.45
...reproductive health...1-’34
7.1
Status ol the
s. erm iat ions
exact language taken
in brackets
exact language taken
in brackets
exact language taken
tn brackets
*4
i
.1
.whether, when and whom to marry; enter into family relations . 1
and when or what method of fertility regulation
or protection against sexually transmitted disca:
use.1
Such rights also require the freedom from sexual abuse, forced
pregnancy, and preventable disease
Women who wish to terminate their pregnancies should have teady
•h ce ss to reliable informauon,
counselling and sate and affordable abortions ..'
ii
not taken
concept taken
’fertility
regulation’
in brackets
I1
not taken
concept taken
'fertility
regulation’
in brackets
i
I
I
■■
•Source:
- Women’s Caucus Draft Compilation of Proposed Revisions on f ''
the Draft Programme of Action of the ICPD
3 ' W'""c":s 5aUCUS Prior,'y A"»:''‘iinenis to the Dratt Programme of Action of the ICPf>
- Women’s Caucus Amendments' ito the Chairman’s Dratt ot Working Groups I A 2
- Women’s Caucus Comments on Draft Final Document ot the Conference
1
I
w. I
I
3-;^
Status in the Diati
Final Ddcuiiiciii
■
Paragraph in
Dr a it Pinal Doc
7.2
Women s ( aliens Suggested AiiieiTdincni*
.also includes respect lot bodily inicgiity as expressed in other hum
iglils dovuincnis
-1.Hu-s ill the I batt
i Ha I I )< iciinicill
.Status ot the
t ‘Ikc|>! taken
in bracken
(delete: In the exercise ot this lights, co
mplc-s and individuals should take into account the needs ot
thcii living and luturc children and theirJ icsponsibilities toward the community.)1
H
\cgotiatii»iK H
iol l.ikcn
governments and...
[language taken
agiccd
I
and to eliminate discrimination based on gender.
(concept taken
agreed
exact language taken
agreed
concept taken as
'pregnancy
termination"
. marital status, age or sexual orientation.1
1
7.3(a)
...full range of...
7.4
..among others...including safe abortion..
j
pregnancy tcrminainm
..and cancers ot reproductive systems
in brackets
1.2
exact language taken
.. .and discriminatory food practices that deprive women and girls of nourishment.1
agreed
not taken
-i
7.4,23
...hiv/aids.... ’•2
7.6
■ ■■to both male and female partners.12
7.7
Governments...1 ’
exact language taken
not taken
exact language taken
....collaborate with.. .at all stages ot planning, implementation atiu icvicw.
7.8
agreed
agreed
not taken
..establish comprehensive reproductive and ser ial health services including.
not taken*
...including women’s access to safe, affordable...1
not taken
(delete: over-)2
taken
I
I
•Source:
2 ' *“"le''',s ^au';us Dfa’i Compilation ot
ot Proposed
Revisions on the Draft Programme of Action of the 1CPD
Proposed Revisions
J - Women s < aucus Priority Amendments to the Draft Programme cl Action of the ICPD
- Women’s Caucus Amendments to the ('hairman's Draft ot Working Groups I & 2
• Womcn’.vCaueus4.'ominrnts <m Draft Hnal-Document ot ihe-(’orrferencc—
&
i
agreed
I
1‘aiagtaph in
Drab Final Doc
7.10
Women's Caucus Suggested A....ndmcnt*
Status in ihc | )f it||
Sicgotiaiioib,
and sexuality...
not taken
----------- ^±52±^.l^i''-.KUcly the M,l,tee, <„ government development so.. ..............
•?
7.11
not taken
............
'■ompheamm.s from illegal abortion. Public health data world w I
a"d knowingly take r.sks to their own lives and hel . m m! T
illegally; thus legal and religious sanctions do not snm ah,
dangers. In support of women s fundamental right to lif,
•roni unwanted pregmmey, abortion shouid 1 p^
’fJ
■
$
I
7.12(a)
...choose the number and spacing of their children;1^
7.12(c)
.and accessible...'-’
t‘>
i
",IU"e unwai»^ pregnancies
it ’Ul '•UealC SCni’US puhllL lualdl
XZh
..............
*
Sl-'rv“*‘> available to
'* ,lle pri‘"ar>' ll,cai« »f fertility
language taken
7.13
exact language taken
i
jind to establish mechanisms for report,,,g and ,edressing vZkn^"
C,’"■SC,,,
'
agreed
I
^grecd
concept taken
i
brackets
i
!
I
7.14
I
7.16
I
"
contraccpiiou should lx- made availahlr
u
.
1
’
i,s SJ,le ’»»t‘diods ol
safety •
dVd,,d,),C ,O WO,nc“ u,‘d^ ^‘'‘dHions ihai guarantee their access and then •
I
i
rela,cd dcallls arc
W',"le',
I
women, irrespective of ability to pay Abortion du,„ii
.
control available to women as opposed to safe contra T'
■
not taken
llus t,:"lr^‘s with the
prevalence on unsafe abortion in many parts ol the
I l.c World Health Organizatton estimates that 50% of 'he' 5(» Xn/.
i
Status di (hc
__and to encourage more men to use coi,do,ns7id voluntary surgical contraception. -
1
7.15
access to safe and affordab.e abort,on serves ■
• • .reproductive health education...2
L
"
--------
~
■ • •and often coercive, thus inconsistent with respeTfor basic ridiK
ctononnc and social incentives and.■..voluntary services
T~-------------- ---------
,IIUM deS,M
rc,,ancc t)n
not taken
1------not taken
not taken
4
i
not taken
■i!
i
•Source:
; - w=s cXs
jkx..-... ..
......... a..,..
- Women S Caucus Comtnents on Draft Fityd Document of the Conference
Fii^l Document of the Conferenci
I- .
8
i
i
I
i
i.
Paragraph tn
Women s Caucus Suggested Amendment*
Draft Final Doc
7.21(a)
...the maximization of choice, health, respectful service and women’s empowerment to make these
decisions
Status in iIk Di.di
l inai I)«n.uinciil
Status ot the
voikept taken
agiecd
exact langu.ig. taken
agt ecd
concept taken
agiced
S
liatloiK
'>•
"i
A
7.21(h)
1
7.23
Hnnly planning and reproduclive liealili programmes should emphasize breast feeding education and
supp^irt services, which can simultaneously contribute to birth spacing and lower fertility, maternal and
child health an nutrition and child survival.?
...in a participatory manner, regional, national facilities...
...including support tor the roles of UNFPA and UNICEF i
in providing procurement services.'
7.24
I
I
I
II
$
I
7.26
not taken
Special outreach efforts need to be made to those who do
not have access to family planning and
reproductive health programmes.21
Tlie power relations between men and women and the lack of access
to information and services
make...1,2
7.28
Special outreach efforts need to be made to those who do not have access...1
... integrated wherever possible and appropriate to....1,2
7.29
pt Idkcll
agreed
taken
agreed
...and referral...'2
i’g-
7.32
I
Healthy and improved quality of life for all also involves recognizing and respecting voluntary sexual i
relations (delete: between men and women).1,2
7.33
not taken
■i
not taken
1
...haimful practices...1,2
agreed
-
I
agreed
not taken
...detection...1,2
Research on wotpen controlled microbicides and viricides needs to be pursued.12
ife*
concept taken
COii
7.30
I?
agreed
...and youth...14
K
•W-
concept and sonic
language taken
Bourcy:
‘ - Women’s Caucus Draft Comptlaiion of Proposed Revisions on the Draft Program-!
the Draft Program 1
i
of Action of the K’PD
• Women s Caucus Priority Amendments to the Draft Programme of Action of the K pD
• Women’s Caucus Amendments to
i the Chairman’s Draft of Working Groups I & 2
• Women’s Caucus Comments on, □ra|t piIW| Document of the Conference
~--
*
I
1
Paragraph in
Dial! Final Doc
Women's Caucus Suggested
7.34(b)
...to ensure that women and men have access to the information, iducalion and services needed io
achieve good sexual health and exercise their reproductive rights and responsibilities 1
icndmuiu*
F
Status tn the Dralt
l inal Oovument •.
Status ot tl»e
Ncgotialioiis
exact language taken
tcproduciiic
tights aixi
respoiisibihn
cs in
brackets and
the rest
agiccd
a
7.35
. . lor their own sexuality and fertility and which help men uxurd iv those responsibilities..
concept taken
agiccd
7.37
Governments should develop the conditions and procedures necessuty to encourage victims to rc|>oii
such violations of their rights
language taken
agreed
Particular attention must be given to the need to eliminate sexual trafficking in women and cltildicn r
and the violence that accompanies it. In addition, steps should be taken to eliminate violcntc and
discrimination based on sexual orientation.1
not taken
Adolescents as a group have been largely neglected by existing reproductive health services. Socio ;
cultural, legal and educational barriers make (hem one of the most undeserved groups of the
i
world....together with the empowerment of young women to make sexual decisions
this responses
must be combined with the education of young men to respect women’s decision making and to share
responsibility and authority widi women in matters of sexuality and reproduction.12
concept and some
language ta>
■J
I
I
I
7.39
...their physical development and their...1-2
not taken
_________
£
1
; 1
^Source:
I
Bi'-.
, - Women’s Caucus Draft Compilation of Proposed Revisions on the I di Programme of Action of the ICPD
‘ • Women’s Caucus Priority Amendments to the Draft Programme of Action ot the ICPD
- Women's Caucus Amendments to the Chairman's Draft of Working Groups I & 2
• Women’s Caucus Comments on Draft Final Document of the Conference
1
agreed
Paragraph in
Draft Hnal Doc
7.42(a)
Women’s Caucus Suggested Amendment*
increased reproductive and sexual health information and services and
Si.inis in ilk I>ialu
Imai liocuineni
Status i»l the
“S egot ian< >ns
concept taken
icproduclicc
and sexual
licaltli in
brackets and
the rest
‘
j
;•
.i
agiced
and violence...1
not taken
. .unsafe abortion.... ‘
!•
concept and language
taken
7.43
1
in bi ack els
...both married%and unmarried...*
not taken
...To be ellecttve services for adolescents must safeguard .cir rights to confidentiality privacy and
access to all sexual and reproductive health services, independent of knowledge or comn/by their
i
parents, including safe abortion.' 2
7.44
i
b
concept taken
in brackets
language take
sexual and
> comrot ny uieit
...ptotect and promote the rights of adolescents
to sexual and reproductive health and information and
services. *J
reproductive
m brackets
and the rest
agreed
I
1
7.45
I
...gender relations and equality, violence against adolescents...1*
...access to...including contraceptives; prevention, treatment and refv
h >1 ioi S I Ds and HIV/AIDS;
and referral for other health needs,...
!
ccact language taken
agreed
concept and language
taken
agreed
h ■
They should in no circumstances involve coercive
I
I
I
or punitive means.1
7.46
...and train...M
♦Source;
2 ’ *O",e";s ‘■aucus
CoinpHadou <>l Proposed Rev^ons on the Draft Programme of Action ol the K PI)
- Women s Caucus I nority Amendments to the Draft Programme of Action of the ICI
• women s Caucu> Amendments to the Chairman's Draft ol Working Groups I Ji ’
■ Wotnen's Caucus Comments on Draft Final Document ol the Conference
-1
not taken
...delivery and evaluation...1*
concept taken
agreed
exact language taken
agreed
-4
l
tu
I
■ ■ ‘:;I
Impact Analysis of the Women s Caucus at PrepCom III on
■II
the l)t att binal Docunient of Conference
Chapter VIII
HEALTH, MORBIDITY AND MORTALITY
Paragraph in Draft
Final Doc
Women s ( auctr^suggested Amendment*
Insert new para after
ACC ss to heal h Care necessary tor well being is a lundame.nal human right protected by
8.2
t
S^his in the Dialt I mJ
I
unient
Komi t ry
4
t,')n A '
a" RlghlS- U"der lhc
*>" >l>e Elimination < f All
bonus ot Dtscrmnnanon Agamst Women, states have a responsibility to ensure women s
Status of the
Negotiations
ik I taken
I
monalhCCS'S l<’ T'^
'0
1,ealth i"'d ,l,e reduui‘,,, >" "'^^nal
mortality was underscored by the Vienna Declaration.1-2
8.2
live pndcr deteriorating economic and social conditions and. .'
I
I
I
“7---------ih|< taken
...particularly girls, young, and adult women,...1
ih)t taken
I
...community and...'
1
j
ndt taken
..imposed increasing burdens rm women as primary custodians
not taken
8.5
reproductive and sexual health care....'-2
8.6
..reproductive and sexual health care including family planning....12
sohie language taken
agreed
some language taken
in brackets
.recognition ot indigenous knowledge...1,2
£
not taken
8.7
• and maternal health...and the early detection and treatment of reproductive cancers
including cervical-uterine cancer, and breast cancer...1
'
concept and some
language taken
agreed
SCmCeS' “>r CXa,"Ple "‘^^'“K'-ild health with fantily
not taken
8 10
adolescents...and migrants...12
8 12
delete |ignorance of the benefits of breast-feeding)'
no
not taken
* Source:
• ’
Hestons on the Draft Program,ne ot Actton ot the It PI)
J '
f?UtUS Pnor"y A"lc"d"»i"ls '«> the Draft Programme of Actton ot the |CPD
- Women > Caucus Amendments to the Chairman’s Dratl of Working Groups I At ’
- Women s ( aucu.s Comments on Drali Final Document o| the Conlervr
I
I /
8.14
..dulctc (high levels <>l inla.
and child nioitality may be a hairier to fertility dcclinc|
not i|k^i
.ccononik and social conditions aic improved.. '
8.15
4
and within. .1
cXikl Lt|iguagv taken
8.17
...... ........................ ..—................ 8.19
i
'I
.terecd
. . .provide reproductive and sexual health information and services including family
Ft
■ including complications of unsafe pregnancy... ’
8.22
not tfikeii
—
N---conceptj taken
...ot pregnancy, delivery, and abortion...1 *
$
concept^ taken
aviced
...inale responsibility...12
not taken
'.eluding access to sate alxiriion.. •’
i
3
•S
not taken
Attention should also be given to programmes and education to engage men's support tor
maternal health.1-2
.
I
I
8 24
.. and men...1*'
8.25
...including the post partum anu post abortion periods...1-2
Alternative 8.25
...reduce...’2
1 ■
In many countries, women rep eseut the fastest grou
L
m brackets
exact language taken
in brackets
8r 29(b)
....and to provide counseling and other support for people infected with HIV/AIDS that
respect their individual rights, sexual orientation and confidentiality.’•2
g group of uew iulcclions.1-'
Govertunents should ensure ll>H the reproductive arid sexual health needs of commercial
sex
workers are integrated into tu icnal programmes.1*’
iH
|x'
' li’v
I
:: erf
concept taken
not taken
8.28
8.30
concept taken
agreed
concept and sonic
language taken
agreed
not taken
I
J
agreed
agreed
...al fordable...'
iI
concept and language
taken
^Source:
- Women s Caucus Dralt Compilation of Proposed Revisions
<»n the Draft Programme ot Action of the K PD
•'
s Caucus Priority Amendments to the Draf' Programme ot Action of the ICPD
4 -• Women
W»««n ’s Caucus Amendments to
i the Chairman's Draft ot Working Groups I A 2
Woincii
’s Caucus Comments on Draft l•'mal Doeumem of the Conference
■• w
',lllc>1,!>
i
I
s
\
J
i
I
8 14
...delete |liigli lc\cls ol iniant and Juki nioiialily may be a bairiei to fertility dcJinc|'
...cconoinic and social conditions are unproved...1
8.15
I
agreed
8.19
...including complications ot unsafe pregnancy...-’
noStaken
8.22
. .of pregnancy, delivery, and abortion...' '
cotkept taken
.r.male responsibility...'2
not taken
agreed
nop taken
Attention should also be given to programmes and education to engage men’s support for
maternal health.‘•2
concept and language
8.24
...and men...1,2
concept taken
agreed
8.25
...including the post-partum and post abortion periods...'2
concept taken______
in b ackets
Alternative 8 25
.. reduce...
cx'act language taken
hi brackets
... affordable...
mjl taken
8.28
In many countries, women represent the fastest growing group of new infections.
8.29(b)
. ..and to provide counseling and other support for people inken I with HIV/Al DS that
respect their individual rights, sexual orientation attd confidenttahiy.'2
8.30
Governments should ensure that the reproductive and sexual health needs of commercial sex
workers are integrated into national programmes.1-2
tl
I I
m..
.
igiucd
‘•oi i .pi taken
I■
aI
exact language taken
P’ovidc icptoductivu and sexual health information and services including family
planning to picvcnt high lisk pi eg nancies; piovide information on the prevention and tisks
of STD infection, including HIV/AIDS,
...including access to sate abortion...•’
I
iuh 'lakcii
8.17
I
a
x
and within
not Liken
incept taken
niiicepi and some
language taken
.
----------|
not taken
^Source.
- Women’s Caucus Draft Compilation of Proposed Revisions on the Draft Programme of Action of the ICPD
- Women’s Caucus Priority Amendments to the Draft Programme of Action of the ICPD
- Women’s Caucus Amendments to the Chairman’s Draft of Working Groups I & 2
. 4 - Women’s Caucus Comments on Draft Final Document ot the Confcrtt ce
$
!
■
agreed
taimen
I
I
I
I
agreed
agreed
.*
ndi'iii ihl
<. k.u.1 laiu'u.ij’t lakcii
.q.’iccd
cpl l.tkcll
.H'f ucd
a.xl ...mp.chenMvc scxuali.y educauon and inhn.nadon, I uhIk, research needs tn k
conducted on public health transmission ol HIV. K..T2
I
• schools ;|nd health lacilnies. .’
i
II
c* ».l language taken
Inlorntattnn about the possible benelits ol using other family planning methods that may
piotu.1 against HIV/AIIJS. such as banter methods, should be pan of services
..........
7
8.33
■ I
Governments and services must develop guidelines and policies to protect the individual
rights of, and eliminate discrimination against, persons infected with HIV/AIDS. Special
progranunes should be developed for the care of persons with AIDS and their families and
partners.
8.35
I
:M
4
m'“ “
Further research needs to Ik- conducted on
women controlled methods of preventing HIV
•infection.12 J
8.34
i
p",“ . ........ ..
... affordable...
inm..... i"
agiccd
ih>( taken
cotkept taken
J I_____ _
CQiJCcpt and solnc
language taken
CQijcept and sonic
language taken
"if
11
ifc I V
I '
■
•Source:
‘ - Women’s Caucus Draft Compilation <
<>l Proposed,Revisions on the Draft Programme of Action ol the ICPD
- Women’s Caucus Priority Amendments» to the Draft Programme of Actn. n of the ICPD
- Women’s Caucus Amendments io
i the Chairman’s Draft of Working Groups I & 2
• Women’s Caucus Comments onLllrali. FbialJlocumeuuuCrhe Conference______
■ t
r
■
..
■'
agreed
agreed
Jl___
t act language taken
I
.u’lucd
agreed
Impact Analysis of the VVomv
C aliens at ICPI) PiepCom 111 on the Di
I
l ilial Docupient of the Conference
Chapter IX
POPULATION DISTRIBUTION, URBANIZATION,
Paragraph in Draft
Final Doc
I
AND INTERNAL MIGRATION
Women’ s Caucus Suggested Amendment*
Status in the Draft
Final Dovumcni
9 1
Status of tire
Negotiations
• ..unequal growth and resource distribution...
not taken
4
Miyata. is.
,„|J| a„KW,B >eJ .....
,
not taken
9.2
................... . .........
*
9.3
4
not taken
.human .‘
a
not taken
I
...equitable...'
not taken
9.4
...equitable sustainable development...1
ik)l taken
I
I
■ ..ensuring equitable distribution of resources...
not taken
9.6
land ownership.. 1
exact language taken
agreed
...es|>ecially women who arc heads ol households...'
.•v
9.10
g
tn order to meet the goal of universal access to basic housing, sanitation and clean
water services
tor all by die year 2000.12
9.13
I
u' :
II
^especially women who often sutler rape and sexual assaull in situations ol anned o.Hhcu.
not taken
1
not taken
i
[
concept taken
9.15
The international community, governments, multinationals and NGO’s. ..and redress the causes of in ’
oluntary migration,...envtronmenially unsustainable growth driven development patterns
i
not taken
■•4
...and forced resettlement...12
i •
exact language taken
-
agreed
:
•Source:
‘ ■ Women’s Caucus Draft Compilation of Proposed Revisions on the Draft Progranune of Action of the 1CPD
>
w‘>"":n.k ^‘‘UCU!‘ Pr‘Ur"y A,nentlll‘el'ls ><> Hie Draft Programme of Action of the ICPD
- Women’s Caucus Amendments I
- Women’s Caucus Comments on
'4
agreed
II
J
'4.......
..
V';
I
j
I
•?; "
hh|u.iv{
\tiiilv
MS Ol tin Winner’ Cuneus ut ICI’l) PrepCom 111
Ji
Oil the 1)|
Final Doc miciit of the t oiitcrviicv
f
Chapter X
i
1
4
■1
INTERNATIONAL MIGR
U Paragraph in
| Draft Final Doc
Women’s Caucus Suggested Amendment*
Status in ihc I)rali
.1
10.1
war.^ten‘^Xal ^"x^Xai1 reahX'n^1 m7ra,iO,, "
" rdUS'"’ SC’US"1' c''
and environtnemal (actors' ‘
It also has the inegate i.npac. oflos, illvesllllcn| .......
away from’the country of origin.'
10.2,3
• involuntary migration...3
10.3
•••diffuse...before they escalate,...1 •’
abuses,
by
religious
^delete: human) (delete: individuals belonging to)4
■ ••.must respect international
to regulate. ..
i
rT .
TC
-L
*Source:
concept taken
agreed
exact language taken
agreed
partially taken
("refugees and
internally displaced
p. Mins* ikit taken)
agreed
I
, .
not taken
'
■
not taken
■I \
Si,UCUS Dratl
‘
agreed
not taken
covenants and conventions as they assert their right
. ..be undertaken without discrimination on grounds
o race, gender, religion and HIV/healtli
including the right to leave or return.1-’
status.. .including
i
concept partially
taken
not taken
...and ensure t‘
are respected when violent conflict docs
10.4
Status ot tlic
Negotiations
,(a|
■
I
at,on
Final Doiuiiiciii
Ji
O, rroposea Kevisions on the D ,tt Promumm ,
of Proposed Revisions
Women’s Caucus Priority A.’.„
' A:"‘717'“ ■” ,lle Drafl ^-^anttne ot A.bon ot the I. PD
Women s Caucus Amendments I
l<> the Chatrman s Draft of Working Groups | A r
■ Women’s Caucus Couunents on
I Dratl Final Document of the Conference
°f
'<’PD
>'
i.
i.
I ■
■ 1
a ~ a
t
10 6
i'.sy-
in acu.rdaiKx- wiili s^indauK contained m thedie Rights of Migrain Workuis and
(heir l aniilics
concept taken, but
weakeiiedt (ioveinni
—1
agreed
1
- I! -’I
cuts arc invited to
consider
ratifying ";
10 7
-
have the documents ithating to...'
not taken
10.9
In addwon to economic frac tots, family rvunitication
is an important I < for in international
migration
■ to ensure that female nignmts who are spouses, but whose families .llsimegi^. are given the right
to cIkkisc to either stay n their adopted country or to return to their country of origin.21
10.11
■
-
s
concept taken
agreed
■ 1
concept taken with
. proviso "within the
limits of national
agreed
■/J
•
■
legislation"
chiSen'"' Cli,“i,,a,i,,«l‘liscri'’‘i*‘a«’ry Praclices u.nce.■>...« tl.d, limj(1(M(|ily allll tl|e |lalj()|la|i,y
ll)m
exact language raken
agreed
7®
..access to justice and equal treatment before the law...1
f concept and some
language taken
1^
and the possibility of citizenship.1
10.12
agreed
I
n
...including citizenship die right to vote,...
not taken
• die right to participate in the political process,...
t
:t
agreed
concept taken •
in brackets
ii
agreed
exact language take
. .and the right to be re j nt ted with close family members.
J
...and gender discrimination.*
10.15
10.17
must be exercised acdording to existing international standards...'
J not taken
...including the right tc non-refoulment...12
! concept taken
agreed
including the non-di^rimination based on HIV/healih status.1’
: not taken
“'s--j.
•Source:
i ■ Women-s Caurtis Dratt CoinpilaHon < t Proposed Revisions on f the Draft Programme of Action of the ICpf)
J ■ vv‘,".'e"'.S ?UCUS Pr,Or“y
<l>e Draft Programme ol Action oi the
• Women’s Caucus Amendments» ito thejChairman’s Draft of Working Groups I A 2
• Women’s Caucus Comments on Draft Final Document ot the Conference
!■
concept taken, but
weakened
I
10 JO
not penalize ot
ex.KI Liiiguagc lakcn
. rccipiocal visa airangviiieiKs..."'
i
ihh fakcn
I
^mnalud XamZm, XVtaskls to mo"-’"1 i'’^ "r . ..........
non
I
negotiations between sending and receiving coun’i'rie^wk L,,"U"I,",S ‘,l.
and to encourage
the migrants themselves.'
' W ,,c 1 “
1 ‘‘bridge the basic human rights of
I
not taken
I0JI
not taken
i
I
...andcivil unrest...*
not lakcn
...and "x-uiioring of the practices of transnational corporations..."n<" 'aken
10.22(c)
J
IO.22(c-n
i
...by insuring the implementation of the
UM ICR Guidelines and CUDAW.'-’
(e) to provide adequate protection for women
i asylum seekers during Hight and
status determination
procedures and in camps and .settlements;
"""S“ ■''d
10.27
.. ... ...
■"
not taken
A
J
ki
agreed
concept taken
agreed
not taken
L. .and esublisl. gender-based procedures for dC|CnniiiinK asylum,
j ®! *
. i'
not taken
3EZ9MUC
O' i.' ■
[ '■
1 'w
^aUCUS Dri’tl
of Proposed Revtsmns on C the Draft Programme of Action of the ICPI)
i vj
CaUCUS PriOr"y A"“'Hlinentli to the Draft Programme of Action
/.
of the ICI’i)
< - Women s Caucus Amendments to the Chairman's Drati ol
Working Groups I A 2
- Women s Cauci. Comments on Drafl Pinal Document
ot the Conference
If
if
-;|g,
Uh' bIbMf
" I’ te..
■-'i-
concept taken
dcUnp.,.J
—
...articulate a clear
i'
basis for the protection of women
against
gender-based
persecution
referred
to in '
the UN Declaration
- 1 0,1 Violence Against Women....
' ' • -T
■«
agreed
.
<
V
•
i
I .
I
Impact Analysis of the VVoiner’ Cancns at 1( I’D I’repCom III on the Dr
Final Doimjient of tlie ( onference
Chapter XI
POPULATION, DEVELOPMENT AND EDUCATION
Paragraph in Draft
Final Doe
Women s C aucus Suggested Amendment*
II.II
...gender and culturally sciisitive... and development related..?
11.12
...sustainable..?
11.13
...men..?
■
IM3.l5(a.c).24,26
Stains ot the
Negotiations
exau Ldiguagc taken
agreed
agreed
...human..?
11.15(b)
...sexual, reproductive and...12
11.15(c)
the Dralt I mal
agreed
sustainable' human development... ‘
11.14
11.15(c)
Status
Doc uir
I
not takdii
languag taken
agreed
languaA taken
agreed
i
...to promote environmental protections and reduce overconsumption.12
...design... and monitoring...3
I
not ta kdn
coikepq taken
agreed
I
I
i
^Source-,
|
, . ,
•{i. |
l, ■
?
-
* Womenraft.Co*npi,al‘on 01 ProPosed ^“‘"s on the Draft Programme of Action of the K’PD
' -- Women
Women’ss Caucus
Caucus Priority
Priority Amendments
Amendments to the Draft Programme of Action of the 1CPD
• Women s Caucus Amendments to the Chairman’s Draft of Working Groups I & 2
■- Women’s Caucus Comments on Draft Final Document of the Conference
‘Ic .t.
E
j
»
-,.v ?. --
I 1.16
.sexual and icpioductivc licit
I
cxavl language taken
.nd i ighis...'
1l|1,?1?‘!'),lp1 cduL'"111" “l,d “’"'■"unication cllorts should be an integral part ol intplctncnting
el(
logtamutc ol Action, by moving away from the ideology ol population control
and tnstead tat.Mng awareness through public education campaigns on pttority issues such as
1
concept and language
paitiali^ taken t idcol«ii’\
ot population v
.I" tux
taken):
id Ih.kUck
.t 1* ICC d
maternal mortality and morbidity;
coiilc||( taken
"sale
iiiiiiIiciIkmhI'
and ‘ tainil)
planning in
biackcis
1
discrinnuauon agains. girl children; child abuse; male responsibility; IIIV/AIDS
pregnancy; violence against women; xenophobia;
sexual orientation;
itcnagc
exact language
taken i
agreed
i
overconsumption and energy consumption.
agreed
II 21
...sexual..?
II 2<
...(he iinpleineniaciim ot ibis programme. *
language taken
concept
i
in bracken
agreed
t*
■
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»«• ’s Draft of Working
.... aGroups
«™ .,fI &."SS
4 ”; Wwwn s Caucus Amendmentsi i(O the Chairman
2
&J
?
I
—4
■
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SaUCUS ?rah Co,nP'
Revisions on
on the Draft Prouramme of Ariimi
• li“'<)n of Proposed
-i—Revisions
...
rwnv
4-• Women’s Caucus Comments on
□rail Filial Document of the Conference
iHh icon
I
y
I
1 :
l'»pac( Analysis of the Women’s Cuneos n lCI»n IV.
......
*,cpt . .........
I
'
„l
v
5
Chapter XII
II
fi
technology, research and development
Paragraph in
Draft Final Doc
J2.3
Women’s Caucus Suggested Amendment*
population and development...
^ho^».u.iu>ri.l8 l)t pt,pulu,i(„, ,rcilds ai|d |J|c prepara|io|| 1)f de[|it|t,rap||.
?
I
Status tn the Draft
Filial Document
Status ol the
Negotiant >n>
exact language taken
agreed
lie projections and|' ’
12.4
not taken
~~~
■ ■ population and development data...2
• gender disaggregation.. .2J
I
• ..taking into account legal and ethical standards..?
exact language taken
agreed
exact language taken
agreed
exact language taken
agreed
'gramme planners for dicir
I
I
12. B((itlc),
10,11.14,16
Ji
i
agreed
concept taken
and scxual/scxual and..?•*
exau language taken
'A
in brackets
3
•v
’’
*S<Mcr
!.
i
’
< men s Caucus Comment on Draft Final Document of the Conference P
I ’
re
■
•s®'
,1
fl
■i
I
.............................. .. ............
f
I-
• y..1
•?f ■
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■
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12 10
luilility icguluiHHi '
r
■'
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dial iiitcgiaic biiili
Hidtil with pioicciion against diseases?.'
*
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1
in hraukcts
ih»i taken
ds..?
partly taken
-g ten ilii\
egulainni i.ikcn,
!
new and improved bartiei methods
in brackets
<
¥
"IKcpt l.iktll
• ••accepted legal.
12 11(b)
12.12
agreed
‘
n
as well as'adequate attention to side-effects that
can worsen the quality ot life even it they
directly life-threateniiiM? ’
arc not
1
All new technologies should he evaluated for abuse potential?-’
~ii. concept
------taken
..second generation effects,..?
I
Ir
agreed
Concept taken
agreed
exact language taken
agreed
I exact language taken
agreed
'4
..towards sexuality..?
12.14
..(deletetcontraceptives) fertility regulation methods.,?-
•and appropriate technologies1
12.15
12.16
..to ensure that all legal and ethical standards
in brackets
exact language taken
..for users of..?
12.13
agreed
I
‘exact language taken
■ ■microbides and viricides.
exact language taken
in brackets
I
exact language taken
agreed
■■
are met?
exact language taken
.women’s organizations..?
^4
? B:/
<
■
exact langu
‘■y
.o.'
gi '
.
agreed
agreed
??.
rxact
not taken
new (ddetexo.nracepuves) feniliiy regulation methods..?I
agreed
V
:•
1t
•Source;
Drati Cumpdaimn
CompHauon of
of
Rev.^
the Oral. Programme of Action )t the .CPP
2 - Women's vC.•aucus
.wcus uratt
»1/O<nen
(
J ” i.
----- S Caucus Priority
, nwniy Amendments
Aine
to the Dran Programme ot Action of the ICPD
4 ‘ Women’s Caucus Amendments
» to the Chairman’s Draft of Working Groups I A 2
* Women’s Caucus Comments oi
on Draft Final Document of the- Confere
-.... ~.ence__________
_______
I
J
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I
I
12 10
lettility ivgulat ion ’
c x au l laiu’u.u'c i.ikvij
'hat integrate both eomrol with protection against diseases?.'
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parti) taken
Hitiaicpiivc) leiuliiy regulation methods.. '
-g letlihi'.
.gulaliitii i.ik < ii >
m brackets
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agreed
y
•leu and improved baiiiei methods ’•l
• •accepted legal
12.12
xaet language t.d
as well assadequatc attention to si de-c fleets that
can worsen (he quality of lite even it they are not
directly life-threatening.1 '
ii
•Hot taken
■i----------------------------
concept taken
agreed
exact language taken
m brackets
exact language taken
agreed
concept taken
agreed
exact language taken
agreed
exact language taken
agreed
exact language taken
m brackets
exact language taken
agreed
exact language taken
agreed
( exact language t<ken
agreed
new (deHexoniracc-pnves) fenilhy regulation methods..?...second generation effects,...1
for users of...1
I
14
12.13
• towards sexuality...’
12.14
...(delctexontracepiives) fertility regulation methods...M
...and appropriate technologies1
12.15
j
...to ensure (hat all legal and ethical standards are met.1
12.16
• women’s organizations...’
■
agreed
I
All new technologies should be evaluated for abuse potential.
.microbides and viricidcs.
I
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12 11(b)
in braK.ki.is
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5 ^Source:
1 - Women’s C.
Caucus Drah Compilation of Proposed Revisions
011 the Dr‘‘f' Programme of Action of the ICPD
• Women’s Cuu;
- aucus Priority Amendments t
to me Draft Programme of Action of the ICPD
5 Women’s Cau<
icus Amendments to the Chairman’s Dratl
----- of Working Groups I
2
- Women’s Cau<icus Conunents on Draft
ki
Final Document of the Conference
Ob
X.
Impact Analysis of the Womens - ’aliens at
ICI’I) PrepCom in »ii (lie Drah
■"al Document of the ( onfeience
Chapter XIII
NATIONAL ACTION
Paragraph in
Drah Final D<>c
Women’s Caucus Suggested Amendment*
.J
13.1.4(h), S(a.h.c
).9(a.b,e),IO
dcvulopiiiciirand
13.1,4(b)
equity and...’
.Status m ihe Di.iii
I iiml DiKunieni
i
111
I
13.3
I
13.4(41)
( onsequenily. devdopmeiu policies
. need to |>e reformulated 1" imegraie gendei cquiiy, die
cinpowennem .,1 women, and sexual and
...... 'I lepioduciive health as a priority ’
dyign. in.pie.nematS^umi,on^
measures which empower wo^alllJ inlegrale....' <
“ 'U"
language ukcii
agreed
euu language uken
agreed
<-‘|ikepi and some
language taken
- ----------------------------------
coin epi and M.nie
language taken
lake n
I
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•'
W-
;
! 4
? i J.-*
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Caucus Dra't Compilaunn
’
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Caucus Comments oni Drah Fmai Document of the Conference
JC U
.
I
i
t
»
'cxual and
fcproduelive
health m brackets
",e
IK
V.
Si.tius ot (he
S»cg<»iiaiioiis
t
agreed
Jill
13 11
''cxual and
reproductive hea
To meet the resources required over the
i .
sectot cexpendiiuies
■
and at least 2()f/ (,| "ext two decades all commies should devote >()y t
HHctuattottal dcvHop.net,, ass,Mance ,„ ,|,e
s , ”
Governments must <ensure
•
that N(i()s |IUVc
adequate access to lesourn s n. n
_ni national policies and
'esourcts to lunctton as full parincis
I Ptngiaiuincs
13 12.16,21
I-----
‘jpl taken
'|>l taken
I
sexual and ^vfnnduciive Ik .dh
13 13
h»r quality sexual and rcpioduciivc health
nj)t taken
•services...'
sbrne language taken
in hraukets
1 ‘quality" and
Sexual
not taken/
• ••high levels Hm^:L^LnH>naliiy and morbidity../
13.14(h)
not taken
• menstrual regulation services. 1
13.14
------ J,____
••■sexual and reproductive health...1
(•
not taken
Mjnie language taken
< "Sexual" not taken)
■i
sexual and 'epHKlucuve hcahh, ,nclud||,i, tann|y plan)
I
13 14(a)
-..quality . 1
13.14(b)
•
13.17
13.22
m brackets
n<y taken
.
fV/AIDS...’
ni-i1 taken
safe abortion services... ‘
M ^'uagc taken
^■and population related issues.. J
in brackets
• and access to sate abortion services.. ’
agreed
lanzuagc taken
no| taken
1
•f
‘SsiMisa
Women’s Caucus
Iff 'J2i .4*• ...^omen's
Caucus
f 4' ’ Women's Caucus Amendments
I; / • omenls Caucus Comments on Draft
■i
"" ,he Dra........
" ’’“'grainnie
<>t Action of the icpo
..............
••at ICPD
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■ I
SEI
Impact Analysis of the Woine-
Caucus at K PI) PiepCom 111
oil the Dr
• l inal Document of the C on fereiice
Chapter XIV
i
?
INTERNATIONAL COOPERATION
Paiagrapli in Drati
I l-iiul Doc
Women's Caucus Suggested Amendment'
Status in the I )• -i
I’inal DiMiinciit
14.1
I
ta»»'
14.2
.development and population’
|
r ■
(
hoi
I
i
I1i
exact language taken
not t.fk
Such objectives and activities must adhere to
"Ueriiatioiiai human rights standards and must take
into account their impact on women.2
14.3
not taken
...center on the well-being of intended benefkiaries, particularly women...
14.3(f)
14. B. (Sub-Tide),
14.11
yjsy x
z,'i!“" s“'"h,‘,s
I
I
r-7 ’I ':"
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i
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i
l% ■ Women’s Caucus urLui
o»« vuinpnanun of
0„„ p,............
- Women’s Caucus Priority Amendments
.» to the Draft I rogramme of Action of the ICPD
« Women s I aucus Amendments
lo the Chairman’s Draft of Working Groups I & ]
Women s Caucus Comments
on Draft Final Document ot the Conference
I
I
■ '■ is
|x k’-- ' !' J
language taken
< "particular!)
women" not taken.
agreed
exact language taken
in brackets
exact language taken
agreed
...development and...2J
<
|V*,: ,
agreed
"" *“*....... r.dd
I
IS
taken
---------------
*
I
Status ot the
Negotiation's
14 4
I
14.8
I
I
I
■
International coopciaiion ellorts amongst recipients and donors should adhere to human rights
standards recognized by the international community and this Programme ol Action. ’
inti lakeii
At the program level, national capacity building and transici ol appropriate technology and know
how must lie core objectives and central activities lor international cooperation including countries
with economics in transition. In this respect, a critical element to meet the very large commodity
needs ol tainily planning programs is the local production ol <oiitraccptivcs of assured quality, lor
which technology cooperation, joint ventures and other forms of technical assistance mights be
required?
concept and inosi
language taken
In the area of population policy covering rcpnxluctive health and contraceptive delivery, each
i
country should assess its financial and technical needs for making comprehensive reproductive
health care services universally available, based on this infonnation, each country should formulate
d 10-year and 20-year plan for increasing investment and resources in providing such services. An1
international; mi nmum of I percent of GNP for overseas development assistance (ODA), and 4 !
percent of ODA tor the provision of comprehensive reproductive health care should be established^,
including but not limited to contraceptive delivery, the allocation and renewal of these funds shoe’ I
lx: based on the broader set of program measures outlined above, including new indicators such a
prevalence of and reduction in STDs and RTls, quality of care, client satisfaction, contraceptive
method mix, adequacy of prenatal and post natal care, and access to safe abortion services. A
minimum condition for international donor assistance to reproductive health and contraceptive
delivery should be complete transparency-the open availability of infonnation on budget
not taken
agiccd.
' l.umly
pl.mmog
brackets
hi
expenditures, health data, client surveys and laws and policies governing access. A minimum of K)
percent of ODASshould be allocated to rapid expansion of primary preventive and curative hcalthl
|:H
services. Finally steps must be taken in every sector of ODA and macroeconomic policy to
eliminate gendei bias in the allocation of resources and investment.123
14.9
...related activities.. sexual and reproductivohealth including..?
I
V
w
'■
Jp
xivv' j?*’ .L™i
•Source:
1 - Women’s Caucus Draft Compilation of Proposed Revisions on iIh l»
Programme of Action ol flic l( PI)
- Women’s Caucus Priority Amerxlmvnis to the Drall Programme ot a. non ol the
i’D
- Women’s Caucus Amendments to lhe Chairman’s Draft of Working (iioups I Ac 2
Women’s Caucus Comments on Dial! Final Document ot the Conhuv
:
language taken
in brackets
I
Impact Analysis ofihe VVol
on the Draft f inal Doctiinent of (he Conlereticc
Chapter XV
i
t
*’s ( aucus at K PI) PrepCom III
PARTNERSHIP WITH THE NON-GOVERNMENTAL SECTOR
I
Paragraph m
Women' s Caucus Suggested Amendment*
Draft Final D<k
Status in the Drat!
Final Document
15.1
and require their participation (deleteiassist)2'1
■I
Stdins ot the
Negotiations
noi taken
es tluation and monitoring... 2 1
Planning
15.2
Non-govenune nta
15.5
...gender...
language taken
orgaiiizalions are an important voice of the people.2
agreed
agreed
...monitoring and^ v a I uat ion... 1
15.6
............by
........
|lt held accountahlc and
t>e
principles recognized
the . huertutlnLVuinmnmh;'
"'I ix-«nk N.„,
exact language taken
agreed
exact language taken
agI ecd
concept taken
aiced.
sexual and
1
fcpriHlutlivc
hcdlih
sei vices” tn
15.8
I
brackets
15.9
-■ rw- t..i..,“„ SXSi........... ■ Ma. ........... ■ -I
criteria used for
I
working on population and development policy. ’
I
1
15.11
JI
Cn * l° ,,(,n’^)Vcr,,lnanlaI organizations
..... .
Women s ( aucus Coinriient:
W* ;:r
■'
■
■
agreed
language taken
eoikcpt takci
\Suurcc;
C Women's Caucus Draft Compilation
"
concept and sonic
guarantee the abiliny of non-governmental
5
K'"'
agreed
Governments and intel governmental organizations must
organizatmns io function freely and independently '
i
|
concept taken
...............................................................................................................................................................................................................................................................................................................................
■
institutions r
Document of the ('onferunc
agived
language ta
15.12
nvatc .sector mvtily. nielli may assist or .supplement but must^mitigatc the responsibility of
governments to provide lull, safe and accessible reproductive health services to all people . The private:
sector must Ik- held actotmiable to all human rights and ethical standards and principles recognized by
the international community and in this Piogramnic of Action.' '
exact laiiL'u.Q’c taken
agreed.
. . loducliw
licaith
services in
brackets
concept Liken
.1 gleet I.
’ reprcMiuchvc
health and
laiinl y
plainiing" in
hrai kets
exact language taken
agreed
i_______________
15.15(b)
quality, low-cost reproductive health, accessible
i
15.16
.. .quality. /
3S3:
I
i
'W
o
W
_
•Source:
* •- Women
aueus Draft
women ss Ccaucus
Draft Compilation
Compilation ct
at Proposed
Proposed Revisions
Revisions on the Draft Programme of Action of the ICPD
Women’s Caucus Priority Aniendmens
Amendments to
m the Draft
Bruft Programme
Pnuiru
j’ *• Women
of Action of the ICPD
4 ‘- Wo,nc,fs
Women’s (’iaueus
»ucus Amerxlments
Ainendinents to the Chainnan’s Draft of Working Groups I & 2
WtHiieii’s Caucus4'omment*ra>n Dr^ltjHniil Document tiHhe Conference
In *
I
L
J
Impact Analysis of the VVomer
aucus at K I’D PiepCom III on the Drau
i’inal Document of the
I
< onfercncv
i
-i
I
1
Chapter XVI
FOLLOW-UP TO THE CONFERE
Paragraph in
1
Women’s Caucus Suggested Amendment*
4
Draft Final Dot
i
16.3
16.4
...development of qualitative and quantitative staiulinK t
.i , •
. .
programs based on ilie goals and human rights nri ' i
o- 3 Uahn^ P0PlJ,at,0,i and development
iiKluding the views^f program u.^s
P
* ' ah,n“Cd ,U lh,S Pr‘^^n.ne of Action,
Implementation of tie Programme of Action must be viewed as i
Status in die I halt
Hnal I.Joviiiiiciii
Negotiations
concept (aken
m brackets
exact language taken
agreed
~~--------------------------------
pan of an integrated
follow-up
major international Conference, the UN Conference on
w
u,' eflbr: to
Conference on Hunun Rights the World Social S
E,lvlrt’,u»e'" and Development, the World
Women?
8
’
d S,K-,‘‘I Sul,,n'". and the Fourtlt World Conference on
1 I
1
1
1
A
1
!
3
^Source:
I 1 ’ w™"e"? 5.aULU' Dru"
- Women’s ('<
Women s ( aucus Comments
ll. !
7
7.......... .. ... .... ..
t-
I
16.9
(1) full and fan
paKupauo,, altu deci.Monmaking by non-goveriuncmal and |x,pu|.„ .nga.nz.unn.s
every level;
<i(
HOI l.lkcll
(2) the integration o gender peisjKctive based on the |
participation of independently selected
«■ 'cscntaiives front non-governmental and
popular organization
•U experts coiicetned with the rights
and eni|)owc!nicni o women;
(3) lull tiranspaieik
-------j of opetations and access to data;
j..... «*•«•*v .mu i{uaiiii(ativc standards
* c
LrX El” ;
pri“""“ ............ ........ . ■"
f program users.
(5) creation of unnplaini and investigafory procedures accessible io
non-govuriiniunial organizations and
individuals;
(6) monitoring by independent ethical bodies,
clinical trials and service delivery programs;
including repicsentatives of the community served, of all!
(7) d.stillation and public disseminaiion of a chaner ol rights, drawn from tins Program.
ne of At tion.
and national commitments thereto
(8) accountability of the tmenutional financial
nmlu-nanonal corporairons (or private sector
'
ftdopSVrXn^a'nd1 rea"'K-a,K,n
and
>-■ '-mane and integrated populauon a
< 10) coordination between in.stitmion.s affecting po|inl,m
, ■ ■
•
md development governmental and the
relevant human rights bodies, as called for by the Vienna Declaration.'
tese mechanisms should be implemented as soon as |«.ssible but no later than
two years from the
adoption of this Plan of Action.
16.10
pnvimtEp, ”
I
I
......... “P1
capacity and
"Wicators based on the goals
16.B. Subtitle
Regional and sub regional activities1
16(all)
development and. ./population-related issues...'
agreed
not taken
i
L
Women s Caucus Draft Compilation
ft
concept taken.
’'indicatois" not taken
comnmmty <
w
5^
agteed
------- I
16.12
and pnnctples of this Programme of Action?
toikepi taken
,
Cy
I
<>l Proposed Rcvisrons on (|lc Oran Programme ol Acnon of the K PI)
w<»nx:n’.s Caucus I......... ..
nurity Amendments to the Draft Programme of Action of the ICPI)
Women s ( aucus Amendments i
----- --------------- '
,hp <’hairinan,s Draft of Working Groups I A J
• Women s < aucus Comments on Dr.di f-mal Document of (he ('ontercncc
> i___
a
t
agteed
i
coikept taken
aglet J
I
/UH U
THIS DOCUMENT HAS NOT YET BEEN OFFICIALLY EDITED.
THE FINAL VERSION WILL BE ISSUED AT A LATER DATE.
UNITED
NATIONS
General Assembly
Distr.
GENERAL
A/48/ /Add.l
21 September 1993
ORIGINAL:
ENGLISH
GENERAL ASSEMBLY
Forty-eighth session
Item 97 of the provisional agenda *
INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT
Annotated outline of the final document of the Conference
Note by the Secretary-General
The Secretary-General has the honour to transmit to the General Assembly,
as an annex to the present note, an annotated outline of the final document of
the
International
Conference on Population and Development.
The
annotated
outline has been prepared, in close collaboration with the Secretary-General of
the Conference,
in response to Economic and Social Council resolution 1993/76
requesting that the annotated outline be included in the progress report referred
to in paragraph 20 of General Assembly resolution 47/176.
The first draft of the
final document based on the present annotated outline will be discussed by the
Preparatory Committee for the Conference at its third session from 4 to 22 April
1994.
*
A/48/150.
/
ANNOTATED OUTLINE OF THE FCNaL DOCUMENT OF THE INTERNATIONA!.
CONFERENCE ON POPUIATION AND DEVELOPMENT
CONTENTS
Chapter
Pa ragraphs
Part One
I.
PREAMBLE
II.
PRINCIPLES .
III.
6
2
6
3
12
9
3
6
9
7
10
9
12
10
10
GENDER EQUALITY AND EMPOWERMENT OF WOMEN
13
22
11
A.
B.
C.
Empowerment and status of women
Male responsibilities and participation
The girl child
14
17
20
16
19
22
11
12
12
THE FAMILY, ITS ROLES , COMPOSTTTOK' SUBSTRUCTURE
23
29
13
A.
B.
24
27
25
29
13
13
B.
C.
V.
1
Choices and responsibilities
THE INTERRELATIONSHIPS BETWEEN POPULATION, SUSTAINED
ECONOMIC GROWTH AND SUSTAINABLE DEVELOPMENT
A.
IV.
Pre.anble and principles
.
Part Two.
Pa Re
Population, sustained economic growth and sustainable
development
Population, socio-economic development and poverty
alleviation
Population and the environment
Diversity of family structures and composition .
Socio-economic support to the family
-2-
Chapter
VI .
Paragraphs
POPULATION GROWTH AND STRUCTURE
30
65
16
31
34
37
40
43
33
36
39
42
45
15
15
16
16
17
REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH AND
FAMILY PLANNING
66
58
17
A.
B.
C.
D.
47
50
53
56
49
52
55
58
18
18
19
19
HEALTH AND MORTALITY
59
71
20
A.
B.
C.
60
63
62
65
21
21
66
69
68
71
22
23
72
84
23
73
75
24
76
79
82
78
81
84
24
25
25
INTERNATIONAL MIGRATION
85
97
26
A.
B.
C.
D.
86
89
92
95
88
91
94
97
26
27
27
28
A.
B.
C.
D.
E.
VII .
VIII.
D.
IX.
Diversity of fertility, mortality and population
growth rates
Children and youth
Ageing populations
Disabled persons
Indigenous people
Reproductive health
Family planning
Human sexuality and gender relations
Adolescents
Maternal morbidity and mortality
Infant and child mortality
Sexually transmitted diseases and acquired
immunodeficiency syndrome
Primary health care and the health-care sector .
.
POPULATION DISTRIBUTION, URBANIZATION AND INTERNAL
MIGRATION
,
A.
B.
C.
D.
X.
Page
Population distribution, natural resources and
the environment
Population distribution policies and sustainable
development strategies
Population growth in large urban agglomerations
.
Displaced persons
International migration and development
Documented migrants
Undocumented migrants
Refugees
-3-
.
Chap re r
Paragraphs
Parc Three.
XI.
XII.
XIV.
98
104
30
A.
B.
99
102
101
104
30
30
CAPACITY-BUILDING
105
114
31
A.
B.
106
108
31
109
112
111
114
32
33
TECHNOLOGY, RESEARCH AND DEVELOPMENT
115
124
33
A.
B.
C.
116
119
122
118
121
124
33
34
34
125
131
35
126
129
128
131
35 36
INTERNATIONAL COOPERATION
132
138
37
A.
B.
Modalities
133
135
37
Resource mobilization: bilateral and multilateral
development assistance
136
138
38
XVI.
PARTNERSHIPS WITH NON-GOVERNMENTAL GROUPS, INCLUDING
NON-GOVERNMENTAL ORGANIZATIONS, THE PRIVATE SECTOR
AND LOCAL COMMUNITY GROUPS
139
144
38
XVII.
FOLLOW-UP
145 -.151
40
A.
B.
146
149
148
151
40
41
Public awareness and dissemination of information
Information, education and communication ....
Management of programmes
Education and training of policy makers, managers
and other personnel
Institutional development
Basic data collection and analysis
Biomedical research and development . . . .
Social and economic research and development
NATIONAL ACTION
A.
B.
XV.
Means of impLemenCaCion
POPULATION INFORMATION, EDUCATION AND
COMMUNICATION ....
C.
XIII.
Page
National policies and plans of action
Resource allocation
Implementation . . .
Monitoring and review
-4-
Part One
PREAMBLE AND PRINCIPLES
-5-
Chapter I
PREAMBLE
.
Ihe preamble will convey the vision and purpose of the International Conference
on Population and Development and define the context of the proposed action programme.
The preamble will cover the following elements:
(a) Brief survey of present population dynamics and their interrelations with
current social, economic and political trends, bringing out the interaction between
population, sustained economic growth and sustainable development.
(b) Overview of the experience gained in the field of population policies and
programmes during the past 20 years.
This assessment, based on the findings of the
progress made in achieving the goals and objectives of the World Population Plan of
Action adopted in 1974, will provide the critical foundation for the development of
goals and strategies for the future.
(c)
Brief presentation of the objectives and general goals contained in the
proposed action programme.
(d) General introduction to the set of actions necessary to achieve the proposed
population objectives that are consistent with sustained economic growth and sustainable
development.
Particular emphasis will be given to human rights, as well as to the
socio-economic situation of the developing countries, particularly the least developed
countries.
(e) Indication of the resources and efforts required for the implementation of
the proposed action programme.
(f) Reference to the most relevant intergovernmental instruments relating to
(f)
population, economic and social development and sustainability.
Chapter II
PRINCIPLES
2.
This section of the proposed action programme will provide the guiding philosophy
in the area of population and development well into the twenty-first century
e
principles will build as much as possible on agreed international instruments, including
the World Population Plan of Action, 1/ the recommendations of the Internationa
Conference on Population (Mexico City, 1984), 2/ the Amsterdam Declaration on a
Life for Future Generations, 3/ the Rio Declaration on Environment and Development
-6-
and Agenda 21 5y adopted by the United Nations Conference on Environment anc
Development, held at Rio de Janeiro from 3 to 14 June 1992. They will also reflect the
Nairobi Forward-Looking Strategies for the Advancement of Women £/ and the applicable
provisions of human rights instruments such as the Universal Declaration on Human
Rights, 7_/ the International Covenant on Social, Economic and Civil Rights, 8y the
Convention on the Elimination of Racial Discrimination, 9/ the Convention on the
Elimination of All Forms of Discrimination Against Women 10/ and the Convention on the
Rights of the Child. 11/ The guiding principles will be organized around the following
major topics:
(a) Human rights and population: recognizing obligations and responsibilities.
Protection of rights of individuals; elimination of all forms of discrimination, rights,
obligations and responsibilities of couples and individuals in relation to their sexual
and reproductive life; protection of vulnerable groups; and opposition to all forms of
coercion to hcive or not to have children.
The responsibility of society for human development, reproductive health
(b)
.nd family planning: ensuring choices and responsibilities.
Sustainable development and population. Linkages between population,
(c)
resource use, consumption, environmental impact and repercussions on the quality of life
for present and future generations.
(d) Partnership in population:
moving from commitment to action. Mutual
responsibility and interdependence among individuals, social groups and nations.
-7-
Part Two
CHOICES AND RESPONSIBILITIES
-8-
Chapter III
THE
INTERRELATIONSHIPS BETWEEN POPULATION, SUSTAINED ECONOMIC GROWTH
AND SUSTAINABLE DEVELOPMENT
Cooperation, in particular the Revitalization of Economic Growth and development of the
Developing Countries, the International Development Strategy for the Fourth United
Nations Development Decade and Agenda 21, the Conference is expectedt° provide guidance
for the formulation of population policies and programmes that seek to simultaneou y
achieve sustained economic growth and sustainable development taking into account, th
interlinkages of population with poverty; production and consumption Pa“erns,
environmental quality; natural resources; and economic, social and gender inequality.
A. Population, sustained economic growth and sustainable development
Basis for action
Lack of development or unbalanced development and poverty are often associated with
Inappropriate spatial distribution of the population and undesirable environmental
conditions. The critical challenge in all countries, whether developed, developing or
in transition, is to improve the quality of life for the present ge^ratJ°nS
compromising the ability of future generations to meet their own needs
gannet be
addressed without recognizing the strong linkages between population, resources,
environment and development
Objectives
5
To create an international environment favourable to the realization of the right
to development and to establish consistent policy frameworks that promote balanced and
part of any
sustainable development, recognizing population factors as an integral
1
environmentally sustain
policy and programme.
Selected topics for recommendations
to
means
of long-term policies and programmes that simultaneously address population growth,
-9-
alleviate poverty and reduce social inequality in both rural* and urban settings,
Ensuring that policies and programmes are responsive to the needs of the poor in all
and family planning and maternal
countries, particularly in health, education, training,
t
and child health programmes.
B. Population, socio-economic d-evsl-oprnenc a.nd poverty allsviacion
Basis for action
7
Widespread poverty is a major challenge to development efforts as poverty is
often accompanied by ignorance, illiteracy, low_status of women and limited access to
health and family-planning services, all these factors tending to result in high leve s
of fertility morbidity and mortality. Women are often among the poorest of the poor.
Alleviating the conditions of abject poverty under which close to 1 billion people live
today is an integral part of the agenda for sustainable development.
It is also
necessary to prepare for meeting the basic needs of Che population that will inevitably
be added in the near future. The goals and objectives of the International Development
Strategy for the Fourth United Nations Development Decade aim at responding to such
concerns.
Objectives
8.
To break the poverty-population growth cycle through integrated population and
development policies and programmes that recognize the key role of human resources in
national development and give strong emphasis in national planning and policy-making
to the development of human resources. To make equity in the allocation of resources
and access to services an important element of national policy, designing policies and
strategies to ensure that the benefits of development are widely shared.
Selected topics for recommendations
9
Making the alleviation of poverty, the achievement of equitable social and
economic relations, and the
the provision
provision of
of basic
basic infrastructure and social welfare
key
components
of
socio-economic
services key components of socio-economic development
development and central factors tor
• ’’ development, Need to give high priority
harmonizing demographic trends with sustainable
training and credit
to investments and expenditures to facilitate access to
t_ education,
-to all deprived sectors of society, as well as to economic policies that increase their
opportunity to participate in the formal labour force; particular attention should be
given to the situation of poor women.
C.
Population and the environment
Basis for action
10.
Current patterns of population growth and spatial distribution, associated with
present levels and patterns of production and consumption exert increasing pressures
of
the nlanet.
planet, which is understood as the number of people that
on che carrying capacity n
f rhe
acceptable
level of quality of life, without irreversibly
the planet can support at an
support
people
in
the future. This carrying capacity is being
reducing its capacity to ;
of
the
world.
Some areas are characterized by deep and
exceeded in many parts
-10-
widespread poverty, while others are affluent.
Associated issues are the loss of
agricultural land, due either to soil degradation and erosion or conversion to urban
land; the destruction of forests; water problems such as scarcity, depletion and
pollution; loss of biological diversity; and climatic change.
Objectives
’ '
nature of environmental degradation and the role of
li.
To recognize the critical
To
adopt
environmentally sustainable development strategies
demographic variables.
to
social
programmes
and policies, including those on population
giving due priority
and education. To address the underlying causes of environmental degradation such as
poverty and unsustainable production and consumption patterns.
Selected topics for recommendations
12.
Formulation of enforceable measures to promote greater harmony between
population, resources, environment and development, so as to achieve improved quality
of life on a sustainable basis, Identification of critically endangered areas subject
to acute population pressures and formulation of actions needed to alleviate pressures
Finding durable solutions to problems related to environmentally
on the environment,
displaced persons.
Chapter IV
GENDER EQUALITY AND EMPOWERMENT OF WOMEN
13.
Gender equality is recognized as a human rights issue by the numerous
’ ►
Universal Declaration on Human
international agreements and declarations since the
Rights, including the World Population Plan of Action (1974) and the recommendations
for its further implementation adopted at the International Conference on Population
(Mexico City, 1984), the Nairobi Forward-looking Strategies for the Advancement of Women
(1985), the Amsterdam Declaration on a Better Life for Future Generations (1989), the
United Nations Conference on Environment and Development (1992) and the World Conference
on Human Rights (1993). Nevertheless, discrimination continues against women and girls.
Hence, the need to empower women and to improve their status is acknowledged by most
Governments. In addition, improvement in the status of women is a key development issue
because of women's vital and multiple roles. It is widely accepted that improvements
in women's advancement, health, education and employment, are mutually reinforcing and
should be pursued simultaneously in a holistic manner.
Changes in men's and womdn s
attitudes and behaviour are necessary conditions for achieving full gender equa ty.
A. Empowerment and the status of women
Basis for action
14.
The improvement of the status of women, particularly in respectt to education,
In addition, it
health and economic autonomy, is a highly important end in itself.
-Il
affects and is in turn affected by c-emographi.c variables such as fertility and maternal,
infant and child mortality. Exp- . icnce shows •hat population and development programmes
are most effective when measure:- have been t i/.on to improve the status of women.
ObJectives
To achieve full gender equality. To fully Integrate women into population and
15.
development programmes, both as beneficiaries and as active participants.
Selected topics for recontnendations
16.
Encouragement of women to participate in the political process, particularly at
the grass-roots level and promotion of women's economic security, right to inherit, own
land and access to credit.
Achieving balanced representation of both sexes in
population and development programmes, especially at management and policy-making
levels, both in the Government and private sectors. Combatting violence against women
and girls, including sexual violence.
B. Male responsibilities and participation
>asis for action
In general, men exercise preponderant power in nearly every sphere of life,
including personal decisions regarding family planning and the policy and programme
decisions taken at all levels of Government, It is essential to improve communication
between men and women, and
and the
the understanding of their respective and joint
that
women
and
men are seen as equal partners in public and private
responsibilities, so
17.
life.
Objectives
18.
To promote gender equity by ensuring that men understand and accept full and
equal responsibility in both family and community life, with regard to all issues of
mutual concern to men and women.
Selected topics for reconmendations
Full and active participation of men in all areas of family and community
19.
esponsibilities , so that these responsibilities may be equally shared by women and men.
C.
The girl child
Basis for action
Since discrimination on the basis of sex starts at the earliest stages of life,
20.
full equality for the girl child is; a necessary condition for women to fulfil their
potential and to contribute effectively to society. Investments made in the girl child s
health and education are steps towards raising the age at marriage and reducing early
child-bearing, while also increasing her options later in life.
-12-
Ob i ectives
po increase public awareness of the value of the girl child and eliminate the
root causes for son preference. To strengthen the girl child's self-image and selfesteem and improve the status of the girl child, especially in health, nutrition and
education.
Selected topics for recommendations
22
Access
Access by
by girls
girls and
and women to education and improvement of the quality and
22.
relevance of their education, including the elimination of gender stereotyping in school
curricula and in the media.
Enforcement of minimum legal age at marriage,
marriage, paying
f
as
educational and
to
attention to the provision of alternatives
early marriage such
employment opportunities.
Chapter V
THE FAMILY, ITS ROLES, COMPOSITION AND STRUCTURE
23
The family, in its many forms, is a basic unit of society and it is the social
These
institution within which most child-bearing and child-rearing occur.
These two
the
mutual
support
universal roles are complemented by other important functions such as
of its members and, in many countries, the care of the disabled and the elderly, The
large diversity of family forms and structures reflects how these functions are
accomplished, how societies value and protect their families, and which patterns of
family formation are prevalent in a particular social context. Families are important
agents of sustainable development at all levels of society and their contribution to~
that process
is crucial. The family also plays an important role m the
intergenerational transmission of social values as a primary agent of socialization and
is therefore a potential agent of social change.
A.
Diversity of family structures and composition
Basis for action
are numerous concepts of the family around the world; this diversity
24.
There
to the wide variety of social, political and cultural systems. As part of
corresponds
of rapid demographic and socio-economic change in both developed and
the process
developing countries, patterns of family formation are undergoing considerable.change
so that the composition and structure of families are being altered. In many societies,
a traditional gender-based division of productive and reproductive functions within the
family coexists with new arrangements. The recognition of the diversity of family
is important because in many cases policies and programmes relative to the family still
refer only to specific sizes and forms of the family that may no longer be predominant;
this issue is particularly important in reference co gender equality and the rights of
children.
-13-
Ob j ectIves
2To adopt policies and laws recogu i z I in; .■ d supporting the plurality of family
forms, including due attention io the large ncmoer of households headed by women
c*cted topics for reconmicndations
26.
Provision of means (i.e. , social services, kindergartens, part-time Jobs,
flexible schedules etc.) to facilitate <compatibility between professional and parental
roles. Elimination of all forms of coercion and
-------- i in policies and practices
-- discrimination
related to marriage and to child-bearing.
B.
Socio-economic support to the family
Basis for action
27.
Asa basic unit of society, the family is entitled to receive protection by
society and the State.
In many parts of the world the rapid process of development
intensifies the strains on family life.
There is an increasing number of vulnerable
families, including single-parent families headed by poor women, poor families with
disabled members, ffamilies separated by the working conditions of their members,, refugee
and displaced families, families affected by
j human immunodeficiency virus (HIV)
infection and acquired immunodeficiency syndrome (AIDS)) or by family disintegration,
domestic violence and child abuse or neglect.
Obj ectIves
28.
-To formulate
’’family-sensitive” policies aimed at providing support particularly
to vulnerable families. To int;roduce the concept of «fam£iy impact’’ into the process
of preparation of plans, policies and programmes of social and economic development.
Selected topics for reconnendations
29.
Assistance to families which manifest specific problems (i.e. , domestic violence,
drug and alcohol dependency, sexual and child abuse, neglect etc.), have special
responsibilities (i.e., handicapped members, care of the dependent elderly etc.), or
are in a particular vulnerable position (i.e., circumstances of war, drought, famine,
racial and ethnic violence, economic deprivation etc.).
Establishing guidelines for
monitoring the Implementation of family policies and programmes.
Chapter VI
POPULATION GROWTH AND STRUCTURE
30.
Growth of the world population, in absolute numbers, is likely to persist at
levels near the present all-time high in the coming decades.
There are also remarkable
-14-
i
differences between regions and countries in terms of population growth and its
These levels and differentials have implications
fertility and mortality components,
gional
distribution of the world population and fcr
ize and reg’
for the ultimate ssize
Action
;
population sstructure
true ture characteristics, in particular population ageing.
r of trends in population growth and
take
more
fully
into
account
the
variety
required to
f sustained economic growth and sustainable development.
s true ture Ln the context oi----- -
A.
Diversity of fertility, morcalLtzy and populacion growth—rates
Basis for action
’ * ongoing transition from high to low levels of fertility
Within the context of the
-variations
exist both at the regional level and within regions
and mortality , important
-----reflecting the present position of countries in their passage through
and countries, i
The majority of countries are
the different stages of their demographic transition.
’
’
:
at
different
speeds of decline, thus
converging to low rates of population growth but
31.
In addition a substantial
of growth that are increasingly diverse.
yielding rates
minority of populations are still at a pre - trans itional stage or at the very beginning
of their transition.
Objectives
To reduce the disparities in regional fertility and mortality levels and achieve
32.
early stabilization of the world population.
Selected topics for recommendations
Action required to accelerate
33.
desire such an acceleration.
B.
the demographic transition in those countries which
Children and youth
Basis for action
Due to declining mortality levels and the persistence of high fertility levels
34.
large number of developing countries continue to have substantial proportions o
a '
- in their
- • populations
’ - *
children and young people
. The ongoing and future demands created
by’ their
large
y“oung’ populations,
particularly
in terms
of health,
education and
employment, represent a major challenge.
Objectives
the fullest extent the well-being of all children and youth in line
35.
To promote to
with the commitments made in this respect at the World Summit for Children.
Selected topics for recommendations
Giving priority and higher levels
36 .
development for children and youth.
of attention
-15-
to
all
dimens ions
o f human
Ageing p<u 1 at i ons
Basis for actton
37.
There have been notable increases in the propollion and number of persons at
older ages in the population of most countries, a trend due to the decline in fertility
The
levels, reinforced by continued declines in mortality level s among the elderly
situation of developing countries that have experienced very rapid declines in their
In most societies the elderly
levels of fertility deserves particular attention
population is composed of considerably more women then men and in many societies,
elderly poor women are especially vulnerable, The steady increase of older age groups
ignificant implications for both the developed and the
in national populations has si^
developing countries. The economic and social impact of this "ageing of populations"
is both an opportunity and a challenge to all societies.
Obj ectives
Create conditions that allow the elderly to work and live independently in their
38.
own communities for as long as possible and as desired.
Selected topics for recooMaendations
39.
Need to ensure that long-term socio-economic planning takes into account the
needs of increasingly large proportions of elderly persons in the population.
Strengthening formal and inforu.al safety nets for the elderly in all countries.
D.
Disabled persons
Basis for action
The implementation of the World Programme of Action concerning Disabled Persons
40.
during the United Nations Decade of Disabled Persons (1983-1992) contributed towards
increased awareness and expanded knowledge of disability issues, increased the role
played by persons with disabilities and by concerned organizations, and the improvement
and expansion of disability legislation. However, there remains a pressing need for
continued action to promote effective measures for the prevention of disability, for
rehabilitation and for the realization of the goals of full participation and equality
for persons with disabilities. By resolution 47/88 of 16 December 1992, the United
Nations General Assembly encouraged the consideration by the International Conference
on Population and Development of disability issues relevant to the subject matter of
the Conference.
Objectives
41.
To ensure the participation of disabled people in all aspects of social, economic
and cultural life to the fullest extent of their abilities.
-16-
Selected topics for recommendations
Recognition of the needs of disabled persons concerning, Inter alia , sexua 1 a■ il
42.
reproductive health, including family planning services and elimination of the speci : 1j
forms of discrimination which disabled people may face with regard to international
migration, reproductive rights and household and family formation.
E. Indigenous people
Basis for action
43.
In many regions of the world, indigenous people are experiencing steady and, in
some places, rapid population growth resulting from improved access, often belated, to
health and welfare services.
At national, regional and international levels, the
perspectives of indigenous people are gaining increasing recognition, most recently at
the United Nations Conference on Environment and Development and the marking of the
This section will give recognition to the
United Nations Year of Indigenous People,
specific perspective of indigenous people on the interrelations between population, the
environment and development.
Objectives
To ensure that the various perspectives of indigenous people on population and
44.
development are brought before the national and international communities, taking into
account the commitments made during the United Nations Year of Indigenous People and
the ongoing activities of the proposed International Decade of the World's Indigenous
People.
Selected topics for recommendations
45.
Recognizing the distinct perspective of indigenous people
population and development and addressing their specific needs.
on
aspects
of
Chapter VII
REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH AND FAMILY PLANNING
46.
The cornerstone of reproductive rights is the recognition of the basic right of
all couples and individuals to decide freely and responsibly the number and spacing of
their children. Although reproductive and sexual health are central to people's lives,
many persons fail to achieve it because the relevant information and means, including
those related to family planning, may not be available to them.
The disparities are
especially marked between those in the developed and the developing countries. The
result is unnecessarily high levels of reproductive mortality and morbidity in many
developing countries, a problem which must be addressed by promoting reproductive anc
sexual health for all people as the fundamental basis for publicly supported
reproductive health and family planning programmes.
-17-
A. Reproductive? health
Basis for action
Reproductive health is not merely absence of disease or disorders of the
47 .
reproductive process. It implies that people have the ability and choice to reproduce,
to regulate their fertility and to practise and enjoy sexual relationships.
Farn^y
planning and safe motherhood are essential components of reproductive health.
The
attainment of optimal reproductive health eludes many persons due to inadequate
knowledge about human sexuality, inappropriate sexual behaviour, gender bias an
inappropriate, inadequate information and services or due to Involuntary sterility
Unsafe abortion is one of the most neglected underlying causes of reproductive ill
health, and constitutes a major public health issue. Genital mutilation is also an
obstacle to reproductive health.
Concerning all factors of reproductive ill'health,
women, adolescents and disadvantaged population groups are particularly vulnerable^
Finally, reproductive health cannot be achieved without the full involvement of bot
women and men.
Objectives
To ensure the provision of appropriate information and services that are free
48.
of coercion, voluntary, accessible, affordable, acceptable and promoting informed
choice.
To provide services which respond to the changing reproductive and sexual
health needs of individuals and couples over the life cycle and reflect the social,
cultural, economic and demograpnic diversity of the communities they serve.
Selected topics for recommendations
49.
Ensuring that reproductive health services for men and women of all ages have
a client-centred approach, are cost-effective, follow high standards of quality and
include maternity care, family planning, prevention and treatment of infertility,
prevention, diagnosis, treatment and referral of sexually transmitted diseases including
HIV infection and AIDS, and education and information on sexuality and responsible
parenthood.
Full involvement of women in the formulation and implementation of
reproductive health programmes. Review of the legal and regulatory barriers to
reproductive health such as early or enforced marriages, illegality of abortion,
maternity leave regulations and access to reproductive health services.
B.
Family planning
Basis for action
50*
Over the past three decades, the emergence of acceptable, safer methods of modern
contraception has permitted greater individual freedom and control of reproduction.
However, these family planning methods remain unavailable to many persons who need them,
both women and men. Proper widespread use of family planning services saves the lives
and health of millions of women and children. Such services are also a cost-effective
intervention, because of their many direct and Indirect benefits for individuals,
couples and communities. The experience of the past decades points at the Importance
-18-
of promoting Informed choice and availability of a wide range of safe and effective
contraceptive methods and ensuring that women play a central role Ln the design and
Hany family planning programmes have
implementation of family planning services,
non-governmental
and private sectors.
benefitted from partnerships between public,
Ob j ectives
51.
To help couples and individuals to achieve the desired number and spacing of
their children thereby reducing the incidence and risk of unwanted pregnancies. To
reduce the incidence of high-risk pregnancies. To extend coverage and improve access
to family planning services to all who need them.
To improve the quality of family
planning services for women and men.
A quantitative goal concerning the size of the
unmet need for family planning information and services and the resources required to
meet that need will be proposed for adoption by the Conference.
Selected topics for reca
ien<ia tions
|HHll
52
Ensuring easily accessible and available high quality family planning counselling
and services responsive to individual needs, in particular through improved human
resource planning, selection and training of staff and community involvement in the
delivery of family planning services. Removal of unnecessary and inappropriate legal,
medical and regulatory barriers to access to family planning while continuing to ensure
safety. Making information, services and supplies available to unreached populations.
Ensuring sufficient and continuous supply of contraceptive commodities and strengthening
of logistics systems.
C.
Human sexuality and gender relations
Basis for action
53.
Human sexuality and gender relations are closely interrelated and together affect
the ability of men and women to achieve and maintain sexual health and control their
fertility. Responsible sexuality and sensitivity in gender relations, particularly when
instilled during the formative years, enhance and promote respectful and harmonious
relationships.
Objectives
54.
To ensure that men and women have access to information, education and services
to exercise their reproductive and sexual rights. To foster mutually respectful gender
relations as an important requisite of sexual and reproductive health.
Selected topics for reco |>IIH1endations
equal rights in
Fostering acceptance among men and women of the importance of
55.
and
girls in and
sexual relationships through sex education and counselling for boys
sexuality
and
Promotion of responsible and safe
beyond the formal school system,
parenthood.
-19-
D.
Ado 1 <• ■
'Hi s
Basis for actlon
56.
Motherhood at. a young age ■•iit.ails a risk f maternal death much greater than the
In many countries,
average, and the children of young mothers also fare less well.
increasingly
at
high
risk
of contracting
sexually active adolescents of both sexes are
including
HIV
infection
and they are
and transmitting sexually transmitted diseases,
*
t
themselves.
In
many
societies,
adolescents
often poorly informed about how to protect
to
prematurely
engage
in
sexual
activity.
Young
women,
are facing increasing pressures
are
especially
vulnerable
because
of
their
subordinate
particularly poor teenage girls,
Millions of teenage girls worldwide seek abortions every year, which
social position,
the critical importance of the issue of unwanted pregnancy.
Overall for
attests to 1-- .
women
early marriage and early motherhood severely curtail educational an
young
employment opportunities.
Programmes addressing these issues have shown to be more
effective when they secure the full involvement of adolescents in identifying an
searching for solutions to their reproductive and sexual health needs, including suppor
to those who wish to abstain from sexual activity.
Obj ectives
To
address
adolescent
reproductive
health issues, including- HIV infection and
57.
XU
dUUlCbb
auu xt
-v*. v-r - --------- ---AIDS
through the promotion of responsible and healthy reproductive and sexual
behaviour. To
To protect
protect the
the human
human rights and well-being of adolescents and to promote
their active involvement in the process of socio-economic development.
ov
hk
Selected topics for recommendations
Recognition of the special needs of adolescents and the programmes required to
58.
—-a in the areas of family planning, family
meet those needs, including education programmes
reproductive and sexual health, sexually transmitted diseases, HIV infection and
life, J
AIDS and reproductive health services including family planning services specially
designed to meet the needs of adolescents.
Chapter VIII
HEALTH AND MORTALITY
59.
Although mortality has continued to decline at the world level, there are
sizeable population groups within countries and jrntiij nc-tj-onal populations that still
survival has increased, but high
experience high morbidity and mortality rates. Child
C..
’
i
some
population groups and regions.
infant and child mortality rates still prevail in
•
>
experience
high
maternal mortality. Another
Women in the developing world continue to ( ,
cause of great concern is the increasing incidence of HIV infection and AIDS among
children of HIV-infected mothers The health of the adult population in the working ages
is being negatively affected by the spread of HIV infection and certain forms of
behaviour, such as the consumption of tobacco, alcohol or drugs, pointing to the need
-20-
for changes in lifestyles.
The growing number of older people is associated with an
increase in the incidence of non-communicable diseases. Adequate access to health care
is still not available to a large
Large portion of the world population.
A.
Maternal morbidity and mortality
Basis for action
60.
Maternal mortality is one of the leading causes of death among women of childbearin-g age in the developing world. At the global level, about half a million women
continue to die each year from pregnancy-related causes; 99 per cent of them in
developing countries. Maternal mortality rates vary widely, In a majority of developed
In
countries, maternal mortality rates are below 10 deaths per 100,000 live births,
contrast, for the less developed regions, the estimated rate is 420 deaths per 100,000
live births with Africa having an estimated rate of 630 maternal deaths per 100,000
births.
In developing countries, mortality resulting from complications of poorly
performed abortions accounts for a significant percentage of maternal deaths.
There
is a particular need to monitor the progress made in reducing maternal mortality so as
to enhance the effectiveness of ongoing and future programmes.
Ob j ecLives
To achieve a rapid and substantial reduction of maternal morbidity and mortality
61in accordance with quantitative goals to 1be adopted by the Conference for the period
up to 2015.
Selected topics for rec
endations
62.
Need to increase the provision of maternity services in the context of primary
health care and improve those services by including safe-motherhood education, nutrition
programmes, family planning, prenatal and postnatal care and delivery assistance by—
adequately trained birth attendants. Need to address the problem of maternal deaths and
complications resulting from unsafe abortion.
B.
Infant and child mortality
Basis for action
63.
Important progress has been made in reducing infant and child mortality rates
everywhere, although improvements have been slower in sub-Saharan Africa.
If^ is
estimated that during 1990-1995, still over 100 out of every 1,000 children born alive
will die before age 1 in a number of African and Asian countries, compared with only
12 per 1,000 in more developed countries as a whole. The mortality of children under
age 5 exhibits a similar pattern.
Poverty, malnutrition, ignorance of proper
sanitation, inadequacy of health facilities, social unrest and wars are factors
associated with high infant and child mortality.
Early, late, frequent and multiple
pregnancies intensify the risks of infant and child mortality.
-21-
Ob j ectIves
64.
To improve the health stains of infant .. and children, to reduce the incidence
of low birth weight and to lower i.fant and chi -< .norlality in line with the commitment
of Governments made at the World Summit foi
hildren.
The document will include
quantitative goals for infant mortality reduction for the pci tod up to 2015.
Selected topics for recommendations
65.
Promotion of comprehensive mother-and-chi Id health services, including prenatal
care , child-spacing, breast-feeding, infant and child health-care services, greater
immunization coverage, prevention and management of childhood diseases and proper
nutrition counselling.
C.
Sexually transmitted diseases and acquired innnunodeficiency syndrome
Basis for action
66.
The incidence of sexually transmitted diseases continues to be high, with an
estimated annual number of cases surpassing 250 million.
In the developed world the
incidence of many sexually transmitted diseases caused by bacteria have stabilized but
in the developing world that incidence appears to be increasing.
In addition, over 1
million people a year are becoming newly infected with HIV, the virus causing AIDS.
The AIDS pandemic has emerged in both developed and developing countries as a major
public health issue, threatening to undermine major gains in the reduction of morbidity
and mortality.
The World Healtn Organization estimates that as of mid-1993 over 2.5
million cumulative AIDS cases have occurred but more than 14 million people worldwide
have been infected since the epidemic began, including more than 1 million children
infected with HIV through their mothers. The estimated distribution of cumulative HIV
infections in adults as of mid-1993 shows that approximately four fifths of all cases
occurred in the developing countries, where the infection is increasingly being
transmitted through heterosexual intercourse.
Objectives
67.
To strengthen the contribution that family planning programmes can make to the
prevention and treatment of sexually transmitted diseases, with special attention to
HIV infection.
Selected topics for recommendations
68.
Strengthening programmes that minimize sexually transmitted diseases and HIV
infection through the promotion of safe and responsible sex and the provision of sexual
health education and of preventive, diagnostic and curative treatment to inhibit the
transmission of sexually transmitted diseases.
-22-
D.
Primary health care and the health-care sector
Basis for action
69.
There have been important advances in improving access to the essential elements
of primary health care and making available basic curative health services, as reflected
in the sustained increases in life expectancy at birch in most parts of the world.
Notable achievements include the vaccination of about 80 per cent of the children in
the world and the wide use of low-cost child survival techniques such as oral
rehydration therapy.
Despite such progress, large segments of the population (mainly
the poor) lack access to public services, such as clean water and sanitation facilities,
and are thus at greater risk of infectious disease. In many countries and regions, the
health effects of environmental degradation (including workplace environmental
conditions) are increasingly a cause for grave concern.
Various forms of substance
abuse (tobacco, alcohol and drugs), inappropriate diets and lack of exercise have been
found to hamper progress in mortality and morbidity conditions, particularly among the
poor and those unreached by health education. There is also concern about the reduction
of social investment in health that has taken place in many countries as a result of
structural adjustment programmes.
Objectives
70.
To attain further and more widely shared progress in general morbidity and
mortality reduction, in accordance with intergovernmental commitments to provide health
for all. Revised quantitative goals for increased expectation of life will be proposed
for adoption by the Conference.
Selected topics for recongnendatzions
71.
Securing improved access to primary health care services, with increased
attention to the prevention of ill-health caused by environmental degradation, and to
the promotion of changes in lifestyle patterns that are conducive to better health.
Chapter IX
POPULATION DISTRIBUTION, URBANIZATION AND INTERNAL MIGRATION
72.
Migration and urbanization are intrinsic parts of the development process.
Although rural-rural and urban-urban migration are the dominant forms of spa£j.al
mobility in many countries, attention has mostly been focused on rural-urban flows
because of their contribution to urban population growth.
The latest United Nations
estimates indicate that the majority of the world population will live in urban areas
by 2005. There are, however, marked differences in the levels and rates of urbanization
among regions and countries.
The less developed regions are undergoing rapid
urbanization, a process that is projected to continue for decades to come. In contrast,
the rate of urbanization in the more developed regions is slow and is expected to remain
so. However, whereas the rural population of the more developed regions is declining,
that of the less developed regions continues to increase despite rural-urban migration.
-23-
A.
Population diAtr i hi 11 i on. Datura1 resources and the environment
Basis for action
' ’
‘
; of
The mode ol development affects both migration and the resulting
patterns
73.
degradation often leads to migration both
population distribution. In rural areas, land
1
In urban areas, environmental strains are also
to urban and to other rural areas,
the extent that industry,
industry, financial services and
prompting people to move.
Yet, to the
communication facilities remain spatially concentrated in urban areas, they will
continue to encourage an unbalanced population distribution, The pursuit of sustainable
development is likely to foster more manageable population distribution patterns and
Since the poor are often
eliminate migration prompted by environmental push factors,
depletion
and environmental
most vulnerable to the impact of natural resource <
rational
use of
degradation, promoting a more 1
------ --- natural resources is also consistent with
the goal of poverty alleviation.
Objectives
74.
To foster a more balanced population distribution by promoting simultaneously
the sustainable development of rural and urban areas, with particular emphasis; on the
promotion of social equity. To reduce the role of push factors in miigration flows.
Selected topics for recommendations
Promotion of strategies that simultaneously encourage the growth of smallL or
75.
Reducing
medium-sized urban centres and the sustainable development of rural areas,
to
address
the risks of environmental degradation by developing appropriate strategies
with
fragile
the problems emanating from the expansion of human settlements on areas ’
ecosystems.
B.
Population distribution policies and sustainable deveJj^Daent^jzrate^es
Basis for action
Population distribution policies should be part of general development
76.
strategies.
In the early 1990s, approximately half of the Governments in the world,
most of them in developing countries, considered their patterns of population
distribution to be unsatisfactory and wished to change them.
To be effective,
population distribution policies should be consistent with other government policies,
especially those fostering economic development and the allocation of resources.
Objectives
77.
To formulate effective popularlorr <.^t*rlbutlon policies whose objectives and
goals do not conflict with other government policies.
To foster administrative
administrative
efficiency and improve services.
Selected topics for reconnendations
78.
Paying explicit attention to the
spatial
-24-
impact of macroeconomic and other
policies which have implications for population distribution, Ln order to bring them
into harmony with relevant national, regional and local development goals.
C.
Population growth in Large agglomerations
Basis for action
79.
In many countries, the urban system is characterized by the overwhelming
preponderance of a single major city or agglomeration, The tendency towards population
concentration, 1fostered by the concentration of public and private resources in some
In 1992, there
cities , has contributed to the rising number and size of mega-cities.
least
10
million
inhabitants
and
their
number
is
expected to
were 13 cities with at
In
that
year,
most
mega-cities
will
be
located
in the
double by the year 2010.
The
continued
concentration
of
population
in
primate
cities
in
developing countries,
and
in
mega-cities
in
particular
poses
important
economic,
social
and
______
general and in mega-cities
^vironmental challenges for Governments, particularly in view of the unbalanced and
unsustainable patterns of production and consumption and the high degree of social
inequality that generally prevails in such environments.
Objectives
80.
To enhance the management of urban agglomerations, reduce the urban bias that
contributes to the further concentration of population in large cities, and improve the
quality of life of the urban poor.
Selected topics for recoiminitendations
81.
Securing the revenue necessary for local authorities to improve urban
\ measures
infrastructure, safeguard the environment and provide urban services through
adoption
of
and
tax-raising
rights,
and
i
such as decentralization of expenditure
equitable cost-recovery schemes.
D.
Displaced persons
Basis for action
82.
During the past decade, awareness about the situation of migrants who are forced
to leave their places of usual residence for a variety of reasons has been rising.
Because there is no single definition of internally displaced persons, estimates of
their number vary as do the causes for their migration.
However, it is generally
accepted that those causes range from natural disasters that destroy human settlements
to internal conflicts that force people to flee from one area of the country to another.
Given the forced nature of their movement, internally displaced persons often find
themselves in particularly vulnerable situations.
Objectives
83.
To offer adequate protection and assistance to persons displaced within their
country.
-25-
Selected topics for recommendations
Measures that can be taken by (he ini < .• na t iona 1 community to assure adequate
84.
protection and assistance to internally displaced
nd persons, especially to those who are
not able to return to their normal place of residence in the
th.- short term
Chapter X
INTERNATIONAL MIGRATION
Voluntary international migration is a rational response of individuals to the
85.
real or perceived economic, social and political differences between countries. Most
international migration flows are of a regional nature, with people moving between
neighbouring countries or between countries in the same region. However, interregional
migration particularly that directed to developed countries, has been growing. During
the 1980s, the population gains of developed countries attributable to net international
migration passed from being relatively low during the early years of the decade to being
relatively high towards the end. The relaxation of exit regulations in Eastern European
countries contributed to that trend as did the growing, although still moderate, outflow
of migrants from developing countries. In Asia, the temporary migration of workers to
the oil-producing countries of Western Asia remained significant and countries such «s
Japan and some of the newly industrializing economies of South-eastern Asia emerge as
receivers of migrant labour.
However, the trend towards increased international
population mobility has not generally been matched by the willingness of countries of
destination to admit more documented migrants. Given that the pressures for migration
are growing in a number of developing countries, especially as their labour force
continues to increase, undocumented or irregular migration is expected to rise. Sue i
developments, coupled with the steady growth of refugee numbers imply that vulnera le
migrant groups will increasingly need the aid of the international community.
A.
International migration and development
Basis for action
86
International migration both affects and is affected by the development process^
When that migration is regular, it can be beneficial for both countries of origin and
destination. A number of measures can be taken by countries of origin and destination
that, by addressing the causes of migration, can contribute to promote its benefits.
Objectives
87.
To maximize the benefits of migration to those concerned and increase the
likelihood that migration has positive consequences for the development of both sending
and receiving communities.
-26-
Selected topics for recommendations
Assessing the effects of the economic, trade and development cooperation polici.c.s
88 .
f
countries
of origin and destination on international migration. Realizing the fu.^1
o
potential of return migration, both permanent and temporary, as a channel for the
transfer of technology and know-how to the migrants' countries of origin.
B . Documented migrants
Basis for action
Documented migrants are those who satisfy all the legal requirements to enter,
89 .
Many
and,
if applicable, to hold employment in the country of destination.
stay
documented migrants have acquired over time the right of long-term residence in the
Their integration into the host society is generally
countries of destination.
Their
being
granted
all of the rights established by the United Nations
desirable.
International Convention on the Rights of All Migrant Workers and Members of their
Families (1990) would contribute to achieve that aim.
Objectives
of documented migrants, especially
90.
To promote the social and economic integration or
Chose who have acquired the right to long-term residence in the country of destination.
To combat discriminatory practices against documented migrants, especially female
migrants. To ensure protection against racism and xenophobia, To promote the welfare
of documented migrant workers and members of their families.
Selected topics for recoi11 fmltendations
in line with tne
the rignts
rights
91.
Ensuring equality of opportunity for documented migrants m
established in the Convention on the Rights of All Migrant Workers and Members of their—
Families, paying attention to the formulation of appropriate strategies to combat racism
and xenophobia. Facilitating the naturalization of documented migrants who already have
the right of long-term residence and of their children, and extend civil and political
rights to long-term foreign residents.
C. Undocumented migrants
Basis for action
92.
It is the sovereign right of every nation State to decide who can enter and^tay
in its territory and under what conditions. Undocumented or irregular migrants who do
not fulfil the requirements established by the country of destination to enter, stay
or exercise an economic activity are a source of concern. The control of undocumented
migration is necessary to safeguard the rights of migrants in general and prevent the
exploitation of those in an irregular situation.
-27-
Objectives
of undocumented
To control undocumented migration, piC/Cut t he exploitation
93.
protected.
migrants and ensure that their b.isic human rig its <are
Selected topics for reconaendations
94
Adoption of effective sanctions against
against those
who organize undocumented migration
those who
94.
and those who exploit undocumented migrants, in particular vulnerable groups such as
a
women and children.
D. Refugees
Basis for action
95
Two thirds of all countries in the world have ratified the 1951 Convention
relating to the Status of Refugees and the 1967 Protocol, which guarantee the right to
rose to nearly 19 million early in 1993 and further increases are expected.
In
addition, the number of persons filing applications for asylum in developed ^un^rle=
has grown substantially, to average well over half a million annually during the first
years of the 1990s. There is a need to combat the root causes of refugee movements, with
explicit condemnation of the practice of "ethnic cleansing", and to support the
international protection and assistance of refugees, particularly of refugee women an
children.
Objectives
’ ■ root causes, to find durable
96.
To reduce refugee flows by combatting their
to
ensure
the
adequate protection and assistance
solutions for the plight of refugees,
the
erosion
of
the right to seek asylum.
of refugee populations and to prevent
Selected topics for recommendations
97.
Need to combat the root causes of refugee movements by fostering conflict
resolution, the promotion of peace, the respect of human rights, the alleviation of
poverty, democratization, good governance and the prevention of environmental
degradation.. Need to ensure the adequate protection and assistance of refugees in first
countries of asylum, keeping in mind the burden-sharing responsibility among the
international community.
Support for the voluntary repatriation of refugees and
provision of reintegration assistance in conjunction with development programmes.
-28-
Part: Three
MEANS OF IMPLEMENTATION
-29-
Chapter XI
POPULATION INFORMATION, EDUCATION AND COMMUNICATION
98.
The creation anu maintenance of awareness about the importance of population
issues is of crucial importance both at the national and local levels to promote the
aims and activities of population programme and at the global level to build worldwide
support for population activities. Population information, education and communication
(IEC) activities usually have a broad mandate and complex functions, involving many
different audiences, messages and channels of communication.
These activities will
require, inter alia, appropriate use of the most modern media available, accompanied
by state-of-the-art monitoring techniques, for maximum effectiveness.
Therefore, a
coordinated strategic approach is necessary.
A. Public awareness
Basis for action
99.
Public awareness is vital for groups and individuals to act constructively on
population issues.
Awareness is needed at several levels (professional, political,
general public and individual), both in industrialized and developing countries, taking
into account the differences in their situations.
Objectives
To create and strengthen population awareness among the various audiences in need
100.
of information, through strategies which provide for responses to specific needs.
Selected topics for recomendations
101.
Creating and maintaining awareness of population issues in a large variety of
groups, including opinion leaders and policy makers.
B. Information, education and communication
Basis for action
Attitudes which form the basis for behaviour and views on population issues . " \
102.
often formed early; for this reason, an approach beginning long before adulthood is
required and population education in the school system is one such approach. Population
education may take place in schools and elsewhere. It may begin with the home and the
school system and continue with counselling for newlywed couples, followed by parent
education to help them educate their own children, and continue the cycle with the
education of children, young adults and even grandparents (who may tend to exert
pressure on couples to have children early etc.).
-30-
Ob i ectives
To take action simultaneously and in a coordinated manner on several fronts to
103.
achieve programme goals, through better strategic IEC planning. To enable activities
to be more client-responsive and effective through more appropriate research and its
application.
To contribute to increased understanding and to the formation of
responsible population attitudes and behaviour through population education, beginning
at an early age.
Selected topics for recommendations
104.
Adoption of comprehensive planning strategies for IEC activities, including the
development of innovative ways of promoting IEC, in particular through the use of new
technologies. Making high-quality population education available to all school children
in the context of Education For All, paying explicit attention to human rights,
opulation and environment, gender relationships, responsible reproductive behaviour,
v reproductive health and sexuality, and the consequential choices and responsibilities.
Chapter XII
CAPACITY- BUILDING
105.
The fundamental purpose of mechanisms for the attainment of population goals is
the generation of the capacity for countries through their Governments, non-governmental
organizations, private and personal initiatives to undertake programmes of action to
further their own national development, advancing the quality of life and range of
choice of their people.
The development of integrated programmes addressing population
issues, particularly family planning, within the context of sustainable economic—
activity, requires the participation of appropriately trained personnel working within
effective institutional arrangements. In order to assure the development and widespread
availability of such a capacity, it will be necessary to facilitate the transfer of
technologies and the development of training and programme-implementation institutions
The
and the dissemination of information and managerial and administrative skills.
building of national capacities and s trengthening of local and regional institutions
to meet the challenges of demographic change must be a priority activity.
A. Management of programmes
Basis for action
National capacity-building in the areas of management skills and strategic
106.
planning is crucial to ensure the appropriate selection and deployment of trained
individuals to maximize institutional effectiveness. In times of budgetary constraints
for governmental and non-governmental institutions there is an increased need to ensure
that trained personnel are retained and function effectively in the areas of their
expertise.
The existence of sufficient cadres of trained staff in population and
-31-
development will also facilitate the establishment of institutional linkages within and
between countries to allow the dissemination of information and transfer of operational
experience in the areas of programme development, analysis and evaluation.
Ob i ectIves
107.
To improve the cost-effectiveness and impact of national population programmes,
by training and retaining staff in key areas of expertise. To facilitate the flow of
information between actors in national population programmes to enhance the formulation
of policy and monitoring of performance, To increase accountability for performance
in the implementation of national populati on programmes.
’
Selected topics for recoatnendations
108.
Strengthening strategic management approaches in public and private population
and development programmes, including the development of management information systems.
B.
Education and training of policy makers, managers and other personnel
Basis for action
109.
The recent trend towards decentralization of authority in many national
population and development programmes, particularly in government programmes,
significantly increases the requirement for training staff to meet new responsibilities
at all administrative levels. This increased demand for trained personnel is added to
the requirement for continued strengthening of national
institutions.
The
decentralization trend modifies the skill-mix required in central institutions more
towards policy analysis, evaluation and strategic planning in collaboration with a
diverse variety of institutions.
New modalities for programme implementation and
development require the assessment of the adequacy of past human resource development
and institution-building strategies and their modification to changing circumstances.
Objectives
110.
To ensure the availability of an appropriately trained supply of personnel for
the formulation, implementation and monitoring of population programmes.
Selected topics for recommendations
111.
Promoting coordinated educational and training activities and advisory services
related to population programmes.
C.
Institutional development
Basis for action
112.
In many countries and in some regions, the formulation of population and
development policies, programmes and plans of action, and their implementation and
monitoring remains constrained by insufficient local capacity. The quality of technical
inputs to programme formulation is, in some cases, another important bottleneck.
-32-
dissemination oi the Lessons Learned in programme impLementation will be
Widespreadto make the development and transfer of tested procedures and approaches more
required
e f f ic Lent.
Objectives
• population and development programme and
To increase national capacities for
113.
?"of trained staff. To facilitate the timely
To reduce attrition <
project formulation,
and policy analyses produced at national
use
of information in
dissemination and
institutions.
Selected topics for recommendations
and national authorities
thereby increasing
Chapter XIII
TECHNOLOGY, RESEARCH AND DEVELOPMENT
ti,. „..d to t...
knowledge is increasingly recognize .
disciplines, to measure an ana yse P
115.
development policies and programmes
„p.°.dsc ^.*1™
research needs involve a 1
at:ion
trends,
' i trends, to
to develop
develop safer
safer and more
delivery of services in accordance with
the delivery of services
the conditions prevailing in various socio-
A.
Basic data collection and analysis.
Basis for action
*-1 have been made over the past 20. years; in the collection
116.
Important improvements
, which have
• data, as well as in population policy' databases
<—
.
and analysis of demographic c
Nevertheless, much crucially important
become more coi
remains to be done.
direct observation are still lacking. Data on migration are
analyses based on current
In all cases, there is need to continuously
generally felt to be scarce and incomplete,
•
L collection and analysis to keep pace with ^ajld
update, consolidate and improve data
--- cak^
Lace in many regions
place in many
and often unprecedented populationL trends
trends currently
curr
y taking
s p
----- -u-reg^s *
4
ic
need
for greater
insight
into
newly
independent
countries.
There
is
also
need
g
where
change
in numerous
those areas and subpopulations which have been neglected in
P
demographic
devising appropriate
appropriate action
—
-«ed the
the process
process
uem g
4
iLtinz to
- help devising
to speed
transition.
Goals and objectives
117.
To enhance the balance, coverage and relevance of programmes
-33-
of data collection
and analysis, to improve the basi s for analysis,
population and relevant phenomena
interpretation and presentation of
Selected topics for reconmendalions
118.
Improving the quali
ty of basic data on vital
quality
processes and national
subpopulations , taking gender into account, and making those data accessible and
available on a timely basis.
B
Biomedical research
Basis for action
119.
As a result of continuing biomedical and related research, more and more people
at present have access to modern methods of fertility regulation
In many parts of the
world, t
this has led to improved reproductive health and reduced fertility. However,
a substantial degree of effort: across a wide range of activities will be required to
ensure 1that
’
all people have the opportunity to achieve and maintain sound reproductive
health and to exercise their basic right to safe and voluntary fertility regulation.
Higher levels of biomedical research and development: are essential elements in achieving
these goals.
Objectives
120.
To expand reproductive choice by developing new <and’ improved
'
‘ methods
’
of fertility
regulation which are safe, effective and respond to the needs and concerns of users,
To continue to ensure the long-term safety of existing and new methods of fertility
regulation.
Selected topics for recommendations
121.
Promoting research on «all methods of fertility regulation, including womencontrolled barrier methods and male methods,, <according to internationally accepted
ethical principles and technical standards and incorporating women's perspectives into
all stages of the research process and seeking the involvement of private industry and
drug-regulatory agencies as partners in biomedical research. Promoting research on
unsafe abortion and other aspects of reproductive health, including those related to
the needs of adolescents.
C.
Social and economic research and development
Basis for action
122.
Greater understanding of social and behavioural processes is essential in order
to achieve many of the goals of population and development programmes; such programmes
should be based on accurate and culturally relevant knowledge of the people whom they
seek to serve. There is need to promote research essential to the design and monitoring
of population policies and programmes, in order to ensure, inter alia, that they respond
to the needs of the society at large, as well as to the needs of women and of
-34-
Such research' should address issues
vulnerable, marginalized and underserved people,
such as quality of care, cost and accessibility of services.
Ob i ectives
and their interrelations
123. To advance the understanding of demographic processes
To establish balanced
with the environment and social and economic development,
To foster the
programmes of research that are policy-relevant and action-oriented.
dissemination and use of research results, particularly to policy makers and programme
officers.
Selected topics for reco [Hltlllendations
Promotion of research on the broad field of interrelations between population,
124.
environment and development. Ensuring that the population programme and policy research
agenda has a balance of theoretical, operational and methodological work.
Chapter XIV
NATIONAL ACTION
125.
National action undertaken by countries to address their own population problems,
in a broadened context of balanced social and economic development, encompasses the
coordinated work of national Governments, regional or local authorities, organizations,
institutions, associations, unions or communities.
National action requires sound
policies to ensure that the benefits of development are shared by the whole population.
National, state and local community-level resource mobilization in each country
according to their capacities is another priority area for action if countries are to
meet the current and future demand of their people for family planning services and
other population programme needs.
A.
National policies and plans of action
Basis for action
National Governments are primarily responsible for designing, implementing and
126.
evaluating national population policies and programmes. In many countries, clarifying
the mode of interaction between the entity of the central government responsible for
coordinating population policies and programmes, the sectoral ministries and other
concerned parties is still a problem to be overcome.
However, over - reliance on the
government sector can become a bottleneck. The experience of the past decades suggests
that the mobilization of sustained political commitment, not only at the highest level
but down to local leaders of the public, private and non-governmental sectors at the
grass-roots level, has been an important factor behind the success of strong national
population programmes.
There has also been growing recognition of the fact that
population policies stand a lesser chance of success in the long run if their
beneficiaries are not fully involved in their design and subsequent implementation.
-35-
Objectives
12/
lo address population problems through effective and concerted action within the
framework of a national population policy and to achieve grass loots invol veinent in
formulating and implementing pl ans of action in the field of population
Sj?
ted topics for recommondaLions
128.
Increasing the political conunitment of Governments to formulate, implement and
evaluate their national population programmes and strengthening their capacity to enlist
the cooperation of the private sector, non-governmental organizations, academia, the
mass media and other influential groups and to foster the grass-roots participation ol
programme beneficiaries.
B.
Resource allocation
Basis for action
129.
The allocation of resources at the national level generally falls into several
broad categories: population data collection and analysis; policy - relevant research;
awareness-creation and advocacy; capacity-building activities; policy formulation and
implementation; family-planning services; IEC activities and special programmes for
youth and women; and population and development. National resource mobilization is a
priority area for action, in light of the very substantial increase in demand for
reproductive health and family planning services that will take place in the coming
decades. Efforts to generate domestic resources to support service-delivery programmes
and associated information, education and communication activities will need to be
intensified, although many of the countries where the demand will be growing most
rapidly are currently witnessing recessionary trends in their domestic economies.
Objectives
130.
To achieve an adequate level of national resource allocation devoted to pro
grammes aimed at resolving population problems, based on a clear understanding of the
costs involved in meeting the unsatisfied demand for family planning services and for
other social - sector services, suchi as primary education and primary health care, which
also affect population dynamics.
Selected topics for recommendations
131.
Intensifying efforts to generate domestic resources to support all categories
of-poyK..-x.ton programme activities, with increased attention to selective use of user
fees, social marketing, cost-sharing and other forms of cost-recovery.
-36-
Chapter XV
INTERNATIONAL COOPERATION
Ua^eTal L7muirilaterira\\SnciesLnCoaptpul^tion
International
132.
technical and financial assis
y
forms of cooperation regarding issues such
activities in developing countries», ^r for^of
co be directed as
as international migration and the A
dvan
s) of various modalities for the
well to the comparative advantages (
ionaf technical and financial assistance .
provision of international assistance.
h efforts of national Governments to
has played an important role in -ilitatrng the
devise and implement popula
growing «..««• «quir.monos as
sogun to implement national
developing countries have formulated and
^og—s.
National population
JU.t.sit and appropriate level,
p
and development programmes ne
nrn„nC the balance and relationship between
Of international •“^7t" "population-related aotlvltle. and international
oE
“;:“ttrco»:«::to bpo.d.r
A. Modalities
Basis for action
coordination of
of international
internationax inputs
^AnVd^
' ' of Governments. 1—
* j and expanding successful programmes
of all donors and active
also a task
that profits
considerably from the cooperation
task that
profits <___
organizations and bodies of the United—
participants including the specialized agencies,
Nations system.
133.
The
Objectives
st
To
ensure
the
full
r^nt-r- ,n the national population programme
mobilization
-rgS:'tJ°.,”;V"7.7^-.t.£
the national population
technical and material contributions are
in..
organizations according co cheir capacities.
Selected topics for recommendations
135 .
-37-
national dove 1 ouim-nl
1 on
Ba s i s for acL i on
136.
Little progress has been ina<li' >r-cr
,,er tth.
In pci.'t
part
i'1 vc.irs towards reaching the
earlier goals art iculat.ed in the (ion>! onm.uni
onun'ini '’ v for aipport foi population activities
as proportions of their overseas develsprrent’ a
assist
ssist ■'<■ - or as proportions of their gross
. 3 per*
p.- ■■■ , jo.'i.p.ired
national product. The current averag- is 11.3
o 2 per cent in the
early 1970s.
Nevertheless, there r ■mains a strong.
strmu
insensus on the need to mobilize
significant additional financial r< sources bo*h
roi? t he int e rna i onal community and
ho’h f roi!
within countries for the implementation of national population programmes in support
of sustainable, development policies.
Add)ilonal resources are required, inter alia,
to satisfy the existing unme* need f i f
ilv planning services, respond to future
increases in demand, keep pace with the increased population sizes which must be served,
and improve the quality of care of programmes. Although intensified additional efforts
to mobilize domestic i esources are needed and projected, additional financial resources
from the international community will, be required especially to assist the least
developed countries and countries implementing structural adjustmerit programmes,
including so-called countries in transition.
Objectives
137.
To satisfy the growing r .-.ource requirements '»f population programmes.
Selected topics for recommendsttons
138.
Mechanisms
for
the
international
community
to
establish
guidelines/
recommendations for assistance levels as proportions of gross domestic product and
overseas development assistance, on the basis of updated estimates for resource
requirements consistent with the scale of efforts needed to achieve the quantitative
goals adopted by the Conference and taking into consideration the constraints created
by economic reform and structural adjustment programmes.
Chapter XVJ
PARTNERSHIPS WITH NON GOVERNMENTAL GROUPS
INCLUDING NON-GOVERNMENTAL ORGANIZATIONS, 'THE PRIVATE SECTOR
AND LOCAL COMMUNITY GROUPS
139.
There is an increasing recogniti
recognition of the need for a partnership on popular ion
and development issues between Governments and non-governmental groups. which, are
composed of non-governmental organizations , the private sector and local cornin'm i ty
organizations. In some areas of population and development activiti
non-governmenta I
groups may have comparative advantages ini relation
re 1 at ion to governmental agencies, either
because their experience of advocacy and programme implementation (especially at the
3H-
Local level) predate that of Governments, or because they represent and interact with
constituencies that are poorly served and hard to reach through governmental channels.
Non-governmental groups operate locally, nationally and, in some cases , inte rna t ion.j_ .y,
often having networks and affiliates facilitating cooperation at all levels and
enhancing partnership among themselves and with Governments.
Where they are working
on population and development activities as partners with Governments, the quality of
services has often improved markedly.
Basis for action
140.
Non-governmental organizations have been actively involved in the provision of
services for population and development programmes and projects and support activities
such as data collection and analysis.
They have been working as partners with
Governments in delivering services and helping implement population and development
programmes; in many cases this partnership has been instrumental in ensuring that
national policy goals were achieved.
They also have acted as catalysts for change,
often serving as a voice for previously unrecognized concerns, reaching underserved
populations, setting quality standards responsive to the beneficiaries' needs and
developing innovative approaches.
141.
In many countries, the private sector has the financial capacity and the
technology to produce and deliver commodities and services in the population field and
Governments usually rely to some extent on the private sector for the procurement of
such programme inputs.
This has produced a valuable partnership which the private
By acknowledging the valuable contribution of the private
sector is keen to expand,
and by seeking more areas for cost-effective and mutually beneficial
sector,
cooperation, Governments may expect to enhance the efficiency of population and
development activities.
Local community organizations vary from country to country. In some countries,
142.
Governments helped establish them and in others they have been created by the
communities themselves. They range from the family and kinship to political, social,
They are
economical, religious and educational institutions and organizations.
generally well-established and continue from one generation to the next, providing a
social framework for their communities. They are generally seen as meeting the needs
of families and individuals and their role as providers of services is widely and
favourably acknowledged. Numerous development processes can be encouraged by fostering
the partnership between Governments and local community organizations. Some who already
provide a number of social services could readily be encouraged to also participate in
population activities.
Objectives
To enhance the partnership between Governments, non-governmental organizations,
143.
the private sector and local communities in order to attain a more effective working
relationship and to identify new areas for cooperative activity, including, as
appropriate, the efficient production of population programme commodities and the fair
cost delivery of services.
Selected topics for recommendations
144.
Creating
suitable
mechanisms
and
frameworks
-39-
to
enhance
the
role
of
non-
governmental organizations in the field of population. Promoting the effective use of
the experience and resources of t1 t private se< or to achieve population and development
goals. Ensuring the participation of loc
communities in the formulation and
Implementation of population policies and pre 'Z 'rmes.
Chapter XVII
FOLLOW-UP
145.
In order to ensure that commitments made at the Conference are implemented with
tangible results, it will be necessary to make arrangements appropriate for the
effective implementation of the recommendations of the Conference. At the level of the
United Nations system, this should involve increased integration of population concerns
into social and economic development efforts,
including policy development.
Arrangements will need to be outlined to ensure ongoing monitoring, review and appraisal
of the outcome of the Conference, Attention will also need to be given to effective
follow-up at the operational level, particularly in regard to funding, technical
assistance and coordination.
A. Implementation
Basis for action
146.
The World Population Plan of Action, adopted in 1974, contained a number of
recommendations related to institutional arrangements for its proper implementation,
further elaborated by the recommendations of the International Conference on Population
held in 1984 at Mexico City. Similarly, there will be a need for the Cairo Conference
to consider how best to organize the involvement of the international community of
Governments, non-governmental organizations, the United Nations system and regional
intergovernmental bodies to assist Governments in the implementation of the new action
programme, adopted by the Conference, also in view of the outcomes of other major United
Nations Conferences of the decade, particularly the United Nations Conference on
Environment and Development, the Human Rights Conference, the World Social Summit and
the World Women's Conference.
Objectives
147.
To ensure the effective implementation of the new action programme.
Selected topics for recommendations
Ensuring the integration of population concerns in governmental, non-governmental
148.
and -international development efforts through appropriate arrangements.
-40-
B.
Monitoring and review
Basis for action
149.
The World Population Plan of Action called for continuous monitoring and perioc
review and appraisal of its implementation. Accordingly, three quinquennial review
appraisal exercises have been carried out to assess the progress in the implementati . .1
of the Plan and a fourth one will take place at the Cairo Conference. The Confercn
may find it necessary to establish appropriate mechanisms for the monitoring and re\ _‘.V
of its action programme.
Objectives
To assess the progress in the implementation of the action programme adopted by
150.
the International Conference on Population and Development and take necessary measures
to guide further action.
Selected topics for reco: urn endations
151.
Establishing accurate and timely mechanisms for assessing the progress made in
achieving the goals and objectives of the action programme adopted by International
Conference on Population and Development.
Notes
1/ Report of the United Nations World Population Conference, 1974, Bucharest,
19-30 August 1974 (United Nations publication, Sales No. E. 75.XIII.3), chap. I.
2/ Report of the International Conference on Population, 1984, Mexico City, 6-14
August 1984 (United Nations publications, Sales No. E.84.XIII.8) , chap. I, sect. B.
3/ Report of the International Forum on Population in the Twenty-first Century,
Amsterdam, the Netherlands, 6-9 November 1989 (New York, United Nations Population Fund,
1990), annex.
4/ Report of the United Nations Conference on Environment and Development, Rio
de Janeiro, 3-14 June 1992, vol. I, Resolution Adopted by the Conference (United Nations
publication, Sales No. E.93.I.8), resolution 1, annex I.
5/
Ibid., resolution 1, annex II.
6/ Report of the World Conference to Review and Appraise the Achievements of
the United Nations Decade for Women: Equality, Development and Peace, Nairobi, 5-6 July
1985 (United Nations publication, Sales No. E.85.IV.10), pp. 2-89.
2/
General Assembly resolution 217 A (III) .
8/
General Assembly resolution 2200 A (XXI), annex.
-41-
2/
Genera 1 Assembly resolution 2106
A (XX)
JLQ/ General Assembly rest, ution 34/18'1
11/ General Assembly resolution 44/25.
-42-
annex
MH u: G ■ I S
ROUNDUP
I.—
UNITED NATIONS NON-GOVERNMENTAL LIAISON SERVICE
Serving the UN system and NGO community for 23 years
Review e# Bei/inf, Berfcerfoe,
Cairo, Copeahagen Confer antes
With a number of the major world conferences on
development issues coming up for five-year reviews,
United Nations member states, secretariats and organi
zations, and NGOs are preparing for a hectic round of
meetings over the next few years. This Roundup gives
brief details about the conference reviews, their
preparatory processes, meetings and events, NGO par
ticipation, relevant documents and contacts lor moie
information.
SIDS+5
I
I
I
In September 1999 prior to its regular opening, the
54th session of the General Assembly will hold a
two-day special session to assess and appraise imple
mentation of the Programme of Action for the
Sustainable Development of Small Island Developing
States (SIDS). Agenda 21, the wide ranging action plan
adopted at the United Nations Conference on
Environment and Development (UNCED) in June
1992, recognizes small islands as particularly vulnera
ble ecological frontlines that require the international
community’s urgent attention. The Global Conference
on the Sustainable Development of Small Island
Developing States, a direct offspring of Agenda 21,
took place in Barbados from 25 April-6 May 1994 and
adopted the SIDS Programme of Action (see E&D File,
Vol. Ill, No. 4).
The Preparatory Process
The first preparatory work for the special session will
be undertaken by an ad hoc inter-sessional working
group of the Commission on Sustain able
Development, which will meet in New York on 1-5
March 1999 to address issues related to oceans and
seas and the review of the SIDS Programme of Action.
At its seventh session from 19-30 April 1999, the
Commission on Sustainable Development (CSD-7)
itself will serve as a preparatory committee for the
General Assembly’s review of the implementation of
the SIDS Programme of Action. A comprehensive
report on the state of implementation of the whole
Programme of Action, as well as various thematic
reports, are being prepared for consideration by
CSD-7.
Meetings and Events
On 1-2 September 1998 a seminar was held on small
island developing states, their vulnerability, the SIDS
Programme of Action, and opportunities for Post-Lome
IV cooperation. The objectives of the seminar, orga
nized by the European Centre on Pacific Issues and
the European Centre for Development Policy
Management, were to discuss the experiences of pro
moting sustainable development of SIDS in interna
tional fora; define opportunities to address SIDS devel
opment needs under the current Lome Convention;
future cooperation between Africa, Caribbean and the
Pacific (ACP) and the European Union; and strength
ening coherence and cooperation between interna
tional actors in promoting the sustainable develop
ment of SIDS.
An international conference on Sustainable Tourism in
Small Island Developing States, organized by the
World Tourism Organization and the United Nations
Environment Programme (UNEP) Industry and
Environment Office, was held on 26-28 October 1998
in Lanzarote, Canary Islands (Spain). Participants in
the conference examined relevant aspects of tourism
including its economic impacts, and tourism and the
environment.
NGO Participation
In Barbados NGOs were invited to participate in the
conference and its preparatory process in accordance
with the procedures followed for the United Nations
Conference on Environment and Development. A total
of 89 NGOs attended the Barbados conference.
As to the forthcoming special session on SIDS, the
General Assembly is working on a draft resolution
(A/C.2/53/L.15) that contains a paragraph on NGO
participation. The paragraph stresses the need for
1
NGLS Roundup, Dec. '98-Jon. '99
CONTA CT FOR SIDS+5
Deonancin Oodit
Chief
Small Island Developing Stales Unit
Water Management and SIDS Branch
Division for Sustain able Development
Department of Economic and Social Affairs
2 UN Plaza
Room DC2-2206
New York NY 10017, United States
telephone +1-212'963 4671
fax +1-212/963 4260
e-mail oodit(cb,un.org
website
un.org esa sustdev sids.htm)
effective participation of actors of civil society, partic
ularly NGOs, and invites the president of the assembly
to propose appropriate modalities for their effective
involvement in SIDS+5Documents
To facilitate the work of CSD-7 as the preparatory
committee for the special session, the following docu
ments are under preparation:
a comprehensive report of the United Nations
Secretary-General on implementation of the SIDS
Progi-amme of Action;
a thematic report on each of the first 14 chapters
of the Programme of Action except the chapter on
Transport and Communication, for which reports
wall be prepared on air transport, maritime trans
port and telecommunication;
a report on donor activities in support of imple
mentation of the Programme of Action; and
a report on resource mobilization in support of
the Programme of Action.
BEUING+5
In the year 2000, five years after the 1995 Fourth
World Conference on Women (see NGLS Roundup,
November 1995) held in Beijing (China), the United
Nations General Assembly will convene a special ses
sion to assess progress achieved in implementation of
the Nairobi Forward-Looking Strategies for the
Advancement of Women and the Beijing Platform for
Action, and to consider further actions and initiatives.
'Flie special session, which will take place from 5-9
June 2000 at United Nations headquarters in New
York, will reaffirm member states’ commitments to the
Beijing Platform for Action and will focus, among
other things, on obstacles encountered in its imple
mentation and strategies to overcome those obstacles.
The Preparatory Process
The United Nations Commission on the Status of
Women (CSW) will ser\'e as the preparatory commit-
2.............................
NGLS Roundup, Dec. '98-Jon. '99
tee (PrepCom) for the review’. All UN member states
will be members of the PrepCom. The CSW’s sessions
in 1999 and 2000 will be extended by one week each
in order to accommodate the PrepCom. The 43rd CSW
session is scheduled to take place from 1-19 March
1999, wdth the PrepCom taking place in the final
w’eek. The PrepCom will also hold intersessional con
sultations as needed.
Following the Beijing Conference, most governments
formulated national plans of action to implement the
Beijing Platform for Action. The General Assembly
encouraged governments to submit these plans to the
Division for the Advancement of Women (DAW) of
the L!N Secretariat’s Department of Economic and
Social Affairs (DESA) by September 1998 as an input
to the start of the review process during the 43rd ses
sion of the CSW.
Governments have been asked to submit information
in 1999 on measures they have taken to implement
the Beijing Platform for Action with particular focus
on positive actions, lessons learned, obstacles, key
challenges remaining, and a vision for gender equality
in the next millennium. They are also invited to
involve civil society in preparation of national evalua
tions on implementation of the Platform for Action.
Specialized agencies, funds and programmes of the
UN system will be actively involved in the review,
which will provide them with the opportunity to pre
sent their experience of best practices and obstacles
encountered in implementation of the Beijing Platform
and Forward-Looking Strategies. They will also pre
sent their vision for the future to accelerate implemen
tation and address new and emerging trends in the
advancement of women.
A number of UN bodies connected to international
treaties and conventions monitor signatory govern
ments’ adherence to these treaties, many of which
include issues relevant to the advancement of women.
These include the Convention on the Elimination of
All Forms of Discrimination Against Women, the
human rights covenants and the Convention on the
Rights of the Child. These bodies, as w^ell as all other
parts of the UN system, are attempting to “main
stream” a gender perspective into their work. The sec
retariat will integrate information on their experiences
with gender mainstreaming into its documentation for
the preparatory process of the review.
Meetings and Events
The results of regional preparatory activities for the
review, including those proposed by governments in
cooperation with regional commissions, will be sub
mitted as an input to the 44th session of the CSW in
the year 2000.
Regional activities include the following.
The Economic Commission for Africa (ECA) will
organize an African regional conference in 1999 to
review’ implementation of the Beijing Platform for
Action. The ECA African Centre for Women has
held subregional meetings on implementation of
the regional and global platforms for action.
The Economic Commission for Latin America and
the Caribbean (ECLAC) will continue to imple
ment the 1995-2001 Regional Programme of
Action for the Women of Latin America and the
Caribbean. The eighth regional conference is
planned for the year 2000 to review implementa
tion of the Regional Programme of Action and to
identify priority issues for the period 2001-2006.
An expert group meeting on National
Machineries for Gender Equality, co-sponsored
by UN/DAW, was held in Santiago (Chile) from
31 August-4 September 1998.
The Economic and Social Commission for Asia
and the Pacific (ESCAP) plans to hold a high-level
meeting in 1999 to review implementation of the
Jakarta Declaration and Plan of Action for the
Advancement of Women in Asia and the Pacific,
and regional implementation of the Platform for
Action. An expert group meeting on Empowering
Women in Rural Poverty and Urban Development
was held in Dhaka (Bangladesh) from 27-29 July
1998.
The Economic and Social Commission for Western
Asia (ESCWA) plans to convene a regional meeting
in 1999 to follow-up implementation of recommen
dations of the Beijing Conference outcome. ESCWA
also plans to convene an Arab conference in 1999
to follow-up on all the recent global conferences.
An expert group meeting on Women and Health:
Mainstreaming the Gender Perspective into the
Health Sector, co-sponsored by UN/DAW and the
World Health Organization (WHO), was held in
Tunis (Tunisia) from 28 September-2 October 1998.
NGO Participation
Emphasizing the important role of NGOs in imple
menting the Beijing Platform for Action, the General
Assembly has called for their active involvement in
preparations for the special session. It has also noted
the need to ensure appropriate arrangements for NGO
contributions to the special session itself.
Documents
Relevant documents to be prepared for the March
1999 session of the CSW by the Division for the
Advancement of Women are:
secretariat suggestions on further initiatives and
actions that might be considered during the
review, with attention to mainstreaming gender
equality and to common trends and themes across
the 12 critical areas of concern;
a world survey on the role of women in develop
ment (preliminary executive summary);
a thematic report on the two remaining critical
areas of concern—women and health, and institu
tional mechanisms for the advancement of
women—which have not been considered in pre
vious sessions of the CSW;
information from the Committee on the
Elimination of Discrimination Against Women on
CONTACT FOR BEIJING+5
Division for the Advancement of Women (DAW)
Department ofEconomic and Social Affairs
United Nations
Room DC2-1204
New York NY 10017, United States
telephone +1-212/963 8034
fax+1-212/963 3463
e-mail dau’@un.org
website (m’m-’M’. un. org/womenwatch)
implementation of the Platform for Action, based
on its review of reports of states Parties to the
Convention on the Elimination of All Forms of
Discrimination Against Women; and
a report on initiation of the quinquennial review
and appraisal of the Platform for Action.
Documents to be prepared for the 44th session of the
CSW in the year 2000 include reports on a compre
hensive review and appraisal of implementation of the
Platform for Action; emerging issues with additional
material on further actions and initiatives for the
preparation of the outlook beyond the year 2000; how
different categories of projects and programmes of
Lhiited Nations organizations have included women’s
interests and gender mainstreaming issues, and on
resources that have been allocated in this regard; and
a draft systemwide Medium-Term Plan for the
Advancement of Women (2002-2005).
The secretariat will also prepare, in collaboration with
the regional commissions, a standardized questionnaire
with a focused set of indicators on all critical areas of
concern as a framework to assist governments in their
assessment of and reporting on implementation of the
Beijing Platform for Action. In a separate report the
secretariat will prepare by the end of 1999 a compila
tion of updated statistics and indicators on the situation
of women and girls in countries around the world.
WSSD+5
The Special Session of the General Assembly on the
Implementation of the Outcome of the World Summit
for Social Development and Further Initiatives will
cany out a five-year review and appraisal of imple
mentation of the 1995 Copenhagen Declaration on
Social Development and the Programme of Action of
the summit (see NGLSRoundup, May 1995).
WSSD+5, which will take place in Geneva in June
2000, will propose concrete actions and initiatives for
further implementation of the commitments made in
Copenhagen. It will also identify progress made, con
straints, and lessons learned in implementation of
Social Summit commitments at the national, regional
and international levels.
NGLS Roundup, Dec. '98-Jan. '99
The Preparatory Process
The General Assembly has set up a WSSD+5 prepara
tory conunittee, which will hold two substantive ses
sions. The PrepCom held its organizational session at
UN headquarters in New York from 19-22 May 1998,
where it took decisions relating to its future sessions
and other preparations for the special session. The
organizational session took eight decisions that set the
objectives of the special session; requested inputs to
the process; recommended the Commission lor Social
Development as the forum for national reporting; invit
ed inputs from other parts of the UN system; invited
contributions to a trust fund to support the participa
tion of least developed countries in the process; set
dates for its future sessions; addressed questions relat
ing to the participation of NGOs; and decided to dis
cuss other organizational matters at its next session.
The PrepCom bureau is meeting periodically until May
1999 to discuss outstanding issues and exchange
views on preparations for the special session. The first
meeting of the bureau was held in September 1998,
just prior to the opening of the 53rd session of the
General Assembly.
The PrepCom entrusted the Commission for Social
Development, which will hold its 37th session from 919 February 1999 in New York, with responsibility of
acting as the forum for national reporting on experi
ences gained and lessons learned in national level
implementation of the Copenhagen Declaration and
the Programme of Action. National reports are to be
submitted on a voluntary basis, based on guidelines
and a common framework to be formulated by the
UN Secretariat for national reporting on progress
made and obstacles encountered.
The Preparatory Committee will hold its first substan
tive session from 17-28 May 1999 in New York. As
national reports will not yet have been prepared, sub
mitted and processed, there will be limited scope for
review and appraisal at the first session. The principal
subject for discussion will therefore be identification
of the specific issues and initiatives that governments
wish to have placed on the agenda of the special ses
sion. The ten commitments agreed upon at the sum
mit, as elaborated in the Programme of Action, will
provide die framework for discussions.
CONTACT FOR WSSD+5
Yno N 'gorwi
Social Affairs Officer and NGO Focal Point
Division for Social Policy and Development
Department of Economic and Social Affairs
United Nations
Room DC2-1326
New York NY 10017, United States
telephone +1-212/963 3175
fax +1-212/963 3062
e-mail <esa@un.org
website (www. tin. org esa/socdev wssd. him)
4
NGLS Roundup, Dec. '98-Jon. '99
The second session of the WSSD+5 PrepCom, to be
held from 3-14 April 2000 in New York, will finalize
preparations for the special session.
Meetings and Events
The United Nations Economic and Social Council
(ECOSOC), at its substantive session in July 1999 in
Geneva, will conduct an overall review of the theme
of poverty eradication to contribute to WSSD+5.
The 54th UN General Assembly, which will meet from
September to December 1999 in New York, will take
stock of the preparatory process and provide addition
al guidance as needed.
The 38th session of the Commission for Social
Development, which will meet from 7-18 February
2000 in New York, will focus on the overall review
and appraisal of implementation of the Social Summit
outcome.
NGO Participation
The PrepCom has decided that its work should be
open to the participation of NGOs that are in consul
tative or roster status with ECOSOC. NGOs accredited
to the Social Summit or other major UN conferences,
that had started the process of application for consul
tative status with ECOSOC and were invited to attend
sessions of the Commission for Social Development,
are also invited to participate in the work of the
PrepCom. Other NGOs that were accredited to the
Social Summit or other major LIN conferences and
summits will be invited to apply for accreditation to
the PrepCom.
The PrepCom has also encouraged governments to
include representatives of civil society in their national
preparatory processes, as well as in their delegations to
the PrepCom and the special session. The PrepCom has
deferred consideration of the modalities for NGO par
ticipation in the special session until its next meeting.
Documents
The bureau of the Preparatory Committee has been
requested to prepare a document, to be distributed
before the fii-st substantive session of the PrepCom in
May 1999, which reflects specific issues raised by del
egations during the organizational session of the
PrepCom in May 1998. The document will be based
on proposals prepared by countries, background
reports prepared by different entities of the UN sys
tem, and the results of expert meetings and reports
prepared by consultants on issues identified by coun
tries for consideration. The proposals, background
reports, expert meeting reports and consultant reports
will also be circulated to delegations.
The UN Secretary-General will prepare the following:
general guidelines and a structure and common
framework for national reporting (to be prepared
as soon as possible);
a report focussing on implementation of the ten
Social Summit commitments at the national,
regional and international levels (to be made
available at the first substantive session of the
PrepCom);
an up-to-date comprehensive assessment of global
trends in a Report on the World Social Situation
(for the second substantive session); and
a comprehensive document assessing the overall
level of implementation of the Social Summit
outcome. It wall include identification of con
straints, obstacles, successes and lessons learned,
and recommendations on further actions and ini
tiatives at the national and international levels,
especially in the promotion of an enabling envi
ronment and strengthening national capacity to
implement Social Summit goals and commitments
(to be made available to the second substantive
session of the PrepCom).
In addition, all organs and agencies of the UN system,
including the Bretton Woods Institutions and World
Trade Organization, are invited to submit proposals
for further actions and initiatives and to report on their
activities to implement the Copenhagen Declaration
and Programme of Action.
Regional commissions and other relevant regional
organizations are invited to identify and share best
practices and lessons learned with respect to imple
mentation of the Social Summit outcome at the region
al and subregional levels.
The UN funds and programmes, particularly (he
United Nations Development Programme (UNDP),
are invited to report on implementation of the Social
Summit commitments, especially those aimed at
poverty eradication. They are also asked to report on
assistance to countries, particularly Africa and the
least developed countries. The International Labour
Organization (ILO) is invited to contribute to the
overall review and appraisal of the implementation
of the outcome of the summit, particularly relating to
its activities to implement the Social Summit commit
ment on employment as part of promoting social
development.
ICPD+5
Progress and challenges in implementing strategies on
population and development will be the focus at a
special session of the United Nations General
Assembly, to be held from 30 June-2 July 1999.
The special session, which will take place live years
after the 1994 International Conference on
Population and Development in Cairo (Egypt), will
provide a forum to review and appraise implementa
tion of the Programme of Action that emerged from
the conference (see NGLS Roundup, October 1994 ).
The review and appraisal will be undertaken on the
basis of, and with full respect for, the Programme of
Action. There will be no renegotiation of the existing
agreements, as decided by the General Assembly in
a December 1997 resolution.
From now’ through June 1999, the United Nations
Population Fund (UNFPA) is sponsoring a series of
review’-related activities that w’ill involve governments,
donors, the United Nations system, and representa
tives of civil society including NGOs and the private
sector. The review’ wall culminate in an international
forum to be held in The Hague (Netherlands) from
8-12 February 1999; an NGO Forum will be held prior
to the Hague Forum.
The Preparatory Process
The 31st session of the Commission on Population
and Development (CPD), held from 23-27 February
1998, adopted a draft resolution that calls on UNFPA
and the Population Division of the UN Department of
Economic and Social Affairs to collaborate and coor
dinate the ICPD + 5 review’ process (see NGLS
Roundup, April 1998). The commission also agreed
that its 32nd session in March 1999 be extended to
seven working days, and that part of the session
serve as an open-ended preparatory meeting for the
special session.
The CPD decided that the report and outcome of the
Hague Forum will be submitted to the commission at
its March 1999 session. At that time, the commission
will also consider a comprehensive report of the
Secretary-General on the quinquennial review’ and
appraisal of implementation of the Programme of
Action.
The draft report of the Secretary-General on further
implementation of the Programme of Action will also
serve as the text to be discussed at the open-ended
preparatory meeting of the CPD. The report will
reflect out comes of the Hague Forum, the quinquenni
al review’ and the preparatory meeting discussion.
Meetings and Events
Meetings related to ICPD+5 include:
a regional review’ of the International Conference
on Population and Development, held on 13-14
May 1998 in Aruba by the Economic and Social
Commission for Latin America and the Caribbean
(ECLAC) and UNFPA;
a UNFPA roundtable meeting on Reproductive
Rights and Implementation of Reproductive Health
Programmes, Women’s Empowerment, Male
Involvement and Human Rights, held on 22-25
June 1998 in Kampala (LTganda);
a UNFPA roundtable on Participation with Civil
Society in the Implementation of the Programme of
Action, held 27-30 July 1998 in Dhaka (Bangladesh);
a meeting held by the Economic Commission for
Africa in Addis Ababa (Ethiopia) from 23-25
September 1998 to i-e\'iew’ the Programme of Action;
a meeting of the Economic and Social Commission
for Western Asia (ESCWA), the League of Arab States
and UNFPA in Beirut (Lebanon) from 22-25
September 1998 to re\dew the Programme of Action;
s
N6LS Roundup, Dec. '98-Jon. '99
a Technical Meeting on Population Ageing in
Brussels on 6-9 October 1998 held by UNFPA and
the Population and the Family Study Centre; and
a meeting held by the Economic Commission for
Europe (ECE) and UNFPA from 7-9 December
1998 in Budapest (Hungary) Io review the
Programme of Action.
inviting and including representatives of civil soci
ety as expert participants to UNFPA roundtable
'and technical meetings; and
inviting NGOs to suggest resource materials to
be considered as part of background documen
tation for UNFPA roundtable and technical
meetings.
NGO Participation
The General Assembly has stressed the need for effec
tive participation of civil society actors, particularly
NGOs, in preparation lor ICPD+5 and for their sub
stantive contributions to and active involvement in
preparatory meetings and the special session.
The NGO Forum on ICPD+5 implementation, to be
held in the Netherlands at the same site as the
Hague Forum, will take place on 6-7 February 1999The NGO Forum is expected to examine issues of
concern to the NGO community in appraising imple
mentation of the ICPD Programme of Action. The
forum will also provide NGOs with an opportunity
to articulate the issues they intend to present and
discuss at the intergovernmental Hague Forum,
which follows.
Actions taken by UNFPA to ensure that the voices and
views of civil society are heard in the process include:
encouraging NGO and parliamentary participation
on country delegations invited to the Hague
Forum and attending the special session;
inviting NGOs at all levels with expertise, capacity
and dedication to 1CPD implementation to the
Hague Forum;
CONTACTS FOR ICPD+5
United Nations Population Fund (UNFPA)
220 E. 42nd Street
New York NY 10017, United States
telephone +1-212/297 5011
fax +1-212/557 6416
website (www. unfpa. org)
Population Division
United Nations Department of Economic
and Social Affairs (DESA)
Room DC2-1950
2 UN Plaza
New York NY 10017, United Slates
telephone +1-212 '963 4838
fax +1-212/963 2147
Population Information Network (POPIN)
website (wvim'. undp. org'popin ')
gopher site (gopher://gopher undp. org: 70/11/
ungophers/popin/unpopcom)
World Population Foundation (WPF)
Amperestraat 10
1221 GJ Hilversum, The Netherlands
telephone +31-35/642 2304
fax +31-35/642 1462
e-mail office@wpf.org
website (www.wpf.org)
Many NGOs around the world are forming networks
or planning activities to be held during the build-up to
ICPD+5. A process to encourage NGO activities at the
national level has also being set up by the World
Population Foundation, with assistance from UNFPA.
Issue areas that national NGO focal points are encour
aged to focus on include:
resources and advocacy;
the ICPD ethos in practice—implementing policies
and services;
rights—rhetoric to reality;
linkages between reproductive health, population,
environment and development; and
partnerships.
Cross-cutting themes for the issue areas will be gender
and youth. A list of the national focal points can be
obtained from the NGO Forum Secretariat at the
World Population Foundation.
Documents
The main document for discussion at ICPD+5 will be a
draft report prepared by GN Secretary-General Kofi
Annan on further implementation of the Programme
of Action. Governments were asked to provide their
comments by mid-August 1998 for submission to the
53rd LIN General Assembly, which will take up the
topic in its Second Committee.
Issues to be addressed include: population levels and
trends; population growth, structure and distribution;
reproductive rights and reproductive health; health
and mortality; international migration and develop
ment; and population and programmes and resources
in national action, international cooperation and the
non-governmental sector.
Service ((NGLS). TfceNGLS Roundup
This edition of NGLS Roundup was prepared by the United Nations Non-Governmental Liaison setwice
is produced for NGOs and others interested in the institutions, policies and activities of the UN system and is not an official record
For more information or additional copies write to: NGLS. Palais des Nations. CH-1211 Geneva 10. Switzerland fax ^2^
0049, e-mail <ngls@unctad.org> or NGLS. United Nations. Room FF-346. New York NY 10017. United states, fax +1-21.2/963 8712,
e-mail <ngls@undp.org>.
6
HGLS Roundup, Dec. '98-Jan. '99
JUN 07 '93
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7 June 1993
POPULATION. POVERTY AND PEQELE
Sudhir Anand
[Draft Outline of Chapter for SIDA Volume]
1. Traditional Economic Arguments for Population Control
Population policies have traditionally been assessed in terms of their impact on some
aggregate economic objective, such as GNP or output per head. [To be documented with
citations.] Although the theories and evidence linking population size (or its growth) to
income per capita (or its growth) are inconclusive [see Mertens chapter], population control
has hitherto been seen instrumentally -- to serve an aggregate income or output objective.
But such an end clearly has no intrinsic significance.
2. Population and Poverty
More recently, there has been a shift in emphasis away from aggregate income
towards a concern with its distribution. Discussions of the objectives of economic
development now commonly emphasize the reduction of poverty rather than raising GNP per
se (see World Bank 1990, 1991). This section will briefly review the theories and evidence
linking population size (or its growth) and poverty, still measured in income space. It will
present cross-country information on poverty, and argue that there is nsJ a rigid link between
population size and poverty. Thus population control is unlikely to be a good instrument for
reducing income poverty, even if that were to be adopted as the objective of economic
policy.
JUN 07 '93
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2
3. People and Well-Being
Here I will argue against viewing the "population" instrumentally to serve some
impersonal economic objective. Rather, people and their well-being - not national income
and its growth - will be defended as the real end of all activities. It will be argued that
well-being has to do with being well, which in the most elementary terms is about being able
to live long, being well-nourished, being healthy, being free, being literate, and so on. What
is valued intrinsically are people’s achievements - their "beings" and "doings" -- or their
"capabilities" to function (Sen). And income cannot serve as a proxy for such basic elements
of well-being. For example, a person’s income level does not reveal whether he or she is
presently healthy (or suffering from a terminal disease), is disabled and incapable of moving
about freely, is likely to live long, etc. Hence, the justification for focussing directly on the
lives that people lead. [A brief review here of the human development literature (UNDP).]
4. Well-Being and gender
Given that enhancing well-being of ail people is the objective, inequalities in well
being will detract from that end. Of all such inequalities, gender inequalities are perhaps the
most pervasive and least justifiable.1 [A brief review here of gender inequalities in literacy
(educational attainments more generally?) and life expectancy.] There is a problem of
assessing life expectancy differentials between men and women, given the biological
advantage of women in maximal potential life expectancy. Some discussion here of the
1 The reason is that there cannot be an "efficiency argument" for such
inequalities. Gender (and race or physical handicap) cannot be altered, ao the
incentive argument (altering behavior to increase aggregate efficiency) does not
hold.
JUN 07 '93
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3
issues, and suggested solutions (e*g. compare shortfall^ — absolute or relative - from the
respective maximal values of life expectancy for males and females). Another approach to
assessing relative female disadvantage in survival is by looking at the rgtifi of females to
males in the population, and estimating the number of "missing women".
5. welfare Economics and Population Policy
Promoting the well-being of existing, people, including their freedom to reproduce,
leaves open the question of whether this may affect the well-being of future people. In this
concluding section, I want to consider the nature of rights of future generations and show
how they might conflict with those of the present generation (Parfit, Broome, Hammond,
etc.). Even if there are such inter-generational "externalities", is population control the way
to deal with them? There are other instruments and policies to protect the "environment
and "resource base" - the quality of life - of people still to be bom. It does not
immediately follow from the stewardship argument that the present population size (or its
growth) should be restricted.
-
• 27-05-1993
MAHMOUD F FATHALLA
20:4S
20 88 334820
P.01
PROFESSOR MAM10UD F. FATHALLA
P.O.Box 30, Assiut, Egypt
Tel/Fax : (* 20) 88 33 48 20
Ms Gita Sen
Co-editor, SIDA Volume
Harvard Center for Population and Development
Studies
Chapter on Contraceptive R&D
May 27, 1993
Five
To:
Subject:
Date:
No. of pages;
I am rushing to you, as promised, a draft outline of the
chapter. I hope it allays your anxiety about the timetable, but
it is very tentative, and I may make changes when I write the
full paper.
Best regards
Yours truly ,
/i.r^
f/
M. F. Fat ha
p.5.
MAY 27 ’93 14:53
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Fa- Vk* I
POPULATION RE-CONSIDERED: HEALTH, EMPOWERMENT AND RIGHTS
Contraceptive Research and Development: A Woman-centered Approach
Draft outline
Gender reietlensfilp© and Gentreoeptive technology
Throughout human history, women have felt a need to regulate
and control their fertility. Until recently, they neither had
the power nor the means. Historians can find in almost every
culture ancient and traditional recipes which women have resorted
to. Whatever the ineffectiveness of these contraceptives, their
use demonstrates the serious intent with which women* control of
procreation was pondered and pursued. Medical writings, as far
back as Hippocrates, describe in detail the serious health
hazards women went through to secure the abortion of an unwanted
pregnancy.
Men, on the other hand, had the power and had means.
Withdrawal, the most ancient effective method, was a method
available for men to exercise their control over the process of
reproduction. The condom provided men with another method they
can effectively use.
In many societies, the objections against contraceptive use
were really objections against contraceptive use by women rather
than objections against contraception itself. Male dominated
societies resented giving control of the process of reproduction
to women, and reasoned that if women had control on their
reproduction, they would also have the unthinkable control on
their sexuality.
Widespread contraceptive use is a very recent phenomenon in
human history. The first wave of the contraceptive revolution
occurred in the west in the 18th and 19th century. It depended on
men using coitus interruptus. The decline in fertility was
gradual.
The second wave of the contraceptive revolution took place
largely in the South in the past few decades, it was associated
with a technology revolution that provided women, for the first
time, with methods which they can use. Independent of the
cooperation of their male partner to control and regulate their
fertility and to share in the joys of sexual life. At the same
time, another change was taking place in the North, and to a less
extent in th© South, with the liberalization of abortion laws.
The decline of fertility was steep.
rile Contraceptive Technology Revolution
The contraceptive technology revolution brought up
significant improvements in already existing methods,
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MAHMOUD F FATHALLA
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particularly in the simplification of methods of female surgical
contraception, to the extent that they no longer require general
anaesthesia nor hospital stay.
For the first time in human history, contraception could be
taken completely out of the bedroom and out of the genital area,
with the development of srst&nic methods which the woman can use.
Another major development has been the introduction of longacting methods. Whereas in the past, people had only the choice
between taking a precaution at every sexual act or adopting
permanent contraception, now women have a broader choice. They
can use methods that offer protection for 1-3 months
(injectables), 5 years (Norplant^), or up to 8 years
(intrauterine devices (IUD)).
A third major development is effectivenes. While in the
past, people had only the choice between coitally-related methods
that are associated with a relatively low levels of useeffectiveness, and permanent contraception which is completely
effective, women now have the choice of other methods that are
very highly effective and also reversible (pills, injectables,
Norplant and IUDs),
1116 unfinished Agenda for Contraceptive Research and Development
The fruits of the contraceptive technology revolution have
been enjoyed by hundreds of millions of people all around the
world: people living in the most varied circumstances, in the
skyscrapers of Manhattan, in peri-urban slums in Latin America,
in rural communitlee of the Indian subcontinent; people in all
socio-economic strata; people with different cultures, religious
beliefs and value systems; and people postponing a first
pregnancy, spacing children or putting the limit on childbearing.
The contraceptive technology revolution, with all its
benefits to the quality of life of women, has left women with
some genuine concerns as well as unmet needs.
h^icf is in control
Contraceptives are meant to empower women and to enable them
to control their bodies and their lives. There are now better and
effective contraceptives for women. But, voices are sometimes
raised, in many cases rightly so, that effective contraceptives
are used to control women rather than to give control to women.
There are several reasons for this concern. The contraceptive
technology revolution was to a large extent demographic-driven,
with emphasis on the development of methods that can have a
demugiaphlc impact. Long-acting methods of contraception ore
provider deiwndent and are not. user controlled. Governments
became an interacted party in what goes on in people s bedrooms,
for reasons that are legitimate but with means that are not
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necessarly legitimate. Some government are short sighted, not to
see that when women are given a real choice, and the information
and means to implement their choice, they will make the most
rational decision for themselves, for their communities and
ultimately for the world at large. They have more at stake than
anyone else.
The question here is not of technology harware alone. The
’’software" is as crucial. But the field can respond by pushing
the development of long-acting methods that are user-controlled,
such as the hormone-releasing vaginal ring.
Hov s^fe is 66fe
As with any drug in medicine, effectiveness commonly has a,
trade-off in decreasing the margin of safety. Concern about
safety Issues will loom large if a service is perceived to be
more concerned about demographic targets than about health and
welfare of women
While the field should continue to respond by improving the
margin of safety of contraceptive technologies, the quality of
the service is what counts. A contraceptive is only as good as
its delivery system and use.
Exp^ndlnjff male GQntraGeptivG cholceff and raaponslblllcy
Women have gained more effective methods of birth control,
but at a price. They had to assume full responsibility for the
inconveniences and risks involved. The role and responsibility of
the male partner have receded when contraception was considered a
woman's business.
Protection against sexually-ti'ansmltted dl6ea6es
Although women now have access to more effective and womancontrolled methods of contraception, there was a trade-off. The
barrier methods which offered a degree of protection against
STD’s became less frequently used. Women badly and urgently need
a technology which they can use Independently of the need for
cooperation with the male partner.
Abortion
The emphasis in the contraceptive technology revolution has
been on the development of methods that are so effective that
they can prevent or decrease the need for abortion. The rationale
for Chis emphasis is not justifiable in most cases on health or
scientific grounds, but was justified by moral controversy and
pressure. Where safe abortion services are not available, there
is a case for the use of the most effective contraction. On
health and scientific grounds, a more rational response of the
field is to develop technologies that decrease the need for
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surgical abortion services, or better still for provider
dependent abortion services. Best would be to develop a simple
and safe technology which a woman can use in the privacy of her
home at the expected time of menstruation if she has been exposed
to unprotected sexual intercourse.
Contraception-21 : The agenda for a second Contraceptive
Technology Revolution
To complete the agenda for contraceptive research and
development, and to provide the contraceptives of the 21st
century* there is a need for a second contraceptive technology
revolution, driven by women needs. The task will not be
accomplished if the field continues to be under-funded, industry
stays retrenched. Science is ripe with new advances in cell and
molecular biology and in biotechnology that can provide the leads
for a woman-centered approach for contraceptive research and
development.
MAY P? ’AA 14:FR
PA AA AA4AP0
TOTAL P.05
PAGE.005
J
I. j k \ \: G-''d
c-Sssw-i'.'
I
PERSPECTIVES PROM THE WOMEN’S MOVEMENT
ON A NATIONAL POPULATION POLICY
!
I
1.
This
is
statement
in
response
the
to
the
of
request
Expert Committee set up by the^ Government of India to formu
a National Population
late
It
Policy.
is
as
if
the
far.
It
has
not
had a population policy so
I
Government has not
I
been one of fertility control, pursued relentlessly,
J
times coercively,
I
to
Planning
Family
the
health,
and
through three decades,
accelerating
bringing disrepute
Programme,
compromising
the
declining
already
and at
women's
sex-ratio,
Now we find that more of the same recipe is being instltutionalised
through
tionable
legislation.
disincentives
constitutionally
and
Monetary
incentives
ques—
already
have
proved a corruptive influence and added economic pressure to
women’s powerlessness.
The women 1s movement
2.
family
■
I
I
and
planning,
all
along been
advocated
women's
in
favour
synonymous
with
population
growth
is
ills,
poverty,
We
of
over
control
Pursuing demographic goals however,
their fertility.
i.e.
has
has
is not
do
not
accept
responsible
for
all
India's
environmental degradation etc.
Govern-
planning.
family
mainly
that
ment however, refuses to recognise that the population rise
is a direct consequence of Increasing injaqulties and dispos
session among the majority and seeks to address the symptom
economic
and
social structures and policies which are the root cause.
cause.
We
of
population
rise
without
addressing
the
maintain that demographic goals of reduced fertility cannot
be
imposed
by
a
fiat
of
the
Government,
as
at
present.
Hence our demand for a national debate before any policy is
f inalised.
While challenging
the validity and
of Government's current approach, we
offer
an
limitations
analysis and
constructive suggestions.
This statement should be read in
conjunction with the memorandum dated
21st
October'93,
submitted by some of us to the Expert Committee on the 23rd
October.
I
I
3
“Sustainable
In
Development"r
context
the
existing gap between India's stated Constitutional
the one hand and the present
reality on the other,
the
of
goals on
iniquitous social
increasingly
the just demands for a better life and
i
of
future
included.
di rected
I
deprived
the
this
section
of
their
rights
to
survival
with
mere
rhetoric
or
people,
the
dignity
const 1tut iona1
promises.
must
be
not
to
misused
and
envi’rwiment,
be
remain
employment,
freedom
the
as
measures
policy
definite
of
inclusion
should
areas of ^health,
the
socio-political
the
dreams
requires
It
and intervention in
t ion,
population
our
Since the present population policies are mainly
at
electoral
of
section
educa-
to
par—
ticipate in decisions that affect their lives.
i
i
4 .
In international fora official representatives of India
have
rightly
the
challenged
assumption
of
the
developed
I
world’s definition of
guarantee
the continuation
consumption
the other
sustainability as being one
of
side
scarce
of
natural
North’s
the
global
that
attributable to
However,
depletion of
the
the over-population of
third world countries which require emergency
ures — seems to have become
must
over-
profligate
resources.
-
assumption
this
global resources are
of
that
control
the unstated bedrock of
meas
present
government approaches.
5.
On
the
credibility
point,
first
of
the
if
over-consumpt ion
elite.
among whom
Itself.
In
structuring
the
we
that
position
itself
addressed
to
of
resources
by
are
forced
include
to
ongoing
India's economy we
are
se e p 11c a1
considerations.
productive
in with
ignore
resources
the
However
and
no
subsequent
p
nationally
and
reality
the
the
of
of
miniscule
Government
process
present
total
the
the
India’s
the
fit
enhance
It would
of
population issues can
of
It
background
recommendation would
"market"
feel
government's
the
internationally -
we
how
of
ro
such
a
domlnat ion
of
approach
to
rat i onaJ
i mbalance
of
cont ro1
consumption patterns
in India,
inequalities of
income and consumerist
values which are again fall outs of
the restructuring proc
ess .
The experience of all other
countries undergoing
structural adjustment proves that the size of
the population
under the poverty line has drastically
increased .
increasing
6.
Aithough it is not the purpose of
this statement to go
into the details of the
extremely adverse impact of the
present economic policies on the bulk of
our population, the
references have been made
necessary because of the approach
advocated in the draft circulated to the
Expert Group which
seeks to disenfranchise further
precisely those sections
already
bearing the brunt of the burden
of the economic
crisis.
7.
One
important
aspect
of
the
present
po1i c ies is the
real allocations to essential
services which
include the public distribution
system and access to food,
health, education etc.
Privatisation of health
services,
charging of fees for tests in Government
hospitals are going
to further worsen the already fragile
health profile of
India's poor .
As women•s
organisations, our experiences
indicate that the fast deteriorating position of women's
of
heal th, indicated by malnutrition, anaemia, increased
vulnerability to illness etc,
s directly related
etc. , i
1s
to increased
levels of poverty,
povertv. lack
laPv of access tQ prlmary health
services
and not primarily to
maternity related prob 1ems as
per
ceived by official analysts.
In this context, we
consider
the equation of health with
family planning to be
nothing
short of criminal,
The? very fact that
successive five year
plans have increased
allocation and attention to
family
planning at the cost of basic health
servjces to the extent
of the former exceeding the
latter in the Seventh
Plan
should make our point clear.
reduction
in
3
8 .
The other
of
infant
of
the
■I
aspect
is
mortal 1ty.
agencies
shockingly
who
are
hrc/h
learn
to
closely
of
Government
Government
the
sti) 1
We were horrified
Internationa 1
advising"
the
India
on
circulated a document
child survival strateg i
the
figures
that
some
involved
in
d i rect ion
of
economic policies,
advocating cuts
in
allocation
as
for
a
way
of
over-
coming the "population trap",
We have 11ttle indication of
the Government's response in this matter.
The present trend
of Increasing child labour, in particular the labour of girl
points
children
assets
What
to
providing
we
demographic
reality
of
stress
factors
play
children
large
livelihood to a
to
wish
the
being
seen
of
families.
number
Is
is
the
in
determining
cruc i a1
role
that
as
non
the
size
control
as
a
precondition
for the reduction of poverty goes counter
to
the history of
of
the
family for a vast number of India's poor .
9.
Therefore
to
see
population
in
other
demographic
transition
transition
against
living reality of
the
parts
of
the
world
and
Indla's
poor majority.
Furto see women as prlmarlly responsible for the Increase
ther,
in population and to devise methods to control
their fertility at all costs, is a position that the
women's movement in
India can never accept.
10 .
We wish to reiterate that
need
easy access
cannot
be
to
As
to
exploited
"shaping of which
their
safe
health,
e1aborated
Minister,
in
a copy
no t
the
need
se ,
but
to
of
for
SAFE
which
had no
easy
accessability
We
wh i ch
the Government
deta1 led
our
plans
A
for use
in
includo
.1
at
and
to
the
in
the
cost
of
the
to
key
futures.
the
Health
question
contraceptives
India
on
need
their
1 cho i ce '
pos i t i on
to
-
and
this
goals
submit ted
enclose,
contracept1ves.
all.
However
hand"
capacities
vie
India want
demograph ic
memorandum
contracept Ives unsuitable
have
reach
earning
our
in
contraception.
they have
their
poor women
wh i ch
1s
no
is
per
inc ludes
cho ice
at
each
cont racept i ve
come
stage
1n
the
memorandum,
which we
request you to consider as part of this statement.
Further,
Family Planning Programme in the
sa id
we
refer
agreement signed with USAID on 30th Sept,
1992 .
as
example
an
of
Government
policy
you
the
to
It specfi-
cally relates to fertility control of women in Uttar Pradesh
(one of the worst states as indicators of women’s status or
infant
mortality
and
demonstrate),
suggested
measures
the
include hormonal implants to be carried out with a grant of
US Dollars 385 millions over a ten year period.
this
agreement,
available
to
signed
be
secrecy
and
still
anti-women
and
anti-national
in
both
We consider
publicly
not
and
strongly recommend its cancellation.
11 .
It
is astounding that the Government of
ting the demographic goals,
seems to have
India
in
set-
ignored
the
vast
body of literature which identify the status of women as one
of
crucial
the
factors finfluencing
trends.
demographic
During the last two decades the shocking increase in female
infanticide, sex determination tests followed by abortion of
female
foetuses,
proves
that
setting
goals without tackling the roots of
inequality
will
have
the
most
of
demographic
such
the problems of women’s
disastrous
impact
on
the
already unbalanced sex ratio prevailing in this country,
and
further depress their status,
ration
apart from providing
alisation to the unethical practices
and misuse
of
science
by a section of the medical profession.
12 .
We strongly recommend the end
of
target
the
oriented,
disincentive approach of the Government of
India and rever—
sal of all
the
related policy decisions e.g.
maternity benefits to only two children.
reduction
of
We also recommend
withdrawal of the present Bill before Parliament disqualify
ing persons with more
election.
than
two children
from standing
for
We believe that such a measure will automatically
disqualify precisely those economically deprived sections of
our
population,
Including
women
5
who
most
need
political
empowerment.
This measure could also become
an instrument
of
discrimination
against
minorities
who
already
feel
threatened because of recent political
developments.
We
also see this
as
measure
militating against the concept of
grassroot democracy as enunciated for Instance
in the 73rd
Constitutional Amendment on
on Panchyati
Raj which for the
first time has sought to expand
women's participation in
decision making at these levels of
government, on the demand
of the women's movement.
13 .
1
There
has been
a
demand
from some sections that the
increased number of women members
in the loca 1 sei f government bodies under the new amendments
should be made respons i b 1 e f or programmes of
women and chi Id deve1opment.
We
oppose this demand,
The diagram attached as
appendix to
this document represents
substantially the overlapping and
close interconnection between the needs
of women and children and
various other
areas of public policy and governnance.
We recommend that women should be inducted
into all
the important standing
committees with a view to ensuring
the much needed coordination
through their personal knowledge and stakes in the
success of policies for education,
health care, child development,
environmental improvement,
livelihood Improvement etc
etc..
They would also
need the sup
port of women's organisations (local,
block level; district,
state etc.), educational/
research/ scientific institutions
to respond to their articulated
information/training/techno
logica1/other needs.
14 .
We be1i eve that not enough attention has
been paid to
the adolescents in Indian
society.
Recent attempts to
identify d1scriminat1on
against girls have only' noted the 1 r
deprivations but not examined the psychological
consequences
of their being forced to assume adult
assume
ro J es from a very
young age, particular ly among the poor.
Many in Western
i ndustrialised countries (whose model
adopted for eco6
I •
nomic growth and the education of our
our
(a) collapsing social cohesion,
(b)
youth)
are admitting
declining desire
to
participate constructively in economic/social/po11tleal
life
and (c) proneness to violence as serious
problems among
their youth.
Some sensitive leaders re J ate
the rising tide
of xenophobia also to the same sources.
Our youth have not
yet come to share all these
tendencies but the situation,
especially in metropolitan cities is changing rapidly and
increasing violence is manifesting itself in many forms,
A
Population Policy for the 21st Century cannot and
must not
continue the mistakes of the 20th Century,
and Ignore the
critical importance of the
generations that must be the
leaders for the next century.
I
15 .
i
Conventional
demography generally includes
fertility,
mortality, labour force participation and
structural distributton of the population between
age-groups and geographic
areas (e.g. rural, urban),
Even gender is not always ineluded as a significant variable
for all purposes.
We feel
morbidity and malnutrition
need to be included in this basic
list, particularly in view of the
questions being raised in
the context of Kerala and
Tamil Nadu where the demographi c
transition has been rapid.
In the Indian,
Indian, the regional and
global context of today, migration - seasonal, long term,
neasona1,
internal and international - have
have emerged as critical, even
emerged
explosive issues.
There
are
distinct
class, gender and
There are distinct class,
age
differentials, with
with vital
enn^eo.,^,^
_ ..
vital consequences
on the structure of
the family, fthe
’
distribution of 1ive1ihood,
r work burden and
responsibilit les for the
care of
•2 children and old dependents, which have yet to find a
place either in demographic
research or in population policies.
16 .
We
wish
root leve .11
to
reiterate the Importance we
we give to
grass
institutions like gram sabhas and district coun-
ci1s
for participatory decisions and interventions in
and
the
non-demographi c factors that ultimately affect
f ami 1y size.
7
We
therefore
recommend
certain Incentives to
for positive achievement like the following:
bodies
a.
Improving the rate of child survival; [provision of
centres for child care and development;
b.
Improving maternal and other health services (out
reach and quality)
for all
—
ensuring
fully
staffed adequate primary health centres;
c.
Achieving full enrolment of all chiIdren
appropriate
age
group
in
primary
and
school;
d.
Organising Informed participation and achieving
support from the .people in implementing all connected policies;
e.
Eradication of child marriage and illiteracy;
f.
i
in the
middle
Reversing declining trends in the sex-ratio espedally at birth and in early childhood;
■
t
We
local
feel provision of such
strengthen the spirit
of
incentives to
the
] ocal
Const i tut iona1
bodies would
amendment
and
provide a sense of direction and possibly changing cultural
attitudes at the grassroots level,
leve1, thus enabling the local
bodies
to play an
e f feet ive
effective
role
in
achieving
the desired
broad policy objectives that we suggest.
only
be
possible
provided
However, this will
Government of India makes
the
enough resources available to state governments to strengthen the f inanc i a 1 capacity of the local bod i es.
This would
mean alter ing the present trend of curtaiIment of funds.
Secondly
we
recommend
that
the
various purposes must not be
transfer
1 inked
of
resources
to meeting
for
demographic
targets.
17 .
Research
Techno 1ogy
1 ook
into
and
Development
in
Hea1th
and
Reproduct ive
We have already requested the Expert Group to
this aspect and make information on this area
available to the publie for scrutiny and debate.
.We are
aware that even Members of Parliament do not have this
i nformat ion.
Market 1sat 1 on of R&D in these vulnerable areas
8
should be resisted at all costs.
India’s experience in sex
<■
selection
tests
alone
should
enough
provide
evidence
for
government,
the
this position.
18 .
Conclusion
:
the
At
higher
leve1s
of
multidimensional tasks/needs of a population policy call for
some major restructuring of the machinery - (a) to achieve a
coordinated
holistic
theory
I
capacity
to
levels;
(b)
make
respond
to
1
self-image as
tc>
assist
function
I
J
and
the
of
a
thinking
and
coming
reality;
Its
from
the
lower
reorient
exchange Its present
to one of catalysts
1 the nation1 r
people
their democratic
and
to
to
order
in
to
au
(c)
Its
institutions
to
Without
the major
restructuring and
power/resources/
authority,
we
creation of
a
or Cells within various ministries,
do
Population
not
think
Commission,
or a National
Research/Trainlng/Documentation
serious
improve
and
leaders or
cosmetic changes like
for
-
a
legitimately.
devolution
demands
the
smooth process of transfer of
resources (including knowledge)
decentralisation
functioning and
the
in
conceptualised
responsibility’)
to
evolve
power,
thorlty,
I
’collective
of
(as
functioning
Institute
can
create
any
f or the Government i tse1f to
fertility control in reproducing bureaucratic
impact.
practice some
It
is time
infrastructures.
/Ini. Cur
pp-2/110
'Ct IM (j*
.
14 <' PvC -J H
.
’
SAHELI
A.
,e:
WOMENS
0feryi.
to rv
> * c3’
A
'
Qru.v
Hq-KaI ex S&-kQoJ.Ihkvx
'4
%%
e-
M AdHu A
C. Q_>Jvs
I
Tfi
<
S
Q
t t. r v- >
16.
SarojjLni x
11.
Jyotsna Chatterjix
12.
DiSTITUTB OF SOCIAL STUDIES TRUST
JAGORI
Joint Womert’i Progranxne
' .^1
.7 .
'I
■’■W,
. Vo,
The Minister Cor Health and 1'amily Welfare,
Nirn.an Bhawan,
Nev/ Delhi 110 001.
• * .
[
<.
Sir,
rh
Women’s organizations have for a long time been voicing concern
over the new trend of introducing hazardous,long-acting,provider cont-,
u
rolledz#hormonal methods of contraception.
. <*
i
We have repeatedly approached the government for restraining them from
the use of such contraceptives because
.
.
In the name of giving women a better choice,they infact take choice
I ! 5J«. ■ •
away from women and subject them to short-term side effects such as ‘y
cardiac problems,hypertension,depression,clotting disorders’and a number
of long-term hazards as well.
’
- /-'r’
i
ese contraceptives require sophisticated procedures for screening and
monitoring users,since contra-indications are numerous and include'liver
disease,diabetes,hypertension,suspected malignancy etc. among other
conditions.Services to carry out screening and follow up do not exist in
L
I
I
I
our country for the vast majority and existing services are being--c^i^mantled or privatized at a fast pace.
'
'
'
These contraceptives have a high potential, for abuse because they can
. be administered without a woman’s consent and not removed either by
the very design of Che contraceptive (as in injectibles) or by the-choice
of the medical practitioner las in implants).
. •
These contraceptives are being promoted in the name of reducing maternal
mortality.however,with their life threatening side-effects and the ,
.inability of the health system to deal with the same, they are going to
<d tremendously to morbidity as well as mortality.Target orientation,
social marketing and camp approach are infact a pointer that the concern
is more with meeting demographic objectives than with peoples health.
Not enough is known about the mechanism of these contraceptives which /
/
.-upset the entire bodily function by acting on the higher brain centres.
Only one of the effects is that of preventing-conception.
Under Indian conditions,lack of patient records,inaccessibility of the
health system to the vast majority means that effective service delivery
is also not possJLblc, leading to high failure rates , which would mean
pregnancies and birth of children with congenital malformations - thereby
adding a new problem for the society.
:i.-j
....
/
1
J
()
//•.-
1 '
J-
•
•)
J- -
<x--.
■ Ji
-
:
The contraceptive need!; of' womeri d 1 f fer, however, all’*- thusUVcdntVA-,) ; y- • ;
ceptive methods are ca ter tag T to-iwomen who neeFcon tinubusrprotfectionV’ !
None of these contraceptiv^C-contribute to the prev^tion of»nID,£>\and
.
STDs ,which has to be'an important criterion Lor dew contraceptives,
particularly when an epidemic is said to be inuninent. ? ’ ’
’ 0
• !
We are'only too aware that women in ouy country have u need^for birth
control,and are asking for-safe methods to control their fc^tillty.But
this need cannot be met by any of these methods.
.
;
We have repeatedly asked for the promotion of barrier methods,and^have
available at our disposal adequate- data to show that these methods in
conjunction with back-up abortion services provide the safest contra.
ception.We fail to understand why methods like the diaphragm,despite
being approved in India are not promoted.lhere is a similar disinterest
in the promotion of vasectomy and male condom.We also fail to unde
stand why women are targetted with a whole range of cafetaria,where
each product is of dubious value, while new methods of vasectomy such
as no-scalpel vasectomy are limited to one or two premier .institutions
i
I
t
in the country.
there is enough experience to show that contraceptive
|
provision is useful only for people ready to adopt a small family norm
;
The world over,
i i
when their life circumstances .improve. In the absence of tjiis,contracep -»
tives are used as weapons to meet targets set by the government and do :
little to meet the reproductive needs.of people.There is also enough
evidence to show that maternal mortality is reduced not merely by
fewer births,but much more when health services reach people and thev
have enough to eat, clean water to drink and education to be aware
their health needs.
%
•
/
Vie find that conditions are being created in our country which ? will
lead to a growth in population,,' because there are increasing cuts in
the arpa of basic necessi ties,Prices of all essential cpnunodi(;4-es are
rising.People are being forced to pay for services in public.h^spitalsand essential drugs are out of the reach of a majority .Thus, the well.,
accepted maxim that social development leads to decreased growth of
population, is not being followed in our country, lhe onjly programme
rI •
- - -x..
c;—--
>5?^
is>the(foinlly planning programme,..where_.in<
. being given great impetus
an^expensive drugs for-contraception.are^.being'
fl i
I
vcasinglyr sophisticated
introduced.
H, U.L. context »e note
i
poettcnl.tl,
e-
“»
'Wl
the new plans to promote family welfare, at a meeting called by t
-imilv Welfare on 18-6*93.We were informed that Depo Proyera kv.
Secretary, ramify We it arc on lo.v
and Cvclofem are going to be' introduced- into the country..without any ■
trials.NET EN is also to be introduced despite a case
•
•
pending against..^ ;
it in the Supreme Court.Wc were told that oral hormonal contraceptives^
were going to be sold from non-edical outlets.Over and above this,
i
government is going to help NCOS /Private Practitioners to set up
I
sterilization centres in areas where PHCs don't have this facility.
• :V;.
aguxu^u
Last year women’s groups had specifically raised an objection against
reversed its plans and
the introduction of NORPLANT. This year ICHR has
s going to carry out a trial even though the sheer volume of biased
r
•;
i
promotional Literature makes us believe that the decision to introduce
this contraceptive has already been taken.
approved in the
;•
•r
Time and again we arc told that these contraceptives arc
information as
point
out
that
the
right
to
.1
US.However,we would J ike to
of
screening
and
follow
up
;
wall as the protection of patients,systems
different and these can make a vital difference to safe delivery.
are very
•
1
We demand tha-t :
1.
contraceptives.
The Drugs Controller be restrained froin licensing untested
.'IET EN not be introduced till the questions raised before the Supreme
Court
’3.
4.
are satisfactorily resolved.
Testing on NORPLANT be immediately stopped and all biased literature
on NORPLANT be destroyed.
provider controlled method, hormonal or immunological, be introduced
No
within the country.
Social iHarketir.g of oral pills be stopped immedi□tely •
(..
Money earmarked Lor sterilization centres be diverted to upgrading PHCs
and C1IC where other needs of people can also be met.
!
7.
“ M.
'I
End the target oriented and camp approach where there is no ppsai^H^.^
bility of niectiiig the needs of the people.
•.
I
Appropriate contraceptive techno) o«jy be promoted which, can be used
without coercion, is safe, and takes‘care of other infections ie.
barrier methods.
. , •
•
Our specific objections to cacl^ of the proposals of the (jovarnment
are presented in Annexure I.
/
*
...
III
J
/
Annexe L
x; .
-I:
TO vnorosEQ sciii:m:s_pf„<yi
I it • no Prove ra :
without Indian Trials and in addition
11 i s being introduced
LDepo Provera 1
JLy .axls^t
'
affcXThe^unctioning of th^depresr.ion?dmyocaidlaia^farctio
I
many mental and phy s ica 1 symp
>>
or- loss allergies t hirsul tlsm, e^C.
thromboembolism, abnormal weight gam or, ancryi
,
In particular it also causes bone loss.
: .
2.
Even though the WHO has given clearance; to the drug on^o-t o^carcino-
drawn whleb e„ on •the,.aide
of the manufacturer.
L
i
I
i
r
I
.
.
In the Indian conditions it is impossible to screen women for contra—.
3.
involves "'screening’' them for early pregnancy, hypertensi
indications which ---clinicLal exam- <
diabetes, alongwith a general cliniial
liver function,
cancer
Therefore
there is every chance that it may be -administered to
ination.
in early nergnancy resulting in congenital malformation among
women in earlj ierj
y^^ exposure to Dcpo Provera.These defects- may
children born afteririlization of female children whereas male children
be manifested in vi
would be susceptible to feminization.These risks arc indeed high on
women using Dcpo Provera because’the drug causes pregnancy like symptoms.;
and thus women might rccieve more than one injection while pregnant.
As such there is no logic for introducing any contraceptive without
•i. Indian trials. This has been amply demonstrated form the fact t’a
Indian women require different dose regimen ( trials with NEJ-EN and
RU48G).
5. Mode of administration makes.it possible to administer it to women witho’
their knowledge and consent.
6. It has a negative impact on Subsequent fertility.
• '
: It is a combined injection of estrogen and- progestogen which-will
Cyclofem:
’
introduced without trials.
be -----'
2.
All evils of hormonal contraception have been blamed on Estroyon by ..
the medical scientists-. In. fact the absence of Estrogen has been used as
a ground for promoting Progestogen only contraceptives such as NET EN
and Depo Provera. Obviously Cyclofem lacks even this dubious advantage.
Like other injcctables it can be given to women without their knowledge
and consent.
c
3. Not only is it•impossible for the health services to screen women forcontraindications but also to reach them every month for administering
.
Cyclofein making high failure rates a distinct possibility.
th-T^Ed: It is being introduced despite the fact that the Andhra Pradesh
government
has admitted to very high failure rates with this injectable.
• rurt.hcf a petition filed by women’s organizations against Het-en is pending
• belore the Supreme Court.
a)so and in addition there
All objccLions to D.'s.q Provera apply to Ncl-en
.i-jh ilr» safety in the Jonj r un . 1 ml i an s laid i es on
is no study to cs’
indicate
thiit a substantia) number of womon fail to
return of (erIiI il,
u:;iir|
this
diug.
even concicvc al let
i
i
i
I
f
i'
t
I
2
i '•
!
h
’
All thas injections are being promoted as being easy. to.administer, just
. | i
on
the basis that the immunization programme has^jaadal heal th workers’’adeip t\
at giving injections but the government has failed to comment on the abilit’ I •I
of the heal th . sys tem to screen and monitor women and to reach; them; at; .(!
regular interval to insure a low method failure.
•*
. i i!
Divorcing contraception^from health care and commercializing c ontraceptive I
■. I •<
delivery *
. • I
This will be done undcr-a proposed scheme to set up six bedded sterilizatic •JI
centres in areas where the Primary Health Centres are ill equipped'”,' by
!
giving grants to private practitioners and NGOs. The grant would amount
to non-recurring amounts for equpment purchase and a recurring.one for .
running the establishment.
•
Tiie logic of this scheme is completely untenable.Firstly if Operat^gn.
;
Theatres are to be set up in areas which lack modern facilities ‘why*should
they cater only to the family planning programme. Why are these not being s
set up in PlICs where they can. meet the health needs of people (more integral J; j!Il
Hi
••
I
::
i
i
• f
Secondly, given
the— —low
level ofa. compensation
being
---—
Wi.i.Ui.X-U
VW offered^
V Uto
UG the
I .J • private
practitioners, it is unlikely that any private practitioner who hasalrez y |J:
established .a practice is unlikely
""
. this unit.
' , There
is every 11k€ j ;j
". to set up
jjikelihood
I ||
likelihood of substandard care being provided at these centres. .’’
Tiiirdly, given the shoddy drafting of the scheme it is unlikely that it
.!
would even succeed in doing contraceptive delivery satisfactorily because
J
there are no allocations for even minimal.cquipment needed for screening
and for supplies Che allocations arc very low.
’•
", 11
Given the above it is very unlikely that any worthwhile NGO would even co
i j
. take this grant. NGOs which have a decent reputation among the people do
! : i
not have it for pushing.government programmes but for viewing peopl1s
problems integrally. For them this concentration on sterilization in the
absence of health facilities is not going to have any meaning. •.
Yet th.s scheme has enough money for unscrupulous people to set up NGO’
shops to misuse this grant.
,
’
’
At any rate it is not clear how 1000 such centres can be set up at.all.”
Even if NGOs were willing to work on the scheme it would be difficult to
find 1000 doctors and specially gynaecologists to man thse centres. If’>•,
indeed there is such a large pool of human resources waiting to get going
with sterilization targets why has the. government not been abl^e . to find /
)!
enough Joe tors to fill vacant posts?
. • ... Jr.’.
. .
^It is obvious that this scheme would.be icusuaed .for substandard service
uollvj^y’b*yi unscrupulous elements^
‘
‘
J
iSuch a scheme is being promoted in a context where people are being
!
“forced to pay to avail of services at government run hospitals. In
/ '’
other words the goverbmnet has money to squander on private practitioners
the people
oeoi.’le of this country for v/hoin
whom medicil .care
care , is
is.’becon>-/i
beconw*^*but not for tho
*■ ’
i
Ing Inaccessible.
..
' ”.‘J... “
There is another contradciton in government’:; stand’on contraception.
All contraceptive deli very i.s being done int eh •name of women* s. reproduct—
ivc health of women who are being told that while the government has no.*;;’
money to even treat you for diseases and you will be charged for •all •. ’ '■
I
I
medical assistance pregnancy is the biggest danger in \ ur life which
Hi
j
i
win be put to
an end free of charge.
I X
7-
:r
•
"3-
!
' .
.
•
:
Social marketing of hormonal contraceptive pills:
*’“
______
* - • :t>
/vll hormonal contraceptives including pills require that the potential..;
user is screened Cor contraindications and are monitored during use- .* •
If these pills are sold tJirough non—medical outlets they will be used /
indiscriminately by women. There is adequate experience from Bangladesh
that the pregnancy rate has gone up with sovial marketing becaucft users
f
I
?:
mistakenly believe that tl>ey are under contraceptive protection even when
they take pills irregularly. Further, purchases are made by men whd> have,
little idea of their wlve’s health status. Leave alone lay men and woraen'*
I
studies in India indicat that even health workers are not aware of the
contraindiaatlons and dd not know how to advise women who have been
i j
i rregular.
,
•
■
i ■
People of Inida have been forved to seek medical attention from private
practitioners because of poor.availability’ of governmental'health Gervice • ;
which have failed to satisfy their * needs.■How this compulsion of people
(
is being turned into an arguemnet against them and wonen are being asked
to pay for the pill saying that people do not like what they get for free
In the meeting held on 10th June wd were informed by the Secretary that*
social marketing presumes that the women have already consulted a doctor
i!
before buying pills. Tills is another instance where the government is fei ’ i’ i
;
*
. egning ignorance of rural reality.
If this channel is extended to include inJcctable contraceptives hell
! s
wi11 break loose, with three different formulations being in the market
I
and illiterate women being unable to distinguishi one from the other. Tills
’is not a figment of our iniagination because newspaper reports have warned
gs .that injectable contraceptives are being cleared for social marketing.
/U1 in all, social marketing is a clear strategy to reach contraceptlves
to people who will be out of the reach of the health system.
>' ii
•i!
•IQB^bAUT trials : llORF-LAHT is an expensive long acting progestogen only h i
hprmonal contraceptive. The government v/as all set tp introduce it but
had to delay Its plans because of opposition from women’s organisations. .
■
0<.r opposition to NORPLANT is based d>n the requirements of the contraccpt ’ •
tive which means facilities for extensive screening, long term follow •
up and surgical Insertion and removal by specially-trained doctors. It
may require emergency removal if life threatening adverse reactions are
• 4
experienced by the yser. Experience with another version of NoORPLANT
n India shows clearly that even during the trials researchers failed to
J
cp track of a significant proportion of women. Since removal ’cannot
I
be done by ail doctors women who hive participated in these
t’___ trials
^^1
are
on record to say that they were forced tp continue with. -------------NORPLANT
’ against.
their wishes.
The logic of promoting NORPLANT is' tha tit releases only a very small
quantity of hormone and is therefore less harmful tthan iikiny other
hormonal contraceptives. This claim is contested byj rn.my reputed mcdltal
scientists.
The safety of NORILAHT is premised on its approval for use in many
countries of the first world. Heedless to sr<y that their screening* and
monitoring systems are qualitatively different from ours and most
women are offered HORtL.vHT as one among many contraceptives. In USA
HORLLaNT has a considerable record of misuse where women oi/welfure an^fl i
in Jan.
'
t
I
.
4
V
*
• A
.‘.f
‘
Ip Finland, Doctors do not consider it to be a ^‘^^bleeding due to ..
•'
choice. Finnish Doctors also tend to treat irrcgul r
•
t'ORPLAMT with a completely irrational ? =
expensive and ’.- :
v
uch wu have maintained that there in n i ' t
Iiclu
The
lu have boon
'sophisticated contraceptive lik®
ter fully subsidizing'training
.
,
o£ ponPLM'lT and the co
ca 5 *2 5 in other Third torld couutric
:.|Jonor agencies have suddenly stoppe
P y
h NORPLANT because ’
concerned goUe r n.nen’al so meant extreme reluctace
J
Cl :’LS high cost. High co^t or cne ae
vcacs leading to coercion. ■
part of the doctors in removing itsbefor
1
Y
commence1 a • lot.
1 any rate even though the trials with ^d is beinU wKely circulated- J
of promotional litc-cature uas been printed and^i^b
dccis.on Lo
■
which means that the trials are J s
y
yOVei-nment. The white.;.-.
;
introduce NORFLANF has been aleady
Y
sn this regud.-vX'•
Jomcn into accepting MORPLAllT. •
•
•
into the very design of
-*T about KOKl-LANT is in
Tr prating Choice an experimental
III trials where in the name
.._______ , _____ ------ a nxians of family Fl a npinn i
the question o£ abortion
who concieve due to
to contraceptive failure v«e
on as has been portrayed in promotional lierature of the. ministry
contraception
1
scheme for privat practioners. This would subject women to
.
and in the :-----vrould become increasingly more irrespindble
endless hazards because men
than willing to subject themselves to unnecessary surgical .
and wonen more
to mentjon
mention RU4U6 which is undergoing
“pioccdutca^VX1 «would
^ui ri also
*i 1 cn 1like
Ik/* tio
j
In this
contM . This pill is
Ill'trlalsl
is being promoted
promoted as
as a do it yourself abortion
phase
tripill and as a
ofp,il^rtion wh/c£ i3 fdr cheaper thab vaccuum aspirtuon
.nay collapse due to. t sWe
We are concerned that
;
“in U~
^.nonal pills wiir pave the • way
the dcath of every ^40th woman
vould oot .even mo., how n-Y
% women have suffered from RU4 86 .when,?t)»e tragedy, .strik o._
•
•
•
• . . •
»• : J.
.
• •
• •
;■
t
!
■ 7
Copy of "Family and Gender Issues for Population Policy" for authors in the
empowerment section (II) of Population Re-Considered
•
IS
Alayne Adams
Srilatha Batliwala
Sarah Castle
Sonalde Desai
Simeen Mahmud
1
i
Family and Gender Issues for Population Policy
Cynthia B. Lloyd
Cynthia B. Lloyd is Senior Associate and Deputy Director, Research
Division, the Population Council, New York.
This is a revised version of a paper presented at the UN Expert
Group Meeting on Population and Women, Gaborone, Botswana, 22-26
June 1992. It is forthcoming in United Nations, Proceedings of the
UN Expert Group Meeting on Population and Women.
I acknowledge helpful comments from Ahmed Bahri, John Bongaarts,
Susan Greenhalgh, Sawong Hong, Shireen Jejeebhoy, and George
Zeidenstein. Special thanks go to Judith Bruce, who has been the
intellectual inspiration for the paper.
♦
Abstract
Assumptions about the family and about the roles of women and
men within it are implicit in all policies seeking to reduce high
fertility. The most central of these assumptions is the long-term
stability of the conjugal family as a closed physical, economic,
and emotional unit within which children are planned, borne, and
reared; this is implicit in the term ”family planning.” Several
additional assumptions about the roles women and men play within
the family and about the intra-family distribution of resources are
implicit in the linkage typically drawn between rising costs of
children and the growing preference for smaller families: (1) that
improvements in women’s livelihoods outside the family provide them
with greater economic mobility and thus lessen reliance on children
and other family members for future economic support, (2) that
fathers share with mothers joint responsibility for their chil
dren’s maintenance and upbringing, and (3) that parents support
each of their children to an equal extent. The paper reviews the
empirical evidence for each of these assumptions and draws out the
implications of the evidence for future research and policy. The
diversity of patterns documented here provide the rationale for a
much broader framework within which to view population issues, one
in which family organization and gender relations are central. The
paper argues that women cannot bring about the demographic
transition alone. Men have much to contribute as well, and their
potential contribution has been largely ignored.
Implicit in the debate over population policy are certain
assumptions about the family and about the roles women and men play
within it.
The central assumption for population policy is the
long-term stability of the conjugal family as a closed physical,
economic, and emotional unit within which children are planned,
borne, and reared.
When the policy debate centers on family
planning and the supply of contraceptive methods, it is often
further assumed that meeting a couple’s needs for fertility
regulation is synonymous with meeting the individual needs of men
and women.
This assumption is implicit in the term nfamily
planning,” which frames decisions about childbearing exclusively
within a family context. Indeed, the 1974 World Population Plan of
Action and the 1984 Mexico City recommendations for its further
implementation assert the centrality of the family as ’’the basic
unit within society,” while at the same time declaring that both
’’couples” and ’’individuals” should have ’’the basic right to decide
freely and responsibly the number and spacing of their children”
(United Nations, 1975, 1984a).
When the debate turns to development policies designed to
affect the demand for children, in particular policies targeted to
improving the ’’status of women,” several additional assumptions
about the roles of women and men within the family and the intra
family distribution of resources are implicit in the linkage
typically drawn between rising costs of children and declining
demand for children: (1) that improvements in women’s livelihoods
outside the family provide them with greater economic mobility and
thus lessen reliance on children and other family members for
future economic support; (2) that fathers share with mothers joint
responsibility for their children’s maintenance and upbringing; and
(3) that parents support each of their children to an equal extent.
These assumptions structure the collection and analysis of
demographic data and the design of population policy. The goal of
this paper is to examine the empirical evidence surrounding these
assumptions and to draw out the implications of that evidence for
future research and policy. In so doing, the paper builds a case
for a much broader framework within which to view population
issues, one in which family organization and gender relations are
central. Women acting on behalf of the family are seen as agents
of change in all aspects of population and development policy,
whether it be the adoption of family planning, the provision of
health care for children, or the acquisition of independent
economic livelihoods. This paper argues that women cannot bring
about the demographic transition alone, particularly within the
context of existing family structures and gender relations in many
of today’s high-fertility countries. Men have much to contribute
as well. Indeed, the extent of women’s autonomy and men’s family
responsibility will likely dictate the pace at which economic and
social change as well as population policy are able to affect
demographic behavior. The effectiveness of population policy would
be much enhanced if we knew more about men’s reproductive and
familial roles and about how the costs and benefits of children are
distributed.
THE FAMILY: WHO IS A MEMBER AND FOR HOW LONG?
The family has different meanings in different cultures, but
at its core in every society are parents and their biological
children. Simple models of the family rely on the assumption that
these core family members reside together in the same household and
function within a unified household economy. Parents are assumed
to plan, bear, and rear children jointly with a long-term view of
their costs and benefits. The head of the family (often synonymous
with the head of the household) is assumed to be an altruist acting
on behalf of this core family unit, organizing production among
family members (both core members and possibly others) so as to
maximize efficiency and distributing resources fairly.
Reality
differs from this model in ways that have important implications
for population and development policy.
The interconnectedness of individuals in family relationships
through bonds of affection and/or obligation leads to joint
decisionmaking, budget pooling, cooperative work roles, and
altruistic parenting within a framework of culturally accepted
I.
4
notions about the division of rights and responsibilities by sex
and generational position. As a result, families, according to the
degree of their connectedness as well as the distribution of power
within them, mediate the effects of policy on intended individual
beneficiaries through the redistribution of resources and responsi
bilities among family members.
The family members with whom an
individual coresides are usually assumed to be the ones with whom
she/he has the greatest degree of connectedness.
Membership in
more than one core family can complicate and potentially weaken
some of these bonds — a problem for children when one or both of
their parents are responsible for offspring from more than one
conjugal relationship. Expectations about the duration of family
relationships can be another important factor determining the
strength of these bonds — a problem for women whose husbands are
much older, are absent for long periods of time, or who are likely
to enter polygamous marriages or consensual relationships with
younger women.
These three factors — coresidence, multiple
membership, and longevity — affect the strength of family bonds
and therefore the extent to which family members function as a unit
and act altruistically toward one another.
In the discussion that follows, we examine each of these
factors in turn and how they vary in different parts of the
developing world. Family arrangements in sub-Saharan Africa often
provide the most dramatic examples of deviations from the hypothet
ical family depicted above and, thus, are often used to make a
point.
However, the paper’s relevance is intended to be much
broader, touching on the essential factors determining the strength
of family ties anywhere.
A.
Connections: residential or relational?
For a variety of reasons, a child’s biological parents do not
always live together.
These include job migration, polygamy,
divorce, and remarriage, as well as childbearing outside wedlock.
While this is widely known, it is more surprising to realize the
extent of a mother’s reproductive years in certain settings that
5
9
are not spent living in the same household with their children’s
biological father(s).
In Table 1, we look at DHS data from the
relatively few (primarily African) countries where surveys asked
women not only about their marital status and marital history but
also explicit questions about their coresidence with spouse.1
The
table includes estimates of the proportion of mothers’ reproductive
years from age 2 0 to 49 spent not married, not resident with a
spouse, or in second or higher order marriages.22 Among those women
who are mothers, the estimated proportion of time during the
reproductive years spent living with first husbands (in most cases
the first child’s father) is as low as 38 and 39 percent in Ghana
and Botswana, 49 percent in Zimbabwe, and 59 and 60 percent in
Senegal and Kenya respectively. The non-coresidence of couples due
to custom or migration as well as to high rates of divorce (and
remarriage) are important factors in explaining these low propor
tions.
In contrast, mothers in Sri Lanka (the only non-African
country that asked questions about spousal coresidence) spend most
(89 percent) of their reproductive lives living with their first
husband.
Thus, the assumption that family members live together in
the same household may be appropriate in some settings but very far
from reality in others.
While physical distance between spouses does not preclude the
exchange of financial support — indeed family separation is often
motivated by economic reasons — distance can make economic links
less secure,
particularly with the passage of time.
A recent
review of the literature on migration points to the fact that,
while the chief reason for men to migrate away from their families
is to generate support for the family, the subsequent flow of
remittances is typically uncertain and highly variable, often
leaving women to support themselves and their children ineffi
ciently or to rely on other family members (Findley and Williams,
1991).
For example, in Lesotho, poor agricultural practices and
yields have been identified as consequences of the unpredic-
6
TABLE 1
PROPORTION OF MOTHERS' REPRODUCTIVE YEARS SPENT
IN DIFFERENT MARITAL AND RESIDENCE STATUSES
(ages 20-49)
MARRIED
PARTNER RESIDENT
COUNTRY
PARTNER
NOT
RESIDENT
NOT
MARRIED
MARRIED
MORE
THAN ONCE
MARRIED
ONCE
AFRICA
BOTSWANA
.45
.12
.04
.39
BURUNDI
.14
.04
.12
.70
GHANA
.14
.27
.21
.38
KENYA
.17
.17
.05
.60
NIGERIA (ONDO STATE)
.05
.16
.10
.69
SENEGAL
.08
.15
.18
.59
SUDAN
.09
.13
.08
.70
ZIMBABWE
.17
.24
.10
.49
.08
.02
.02
.89
ASIA
SRI LANKA
Source: DHS standard recode tapes.
7
tability of remittances of male migrants to women and children
(Safilios-Rothschild, 1985). Research based on US data shows that
a father’s presence in the home is closely linked to the extent of
his financial and emotional commitment to his children (Macunovich
and Easterlin, 1990; Garfinkel and McLanahan, 1986; Duncan and
Rodgers, 1988; Weiss, 1984).
Financial exchange between parents is even more precarious
when parents are not linked to each other through marriage, either
because of childbearing outside of marriage or because of separa
tion and divorce.
The extent of a father’s support for his
children appears to be affected by, among other factors, his sexual
access to the mother of those children. Research on child-support
arrangements in the United States demonstrates that, when parents
are divorced or separated, relatively few children receive
financial support from their father (Peterson and Nord, 1990).
Much less information is available for developing countries on
fathers’ contributions to children’s support in cases of divorce or
nonmarital childbearing.
This is mainly because so much of the
data we rely on are derived from women-based surveys, such as the
DHS, which link children with their biological mothers but not
explicitly with their biological fathers (Lloyd and Desai, 1992).
Table 2 provides some hint of the potential scope of the
problem
in
different
societies
by
showing
the
proportion
of
mothers * reproductive years spent unmarried or in second or higher
order marriages.
The proportion of a mother’s reproductive years
after age 2 0 spent not currently married varies from a low of 4
percent in Tunisia to a high of 46 percent in Botswana. In certain
countries, women spend substantial amounts of time married to
husbands who are not their first. There is substantial intercoun
try and interregional variation in both of these indicators; but,
on average, mothers in sub-Saharan Africa spend roughly one-third
of their reproductive years outside of marriage or in second or
higher order marriages. The average for Asia and North Africa is
less
than half the African average,
with Latin America
8
TABLE 2
PROPORTION OF MOTHERS' REPRODUCTIVE YEARS SPENT
IN DIFFERENT MARITAL STATUSES
(ages 20-49)
NOT CURRENTLY
MARRIED
IN HIGHER ORDER
MARRIAGES
TOTAL
SUB-SAHARAN AFRICA
BOTSWANA
.46
.05
.51
BURUNDI
.14
.13
.27
GHANA
.14
.33
.47
KENYA
.17
.06
.23
LIBERIA
.19
.34
.53
NIGERIA (ONDO STATE)
.05
.13
.17
SENEGAL
.08
.23
.31
ZIMBABWE
.17
.13
.30
AVERAGE
.35
ASIA & NORTH AFRICA
EGYPT
.09
.05
.13
INDONESIA
.08
.15
.23
MOROCCO
.08
.13
.22
SRI LANKA
.08
.02
.10
SUDAN
.09
.10
.18
THAILAND
.09
.09
.18
TUNISIA
.04
.03
.07
AVERAGE
.16
LATIN AMERICA & CARIBBEAN
BOLIVIA
.15
.07
.22
BRAZIL*
.13
.09
.22
COLOMBIA
.21
.09
.30
DOMINICAN REPUBLIC
.20
.26
.47
ECUADOR
.12
.11
.23
GUATEMALA*
.13
.11
.24
PERU
.14
.08
.22
AVERAGE
* Based on ages 20-44
Source: DHS standard recode tapes.
.27
9
falling between the two extremes. The Dominican Republic, the only
Caribbean country for which data are available, shows its own
distinctive pattern — with only slightly more than 50 percent of
a mother’s reproductive years spent in a first marriage.
Obviously, when parents do not live together, children cannot
live with both biological parents.
Even when parents do live
together, however, children sometimes live apart from them,
particularly in sub-Saharan Africa where child fostering is common.
Unfortunately, because most data collected on fostering are based
on interviews with women, there has been no attempt to establish
the relationship between a woman’s children and her current marital
partner; therefore, it is not possible to assess the extent to
which children live with both biological parents. Table 3 shows
the proportion of their childhood years children spend away from
their mother or living with their mother only.3 The proportions
differ strikingly across regions, with more than a quarter of
children’s lives on average spent in these arrangements in subSaharan Africa, 18 percent in Latin America, and 8 percent in Asia
and North Africa.
To get a fuller picture of children’s living arrangements, we
need household-based data. Table 4 provides an example from Ghana,
showing the proportion of school-age children who live with both
parents, mother only, father only, and neither parent (Lloyd and
Gage-Brandon, 1992) . The proportion of school-age children living
in a household without their biological father is 43 percent, with
as many as 22 percent of children living in a household with
neither biological parent.
While Ghana presents an extreme
contrast to the traditional assumptions about the coresidential
core family unit, it highlights the importance of not taking these
assumptions for granted and of exploring the particular social
arrangements in each setting that may lead to violations of
commonly held assumptions.
10
TABLE 3
PROPORTION OF CHILDHOOD POTENTIALLY SPENT
LIVING APART FROM BIOLOGICAL PARENTS
(ages 0-15)
AWAY FROM
MOTHER
LIVING WITH
MOTHER ONLY
TOTAL
SUB-SAHARAN AFRICA
BOTSWANA
.28
.26
.54
BURUNDI
.06
.08
.14
GHANA
.18
.08
.26
KENYA
.07
.10
.17
LIBERIA
.29
.10
.39
MALI
.12
.02
.14
SENEGAL
.16
.04
.20
ZIMBABWE
.15
.08
.23
AVERAGE
.26
ASIA & N. AFRICA
INDONESIA
.04
.04
.08
MOROCCO
.03
.04
.07
SRI LANKA
.03
.05
.08
THAILAND
.07
.05
.12
TUNISIA
.01
.02
.03
AVERAGE
.08
LATIN AMERICA & CARIBBEAN
BRAZIL
.04
.09
.13
COLOMBIA
.06
.13
.19
DOMINICAN REPUBLIC
.13
.14
.27
ECUADOR
.04
.07
.11
PERU
.04
.09
.13
TRINIDAD & TOBAGO
.06
.17
.23
AVERAGE_________________
Source: Lloyd and Desai (1992).
11
.18
TABLE 4
PROPORTION OF SCHOOL-AGE CHILDREN CORESIDING
WITH ONE OR BOTH PARENTS OR NEITHER PARENT,
BY AGE AND SEX
GHANA
1987/88
AGES
Both Parents
Mother
Only
Father
Only
Neither
Parent
6-11
Boys
.54
.20
.09
.18
Girls
.50
.20
.06
.24
Boys
.48
.20
.13
.20
Girls
.40
.22
.10
.28
TOTAL
.48
.21
.09
.22
12-17
Source: Lloyd and Gage-Brandon (1992).
Boundaries; exclusive or overlapping?
One reason core family members cannot all live together in the
same household is that some of them are members of more than one
core family. Men and women do not always form exclusive bonds that
last throughout their respective reproductive years, but sometimes
have children with more than one partner. From a child's perspec
tive, this means that the set of siblings they share with their
mother may not be entirely the same as the set they share with
their father.
Thus, rather than functioning within a unified
family economy, many children compete with one set of siblings for
B.
12
their mother’s resources and with another set of siblings for their
father’s resources.
Currently available women-based data do not
tell us the prevalence of such divergent sibsets among children in
different settings.
Again taking Ghana as an example, however,
Lloyd and Gage-Brandon (1992) report that the average number of
siblings school-age children share with their father is substan
tially greater (5.9) than the number they share with their mother
(4.1), suggesting that divergent sibsets among children are not
uncommon in a polygamous society or one in which divorce and
remarriage are prevalent.
The fact that men’s reproductive years extend over a much
longer period than women’s is an additional factor contributing to
the phenomenon of overlapping sibsets. Male and female fertility
rates often diverge at older ages, with men experiencing higher
fertility than women.
While little data have been collected on
overall male fertility as compared with female fertility, a few
recent surveys in West Africa
(Ghana and Mali)
allow a direct
comparison of the cumulative fertility of currently married women
and their husbands by age. In Table 5, we see the sharp divergence
of the mean number of living children reported by husbands and
wives at older ages in these two settings where polygamy is common.
In Mali, women end their reproductive careers with 4.3-4.5 living
children, while those husbands in the sample between ages 50 and 55
have on
average
8.0
living children.
In Ghana the
story
is
similar, with women ending their reproductive careers with 5.7
living children on average while those husbands in the sample over
age 50 had on average 8.5 living children.
Not surprisingly, in
Ghana 3 6 percent of all couples with women in the reproductive ages
differ in their individual parity (Ezeh, 1991).
C.
Stability:
long or short term?
A life cycle perspective provides an more wide-angled view of
the
stability
or
instability
of
13
the core
family unit.
What
TABLE 5
NUMBER OF LIVING CHILDREN REPORTED BY WOMEN
AND WOMEN'S HUSBANDS BY RESPONDENTS' AGE
(Mali and Ghana)
Ghana (1988)
Mali (1987)
Ages
Women
Husbands
Women
Husbands
40-44
4.5
5.6
5.4
5.1
45-49
4.3
8.3
5.7
6.7
8.0
8.5*
50-55__________
*Husbands aged 50-1Sources: Rdpublique du Mali (1989); Ghana Statistical Service (1989).
percentage of men and women will remain with the same spouse
throughout their reproductive lives? What percentage of children
will live with both biological parents throughout their childhood
years?
What percentage of children will acquire a stepparent
before they become adults? These are questions that need answers
if we are to understand the family context within which reproduc
tive decisions occur and childrearing takes place.
Women-based surveys can only provide some of the answers
because the reproductive lives of men are not investigated and
children’s link with their biological fathers is rarely traced.4
For example, using DHS data, we can calculate the proportion of
ever-married women at the end of their reproductive careers (aged
40-49) who had experienced a marital disruption due to divorce,
separation, or widowhood (see Table 6) . On average, the proportion
of women experiencing a disruption is 36 percent in sub-Saharan
Africa, 34 percent in Latin America, and 24 percent in North Africa
and Asia. Variations between countries are particularly striking
in sub-Saharan Africa, where the proportion of women experiencing
a marital disruption varies from 7 percent in Mali to 61 percent in
Ghana.
14
TABLE 6
PROPORTION OF EVER-MARRIED WOMEN (ages 40-49)
WHOSE FIRST UNION HAS DISSOLVED*
SUB-SAHARAN AFRICA
BOTSWANA
.32
BURUNDI
.38
GHANA
.61
KENYA
.24
LIBERIA
.56
MALI
.07
NIGERIA (ONDO STATE)
.24
SENEGAL
.42
ZIMBABWE
.35
AVERAGE
.36
ASIA & NORTH AFRICA
EGYPT
.23
INDONESIA
.37
MOROCCO
.31
SUDAN
.28
SRI LANKA
.16
THAILAND
.25
TUNISIA
.11
AVERAGE
.24
LATIN AMERICA & CARIBBEAN
BOLIVIA
.25
BRAZIL**
.23
COLOMBIA
.32
DOMINICAN REPUBLIC
.50
ECUADOR
.29
GUATEMALA**
.29
PERU
.26
TRINIDAD & TOBAGO
.26
AVERAGE
•Marital dissolution includes widowhood, divorce, separation, and remarriage.
*‘Based on ages 40-44
Source: DHS standard recode tapes.
.34
15
The much richer data on women’s marital histories from WFS
surveys conducted from the mid to late 197 0s can be used to
determine the proportion of children whose biological parents
experienced a union disruption by a certain age as well as the
number of years spent with a single mother.
Richter (1988) has
estimated that, by age 15, 20 percent of Mexican children and onethird of Colombian children had experienced a union disruption or
had begun their own lives outside a union.5 For children experi
encing a period of separation between their biological parents, the
average time spent with a single mother until the formation of a
new union was roughly 7.4 years in Mexico and 5.9 years in
Colombia.
At the time of these surveys, union dissolution rates
were on the rise, suggesting that the numbers of children affected
in these two countries may have increased in the last decade.
Surveys that encompass the complete demographic and economic
status of core family units — whether they are subsumed within the
same household or include several households — are sorely needed.
We need to know more about how membership in families changes over
time, how coresidence, multiple membership, and longevity affect
the strength of family ties, and how men see their family roles,
including the factors influencing their sense of connectedness with
their family or families.
II.
FERTILITY REGULATION:
Couples
children.
AN INDIVIDUAL OR FAMILY STRATEGY?
form family units within which to
At the same time, however,
(boys and girls)
bear
and rear
individual men and women
engage in sexual relations outside of marital
unions — sometimes leading to pregnancy and childbirth — without
planning for a family.
Furthermore, some of these men and women
are simultaneously spouses in marital relationships.
Thus,
individual needs for fertility regulation relate simultaneously to
the achievement of fertility goals within families and the control
of fertility outside of families.
To complicate things further,
husbands and wives may not share the same fertility goals for their
family unit or for their reproductive careers.
In such cases,
16
differences can be resolved within the marriage if both members
compromise, if one member subsumes her/his wishes to those of the
other, or if the husband or wife realizes his/her excess fertility
goals with another partner outside the marriage.
Differences in
fertility preferences, however, can also be a cause of marital
dissolution.
The threat of marital dissolution is a factor
determining how differences are resolved. The partner who is more
dependent on the marriage is the one more likely to defer to the
preferences of the other.
A.
Outside of marriage:
who is responsible?
Research on fertility regulation behavior has been typically
based on currently married women of reproductive age.
These are
the women assumed to be exposed to the risk of pregnancy and child
birth.
While there is growing recognition of the wide variation
across societies in sex outside of marriage, studies estimating
current levels and projecting future trends in contraceptive
prevalence traditionally ignored the behavior of unmarried women,
for the practical reason that many surveys have not asked unmarried
women about their contraceptive practice (Ross et al., 1992; United
Nations, 1984b, 1989).
Estimates of "unmet need" for contraception (Bongaarts, 1991;
Westoff, 1988), "couple years of protection," future contraceptive
demand, and the costs of contraceptive commodities (Mauldin and
Ross, 1992) are largely based on the assumption that unmarried
women are not sexually active.6 Recent data on contraceptive use
among unmarried women from the United Nations (1992) presented in
Table 7, however, reveal that they (and their male partners) are a
potentially important group of users in many countries. Indeed, in
several African countries — notably Ghana, Liberia, Mali, Togo,
and Uganda — use among formerly married and/or single women
exceeds use among the married group.
In some sense, this should
not be surprising given the strong motivation of unmarried people
to avoid pregnancy despite the obstacles they may face in obtaining
17
TABLE 7
PROPORTION OF REPRODUCTIVE-AGE WOMEN (ages 15-49)
USING CONTRACEPTION BY MARITAL STATUS
(all methods)
*
CURRENTLY
MARRIED
BOTSWANA
BURUNDI
GHANA
KENYA
LIBERIA
MALI
SENEGAL
TOGO
UGANDA
ZIMBABWE
AVERAGE
SRI LANKA
THAILAND
AVERAGE
FORMERLY
MARRIED
SUB-SAHARAN AFRICA
.33
.09
.13
.27
.06
.05
.11
.16
.05
.43
.17
ASIA
.62
.30
.06
.14
.23
.13
.07
.09
.26
.09
.32
.17
.68
.16
.19
.65
.18
SINGLE
.27
.01
.09
.14
.13
.01
.06
.28
.05
.07
.11
LATIN AMERICA & CARIBBEAN
BOLIVIA
.30
.08
.01
BRAZIL*
.66
COLOMBIA
.66
.53
.47
.39
.29
.06
.04
.01
ECUADOR
EL SALVADOR
GUATEMALA*
MEXICO
PERU
TRINIDAD & TOBAGO
AVERAGE
.23
.53
.46
.53
.49
*Based on ages 15-44
-- not available
Source: U.N. (1992).
18
.16
.24
.12
.23
.12
.12
.20
.01
.00
.01
.02
.01
.02
information and supplies. Among those countries for which data are
available, contraceptive prevalence among the formerly married
averages roughly 17 percent in sub-Saharan Africa, 20 percent in
Latin America, and 18 percent in Thailand and Sri Lanka — the only
Asian countries for which data are available.7 Use among single
women in Africa averages 11 percent but is notably lower in Latin
America and no data are available for Asia. When men and women
engage in sexual activity outside a marital union, their needs for
contraception are individually based rather than couple based. An
assessment of contraceptive needs requires information on the
behavior of both men and women.
Rising ages of marriage have been the most important factor
leading to increases in women’s exposure to the risk of pregnancy
outside of marriage. Table 8 shows trends during the 1980s in the
proportion of her reproductive years a woman spent in an unmarried
state — whether single, divorced, separated, or widowed — between
ages 15 and 49. Countries included are confined to those for which
both WFS and DHS data were available spanning roughly a ten-year
period. (Surveys were conducted during 1975-80 in the case of WFS
and during 1986-90 in the case of DHS.)
In this sample of 14
countries from different parts of the developing world, the
proportion of a woman’s reproductive years spent unmarried has
risen from roughly 29 percent to 32 percent. The variation between
countries has declined as countries where women had the lowest
proportions of time unmarried have experienced the largest
increases over the decade. With the exception of Senegal, where
women spend less than one-fifth of their reproductive years
unmarried, proportions range from 26 percent to 40 percent, with
the sharpest increases having occurred in Africa.
These data highlight the substantial and growing proportion of
women’s reproductive years that escape our attention when we focus
exclusively on couples.
The contraceptive service needs of
adolescent men and women are particularly noteworthy. Desirable
features for such services, particularly in the African context,
19
TABLE 8
PROPORTION OF WOMEN'S REPRODUCTIVE
YEARS SPENT UNMARRIED
(ages 15-49)
COUNTRY
WFS
DHS
SUB-SAHARAN AFRICA
GHANA
.22
.26
KENYA
.22
.28
SENEGAL
.13
.19
ASIA & NORTH AFRICA
EGYPT
.28
.29
INDONESIA
.28
.27
MOROCCO
.27
.34
SRI LANKA
.37
.36
SUDAN
.28
.35
THAILAND
.31
.34
TUNISIA
.23
.34
LATIN AMERICA & CARIBBEAN
COLOMBIA
.39
.40
DOMINICAN REPUBLIC
.34
.34
ECUADOR
.34
.31
PERU
.34
.34
Sources: UN (1987); DHS standard recode tapes.
20
include a multiplicity of outlets outside the traditional MCH
networks, client anonymity, and ease of purchase (Caldwell,
Orubuloye, and Caldwell, 1992). Furthermore, the growing risks of
unwanted pregnancy and extra-union childbearing point to the
importance of giving greater attention to male sexual behavior and
contraceptive needs in the interest of helping men become more
responsible partners.
B.
Within marriage;
who decides?
The assumption underlying estimates of unmet need is that, if
a married woman expresses a desire to limit fertility but is not
currently using contraception, she would adopt family planning if
it became available.
The potential influence of her husband
(and/or other family members) on her contraceptive behavior is
ignored.
The question here is whether women and men (or other
family members) share the same fertility preferences and the same
attitudes toward family planning and, if not, what are the
implications for contraceptive use and fertility.
Mason and Taj (1987), in a comprehensive review of the
literature, found no evidence that women consistently want fewer
children than men on average.
However, it is not always clear
whether questions about desired family size are interpreted by
respondents to relate exclusively to their current conjugal
relationship or more broadly to their lifetime, which might include
the possibility of multiple partners.
Furthermore, agreement at
the societal level may mask disagreement at the level of the
couple.
In Ghana, for example, only 23 percent of couples report
the same desired family size (Ezeh, 1991). Data on husbands* and
preferences in Ondo State, Nigeria (Mott and
Mott, 1985) show little agreement between husbands and wives on
future fertility. The authors concluded that fertility intentions,
at least in this setting, "were essentially formed on an individual
wives’
fertility
and not a family level.” In other settings, disagreement is less
extensive but nonetheless problematic for a potentially pivotal
group of couples.
For example, 20 percent of Thai couples gave
21
contradictory answers to the question on whether more children were
desired (Institute of Population Studies, 1977). In Egypt, 17
percent of urban couples and 22 percent of rural couples gave
different responses on the question on desire for more children
(Central Agency for Public Mobilisation and Statistics, 1983).
As Bongaarts (1990) has pointed out, the implications for
fertility of differences in preferences depend on how such
conflicts are resolved. Fertility could be lower than implied by
women•s fertility preferences alone if childbearing stopped when
either parent wanted no more, but could be higher if childbearing
proceeded until neither partner wanted more.
Attitudes toward family planning form an important link
between fertility preferences and actual contraceptive behavior.
Even when husbands and wives agree on their fertility preferences,
they may not share the same attitudes toward the actual practice of
family planning.
For example, in Mali the opinions of wives and
husbands were very different, with 16 percent of husbands and 62
percent of wives approving of the use of family planning for
limiting or spacing births (Republique du Mali, 1989).
What happens when partners disagree? Data on male attitudes
from Zimbabwe (Mbizvo and Adamchak, 1991) and Sudan (Khalifa, 1988)
document that men perceive that they should have the major role in
the decision to use family planning. In Ghana, both men and women
who participated in recent focus group discussions expressed the
view that, when differences in fertility preferences occur between
a husband and wife, the man’s preferences usually dominate (Ezeh,
1992).
A young mother from the Volta region spoke as follows:
’’When I wanted to do family planning, my husband did not allow me
so I didn’t do it.”
Only a few studies of husbands’ and wives’ attitudes toward
family planning attempt to link these attitudes with actual
behavior.
Results from the Egyptian WFS showed that husbands’
fertility preferences are substantially different from those of
wives and more closely linked to women’s use of contraception
(Singh, 1987). Women-based data from metropolitan Indonesia show
22
that a wife’s perception of her husband’s approval of contraceptive
use is the most important determinant of her actual use (Joesoef,
Baughman, and Utomo, 1988) . An analysis of the recent DHS in Ghana
shows that the consistency of husbands’ and wives’ attitudes toward
family planning is an important factor in the level of contracep
tive use.
Whereas 38 percent of couples in which both partners
approve of family planning are currently using some form of
contraception, less than 11 percent of those where only one spouse
approves are doing so (Ezeh, 1991).
Clearly, women have an important say, but not always the final
say, in contraceptive use. These data reveal, however, that the
formation of preferences, the reconciliation of differences, and
the specific actions taken by individual men or women are the
outcome of a complex negotiation process.
The relative power of
women in sexual relationships will depend on their access to and
control over resources as well as on the strength of the ties that
bind their male partners to them.
The types of family planning
methods most suited to individual needs in terms of privacy,
secrecy, and the need for cooperation between partners will depend
on the nature of these relationships.
Our understanding of this
process would be greatly enriched if we knew more about men’s sense
of responsibility for their sexual behavior and their roles in
reproductive decisionmaking and contraceptive practice. It is also
important to learn more about the influence of other family members
on reproductive decisionmaking.
III. THE DEMAND FOR CHILDREN:
DO RISING COSTS LEAD TO DECLINES IN
FERTILITY?
No one denies that the costs of rearing children are rising
rapidly in most parts of the developing world.
Growing labor
market opportunities for women provide them with alternatives to
children as sources of support and fulfillment, thus raising the
opportunity cost of their time and the indirect costs of children.
As economies modernize and diversify, child maintenance requires
increasing access to the cash economy for the purchase of nutri-
23
tious foods, essential medicines, and school books and uniforms.
While primary health clinics and schools are now accessible to most
parents, the direct costs of these services have been rising
rapidly as many governments seek to privatize them.
With various elements of the costs of children rising, in part
due to the withdrawal of government subsidies, parents may be
induced to consider changes in their fertility behavior. However,
other responses are also possible. Parents may seek ways to shift
some of the increased costs of childrearing onto other relatives
and older children. Fathers may seek to shift more of the burden
onto mothers. Alternatively, when family resources are inadequate
or credit is unavailable and when returns on child investment
appear low or uncertain, parents may select only certain children
to be the beneficiaries of their investments or distribute their
investments unequally.
Less favored children can stay at home,
fend for themselves, and help support their parents and siblings
without the benefit of education or proper health care.
Few
developing country governments make ’’altruistic parenting institu
tionally compulsory” (Johansson, 1991), and in many cultures the
idea of equity among household members — in particular, siblings
— is completely foreign.
A.
Improved livelihoods for women:
who benefits?
Improvements in the status of women and the equalization of
their rights with those of men were identified as essential
prerequisites for the effective implementation of the World
Population Plan of Action in the recommendations of the 1984
International Population Conference in Mexico City. Included among
the recommended improvements were women’s equal access to and
control over resources, in particular education and employment in
the paid labor force (United Nations, 1984a). These were enthusi
astically and unanimously adopted by the largely male-headed
delegations of the UN’s member countries. Their universal support
suggests that they were viewed as ”win-win” propositions, with
24
women having much to gain and men having nothing to lose and
perhaps even something to gain as well.
However, unless women can capture directly the gains from
improvements in education and livelihoods and translate them into
greater personal autonomy and economic mobility, their economic
gains are likely to be dissipated within the family. The result is
apt to be a reduction in men’s family responsibilities, leaving
women dependent on men for essential complementary resources and
dependent on children for long-term security.
Such an outcome
would lead to a reduction in men’s economic contribution, an
increase in women’s labor market work, and relatively little change
in the demand for children, despite the increased personal costs of
children shouldered by women.
A growing body of evidence from developing country settings
indicates that women’s economic activity is not necessarily
incompatible with the bearing and rearing of children (Lloyd, 1991;
Mason, 1985) .
In some cases this may be because the burden of
childcare does not fall exclusively on the mother, but is shared by
siblings and other family members (Desai and Jain, 1992) . In other
cases this may be because of the nature of women’s work, which is
often flexible in terms of scheduling and physically proximate to
the home.
In other cases still, the economic demands of a growing
family require women to work despite any difficulties or costs they
may encounter. However, certain types of work are more difficult
to reconcile with the bearing and rearing of large families — in
particular, work for cash in the modern sector (Lloyd, 1991).
As a result, there has been much effort in the donor community
to promote income-earning opportunities for women through training
and access to credit. Indeed, some of these interventions (e.g. in
Bangladesh, Indonesia, Thailand) have been directly linked to the
design and implementation of family planning programs (UNFPA, 1990;
Weeden et al., 1986). These efforts have been largely confined to
individual enterprises within the informal sector for obvious
reasons:
it would be difficult to intervene directly in the
employment practices of family enterprises, private companies, or
25
government ministries.
There
is evidence,
however,
that even
women’s gains from certain types of self-employment in the modern
sector, specifically in commerce, do not necessarily lead to
increased mobility in the form of business expansion, given the
constraints imposed on women by family institutions and prevailing
gender ideologies (Greenhalgh, 1991).
In three case studies drawn from disparate cultural settings
— Ghana, India, and Thailand — Greenhalgh (1991) identifies the
factors limiting women’s business opportunities.
In the case of
vegetable vendors in Madras, women’s limited physical mobility
required them to depend on men to perform crucial business
transactions. Women turned over their income to the men. Business
success led to greater male inputs, with the inevitable consequence
that growing businesses gradually became male-controlled. In the
case of market women in Ghana and Thailand who had full indepen
dence in the conduct of business, their business mobility appeared
to be limited by claims made on their income by other family
members.
The financing of children’s education was an important
element of women’s financial ’’obligations” in both instances.
Husbands made additional financial claims in the case of Thailand,
as did extended kin in the case of Ghana.
In the Indian case,
women’s success led to increasing male control; in Thailand and
Ghana, women’s success led them to take over a larger share of
family obligations.
women’s
In each case, men reaped the surplus from
entrepreneurship,
either
directly
for
themselves
or
indirectly in the form of reduced obligations to other family
members.
Further evidence of women’s sense of family obligation as an
important motivation for work comes from studies of autonomous
female migrants. In a recent review of the literature, Findley and
Williams (1991) find evidence from various settings that women
migrants are often more reliable remitters than men, and that,
despite lower incomes, they remit the same proportions of their
income to their families as men.
26
These examples indicate that, in talking about women’s
livelihoods, it is important to identify those elements that are
likely to enhance their access to and control over the necessary
inputs for their work as well as the profits derived from such
work. Men’s dominant position within the family and situational
advantage in the world of work must be directly recognized in the
design of interventions to enhance women’s income-earning opportu
nities if these are to become genuine economic alternatives to the
family as a source of women’s economic support. More research will
be needed to understand the factors that support and encourage
men's economic support of families — in particular, their children
— in a world in which women are playing an increasingly important
role in the cash economy.
Locating the costs of children: who pays?
In an idealized traditional division of labor between mothers
and fathers in the maintenance and support of their biological
children, mothers contribute their time directly to care and
nurturing while fathers provide necessary material inputs.
In
societies where the support of children is not confined to the
nuclear family unit, female relatives (in particular grandmothers,
aunts, and older sisters) share the mother’s roles and male
relatives the father’s roles. In the process of development, the
costs of children to their parents (and other family members)
inevitably rise, primarily because of increased aspirations for
children’s education. Children’s enrollment in school involves not
only direct monetary outlays but also a reduction in the family
labor force.
How do changes in the cost of children affect the
traditional division of parental and more broadly shared family
responsibilities? Few studies have addressed the question but the
answers are likely to depend on, among other factors, the structure
of the family and the role of family members other than parents in
the support of their children.
In polygamous societies, men view wives as a source of wealth.
Wives are expected to provide largely for themselves and their
B.
27
children through their own labor and through their access to the
resources of other family members. Evidence suggests that in subSaharan Africa, where polygamy is prevalent, mothers provide food
for themselves and their children (Boserup, 1970; Oppong, 1983;
Joekes, 1987) . In these societies, food represents the overwhelm
ing share of the household budget; for example, in Ghana the share
is roughly 70 percent (Lloyd and Gage-Brandon, 1993a). Concrete
evidence of mothers’ and children’s independence from fathers for
economic support emerges from a comparison of children’s nutrition
al status in monogamous and polygamous unions in Ghana, Mali, and
Senegal. Desai (1992) found that child malnutrition was no more
apparent among children in polygamous unions than in monogamous
unions, despite the fact that women in polygamous unions have claim
to a smaller proportional share of their husband’s resources than
women in monogamous unions.
Because co-wives operate with a certain amount of financial
autonomy and without full knowledge of their husband’s resources,
it is relatively easy for a man with several wives to shift a
substantial share of the material costs of his children onto their
mothers.
This process is facilitated by the breakdown of the
traditional marriage contract with the introduction of Western
monogamous marriage forms in much of urban West Africa. This has
resulted in the spread of informal polygamy (deuxieme bureau),
which is outside the reach of customary law and practice (Fapohunda
and Todaro, 1988) . The result is that men can choose the amount of
support they provide to their children and discriminate between
them according to the status of their relationship with the child’s
mother (Bledsoe, 1988).
In Latin America and the Caribbean, the role of the extended
family in child support is not as extensive and, hence, the
consequences of weaker conjugal bonds for children’s welfare are
more apparent. Desai (1992) provides evidence of a substantially
higher prevalence of stunting among children whose mothers are in
consensual unions compared with mothers in legal unions, control
ling for family size and parental resources. This suggests lesser
28
child investment by parents in consensual unions, probably the
result of a smaller paternal contribution in less stable unions.
Cain (1984) referred to this as the ’’free rider” problem, in which
men can father children with few, if any, economic consequences for
themselves.
There is evidence of rising numbers of female-headed and
-maintained households in developing countries (United Nations,
1991), causing concern that a growing proportion of children may
not be receiving their full share of support from their biological
fathers. However, households become female-headed for a variety of
reasons.
average,
While female-headed households with children are, on
poorer than male-headed households, well-off women and
children are found in a variety of household types.
Children’s
welfare is conditioned less by headship or even residence than by
whether the costs of children are primarily borne by women alone or
are shared (Bruce and Lloyd, 1992). The growing evidence that the
internal distribution of resources in female-headed households is
more child-oriented than in male-headed households suggests that
mothers and fathers have very different expenditure priorities.
This may be due to the very different benefits mothers and fathers
expect from investments in their children.
In a polygamous
society, for example, older men can expect to be supported by
younger wives, while older women may have to rely largely on the
support of their own children. This material support may come in
exchange for further childcare responsibilities, as grandmothers
become the caretakers of the next generation.
It is important to note here that suggestions of possible cost
shifting
between fathers
observation
but
rather
and mothers
are not based
on direct
on
differences
in
resource
observed
allocation that occur between family and household types to which
men (in particular, fathers) have varying degrees of commitment.
We have not yet begun to explore the factors influencing the
bargain that parents strike with each other and other family
members over the division of childrearing responsibilities or how
it is renegotiated over time in response to the arrival of
29
additional children and changing family relationships,
should be future research priorities.
C.
Resources for children:
who is the lucky child?
An
in
implicit
assumption
much
research
on
These
intra-family
resource allocation is that parents are altruistic toward their
children — in other words, that they distribute resources Mfairly"
among them. A fair distribution is sometimes taken to mean giving
the same amount of resources (both parental time and material
resources) to each child and at other times is viewed as allotting
the resources required to give each child an equal opportunity or
equal
success.
The first type of distribution
could
lead to
inequality between children according to birth order,
even if
equality between children was preserved at any point in time,
because children do not arrive in a family all at once.
Given
differences between children in natural endowments, the second type
of distribution would imply that resources invested would not be
the same but the result would be equality between children in their
ultimate welfare. Both of these approaches to the distribution of
resources among children would lead to the prediction that a rise
in the costs of children on average would lead to a decrease in
demand. Neither of these altruistic approaches to the intra-family
allocation of resources among children would be expected to lead
parents to differentiate between children on the basis of sex
unless parents are thought to believe that girls and boys, given
their different endowments, need different levels of resources to
achieve the same ultimate level of welfare.
The negative effects of family size on child outcomes have
been interpreted as the result of parents having to distribute
their given resources "fairly" among more children (e.g. Knodel,
Havanon, and Sittitrai, 1990). However, if alternatively parents
are able to accommodate the rising costs of health care, food, and
education by choosing to invest in some children but not in others,
then the link between rising costs and declining demand would not
be as direct or as strong. Such a strategy would involve parents
30
in investing in quality and quantity simultaneously, hedging their
bets and preparing some of their children for a modern world and
some for a more traditional one. Empirical evidence of systematic
differences between boys and girls within the same sibsets in such
outcomes as mortality (D’Souza and Chen, 1980; Das Gupta, 1987),
nutrition (Chen, Huq, and D'Souza, 1981), child care (Levine,
1987), and education (Jeejebhoy, 1992) suggests one of the ways
parents may be at least partially accommodating the rising costs of
children — that is, by increasing their investments in sons but
not in daughters. A few studies that have explored differences in
educational outcomes for boys and girls in high-fertility settings
have found that the negative consequences of having many siblings
— or more specifically younger siblings — is much greater for
girls than for boys (Sathar, 1992; Lloyd and Gage-Brandon, 1992;
Basu, 1992).
Not all parents can afford the luxury of being fair, and one
easy way to differentiate between children is according to sex.
Both mothers and fathers may see very different payoffs to
investments in their sons vis-a-vis investments in their daughters,
and these will vary across societies according to marriage customs
and family organization,
Differential investments in sons and
daughters are likely to make economic sense from a parent1s
perspective.
Birth order is also a factor in differential care,
In some
settings older children are advantaged relative their younger
siblings, whereas in others they may be expected to carry an extra
burden of caring for younger siblings. A child's value in Nepal,
for instance, is calculated in terms of future household needs and,
once those needs have been met, children become redundant (Levine,
1987) . In Taiwan the oldest children in large families, especially
females, do particularly poorly with respect to education (Parish
and Willis, 1992) . Foreshortened education and early marriage are
often the fate of older girls from large families, with the result
that patterns of early and high fertility are perpetuated and
31
intergenerational
Brandon, 1993b).
inequality
is
accentuated
(Lloyd
and
Gage-
This section of the paper started with the question:
will
rising costs of children lead to declining demand? The discussion
has pointed out the ways in which the organization of families and
gender relations within the family can affect the distribution of
material and opportunity costs of children among family members.
In settings where decisionmaking authority rests largely with men
who do not carry the bulk of the childrearing costs, there is the
likelihood of a lag in the fertility response to rising costs. The
possibility that some parents will choose not to pay the costs, to
shift them onto others (including their own children) , or to pay
them for some children only (with a preference for boys) further
weakens the expected
fertility decline.
relationship
between
rising
costs
and
Future research will need to probe the determinants of
altruistic behavior within families, particularly between parents
and children. Why are women more child-centered in their expendi
tures than men?
How could government policy induce mothers and
fathers to treat their sons and daughters equally? The answers to
these questions would provide the framework for more equitable and
more effective population policy.
IV.
SUMMARY AND CONCLUSIONS
This paper has illustrated the ways in which assumptions about
family organization and gender relations inform our thinking about
population policy. Our empirical view of the family is needlessly
limited, largely because of the biases introduced by our womencentered approach to the collection of demographic data for policy
analysis.
The cross-country diversity in family forms is only
hinted at in the data presented here.
The full extent of the
diversity will only be fully known once proper account is taken of
father-child links and of membership in multiple families.
The
expectations of men and women about the stability and economic
cohesiveness of their own families are surely important factors
32
influencing their family size goals and their choice of individual
vs. couple-based strategies for achieving those goals.
Yet we
currently have only fragmentary data on the stability of the family
in different cultural settings.
Population experts seem to have implicit faith in women’s
capacity to act as demographic innovators.
From either a supply
side or demand side perspective, they are seen as having the most
immediate stake in fertility regulation. However, within a variety
of family systems, women face constraints that limit their options
outside the family and circumscribe their roles within it. Whether
the limitations are on their physical mobility, as in parts of
South Asia and the Middle East, or on their economic mobility as in
much of the developing world, the consequence is that, even when
the costs of bearing and rearing children are high, the benefits
may also be relatively high where women have limited access to
alternative sources of support.
Given men’s dominant position
within the family, increases in the costs of children will have
their most direct and immediate impacts on fertility behavior in
families where fathers carry a significant portion of the financial
costs.8 Given men’s dominant position within society, improvements
in women’s livelihoods will have the most direct and immediate
impact on fertility behavior where women can retain a fair share of
their economic gains for their personal benefit.
Finally, given
the fact that parents do not necessarily treat all children
"equally" but invest in them according to expectations of return,
increases in the costs of children will have their most complete
impact
on
fertility
behavior
in
settings
where
the
economic
prospects for girls are as promising as for boys.
Bringing men into the picture, adding an individual perspec-
tive to the more traditional couple perspective, developing a more
realistic view of "the family" in all its manifestations, gaining
a sense of fairness about the process of change — these are all
essential steps that will lead to more effective population
policies.
The details will have to be worked out country by
country,
relying on a process of policy assessment,
33
assumption
testing, and empirical analysis that, taken together, will provide
a critical review of gender relations and the structure and
organization of families.
Nothing about families should be taken
for granted if these new inquiries are to yield the understanding
necessary to achieve the international and national goals original
ly adopted in 1974 by the World Population Plan of Action.
34
Notes
1.
In each table, the choice of countries included is dictated by
the availability of data on that topic at the time the paper
was written.
Each table should be seen as illustrative and
designed to demonstrate the possible range of situations that
may apply.
2.
These are synthetic cohort measures which assume that mothers
(women who have ever given birth to a child) would progress
through their reproductive years starting at age 20 experienc
ing the same residential and marital pattern at each age as
mothers in each age group at the time of the survey. Obvious
ly, some children are the product of later marriages — not
the first one — so this categorization gives only a crude
measure of the extent to which children’s parents live apart.
3.
Some children living away from their mother may live in the
same household with their biological father.
On the other
hand, some children who live with their mother and her spouse
may not be living with their biological father. Thus, these
data do not measure what we would ideally like to know, namely
what percentage of children live with both biological parents.
4.
In surveys with detailed marital and birth histories, individ
ual children can be linked with their biological fathers.
5.
This includes
unions.
6.
In those countries where all women were asked about their
contraceptive practice, Mauldin and Ross (1992) reclassified
unmarried women reporting contraceptive use as married and
their use was thus accounted for in the estimates of future
contraceptive use and commodity costs.
7.
Use among the formerly married in some cases includes terminal
methods previously adopted within a marital union.
8.
Indeed, in low-fertility societies, it could lead to an
increase in fertility, which may be seen as desirable in some
countries.
children born prior
35
to a
union
or between
A
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Deputy Director, Programs Division
Population Council
One Dag Hammerskjold Plaza
New York, NY 10017
PHONE: 212/339-0639 FAX: 212/755-6052
Chapter Title: Measuring Efficacy of Family Planning Programs (w/Jain)
Sarah Castle
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/495-3008 FAX: 617/495-5418
Chapter Title: Women's Reproductive Decisions in West Africa (w/Adams)
Mirai Chatterjee
Self-Employed Women's Association
Reception Center
opp. Victoria Gardens
Ahmedabad 3 AO 001 INDIA
PHONE: 91.272.442.407 FAX: 91.272.390.577
Chapter Title: Women's Work and Child Care -- Lessons from an NGO
(will not be used as chapter, but as box)
Lincoln Chen
Director
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/495-3009 FAX: 617/495-5418
Chapter Title: Financing Reproductive Health Services (w/Zeitlin and Govindaraj); editor
Amparo Claro
Casilla 2667
Correa Central
Santiago, CHILE
PHONE: 56.2.633.4582 FAX: 56.2.6383142
Chapter Title: Challenges to Population Policy: The Rise of the Women's Health Movement (w/GarciaMoreno)
Sonia Correa
Director
S.O.S. Corpo
Rua de Hospicio, 859, 4o andar
Boa Viste, Recife
PE CEP 50050 BRAZIL
PHONE: 55.81.221.3018 FAX: 55.81.221.3947
Chapter Title: Reproductive Rights in Feminist Perspective (w/Petchesky)
Goran Dahlgren
Office of the Director General
SIDA
Birger Jarlsgarten 61
S-105 25 Stockholm SWEDEN
PHONE: 46.8.728.5100 FAX: 46.8.612.6380
Representative of Sponsor
Sonalde Desai
Population Council
One Dag Hammerskjold Plaza
New York, NY 10017
PHONE: 212/339-0686 FAX: 212/755-6052
Chapter Title: Health and Equity: Refocusing on Livelihood Strategies and Basic Needs
Bertil Egero
Department of Sociology
University of Lund
Box 114
22100 Lund SWEDEN
PHONE:
FAX:
Advisor
Mahmoud Fathalla
P.O. Box 30
Assuit, EGYPT
PHONE: 20.88.334.820 FAX: same
Chapter Title: Contraceptive Research and Development
Minou Fuglesang
IHCAR
Karolinska Institutet
P.O. Box 60400
S-104 01 Stockholm SWEDEN
PHONE: 46.8.30.08.63 FAX: 46.8.31.15.90
Advisor
Thomas Gardner
P.O. Box 2652
Cambridge, MA 02138
PHONE: 617/864-9528
Technical Editor
FAX:
Adrienne Germain
Vice President
International Women's Health Coalition
24 East 21st Street
New York, NY 10010
PHONE: 212/979-8500 FAX: 212/979-9009
Chapter Title: Rethinking the Concept of Reproductive Health (w/Nowrojee and Pyne); editor
Ramesh Govindaraj
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/495-8498 FAX: 617/496-3227
Chapter Title: Financing Reproductive Health Services (w/Zeitlin and Chen)
Kirstan Hawkins
International Planned Parenthood Federation
Regent's College
Inner Circle, Regent's Park
London NW 14NS UNITED KINGDOM
PHONE: 44.71.486.0741 FAX: 44.71.487.7950
Chapter Title: Adolescent Sexuality: Experiences from the Field and Policy Implications
Anrudh Jain
Deputy Director, Programs Division
Population Council
One Dag Hammerskjold Plaza
New York, NY 10017
PHONE: 212/339-0636 FAX: 212/755-6052
Chapter Title: Measuring Efficacy of Family Planning Programs (w/Bruce)
Naila Kabeer
Institute for Development Studies
University of Sussex
Brighton BN1 9RE UNITED KINGDOM
PHONE: 44.273.606261 FAX: 44.273.621.202 or 691.647
Chapter Title: A Gender Perspective on Population Policy
Simeen Mahmud
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/495-3639 FAX: 617/496-3227
Chapter Title: Empowerment & Reproduction
Walter Mertens
15 Clemmons Street
Southboro, MA 01772
PHONE: 617/875-5390 FAX:
Chapter Title: Population and Development Theories and their Implications for Population Policies
Claudia Garcia-Moreno
OXFAM Health Unit
274 Banbury Road
Oxford OX2 7DZ UNITED KINGDOM
PHONE: 44.865.312.315 FAX: 44.865.312.380 or 600
Chapter Title: Challenges to Population Policy: The Rise of the Women's Health Movement (w/Claro)
Sia Nowrojee
International Women's Health Coalition
24 East 21st Street
New York, NY 10010
PHONE: 212/979-8500 FAX: 212/979-9009
Chapter Title: Rethinking the Concept of Reproductive Health (w/Germain and Pyne)
Rosalind Petchesky
Department of Political Science
Hunter College
695 Park Avenue
New York, NY 10021
PHONE: 212/772-5682 FAX: 212/772-4268
Chapter Title: Reproductive Rights in Feminist Perspective (w/Conea)
Hnin Hnin Pyne
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/496-8640 FAX: 617/496-3227
Chapter Title: Rethinking the Concept of Reproductive Health (w/Nowrojee and Germain)
Sudhakar Rao
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/484-3191 (home) FAX: 617/496-3227
Chapter Title: Human Rights and Population: Conventions and Treaties (w/Zeidenstein)
Laura Reichenbach
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/495-2021 FAX: 617/495-5418
Research Assistant
Anna Runeborg
Office of the Director General
SIDA
Birger Jarlsgarten 61
S-105 25 Stockholm SWEDEN
PHONE: 46.8.728.5100 FAX: 46.8.612.63.80
Representative of Sponsor
Gita Sen
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/495-2026 FAX: 617/495-5418
Editor
Rachel Snow
Department of Population and International Health
Harvard School of Public Health, HSPH1-1105
665 Huntington Avenue
Boston, MA 02115
PHONE: 617/432-4619 FAX: 617/566-0365
Advisor
Goran Sterky
IHCAR
Karolinska institutet
P.O. Box 60400
S-104 01 Stockholm SWEDEN
PHONE: 46.8.30.08.63 FAX: 46.8.31.15.90
Advisor
Goran Tomson
IHCAR
Karolinska Institutet
Box 60400
S-104 01 Stockholm SWEDEN
PHONE: 46.8.300863
FAX: 46.8.31.15.90
Advisor
George Zeidenstein
Center for Population and Development Studies
9 Bow Street
Cambridge, MA 02138
PHONE: 617/496-3219 FAX: 617/495-5418
Chapter Title: Human Rights and Population: Conventions and Treaties (w/Rao); Population and
Human Rights (w/Boland)
Jennifer Zeitlin
Department of Population and International Health
Harvard School of Public Health
665 Huntington Avenue
Boston, MA 02115
PHONE: 617/876-0497 FAX: 617/566-0365
Chapter Title: Financing Reproductive Health Services (w/Chen and Govindaraj)
I'vJ H I G
OSo' ■
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-
Woman’s EnvironmentS
Development Organization
BRIEF! N G
•MU
I*,
P A C K EV
if?
i
■■'.^OpOIOlICWl Ot' ;■
CAIRO • SEPTEMBER 1994
IB
»0
Women’s Environment & Development Organization
845 7hird Avenue • 15th Floor • New York. New York 10022 USA
Telephone: (212) 759-7982 • Fax: (212) 759-8647
Email: wedo@igc.apc.org
Women's Environment & Development Organization
New York, NY 10022
•
845 Third Avenue
c
15th floor
Fax:(212) 759-8647
6
E-mail: wedo@igc.org • Telephone: (212) 759-7982
•
U.S.A.
Co-Chairs
Bella Abzug
Co-Chair
Women's Foreign Policy
CouncliWEDO
May 31, 1994
U.S.'
Dear Women’s Caucus member,
Thaii Corral
REDEH, the Network
tn Defense of Humankind
brazil
Marla F -nia de Cotter
Execulm Jirector
Anas Foundation
Costa Rica
Jocdyn Dow
Red Thread
Women's Development Project
Guyana
• <
Bin Enge
Norwegian Forum for
Environment and Development
Norway
Dr. Farkhonda Hassan, M.P.
Profosor of Geology
American University in Cairo
W
Wangari Maathai
Coordinator
Green Belt Movement
Kenya
Chief Biii Ogunleye
Country Women Association
of Nigeria (COWAN)
Nigeria
Vandana Shiva
Research Foundation for
Science, Technology and
Naiural Resource Policy
India
Marilyn Wahng
Author and senior
Omversity lecturer
Ntv Zealand
Susan Davit
Executive Director
l'O.
I
I trust you have recovered from PrepCom III a nd-are now engaged in
crucial advocacy work at home, before the final round ot negotiations in
Cairo at the International Conference on Population and Development
(ICPD). Here in New York the overwhelming perception of the 1CPD
Secretariat, government delegates, NGO representatives on UN
delegations and NGOs actively tracking the ICPD deliberations is that the
Women’s Caucus was highly effective and efficient at PrepCom III and I
believe the Caucus can legitimately take pride in moving the agenda in a
positive way.
•" ycled paper
More than ever before, it was made clear that family planning had to be
discussed within a framework of reproductive and sexual health and
rights. World leaders also recognized that family planning alone is not
sufficient, but the need to address the status of women, to alleviate
poverty, provide women with access to education, housing a. d general
health care arc essential ingredients in addressing population and
development.
Unfortunately, the largely Vatican-lc i effort at PrepCom III resulted in the
bracketing of such critical issues as sexual and reproductive health,
services and rights, safe motherhood, fertility regulation and adolescent
sexuality.
It is now essential, in each of our countries, wherever possible, to launch
a public campaign developing support for the core ideas and language in
the document, building support for removing bracketed language which is
antithetical to women’s perspectives and fighting for the maintenance of
bracketed language wherever supportive.
ANALYSIS OF DOCUMENT
Prom our end we have prepared the enclosed«analysis to assist each of you
in continuing our collective advocacy and outreach efforts. Enclosed
please find the following:
• m of Women U.S.A Fund, Inc., a 5C1 (c)(3) educational organization
612
•
An Impact Analysis of the Women’s Caucus Recommendations on the Draft Final Documer
of the Con 1 enceT-"This is a comprehensive analysis of the exact language adopted, the concepts
incorporated and the unfinished agenda The review clearly shows the significant impact we had orHIT
official document. To receive the complete 118-page text of the Draft FtnaJ Document, please comae:
Linda Libront, Chief NGO Unit, at the ICPD Secretariat, 220 East 42nd Street. New York. NY KXH'7
Tel. 212-297-5287f3Fax. 212-297-5250: and
•
My "Assessment of PrepCom III" (Earth Times, 4 May, 1994) which I hope you will find
useful and informative. For an eight-page summary report of PrepCom HI. please write to The Earth
Negotiations Bulletin. USD 161 Portage Avenue East. 6th Floor. Winnipeg Manitoba R3B OY4
CANADA. E-mail:'iisd@web.apc.org.
ACTIONS
We need each of you to take action and keep involved in this public debate about the most private of
subjects, sexuality and reproduction. The outcome will affect us all. Here are some practical
suggestions:
•
Disseminate information to Women's and NGO networks, between now and Cairo It is viial
to publicize the ICPD Draft Final Document and what transpired at PrepCom HI. highlighting the
unfinished age- da contained in the bracketed text:
•
Organize local, national and regional meetings. Meet with government officials, policy
makers. Women's and NGO networks to engage in a public dialogue on the core agenda and. in
particular develop support for what has to be changed in the bracketed issues;
4
Ensure that governments select progressive and knowledgeable delegates to Cairo.
particularly women and NGOs who understand
the issues,
i
------------- ...e
the linkages ?c -— . ..
development, and sexual and reproductive rights and health:
•
Encourage governments to form national committees foi the ICPD. iit they haven’t already
done so, and secure representation of women s NGOs. Where national committees already exist,
exist.
persuade them to review and discuss the Women's Caucus positions at PrepCom HI in order to gam
their support in Cairo:
•
C ultivate the media to effectively increase public awareness about the ICPD and the core issues
of the conference. 1 he media is a central tool to spread the messace
WE NEED YOUR INPUT
We are in the precess of refining our collective political analysis based on government positions on the
key issues at PrepCom HI. The list of countries which ended up supporting the Vatican's position is
not that long. Nevertheless, we must work to convert the Jem states .mo forceful advocates and help
to reinforce the favourable positions taken by others at PrepCom III. We mav also help to soften or
reverse positions, taken by some states, with strategic NGO involvement in the interim period
-.^11 !«■
J
Please share with
any information you have on your own country or others in your region,
highlightinglho on which we should focus our lobbying efforts. Please organize your list into three
categories: Positive. Negative and Silent (differentiating between those likely 10 lean favourably and
likely to lean against). This compilation will be invaluable for the Women’s^Caucus in developing a
comprehensive and coherent strategy for Cairo. We need and welcome your input
We have been informed by Dr. NaTis Sadik that a 27-member Bureau for the Conference will be elected
during the pre-con fere nee government consultations (3-4 September. 1994) in Cairo. In due course,
each UN regional group will consult with country members as to which countries are interested m
serving on the bureau.
PREPARATIONS FOR CAIRO
WE DO has developed its methodology of organizing a Women's Caucus over the Iasi few years,
starting at the World Women's Congress for a Healthy Planet and carried through UN('!-D. the Small
Island Developing States Conference. Social Summit and World Conference tor Women PrepComs
well as during the Commission on Sustainable Development, it is a democratic, open vehicle lor
maximizing the participation of women and men NGOs in global policy-makinc ■ ’ocesses.
In preparation for the ICPI). VVEDO plans to convene
convene an
an interactive vvtorkshop to initiaie
newcomers into the Women s Caucus and related UN process, and refresh old-timers.
----- The workshop
is scheduled tor 4 September. 1994, one day before the official meetings begin, for two hours in the
afternoon. Details will follov. next month.
We aho plar^to consene an NGO-Delegate Dialogue on our critical concerns focusing on how to hold
the world s govetiiiiients accounta -e to our these concerns. This dialogue session will give us an
oppoitunity to
outcomes and decisions
-‘gag: ceiegates or. how they plan to implement Conference
By early Jmy. each of y ou should receive our analysis of the bracketed text in the Draft Final
Document to be discussed and resolved in Cairo. This analysis is being compiled in close collaboration
with the PrepCom III Women’s Caucus Task Force Chairs* and key Chapter Monitors.
In the meantime -ac look forward -o receiving your responses io this letter and our continued close
communication till we reach rairo
With warmest records
> ours sincerely.
Sella S Abzug
See list of 1 ask l-oice ('hairs on reverse
WOMEN’S CAUCUS JCPD PREPCOM HI
TASK FORCE CHMR^
Chapter I A 2
Cha pi er 10
Carol Narcisse
Association of DevcHpinent Agencies in Jamaica
2 Waterloo Road
Kingston 10
'
Audrey R■ ■'bei’s
c m WAND Wm
Pmeland. S? Michav:
BARB Al)(JS
MAIGA
Her 10
Chapter 1 & 2
Charito Ba>.
Via Cehr.O!00172 Romv
1TAI.Y
Mona Zulficar
Egyptian National Steering Committee h’r ICPU
5 12 E’ Marashlv St
Zamaiek. t airo
EGYPT
Chapter 7; X
Chapter
12
' & 6
Joan Duniop
President
International Women’s Health Coalition (TWHC)
24 East 21st Street
New York. NY 10010-7200
USA
Gila Sen
Indian Institute -■! Management
942 Ual III Stage
bangalore 560075
INDIA
Chapter 3. 5 & 6
Bene E.
rdunagu
Coaiiiioi'
Nigerian NGOs on
Health. Population and Development
I' O Box .63 Unical Post Office
Calabar
NIGERIA
Pegg} Antrobus
I ■■ ector
Women and Development Unit (WAND*
School of Continuing Stud.es
University of the West Indies
Pinelands. St Michael
BARBADOS
Chanter 13-th
Chapter 4. 9-11
Sandra M. Kai
Bangladesh Women s Health Coalition (BV H<
Sonia Correa
National Feminist Health and
Reproductive Rights Network
c o SOS Corpo
Rua Major Condeccira
Sto Amaro - 50.100 070
Recite Pernambuco
BR A 711
Hs. 46A. Road nA. Dhanmond; R \
Dhaka 1209
BANG1 ADI-SI1
4
k) H ' 11’3.
International Conference on
Edging
.
Population^ ssues
irfthe
in the Asia Pac
Pacific Region:
Challenges
for the 21 st Century
wk
®
Golden Jubilee
Year 1956-2006
Date: 10-13 December 2006
Venue: Grand Hyatt,
Mumbai. India
■
International Institute for
Population Sciences
Deonar, Mumbai-400088, India
(
The International Institute for Population Sciences (UPS), Mumbai, is completing
50 years of glorious service in teaching and research in the field of population studies.
As part of its Golden Jubilee celebrations, the Institute is organizing an International
Conference on "Emerging Population Issues in the Asia Pacific Region: Challenges
for the 21st Century" in Mumbai from December 10-13, 2006.
The Conference aims at offering a platform to various academicians, researchers,
program managers and the Institute's alumni from around the world to debate on the
changing population scenario in the region and the resultant implications on socio
economic policies. The Conference will provide a forum for the presentation of
scientific papers
