Population Issues - Population Programmes: Challenges for the 21st Century

The International Conference on Population and Development (ICPD) helped place population concerns at the heart of sustainable development. Rapid population growth and high fertility hold back development and help to perpetuate poverty. The Cairo conference also put an end to the concept of "population control", recognizing that smaller families and slower population growth depend not on "control" but on free choice.

Choice means access to reproductive health care, including a range of family planning information and services, but it doesn't stop there. Women and men must feel that the services available and the quality of care meet their reproductive health needs. Most women, given the choice, will have fewer children than their mothers did.

The Cairo agenda also means more attention to education for women and girls. It means leadership, encouraging family and community support for women's choices. It means more women active in the community, in government at all levels, in the private sector. It means protection for women's legal rights. It means empowerment, equity and equality.

ICPD's 20-year programme is ambitious, but practical. It is the outcome of three years' hard negotiations, and was agreed by all 180 countries, rich and poor, industrialized and developing, who attended the Cairo conference. By 2015, it calls for:

universal access to quality and affordable reproductive health services, including family planning and sexual health
significant reductions in infant, child and maternal mortality
broad-based measures to ensure gender equity and equality and the empowerment of women
universal access to primary education and closing the "gender gap" in education

To reach the Cairo goals, governments agreed to increase spending on population and related programmes. The needed resources were estimated as an ambitious $17 billion a year by the turn of the century, climbing to nearly $22 billion by 2015. Two-thirds would come from developing countries and up to one-third from the more developed or donor countries. In 1994 and 1995 population funding increased substantially. In 1995, $9.5 billion was earmarked for population programmes and projects globally. Donor countries accounted for $2 billion of this amount.

While some developing countries continued to increase allocations for reproductive health, international assistance stagnated in 1996 and 1997, causing concern that donors might not reach their one-third of the $17 billion estimated target for the year 2000. Indeed, rather than growing at the rate projected when the ICPD goals were first set, the amount of total official development assistance ODA from developed countries has declined -- from the high of $61 billion in 1992 to under $48 billion per year in 1997 (actual dollars). As a result, the commitment to an increased share of total assistance devoted to population activities has been overshadowed by an over- all decline in development assistance. A higher proportion of ODA, over 3 per cent, is going to population and reproductive health programmes than in 1994, but it is a bigger slice of a smaller pie.

While the commitment to achieving the ICPD goals within the context of the 20-year Programme of Action launched at Cairo in 1994 holds firm, a new set of benchmark indicators has been devised to help gauge progress while generating quantifiable momentum towards those goals. For example, to better measure progress towards the ICPD goal of reproductive health for all, governments and countries should now strive to ensure that:

By 2005, 60 per cent of primary health care and family planning facilities should offer the widest achievable range of safe and effective family planning methods, essential obstetric care, prevention and management of reproductive tract infections including STDs, and barrier methods to prevent infection; 80 per cent of facilities should offer such services by 2010, and all should do so by 2015.
Any gap between the proportion of individuals using contraceptives and the proportion wanting to space or limit their families is reduced by half by 2005, 75 per cent by 2010, and 100 per cent by 2050. (Recruitment targets or quotas should not be used to reach this goal).

In monitoring progress towards the ICPD goals for maternal mortality, countries should use the proportion of births assisted by skilled attendants as a benchmark indicator and ensure:

By 2005, that at least 40 per cent of all births are assisted by skilled attendants, where the maternal mortality rate is very high, and 80 per cent globally; by 2010, the figures should be 50 and 85 per cent, respectively; and, by 2015, 60 and 90 per cent.

In an effort to stem the onslaught of HIV/AIDS (spreading even faster than anticipated at the time of ICPD) by reducing vulnerability to infection, another benchmarks calls for providing at least 90 per cent of young men and women aged 15 to 24 with access to preventive measures such as female and male condoms, voluntary testing, counselling, and follow-up by 2005, and at least 95 per cent by 2010. It also calls for reductions of 25 per cent in HIV infection rates among persons in that age group in the most affected countries by 2005, and a global 25 per cent by 2010.

Meeting the increased contraceptive needs of growing populations, overcoming the low levels of services available for the young (although numbering over 1 billion, the most under served population group), upgrading infrastructure and retraining staff for modern services, combating HIV/AIDS, all combine to make a formidable list of pressing demands on limited resources.

Failure to mobilize the necessary funding will prevent the realization of the Cairo vision, the ICPD Programme of Action, with consequences that will undoubtedly include continued high rates of unwanted pregnancy, continued recourse to abortion, increased infant, child and maternal mortality, the faster spread of the HIV/AIDS pandemic and slowed implementation of the client-centred approach to reproductive health services.

Moreover, the consequences of a resource shortfall will be felt far beyond the population field. Continued rapid population growth will wipe out gains already made in other crucial areas, such as schools, primary health care, affordable housing, public transport and roads, and managing critical natural resources. Such growth will also work against progress in the future.

Beyond the resources needed to carry out the 20-year plan for expanding access to basic reproductive health care, the Cairo Programme of Action recognizes the need for additional resources for the health sector as a whole, for education -- especially of girls and women -- and for other development programmes aimed at alleviating poverty and preserving the environment in which we live. The Programme of Action urges donor nations to fulfill the 0.7 per cent of GNP target for development assistance. The more effective use of resources requires institutional reforms, including:

increased service integration and improved referral systems;
more effective decentralization;
participation of women in policy and decision-making roles;
greater accountability to local stakeholders;
improvement in the quality and use of policy-relevant data;
closer collaboration between government and civil society;
closer matching of institutional structures to policies;
better management and supervision;
continuous commitment to quality.

Implementing these reforms, along with the full range of recommendations of the ICPD Programme of Action, will require a greater development and use of national capacity. Ensuring more effective use of all resources is an urgent priority that requires the commitment of political and managerial will.