Asia & the Pacific

Overview

The vast and culturally diverse Asia and the Pacific region is home to 60 per cent of the world's people. It encompasses the huge, rapidly industrializing economies of China and India, the remote, mountainous communities of Nepal and Bhutan and the small Pacific island countries. In the past two decades, spurred on by the International Conference on Population and Development (ICPD) Programme of Action and the Millennium Development Goals (MDGs), the region has made great progress on both the social and economic fronts. But this overall progress marks wide disparities and stark contrasts. Hundreds of millions of people have been lifted out of poverty, yet hundreds of millions of others struggle to survive on less than $1 a day. Two out of every three people living in extreme poverty live in the Asia and the Pacific region.

The biggest demographic challenge and opportunity of the region is its enormous population of youth. More than half of the world's young people -- some 850 million between the ages of 10 and 24 -- live in Asia and the Pacific. In some parts of South and South-east Asia, young people make up between one third and one half of the population. This demographic surge of people entering their productive and reproductive years offers great potential for development -- if countries invest wisely in the education, health, skills and economic opportunities of youth.

Asia is also home to the majority of the world's older people. People over the age of 60 made up about 9.3 per cent of the region's population in 2005 and are projected to account for almost 15 per cent by 2025. This emerging issue has major ramifications, as the developing countries of Asia and the Pacific still do not have systems of social protection in place, particularly old age security and health insurance for the elderly.

Several Asian countries began addressing population issues decades ago. As a result, population growth rates in the region peaked in the late sixties and early seventies and have been falling ever since. The population growth rate for Asia and the Pacific is now close to the world's average (1.21 per 1,000 population), with some countries having reached fertility levels of 2.1 or below. However, high fertility in some countries, especially in South and West Asia, continues to outpace economic and development gains and stall poverty reduction efforts. The large percentage of young people means that the region will continue to grow for years to come, although some Pacific island countries are losing population and capacity, due to migration.

Urbanization is occurring at an unprecedented pace, bringing with it both problems and possibilities. Nearly 40 million people in the region, many of them women and young people, migrate each year to urban areas in search of economic opportunity. The majority end up living in slum-like conditions characterized by insecure tenure, inadequate housing and a lack of access to water or sanitation. Within the next 15 years, 18 of the projected 27 megacities (urban areas with more than 10 million people) will be in Asia, and over half of the people will live in slums and informal settlements. This urbanization poses serious environmental threats, including high levels of water and air pollution and attendant health risks.

The 2004 tsunami, which claimed the lives of over 300,000 people and displaced whole communities, called attention to the region's acute vulnerability to natural disaster, which is exacerbated by the large numbers of people in crowded cities located in earthquake zones, dense rural settlements in low-lying flood plains. Small islands in the region are already affected by rising sea levels. Few of these countries, however, have the infrastructure for emergency preparedness or the capacity to deal with the social upheaval that follows a major catastrophe.

Although empowering, educating and improving the reproductive health of women are keys to achieving the targets of the ICPD and the MDGs, gender disparities persist in the areas of health, literacy, education, political participation, income and employment. As a result, many women, especially those who are impoverished, are prevented from exercising their human rights and realizing their full potential. Their families, communities and countries miss out as well. Although most countries in the region have signed or ratified the UN Convention on the Elimination of All Forms of Discrimination against Women, not all ensure equal rights for women in their own constitutions. Gender-based violence remains widespread and has only recently been recognized as a significant public health and development concern. A strong preference for sons in some countries has led to pre-natal sex selection or neglect of infant girls, with the result that least 60 million girls are "missing" in Asia, with potentially serious social consequences.

Considerable progress has been made in closing gender gaps in education in South-east Asia and Bangladesh. Many countries in the region have made significant progress in promoting reproductive health and taking a rights-based approach in the provision of information and services, as called for at the ICPD. However, poor access to reproductive health services in many countries, especially for the poor and those living in remote areas, compromises the well-being and productivity of women and undermines efforts to achieve the targets set by the ICPD and the MDGs. Through some countries (e.g. Vietnam) have narrowed differentials in access to reproductive health services between richer and poorer segments of society, many countries continue to have inequitable distributions of services access and quality. The poor are least able to implement their family size and spacing choices effectively and to deliver their children safely. The high rates of maternal and infant mortality in some countries underscore extreme inequities in health care: In Afghanistan, Bhutan, Cambodia, India, Lao PDR, Nepal, Papua New Guinea and Timor-Leste, maternal mortality ratios exceed 400 per 100,000 live births. These countries, as well as Myanmar, Pakistan and the Philippines, also have large unmet needs in the areas of family planning and reproductive health.

HIV prevention is an urgent reproductive health challenge. Until recently, HIV prevalence in most countries in the region had been restricted to high-risk groups involved in injecting drug use and sex work. There is now a serious threat of the virus quickly spreading to the general population. The Asia and Pacific region has more than 6.5 million people living with HIV/AIDS, some 5 million in China and India alone. Without far-reaching interventions, epidemiologists believe the virus could spread rapidly, creating a new epicentre of the global AIDS pandemic in the next decade and undoing years of development progress. Cambodia, Myanmar and Thailand are already dealing with serious epidemics, but Thailand has shown that it is possible to reverse the spread of the infection with large-scale, sustained and concerted programming.

The situation demands a scaling up AIDS advocacy, prevention and treatment efforts. However, several factors have muted an effective response in some countries, including denial of the problem, stigma and discrimination against those living with the infection, and lack of resources and political commitment. Tackling the issue is further complicated by the increasing volume of migration and by the trafficking of women and youth for the sex industry, especially in the Mekong area.

The large proportion of young people in the region could also help fuel an epidemic, especially because the reproductive health needs of young people have been overlooked in many countries. A major initiative to prevent HIV, and address other sexual and reproductive health concerns of young people, was launched in early 2003 with funding from the European Union. The Reproductive Health Initiative for Youth in Asia covers projects for both urban and rural youth in seven South and Southeast Asian countries (Bangladesh, Cambodia, Lao PDR, Pakistan, Nepal, Sri Lanka and Viet Nam). All have prioritized HIV prevention and emphasize gender equality.

The UN Millennium Project refers to East and South-east Asia as having shown 'tremendous progress' in the reduction of poverty, hunger and gender inequality, and many countries in this sub-region are on target to reach most of the MDGs. Their social and economic progress was associated with investments in reproductive health, including family planning, and education, as well as the 'demographic bonus' of a large cohort of young people entering the workforce. This demographic window is now opening for South Asia, offering the possibility for improving lives and reducing poverty on a large scale, if governments strengthen their investments in human capital and reduce inequities. Slow progress (and a backsliding for some health targets) suggests that greater efforts will need to be made if the Pacific island countries are to achieve the MDGs.

Back to top