WPC @I<`׬aG&FUѕOYo#iu"M-i)>y:gek3EWtK׆?bZb#4:>6WsFaݙ[ b/#:ZqfmaQ\L'/)E3~ GF+w B k&n*`xsgϰF`0pZw\+9pWp{n̓fN"hG>|sJɷ"9TB9ypq+<͚+līK lTZm{i'O3zEQH!.$*!/SwŦp鹲~WTHln?Ҥ}`(T$(^[eNJ>T3WGCӓ`{#XropR:^=}:5^Ze CLb~ C:mH#UzB %,2 0t 0k8 0p 0m 0%r 0 0 0} 0G 0 0 0o 0! 0! 0" 0e# 04$ 0W % 0jd&' 0+ AQ, 0d, 04D,5-U :-6.1UB44s4UBW88M_9 :U.;";1 < 0D:= 0s~== 0"> 0? 0AuC 0BwkD 0DnFIH 0pL 0pL 0qM`O 0WAQR m@T B1WT 0WtTnUUNzZZUN[f[[["]f__n_ 0rhfi 0Ni 0hi 1miw@cj4j 0[Nj 0ck 1mhk 0k 0Dcl D/l Bll^m 0o DMppassasas AMs|s@0xu 0Kuu|wTzuTz h{!UBJ Aτl D+=$ ha& ho-8UB@ o &Xi fs;|]ZMXB^zl m 9 !7 X3<ooooooqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq D3y\  `*Times New RomanTT'   Chapter I Watanabe0Watanabe .   h:Default ParaDefault Paragraph FontXXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTWT:endnote textendnote text  XXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTW^:endnote refeendnote referenceXXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTWV:footnote texfootnote text  XXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTW`:footnote reffootnote referenceXXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTW88T,toc 1toc 1   (#        >4X` hp x (#>8;T,toc 2toc 2  ` (#        >4X` hp x (#>8>T,toc 3toc 3  ` (#        >4X` hp x (#>8>T,toc 4toc 4   (#        >4X` hp x (#>8>T,toc 5toc 5  h(#        >4X` hp x (#>88T,toc 6toc 6   (#        >4X` hp x (#>8!,toc 7toc 7          88T,toc 8toc 8   (#        >4X` hp x (#>88T,toc 9toc 9   (#        >4X` hp x (#>@;T0index 1index 1  ` (#        >4X` hp x (#>@;T0index 2index 2  ` (#        >4X` hp x (#>P5T8toa headingtoa heading   (#        >4X` hp x (#>@0captioncaption  XXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTW^:_Equation Ca_Equation CaptionXXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTW  Iy!PPP   XXP  XXXXXXXX      XXXXXXXX        B.` hp x (#XB  1  I    XXXXXXXX  ݀UnitedNations,PopulationandDevelopment.ProgrammeofActionadoptedattheInternational < ConferenceonPopulationandDevelopment,Cairo,513September1994.Volume1.Department 6 forEconomicandSocialInformationandPolicyAnalysis,ST/ESA/SER.A/149(NewYork,UnitedNations,1995).(e2$ Iy!PPP   $LSTUC<< C(e2$ Iy!PPP   ($$  0   -7I%PPP  XXP  24    ݛIbid. ! <6X9`("Courier NewTT  Iy!PPP   E1` hp x (#XEXX,P  49  #PhXı#XXPTheauthorsoftheNIDIcasestudiesstatethatalthoughthefunctionalpopulationcategoriesusedfor   measuringresourceflowsarebasedonparagraph13.14oftheICPDProgrammeofAction,reportingofallocationsamongtheelementsofreproductivehealth,familyplanning,andoccasionallyHIV/AIDSpreventionactivitiesarenotconsistentacrosscountries.Thedifficultyofallocatingresourceflowsoftheshareddeliverysysteminfrastructurebetweenfamilyplanningandotherreproductivehealthserviceswasrecognizedinparagraph13.15oftheProgrammeofAction,whereacombineddeliverysystemproportionwasindicated.  Iy!PPP   ݛXXP  XXXXXXXX      XXXXXXXX        ?+ ` hp x X?  2  ڀI    XXXXXXXX  Ibid.,paragraphs3.43.9.   \  `*Times New RomanTTU i Iy!PPP   XXPE1` hp x (#XE  XXXXXXXX      XXXXXXXX        #XXhX  3  ڀFI    #XXX#XXXX#X  #XXXXPreliminaryProjectSummaryforNationalReportSummariesonCairo+5(NewYork,Centerfor   InternationalCooperation,NewYorkUniversity,1998).XXX#X DD  *Times New RomanTTLevel 1Level 2Level 3Level 4Level 5 C -7I%PPP  XXP  5    ݀MinistryofHealth,PopulationandHealthSectorStrategy(Dhaka,1997).  ?+ 4 <DL!X?  -7I%PPP  XXP  50    ݀UNAIDSandWHO,ReportontheGlobalHIV/AIDSEpidemic(Geneva,1998).  2xA`ArialTT     ' :/   -7I%PPP  XXP  29    ݀UNFPA,DonorSupportforContraceptiveCommodities1996(NewYork,UNFPA,1998). H (#$  0  B121, 2, 3,Numbers,  .,0 1, 2, 3,Level 1Level 2Level 3Level 4Level 5(27I$ Iy!PPP   XXP  0  H4heading 1heading 1&    8.` hp x (#8XXXW\  `*Times New RomanTTW          W\  `*Times New RomanTTW>4X` hp x (#>'  H4heading 2heading 2&    ;1` hp x (#;XXXW\  `*Times New RomanTTW        W\  `*Times New RomanTTW>4X` hp x (#>'   -7I%PPP  XXP  23    ݀Haberland,Miller,BruceandFassihian,opcit.  Ѐ@!0Level 1Level 1          H4Body TextBody Text  8.` hp x (#8XXXW\  `*Times New RomanTTW         W\  `*Times New RomanTTW>4X` hp x (#>ӫ\  `*Times New RomanTTC\  P6QP\  `*Times New RomanTTXXP\  P6QXP<6X9`("Courier NewTTTTXXx6X@DQX@ ?B.` hp x (#XB  XX,  42  ڀ#PXXR#XXPTheProgrammeofActionalludes,butdoesnotspecificallyrefer,tothe"civilsociety".Definitionsofthe W" term"civilsociety"arediverse.Forthepurposesofthispaper,civilsocietywillbeusedtorefertononstateinstitutions(e.g.,NGOs;communitygroups;professionalassociations;religiouscommunities;theprivate(forprofit)sector;labourandtradeunions;foundations;academicinstitutions;andwomen,menandyouthgroups)aswellasindividualmembersofsociety.Parliamentariansareuniqueinthattheyserveasbridgesbetweenthecivilsocietyandthegovernmentalapparatus.>$1footnote ref        d:annotation rannotation referenceW\  `*Times New RomanTTW        XXXW\  `*Times New RomanTTWZ:annotation tannotation text  W\  `*Times New RomanTTW        XXXW\  `*Times New RomanTTW  -7I%PPP  XXP  6    ݀UNFPA, ICPD:FourYearsLater,backgroundpaperpresentedattheExpertRoundTableMeeting  onEnsuringReproductiveRightsandImplementingSexualandReproductiveHealthProgrammes,includingWomensEmpowerment,MaleInvolvementandHumanRightsinKampala,2225June1998.T}:Document MapDocument Map  XXXC'%2A`ArialTTC        XXXW\  `*Times New RomanTTW  -7I%PPP  XXP  7    ݀K.Hardee,K.Agarwal,N.Luke,E.Wilson,M.Pendzich,andH.Cross,PostCairoReproductive  HealthPolicies:AComparativeStudyofEightCountries(NorthCarolina,TheFuturesGroup  International,1998).U d@$2footnote text  W\  `*Times New RomanTTW        XXXW\  `*Times New RomanTTWԫ\  `*Times New RomanTTC\  P6QP\  `*Times New RomanTTXXP\  P6QXP\  `*Times New RomanTT6\  P6QP%2A`ArialTTomanTTXXX2PQXPoo *Times New RomanTTXX.oo0oXohoX%2A`ArialTTomanTTJ2PQP<6X9`("Courier NewTTTTXXx6X@DQX@(hH  Z 6Times New Roman RegularLevel 1Level 2Level 3Level 4Level 59 Z6Times New Roman Regular  X   Iy!PPP   ݛ?+ ` hp x X?  XX,P  43  #PhX#XXPTheGlobalPopulationAssistanceReportisavailableontheInternetat -) Тhttp://www.nidi.nl/resflows.  Iy!PPP   ݛE1` hp x (#XEXX,P  44  #PXXĮ#ԀXXPAlthoughsuchloansareusuallycountedasexternalassistance,aportionofthemmustbepaidbackby , therecipientcountries,soalargefractionofthetotalloanscouldreallybecountedasdomesticallocations.̀3|xC\  `*Times New RomanTTC\  P6QP\  `*Times New RomanTTXXP\  P6QXP<6X9`("Courier NewTTTTXXx6X@DQX@%2A`ArialTTomanTTg2PQP\  `*Times New RomanTT,,)\  P6Q,P DD  *Times New RomanTToDD0DXDhD\  `*Times New RomanTT6\  P6QP<6X9`("Courier NewTTTTd6X@DQ@\  `*Times New RomanTT^\  P6QP2xA`ArialTTomanTTXXxP7XP\  `*Times New RomanTT&&J\  P6Q&P<6X9`("Courier NewTTTT&&n6X@DQ&@\  `*Times New RomanTT<\  P6QP(Jy$jjj  >$Large Circle0  (f3X$ Iy!PPP   Q#qe37=CIQYag1.a.i.(1)(a)(i)1)a) CCCCCCPCCCCEM% `>$"Small Circle"0  (;3$2qe  0  .3  0  Q'qe37=CIQYag1.a.i.(1)(a)(i)1)a)(f3X$ Iy!PPP   ($$   1  VV' dxdP Pd Lׄ"~O~O~O   NOTFORPUBLICATIONORQUOTATION T  /   Iy!PPP   E1` hp x (#XEXXPXXXX        45  I    PXXPP  ݀XXPODAisthefundingoriginatingfromdonorcountriesonly,notmultilateralorprivatesources.(f(3Ns$ Iy!PPP       0  <<E"Thin Top/Bottom dxd  Iy!PPP   E1` hp x (#XE  XXPXXXX      XXXXXXXX        46  (I    XXXXXXXX  ݀Thedataprovidedfor1997(andbelowfor1998)arepreliminaryandincomplete.TABLE BTable_ATABLE A@Sb"A<< C r Iy!PPP   E1` hp x (#XEXX,P  47  NGOexpenditures,fromtheirownincome,areaverysmallproportionofthetotalcomparedto  Governmentexpenditures.rC:\FLW\WORK\LOGO.BMP( $ Figure  1    -7I%PPP  XXP  4    ݀TheExpertRoundTableonEnsuringReproductiveRightsandImplementingReproductiveHealth  IncludingWomen'sEmpowerment,MaleInvolvementandHumanRightswasheldinKampalain2225June1998;theRoundTableonAdolescentSexualandReproductiveHealthwasheldinNewYorkinApril1998. r Iy!PPP   E1` hp x (#XEXXPXXXX        48  ڀI    PXXPP  XXPEstimatesofexpenditurepercapitawerecalculatedbysubregionandthenexpandedtoencompassthe Z  regions'entirepopulations. k Iy!PPP   XXP  15  Haberland,Miller,Bruce,Fassihian,UnutilizedCapacityandMissedOpportunitiesinFamily 6 PlanningServices(NewYork,PopulationCouncil,forthcoming). 0 B$B@CB@CB @CB$@CB(@CB,@CB0@CB4@CBCB @CB@CB@@CB*@CB @CB`@CB@@CB;@CBCB@CB0@CB@CBH@CB@CBp@CBd@CB@CBCB)\(?CBQ?CB)\(?CBffffff?CBffffff?CBQ@CBGz@CB)\(@CTable_AB  Iy!PPP   XXP  XXXXiXXXX        I    iXXXiXXXXiX  XXXXiXXXX        19  I    iXXXiXXXXiX  ݀"TheUnfinishedTransition,ThePopulationCouncilIssuesPapers(NewYork,ThePopulation  Council).\  `*Times New RomanTT { Iy!PPP   ݛXXP26Thisestimationwasmadefor19901995.UnitedNations,WorldPopulationMonitoring1996 # SelectedAspectsofReproductiveRightsandReproductiveHealth(NewYork,UnitedNations, |$ 1998).@Sbm I&mage <=8C HKKKK  Iy!PPP   B.` hp x (#XBXXPXXXX        51  ڀI    PXXPP  XXPUNFPA,GlobalPopulationAssistanceReport1996(NewYork,UNFPA,1998),p.20.#PXX#XXP'dxd 3 Iy!PPP   XXP  32  WHO/UNICEF,Revised1990EstimatesofMaternalMortality(WHO/FRH/MSM/96.11and   UNICEF/PLN/96.1)(Geneva,WHO,1996).FFF(@FF@FFF4@FF@FF(@FFF @FF2@F F B@F F $@TABLE AF v Iy!PPP   XXP  35  WHO,GlobalandRegionalEstimatesofIncidenceofMortalityDuetoUnsafeAbortionwitha  ListingofAvailableCountryData(WHO/RHT/MSM/97.16)(Geneva,WHO,1998).  JJ@J@J @J$@J(@J,@J0@J4@JJ`@Jh@J$@Jx@J@Jȟ@J@J@TABLE BJWPC') $D) $D* $D) $D 7}|___?___`````?\[ ?ZZ?Z?Z[[\\]^ ^ ?[YY Y ?X  X  X  X  X  X  W ? ?W  ?W  W  W ? C ?C  B ? ? ( ~?? `? p ? p ??? x ??? x ? | >? ~ |?  ~ |   x   x?   x   x?  ? x?   p   p  ? p     <?   |?    ?  ?  ? ?  ? ?    ? ? ??? ? ?  ?  ?  ?  ?|??  p?p?   ?    ???    ??   ? ?   ? >  >  > ?? >?  ?  ?? ? ?  < ? ?? ?  ?    < ??  <   |              ?  ?  ???    ?~  ?`         8? ?  x ?  | ?   ~ ??    ??  ? ?|>? ??   ~    >> ?   >? ?   ? ?  ?  ?π  ?  ?  ~ ? ?  ~     ?     ?  p    p   ?                                 ?     ?    8? ?     x? ?    ?`     ??   |  ?? ? ~  ?? ?? ~  ?? ?? ~  ? ??   ? ? ?  ? ?< ?  ? `?8 ?  x? ?x ? <? p  ?   ~ |  | |   >   >    8   |  ?>  ?>  ??~  ????~  ??~ ??~ ? ??  ? ??? ???? ???? ??? ?? ? >~? ?<ǀ? ? q>? ?  ~??  ??  ????  ? >?  ???  ???  ??  ???  ??  ??  ??  x??  00?? ? 0<?>? ? 8x?  <p?  >??  ??  ?q?  ??  0??  x??8?  ? ??8? ? ? 8?   x?   x?  ?x? ? x? ? ? ?????? ???? >V ~V V V ??W W ???X ??X X X ??X Y \?\\]]?]?]^ ^ ^ ^__??_```b|-  Iy!PPP   ݛXXPE1` hp x (#XE  XXXXtXXXX        I    tXXXtXXXXtX  XXXXtXXXX        41  I    tXXXtXXXXtX  ݀UNAIDS,ImpactofHIVandSexualHealthEducationontheSexualBehaviourofYoungPeople:  AReviewUpdate(UNAIDS/97.4)(Geneva,UNAIDS,1997).\  `*Times New RomanTTwA:\FNUAP.TIF  -7I%PPP  XXP  8    ݀M.Xaba,S.Fonn,K.Tint,D.Conco,andS.Varkey,TransformationofReproductiveHealth  ServicesProject,SouthAfrica:ACollaborationBetweentheWomensHealthProjectandThreeProvincialDepartmentsofHealthandWelfare,editeddraft,1998.  WPCXX9X %X}J???     ? ?  ? ? ? ?       ? ? ? ?      ????                  @       ?  ?  ?                   ?  ?  ?         ?  ?@ ` ` ` ` `pppppxxx?xxxx x |~ |~ ?|| || || ~| ?~|  ~|  ~|  ~|  |  |  |  |  |  ?|  ?                                                               ?  ?  ?                ?  ?  ?    ?            ? ?           ? ? ??   !$!$!%J@ LX"PPP   ݀NOTFORPUBLICATIONORQUOTATION  -7I%PPP  XXP  9    ݀TheWorkingGrouponReproductiveHealthandFamilyPlanning,AccountabilityMechanisms: ! MarkingProgressintheImplementationofICPD,NationallevelPolicyReforminBrazil:thePaismeExperience(NewYork,1997). #  _ -7I%PPP  XXP  21    ݀UnitedNations,WorldPopulationMonitoring.SelectedAspectsofReproductiveRightsand  ReproductiveHealth(NewYork,UnitedNations,1998).   \ -7I%PPP  XXP  22    ݀UNFPA,TheStateoftheWorldPopulation1997TheRighttoChoose:ReproductiveRightsand  ReproductiveHealth(NewYork,UNFPA,1997).   -7I%PPP  XXP  10    ݀Hardeeetal.,opcit. v%  -7I%PPP  XXP  11    ݀Ibid. j'  1 -7I%PPP  XXP  12    ݀Z.U.Gill, ICPD1994,RHAgenda:ExperienceofTurningDreamintoRealityinBangladesh, ^) unpublishedpaper,1997. S -7I%PPP  XXP  13    ݀F.MehrotraandE.Singh,AssessmentofGenderMainstreaminginUNFPAProgrammesand L, Projects:TheIndiaCountryprogramme(1997). F-   :/   -7I%PPP  XXP  14    ݀EconomicandSocialCommissionforAsiaandthePacific,ReportandKeyFutureActionsRequired H toAchievetheGoalsoftheICPDPOAandBaliDeclaration(Bangkok,ESCAP,1998). B  P -7I%PPP  XXP  16    ݀FamilyHealthDivision,DepartmentofHealthServices,MinistryofHealth,NationalReproductive $  HealthStrategy(Nepal,1998).    x -7I%PPP  XXP  17    ݀R.Cardich,J.Helzner,M.Marques,J.SchuttAine,V.Ward,andT.Williams, EstudiodeCalidad   desdelaPerspectivadeGnero,draft,unpublished,1998.     -7I%PPP  XXP  18    ݀UNFPA, EnsuringReproductiveRightsandImplementingSexualandReproductiveHealth  ProgrammesincludingWomensEmpowerment,MaleInvolvementandHumanRights,reportoftheExpertRoundTableMeetinginKampala,2225June,1998. y -7I%PPP  XXP  20    ݀UNFPA, ReproductiveHealthandRightsofRefugees,backgroundpaperpreparedfortheTechnical  ConsultationonReproductiveHealthofRefugeesheldinRennes,France,35November1998. -7I%PPP  XXP  26    ݛUnitedNations,WorldPopulationMonitoring. j'  N -7I%PPP  XXP  27    ݀Notesfromthe2nd,3rdand4thAnnualMeetingonEmergencyContraception,organizedbythe ^) ConsortiumonEmergencyContraception,1996,1997and1998. 8 -7I%PPP  XXP  28    ݀ FDATellsTwoResearcherstoStopDistributionofDrugforSterilizationTheWallStreetJournal, L, October19,1998.  -7I%PPP  XXP  30    ݀DKTInternational,1997ContraceptiveSocialMarketingStatistics(Washington,1998). <  } -7I%PPP  XXP  31    ݀Ch.Westoff,A,Sharmanov,andJ.Sullivan,J.,TheReplacementofAbortionbyContraceptionin 0 ThreeCentralAsianRepublics(Princeton,PopulationResourceCenter,1997). *  b -7I%PPP  XXP  33    ݀InterAgencyGroupforSafeMotherhood, SafeMotherhoodintheNewMillenium:TheAction   Agenda,reportontheSafeMotherhoodTechnicalConsultation,Draft,1998. -7I%PPP  XXP  34    ݀Ibid.   -7I%PPP  XXP  36    ݀Ch.Westoff,A.Sharmanov,andJ.Sullivan,J.,opcit.    -7I%PPP  XXP  37    ݀V.Ghetau,MaternalMortalityandAbortioninRomania19901997,(Bucharest,UNFPA,1998).   -7I%PPP  XXP  38    ݀IPAS,Personalcommunication,1998.   ) -7I%PPP  XXP  39    ݀UnitedNations,WorldPopulationEstimatesandProjections,1998Revision(NewYork,United  Nations,1998). -7I%PPP  XXP  40    ݀UNAIDS,AIDSEpidemicUpdate:1998,(Geneva,UNAIDS,1998).  <<<<'dxd Iy!PPP     APPAXXAP_aUEAj| ` E7 @E...#XXXAXq##PXXĐ#APPAXXAPsku?/+b|1 `@E| 1 Fs#XXXAXĀ##PXXğ#kxZ5%!h pm `E<dttyk (#(#APP',4XX'88 "  UnitedNations FondsdesNationsUnies  [ " PopulationFund pourlapopulation  $  (#(##PAP#LP@) 򀀈 w    #PLB#H~PAFiveYearReviewofProgresstowardstheImplementation   oftheProgrammeofActionoftheInternationalConferenceonPopulationandDevelopment#PH~# {    LPAbackgroundpaperpreparedby#PL#Ԁ e  LP#PL_#  PtheUnitedNationsPopulationFund(UNFPA) #P  # # s LPfor#PL'# %"u!    PTheHagueForum #E# TheHague,Netherlands812February1999#P  #  '"& C RQ qe'#MQCCC̜CiWZ3#h 0 `E+<dtt$+yiߛCC̛̛̛̛CCCC̛̛CLPԛ@* CCCCCC   Ӝ7Pdd7ћ0XpX,4X0 +'* ЇXXLNote: G Inthetextofthispaper,thedesignations"developed"and"developing"countriesand"moredeveloped"and"lessdeveloped"countriesandregionsareintendedforconvenienceanddonotnecessarilyexpressajudgementaboutthestagereachedbyaparticularcountryorareainthedevelopmentprocess.  ##  TABLEOFCONTENTS   d!d!F(#Pages LISTOFTABLES""J(#. v  LISTOFACRONYMSANDABBREVIATIONS""I(#.,vi   EXECUTIVESUMMARY""J(#.q q 1 z   CHAPTER̀I.  INTRODUCTION""J(#.0 0 3 b     Background  V   GlobalPopulationandDemographicSituation  RegionalPopulationandDemographicSituation II.  CREATINGANENABLINGENVIRONMENT""J(#./9  >   FormulatingorRevisingNationalPopulationandDevelopmentPolicies  EstablishingInstitutionalMechanisms  StrengtheningInformation,EducationandCommunicationProgrammes  ImplementingRegionalInitiativestoPromotePopulationandDevelopment  Constraints  FurtherActionRequired &  ԀIII.  GENDEREQUALITY,EQUITYANDEMPOWERMENTOFWOMEN`"`"I(#.?22  X    IncorporatingaGenderPerspective  ChangingtheEnvironment  StrengtheningInstitutions  AdvocatingaRightsbasedApproach  ProtectingtheGirlChild  EmphasizingMaleResponsibilityandPartnership  Constraints  FurtherActionRequired'    *&' IV.  REPRODUCTIVEHEALTH,INCLUDINGFAMILYPLANNINGAND  0  SEXUALHEALTH,ANDREPRODUCTIVERIGHTS#`"`"I(#.5(#(##32     DevelopingReproductiveHealthPoliciesafterCairo  ImplementingQualitySexualandReproductiveHealthProgrammes  IncreasingAccesstoReproductiveHealthServices  AddressingComponentsofReproductiveHealth  FurtherActionRequired V.  BUILDINGPARTNERSHIPS`"`"I(#.$53 z      ForgingPartnershipswiththeNonGovernmentalSector   n    CreatinganEnablingEnvironmentforPartnershipinPolicyFormulationand   ` ProgrammeImplementationandMonitoring  StrengtheningtheHumanResourceandInstitutionalCapacity   ` ofCivilSocietyforEffectivePartnership  PromotingPartnershipswiththePrivateSector  RecognizingtheUniqueRoleofParliamentarians  StrengtheningCollaborationamongUnitedNationsandIntergovernmentalOrganizations  Constraints  FurtherActionRequired   8  VI.  MOBILIZATIONOFREQUIREDRESOURCESFOR ,|   IMPLEMENTINGTHEICPDPROGRAMMEOFACTION`"`"I(#.**867 &v      TheCostedICPDReproductiveHealthandPopulationPackage:DonorResponse  TheCostedICPDReproductiveHealthandPopulationPackage:DevelopingCountries  TheRoleofthePrivateSectorC  CTheRoleofNon-GovernmentalOrganizationsandPrivateFoundationsC  CSectorInvestmentProgrammesandSector-WideApproachesC  CResourcesfortheBroaderICPDGoalsC  CRecentAdvancesinDevelopmentPartnershipsC  CConstraintsC  CFurtherActionRequiredCTheCostedICPDReproductiveHealthandPopulationPackage:   ` DonorResponse   %4!"   TheCostedICPDReproductiveHealthandPopulationPackage:   ` DevelopingCountryResponse   '(#$   NationalversusInternationalFlows  PrivateSector  PrivateFoundationsandNonGovernmentalOrganizations  SectorInvestmentProgrammesandSectorWideApproachesCC  ResourcesfortheNonPackageICPDGoals  Constraints  FurtherActionRequiredC SELECTEDREFERENCES`"`"I(#.79@(#(#K(# &."#  ENDNOTES`"`"I(#." " 80  '(#$ &   LISTOFTABLES   Table3.10 ` Parliamentaryseatsheldbywomen,1January1997#`"`"I(#.E` (#` (##27  Table6.1 ` TrendsinTotalExternalPopulationAssistance,19901997`"`"I(#.M @   @x 68  Table6.2 ` Officialdevelopmentassistance(ODA)ofdonorcountries,19901997`"`"I(#.UUW68   '  z   LISTOFACRONYMSANDABBREVIATIONS̜CC ACC   ` UnitedNationsAdministrativeCommitteeonCoordination  МAHD   ` AdolescentsHealthandDevelopmentProgramme  AIDS   ` Acquiredimmunodeficiencysyndrome p   МAVSC   ` AssociationforVoluntarySafeContraception  МBSSA   ` BasicSocialServicesforAll   МCEDAW ` ConventionontheEliminationofAllFormsofDiscriminationagainstWomen   МCELADE ` LatinAmericanDemographicCentre   МCIS   ` CommonwealthofIndependentStates   COPE ` ClientOriented,ProviderEfficientservices z   МDESA   ` DepartmentforEconomicandSocialAffairs,UnitedNations t  МDHS   ` DemographicandHealthSurvey n  МECA   ` EconomicCommissionforAfrica h  МECE   ` EconomicCommissionforEurope b  МECLAC ` EconomicCommissionforLatinAmericaandtheCaribbean \  МESCAP ` EconomicandSocialCommissionforAsiaandthePacific V МESCWA ` EconomicandSocialCommissionforWesternAsia P МFGM   ` FemalegenitalmutilationUKUS., J GNP   ` Grossnationalproduct D HIV   ` Humanimmunodeficiencyvirus > ICPD   ` InternationalConferenceonPopulationandDevelopment 8 IDA   ` InternationalDevelopmentAssociation 2 IDB   ` InterAmericanDevelopmentBank ,| IEC   ` Information,educationandcommunication &v ILO   ` InternationalLabourOrganization  p IOM   ` US.,UK.,-(InternationalOrganizationforMigrationUKUS., j IPPF   ` InternationalPlannedParenthoodFederation d MCH/FP ` Maternalandchildhealth/familyplanning p    ^ NGO   ` Nongovernmentalorganization  X RTI   ` Reproductivetractinfection !R US.,UK.,*SIP   ` SectorInvestmentProgrammeUKUS., !L STD   ` Sexuallytransmitteddisease "F STI   ` Sexuallytransmittedinfection #@  SWAP ` US.,UK.,,SectorWideApproach $: ! UKUS.,TFR   ` Totalfertilityrate %4!" UNAIDS ` US.,UK.,-JointUnitedNationsProgrammeonHIV/AIDSUKUS., &."# UNDP   ` UnitedNationsDevelopmentProgramme '(#$ UNFPA ` UnitedNationsPopulationFund ("$% UNHCR ` US.,UK.,.UnitedNationsHighCommissionerforRefugees )%& UNICEF ` UnitedNationsChildren'sFund p  *&' WHO   ` WorldHealthOrganization  +'( (sQ@" EXECUTIVESUMMARY   2qe  1  .3  ԀThisreporthasbeenpreparedbytheUnitedNationsPopulationFund(UNFPA)asabackgrounddocumentfortheHagueForum,tobeheldinTheHague,theNetherlands,812February1999.TheForumwillexaminetheprogressmadeandtheconstraintsencounteredduringthefirst45yearsoftheongoingimplementationofthe20yearProgrammeofActionoftheInternationalConferenceonPopulationandDevelopment(ICPD)heldinCairo,Egypt,in1994.Adoptedby179countries,theICPDProgrammeofActionunderscorestheintegralandmutuallyreinforcinglinkagesbetweenpopulationanddevelopmentandendorsesanewrightsbasedstrategywhichfocusesonmeetingtheneedsofindividualwomenandmenratherthanonachievingdemographictargets.N1` hp x (#XpXNSincetheICPD,severalextensivereviewshavebeenmadeofthefirstphaseoftheimplementationofitsrecommendations.Thisreportreflectsthefindingsofthoseefforts,whichincludeaseriesofroundtableandtechnicalmeetingsorganizedbyUNFPAduring1998;consultationsorganizedbyUnitedNationsregionalcommissions;andaglobalinquiryconductedbyUNFPAinmid1998,inwhichinformationwascollectedfrom114developingcountriesandcountrieswitheconomiesintransitionthroughUNFPAFieldOfficesandtowhich18donorcountriesalsoresponded.K1` hp x (#XK2qe  2  .3  ԀK1` hp x (#XKӀConsiderableprogresshasbeenmadeinimplementingkeyareasoftheICPDProgrammeofAction,throughpolicyreformulation,programmeredesign,increasedpartnershipandcollaboration,andincreasedresourceallocation.Inparticular,therehasbeenencouragingprogresssince1994inpromotingreproductiverightsandimplementingreproductivehealthasdefinedbytheProgrammeofAction.Asofmid1998,manycountrieshadmadepolicy,legislativeand/orinstitutionalchangesintheareaofreproductivehealthand/orrightssincetheICPD.Severalcountriesaretestingwaystointegratevariousreproductivehealthservices,andothersareexploringothermeanstoensurerightsbasedapproaches.H.` hp x (#XH2qe  3  .3  E1` hp x (#XEӀSectorwideprogressinpolicyformulationisoccurringinseveralcountries,whileworkonimprovingspecificaspectsofpolicieshasbeguninothers.TheUNFPAFieldOfficesreportedthat41countrieshadmadepolicy/legislativechangesinreproductivehealthaftertheICPD.CriticalmeasuresundertakenbycountriesmoreadvancedintheimplementationoftheICPDagendahaveprovidedtherighttohavefreeandeasilyaccessiblereproductivehealthservicesasanoverallhealthcomponent,throughoutthelifecycle,includingthevoluntarychoiceoffamilyplanningmethods.2qe  4  .3  K1` hp x (#XKӀAsoneofitskeyprinciples,theICPDProgrammeofActionemphasizesthatadvancinggenderequality,equityandempowermentofwomen,eliminatingallkindsofviolenceagainstwomen,andensuringwomen'sabilitytocontroltheirownfertilityarecornerstonesofpopulationanddevelopmentrelatedprogrammesandarecentraltothenotionofsustainabledevelopment.TheProgrammeofActionsetsoutasanimportantobjectivetoencourageandenablementotakeresponsibilityfortheirsexualandreproductivebehaviourandtheirsocialandfamilyroles.Theseaimsareimportantconditionsforbuildingasustainable,justanddevelopedsociety.H.` hp x (#XH  *'( (sQ  C(sQ   CC(sQ  CHHC/V2qe  5  .3  ԀTheincorporationofagenderperspectiveinpopulationanddevelopmentprogrammeshasfacedconsiderableconstraints.Foremostamongthesehasbeenthedifficultyassociatedwithoperationalizingconceptsrelatedtogenderequality,equityandempowermentofwomeninvarioussocial,culturalandpoliticalcontexts.Thisconstrainthasslowedtheintegrationoftheseconcernsinanumberofimportantplanningandprogrammingprocessesbecauseoftheabsenceofaconsensusonwhattheymean.Thisproblemiscloselylinked,inmanycountries,totheabsenceofdataorresearchstudiesthatwouldhelpinestablishingclearoperationaldefinitionsoftheseconcepts.Mostavailabledataarebasedonquantitativemethodologiesandstatisticalanalysesofonlyafewvariables.Eveninthosecountrieswhereconceptualissueshavebeenresolved,actionplanshavenotalwaysbeenaccompaniedbythenecessaryresourceallocations,constrainingtheextenttowhichsuchplanscanbeeffectivelyimplemented.̀B.` hp x (#XB2qe  6  .3  ԀTheProgrammeofActioncallsforthepromotionofaneffectivepartnershipbetweenalllevelsofGovernmentandthefullrangeofnongovernmentalorganizations(NGOs)andlocalcommunitygroupsinthedesign,implementation,coordination,monitoringandevaluationofpopulationpoliciesandprogrammes.FouryearsafterCairo,changingdevelopmentparadigmsarecontinuingtoshifttherolesofGovernment,civilsocietyandtheinternationalcommunity.PartnershiphasemergedasabasicelementtosupportandadvancetheProgrammeofActionimplementationprocess.IthasbecomeincreasinglyapparentthatGovernmentsalonecannotmanagetoprovidethedevelopmentservicestomeetthebasichumanandsocialneedsandaspirationsoftheircitizens.NGOsweregenuinepartnersinframingtheProgrammeofActionagreementsandarenowpartnersinitsimplementation.Effectiveandempoweredwomen'smovementsandothermassmovementsareprovingtobeimportantinensuringprogressinpolicydevelopmentandimplementationinmanypartsoftheworld.B.` hp x (#XB2qe  7  .3  ?+` ` @ hp x (#X?ӀAreviewofprogressoverthelastfewyearsonthescopeofcollaborativeeffortswiththecivilsocietyprovidesabasisforoptimism.Majorstrideshavebeentakeninproceduralareas,suchaspositivechangesintheconceptofparticipationandtheprocessesforconsultation;recognitionofthechangingrolesofcivilsociety;increasingacceptanceofinnovativedevelopmentapproaches,includingdecentralizedandcommunitybasedmodalities;andimprovedpartnershipamongUnitedNationsorganizationsandbodies.Similarly,thecontextforsubstantivediscourseandactionbyallpartieshasalsochanged,withincreasingawarenessofthesocietaldimensionsofdevelopmentandeconomicissues;growingrecognitionofthenecessityforahumanrightsbasedapproach;expandingacceptanceofreproductiveandsexualhealthconceptsandprogrammes;anddeepeningawarenessandrecognitionoftheneedforgenderequalityandtheempowermentofwomen.H.` ` | hp x (#` ` @ XH2qe  8  .3  ԀAlloftheregionalconsultationsandtechnicalmeetingsheldaspartoftheICPD+5processunderscored,however,thatiftheICPDgoalsaretobeachieved,effortstomeetthefundinglevelsspecifiedintheProgrammeofActionwillhavetobeintensified.ManycountrieshavemadeimpressiveprogressinrealigningdomesticbudgetstoaddressICPDgoalsforimprovingtheaccessibilityandqualityofreproductivehealthprogrammes,reducingmortalityandincreasingattentiontorelatedsocialsectors.However,financialcrisesareaffectingtheabilityofmanycountries,andespeciallydevelopingcountriesandcountrieswitheconomiesintransition,tomaintaintheinitialmomentumtowardsachievingthesegoals.Donorcountriesarestronglyencouragedtoredoubletheireffortstoreachthe$5.7billiontargetforinternationalassistancebytheyear2000aswasagreedtoatCairo. F-)+ K.` hp x (#` ` | XK    ChapterI.INTRODUCTION H   Background S  6    PurposeandFramework  * Ѐ $  &  2qe  9  .3  E1` hp x (#XEӀThisreportwaspreparedbytheUnitedNationsPopulationFund(UNFPA)asabackgrounddocumentfortheHagueForum,tobeheldinTheHague,theNetherlands,from8to12February1999.TheForumwillassesstheprogressmadeandconstraintsencounteredintheimplementationoftheProgrammeofActionoftheInternationalConferenceonPopulationandDevelopment(ICPD),heldinCairo,Egypt,in1994.AreportontheoutcomeoftheForumwillbesenttotheMarch1999sessionoftheCommissiononPopulationandDevelopmentandwillbetakenintoaccountinthepreparationoftheReportoftheSecretaryGeneraltotheUnitedNationsGeneralAssemblySpecialSessionontheImplementationoftheICPDProgrammeofAction,tobeheldfrom30Junethrough2July1999.' !TH.` hp x (#XH2qe   10  .3  E1` hp x (#XEӀThisreporttakesintoaccountthefindingsofaseriesofextensivereviews,including:N4d` hp x (#XNP  PFY"0 d   0d(#d(#0(#(#  d   AseriesofroundtableandtechnicalmeetingsorganizedbyUNFPAduring1998;PFYaY݌(#(# Ќ  P  PmZ"0 d   0d(#d(#0(#(#  d   ConsultationsorganizedbytheUnitedNationsregionalcommissions;PmZZ݌(#(# Ќ  P  P["0 d   0d(#d(#AglobalfieldinquiryconductedbyUNFPAinmid1998inwhichinformationwascollectedfrom | 114developingcountriesandcountrieswitheconomiesintransitionthroughUNFPAFieldOffices,andtowhich18donorcountriesalsoresponded;P[[݌ (#(# Ќ  ̛P  P&]"0 d   0d(#d(#ProgressreportsontheimplementationoftheICPDProgrammeofActionfromUNspecialized d agenciesandotherUNorganizations;and,P&]A]݌ (#(# Ќ  P  P[^"0 d   0d(#d(#Reviews,includingcasestudies,conductedbyinternationalorganizations,nongovernmental R organizationsandacademicinstitutions.P[^v^݌ (#(# Ќ  2qe   11  .3  N1` hp x (#dXNӀTheICPDProgrammeofAction,adoptedby179countries,underscorestheintegralandmutuallyreinforcinglinkagesbetweenpopulationanddevelopmentandendorsesanewrightsbasedstrategyfocusedonmeetingtheneedsofindividualwomenandmenratherthanonachievingdemographictargets.  $  1       |$4!" TheICPDProgrammeofActionsetsoutanumberoftimeboundpopulationanddevelopmentgoalsfora20yearperiod,from1995to2015,including:theprovisionofuniversalaccesstoreproductivehealthservices,includingfamilyplanningandsexualhealth;areductionininfant,childandmaternalmortality;andtheprovisionofuniversalaccesstoeducation,especiallyforgirls.Itstressestheempowermentofwomenbothasahighlyimportantendinitselfandasakeytoimprovingthequalityoflifeforeveryone.H.` hp x (#XH̜  R+ ()   OrganizationofReport d H 2qe   12  .3  E1` hp x (#XEӀFollowingtheoverviewofthemajorthemespresentedintheICPDProgrammeofActionandconsiderationofthepopulationsituationcontainedinthischapter,ChapterIIdiscussespolicyinitiativestakenbycountriessince1994towardscreatinganenablingenvironmentfortheimplementationoftheProgrammeofAction.ChapterIIIfocusesonreproductivehealth,includingfamilyplanningandsexualhealth,andreproductiverights.ChapterIVdiscussesprogressintheareaofgenderequality,equityandtheempowermentofwomen.ChapterVexaminespartnershipsbetweenGovernmentsandcivilsocietyandamongUnitedNationsorganizations.ChapterVIexaminesissuespertainingtotheresourcesrequiredtoimplementfullytheICPDProgrammeofAction,includingfinancialresourceflowsinbothdevelopinganddonorcountries.EachchapteranalysesprogressmadeinachievingthegoalsandobjectivesoftheICPDProgrammeofActionaswellastheconstraintsandchallengesinpopulationanddevelopment.ThechaptersconcludewithfurtheractionsrequiredtoaccelerateprogressinimplementingtheICPDProgrammeofAction.H.` hp x (#XH &     GlobalPopulationandDemographicSituation i     2qe   13  .3  E1` hp x (#XEӀIn1960,theworld'spopulationstoodat3billionandthegrowthratewas2percent;in1980,thepopulationwas4.4billionandthegrowthratewas1.7percent.Worldpopulationtodaystandsat5.9billionandisgrowingat1.33percentannually.Favourabledemographictrendsgiverisetothehopeofaneventualstabilizationofglobalpopulationataleveltheearthcansupport.However,thedemographicmomentumwillcontinuetoleadtolargegrowthinnumbersforatleastthenexttwodecades.AccordingtoUnitedNationsglobalpopulationanddemographicestimatesandprojections,theworld'spopulationwillexceed6billionforthefirsttimein1999.Ofthistotal,some80percentwillbelivingindevelopingcountries.Globalpopulationisexpectedtoreachsomewherebetween7.0and7.5billionbytheyear2015andwillcontinuetogrowuntilatleastthemiddleofthenextcentury.Althoughtherateofpopulationgrowthhasdeclined,worldpopulationiscurrentlyincreasingbysome78millionpersonsayear,comparedwith63millionayearin1960,becauseofthelegacyofhighfertilitylevelsintherecentpast.Approximately97percentoftheincreaseinworldpopulationisoccurringintheleastdevelopedregions,whicharegrowingat2.6percentannually,andthelessdevelopedregions,whicharegrowingatarateof1.7percentannually.Themoredevelopedcountriesareincreasingbyonly0.3percentannually,andinsomeofthemoredevelopedcountriespopulationisdeclining.'iH.` hp x (#XH2qe   14  .3  E1` hp x (#XEӀTheavailableevidencesuggeststhatreductionsininfantandchildmortalityhavecontinuedinthe1990sbroadlyconsistentwiththegoalsoftheICPD.Averagelifeexpectancyatbirthisprojectedtoriseby2yearsbetween19901995and19952000,thatis,from64yearsto66years.However,theoverallfiguresconcealwidedisparitiesbetweenregionsandcountries.Forexample,theaveragelifeexpectancyatbirthin19952000is74.5inthemoredevelopedcountries,63.6inthelessdevelopedcountriesandjust52intheleastdevelopedcountries(LDCs).Moreover,atthecountrylevel,itisestimatedthatlifeexpectancyhasdeclinedinpartsofsubSaharanAfrica,wheretheimpactofthehumanimmunodeficiencyvirus/acquiredimmunodeficiencysyndrome(HIV/AIDS)pandemichassignificantlyaffectedmortalityrates, andamongafewofthecountrieswitheconomiesintransition.Averagelifeexpectancyatbirthrangesfrom L,)* 70.6formenand78.4forwomeninthemoredevelopedregionsto50.9yearsformenand53.0yearsforwomenintheleastdevelopedcountries(LDCs). 2qe  15  .3  ԀOverallimprovementsinmortality,coupledwithadvancesineducationalattainmentandincreasedimplementationoftherighttoreproductivechoice,haveresultedinwomenmarryingatalaterageandbearingsignificantlyfewerchildrenthaninthepast.Globally,womenarenowhavinganaverageof2.8children,comparedwith3.0fiveyearsearlier.However,aswithmortality,theoverallfiguresconcealwidedisparitiesbetweenregionsandcountries.Forexample,theaveragenumberoflivebirthsperwomanin19952000is1.6childreninthemoredevelopedcountries,3.1inthelessdevelopedcountriesand5.3intheleastdevelopedcountries(LDCs).H.` hp x (#XHE1` hp x (#XE2qe  16  .3  ԀTheagestructureoftheworldspopulationischangingrapidly,particularlyinthedevelopingcountries.Ascountriescontinuetoreducetheirbirthrates,therelativeshareofchildrendecreasesandthepopulationofworkingageincreases.Increasesintheproportionofpersonsofworkingageprovideanexcellentopportunityforcountrieswhotakeadvantageofittoincreasesavingandinvestmentinproductiveassets,aswellastomakegreaterhumancapitalinvestmentsineducationandhealth.Whiletheproportionofchildrenisdeclining,thenumbersandproportionsofyoungpersonsaregrowing.Todaysgenerationofyoungpeoplebetweentheagesof15and24isthelargestever,numberingmorethan1billion.H.` hp x (#XHE1` hp x (#XEUKUS.,2qe  17  .3  ԀOverthepasttwodecadesorso,inallbuttheleastdevelopedcountries(LDCs),thegrowthrateforthepopulationaged60andoverhasbeenincreasingat,orfasterthan,thegrowthrateforthetotalpopulation.Worldwide,thegrowthrateforthoseaged60andoverisdoubletheoverallrate.Evenmorenoteworthy,however,istherateofgrowthinthepopulationaged80yearsandover.Ratesfortheseagesworldwideexceed3percent,reflectingincreasedlifeexpectancyfortheoldestages.USUK.,ԀInmuchofEurope,NorthernAmericaandJapan,theproportionofolderpeopleisincreasingmorerapidlythananyotheragegroup.H.` hp x (#XH2qe  18  .3  E1` hp x (#XEӀPopulationageingisthusbecomingafeatureofpopulationsworldwideasfertilityratesdeclineandlifeexpectancyincreases.Thistrendevidenced,atfirst,inreducedproportionsofchildrenandenlargedgroupsofadultsofworkingageisrapidlyextendingitsimpactbeyondthecountriesofestablishedlowfertility.Bytheyear2015,itwillresultinabout13percentoftheworldspopulationbeingaged60andover.Amajorfeatureistheincreasedspeedwithwhichthisageingwilloccurindevelopingcountriescomparedwiththeearlierexperienceofmoredevelopedcountries.Developingcountrieswhichcurrentlyaccountfor80percentoftheworldspopulationoverallalreadyhavemorethan60percentofpersons60yearsorolder.By2015,thisshareisexpectedtoincreasetoalmost70percentofolderpersons.Becauseofhighermalemortalityrates,femalespredominateatolderages,andthediscrepancybetweenthesexesbecomesgreaterwithadvancingage.Thistrendwillresultinalargeproportionofolderwomenspendingmanyyearswithoutpartners.2qe  19  .3  ԀThereremainsasubstantialgapinthedataandresearchontheconditionsamongolderpersons,andtherelationshipsbetweenshiftsinagestructureandcurrentandfuturesocialandeconomicdevelopmentissues.Thesedataandresearchprovidethebasisforpoliciesandprogrammesaddressingtheparticularneedsoftheelderly,includingtheeconomicandsocialsecurityoftheelderly,especiallyofolderwomenandthefrail;affordable,accessibleandappropriatehealthcareservices;increasedrecognitionofthe F-)+ productiveandusefulrolestheelderlycanplay;andsupportsystemstoenhancetheabilityoffamiliestocarefortheirolderfamilymembers.̀K1` hp x (#XK2qe  20  .3  ԀContinuinghighlevelsofinternalmigrationandurbanizationarekeyissuesinsocioeconomicdevelopment.Theunprecedentedmovementofpeoplewithinthebordersoftheirowncountriesisoneofthegreatesttransformationswitnessedinthetwentiethcentury.Therecontinuetobelargemovementsofpeoplefromruraltourbanareasinmostdevelopingcountries,withdramaticratesofurbanization,whichhaveledtothecreationofagrowingnumberofmegacitiesthathaveinmanycasesoverwhelmedthesocialandenvironmentalresourcesandspawnedhugeperiurbanslums.Manydevelopingcountrycitiesaregrowingfarfasterthaneconomicopportunitiesarebeinggenerated.Thehighratesatwhichmovementstourbancentresaretakingplaceareoftenduetotheunsustainablegrowthofruralpopulations.H.` hp x (#XH2qe  21  .3  E1` hp x (#XEӀTheinternationalflowofpeoplebetweencountriesisacomplexresultofeconomic,politicalandculturalinterrelationsandforces.Suchmovementsofpeopleaffect,andareaffectedby,thedevelopmentalprocessestakingplaceinboththesendingandthedestinationcountries.Internationaleconomicimbalancescombinedwiththeabsenceofpeaceandsecurity,includinggrosshumanrightsviolations,exacerbatedbytheeffectsofwidespreadpovertyandenvironmentaldegradationhaveledtorisingnumbersofinternationalmigrants.H.` hp x (#XH2qe  22  .3  E1` hp x (#XEӀSincetheICPD,theneedtoaddresstheproblems,issuesandchallengesraisedbyvariousformsofinternationalmigrationhavepromptedGovernmentstoincreasecooperationatbilateral,subregionalandregionallevels.Someoftheinitiativesundertakenarebeginningtoshowresults.Atthemultilaterallevel,twoprocessesmeritmention:thatinitiatedbythe1996RegionalConferencetoAddresstheProblemsofRefugees,DisplacedPersons,OtherFormsofInvoluntaryDisplacementandReturneesintheCountriesoftheCommonwealthofIndependentStatesandNeighbouringStates(anditsresultingProgrammeofAction);andthePueblaProcess,whichbeganin1996andwhichentailsconsultationbetweenthecountriesofNorthernandCentralAmerica.Inaddition,theinternationalcommunityhascontinuedtoconsidertheinterrelationsbetweeninternationalmigrationanddevelopment.TheTechnicalSymposiumonInternationalMigrationandDevelopment,heldinTheHaguein1998,undertheauspicesoftheUnitedNationsAdministrativeCommitteeonCoordination(ACC)TaskForceonBasicSocialServicesforAll(BSSA),servedasaforumtodiscussthemanywaysinwhichinternationalmigrationinteractswithdevelopmentissuesandtoassesstheeffectivenessofpoliciesinthatregard.H.` hp x (#XH&  B.` hp x (#XB m   RegionalPopulationandDemographicSituation _ xm |$4!"   E1` hp x (#XE2qe  23  .3  ԀAfricahasapopulationofalmost780millionandatotalfertilityrate(TFR)ofjustover5.3comparedwith282millionin1960andaTFRof6.7.Withanaverageannualgrowthrateof2.6per'#cent,theregioniscurrentlygrowingby17millionayearandisexpectedtoincreasetojustover1.5billionbytheyear2025.Infantmortalityis86per1,000livebirths,andoveralllifeexpectancyis52.3yearsformalesand55.3yearsforfemales.However,regionalfiguresmaskgreatvariationsamongindividualcountries.NotwithstandingtheirachievementsintheareaofpopulationanddevelopmentinrecentyearsprimarilybecauseanincreasednumberofcountriesinAfricahaveformulatedpopulationpoliciesandbecausecollaborationhasincreasedamongGovernments,NGOs,CC/V XH  Cwomenandyouthgroups,andlocalcommunities z-2*+ C/VXH  inpopulationrelatedactivitiesmostAfricancountriescontinuetofacehighpopulationgrowthrates,highlevelsofmortalityandthespreadofHIV/AIDS.AmongthechiefconstraintstoachievingthegoalsoftheICPDProgrammeofActionintheregionarelimitedaccesstoreproductivehealthservices,insufficientnumbersoftrainedpersonnel,inadequatefinancialresourcesandineffectiveadvocacystrategies. xH.` hp x (#XHE1` hp x (#XE2qe  24  .3  ԀAsiaspopulationnumbersalmost3.6billionandcurrentlyhasanaverageannualgrowthrateof1.4percent.ExcludingChina,thegrowthratestandsat1.6percent.Giventheverylargepopulationbaseoftheregion,theannualincreaseinabsolutenumbersisstaggering:over50millionpeoplearebeingaddedannuallytotheregionspopulation.ThecountriesofAsiaarecharacterizedbyextremediversityinthelevelsoffertilityandmortality.Insomecountriesintheregion,fertilityhasdeclinedtobelowreplacementlevels,whereasinothersitremainshigh.Laterfemaleageatmarriage,adeclineintheageatmenarcheandadeclineintheagedifferencebetweenspousesraiseimportantpolicyissuesrelatingtotheprovisionofreproductivehealthservicesforunmarriedadolescentsandyoungadults.Populationisgenerallyconsideredanintegralcomponentofgovernmentplanningefforts,withmostcountriesintheregiontryingtointegratepopulationfactorsintotheirdevelopmentplans.However,therearevaryingdegreesofsuccessinimplementingtheICPDProgrammeofAction.Thechiefconstraintsincludethelackofpoliticalcommitmentandlimitedhumanandfinancialresources.Moreover,the1997/98financialandeconomiccrisisaffectinganumberofAsiancountriescontinuestocompoundthechallenges.H.` hp x (#XHE1` hp x (#XE2qe  25  .3  ԀEuropehasapopulationofjustover729millionandazeroaveragepopulationgrowthrate.Itspopulationisexpectedtodeclinetojustover700millionbytheyear2025.TheregionsTFR,at1.5,isthelowestintheworld.Almostallcountriesintheregionareatbelowreplacementleveloffertility.Withintheregion,infantmortalityishighestineasternEurope,at17per1,000livebirths,andlowestinnorthernandwesternEurope,at6per1,000.LifeexpectancyinEuropeis68.3yearsformenand77.0yearsforwomen.2qe  26  .3  ԀCountrieswitheconomiesintransitionoftheformerUSSRareexperiencingsimultaneousdeclinesinfertilityandlifeexpectancy.Amongthecontributingfactorsarethepoliticaltransformationandeconomictransitionthatthesecountriesareundergoing,whichtodatehasadverselyeffectedthestandardoflivingoflargesegmentsofthepopulation,adeteriorationofpublicinfrastructureandadeclineinthequalityandrangeofhealthcareservices.Inaddition,civilunrestandarmedconflictshavecontributedtoahealthcrisisinanumberofcountriesintheregion.H.` hp x (#XHE1` hp x (#XE2qe  27  .3  ԀLatinAmericaandtheCaribbeanregionhasapopulationofalmost500millionandanaverageannualgrowthrateof1.5percent.AlthougharapiddeclineinfertilityhasbeenthedistinguishingfeatureofdemographictrendsinLatinAmericaandtheCaribbeanoverthepastthreedecades,majordifferencesinfertilityandmortalityratesexistwithintheregion,andthevariationswithincountriesthemselvesareconsiderable.Thisisduechieflytotheexistenceofsocialinequalities,whichtranslateintohighproportionsofpeoplelivinginpoverty,exhibitinghigherfertilityratesandexperiencinghigherinfantandmaternalmortalityrates.Thedeclineinfertilityhasbeenespeciallynoticeableamongwomenovertheageof35;teenfertilityhasalsodeclined,butataslowerrate.TheregionsTFRofalmost2.7maskslargedifferencesbetweencountries.Mortalitylevelsandlifeexpectancyalsovarysignificantlyacrosstheregion.LatinAmericanandCaribbeancountrieshaveagreedonastrategyofofferingaccesstohighqualitysafemotherhoodservicesandfamilyplanning,takingintoaccountthesocioculturalidentityoftheusersandgivingprioritytothemostvulnerablegroupsinthepopulation.Toimplementthisstrategysuccessfully, @.*, countrieswillhavetoaddresssuchconstraintsasthelackofadequatehumanandfinancialresourcesandthelackofinstitutionalexperienceinimplementingintegratedreproductivehealthservicesinaregionwheretraditionalfamilyplanningandmotherandinfanthealthprogrammespredominate.Furtheraccountwillneedtobetakenofsocioculturalbarrierstotheacceptanceofreproductivehealthservices,particularlythoserelatingtosexualbehaviourandfertilityregulation.H.` hp x (#XHE1` hp x (#XE2qe  28  .3  ԀNorthernAmerica,themosthighlyurbanizedregion,hasapopulationofjustover304million,whichisexpectedtoreach369millionbytheyear2025.Ithasanaverageannualgrowthrateof0.8percent.Infantmortalitystandsat7per1,000livebirthsandlifeexpectancyis73.6yearsformenand80.3yearsforwomen.Lowfertilityandlonglifespanshaveresultedinarapidincreaseintheproportionofthepopulationaged65andover.H.` hp x (#XHE1` hp x (#XE2qe  29  .3  ԀOceania,thesmallestregion,hasapopulationofjustunder30millionandanaverageannualgrowthrateof1.3.TheTFRfortheregionisalmost2.5.Theinfantmortalityratevariesfrom6per1,000livebirthsinthelowestmortalitycountryto61per1,000inthehighest.K1` hp x (#XK     ChapterII.CREATINGANENABLINGENVIRONMENT  H &    2qe  30  .3  K1` hp x (#XKӀTheICPDgreatlyincreasedpoliticalactionandpublicattentionconcerningpopulationissuesandheightenedawarenessofthemanylinkagesbetweenpopulationandacountry'ssocial,economic,andenvironmentalconcerns.Theparadigmshiftthathasbeenspokenofinpublicpolicycirclessince1994referstothemovementawayfromtheconceptualizationandpracticeoftopdownpolicymakingforpopulationissuesasnumericaldemographicconcernsandtowardsarightsbasedapproachgivingcentralitytothemeetingofreproductivehealthneedsandtothefullestpossibleinvolvementofcivilsocietyinidentifyingandprioritizingthoseneeds.Themanifestationofthisconceptualshiftappearsinthenationaldevelopmentplans,populationpoliciesandprogrammesofactionthathavebeenformulatedorrevisedinthewakeoftheICPD.' <ZH.` hp x (#XHE1` hp x (#XE2qe  31  .3  ԀTheICPDProgrammeofActionsetoutthefollowingobjectivesandactionsonpopulationissuesastheyrelatetodevelopment:P  H.` hp x XHP"0    0!!Populationconcernsneedtobeintegratedintotheformulation,implementation,monitoringand  evaluationofallpoliciesandprogrammesrelatingtosustainabledevelopment,andresourceallocationatalllevelsandinallregions;P,݌ !! Ќ  P  P"0    0!!Governments,internationalagencies,NGOsandotherconcernedpartiesshouldundertake  timelyandperiodicreviewsoftheirdevelopmentstrategies,withtheaimofassessingprogresstowardsintegratingpopulationintodevelopmentandenvironmentprogrammes;Pû݌ !! Ќ  P  P["0    0!!Governmentsshouldestablishtherequisiteinternalinstitutionalmechanismsandenabling p environment,atalllevelsofsociety,toensurethatpopulationfactorsareappropriatelyaddressedwithinthedecisionmakingandadministrativeprocessesoftherelevantgovernmentagenciesresponsibleforeconomic,environmentalandsocialpoliciesandprogrammes;P[v݌ !! Ќ  P  Pp"0    0!!Politicalcommitmenttointegratedpopulationanddevelopmentstrategiesshouldbe R strengthenedbypubliceducationandinformationprogrammesandbyincreasedresourceallocationthroughcooperationamongGovernments,NGOsandtheprivatesector,andbyimprovementoftheknowledgebasethroughresearchandnationalandlocalcapacitybuilding;andPp݌ !! Ќ  P  P"0    0!!Toachievesustainabledevelopmentandahigherqualityoflifeforallpeople,Governments v%."# shouldreduceandeliminateunsustainablepatternsofproductionandconsumptionandpromoteappropriatedemographicpolicies.XXXXXXXX        $  2     P݌j'"$%!! Ќ  E+ ` hp x ,` XE2qe  32  .3  ԀThischapterfirstconsidersprogressmadesincetheICPDinintegratingpopulationconcernsintodevelopmentstrategiesandpolicies.ThisisfollowedbyadiscussionofconstraintsandchallengesencounteredandfinallyprovidesoperationalandtechnicalperspectivesonfurtherimplementationoftheICPDProgrammeofAction.B.` hp x (#XB  @.*,   FormulatingorRevisingNationalPopulationandDevelopmentPolicies  H   B.` hp x (#XBE1` hp x (#XE2qe   33  .3  ԀAsignificantnumberofcountrieshaveformulatednew,andincertainothercasesrevisedexistingnationalpopulationpoliciesornationalsocialandeconomicdevelopmentstrategiesincorporatingpopulationissues.Namibia,forexample,launcheditsNationalPopulationPolicyforSustainableDevelopmentinAugust1997.MexicodevelopedbothaNationalPlanofDevelopmentandaPlanofPopulationfor19952000,whichidentifiesthestatedpopulationpolicyasatoolandfundamentalreferenceforthecountryssocialandeconomicdevelopment.InlinewiththeobjectivesoftheICPDProgrammeofAction,thisprogrammeemphasizesthelinkagesbetweenpopulationanddevelopment.KenyaformulatedthePopulationPolicyforSustainableDevelopment,basedontheICPDProgrammeofAction,toreplaceits1984populationpolicy.Outliningthedevelopmentgoalsthatwillguidetheimplementationofpopulationprogrammesuptotheyear2010,thepolicyincorporatesissuesaddressedintheProgrammeofActionandemphasizesnewconcerns,suchaspopulationdistributionandtheenvironment.2qe!  34  .3  ԀSomecountriestranslatedtherecommendationsoftheProgrammeofActionintoanewpopulationactionplanandrelatedsectoralactionplans.InMali,forexample,theGovernmentdraftedtheActionPlanonPopulation,19952000,astrategicplanthatfocusesontheoperationalizationofthepopulationstrategywithintheobjectiveofmakingbasicsocialservicesmoreaccessible;inaddition,theGovernmentcreatedactionplansforHIV/AIDS,womensempowerment,adolescentreproductivehealthandpovertyreduction,withprogrammesthatpromotethebasichealthneedsofthepopulationandemphasizethegoalsoftheProgrammeofAction.SenegaladoptedaNationalPlanaftertheICPD.Becauseoftheconclusionsandrecommendationsofthisplan,theNinthPlanofDevelopment(EconomicandSocialDevelopment)19962001considerspopulationissuesintheformulationofitsdevelopmentstrategy.InBangladesh,aNationalCommitteefortheImplementationoftheProgrammeofActionwasformed,comprisingpolicymakersfromwithintheGovernmentalongwithrepresentativesofUnitedNationsagenciesandorganizations,developmentagencies,nationalandinternationalNGOsandresearchers.TheCommitteedevelopedaNationalPlanofActionandastrategicplanforfamilyplanning,aswellasforthebasichealthandpopulationsector.ThePlanemphasizeshumandevelopment,withspecificdevelopmentalgoalsrelatingtomortality,educationandhealth,withgenderequityandwomensempowermentasunderlyingthemes,andalsoaddressesfinancialsustainability,privatesectorandNGOroles,andanexaminationandupdateoftheNationalDrugPolicy.H.` hp x (#XH &     EstablishingInstitutionalMechanisms  #: !    InstitutionalReview c  v%."#   E1` hp x (#XE2qe"  35  .3  ԀProgressmadeinareasofpopulationpolicysincetheICPDhasoftenbeendemonstratedintheestablishmentofaministerialbodyorsubcommitteechargedwithaddressingpopulationconcerns,and,inparticular,withintegratingthemintonationaldevelopmentstrategiesandpolicies.Somecountries,guideddirectlybytheICPDProgrammeofAction,establishednationalcommissionstohelpformulatepoliciesandimplementintegratedpopulationrelatedactivities.Thesebodies,usuallychargedwithfollowinguptherecommendationsoftheICPDProgrammeofAction,oftenincludedrepresentativesfromsectoralministriesinsocialsectorsaswellasfromcivilsociety.' #H.` hp x (#XH @.*, E1` hp x (#XE2qe#  36  .3  ԀNepal,forexample,undertookanextensiveresponsetopopulationissuesandconcernsaftertheϢICPD.In1995,theGovernmentestablishedaseparateMinistryforPopulationandEnvironmentresponsibleforformulatinganappropriatepopulationpolicy,developingsuitableprogrammes,conductingresearchand,inparticular,coordinatingpopulation,familyplanningandrelatedactivitieswithvariousgovernmentalbodiesandNGOs.TheGovernmentalsoformulatedandadoptedanumberofpoliciesandϢprogrammesonpopulationandhealthinlinewiththeICPDrecommendationsandobjectives.H.` hp x (#XHE1` hp x (#XE2qe$  37  .3  ԀBrazilsetupaNationalCommissiononPopulationandDevelopmentin1995,withrepresentativesfromcivilsocietyandsocialdevelopmentsectorsaswellasseveralministries.ByactingasafocalpointonboththedomesticandinternationallevelandplayingakeyroleinthedevelopmentofpoliciesandϢprogrammes,institutionslikethiscommissionarestrategicallysituatedtopermitsufficientintegrationofpopulationconcernsintosocialandeconomicdevelopmentplansandtoensurethemonitoringandmeasurementoftheICPDgoalsandobjectives.3 x (#X3K1` hp x (#XK2qe%  38  .3  ԀInotherinstances,countriescreatedpopulationdivisionsorunitsoperatingwithinotherministries,suchaswithintheMinistryofInteriorortheMinistryofPlanning.Inthesecases,theintegrationofpopulationconcernsintodevelopmentstrategyiswellsituatedforprogrammingandimplementation.Forexample,BelizeestablishedaPopulationUnitwithintheMinistryofHumanResourcestodesignandimplementanationalpopulationanddevelopmentpolicy.3 x (#X3K1` hp x (#XK2qe&  39  .3  ԀSomecountriesupdatedtheirpreICPDpopulationpoliciesandinstitutionsinresponsetotheϢProgrammeofAction.Attimes,theprocessofrevisingthepoliciesandinstitutionsincludedinputfromothersectoralbodies.Inmanycases,thescopeandplanningofpopulationactivitieswereincreasedextensivelywhenmodifiedtotakeintoaccountthegoalsandrecommendationsestablishedattheICPD.Often,thiswasanongoingprocessinthemodificationandrevampingofolderinstitutionsandpolicies.Peru,forexample,developedanextensiveinfrastructureofinstitutionalsupportinordertoaddressmanyaspectsofpopulationissuesraisedattheICPD.TheGovernmentdismantledtheNationalPopulationCouncil(CONAPO)andtransferreditsdutiestothenewlyformedMinistryfortheAdvancementofWomenandHumanDevelopment(PROMUDEH),withaHumanDevelopmentDivisionandaPopulationϢProgrammeUnittodealdirectlywithpopulationissues.TheGovernmentintegratedthegoalsoftheICPDϢProgrammeofActionintosectoralplansandprogrammes,particularlyinthehealthandeducationsectors,inthecourseofimplementingtheNationalReproductiveHealthandFamilyPlanningProgramme19962000andtheNationalSexEducationProgramme.2qe'  40  .3  ԀOthercountriesthathadpreICPDinstitutionalarrangementsandmechanismsforaddressingpopulationissuesmodifiedtheirstructuresand/orresponsibilitiestoensurethattheyincorporatedthegoalsandrecommendationsoftheICPDProgrammeofActionandcould,thus,workintersectorallytointegratepopulationconcernsintoothernationalconcerns.InEgypt,forexample,theGovernmentsNationalPopulationCouncilwasmaderesponsibleforpopulationpolicyandreform;populationstrategyandϢmultisectoralplanning;populationprogrammemanagement,includingmonitoringandevaluation;andresearchstudiesonpopulationconcerns.H.` hp x (#XH2qe(  41  .3  E1` hp x (#XEӀIndonesia,likewise,isaninterestingcasestudyofhowintegratingpopulationintodevelopmentstrategieschangedafterCairo.Indonesia'sMinistryofPopulationwasmergedintotheNationalFamilyPlanningCoordinatingBoardpriortotheICPD.Themoresubstantivedutiesrelatingtopopulationwere @.*, graduallyshiftedtotheuniversitybasedPopulationStudiesCentre(PSC).TheGovernmentwasinstrumentalinfacilitatingthisinstitutionalshift,usingbothdomesticandinternationalresourcestoexpandandstrengthenPSC.Morespecifically,acollaborativeUNFPAprojecttransformedPSCintoseveralnewlyestablisheddecentralizedcentresthatdealwithavarietyofpopulationanddevelopmentissues,particularlythoserelatingtofamilywelfareandpovertyalleviation.&    H.` hp x (#XH  Decentralization   $    E1` hp x (#XE2qe)  42  .3  ԀIncountrieswheremovestowardsdecentralizationofpolicyandprogramminghavebeentakingplace,agreatersenseofprogresshasbeennotedintermsofawarenessgeneratedaboutpopulationissuesandtheirrelevancetodevelopment.InIndia,forexample,thestate,district,andcommunitylevelhaveallbeguntoreceivemuchmoreinformationonpopulationandreproductivehealthissues,whichhashelpedthemdevelopandimplementappropriatepopulationprogrammesfortheirrespectivedistrictsandlocalareas.'$ xH.` hp x (#XHE1` hp x (#XE2qe*  43  .3  ԀPreexistingcivilsocietyinstitutionscanalsobevaluabletoolsfordecentralization.Insomecountries,forexample,supportforimprovingcapacitiesofuniversitieshasprovedsuccessfulinfurtheringtheICPDϢProgrammeofAction.Particularlyincountrieswitheconomiesintransition,wheretheGovernmentmaybepreoccupiedwithconflictoreconomiccrises,alternativechannelsforsocialdevelopmentsuchasuniversitiesandotherorganizationsofcivilsocietyhavebeenimportantplayers.H.` hp x (#XH&      MeasurementandMonitoring       E1` hp x (#XE2qe+  44  .3  ԀTheintegrationofpopulationissuesintodevelopmentstrategiesalsorequiresmechanismsformonitoringandmeasuringprogresstowardsmeetingthegoalsandobjectivessetforthinCairo.Mostcountrieshavecontinuedtousetraditionaldemographicandsocialserviceindicatorsaspartoftheirmeasurementprocess.Manyaugmentedtheseindicatorswithmoredetailedreproductivehealthindicators,suchastheproportionofbirthsatwhichskilledattendantsarepresent,accesstocontraception,andtheadequacyofcounsellingandfollowup,aswellaswithwidersocialservice,environmentalandeconomicindicators.'H.` hp x (#XH2qe,  45  .3  E1` hp x (#XEӀThecountriesthathavebeensuccessfullymonitoringtheirprogressinintegratingpopulationconcernsintodevelopmentstrategieshavedevelopedacomprehensivelistofindicatorsandhadchargedspecificministries,subcommitteesordepartmentswithtrackingthem.Somecountriesplannedtoimplementacomputerizednetworkingsystemforprogrammeplanninganimportantareainwhichthefullavailabilityofdataiscrucialforthedevelopmentandexecutionofappropriateprogrammesaswellasforthetrackingofdomesticandinternationalresourceflows.H.` hp x (#XHE1` hp x (#XE2qe-  46  .3  ԀTheaccuracyandefficiencyofmonitoringandmeasurementhavebeenincreasedinthosecountriesthathaveexpandeddatacollectiontoincludeavarietyofsources,ratherthanrelyingonasinglesource,suchasaDemographicandHealthSurvey(DHS).InGhana,forexample,keyreproductivehealthindicatorsaretrackedthroughtheDHSbutarealsobeinggatheredfromtheinstitutionalreportsoftheMinistriesofHealthandEducationaswellasthereportsofimplementingagenciessuchastheNationalCouncilonWomeninDevelopmentandacademicandresearchinstitutions.Othercountrieshaveestablished coordinatingcommittees onreproductivehealthandfamilyplanningpoliciesthatmonitorall @.*, relevantprogrammesexecutedbysectoralministries.IntheUnitedRepublicofTanzania,theGovernmentcreatedfourinstitutionalstructuresforthecoordination,monitoringandevaluationoftheimplementationofthenationalpopulationpolicyandprogramme,includingtheintegrationofpopulationissuesintothedevelopmentplanningprocess.PXX 6 &    H.` hp x (#XHXXP'0&     StrengtheningInformation,EducationandCommunicationProgrammes ~  $    '$ cE1` hp x (#XE2qe.  47  .3  Ԁ?XXXXNootherarenaindevelopmentmoreclearlyillustratestheimportanceofthecapacityofpeopleto   communicatewithoneanotherthanthatofpopulationandreproductivehealth.Theplacingofreproductiverightsandsexualhealthattheheartofthepopulationagendaismakingtheworkofthoseconcernedwithsuchissuesbothmoreethicalandmorepoliticallyandculturallycomplex.AwholerangeofreproductiverightsandHIV/AIDSissues,fromdomesticviolencetofemalegenitalmutilationtomalesexualresponsibility,havecrystallizedtheneedforavigourousandpublicdebate.Suchdebatedependsfundamentallyoncommunicationwithinsocieties,withinfamilies,withincommunities,andoncommunicationbetweensocieties,throughpoliticaldiscourseandadvocacy.#XXX?XĞ#Increasingtheflowofinformationon  populationissuescanhaveprofoundeffectsonmanylevelsofsociety.?XXXX  #XXX?X~#2qe/  48  .3  ԀInformation,education,andcommunication(IEC)strategiesandtrainingrelevanttotheimplementationoftheICPDProgrammeofActionincludetheexchangeofinformationontheeffectsofpopulationonmanyothersocioeconomicissues,migration,urbanizationandthemacroeconomy.Theyincorporatepopulationissuesintoeducationalcurricula,publicawarenesscampaigns,research,roundtables,trainingandadvocacyactivities.?XXXXTheformerandsimplerstrategiesofeducationandpersuasionwheresuccesswas | measuredbythenumberof acceptorshavebeenreplacedbythecomplexitiesofchoiceandrights,wherepeoplethemselves,andespeciallywomenandadolescents,areregardedasthemaindecisionmakersandareentitledtodeterminewhatshouldhappentotheirbodiesandtheirlives.#XXX?X#ԢAlthoughmuchtimeandeffort j arerequired,IECstrategiescanhavefarreachingeffectsonsocialnormsandbehaviourandprovideopportunitiesforfurtheringthegainsmadeatCairobyeducatingthepublicandpolicymakersaboutpertinentpopulationissues.3 x (#X32qe0  49  .3  ԀThedevelopmentofinformationandcommunicationstechnologies(ICT)presentspromisingopportunitiesforaddressingglobalpopulationandreproductivehealthissues.?XXXXThecurrentinformation !F revolution#XXX?X #AXXXXԀhasresultedinglobalcommunicationlinksunprecedentedinworldhistory.#XXXAXO #Ԁ?XXXXEmailforinstance "@  hastransformedtheopportunitiesavailabletoadvocacyNGOsandcommunityorganizationstonetwork,lobby,andorganizearoundmanypopulationanddevelopmentissues,nottheleastinthefieldofreproductivehealthandrights.#XXX?X #ICTshavegreatpotentialintheareaofadvocacyaswellasinencouraging v%."# socialinteractionamongallstakeholdersandstimulatingpublicdebateofpopulationissues.2qe1  50  .3  ԀNewinformationandknowledgemanagementtechnologieshavebeenincreasinglyoperationalsincetheICPD.Forthelastfiveyears,keyICPDrelateddevelopmentsincludedsuchprogrammesasϢPOPLINE,POPIN,theDevelopmentofOnlineInformationServiceonPopulationandEnvironmentLinkages,thedevelopmentofnewsoftware,theuseofwebsitesandCDROMSformediamaterials,andtheGlobalKnowledgePartnership.Theseactivitieshavefacilitatedthesystematiccollection,analysis,disseminationandutilizationofpopulationrelatedknowledgeandpromotedinformationandexperienceexchangeatthenational,subregional,regionalandgloballevels.Atfieldlevel,powerfulinformationand @.*, communicationtechnologiesarebeingusedtoempowercommunities,couplesandindividualstomakeinformeddecisions.Forexample,somecountriesinAsiaandAfricaaretryingouttheconceptof cyberbusandelectronicchatrooms,toeducateyoungpeopleonpopulationandreproductivehealthissues.ManyyoungpeoplehavealsousedtelephonehotlinessetupbyNGOsandhealthinstitutionstoobtaininformationandcounselingonsensitiveissuessuchaspregnancy,sexualrelations,domesticviolence,sexuallytransmitteddiseases,includingHIV/AIDs.InBangladesh,mobiletelephoneshaveenhancedspousalcommunicationandinformationonreproductivehealthamongthoseinvolvedinmicrocreditprogrammesofferedbytheGrameenBank.̀&    H.` hp x (#XH  AdvocacyCampaigns \       2qe2  51  .3  E1` hp x (#XEӀManycountrieshavedemonstratedtheirpoliticalcommitmenttointegratedpopulationanddevelopmentstrategiesthroughtheinitiationofadvocacycampaigns,eitheronpopulationasageneralissueoronspecificreproductivehealthconcernsasaresponsetotheICPDrecommendationsonpromotingthegeneralreproductivehealthofallmembersofsociety.Insomecountries,Governmentshaveinitiatedmultifacetedawarenessraisingcampaignsontheseissues.InBrazil,forexample,theMinisterofHealthestablishedaNationalDayagainstMaternalMortalityaspartoftheSafeMotherhoodInitiative,amultilateraleffortinvolvingtheUnitedNationsChildren'sFund(UNICEF),PanAmericanHealthOrganization(PAHO),UNFPAandtheBrazilianFederationofGynaecologyandObstetrics.Inaddition,theGovernmentorganized"Cairo+5"eventstofurthereducatethepublic,politiciansandtheprivatesectorontheseissues.'  H.` hp x (#XHE1` hp x (#XE2qe3  52  .3  ԀMoreover,theimpactofthepersonalcommitmentofpoliticalleaderstointegratingpopulationanddevelopmentcanbeseenincountriessuchasMexico,wherethePresidentpubliclypresentedtheNationalϢProgrammeforSexualHealthandFamilyPlanning19952000throughthemassmedia.Thisgaveaclearmessagethatreproductivehealthshouldbeabasicpartofhealthservices,alongwithnutritionandvaccination.SomecountriesreportedthatpresidentialcandidatesincludedtheICPDProgrammeofActionintheircampaignplatforms.H.` hp x (#XHӜ&    Research/Training/RoundTables F  R 2qe4  53  .3  E1` hp x (#XEӀManycountrieshaveinitiatedstudiesontraditionalpopulationissuesorinitiatedarevisednationalcensusthataddressedthepopulationandreproductivehealthconcernsincludedintheICPDProgrammeofAction.Universityandinternationalorganizationssponsoredinquiriesintospecificpopulationorreproductivehealthissues,and,insomecases,privatesectorcompaniesconductedresearchonpopulationissues.Forexample,IndiasEnergyResearchInstituteconductedastudyondemographicconcerns.'4H.` hp x (#XHE1` hp x (#XE2qe5  54  .3  ԀInMali,aninternationalNGOhasbeenconductingresearchonmigrationandurbanizationinWestAfricaandananalysisofthereproductivehealthsituation.Likewise,insomeLatinAmericancountries,boththeprivateandpublicsectorsgeneratedasignificantamountofresearchandinstitutionalknowledgeaboutpopulationanddevelopmentissues.Bothacademicandgovernmentalinstitutionsanalysednationaldevelopmentplansalongwithprogrammesonpopulationandpublichealthsectorreformaswellasnewpoliciesonwomenanddemographicissues. H.` hp x (#XH F-)+ E1` hp x (#XE2qe6  55  .3  ԀInadditiontotheUNRegionalEconomicandSocialCommissionsmeetings,manycountrieshaveheld meetingsorroundtablesonICPD+5,or"CairoinAction",tomeasureprogressinimplementingtheϢProgrammeofActionandtogarnercontinuedsupportforintegratingpopulationissuesintoothersectorsofpolicyplanninganddevelopment.InBurkinaFaso,forexample,theGovernmenthaspromotedtheadoptionofawiderdevelopmentstrategy,withaconsiderationofdemographictrendsparticularlyinregardtowomenandaccesstoreproductivehealthservices,byholdingaroundtableonsocialsectoractivities,includingpopulationanddevelopment.H.` hp x (#XH&    Ӝ  ImplementingRegionalInitiativestoPromotePopulationandDevelopment 3&       ' &E1` hp x (#XE2qe7  56  .3  ԀSeveralregions,throughtheirEconomicandSocialCommissions,haveheldmeetingsontheICPDϢProgrammeofAction,draftedtheirownregionalprogrammesofaction,anddeveloped,implemented,andstrengthenedregionalnetworksforcooperationandcoordinationofpopulationanddevelopmentactivities.H.` hp x (#XH&      Africa (     E1` hp x (#XE2qe8  57  .3  ԀTheEconomicCommissionofAfrica(ECA)heldaseriesofregionalconferencesasafollowuptotheICPDandasameansofassessingbenchmarksintheintegrationofpopulationconcernsintothevariousdevelopmentplansoftheregion.ECAdevelopeditsowncountryinquiryforassessingnationalimplementationoftheDakar/NgorDeclarationandtheICPDProgrammeofAction.AtthemostrecentfollowupmeetinginAddisAbabainSeptember1998,ECAreviewedprogressintheregionasawholeandthetrendsandspecificperspectivesinthe36countriesthatrespondedtothesurvey.'(K1` hp x (#XKParticipantsatthemeeting,includingGovernments,internationalorganizations,donorsandNGOs,reviewedAfricanexperiencesintheimplementationoftheICPDProgrammeofActionandtheDakar/NgorDeclarationandarrivedat75recommendationscoveringthefullrangeoftopicsincludedintheICPD+5discussions.0 x (#X0K1` hp x (# XK2qe9  58  .3  ԀThepolicyissuesthatemergedasthoseofprimeimportancetotheregionwererelatedtostrengtheningsupportforpolicydevelopmentandprogrammingofHIV/AIDSpreventionandrelatedservices,andrecognizingandincreasingtheroleofNGOsandtheprivatesectorinaddressingpopulationconcerns.Themeetingurgedtheadoptionofappropriatepopulationpoliciesbythosecountriesthathavenotdonesoandtheestablishmentofadequatepolicyandprogrammecoordinatingmechanisms,inparticular,thoseforSouthSouthcooperation.K1` hp x (#XKӀTheECAregionalrecommendationsalsoproposedpolicydevelopmentinregardtoadolescentsandyouthinallaspectsofreproductivehealthprogramming.ThefindingsoftheECAquestionnaireandrecommendationswillbeformallyreviewedatfutureregionalECAandAfricanPopulationCommissionmeetingsaswellasattheOrganizationofAfricanUnity(OAU)SummitofHeadsofStateinJune1999.H.` hp x (#XH  ArabStatesandWesternAsia  d(%& E1` hp x (#XE2qe:  59  .3  ԀTheEconomicandSocialCommissionforWesternAsia(ESCWA)andtheLeagueofArabStatesmetinBeirutinSeptember1998toreviewtheICPDProgrammeofAction,theAmmanDeclarationandactivitiessurroundingtheirimplementationandadaptationtopoliciesandprogrammesintheregion.MemberStatesproposedfutureactionsonpopulationanddevelopmentstrategiesandcomprehensivereproductivehealthpoliciesandprogrammes.Therepresentativesreaffirmedtheircommitmenttothegoals @.*, oftheProgrammeofActiontointegratepopulationintonationaldevelopmentstrategiesandmentionedtheimportanceofconsideringaccesstoandthequalityofreproductivehealthcareandofaddressingunmetneedsresultingfromage,genderandsocialstatus,allwithinthecontextoftheeconomicrestructuringoccurringintheregion.TherecommendationscalluponGovernmentstoencouragethedevelopmentofcomprehensivereproductivehealthpoliciesandprogrammes,payingattentionspecificallytoSTDs,violenceagainstwomenandchildren,harmfulculturalpracticessuchasfemalegenitalmutilation(FGM),andmaleinvolvementinfamilyplanningandreproductivehealth.ThereportalsocallsforinternationalandϢintersectoralcollaborationtocreatereliableindicatorsandmechanismstomeasureprogressinimplementingϢprogrammesofaction,particularlytheintegrationofpopulationintodevelopmentstrategiesandnationalsocialdevelopmentplans.H.` hp x (#XHE1` hp x (#XE2qe;  60  .3  ԀSeveralofthecountriesoftheregionreportedthatcomprehensivenationalstrategieshadbeendeveloped,includingsocialdevelopmentstrategiesthattakeintoaccountequityandaccesstobasicsocialservices,createneweconomicopportunities,strengthengovernmentawarenessofissuessuchaspovertyandcatalyseeffortstorehabilitatesocialsectors.TheESCWArecommendationsalsoemphasizeadvocacyfordecisionmakersandofficialsinchargeofprogrammeimplementationandtheimportanceofintersectoralcoordinationamongreproductivehealthserviceproviders,includingNGOs,theprivatesectorandpublichealthinstitutions.H.` hp x (#XH AsiaandthePacific 2   ,,XX ,,,,E1` hp x (#XE XX, ,XXX X2qe<  61  .3  ԀTheEconomicandSocialCommissionforAsiaandthePacific(ESCAP)heldameetinginMarch H 1998toreviewtheimplementationoftheICPDProgrammeofActionandtheBaliDeclarationonPopulationandSustainableDevelopment.TheforumgavethecountriesoftheregionanopportunitytodemonstratetheircommitmenttofulfillingthegoalsoftheProgrammeofActionandtheopportunitytoidentifykeyactionsthatshouldreceiveurgentattentionfromalldevelopmentpartners.ThemeetingalsoconsideredthevariousstructuralreformsthatcountriesoftheESCAPregionwereundertakingtoadjusttoandbenefitfromtheopportunitiesposedbyglobalization.Inall,theAsiaPacificRegionalMeetinggenerated63recommendationsforfutureactionandoneresolution,whichassertedtheneedformobilizationofhumanandfinancialresourcesforfurtherimplementationoftheESCAPregionalpopulationanddevelopmentgoals.TheresolutionendorsestheutilizationofSouthSouthcooperationandNGOsasalternativemechanismstogovernmentalinstitutions.H.` hp x (#XHE1` hp x (#XE2qe=  62  .3  ԀThe63recommendationsforactionsinthepolicyandinstitutionalframeworkincludeaddressingtheissuesofinternationalmigration,genderequalityandequity,andthesettingofexplicitprioritieswithinreproductivehealthcare,adolescenthealthandtheroleofcivilsociety.TheESCAPmeetingconcludedthatprogresshadbeenmadeinimplementingtheICPDProgrammeofActionbutchallengesremained,includingthatofbalancingtheroleofgovernmentintheplanningandprovisionofserviceswiththeprivatesector'scapacityforthefundingandprovisionofservices.TheESCAPnationsrecognizedthatusingthemarketmechanismfortheprovisionofserviceswouldbeanimportantstepinfurtherimplementingtheICPDProgrammeofAction,particularlyintermsofaddressinginequities.Theprimaryresolutioncallsforareportontheprogressoftheregioninsecuringfurtherhumanandfinancialresourcesforpopulationanddevelopmentpoliciesandprogrammestobepresentedatafollowupconferenceintheyear2002. H.` hp x (#XH ,|)+ &        CentralandEasternEuropeandtheCommonwealthofIndependentStates H  H   E1` hp x (#XE2qe>  63  .3  ԀThecountriesoftheEconomicCommissionforEurope(ECE)consideredinthisdiscussionareϜprimarilythecountriesofcentralandeasternEuropeandthestatesoftheformerSovietUniontheCommonwealthofIndependentStates(CIS).AsafollowuptotheICPD,thecountrieswitheconomiesintransitiongatheredforaUNFPAsponsoredworkshoponpopulationpolicyandprogrammesintheregion,hostedbytheRomanianNationalCommissionforStatistics,inRomaniainMay1995.'HGH.` hp x (#XHE1` hp x (#XE2qe?  64  .3  ԀThepopulationissuesofmostconcernhighlightedatthemeetingwerethehighrateofabortion,lowuseoffamilyplanning,unsafeabortionasaleadingcauseofmaternalmorbidityandmortality,andthelevelofinfertilityamonglargeproportionsofthefemalepopulation.CountriesalsoreportedextremelyhighlevelsofSTDsespeciallyamongadolescents,andlowlevelsofqualityofcareandofIEConreproductivehealthcarebothwithintheserviceprovidercommunityandthewiderpublic.Mostofthecountriesdid,however,possesssomekeyadvantagesinpursuingpopulationanddevelopmentgoals,includinghighlevelsofliteracyduetoanemphasisoneducation,withequalaccessforwomenandmen,anddevelopingprivatesectorchannelsforhealthservicedelivery.Althoughprogresshasbeenregisteredsince1995inaddressingmanyoftheseissues,significantobstaclesstillremaininmanyofthesecountriestofullyimplementtheICPDProgrammeofAction.H.` hp x (#XHE1` hp x (#XE2qe@  65  .3  ԀInDecember1998,theECEheldaregionalmeetinginBudapest,Hungary,onICPD+5followup.ThemeetingprovidedanopportunitytoreviewprogressmadeinimplementingtheICPDProgrammeofActionunderfiveprioritythemes:fertility,familyandgenderissues;reproductiverightsandsexualandreproductivehealth;mortalityandhealth;populationageing;internationalmigration.Theconclusionsofthemeetingcoverthesethemes,whilebrieflymentioninginternationalcooperation.XXXXXXXX       v H.` hp x (#XH   LatinAmericaandtheCaribbean  j   E1` hp x (#XE2qeA  66  .3  ԀIn1996,thedraftRegionalPlanofActionapprovedatthetwentyfifthsessionoftheEconomicCommissionofLatinAmericaandtheCaribbean(ECLAC)becametheLatinAmericanandCaribbeanRegionalPlanofActiononPopulationandDevelopment,afterbeingfurtherdevelopedfollowingtheoutcomeoftheICPD.Itdescribesactivities,includingroundtablesheldinconjunctionwithUNFPA,onissuessuchasadolescentreproductivehealth,reproductiverightsandtheimplementationofreproductivehealthprogrammes,andpopulationandmacroeconomiclinks.AfollowupconferenceinArubainMay1998demonstratedthecontinuingpoliticalcommitmentofcountriesintheregiontofurtheringtheICPDgoalsandrecommendationsthroughtheestablishmentofnationalplans,declarationsofprinciplesconcerningpopulationandsustainabledevelopment,sectoralplansandprogrammes,andthecreationofpopulationunitsorcommissionstoformulateandcoordinatepoliciesandprogrammes.2qeB  67  .3  ԀTheECLACsubregionalheadquartersfortheCaribbeanisresponsibleforfollowupactionandsupportwithrespecttotheimplementationoftheCaribbeanSubregionalPlanofActiononPopulationandDevelopment,whichpresentsthecontentsoftheRegionalPlanofActionandtheICPDProgrammeofActionfromtheCaribbeanperspectiveandwhichservesasafurtherguidetoactionforcountriesinthesubregion.Technicalassistanceprovidedtocountriesofthesubregioninareassuchasappliedresearchhasbeengearedtothespecificneedsandconcernsofthesecountries,whichincludeinternationalmigration,theimpactofimmigrationonsmallislandsandcoastalareas,theroleandimportanceoffamilyremittances @.*, fromabroad,returnmigrationandadolescenthealth.Dataforthepolicyandprogrammaticactivitiesweresystematicallycollectedanddisseminatedaspartoftheregionalsociodemographicdatabank.    Constraints (\  0   K1` hp x (#XK2qeC  68  .3  ԀDespitetheprogressobserved,implementationoftheProgrammeofActionhasbeenunevenbecauseofthemanyconstraintsandchallengescountriesface.Theyincludelimitedfinancialandhumanresources,competingpriorities,limitedinstitutionalinfrastructure,insufficientintersectoralcoordination,inadequatemeasurement/monitoringmechanisms,economiccrisesandcivilunrest.H.` hp x (#XH   LimitedFinancialandHumanResources      E1` hp x (#XE2qeD  69  .3  ԀOneofthemostwidelyrecognizedconstraintsencounteredintheimplementationoftheProgrammeofActionwasthelimitedamountoffinancialandhumanresources,includingthelackoftrainedpersonneltocreateandimplementpopulationanddevelopmentpolicies.Humanresourcemanagementlimitationsappearedinmanyministriesthatweregreatlyoverburdenedduetoanemployeebasethatwasinsufficientlyskilledandtrainedfortheconsiderableworkflowinthesocialandeconomicdevelopmentsectors.H.` hp x (#XHE1` hp x (#XE2qeE  70  .3  ԀCountriesthathavemadeinstitutionalandprogrammaticchangesintheyearsfollowingCairooftenmentioneddwindlingresourcesasareasonforchangesbecominglessdynamicorevenunsustainable.Thisconstraintwasillustratedbythecountriesinwhichpopulationministriesorsimilarinstitutionalbodieshavenooperationalcapacity,oftenduetoalackoffunding.H.` hp x (#XH&     CompetingPriorities  v   E1` hp x (#XE2qeF  71  .3  ԀTheinterdependenceofpopulationissueswithmacroeconomic,environmentalandotherdevelopmentissuesmadethepursuitofthegoalsandrecommendationsoftheICPDProgrammeof'AdActionessential.However,Governmentsoftenfaceprioritiesthatcompetewithintegratingpopulationintodevelopmentstrategies.Insomedevelopingcountriesandcountrieswitheconomiesintransition,populationissueshavebeenseenasindependentof,orsecondaryto,economicgrowthorpovertyalleviation.Thus,thereisaneedformoreawarenesscreationandadvocacyactivitiesonthelinksbetweenpopulationandotherdevelopmentissues.H.` hp x (#XHE1` hp x (#XE2qeG  72  .3  ԀResearchstudiesconductedbyindependentinternationalinstitutionsshowthatupto98percentoffundsallocatedfordevelopmentactivitiesarespentonsectorsotherthanpopulation.XXXXXXXX       " $  3     Populationissues |$4!" suchasthosediscussedatCairoespeciallytheempowermentofwomen,schoolingofgirlsand,moregenerally,theintegrationofpopulationintodevelopmentstrategiescanbeovershadowedbymoreimmediatelypressingeconomicorenvironmentalconcerns.H.` hp x (#XH̜  ^)&' Л   LimitedInstitutionalCapacity  H   E1` hp x (#XE2qeH  73  .3  ԀAsignificantnumberofthecountriescoveredbytheUNFPAICPD+5Inquirycitedthelimitedinstitutionalinfrastructureorthelackofpoliticallyempoweredsectoralbodiescapableofaddressingintegratedpopulationanddevelopmentissuesasconstraints.Forexample,somecountriesreportedthatanationalcommissiononpopulationanddevelopmenthadbeenestablished,butitwascreatedwithoutthesupportofanoverarchingplanningsystemornationaldevelopmentplan.Inothercases,thegovernmentalministryorbodyestablishedorchargedwithaddressingpopulationissueshadnodecisionmakingpowerorformalmechanismstomeasureprogresstowardsachievingthegoalsandobjectivessetforthattheICPD.H.` hp x (#XHE1` hp x (#XE2qeI  74  .3  ԀManycountriesinAfricaandAsiareportedthatalackofcoordinationbetweenministriesorinstitutionshadmadeincorporatingthepolicyaspectsoftheCairoagendaextremelychallenging.Inonlyaveryfewcases,didthecountriessurveyedmentionthatrelevantsectoralagencieshadeitherreviewedoractivelyparticipatedindevelopingandimplementinganewpopulationordevelopmentstrategyoractionplan.ThishasalsobeenreportedinotherregionalandsubregionalreviewsofpostICPDactivitiesaimedatimplementingtheProgrammeofAction.H.` hp x (#XH   LackofDataandMonitoringMechanisms     E1` hp x (#XE2qeJ  75  .3  ԀManydevelopingcountriesandcountrieswitheconomiesintransitionreportedthatimplementationoftheICPDProgrammeofActionwasconstrainedbothbyalackofdataorinformationandbyinadequatemeasurementormonitoringmechanisms.Manycountrieswitheconomiesintransition,especiallythenewlyindependentstates,lackcensusdataandthecapacitytoundertakeacensus.H.` hp x (#XHE1` hp x (#XE2qeK  76  .3  ԀManycountriescitedasmajorconstraintsthelackofsystematicmechanismsformonitoringICPDgoals,thedifficultyinobtainingdisaggregatedreproductivehealthandbasicsocialindicators,and/orinadequateorinsufficientdataandanalyticalsystems.ThischallengecanariseincountrieswhereDHSsorcensusesarenotconductedregularly,wheretheyarecarriedoutbydifferentagencies,orwherethedataarecollectedandanalysedbydifferentagenciesororganizations.Inaddition,thevariousbodiesresponsibleforcollectingandanalysingthedatamaybeconstrainedbylimitedresourcesandtechnicalcapacity.H.` hp x (#XH   ExternalFactors  #: !   E1` hp x (#XE2qeL  77  .3  ԀIncountrieswheredomesticmarketswereweakorexperiencingrecessions,thefundingandmaintenanceofsufficienttrainedpersonnelintherelevantministriesbecameacentralissue.Thissituationwasoftencoupledwithemigrationofskilledpersonnel,causingfurtherpressureonconstrainedministriesandsectoralagencies.Clearly,thesesituationscannotbecorrectedwithoutattackingtheirrootcauses,makingpolicyprogrammingandimplementationvirtuallyimpossibleintheshortterm.H.` hp x (#XHE1` hp x (#XE2qeM  78  .3  ԀManycountriesundergoingrapidstructuralchangesandthoseinintensepoliticalandeconomicstresshavewitnessedasignificantincreaseintheamountofcivilandpoliticalunrestoverthelastfewyears.Wars relatedtoethnicstrife,politicalconflictsandeconomichardshiphaveresultedingrowingpublichealth F-)+ problemsandabreakdownintheinfrastructuretodealformallywithpopulationandreproductivehealthissues. ̜ InformationGap  6 2qeN  79  .3  Ԁ?XXXXThe informationgapbetweentherichandpoorandbetweengenderisstarkandthedistributionof * newinformationandcommunicationtechnologiesisevenlessequal.#XXX?Xm~#ԀAccessforinformationmeansaccess $  topowerandmostsocietiescontinuetoexcludewomen.ThedominationofInternetbymenhasalsobeenasourceofconsistentcriticismsinceitsinception.Despitesuchlackofaccess,theInternethashadamajorimpactinenablingthecivilsocietyorganizationstoorganizethemselvesandcampaign.Indevelopingcountries,thereisaraceforharnessingtechnologiesforknowledge,informationandnetworkingandforincreasingparticipationofandinteractionwiththepublic.Womensorganizationsareincreasinglyunderstandingandseizingthestrategicimportanceofnewtechnologiesforexercisingthefullbenefitsofreproductiverights. Thefreedomtohaveaccesstospacesotherthanthebedroomandthekitchen,andtofullyandsafelybeabletoactinotherpublicspacesiskeytowomensfullparticipationintheworldsfuturearguesMarieHeleneMottinSylla,oftheNGOEndaTiersMondeinSenegal.Furthermore,itistheprivatesectorthatisdrivingtheinformationrevolutionandpopulationadvocatesareoftenabsentfromthediscussionsinwhichkeyglobalandnationalcommunicationpoliciesarebeingshaped.H.` hp x (#XH&       FurtherActionRequired PXX   XXP  E1` hp x (#XE2qeO  80  .3  ԀGovernmentsshouldfullyacknowledgethelinkagesamongpopulation,reproductivehealth,macroeconomicandothersectoralissuesandtheneedfornationalpolicyandprogrammeplanningmechanismsthattaketheinterdependenceoftheseissuesintoaccount.'vH.` hp x (#XH   InstitutionalStrengthening  d   B.` hp x (#XB2qeP  81  .3  ԀE1` hp x (#XEGovernmentsshouldelaboratestrategicframeworksthatencourageandsupportintersectoralcollaborationandcoordinationasawayofexpandingthedepthandscopeoftheattentiongiventopopulationissues.H.` hp x (#XH2qeQ  82  .3  ԀE1` hp x (#XEGovernmentsshouldcontinueorbegintheprocessofdecentralizationinpopulationanddevelopmentprogrammeplanningandimplementationandshouldprovidethenecessarysupporttocarryouttheprocesseffectively.ManycountriesthathavebeguntheshifttodecentralizationinsectoralprogrammesandpoliciescitedthecontinuationofthistrendasakeyopportunityforbeginningorcontinuingtocarryoutthegoalsoftheICPDProgrammeofAction.2qeR  83  .3  ԀH.` hp x (#XHAllstakeholdersinthepopulationanddevelopmentfieldneedtodefineclearlytheirrolesandresponsibilitiesinimplementingthegoalsandrecommendationsadoptedinCairo.2qeS  84  .3  ԀE1` hp x (#XEGovernmentsshouldstrengthentheircollaborationwithcivilsociety,includingNGOs,inpopulationanddevelopmentplanning,implementationandmonitoringandevaluation,takingintoaccounttheircomparativeadvantagesandcomplementarities. @.*, 2qeT  85  .3  ԀGovernmentsshouldallocatemoreresourcestostrengthenexistinginstitutionsortocreatenewonesthataddresspopulationissuesinordertoensurethattheinstitutionalframeworkisadequatetoachievetheICPDgoals.H.` hp x (#XH   TechnicalandHumanResources  0   E1` hp x (#XE2qeU  86  .3  ԀGovernmentsshouldworktogetherwithNGOsandtheprivatesectortoensurethattheappropriatetechnicalresourcesarepresent,i.e.,skilled,trainedpersonnelandadequatelyfundedprogrammes,thatwillallowthefullintegrationofpopulationintodevelopmentplanning.H.` hp x (#XHE1` hp x (#XE2qeV  87  .3  ԀGovernments,NGOsandothercivilsocietyrepresentativesshouldworktoestablishasustainablebaseofwellinformedandadequatelytrainedpersonnelwithinthegovernmentandhealthsectorsinordertosupportpopulationanddevelopmentpolicyandprogrammes.H.` hp x (#XH  IECandAdvocacy      E1` hp x (#XE2qeW  88  .3  ԀGovernments,aswellasNGOsandprivatesectoractors,shouldinitiateandincreaseawarenessraisingactivitiesthatmobilizesupportforintegratedreproductivehealth;women'sempowerment;andeconomic,environmentalandothersocialwelfareprogrammes.H.` hp x (#XH2qeX  89  .3  E1` hp x (#XEӀGovernmentsshouldstrengthennationalnetworksandcoalitionsforadvocacy,targetingmultipleaudiencesrangingfromnationalleadershiptothegrassrootslevel,forthegoalsandrecommendationsoftheICPDProgrammeofAction,incooperationwithcivilsocietyorganizations.Theyshouldnurturenetworksthatlinksendersandreceivers,citizensanddecisionmakers,publicandprivatesectors,communicationprofessionals,communityandmassmedia,andopinionleaders.H.` hp x (#XH2qeY  90  .3  ԀGovernments,aswellasNGOandprivatesectoractors,shouldavailthemselvesoftheopportunitiesofferedbythenewparticipatoryandopenparadigmoftheGlobalInformationSociety.ICTsoffernewprocessesandtoolsforadvocacycommunicationinsupportoftheICPDProgrammeofAction.Stateofthearttoolsincludeinteractiveandinterlinkedwebsites,theproductionoflocalized,moreattractiveandinteractivepopulationdata,electronicarchives,distancelearningsystems,andelectronicconferences.̀   ResearchandData  "@    E1` hp x (#XE2qeZ  91  .3  ԀGovernments,aswellascivilsocietyorganizations,shouldengageinstrategicallyfocusedresearchtoimprovetheeffectivenessandefficiencyofpopulationandreproductivehealthprogrammes.Timelyavailabilityofresearchresultsandtheireffectiveapplicationinprogrammedesignshouldbestressed.H.` hp x (#XHE1` hp x (#XE2qe[  92  .3  ԀGovernmentsandcivilsociety,includingacademicortechnicalinstitutions,shouldworktogethertoprovideandshareintegratedandcomprehensivedatathataremanageableandsustainable.  R+ () H.` hp x (#XH ChapterIII.GENDEREQUALITY,EQUITYANDEMPOWERMENTOFWOMEN  H  62qe\  93  .3  E1` hp x (#XEӀAsoneofitskeyprinciples,theICPDProgrammeofActionemphasizesthatadvancinggenderequality,equityandempowermentofwomen,eliminatingallkindsofviolenceagainstwomen,andensuringwomen'sabilitytocontroltheirownfertilityarecornerstonesofpopulationanddevelopmentrelatedprogrammesandarecentraltothenotionofsustainabledevelopment(Principle4).TheProgrammeofActionalsosetsoutasanimportantobjectivetoencourageandenablementotakeresponsibilityfortheirsexualandreproductivebehaviourandtheirsocialandfamilyroles(paragraph4.25).Theseaims,goalsandobjectivesareimportantconditionsforbuildingasustainable,justanddevelopedsociety.H.` hp x (#XHE1` hp x (#XE2qe]  94  .3  ԀTherationaleforthepromotionofgenderequality,equityandempowermentofwomenpopulationanddevelopmentprogrammesisunderscoredbythefactthatwomen'sdisadvantagedsocialposition,whichisoftenrelatedtotheeconomicvalueplacedonfamilialroles,helpsperpetuatepoorhealth,inadequatediet,earlyandfrequentpregnancyandacontinuedcycleofpoverty.Frominfancy,femalesinmanypartsoftheworldreceivelessandlowerqualityfoodandaretreatedlessadequatelywhensickthanaremales.Incountrieswherewomenarelesseducated,theyreceivelessinformationthanmenandhavelesscontroloverdecisionmakingandfamilyresources.Theyarealsolessapttorecognizehealthproblemsortoseekhealthcare. 6H.` hp x (#XH2qe^  95  .3  E1` hp x (#XEӀWomen'slowsocioeconomicstatusalsoexposesthemtophysicalandsexualabuseandmentaldepression.UnequalpowerinsexualrelationshipsexposeswomentounwantedpregnancyandSTDs,includingHIV/AIDS.Withchangingsocialvaluesandeconomicpressures,girlsareengaginginsexualrelationshipsatearlierages.Additionalhealthrisksforwomenalsoarisefromthegenerallevelofunderdevelopmentthatarereflected,forexample,bypoorroadsandlackoftransport.Thismayhinderwomenfromreceivingtimelymedicaltreatmentforpregnancyrelatedcomplications.Inadequatewatersupply,lackofelectricityandpoorsanitationimposeextraburdensonwomenbecauseoftheirhouseholdresponsibilities,suchasfetchingwaterandfuelwood.2qe_  96  .3  ԀBuildingonagreementsfrompreviousinternationalconferencesonpopulationandonwomen,theconsensusreachedattheICPDsetthestagefortwomajorstrategicshiftsintheformulationandimplementationofpopulationanddevelopmentprogrammes.Thefirstshiftentailedadoptinganevenstrongergenderperspectiveinprogrammes,suchthatthefocuswouldnolongerbeonwomenseparately,butratheronthesocialcontextinwhichtheylive.Thisincludestheunequalgenderandpowerrelationsthatcircumscribetheirlivesandenableorhinderthemfrombenefitingfrompopulationanddevelopmentprogrammes.Thesecondshiftinvolvedtheadoptionofarightsbasedapproachtoenablewomentosecureandsafeguardtheirreproductiveandsexualrights.H.` hp x (#XH2qe`  97  .3  E1` hp x (#XEӀPromotingtheICPDgoalsofgenderequality,equityandempowermentofwomenhas,formanycountries,meanttheadoptionofadualstrategy.Ontheonehand,activitiesfocusingexclusivelyonwomenormenmaybenecessaryinspecificcontextswheregendergapsarewide,providedthatdoingsodoesnotpromotegenderstereotypesorinadvertentlyreinforcegenderinequalities.Womenspecificprogrammesarestillconsideredimportantbecauseofthebiologicalandsocialburdenthatwomencarry,relativetomen,inreproduction.Suchprogrammesare,therefore,usefulinimplementingstrategiesforthe .*+ empowermentofwomen.Ontheotherhand,manycountrieshavealsoadoptedthemainstreamingofgenderconcernsinallpopulationanddevelopmentactivitiesasameansofachievingthecommitmentsmadeattheICPD.Gendermainstreamingentails,amongotherthings,addressingissuesrelatedtoequalitybetweenmenandwomeninopportunitiesandaccess.Thishasmeantcarefulplanningbothforthestrategiesusedandfortheoutcomesexpectedtobeachieved.2qea  98  .3  ԀThischapterassessestheprogressmadetodateinvariouscountriesinpromotinggenderequality,equityandtheempowermentofwomen.Theareascoveredincludetheadoptionofagenderperspectiveorgendermainstreaming;thecreationofanenablingenvironmentforgenderequality;advocacyfortheintegrationofarightsbasedapproachtopopulationanddevelopmentprogrammes;protectionoftherightsofthegirlchild;andthepromotionofmaleresponsibility,especiallywithregardtoreproductivehealth.Thechapterconcludeswithproposalsforpursuingthegoalsofgenderequalityandempowermentofwomen.H.` hp x (#XH   IncorporatingaGenderPerspective       E1` hp x (#XE2qeb  99  .3  ԀTheICPDProgrammeofActionemphasizestheincorporationofagenderperspectiveinthedevelopmentofpopulationprogrammes.ThePoAnotesthatwhilewomenaregenerallythepoorestofthepoor,theyarealsokeyactorsinthedevelopmentprocess.Theyareoftenomittedfrompolicydialogue,ortheirneedsandprioritiesaredefinedontheirbehalfbyothers,toooftenintermswhichactuallyreinforcepreconceivedrolesandrelationshipswhicharenormallycharacterizedbyinequalitiesandinequities.2qec  100  .3  ԀInattemptingtoimplementtheagendaofICPDongenderissues,manycountrieshavepromotedplanningandpolicyformulationprocessesinwhichthedefinitionofkeystakeholdershaswidenedtoincludepreviouslyexcludedgroups.Atthepolicylevel,thegreatestchallengehasbeeninpromotingthelegitimacyand,indeed,necessity,ofgenderequalityasafundamentalvaluethatshouldbereflectedinallpopulationanddevelopmentchoicesandininstitutionalpractices.Inthisrespect,genderequalityissuescannotbedivorcedfromotherfundamentalchallengesthatcountriesface,suchasdemocratizationprocesses.H.` hp x (#XH2qed  101  .3  E1` hp x (#XEӀFormanycountries,animmediateactionfollowingtheICPDwastoassesstheextenttowhichtheexistingpolicyenvironmentwasconducivetomainstreaminggenderconcerns.Inmanycases,theabsenceofaconduciveenvironmentpromptedcountriestoestablishapolicyframeworkinwhichgenderconcernscouldbegintobeaddressedsystematicallyandatalllevels.Themainstrategyusedwastodevelopgenderanddevelopmentpoliciesandactionplanstoguidevarioussectorsinthisendeavour.Thedevelopmentofgenderdisaggregateddataplayedanimportantroleinthisrespect.Theprocesswasacceleratedconsiderablybythepreparationsfor,aswellastheaftermathof,theFourthWorldConferenceonWomenheldinBeijingin1995.H.` hp x (#XH2qee  102  .3  E1` hp x (#XEӀTheMarshallIslands,theFederatedStatesofMicronesia,NamibiaandUgandaareamongthecountrieswhichdevelopedcomprehensivenationalpolicesonwomenorongenderfollowingtheICPD.Intheseandothercountries,nationalactionplansindicatingtheareasneedingactiontopromotegenderequalitywerealsodeveloped.InThailand,theGovernmentpreparedacomprehensive20yearplantoensuretheadoptionofagenderperspectiveinplanningprocesses.Thisplanaddresseswomen'sconcernsinthejudicialsystem,inresearchanddatacollectionsystems,andinthehealthsector.Ecuadorand @.*, Paraguayadoptedfiveyearplansforthepromotionofequalopportunitiesforwomen.Thecreationofanenablingenvironmentincludedothersectoralpolicies,suchasinVenezuela,wherethereformsofboththeeducationalandthehealthsectorssystematicallyincorporatedagenderperspective.H.` hp x (#XHE1` hp x (#XE2qef  103  .3  ԀTheadoptionofagenderperspectiveinreproductiveandsexualhealthprogrammesisabenchmarkfortheachievementofthegoalsoftheICPDProgrammeofAction.Itisnowevidentthatgenderrelationsandsexualityareintimatelylinkedtoissuessuchaseffectiveuseofcontraceptives,unwantedpregnancyandSTIs.Thislinkisforgedinaperson'ssocializationintosexualityandgenderroles.Theprocessofsocializationbeginsearlyinlifeinboththefamilyandthecommunityandisreinforcedbybasicsocialinstitutions,themassmediaandotherfactors,andthisoftensubsequentlyleadstothepolitical,economic,legalandculturalsubordinationofwomen.H.` hp x (#XHE1` hp x (#XE2qeg  104  .3  ԀManycountrieshavebeguntograpplewithdoublestandardsregardingmaleandfemalesexualbehaviouraswellascertainbeliefsandpracticesregardingwomensbodiesandsexualitywhichhavenegativehealthconsequences.Theseincludebeliefsthatwomenshouldbeignorantaboutsexuality"sothattheywillnotbepromiscuous"whichexposesthemtoahighriskofSTIsandunwantedpregnancyandmaymakethemreluctanttoseekhealthcare.Theseandothersocialconstructionsofsexualityandgenderrelationsareadenialofbasicrightsandanimportantdeterminantofreproductiveandsexualillhealth.H.` hp x (#XHE1` hp x (#XE2qeh  105  .3  ԀToaddressthissituation,countrieshaveemployedanumberofstrategies.Forexample,Zimbabweestablishedareproductivehealthtaskforcetoensurethatgenderconcernsarereflectedinreproductivehealthpoliciesandservices.ElSalvadorontheotherhanddevelopedaFamilyLawCodetostreamlineandclarifyformerlyambiguousgenderrelatedissues.H.` hp x (#XHE1` hp x (#XE2qei  106  .3  ԀTheincorporationofagenderperspectiveintopopulationanddevelopmentprogrammeshasnotbeeneasy.Onecommonproblemhasbeentheabsenceofaconsensusonthebestandmosteffectivestrategiestousetopromotegenderequality,equityandempowermentofwomenindifferentsocial,culturalandpoliticalcontexts.Thishasslowedtheintegrationoftheseconcernsinsometimesvitalplanningandprogrammingprocesses.Anotherdifficultyhasbeenposedbythelackofgenderdisaggregateddataandresearchstudieswhichusegenderappropriatemethodologiestoevaluatetheimpactofstrategiesthatarebeingused.Mostavailabledataarebasedonquantitativemethodologiesandstatisticalanalysesofafewvariables.Certainlimitationsthusariseintheextenttowhichsuchdataandanalysescanelucidatesomeoftheemergingissuesrelatedtogenderequality,equityandempowermentofwomen.Eveninthosecountrieswheretheseproblemsarenotsevere,nationalactionplanstointegrategenderconcernsinpopulationanddevelopmentprogrammehavenotalwaysbeenallocatedsufficientresourcestoimplementthemfully.H.` hp x (#XH   ChangingtheEnvironment  ^)&'   TheLegalContext  R+ () E1` hp x (#XE2qej  107  .3  ԀTheachievementoftheICPDProgrammeofActiongoalsdemandsthecreationofanenablingenvironmentasthebasisforthepromotionofgenderequalityandempowermentofwomen.TheICPD @.*, ProgrammeofActionreiteratedthe1993WorldConferenceonHumanRightsinVienna,whichenshrinedwomen'srightswithinthecontextofthehumanrightsdoctrine,makingclearthatcultureandhistorycannolongerjustifylimitationsonwomen'srights.Thisisbecausethetreatmentofwomenincriminalorfamilylawcodesreflectsthewayinwhichtheirroleisconceptualizedinmanysocieties.Inmostinstances,womenembodyaseriesofphysiological,socialorpsychologicalconditionsthatmakethem"victims"tobeprotected.Throughout,theconceptofwomenassubordinateisbasedonbiological,socialandeconomicdefinitionsofwomen'sexperiences.Lawsthenformalizethisperception.Internationalmandatesprovidethenecessarycriteriabywhichnormscanbetransformed.Asaresultoftheseconferences,allcountriesnowhaveanobligationtorevisetheirlegalsystemsinaccordancewithinternationalmandates.&  2qek  108  .3  ԀForthemajorityofcountries,thishasmeantdismantlingoldlawsthatdiscriminateagainstwomenandgirlsandinstitutinglargescalelegalreform.Inthisregard,theConventionontheEliminationofAllFormsofDiscriminationagainstWomen(CEDAW)hasbeenausefulreferenceinstrumenttobroadenthenotionoffundamentalrightsandtoadaptnationalnormstointernationalstandards.' H.` hp x (#XH2qel  109  .3  ԀWith162Statepartiesand97signatories,CEDAWhasbeenratifiedbyallbutafewcountries.Amongthosethathaveratifiedit,severalhavestilltoimplementit,andCEDAWremainsoneoftheinternationalconventionswiththehighestnumberofreservations.SomecountriesthathavenotratifiedtheConventionhavecitedreligiousgrounds.NonimplementationisoftenhinderedbyreservationsoncertainclausesoftheConventionaswellasbytraditionalnormsandvalues.E1` hp x (#XE2qem  110  .3  ԀManyLatinAmericancountrieshavemademajorprogressinchangingdiscriminatorylawsorinenactinglawsthatprotectwomen.TheInterAmericanConventiontoPrevent,SanctionandEradicateViolenceAgainstWomen,enactedin1994inthecourseofpreparationsfortheICPD,isanexampleoftheapplicationofgenderanalysistotheformulationofregionallegislationtoprotectandrespondtotheneedsofthefemalepopulation.Itsexistencecreatedadditionalimpetusforindividualcountriestoadoptsimilarlegislation.Thus,Bolivia,Cuba,theDominicanRepublic,Ecuador,Honduras,Mexico,NicaraguaandPanamaallenactedlawsthatmakeviolenceagainstwomenaseriouscrime.Violationsofsuchlawsareclassifiedastorture.HondurasandothercountriesevencreatedaSpecialPublicDefenderpositionforwomenandunprotectedminors.AdditionallawreformsinLatinAmericaincludenewlabourlawseliminatingdiscriminationinthelabourmarket;reformofagriculturallawstoimprovewomen'saccesstoland;andneweducationallawstoeliminatesexistlanguageinpedagogicalmaterialsandtopromotegenderequalityinaccesstoeducationalopportunities.   "@  H.` hp x (#XHE1` hp x (#XE2qen  111  .3  ԀInAsia,China,thePhilippinesandVietNamadoptedspecificlegislativechangestoprotectwomenfromsexualharassmentandviolence.H.` hp x (#XHE1` hp x (#XE2qeo  112  .3  ԀInAfrica,the14countriesthatconstitutetheSouthAfricanDevelopmentCommunity(SADC),namelyAngola,Botswana,theDemocraticRepublicofCongo,Lesotho,Malawi,Mauritius,Mozambique,Namibia,Seychelles,SouthAfrica,Swaziland,theUnitedRepublicofTanzania,ZambiaandZimbabwe,haveallpledgedtoenactlawsagainstviolenceagainstwomen.Mauritiushasalreadydonesoandfollowedtheenactmentwithamassinformationcampaign.InGabon,theGovernmentisapprovingalawonthesocialprotectionofwomen,mothersandchildren.Zimbabweputintoeffectaninheritancelawthatprotectswidows. @.*, 2qep  113  .3  ԀDespitethemeasuresthathavebeentaken,thelegalenvironmentforwomenisstillfarfromsatisfactory.Womeninmanycountriescontinuetobesufferfromthelackoflegalprotectionforexercising,inparticular,theirsexualrights.Patriarchalperceptionsofwomen'sgoodbehaviour,propermanners,honour,chastityandvirtuearestillevidentinmanylaws.Wherethesehavebeensuccessfullyremovedfromlegaltextsthey,nonetheless,oftenpervadethejudicialmentalityusedtointerpretthem.Onesuchexampleisthewidespreadfailurebythejudicialsystemtoenforcetheminimumageatmarriageforgirls,whereithasbeenenacted,becauseculturalandsocialimperativesand,increasingly,economicfactors,stillfavourearlymarriageforgirls.Similarly,manycountrieshavenotrecognizedtheconceptofrapewithinmarriage,despitethenewdimensionintroducedbyHIV/AIDS.ThismakesitverydifficultformarriedwomentonegotiatethepracticeofsafesexwiththeirpartnersandcurrentlyHIVtransmissionratesformarriedwomenareamongthehighest.Otherlegalimpedimentsrestrictwomen'saccesstoessentialhealthservicesonthebasisofage,maritalstatus,spousalconsentrequirementsorotherfactors.H.` hp x (#XH WomeninPolicyPositionsandatDecisionmakingLevels    &  E1` hp x (#XE2qeq  114  .3  ԀTheunderrepresentationofwomeninpositionsofpoweranddecisionmakingmeansthattheirperspectivesandvisionsareoftenexcludedfrompopulationanddevelopmentpoliciesandstrategies.Asignificantincreaseinthenumbersofwomentakinganactiveroleindecisionmaking,includingparticipationinelectoralpolitics,is,therefore,essentialiftheyaretoinfluencepolicies.'H.` hp x (#XHE1` hp x (#XE2qer  115  .3  ԀToaddressthisproblem,manycountrieshavecreatedorstrengthenedinstitutionalmechanisms,suchaswomen'sministriesorwomen'sbureaus,forwomen'sequalparticipationinpolicyprocesses.Brazil,forinstance,establishedtheWomen'sIntersectoralHealthCommissionintheNationalHealthCouncilattheMinistryofHealth.Itisahighlevelorganwhoseaimistoinvolvewomeninplanning,managingandmonitoringreproductivehealthcareservices.Amongitsfunctionsisthemonitoringofpublichealthpoliciesfromagenderperspective.2qes  116  .3  ԀInAsia,somecountrieshavepromotedwomen'sparticipationintheplanning,managingandmonitoringofreproductiveheathprogrammes.InAzerbaijan,theIslamicRepublicofIran,thePhilippinesandThailand,Governmentsenhancedtheparticipationofwomenbynominatingthemtohighlevelpolicybodies,includingreviewandoversightbodiesatboththecentralgovernmentandregionallevels.SomeCaribbeancountrieshaveadoptedsimilarstrategies.H.` hp x (#XHE1` hp x (#XE2qet  117  .3  ԀInthepoliticalarena,achievementshavebeenmixed,withgainsmadeinseveralcountries,butgroundlostinothers.Ingeneral,theenvironmentforpoliticalactivitiesisstillnotconducivetowomen'sparticipation.Womenwhowanttoenterpoliticsfindthatthepolitical,public,culturalandsocialenvironmentisoftenunfriendlyorevenhostiletothem.Inmanycountries,traditionscontinuetoemphasize,andoftendictate,womenXXXX'#XXXXT#sprimaryrolesasmothersandhousewives.Thistypeofgenderideologyserves j'"$% todiscouragewomenwhowishtobreakoutoftheirtraditionalsexsegregatedmotherhoodrolesand,often,topenalizethosewhodo.H.` hp x (#XHӀE1` hp x (#XE2qeu  118  .3  ԀHowever,manycountrieshaverespondedpositivelybytakingstrongmeasurestoincreasethenumberofwomeninelectoralpolitics(Table3.1).InMorocco,fourwomenwereappointedasSecretariesofStatein1997.InGhana,thenumbersofwomeninParliamentaswellasthoseholdingcabinetpostshasincreased.InEcuador,theGovernmentapprovedalawtopromotethepoliticalparticipationofwomen @.*, byestablishinganobligatory20percentofrepresentativestobewomeninthepopularelectionballotsforalllegallyrecognizedparties.InCostaRica,reformoftheelectoralcodeestablishedaquotaforwomen,setat40percentforallofficialelectionlists.   Table3.1Parliamentaryseatsheldbywomen,1January1997(aspercentageoftotal)  $   *wF<^ddd Xdd Xdd X(#(#w,dd ,@dd +  *<    *Africa,subSaharan Q<D| 4  <  (@12(@ Q  12 XND| 4 0  (@12  (@ < XArabStates D: N   @4@D  4 WMC N 0  @4  @ WAsia0 D /%  h D pD p /  8.$ h 0   8R0 D EastAsia OE  D pD p  4@204@O  20 XND 0  4@20  4@ X 0 D SouthAsia ND  D pD p  @7@N  7 WMC 0  @7  @ W0 D SoutheastAsiaandthePacific OE  D pD p  (@12(@O  12 XND 0  (@12  (@ XEurope % %  8.$0   8r0 D EasternEuropeandCIS ND 2D pD p   @8 @N  8 WMC20   @8   @ W60 D WesternandSouthernEurope OE LD pD p  2@182@O  18 XNDL0  2@18  2@ X 0 D NordicCountries OE fD pD p  B@37B@O  37 XNDf0  B@37  B@ XLatinAmericaandtheCaribbean E;8  $@10$@E  10 XND80  $@10  $@ & XNorthAmericaC  ԍC  ԍ̎  F<R   (@12(@F  12 _<NDR 0  (@12 & (@ _ ,<x!< ,  4*(x"0  < 4     `  PXXSource:UnitedNationsDevelopmentProgramme,HumanDevelopmentReport1997.#XXP# " 0   (#(# E+` ` | hp x (#XE    2qev  119  .3  ԀWomen'slowsocioeconomicstatusalsostandsinthewayoftheirentryintothehigherlevelsofdecisionmaking.Socioeconomicobstaclesincludepovertyandunemployment,inadequatefinancialresources,illiteracy,limitedaccesstoeducation,andthedualburdenofdomestictasksandprofessionalobligations.Soinspiteoftheobviousadvantagesevidentinbroadeningthescopeofparticipationinpoliticsandinpubliclifethroughtheadoptionofdemocraticpracticesinmanycountries,women,byvirtueoftheirreproductiveroles,arestillunabletoreapthejustrewardsofdemocratization.Therefore,womenstillneedtobeempoweredatfamilyandcommunitylevelstohaveselfesteemandconfidencetoenterthepoliticalarenaoutsidethehome,whilethesocietyatlargealsoneedstorecognizethatwomensperspectivesinpoliticsareessentialtosustainabledevelopment.B(` ` hp x (#` ` | XB%@ StrengtheningInstitutions   g&#0 ?+` ` | hp x (#` ` X?  2qew  120  .3  ԀOneofthemajorchallengesemphasizedintheICPDProgrammeofActionishowtoinstitutionalizeandsustainchangerelatedtogenderequality,equityandtheempowermentofwomen.Theprocessofinstitutionalizationrequiresbroadbasedalliancesthatsupporttheadoptionofproceduralandtechnicalprocesseswhichensurethatsocialpracticesthatpromotegenderequalitybecomecontinualandfullysanctionedbyprevailingnorms.Italsoentailsthecreationofcapacityamongstafftoundertakepolicyanalysisfromagenderperspectivesoastoclarifypolicyobjectives,establishmeasurablegoalsandtimetablesanddesignappropriateoperationaltools. 7.*8 B(` ` hp x (#` ` | XB2qex  121  .3  ?+` ` | hp x (#` ` X?ӀFormanycountries,thishasmeanttakingstepstoassistorganizationsandinstitutions,bothgovernmentalandnongovernmental,inusinginstrumentsandmeasuresthatarecompatiblewiththegoalsofgenderequalityandtheempowermentofwomen.Thepresenceofsuchinstruments,permeatingallstructures,preemptsthetendencytotreatissuespertainingtogenderequalityasperipheraltotheorganization'sorinstitution'smandates.B(` ` hp x (#` ` | XB2qey  122  .3  ?+` ` | hp x (#` ` X?ӀEstonia,forexample,tookstepstoestablishastrongnationalmachineryforpromotinggenderequalityatalllevelsofgovernmentbycreatinganinterministerialcommitteeandaBureauofEquality.Indonesiaandothercountriesdevelopedgendersensitizationtrainingmaterialstobuildcapacityingenderanalysisforcadresinvariousinstitutions.     &  B(` ` hp x (#` ` | XB?+` ` | hp x (#` ` X?'    AdvocatingaRightsbasedApproach W     E+` ` | hp x (#` ` | XE2qez  123  .3  ԀTheintegrationofahumanrightsapproachisoneofthefundamentalgoalsoftheICPDProgrammeofActionandisnecessaryfortheachievementofgenderequalityandempowermentofwomen.Thebasisforarightsbasedapproachistheaffirmationthathumanwellbeingandhealthareinfluencedbythewayapersonisvalued,respectedandgiventhechoicetodecideonthedirectionofherorhislifewithoutdiscrimination,coercionorneglect.ManycountrieshaveusedCEDAWasastrategytothateffect.Anumberofcountrieshavealsobeguntoproposeandtoimplementaffirmativeactionprogrammesasinterimmeasurestoenablewomentoexerciserightsthat,hitherto,hadbeenoutoftheirreach.B(` ` hp x (#` ` | XB?+` ` | hp x (#` ` X?2qe{  124  .3  ԀDialoguehasalsobeenestablishedwiththesixhumanrightstreatybodiestofindwaysinwhichthetreatybodiescaninterpretandapplyhumanrightsstandardstoissuesrelatingtowomen'shealth.AnotherpurposewouldbetoencouragecollaborationinthedevelopmentofmethodologiesandindicatorsforusebothbythetreatybodiesandbyUnitedNationsagenciesandotherbodiestopromote,implementandmonitorwomen'srights,inparticular,theirreproductiveandsexualrights.B(` ` hp x (#` ` | XB&     ProtectingtheGirlChild    L   ?+` ` | hp x (#` ` X?2qe|  125  .3  ԀConsiderableprogresshasbeenmadeinmanycountriesinadvocatingfortheprotectionofthegirlchildasamajorsteptowardschallengingpracticesthatperpetuatethelowstatusofwomen.Ghana,forinstance,tookstepstoeliminatetraditionalandreligiouspracticesthatjeopardizethe' reproductiveandsexualhealthofthegirlchild.ItenactedalawagainstFGM,whichalsocriminalizes,  interalia, v%."# discriminatorywidowhoodritesandpunitiveactions,includingtheirseclusionfromsociety,againstwomensuspectedofpractisingwitchcraft.InBurkinaFaso,alawbanningFGMwentintoeffectin1997,whilein1998thePresidentofSenegalbannedthepractice.InEasternUgandacommunitybasedeffortstoeradicateFGMhaveresultedinadeclineofthepractiveofthirtysixpercent.E+` ` | hp x (#` ` | XE2qe}  126  .3  ԀWithregardtoeducation,avarietyofinterventionsarebeingimplementedtonarrowgendergapsineducationalattainmentandtoremovegenderbaseddiscriminationineducationalsystems.CambodiacreatedaWorkingGroupintheMinistryofEducationtoaddresstheissuesofgirls'enrolmentandretentionlevelsinschool.IntheUnitedRepublicofTanzania,theGovernmentestablishedadditionaldayclasses @.*, forgirlsinsecondaryschoolsincommunitieswheregirls'secondaryeducationwasadverselyaffected.Manycountrieshavealsousedcurriculumreformprocessestoensurethatcurriculabecamemoregendersensitiveinboththeircontentandintheimagestheypresented.̛B(` ` hp x (#` ` | XB&    EmphasizingMaleResponsibilityandPartnership  0   ?+` ` | hp x (#` ` X?2qe~  127  .3  ԀAlthoughprogresstowardsensuringthatmentakeequalresponsibilityfortheirownaswellastheirpartnersreproductiveandsexualhealthwasslowinitially,thegainssince1994havebeenimpressive.Thereisnowclearlyamoreopendialogueaboutthemannerinwhichvariousculturalpracticesperpetuategenderstereotypingandgenderinequalities.'0"B(` ` hp x (#` ` | XB2qe  128  .3  ?+` ` | hp x (#` ` X?ӀSomecountrieshavetriedtoguaranteeaccountabilityamongmenbyenactinglawsthatmakeitillegalnottoacknowledgetheirresponsibilityregardingtheiroffspring.Brazil,forinstance,enactedacivilcodereformthatfacilitatestheidentificationoffatherhoodthroughDNAtests.Atthesametime,changestothePenalCodewereproposedtoincreasepenaltiesformenwhohavesexwithgirlsundertheageof14.B(` ` hp x (#` ` | XB?+` ` | hp x (#` ` X?2qe  129  .3  ԀThechangingperspectivesofmenonawiderangeofpopulationandrelatedissuesarebeingdocumented,thuscreatingabasisforthedevelopmentofappropriateinterventions.Researchonmasculinityindifferentsocioculturalsettingsisdemonstratingthatmen'srolesascustodiansofideology,knowledgeandfinancialresourcesmakethemcriticalandpotentiallystrongagentsforchangetowardsthegoalofgenderequality.Suchresearchisalsoattemptingtodecipherwhythesocialconstructionofmalegenderidentitiesseemstopredisposemanyofthemtowardsviolenceagainstwomen,andhowthiscanbedeflected.CostaRica,forexample,hasundertakenanationalstudyonmasculinity,sexualityandresponsiblefatherhoodtoinvestigatetheattitudesofmen,theirsexualpracticesandtheirfatherhoodroles.B(` ` hp x (#` ` | XB@  % Constraints  d 2qe  130  .3  ԀDespitetheachievementssofar,muchmoreremainstobedonetoaddresscontinuinggenderinequalitiesthatconstraintheabilityofwomenandgirlstoexperiencehighstandardsofreproductiveandsexualhealth.Thepersistenceoftraditional,religiousandculturalattitudesandpracticesthatsubjugatewomen,suchasFGM,alsoimpactsnegativelyonthereproductiveandsexualhealthofwomenandgirls.2qe  131  .3  ԀSomeofthemechanismsforpromotinggenderequalitywithingovernmentstructureshavesufferedfromunderfinancinginrelationtotheiroftenhugetasks.Structurally,somebureaushavenoaccesstohighlevelpolicyprocesses,whichmayhindertheireffortsingendermainstreaming.Althoughmanygovernmentministriesordepartmentssuffergenerallyfromthelackoftechnicallyqualifiedstaff,thosetaskedwiththepromotionofgenderequalitymayberelativelymoredeprivedbecauseofthescarcityofpersonneltrainedintherelevanttechniques:genderanddevelopmentisafairlyrecentfieldofspecializationinmostacademicinstitutions.<(` ` hp x (#` ` X<?+` ` | hp x (#` ` X?2qe  132  .3  ԀInaddition,manynewgovernmentstructureshavebeengivenchallengingtermsofreference,withmultipletasksofpolicyandstrategydevelopment;technicalsupporttooperationaldepartments;monitoringandfunctioningaswatchdogsvisvisgenderequalityandwomen'sempowermentissues;andnetworkingwithwomen'sorganizationsandthecivilsociety.Toperformtheirtasksadequately,manyofthe @.*, machineriesestablishedforwomen'sparticipationstillrequirestrengtheninginresourcemobilizationandtechnicalcapacityformonitoringandpolicyanalysis.Theirorganizationalstructuresandnumberofstaffshouldalsoreflecttheirlargemandates.Mostimportant,measuresshouldbeestablishedtoensurethatthesemechanismsareabletoholdsectoralministriesaccountablewithregardtothepromotionofgenderequality,equityandempowermentofwomen.  0 B(` ` hp x (#` ` | XB <(` ` hp x (#` ` X<2qe  133  .3  ?+` ` | hp x (#` ` X?ӀEffortstoimprovetheeducationofthegirlchildareconstrainedattwolevels.Atthemacrolevel,thereisanoverallscarcityofresourcesearmarkedfortheeducationalsector.Thisissometimescompoundedbyweakpoliticalwilltoinvestintheeducationofgirls.Atthemicrolevel,culturalattitudesstillresultingreaterfamilyinvestmentintheeducationofboysasopposedtogirls.B(` ` hp x (#` ` | XB?+` ` | hp x (#` ` X?2qe  134  .3  ԀFinally,itisessentialtonotetheincreasingprivatizationofmanysocialservicesindifferentcountriesoftheworldhasoftenhadagreaterimpactonwomenthanonmen.Withregardtohealth,thedecliningroleofthestateisintroducinginequitiesinaccesstohealthbecauseoftheincreasingcostofprivatesectorhealthprovision.Thismeansthatitisthepoor,alargeproportionofwhomarewomen,whoareoftenshutofffromaccesstohealthservices.Inthiscontext,womenarealsoshoulderingmoreofthehealthburdenaccruingtofamilieswhocannolongeraffordhospitals,forcingtheilltobelookedafterathome,oftenbywomen.Anotherfactorwithgenderimplicationsistheglobalizationoftheworldeconomy,whichhassometimesledtotheincorporationofwomenintoindustrialworkcharacterizedbylowerwages;poorworkingconditions,oftenmarkedbyoccupationalhazards;andabsenceofworkersrights,includingmaternityleaveandcollectivebargaining.  FurtherActionRequired  v   2qe  135  .3  ԀGovernmentsshoulddevelopmultisectoralcoordinationandinterdisciplinarytechnicalteamstosystematicallyaddressgender,populationanddevelopmentissuesatcommunityandnationallevels.E+` ` | hp x (#` ` | XE2qe  136  .3  ԀGovernmentsshouldpromotezerotoleranceofgenderbasedviolencethroughtheenactmentandenforcementofappropriatelaws,theimplementationofCEDAWandtheundertakingofstudiesthatdemonstratethemultipleconsequencesofgenderviolenceonthehealthofwomenandgirlsanditsimpactonpublichealthexpenditures.B(` ` hp x (#` ` | XB2qe  137  .3  ?+` ` | hp x (#` ` X?ӀCivilsociety,especiallyNGOs,shouldstrengthentheiradvocacyeffortstoincreaseandsustainbroadbasedpoliticalwillforthepromotionofgenderequality.ThiscanbeaccomplishedthroughthecreationofNGOcoalitionsandconsortiumswhichpooltheirdifferentexpertisetogether.B(` ` hp x (#` ` | XB2qe  138  .3  ԀParliamentarygroupsshouldestablishstronglinkageswiththecivilsociety,especiallytheNGOs,tostrengthenadvocacyfortheutilizationofinternationalinstrumentsandconventions,suchasCEDAW,togaugeprogresstowardsgenderequalityatthenationallevel.2qe  139  .3  ԀCivilsociety,especiallyNGOs,shouldreinforcetheirIECcampaignstocreateawarenessincommunitiesandamongreligiousandotherpublicopinionleadersaboutthenegativeimpactofsomeprevailingtraditionalattitudesandpracticesonwomen'sselfdeterminationandtheircapacitytomakedecisionsthataffecttheirownlivesand/ortoparticipateinnationaldecisionmaking.Equally,programmes @.*, thataimateradicatingharmfultraditionalpractices,suchasFGM,mustbeexpandedandreinforced,buildingonthelessonslearnedfromearliersuccessesandfailures.2qe  140  .3  ԀGovernmentsshouldensurethatpopulationanddevelopmentprogrammessupportandreinforcethepositiverolesthatmenplayinreproductiveandsexualhealthwhilesafeguardinganenhancedpositionforwomeninsociety.Operationalprogrammesshould,therefore,incorporatestrategiesthatenlistthesupportofmenforthepromotionofreproductiveandsexualhealthandrightsoftheirpartners,whilealsoenablingmenthemselvestotakeresponsibilityfortheirownreproductiveandsexualbehaviour.2qe  141  .3  ԀGovernmentsshouldreinforcetheirsupportfortheprotectionofthehealthofthegirlchild,includingincreasedinvestmentinhereducation,lifeskillsdevelopment,andpromotionofequalconditionsofemploymentforbothyoungwomenandmen.Theseeffortsshouldalsoincludestrategiesandactivitiesthatencourageandenhancegendersensitivesocializationprocessesforboysathomeaswellasatalllevelsofbothformalandinformaleducation.?+` ` | hp x (#` ` X?2qe  142  .3  ԀNGOsshouldreinforceadvocacyforstrengtheninglegalframeworksandpoliciestopromoteandprotectthehumanrightsofwomenandgirlsandtoenforcethemeffectively.Mechanismstomonitor,documentandredresshumanrightsviolations,especiallywithregardtovulnerablegroupssuchasrefugees,shouldbeputinplace.B(` ` hp x (#` ` | XB2qe  143  .3  ԀGovernmentsandcivilsociety,especiallyNGOs,shouldstrengthencollaborationandcooperationforthepromotionofgenderequalityandtheempowermentofwomen.ThiscanbeachievedthroughtheestablishmentofnationalmechanismssuchasCommissionsforGenderEqualitywithamandateofcomprehensivemonitoringofprogresstowardstheachievementofICPDgoals.<(` ` hp x (#` ` X<2qe  144  .3  ԀTheprivatesectorshouldestablishmechanismsthatmonitortheinstitutionalizationofgenderequalitynormsandvalues,includingeliminationofsexualharassmentandtheactivepromotionoftheempowermentofwomen,inaccordancewithinternationalconventionsandpractices.?+` ` | hp x (#` ` X?2qe  145  .3  ԀGovernments,theUnitedNationsandthedonorcommunityshouldsupportthedevelopmentandwideavailabilityandapplicationofgenderdisaggregateddataandthedevelopmentofappropriateindicatorsformonitoringprogresstowardsgenderequality.Inparticular,thegenderdifferentiatedeffectsofglobalizationneedtobewellresearchedandunderstoodsothatappropriatemeasurescanbeputinplacetosafeguardinteraliawomenshealth. #: ! E+` ` | hp x (#` ` | XE2qe  146  .3  ԀTheUnitedNations,donorsandtheinternationalcommunityshouldsupporttheprovisionanddevelopmentoftechnicalcapacityatthenationalleveltodevelopandinstitutionalizeeffectivestrategiesforgendermainstreaming,throughbothNorthSouthandSouthSouthstrategies.B(` ` hp x (#` ` | XB2qe  147  .3  ԀGovernmentsandtheinternationalcommunityshouldallocatemoreresourcesfortheimplementationofcomprehensivestrategieswhichensurethatwomen'sneedsandconcernsarewellreflectedinpopulationanddevelopmentpolicyandprogrammingprocesses. <(` ` hp x (#` ` X< L,)* &      B.` hp x (#` ` XB ChapterIV.REPRODUCTIVEHEALTH,INCLUDINGFAMILYPLANNING H ANDSEXUALHEALTH,ANDREPRODUCTIVERIGHTS  B 'HCU  E1` hp x (#XE2qe  148  .3  ԀTheICPDProgrammeofActionendorsestherightofallindividualstohavetheirreproductivehealthneedsmetovertheirlifespansthroughasexualandreproductivehealthapproachtoinformationandservicedelivery.Reproductiverightsareunderstoodashumanrights.Therighttovoluntarychoiceinreproductivedecisionsinvolvesensuringequalityandequitybetweenwomenandmenandtheprovisionofuniversalandequalaccesstocomprehensivequalitysexualandreproductivehealthservicesthatprotectprivacy,informedandfreeconsent,andconfidentiality.H.` hp x (#XHE1` hp x (#XE2qe  149  .3  ԀIntheyearsbefore1994,somedevelopingcountrieshadwitnessedsignificantchangesintheirpopulationprogrammes,havingshiftedfromusingfamilyplanningprogrammesforcontrollingpopulationgrowthtoemployingtherightsbasedapproachlateradoptedbytheICPD.TheICPDprovidedallcountriesamajorimpetusforacceleratingthisshiftawayfromverticalserviceprovision,targetsandquotas,andtowardscoveringallthereproductivehealthneedsofclientsandpromotinggenderequality,equityandtheempowermentofwomen,andadolescentreproductivehealth.   H.` hp x (#XHE1` hp x (#XE2qe  150  .3  ԀTheProgrammeofActiondescribesthebasicprinciplesforimplementingqualitysexualandreproductivehealthservices.Theseincludetheneedto:P  K1` hp x (#XKP]"0    0(#(#Developadynamicpolicyandimplementationprocessthatisparticipatoryandrepresentativeof  allstakeholders;P]"^݌ (#(# Ќ  P  P%_"0    0(#(#Developastrategicimplementationplanthatisbasedonphasedprioritizationandonresource p availabilitytoensureeffectiveprogressandaccountabilityPXX;XXPP%_@_݌j(#(# Ќ  P  P`"0    0(#(#Conductastructuralandstrategicreorientationofhealthsystemsandfinanceinthecontextof ^ healthsectorreformandconsidershiftingfromverticalmaternalandchildhealthandfamilyplanning(MCH/FP)torightsbasedsexualandreproductivehealthprogrammes,recognizingthatreproductivehealthisnotsimplyamatterofaddingservicesandinformationtoexistingfamilyplanningservices;andP``݌ (#(# Ќ  P  Pb"0    0(#(#Involveandcoordinatevarioussectorstodealwiththesocial,economicandpoliticaldimensions #: ! ofsexualandreproductivehealth,acknowledgingthatreproductivehealthisbestaddressedthroughbroad,multisectoralapproachesandnotjustbyhealthsectororganizations.Pbc݌ (#(# Ќ  H.` hp x (#,` XHE1` hp x (#XE2qe  151  .3  ԀThischapterreviewstheextentofthechangethathastakenplaceinmeetingthereproductiverightsandsexualandreproductivehealthgoalsandobjectivesoftheICPD.Itbuildsoninformationgatheredthroughareviewoftheliteratureonthesubject,interviews,UNFPAfieldinquiriesandExpertRoundTableMeetingsorganizedbyUNFPAontheseissues. c $  4      ׀ X*'( 2qe  152  .3  K1` hp x (#XKӀTherehasbeenconsiderableprogressinimplementingkeyareasoftheICPDProgrammeofActionthroughpolicyreformulation,programmeredesign,increasedpartnershipandcollaboration,andincreasedresourceallocation.Inparticular,therehasbeenincreasingprogresssince1994inensuringreproductive @.*, rightsandimplementingreproductivehealthasdefinedbytheICPDProgrammeofAction.By1998,manycountrieshadmadepolicy,legislativeand/orinstitutionalchangesintheareaofreproductivehealthand/orrightssincetheICPD.Severalcountriesweretestingwaystointegratereproductivehealthservicesandwereexploringothermeanstoensurerightsbasedapproaches.H.` hp x (#XHE1` hp x (#XE2qe  153  .3  ԀEffectiveandempoweredwomensmovements,othermassmovementsandNGOswereprovingtobeimportantinensuringprogressinpolicydevelopmentandimplementationinmanypartsoftheworldandinmanyareasofconcern,includinggeneratingpoliticalwillforpopulationandhealthpoliciesthatarerightsbased.NGOs,whichhadbeengenuinepartnersinframingtheProgrammeofActionagreements,havebecomepartnersinitsimplementation.H.` hp x (#XHE1` hp x (#XE2qe  154  .3  ԀReproductivehealthismoreoftenbeingaddressedasacomponentofbroadhealthprogrammesincountriesundertakinghealthsectorreforms.Thisbroaderapproachisexpectedgenerallytobemorecosteffectiveandtoyieldgreaterconsumersatisfaction,which,inturn,islikelytoleadtomoreeffectiveuseofinformationandservicesbyconsumers.&    H.` hp x (#XH DevelopingReproductiveHealthPoliciesafterCairo     'fo PolicyFormulation   E1` hp x (#XE2qe  155  .3  ԀSectorwideprogressinpolicyformulationhasoccurredinseveralcountries,whileworkonimprovingspecificaspectsofpolicieshasbeguninothers.CriticalmeasuresundertakenbycountriesthataremoreadvancedintheimplementationoftheICPDagendahaveincludedeffortstoprovidefreeandaccessiblereproductivehealthservicesasanoverallhealthcomponentthroughoutthelifecycle(includingthevoluntarychoiceoffamilyplanningmethods).Therehavealsobeeneffortstobroadenissuesofreproductivedecisionmakingsothattherightstoconsensualsexuality,voluntarychoiceinmarriage,familyformationandthedeterminationofthenumber,spacingandtimingofchildrenaremorewidelyavailable.H.` hp x (#XHE1` hp x (#XE2qe  156  .3  ԀSomepoliciesrecognizetheequalrightsofwomenandmenandtheneedtoenhancewomenXXXX'XXXXsstatus  L soastoallowthemtoexercisetheirrights.Mostcountriesgivehighestprioritytothoseaspectsofrightsdealingwithprovisionofservices,whereasafewspecificallyaddressthecontextinwhichreproductivedecisionsaremade,i.e.,genderandpowerrelations.H.` hp x (#XHE1` hp x (#XE2qe  157  .3  ԀThesuccessofsomecountriesinformulatingreproductivehealthpoliciesappearstoresultfromtheidentificationbyGovernmentofpriorityneedsandtheinvolvementofstakeholdersinamultisectoralapproach,makingthepublicawareandplacingreproductivehealthatthecentreofhealthsectorreform.Inthissense,donorsandinternationalagencieshaveplayedafacilitatingroleinGovernmentNGOcollaboration.However,theirsupportforpolicyandprogrammedevelopmenthasoftenbeenfragmented,whichhastendedtoinhibitthedevelopmentofnationalleadershipandcomprehensivepolicyandprogrammedevelopmentforreproductivehealth,rightsandequality. H.` hp x (#XH L,)* E1` hp x (#XE2qe  158  .3  ԀVariousmodelsforpolicydevelopmenthavebeenidentified.Somecountriesembarkedonthedevelopmentofnationalreproductivehealthpolicies;othersincludedreproductivehealthinpoliciesthataddresswomen'shealth;andsomedealtonlywithspecificaspectsofreproductivehealth. H.` hp x (#XH2qe  159  .3  ԀBuildingconsensusregardingthereproductivehealthconceptandinvestingtimeandresourcesinthedevelopmentofpoliciesitselfappeartobeanauspiciousstrategyusedinsomeAsiancountries.BangladeshoffersauniqueexampleofNGOsengagedinaconsortiumandofdonorsworkingtogethertosupportanationalgoal.The1997"HealthandPopulationSectorStrategy",formulatedwiththeinvolvementofNGOs,professionalgroupsandconsultants,affirmstheprinciplesoftheICPDandrecognizestheneedforaclientcentred,lifecycleapproachinwhichfourareashavepriority:safemotherhood,familyplanning,menstrualregulationandcareofpostabortioncomplications,andthemanagementofRTIsandSTDs % $  5      .ThestateofRajasthaninIndiaprovidesanexampleofaclientoriented   andneedsbasedpolicydevelopedinresponsetothetargetfreeapproachinthecountry 8 $  6      .   B.` hp x (#XBE1` hp x (#XE2qe  160  .3  ԀInAfrica,Zambiaundertookamultisectoralanddecentralizedapproachinvolvingcivilsocietyinformulatinganewreproductivehealthpolicywhichaddressesgenderissues,includingmaleinvolvement,aswellastheallocationofresourcesforitsimplementation.Thedevelopmentofthenationalreproductivehealthpolicywasbasedonanextensiveneedsassessmentprocess.Healthdistricts,NGOs,donoragencies,andprivateandindustrialinstitutionswereallinvolved.InGhana,theMinistryofHealthdevelopedareproductivehealthpolicyaswellasreproductivehealthstandardsandprotocols.Thepolicywasbasedontheresultsofaneedsassessmentprocessthatincludedconsultationwithcivilsocietygroups : $  7      .InSouthAfrica,NGOsprovidedkeysupporttoprovincialgovernmentsinthedevelopmentof  awomenXXXX'XXXXshealthpolicy v $  8      . | H.` hp x (#XHE1` hp x (#XE2qe  161  .3  ԀThecaseofBraziloffersaninterestingexampleofwhathashappenedsinceCairo.AlthoughacomprehensivewomenXXXX'XXXXshealthpolicyhadbeendevelopedinBrazilevenbeforetheICPD,progress j acceleratedafterCairowithanincreasedfocusoncertainaspects,includingSTDsandHIV/AIDS,safeabortionwithinthelegalprovisions,postabortioncare,andadolescents.In1997,theCongressapprovedaNationalFamilyPlanningLaw,whichcoversalltemporarycontraceptivemethodsandalsorecognizesvoluntarysterilizationasanacceptableprocedureforreimbursementbytheUnifiedHealthSystem y $  9      . R H.` hp x (#XH FundingIssues !F  E1` hp x (#XE2qe  162  .3  ԀThereappeartobenoconsistenttrendsinfinancingreproductivehealthpolicies.Fundingincreasedinsome  countries(Bangladesh,Peru),andplansfortheintroductionofuserfeesandcostrecovery |$4!" mechanismswerebeingdevelopedinothers | $  10      .Evenwheretherewasashifttowardsincreasingprivate v%."# sectorprovisionofservices,someGovernmentswerecommittedtotheprovisionofasafetynetoffreeservices.H.` hp x (#XHE1` hp x (#XE2qe  163  .3  ԀTheotherissueinvolvedinfundingforreproductivehealthisthequestionofdecentralizationanimportantpartofhealthsectorreforminmanycountries.Whenhealthspendingprioritiesareidentifiedatthelocallevel,safeguardingspendingforreproductivehealthwillbedependenteitheronanunderstandingofreproductivehealthhavingtrickleddowntotheregionalorlocalleveloritshaving"trickledup"fromademandfromwomen,whichwouldbedependentontheirempowermenttorecognizetheirneeds.InZimbabwe,acountryseriouslyaffectedbytheHIVepidemic,women'sNGOswereinstrumentalin @.*, organizingthedemandforstatesubsidizedfemalecondomsthatallowwomentotakecontroloverprotectionagainstHIVinfection.H.` hp x (#XHE1` hp x (#XE2qe  164  .3  ԀInmostcountries,however,resourcesforreproductivehealthhavebeenlimited.Becausethecapacitytodelivercomprehensiveservicesandtomakesweepingsocialchangewaslimited,mostcountrieshavedefinedpriorityareasforinvestment,makinghardchoicesabouttheallocationofscarcehuman,financialandinstitutionalresources.Often,strategieshavecontinuedtofocusonthepreviouslyhighpriorityareasoffamilyplanningandMCH.H.` hp x (#XHE1` hp x (#XE2qe  165  .3  ԀIncountrieswheretheprocessofhealthsectorreformhasbegun,aspecialeffortisbeingmadetoincludereproductivehealthasapriorityareainthepackageofbasichealthservices.InZambia,wherethehealthsectorreformprocesshasbeenunderwaysince1992,abroadbasedunderstandingofreproductivehealthwasfacilitatedbytheinvolvementofalllevelsofthepublichealthsysteminthepolicyformulationprocess.H.` hp x (#XH&      ConstraintsintheDevelopmentofPolicies       'E1` hp x (#XE2qe  166  .3  ԀDespiteunmistakableprogressinthedevelopmentofpoliciesworldwide,countriesreportedthattherewasstillaninadequatelevelofknowledgeandunderstandingofreproductiverightsandhealthasdescribedintheICPDProgrammeofAction,partlybecauseithadnotyetbeensufficientlydisseminated.H.` hp x (#XHE1` hp x (#XE2qe  167  .3  ԀEvenwheretherewasgeneralsupportforandincreasedunderstandingoftheICPDProgrammeofAction,policiesdidnotyetconsistentlyreflectahumanrightsapproachnorwastheresufficientpoliticalcommitment.Fullsupportwasstilllackingforlegislationtoensurereproductiverightsandreproductivehealthandgenderequityandequality.Inmanycountries,existinglawsandregulationsimpededtheimplementationoftheICPDProgrammeofActioninareassuchassexualityeducationandadolescentaccesstoreproductivehealthservices.H.` hp x (#XHE1` hp x (#XE2qe  168  .3  ԀReproductivehealthpolicyhastendedtobeshapedprimarilybyhealthsectororganizationsandprofessionals,totheexclusionofothersectorsanddisciplines.Theresulthasbeeninadequateattentiontothesocial,economicandpoliticaldimensionsofsexualhealthandreproductiverightsandlittleattentiontothepsychosocial,genderandemotionalaspectsofindividualhealthandwellbeing.Politicalinstabilityandfrequentturnoverofcivilservantshavealsounderminedthecontinuityofpolicydevelopment,implementationandmonitoring.&  H.` hp x (#XH   ImplementingQualitySexualandReproductiveHealthProgrammes  p&(#$   IntegratingSexualandReproductiveHealthProgrammes  d(%&   E1` hp x (#XE2qe  169  .3  ԀManycountriesreportedtheavailabilityofvariouselementsofreproductivehealthcare,andmanyhadtakenstepstointegratesomecomponentsofreproductivehealthintotheprimary'|$9healthcaresystem.Yet,progressinimplementingcomprehensive,integratedserviceshasbeenlimited.Somecountriesweremoreadvancedinmovingfrompolicyadjustmentstoactualimplementationofthereproductivehealthapproach,whileotherswerejustsettingouttoundertakechangesinservicedelivery.Thiscontrastshould @.*, bekeptinmindforthefollowinganalysis.However,inleadingcountriesinallcontinentsBrazil,Bangladesh,Ghana,SouthAfrica,TunisiaandZambiaitispossibletoidentifyprevalentstrategiesandkeyissuesinimplementingthereproductivehealthapproachatthenationallevel.Inaddition,evenwherehealthcaresystemshadnotchangedtoimplementingreproductivehealthapproaches,NGOswereoftenalreadydoingso.TheinitialstepstakenbycountriesthatwereadvancinginthisareaincludedtranslatingreproductivehealthpoliciesintooperationalguidelinesbydesigninganapproachtoreproductivehealthservicesreflectiveoftheICPDcommitment,analysingthehumanandinstitutionalconstraints,andpreparingformonitoringprogress.H.` hp x (#XH&      IntegratingandBroadeningServiceDelivery       ' E1` hp x (#XE2qe  170  .3  ԀTwokeystrategicaspectsofmovingtowardsareproductivehealthapproacharetheintegrationofexistingservicesandthebroadeningtheconstellationofavailableservices.Managerialconcernsinimplementingthesestrategiesincludeinstitutionalsetup,trainingandsupervision.H.` hp x (#XHE1` hp x (#XE2qe  171  .3  ԀIntegratingservices.ManycountriesinallregionsBangladesh,Brazil,Ghana,Jamaica,Mexico,  Peru,SouthAfrica,TunisiaandZambia,amongothershavebeentestingwaysofintegratingreproductivehealthservices.Institutionalintegrationseemedtoconstituteamajorhurdle,evenincountrieswhichhadmadeintegrationapriorityissue.Inmanycountries,theverticalorganizationalstructurealongwithcompartmentalizedbudgetsandpersonnelconstitutedthemaininstitutionalbarrierstoamoreintegratedapproach.Whenservicedeliveryactivitiesweredivided,forinstance,betweenfamilyplanningandhealthstructures,possiblymanagedbydifferentministries,countriesexperiencedparallelsystemsandwastedresources.Thus,inmanycases,theinstitutionalchangewasonlyaformaloneduetobureaucraticinactionandmanagementsegmentationincludingprogramming,trainingandevaluation.Inlessdevelopedcountriesthatdependtoagreaterextentonoutsidedonors,thelackofcoordinationamongdonorsalsocontributedtosuchsegmentation.H.` hp x (#XHE1` hp x (#XE2qe  172  .3  ԀThemostcommoninstitutionalchangewastheintegrationoffamilyplanningandMCHunderacommoninstitutionalumbrella.Althoughsomereproductivehealthcomponentshadbeenassembledunderoneinstitution,itwasrecognizedthatonlybettercoordinationwasachievedinthesecases,notfullintegration  $  11      .  L H.` hp x (#XHE1` hp x (#XE2qe  173  .3  ԀAttheservicedeliverylevel,countriesmadeprogressthroughinitiativesoftenbegunbefore1994τinintegratingMCHandfamilyplanningservices.AftertheICPD,thefocuswastofurtherintegratetheseserviceswithSTDandHIV/AIDSprevention,screeningandtreatment.Suchintegration,however,mayhaveinvolvedonlyofferingservicesatthesamedeliveryplace,whiledifferentproviderscontinuedtoaddressindividualaspectsofreproductivehealth,forinstance,screening,counsellingandmethodprovision.Insomecases,serviceswereofferedatthesameplaceandbythesamepersonnelbutondifferentdays.H.` hp x (#XHE1` hp x (#XE2qe  174  .3  ԀBroadeningthescopeofservices.Broadeningthescopeofservicesdoesnotnecessarilyentailthe ^)&' institutionalproblemsofintegration,asnewservicescanbeplacedunderthesameroofasexistingservices.Also,abroaderapproachtoservicedeliverycanoccurevenwithinverticalstructures,whichisthecasewhenserviceprovidersaretrained,forinstance,incounsellingskills,gendermainstreamingandmaleinvolvement.Broadeningservicesinvolvesmanyofthesameconsiderationsregardingtrainingasintegratingservices.Oneofthemostfrequentlyaddedservicestofamilyplanningprogrammeswastheprevention @.*, andmanagementofSTDs,includingHIV/AIDS,followedinsomecasesbyservicesforthetreatmentofthecomplicationsofunsafeabortion(asinBurkinaFaso,IndiaandMozambique).H.` hp x (#XH&    ReferralSystems 1 6  E1` hp x (#XE2qe  175  .3  ԀReferralsystemsrelatebothtotheintegrationofservicesandbroadeningofthescopeofprogrammes.Theestablishmentofhorizontalreferralsystemshasbeenidentifiedasausefulfirststepinintegrationwhereverticalstructuresstillexist.ThiswasthecaseformanyprogrammesinAfricancountriesthatwerebeinglinkedtoSTDsandHIV/AIDSprogrammes.'6H.` hp x (#XHE1` hp x (#XE2qe  176  .3  ԀVerticalreferralsystemsarealsoessentialwithregardtocertainaspectsofreproductivehealth,forinstance,withregardtomaternalcareinwhichreferral,includingtransportation,toemergencyobstetriccareisanessentialinterventiontolowermaternalmortalityandmorbidity.H.` hp x (#XH&    Training л    'E1` hp x (#XE2qe  177  .3  ԀAnumberofcountriesinvolvedtraininginstitutionsveryearlyintheprocessofimplementingthereproductivehealthapproachtoinstitutionalizereproductivehealthtraining.Alsotrainingcurriculaforbothinitialandinservicetrainingwereadaptedtothereproductivehealthclientcentred,needsbasedapproach,evenwhenfullfledgedintegrationhadnottakenplace.InRomania,thetrainingofstaffinfamilyplanningtointegratethisintoprimaryhealthcarehasbeenapriorityasameansofovercomingtheserviceproviders'lackofinformation.InBangladeshwhereamainneedwastoimprovethecompetenceofhealthcareprovidersthetrainingprogrammeisreflectingabroaderscopeofservicestobedeliveredbythesameserviceproviders  $  12      . v H.` hp x (#XHE1` hp x (#XE2qe  178  .3  ԀTrainingisalsokeyinintegratingcrosscuttingissuessuchascounselling,gendermainstreamingandmaleinvolvement.Theenhancementofgenderskillsofstaffhasbeenidentifiedasafirstandcrucialstepinmainstreaminggender  $  13      .Progressinthisareaincludedthedevelopmentoftechniquesformainstreaming ^ genderinreproductivehealthtrainingandexpandingtheavailabilityofsuchtraining.Forinstance,theWorldHealthOrganization(WHO),theWomensHealthProject,SouthAfrica,andHarvardSchoolofPublicHealth,USA,developedacorecurriculumingenderandreproductivehealth.H.` hp x (#XHE1` hp x (#XE2qe  179  .3  ԀContinuedsupervisionthatincludesproblemsolvingskills,especiallyasafollowuptotrainingactivities,hasbeenidentifiedasakeytosuccess.H.` hp x (#XHE1` hp x (#XE2qe  180  .3  ԀAproblemidentifiedintrainingintheAfricancontextalthoughtheproblemmayapplyelsewhereisthat,historically,verticaltrainingcurriculahadbeendevelopedforwhatnowconstitutethecomponentsofreproductivehealth.Inmanyplaces,inservicetrainingcontinuedtobeprovidedcomponentbycomponent.Inatypicalsituation,traininginfamilyplanning,postabortioncare,STDs,HIV/AIDSandsafemotherhoodwasgiven,eachcomponentinseparatetrainingsessions.Thissituationmaywellreflectthesegregationofbudgetsandlackofcoordinationwithinprogrammes,whichareidentifiedasimportantconstraintstointegration.H.` hp x (#XH2qe  181  .3  ԀAlthoughmoreintegratedtrainingcurriculaweredevelopedinLatinAmericaandtheCaribbean(asinColombia,Jamaica,MexicoandPeru),issuesrelatedtosexuality,criticaltosexualandreproductive @.*, health,wereoftenabsentordilutedinthereproductivehealthpartofthewholeconcept.Reproductiverightsandgenderperspectiveswerealsooftenmissing,witharesultingeffectonclientproviderinteractions.B.` hp x (#XBE1` hp x (#XE2qe  182  .3  ԀTheshortageofappropriatelytrainedstaffwasanobstacletodevelopingandimplementingtrainingprogrammes.Thiswasthecaseatthenationallevel,wherehumanresourceswereneededtoredesigntrainingcurriculaandcarryoutthetrainingoftrainers.Thedecentralizationofprogrammeactivitiesalsohighlightedthelimitedhumanresourcesavailableatthelocallevel  $  14      .   H.` hp x (#XH&      QualityofCareImplementingReproductiveRights        ' E1` hp x (#XE2qe  183  .3  ԀAmainobjectiveoftheICPDProgrammeofActionistoimprovethequalityofservices,definedasthewayclientsaretreatedbytheservicedeliverysystem.Thedefinitionfocusesontheprocessofservicedelivery,includingcommunicationandinformationsharing;criteriaforminimalstandardsforproceduresandexaminations;andwhetherclientsreceivetheserviceappropriatetotheirneeds.SincetheICPD,muchofthedebatehascentredonthefeasibilityofimprovingthestandardofqualityofcare,becauseitisseenastoocostly.However,manystudiesrevealthatimprovementsinthequalityofserviceprovisioncanbemadeatareasonablecostandthatwithoutsuchimprovements,initialandcontinuingutilizationofservicesmaysuffer.H.` hp x (#XHE1` hp x (#XE2qe  184  .3  ԀThePopulationCouncildevelopedasituationanalysismethodologythatassessesthequalityofservicesbyobserving,amongotherthings,theeffectivenessoftheuseofresourcesintheclinicalsetting.SituationanalysisstudiesinsomecountriesofsubSaharanAfricaXXXXXXXX       f $  15     havelookedatkeyaspectsofquality | ofservices,suchascontraceptivemethodchoice,clientload,useofclinicalequipmentandwater,thesocialcontextandclients'sexualrelationships.Thisinformationhasbeguntoshedlightontheunderutilizationofexistingresources.Thesefindingsalsorevealthat,withthetrainingofhealthproviderstoenhancetheirinterpersonalcommunicationandtechnicalskills,supervisorysupport,protocolsandappropriaterewards,staffcanprovidebetterserviceswithintheexistingnarrowscopeofservices(familyplanning),andsuchtrainingmayalsoallowtheexpansionofservicestorespondtootherreproductiveandsexualhealthneeds.H.` hp x (#XHE1` hp x (#XE2qe  185  .3  ԀOneofthecriticalquestionsinimprovingthequalityofcareishowtodefineminimumstandardsinpoorresourcesettingsand,atthesametime,improvethequalityofcarecontinuallyasmoreresourcesbecomeavailable.Minimumstandardsshouldalsoapplytotheprivatesector,justasspecialattentionshouldbegiventosettingminimumstandardsforunfamiliarornewservicesandforservicesprovidedinemergencies.H.` hp x (#XHE1` hp x (#XE2qe  186  .3  ԀAmongthetoolsdevelopedforimprovingthequalityofcareisClientOriented,ProviderEfficientservices(COPE),whichwasdesignedbyAVSC.Nowusedworldwideinmorethan30countries,COPEfacilitatesselfassessmentandproblemsolvingbyallclinicstaff.Familyplanningprovidersandsupervisorsarebeingtrainedtosolveproblemsastheyarise.H.` hp x (#XH2qe  187  .3  ԀCounsellingandinterpersonalcommunicationbetweenserviceprovidersandclientsarekeyaspectsofensuringinformedandvoluntaryreproductivechoicesandthus,reproductiverights.Ifclientsarenotprovidedwithsufficientinformationtomakefullyinformedchoices,theirhumanrightsarenotbeingrespected.Qualityofcarealsoincludesissuesofconfidentiality,privacy,counsellingandinterpersonal @.*, relations.SincetheICPD,somecountrieshavemadeprogressininvolvingclientsindecisionsregardingtheirreproductivehealth.B.` hp x (#XB  6 E1` hp x (#XE2qe  188  .3  ԀToensurehighqualitycareinthepublicandprivatesectors,somecountriesreportedhavingimprovedordevelopedregulatoryframeworks.Forexample,inIndia,institutionalqualityassuranceinthehealthsystem,includingtheprivatesector,willbepursuedaccordingtotheguidelinesdisseminatedbythecentralgovernment.InNepal,theGovernmentrecentlyestablishedtheQualityofCareManagementCentrewithintheFamilyHealthDivisiontoprovidesupporttodistricthealthcarecentresforimprovingthequalityofreproductivehealthservices  $  16      . * H.` hp x (#XHE1` hp x (#XE2qe  189  .3  ԀStrengtheningnationalinformationsystems,includingthedevelopmentofindicatorsalongwithoperationalandpolicyrelevantresearch,isconsideredakeytoallowingmoreeffectiveplanning,implementationand monitoringprogresstoachievethereproductivehealthgoalsandobjectivesofthe    ICPDProgrammeofAction.TheIslamicRepublicofIranandthestateofRajasthaninIndiaofferexamplesofefficientinformationsystemdesignsthataresimpleandcleartouseattheservicedeliverylevel.Inthesesystems,onlythemostessentialdataarecollected;appropriatetechnologyisapplied;andthefindingsareofimmediateusebothattheservicedeliverylevelandathigherlevelsofthehealthcaresystem.H.` hp x (#XHE1` hp x (#XE2qe  190  .3  ԀHowever,theessentialissueregardingthequalityofnationalinformationsystemsisthequestionofindicators.Identifyingindicatorsshouldentailaconsiderationofwhethertheymeasureprocessoroutputandwhethertheyarequalitativeorquantitative.Anumberofinternationalagencies,includingUNFPA,WHO,WorldBankandtheEvaluationGroupsupportedbytheUnitedStatesAgencyforInternationalDevelopment(USAID),havedevelopedgroupsofglobalindicatorstoassistinthefurtheradoptionofindicators.Theseindicatorsarenowbeingtestedinthefield.H.` hp x (#XHE1` hp x (#XE2qe  191  .3  ԀAtthenationallevel,ithasbeenfoundtobeanadvantageifallstakeholdersi.e.,allpartiesthatcanmakeuseoftheinformation,suchascommunityrepresentatives,serviceproviders,programmemanagersandresearcherscometogetherindesigninginformationsystems.Theyhavetoidentifywhatinformationtheyneed,howshoulditbeanalysedandhowtheresultsshouldbepresentedtodifferentusers.Forexample,theLatinAmericanandCaribbeanHealthNetworkincollaborationwithsomeGovernmentsintheregionidentifiedsixthematicissuestomonitorineachcountrytheyworkin,includingsexualityandthereproductivehealthofadolescents,qualityofcare,managementofunsafeabortion,maleinvolvementandtheparticipationofwomenindecisionmaking.Qualitativeandquantitativeindicatorselaboratedforeachoftheseissueswillbeusedtoassessthereproductivehealthsituationineachcountry  $  17      . !F H.` hp x (#XH  IncreasingAccesstoReproductiveHealthServices  v%."#   &     CommunicationandEducation   j'"$%   'j'{E1` hp x (#XE2qe  192  .3  ԀInformationandtheconfidencetotakeactioninpersonalandinstitutionalrelationshipsarepreconditionsforsexualandreproductivehealth.NGOshavebeensuccessfulinbuildingtheknowledgebaseandconfidenceofwomen,menandadolescentstoclaimtheirsexualandreproductiverightsandpromotetheirsexualandreproductivehealth,includingtheeffectiveuseofhealthservices. H.` hp x (#XH F-)+ E1` hp x (#XE2qe  193  .3  ԀManydiverseandinnovativecommunicationmethodologiesandmaterialshavebeendevelopedto empowerpeopletoactontheirsexualandreproductiverights.Theseincludedrama,massmediaandpeereducation.However,theeffectivenessofmethodologiesandmaterialshasnotalwaysbeenevaluatedandthecontenthasnotalwaysaddressedthecommonhumanexperience,suchassexualityandgenderpowerrelations,includingviolence.H.` hp x (#XHE1` hp x (#XE2qe  194  .3  ԀOnlyafewcommunicationprogrammes,carriedoutmainlybyNGOs,havehelpedmenunderstandhowpreventingwomensaccesstosexualandreproductivehealthcareendangerswomen'shealthandlivesandhelpedthemchangetheirbehavioursoasnottoputwomen'shealthatriskandtoprotecttheirownhealth.H.` hp x (#XH&      DiversificationofServiceProvision 4      'E1` hp x (#XE2qe  195  .3  ԀThediversificationofserviceprovisionforselectedreproductivehealthservicesthroughtheparticipationoftheprivatesectorandNGOshasimprovedaccessinsomecountries.Forexample,inColombia,PROFAMILIA,anInternationalPlannedParenthoodFederation(IPPF)affiliateprovidingmorethan60percentofthenationalfamilyplanningservices,broadenedtheprovisionofreproductivehealthservicesafter1994.Throughacostrecoveryprogramme,PROFAMILIAsubsidizedservicesinpoorandremotecommunitiesandforteenagers.Costrecoveryhelpedtoensurevoluntaryandinformedchoiceaswellastomaintainahighqualityofcare  $  18      .  H.` hp x (#XH&     ConstraintsofAccess     'nE1` hp x (#XE2qe  196  .3  ԀNotwithstandingimprovements,economicconditionsandtheresultingpoorhealthcareinfrastructureinmanycountriescontinuetoobstructaccesstoservices.Barrierstoservicesincludedistance,cost,ignoranceandthepoorattitudeofproviders.Theseparationofbasicprimaryhealthcareservicesplacesanexceptionalburdenonwomentomeettheirdiverseneedsandthoseoftheirchildren.Italsoleadstoduplicationofinfrastructural,management,informationandothersystems.̀&      IncreasingAccesstoHealthServicesforAdolescents o  R   'QK1` hp x (#XK2qe  197  .3  ԀTheworldtodayhasthelargestgroupofadolescentsinhistory,with1.1billionpersonsaged1019.Investingintheseyoungpeopleandprovidingthemwithrealopportunitiesinlifearevitalstepsinpromotingindividualandsocietaldevelopment.However,fartoomanyadolescentslackhomes,formaleducation,workandbeneficialrecreation,andmanyliveinextremepoverty.Opportunitiesforgirls,ascomparedwithboys,areespeciallylimited.H.` hp x (#XHE1` hp x (#XE2qe  198  .3  ԀProgrammeexperienceindicatesthatadolescentsneedsupporttobuildselfesteemandtodeveloplifeskillsandskillstomanageintimaterelationshipsandtopracticegenderequality.UnprotectedsexualrelationsplaceadolescentgirlsatriskforbothunwantedpregnancyandSTDs,includingHIV/AIDS,andboysatriskforSTDsincludingHIV/AIDS.Therefore,theyneedaccessnotonlytopreventiveservices,suchasinformationandcontraception,butalsotoyouthfriendlyhealthservices,includingdiagnosis,treatment,informationandcounselling. H.` hp x (#XH F-)+ E1` hp x (#XE2qe  199  .3  ԀInthe1998UNFPAFieldInquiry,itisreportedthat55countrieshadtakensomemeasuresto addressthehealthneedsofadolescents,includingreproductivehealth.Amongsuchmeasuresweretheinclusionofadolescentreproductivehealthinyouthandnationalhealthplans,thedevelopmentofpoliciesandguidelinesforadolescentreproductivehealth,andtheestablishmentofministriesofsportsandyouth.Insomecountries,NGOswereespeciallyactiveintestingnewapproachestoprogrammedevelopmentforadolescentssuchaspeereducation,skillsbuildingandcounselling.Actionstofosterunderstandingandsupportamongadultsinthefamilyandinthecommunitywerebeingrecognizedaskeyinvestments.H.` hp x (#XH2qe  200  .3  ԀInColombia,PROFAMILIAsupportedactivitiesinyouthcentresin20ofthecountryscities,wheretheyouthpopulationhaveattheirdisposalmedicalservices,diagnosticsupportandinformation,andsexualandreproductivehealtheducation.InKenya,thesong"INeedtoKnow",performedbyyoungNairobimusicians,wasahit.Thesonghelpedadolescentsaskforareproductivehealthcomponenttobeaddedtoschoolhealthservices.IntheMarshallIslands,ayouthtoyouthprogrammetrainedpeereducatorsandcounsellorssothattheycouldprovidehealtheducationonissuessuchasteenagepregnancy,STDsandHIV/AIDS,substanceabuseandnutritiontoyouth,theirfamiliesandthecommunity.Theprojectalsocateredforthecontraceptiveneedsofadolescents.B.` hp x (#XBE1` hp x (#XE2qe  201  .3  ԀYounggirlsareatparticularriskofreproductiveillhealth.Morethan14millionadolescentgirlsgivebirtheachyear.Alargeproportionofthesepregnanciesareunwanted.WHOestimatesthatasmanyas4.4millionabortionsaresoughtbyadolescentgirlseachyear.Harmfulpractices,suchasFGMandchildmarriagefollowedbyexpectationsofearlychildbearing,furtherincreasetheriskofreproductiveillhealthinadolescentgirls.H.` hp x (#XHE1` hp x (#XE2qe  202  .3  ԀEarlychildbearingalsonarrowsthelifeopportunitiesofgirls.Inmanycountries,girlswhobecomepregnantarenotallowedtocontinuetoattendschool.Inothers,theeducationofboysissimplyvaluedhigherthanthatofgirls.Theresultisthatgirlsconstitutetwothirdsofthemorethan130millionchildrennotattendingschool.Somecountrieshave,however,beguntotakemeasurestopromotegirlseducation,includingdirectincentives,suchaswaivingfeesorprovidingasmallpaymentorfoodallocationforgirlsattendance,andadaptingtheschoolsystemtofacilitategirlsparticipation.Forinstance,overthepastdecade,theBangladeshRuralAdvancementCommitteecreatedmorethan30,000schoolsofferingnonformalprimaryeducation,inwhich70percentofthepupilsweregirls.XXXXXXXX       h $  19       L H.` hp x (#XHE1` hp x (#XE2qe  203  .3  ԀManystudiesshowthatsexeducationpromotesresponsibleattitudesandbehaviour.Thesestudiesalsoshowthatprovidingadolescentswithinformationandservicesonreproductiveandsexualhealthenablesthemtopostponetheonsetofsexualactivityandthat,whentheydoengageinsex,theyaremoreabletoprotectthemselvesfrompregnancyandSTIs,includingHIV/AIDS.H.` hp x (#XHE1` hp x (#XE2qe  204  .3  ԀEnsuringadolescentsexualandreproductivehealthandrightsaswellasimprovedlifeopportunitiesequallyforgirlsandboyswillrequiremuchgreaterinvestment.Asyet,fewGovernmentshavedevelopedcomprehensivestrategiesforinvestinginadolescentreproductivehealth. H.` hp x (#XH X*'( &        IncreasingMaleResponsibility   H   E1` hp x (#XE2qe  205  .3  ԀTheICPDProgrammeofActionrecognizesthathumansexualityandgenderrelationssignificantlyaffectsexualandreproductivehealthandthatmenneedtotakeresponsibilityfortheirownsexualbehaviouraswellastorespectandsupporttherightsandhealthoftheirpartners.Many'HԀcountrieshaveundertakenadvocacycampaignstobroadenorpromotemaleinvolvementinsexualandreproductivehealth.SincetheICPD,therehasappearedtobesomeincreaseinmen'suseofcondomsandvasectomyandsomeexpansionofmaleSTDservices.Inafewcountries,NGOs,especially,developedinnovativeapproachestosupporttheinvolvementofmalesinpregnancyandchildcareandtoencouragethemtodeveloprelationshipsbasedonequalityandmutualrespect.Forexample,inMexico,agroupofmidwivesorganizedaprogrammetotrainCommunityHealthWorkerstoencouragemaleparticipationinreproductivehealthcare,teachingmenthatpregnancyandbirthareafamilyaffairandnotjust"women'sbusiness".H.` hp x (#XHE1` hp x (#XE2qe  206  .3  ԀItisincreasinglyrecognizedthatworkwithboysandyouthisessential.SomecountriesstrengthenedlegislationthatsupportsmenXXXX'XXXXsrolesinthefamily,especiallyconcerningchildsupport.Therehasbeenlittle  improvement,however,inimplementinglawsconcerningviolenceagainstwomen,andoverallprogressonmaleinvolvementinthisareahasbeenlimited.H.` hp x (#XH    Ensuringreproductivehealthforrefugees      E1` hp x (#XE2qe  207  .3  ԀUntilrecently,reproductivehealthwasnotconsideredapriorityintheprovisionofhealthservicesinemergencysituations.However,theICPDProgrammeofActionrecognizestheneedtoensurereproductiverightsandtoprovidereproductivehealthcare,sincereproductivehealthneedscontinuetoexist.Thisisespeciallytrueforadolescentsandwomen.Womenarealsoatgreaterriskofsexualviolenceandrapeinemergencysituations.H.` hp x (#XHE1` hp x (#XE2qe  208  .3  ԀSincetheICPD,reproductivehealthcarehasbeenincreasinglyguaranteedinallemergenciesduetotheimprovedcapacityandmechanismsofresponsebytheinternationalcommunity.AninitiativebyUnitedNationsagenciesandinternationalNGOswasinstrumentalindevelopingacoordinatedandcollaborativeapproachtoreproductivehealth.Thisincludedthedevelopmentofareproductivehealthmanualdetailingabasicpackageofservicesforemergencysituationsthatincludesmaternalcare;familyplanning,includingemergencycontraception;andthepreventionandmanagementofSTDsandHIV/AIDS.Emergencyreproductivehealthkitshavealsobeendevelopedandstockpiledforimmediatedistributionwhenneeded.H.` hp x (#XHE1` hp x (#XE2qe  209  .3  ԀIn1995,anInterAgencyWorkingGroupwasestablishedunderthecoordinationoftheUnitedNationsHighCommissionerforRefugees(UNHCR),withtherepresentationof30NGOs,UnitedNationsagencies,governmentalagenciesanddonorinstitutions,toorganizeandfacilitatereproductivehealthinallemergencysituations.Asaresult,theMinimumInitialServicePackage(MISP)wasdeveloped,consistingofmaterialresourcesnecessarytoimplementservices,includingessentialdrugs,suppliesandbasicsurgicalequipment  $  20      . R+ ()  H.` hp x (#XH L,)* E1` hp x (#XE2qe  210  .3  ԀAlsoin1995,theReproductiveHealthforRefugees(RHR)Consortiumwasfundedbyorganizationsrepresentingamixoffieldserviceorganizations,publichealthorganizationsandpolicy/advocacygroups.Needsassessmentmanualsandmaterialsweredeveloped. H.` hp x (#XHE1` hp x (#XE2qe  211  .3  ԀAlthoughthecapacityandmechanismsoftheinternationalcommunitytorespondtoemergencysituationshaveimproved,andcomprehensivereproductivehealthservicesarenowbeingimplementedearlierinemergencies,theavailabilityofemergencyhealthpersonnelskilledinreproductivehealthinformationandservicesremainslimited.H.` hp x (#XH    &     AddressingComponentsofReproductiveHealth ,  H   'H,E1` hp x (#XE2qe  212  .3  ԀWhethercountriesintheiroverallprogrammedesignhavepursuedtheintegrationofservices,improvedqualityofcareorincreasedaccesstoservices,amorecomprehensivereproductivehealthapproachcanbedistinguishedbylookingatachievementsinitskeycomponents.Withintheconceptofintegratedandcomprehensivereproductivehealth,threecentralissueshaveemergedasglobalconcerns:P  Pz/"0    Meetingtheneedforfamilyplanning;Pz//݌ (#(# Ќ  P  P-0"0    Ensuringmaternalhealth,andpreventingandmanagementofunsafeabortion;andP-0H0݌  (#(# Ќ  P  P 1"0    PreventingandtreatingSTDs(includingHIV/AIDS).P 1%1݌ (#(# Ќ  Somecountries,however,areincreasinglyaddressingotherreproductivehealthissuesnamely,thepreventionofcervicalandbreastcancerandinfertility.H.` hp x (#XH&      MeetingtheNeedforQualityFamilyPlanning 2     '2E1` hp x (#XE2qe  213  .3  ԀEnsuringtheabilityofpeopletochoosewhethertobecomeparentsand,ifso,tochoosewhenandhowoften,isnotonlyakeyinterventionforimprovingthehealthofeveryonebutisalsoahumanright.Forcouplesandindividualstodecidefreelyandresponsiblythenumberandspacingoftheirchildren,afullrangeofsafeandeffectivemethodsoffamilyplanning,whichmeettheexpressedpreferencesofpeople,needstobeaccessibleandaffordable.H.` hp x (#XHE1` hp x (#XE2qe  214  .3  ԀAsof1998,almostallcountrieshadaffirmedtherightofcouplesandindividualstochoosethenumberandtimingofchildrenandtohaveaccesstoinformationandthemeanstodoso.OnlytwoMemberStatescontinuedtoseverelylimitaccesstofamilyplanning z $  21      . d H.` hp x (#XHE1` hp x (#XE2qe  215  .3  ԀInmanycountries,policieslimitingaccesstofamilyplanningservicesarebeinglifted.Also,inmanycountries,regulationsandpoliciesarebeingreviewedconcerningsuchissuesasspousalauthorization,maritalstatusandagelimitsorthosethatdenyservicestoadolescents,tounmarried,divorcedorwidowedwomen,andtowomenwhowanttodelayorspacepregnanciesbutarenotabletonegotiatethiswiththeirhusbands.By1997,however,14countriesstillrequiredspousalauthorizationforwomentoreceivecontraceptiveservices,and60additionalcountriesrequiredspousalauthorizationforpermanentmethods { $  22      . #: ! H.` hp x (#XHE1` hp x (#XE2qe  216  .3  ԀFamilyplanningremainedthecentralfocusofmostprogrammes.However,areproductivehealthapproachtofamilyplanningwasthefirststeptakeninthemajorityofcountrieswhereICPDimplementationhadbegun.Thismeansthateffortsnowneedtobemorefocusedonmeetingtheneedsofclients.Thisincludesreconsideringtherangeofcontraceptivemethodsmadeavailable;informationandcounsellingservicestoenablecontraceptivechoiceinthecontextofassessingtheindividualXXXX'XXXXssexuality,partner's ^)&' relations,genderissuesandthesocialcontext;andinformationandcounsellingonsideeffectsandtheirmanagement.NGOs,suchasIPPFfamilyplanningassociations(FPAs)andwomen'sNGOs,areleadinginthisdomain.However,nationalprogrammesarealsomakingprogress.Forexample,the"targetfreeapproach"wasintroducedinIndiain1995.Itdiscardeddemographicandcontraceptivegoals,replacingthemwitha"communityneedsassessment"approach.China,similarly,wasendeavouringtochangefrom @.*, pregnancyquotastoaclientcentredapproachbasedonreproductivechoiceinaprogrammebeingintroducedwithUNFPAsupportin32countiesthroughoutthecountry.H.` hp x (#XHE1` hp x (#XE2qe  217  .3  ԀSomecountrieshaveadoptedqualityofcareapproaches,whichhaveincludedappropriateservicefacilities;appropriatetechnology;andtrainingofpersonnelincounsellingandcommunicationskillsandtheavailabilityofavarietyofcontraceptivemethods.OftheclinicsstudiedinfiveSubSaharanAfricancountries,81percenthadatleastfourcontraceptivemethodsinstock. 0 $  23      ף $  H.` hp x (#XHE1` hp x (#XE2qe  218  .3  ԀDespitetheencouragingemphasisonimprovingthedeterminantsforqualityofcare,thishasnotautomaticallyledtoclients'actuallyreceivingqualitycare.Areviewoffivesituationanalysisstudiesfoundthatatclinicswithfourormorecontraceptivemethodsinstock,only34percentofnewclientsinterestedinspacingbirthswereinformedaboutatleastthreemethods.Inaddition,inclinicswhichhadinformationalmaterialsavailable,thesematerialswereactuallyusedinlessthanonefifthofclientproviderinteractions.Moreover,between23percentand88percentofproviderswithwaterreadilyavailabledidnotwashtheirhandsbeforeapelvicexamination.  $  24         H.` hp x (#XHE1` hp x (#XE2qe  219  .3  ԀSomecountrieshavemadeprogressinensuringinformedconsentinfamilyplanningsettings.InBangladesh,MexicoandPeruandinsomestatesofIndia,forexample,providerswerebettertrainedinprovidinginformationandinobtainingfullvoluntaryconsentfromclients.H.` hp x (#XHE1` hp x (#XE2qe  220  .3  ԀMostdevelopingcountrieswithavailabletrenddatashowedasubstantialincreaseincontraceptiveuse.Theoverallyearlyincreaseincontraceptiveprevalenceforthedevelopingcountrieswas1.2percentagepointsperannum,whenweightedbythenumberofmarriedwomenofreproductiveage.XXXXXXXX       j $  25      | H.` hp x (#XHE1` hp x (#XE2qe  221  .3  ԀAlthoughthereappearstohavebeenasubstantialincreaseincontraceptiveuseinmanydevelopingcountries,variousindicatorssuggestthatthelevelofunmetneedremainedhigh,atabout2025percentofcouples.Forregionalgroups,thelevelofunmetneedwashighestinsubSaharanAfrica(29percent)andlowestinLatinAmericanandtheCaribbean(18and20percent)  $  26      . ^ H.` hp x (#XHE1` hp x (#XE2qe  222  .3  ԀTwonewcontraceptivemethodsbecameavailableafter1994:onceamonthinjectablesandthefemalecondom.Approximately22countriesinsubSaharanAfricawerebeginningtoprovidethefemalecondom,clearlyrecognizingthatwomenneedamethodthattheycancontrol.Inaddition,researchshowsthatIUDCUT380Aisnoweffectivefor10years.Researchorganizationscontinuedtheirworkoncontraceptivesafetyandpostmarketingsurveillance.H.` hp x (#XHE1` hp x (#XE2qe  223  .3  ԀEmergencycontraceptionhasbecomebetterknownandaccessiblesince1994.Itcoversspecificneedsofwomenwhoareexposedtounprotectedintercourseandcanactearlytopreventunwantedpregnancy.Emergencycontraceptionhasbeenintroducedinanumberofcountries,andtrainingeffortsarealsobeingundertaken  $  27      . d(%& H.` hp x (#XHE1` hp x (#XE2qe  224  .3  ԀIn1998,theuseofQuinacrineforfemalemedicalsterilization,neverconsideredsafebyWHO,wasfinallybannedbytheU.S.FederalDrugAdministration,whichalsorequestedtheU.S.promotertoceasedistributionofthedrugintheUnitedStatesandyieldupallitsstocks  $  28      . L,)*  H.` hp x (#XH F-)+ E1` hp x (#XE2qe  225  .3  ԀDonorsupportforcontraceptivesincreased15percentbetween1994and1996.XXXXXXXX       ) $  29     Byregion,donor H  contraceptivesupportfortheAsiaandthePacificregiondoubledin1996fromtheyearbefore.Themainreasonforthiswasanexpandedsocialmarketingoperationinthearea.DonorsupportfortheAfricaregionovertheperiod19951996was52percenthigherthanthepreviousbiennium.Initiativesareunderwayatglobalandnationallevelsamongthepublic,donorandcommercialsectorstoexpandtheroleofthecommercialsectortomarketlowerpricedhormonalcontraceptivesindevelopingcountriestothosewhocanaffordthem.H.` hp x (#XHE1` hp x (#XE2qe  226  .3  ԀThediversificationofserviceprovidershasimprovedaccesstofamilyplanningservicesinmanypartsoftheworld.Forexample,socialmarketingincreasedby13percentin1997.Morethan16millioncouplesin55countriesbenefitedfromsocialmarketingin1997,versus14.4millionin1996.ThelargeincreasesweremostlytheresultoftheIndianandIndonesianprogrammes.Atotalof937millioncondomsweresoldbysocialmarketingprogrammesin1997,anincreaseof20percentoverthepreviousyear.Thesaleofmorethan900millioncondomsindicatestheimportanceofsocialmarketing,especiallyinviewoftheAIDSepidemic  $  30      .   H.` hp x (#XHE1` hp x (#XE2qe  227  .3  ԀAccesstofamilyplanningincreaseddramaticallyintheCentralAsiancountriesofKazakhstan,UzbekistanandKyrgyzstan.Inthesethreecountries,59percentofmarriedcoupleswerepracticingcontraception,includingmodernandtraditionalmethods,comparedwithlessthan20percentwhodidsoin1990  $  31      .  H.` hp x (#XHE1` hp x (#XE2qe  228  .3  ԀDespiteadvancesincontraceptivetechnologiesandthedeliveryoffamilyplanningservices,thereremainmanypeoplewhoseaccesstoinformationandservicesisseverelyrestrictedbylogistical,socialandbehaviouralobstacles.Theseobstaclescanbeovercomewithsensitivitytothechangingneedsofusersandtheirconstraintsandwithgreaterattentiontologisticsystems,managementcapacityandpublicinformation.Providingfamilyplanninginthecontextofcomprehensivereproductivehealthservicesandencouragingmentoacceptandsupporttheirpartners'contraceptivechoiceswillhelpremovethesebarriers.LXX d H.` hp x (#XHE1` hp x (#XEXXL2qe  229  .3  ԀMethodsformalefertilityregulationremainseverelyinadequate.Inthisregard,donorsandtheprivate e sectorshouldincreaseinvestmentsinresearchandthedevelopmentofnewmethodsformenaswellasfemalecontrolledbarriermethodstopreventSTDtransmissionaswellaspregnancy.LXX   Y H.` hp x (#XH  XXLPromotingWomenXXXX'XXXXsHealthandSafeMotherhood  "[    E1` hp x (#XE2qe  230  .3  ԀGreaterawarenessoftherisksofmaternalmortalityandmorbidityexiststhan10yearsagoduetothemomentumgeneratedbytheSafeMotherhoodInitiative,reinforcedbytheICPDandotherUnitedNationsconferences.Theinternationalhealthanddevelopmentcommunityhasrecognizedthatmaternalmortalityisbothadevelopmentandahumanrightsissue.WHOandUNICEFestimatedthattherewere585,000maternaldeathsin1990.Foreverywomenwhodies,manymoresuffersevereinjuryorillhealth.TheICPDtargetistoreducethe1990levelsofmaternalmortalitybyonehalfbytheyear2000.Althoughaccuratemeasurementisdifficult,itisclearthatmaternalmortalitylevelsremainhighestinsubSaharanAfricaandSouthEastAsiaXXXXXXXX       n $  32     and,moregenerally,thatwomenindevelopingcountriesfacean w+/() unacceptableandfargreaterriskofdeathinpregnancyandchildbirth(1in48)thandowomenlivingindevelopedcountries(1in1,800).H.` hp x (#XH e.+,   H E1` hp x (#XE2qe  231  .3  ԀIn1997,amajortechnicalconsultationinColombo,SriLanka,organizedbytheInterAgencyGroupinSafeMotherhood(whichincludesUNICEF,UNFPA,theWorldBank,WHO,IPPFandThePopulationCouncil),reviewedstrategiesandapproachestoreducingmaternalmortality.Themeetingconcludedthattrainingtraditionalbirthattendants(TBAs),providingantenatalscreeningforhighriskpregnantwomenandprovidingsimplebirthkitswasnotenough.Womenmusthaveaccesstoskilledpersonnelatdelivery, includingassisteddeliveryandlifesavingtreatmentsbackedupbytransportincase * emergencyreferralisrequired;andtopostpartumcare.Torealizethisgoal,sufficientnumbersofskilledattendantsprimarilymidwivesneedtobetrainedanddeployed,especiallyinruralareas.Theyneedtobesupportedwithadequatesuppliesandequipment,regulationsthatpermitthemtocarryoutnecessaryprocedures,andsupportivesupervisionandmonitoring.TBAs,trainedoruntrained,arenotdefinedasskilledattendants  $  33      .   H.` hp x (#XHE1` hp x (#XE2qe  232  .3  ԀAtthemeeting,itwasalsorecognizedthatwomenneedtohavemoreautonomyandchoices.Increasingeducationforgirlsandwomenandexpandingtheiraccesstoincomeearningopportunitiesandtoopportunitiesforlearninglifeskillscanhelpthemimprovetheirstatusandtheiraccesstoresources.Inthisway,theycouldbetteravoidpoorreproductivehealthandunsafemotherhood,evenbeforepregnancyoccurs.H.` hp x (#XHE1` hp x (#XE2qe  233  .3  ԀDespitethelimitedprogressoverall,someGovernmentsinvestedresourcesanddevelopedinnovativeapproaches,somebegunbeforetheICPD.InTunisia,forexample,theSafeMotherhoodProgrammewasinitiatedin1990toimprovethequalityandcoverageofmaternalandneonatalhealth.AftertheICPD,theMinistryofHealthdevelopedacomprehensivereproductivehealthstrategywithothercomponents,suchasreproductivecancersandthepreventionandmanagementofSTDs.InIndonesia,thecoverageofantenatalcareandsuperviseddeliverysignificantlyimprovedaftertheGovernmentdevelopedaprogrammetotrainmorethan54,000communitymidwives.InGhana,Nigeria,UgandaandVietNam,projectsweredevelopedtotrainmidwivesinlifesavingskills,atrainingpackagedevelopedbytheAmericanCollegeofNurseMidwives.Theskillscoveredinthetrainingwerethoseneededtosavethelivesofwomenduringobstetricemergencies,includingriskassessment,problemsolvingandclinicalmanagement.InUganda,theMinistryofHealthlaunchedapilotprojectinonedistricttoestablishasustainablereferralsystem,whichincludedstrengthenedreferralfacilities,communicationandtransportation.Asaresult,obstetricreferralsandCaesareansectionsincreasedthreefoldbetween1995and1996  $  34      .  L H.` hp x (#XHE1` hp x (#XE2qe  234  .3  ԀInterventionsinmaternalhealthareamongthemostcosteffectiveinthehealthsector.Akeychallengetotheirimprovementistoalterexistinghealthfacilities,logisticsystemsandtrainingtoensureappropriateandeffectivecare.Anotherchallengeistoovercomesocialbarrierstoaccess.H.` hp x (#XH&      PreventionandManagementofUnsafeAbortion }  p&(#$   'p&}E1` hp x (#XE2qe  235  .3  ԀWHOestimatesthatsome20millionunsafeabortionstakeplaceindevelopingcountrieseachyearandthatasmanyas70,000womendie,accountingfor13percentofmaternaldeaths.XXXXXXXX       p $  35     Mostcountries ^)&' arestrengtheningeffortstopreventunwantedpregnancies,andsomeareworkingmoresystematicallytoreducethehealthimpactofunsafeabortion,whichremainsamajorpublichealthconcern.AstudybytheAlanGuttmacherInstituteofabortionlawsof152nationsandterritorieswithapopulationof1millionormorefoundthat,since1985,19countries(amongthem,3since1994)enactednewormodifiedexistingabortionlawstoexpandwomenXXXX'XXXXsaccessandchoice. @.*, H.` hp x (#XHE1` hp x (#XE2qe  236  .3  ԀThepreventionofunwantedpregnanciesistheprimaryobjectiveofanyfamilyplanningprogrammeorfamilyplanningcomponentofreproductivehealthprogrammes.ThecorrelationofsucheffortstodecreasingabortionratesisillustratedinthethreeCentralAsianRepublicsofKazakhstan,UzbekistanandKyrgyzstan.DatafromtheMinistriesofHealthshowthattheuseofmoderncontraceptionincreasedinthesecountriesfrom30percentto50percentsincethebeginningofthisdecade  $  36      .Atthesametime, * reportedabortionratesdeclinedbyasmuchas50percent.H.` hp x (#XHE1` hp x (#XE2qe  237  .3  ԀHighratesofabortionarealsocharacteristicofanumberofeasternEuropeancountries.Here,too,effortsareunderwaytoreversethisbyincreasingcontraceptiveuse.AninterestingexampleisRomania,wherefamilyplanningwasillegalunderthepreviousregime.Consequently,maternalmortalitylevelscausedbyunsafeabortionswereveryhigh.AdramaticfallinthematernalmortalityratiowasevidentafterDecember1989,whenanabortionlawwasenacted.However,tofurtherdecreasematernalmortalitylevelscausedbyabortioncomplications,thepromotionofmodernfamilyplanningmethodswithinthescopeofthelaw,weremadepriorities  $  37      .   H.` hp x (#XHE1` hp x (#XE2qe  238  .3  ԀAnumberofcountriesincluding,inAfrica,Ghana,Ethiopia,Kenya,Malawi,Nigeria,SouthAfrica,Uganda,theUnitedRepublicofTanzania,ZambiaandZimbabwe,and,inLatinAmerica,Brazil,Chile,Ecuador,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,ParaguayandPeruhavefocusedonreducingthehealthimpactofunsafeabortionthroughpostabortioncare.Asof1997,morethan114hospitalsandhealthcentresinMexicowereusingmanualvacuumaspiration(MVA)forthetreatmentofincompleteabortion.InGhana,astudywasundertakenonthetrainingofmidwivesworkingatprimaryandsecondarylevelstoofferpostabortioncare,includingthetreatmentofincompleteabortion.Thestudydemonstratedthefeasibilityandacceptabilityofauthorizingmidlevelproviderstoofferpostabortioncareandhadfarreachingrepercussionsinareassuchasimprovedreferralwithareahospitals,bettercommunityeducationaboutunsafeabortionandimprovedstandingofthesemidwiveswithintheircommunities  $  38      . d H.` hp x (#XH&      HIV/AIDSandSTDs   X   'nE1` hp x (#XE2qe  239  .3  ԀTheJointUnitedNationsProgrammeonHIV/AIDS(UNAIDS)estimatesthat33.4millionpeoplecurrentlylivewithHIV/AIDS,ofwhom5.8millionwerenewlyinfectedin1998,themajorityduetounprotectedsexualintercourse.Anestimated13.9millionAIDSdeathshaveoccurredsincethebeginningoftheepidemic,2.5millionofthemin1998  $  39      .Itisfurtherestimatedthathalfofallnewinfectionsareto #: ! youngpeoplebetweentheagesof15and24.TheHIV/AIDSepidemicdrawsitslargesttollinSubSaharanAfrica,where20.8millionorcloseto70percentofHIVinfectedpeoplelive.In29countriesofthisregion,lifeexpectancyatbirthisalready7yearslessthanitwouldhavebeenintheabsenceofAIDS.Moreover,atotalof7.8million,equaling95percent,ofchildrenwhoareorphansbecauseofthediseaseliveinSubSaharanAfrica.Nevertheless,severalcountriesstilldonotrecognizeHIVasamajorthreattopublichealth  $  40      . ^)&' H.` hp x (#XHE1` hp x (#XE2qe  240  .3  ԀUNAIDS,whichbecameoperationalaftertheICPD,iscosponsoredbyUNICEF,theUnitedNationsDevelopmentProgramme(UNDP),UNFPA,UNESCO,WHOandtheWorldBank.ThemissionofUNAIDSistolead,strengthenandsupportanexpandedresponseaimedatpreventingthetransmissionofHIV,providingcareandsupport,reducingthevulnerabilityofindividualsandcommunitiesto @.*, HIV/AIDS,infullpartnershipwithitsUnitedNationscosponsors.SinceJanuary1996,UNAIDSthemegroupsconsistingofrepresentativesofthecosponsoringorganizationsand,insomeplaces,ofotherinterestedparties,havebeenestablishedinmostcountriestoincreasetheefficiencyandeffectivenessoftheresponseofUnitedNationssystemandtocoordinateHIV/AIDSactivitiesamongthecosponsoringagenciesandwithnationalAIDSprogrammes.NGOsarealsomembersofthethemegrouportechnicalworkinggroupinanumberofcountries,includingBrazil,Chile,DemocraticRepublicoftheCongo,Jordan,RwandaandSwaziland.H.` hp x (#XHE1` hp x (#XE2qe  241  .3  ԀThereiswidespreadagreementthatRTIsandSTDs,includingHIV/AIDSpreventionandtreatment,shouldbeanintegralcomponentofreproductivehealthprogrammes.SincetheICPD,muchefforthasgoneintodevelopingoperationalstrategiesandapparatus.Studieshavedemonstratedthefeasibilityofintegration.Specifically,reproductivehealthprogrammescanreducelevelsofSTDs,includingHIV/AIDS,by:P  P="0    Providinginformationandcounsellingthataddressescriticalissuessuchashumanrelationships,   includingsexuality,genderrolesandpowerimbalancesbetweenwomenandmen,andmothertochildtransmissionofHIV;P=X݌ (#(# Ќ  P  P"0    Distributingfemaleandmalecondoms;andP͝݌(#(# Ќ  P  Ph"0    DiagnosingandtreatingSTDs,developingstrategiesforcontacttracingandreferringpeopleinfected  withHIVforfurtherservices.Ph݌ (#(# Ќ  H.` hp x (#XHE1` hp x (#XE2qe  242  .3  ԀSomecasestudiesindicatethatthetrainingandsupportforserviceprovidersisinsufficient,especiallyinsuchactivitiesasinformationandcommunication,andcounselling.Forinstance,fourcasestudiesconductedinEastandSouthernAfricaunderlinetheneedforproviderstohavesufficienttraining,availableequipmentandimplementationaids.Thesestudiesalsoidentifyasimportantfactorsforthesuccessofintegrationtheproviders'willingnesstodiscusssexualityandSTDswithclientsandtheirabilitytocorrectlyidentifyriskcasesforscreening.H.` hp x (#XHE1` hp x (#XE2qe  243  .3  ԀTheeducationofyoungpeopleisclearlycriticaltopromotingbehaviouralchangeinhumanrelationships,valuesandnormsregardinggenderrolesandgenderpowerimbalances.In64countries,supporthadbeenprovidedfortheintegrationofHIV/AIDSpreventionmodulesintoinschoolandoutofschooleducationprogrammes.Accordingtoa1997UNAIDSreviewoftheimpactofpreventiveeducationonthesexualbehaviourofyoungpeople,qualitysexeducationhelpsadolescentsdelaysexualintercourseandincreasesafesexualpractices.XXXXXXXX      ݢ s $  41     ףThevalueoffocusedeffortscanbeseeninUganda,where v%."# adirectandcomprehensiveapproachwastakentoaddresstheproblemamongyoungpeople,inparticular,andwhereHIV/AIDSprevalenceratesarenowstabilizingamongyouth.H.` hp x (#XHE1` hp x (#XE2qe  244  .3  ԀThetechnologyforHIV/AIDSpreventionandcontrolisstillinadequate.Avaccineisnotyetavailable,butanimportantaccomplishmenthasbeenthedevelopmentofthefemalecondom,theonlyfemalecontrolledbarriermethodthatcanprotectagainstHIVtransmission.Countrieshavealreadyintroducedthisnewmethodasaresultoftheorganizeddemandofwomen'sgroupsandinrecognitionof theimportanceofsupportingwomenXXXX'XXXXscontrolinthisarea.Indicationsarethatthepublicsectorpricewill F-)+ fallinresponsetoincreasingdemand.Withregardtomicrobicides,40newleadshavebeenidentifiedand15arenowintheclinicaltrialstage. H.` hp x (#XH  6 E1` hp x (#XE2qe  245  .3  ԀUNAIDS,UNFPA,UNICEFandWHO,in1998,embarkedonanewinitiativetoreduceHIVtransmissionfrommothertochildinlowincomecountries.TheinitiativeaimsatofferingvoluntaryandconfidentialHIVcounsellingandtestingtopregnantwomen,andatprovidingthosewholearntheyareinfectedwithantiretroviraldrugs,betterbirthcare,safeinfantfeedingmethodsandpostnatalcounsellingandfamilyplanning.Theinitiativeseeks,initiallyinapproximately11pilotcountries,totranslateintoactionthefindingsofresearchintotheefficacyofshorttermdrugregimens,asinonestudyinThailand,whichfoundthataonemonthcourseofanantiretroviraldrughadeffectivelyhalvedtheriskofHIVinfectioninnonbreastfedinfantsborntoHIVpositivewomen.H.` hp x (#XH  FurtherActionRequired      E1` hp x (#XE2qe  246  .3  ԀTofullyrealizethegoalsandobjectivesoftheICPDProgrammeofActioninreproductivehealthandrights,anumberofkeyareasrequireincreasedattention.Futureactionsmustbebasedontheprinciples,goalsandobjectivesadoptedbytheICPD,whichemphasizetheuniversalityofhumanrights,includingthesexualandreproductiverightsofwomen,menandadolescents,andtheneedforpartnershipsofallkindstoenableGovernmentstomeettheICPDProgrammeofActionobjectives.&    H.` hp x (#XH  DevelopingReproductiveHealthPolicies      '!E1` hp x (#XE2qe  247  .3  ԀGovernmentsshouldensurethatnationalhealthplans,includinghealthsectorreformprocesses,fullytakeintoaccountthesexualandreproductivehealthneedsoftheirpopulation.H.` hp x (#XHE1` hp x (#XE2qe  248  .3  ԀGovernmentanddonorsshouldbothfacilitateandfinanceparticipatorypolicydevelopmentprocessestoincluderepresentativesofallstakeholders.Toensureeffectiveprogressand  accountability,policiesmust p includeastrategicimplementationplanthattakesintoaccounthumanresources,institutionalcapacityandresourceavailability.H.` hp x (#XHE1` hp x (#XE2qe  249  .3  ԀGovernmentsshouldenactandimplementlegislationandpoliciesrequiredtomeetthecommitmentsmadeinCairo,usingallnecessaryandappropriatemeans,suchasremovingrestrictivelaws.Theyshouldcontinuetopromotereorientationofthehealthsystemtoensurethatpolicies,strategicplans,andallaspectsofimplementationarerightsbased,coverthelifecycleandserveeveryone.H.` hp x (#XHE1` hp x (#XE2qe  250  .3  ԀGovernmentsshouldinvestintrainingparliamentarians,legislatorsandthemediaintheimportanceoftheProgrammeofAction.H.` hp x (#XHE1` hp x (#XE2qe  251  .3  ԀGovernmentsshouldengagenotonlythehealthsectorbutallrelevantsectorsinpolicydevelopmentandimplementation.'XXXX j'"$% H.` hp x (#XHE1` hp x (#XEXXX'X2qe  252  .3  ԀGovernmentsshoulddevelopreproductivehealthprogrammesbasedonanassessmentofsexualand H)&' reproductivehealthneedswhichfullyinvolvesallstakeholders.'XXXX B*&( H.` hp x (#XHE1` hp x (#XEXXX'X2qe  253  .3  ԀGovernmentsshouldensurethatNGOsandtheprivatesectorareenabledtomaketheirfullest  ,(* possiblecontributiontonationalreproductivehealthprogrammes.H.` hp x (#XH .*, E1` hp x (#XE2qe  254  .3  ԀGovernmentsandtheinternationalcommunityshouldensurethatthecontinuingreproductivehealthneedsofindividuals,especiallywomenandadolescents,inemergencysituationsaremet.'XXXX B H.` hp x (#XH   `     h   XXX'XԀ < &     ImplementingQualitySexualandReproductiveHealthProgrammes   6   '6E1` hp x (#XE2qe  255  .3  ԀTomoveverticalservicesandmanagementsystemstowardsintegratedcomprehensivecare,Governments,supportedbydonorsandNGOs,willneedtoundertakeseveralactions,asfollows:P  P"0    K1` hp x (#XK0(#(#Bringaboutthestructuralintegrationofreproductivehealthservicesor,atleast,functional   integration,includingeffectivereferralsystems,trainingandsupervision;P݌ (#(# Ќ  H.` hp x (#,` XHP  E1` hp x (#XEP"0    0(#(#Increaseinvestmentsinstandardsofserviceprovision,maximizingtheuseofexistingresourcesto   providequalityservicesandconductingcontinuingevaluation;P݌ (#(# Ќ  H.` hp x (#,` XHP  E1` hp x (#XEP"0    0(#(#Increaseinvestmentsintrainingnotonlytoprovidetechnicalskillsbutalsotoprepareproviders   tocommunicateclearlywithempathyandwithrespectforhumanrights,genderequality(includingarecognitionofviolenceagainstwomen)anddignity,andtoprovidedignifiedcare;and,P݌ (#(# Ќ  H.` hp x (#,` XHP  P"0    E1` hp x (#XE0` (#(#  Improveregulatoryframeworksandtheirapplicationtoensurehighqualitycare. kGP݌` (#` (# Ќ  H.` hp x (#,` XH2qe  256  .3  ԀE1` hp x (#XEAllreproductivehealthserviceprovidersshouldhaveintegratedreproductivehealthtraining,whichwouldincreasinglyenablethemtoprovideadditionalreproductivehealthservicesattheprimaryhealthlevel. N H.` hp x (#,` XH    StrengtheningCommunicationandEducation Q     E1` hp x (#XE2qe  257  .3  ԀGovernments,aswellasNGOs,shouldincreasetheireffortstoevaluatetheeffectivenessofcommunicationtechniquesandmaterialsandsharethemwidely.Thecontentmustaddressallappropriateaspectsofsexualandreproductivehealth,includingsexuality,powerrelationsbetweenmenandwomen,andviolence.H.` hp x (#XHE1` hp x (#XE2qe  258  .3  ԀThemassmediashouldbeencouragedtoconveyimagesandmessagesthatarerespectfulofbothwomenandmen,fosterpositiveadolescenthealthandpromotegenderequality.H.` hp x (#XH& 9    IncreasingAccesstoHealthServicesforAdolescents e  .'#"   '9.'JE1` hp x (#XE2qe  259  .3  ԀGovernmentsshoulddevelopandimplementanationalplanforinvestinginyoungpeople.Theplanshouldincludeeducation,vocationaltraining,incomegeneratingopportunities,andsexualandreproductivehealthinformationservices.Specialattentionshouldbegiventogenderequalityandequityandtoyouthwhoaredisadvantagedduetopoverty,residenceordisability.H.` hp x (#XH -*( E1` hp x (#XE2qe  260  .3  ԀGovernmentsshouldensurethatsexualandreproductivehealthprogrammesencompassmorethan"sexeducation"andtheprovisionofcontraceptives.TheyshouldincludebasichealthcareandSTDscreeningandtreatment,effectivereferralservices,andcounsellingthataddressessexuality,buildsselfesteemandpromotesgenderequality;skilltrainingtodevelopbroadbasedlifeskills,includingassertivenessanddecisionmakingtrainingtoresistpeerpressureorabusivesituationsandtomanagesexualfeelingsandovertures,bothwantedandunwanted.H.` hp x (#XH& 9     IncreasingMaleResponsibility i  `   '9 NE1` hp x (#XE2qe  261  .3  ԀGovernments,togetherwithNGOsandinternationalorganizations,shouldenhancetheirsupportforthepromotionofmaleresponsibilityinreproductiveandsexualhealth,includingrespectforhumanrights,supportforapartner'saccesstoreproductivehealthcare,andincreasedresponsibilityinchildcare.InformationonandaccesstocontraceptivemethodsthatprovideprotectionagainstSTDs,includingHIV/AIDS,needtobeextendedasawayofhelpingmentotakeresponsibilityfortheirownreproductiveandsexualbehaviour.H.` hp x (#XH& 9    MeetingtheNeedforQualityFamilyPlanningServices  >   '9E1` hp x (#XE2qe  262  .3  ԀGovernmentsshouldincreasetheireffortstoensureaccesstoafullrangeofsafecontraceptivemethods,includingnewoptionssuchasthefemalecondomandemergencycontraception.H.` hp x (#XH&     PromotingWomenXXXX'XXXXsHealthandSafeMotherhood  |4   LXX  E1` hp x (#XEXXL2qe  263  .3  ԀGovernmentsanddonorsshouldinvestintrainingskilledprovidersandinensuringeffectiveaccess  towellstaffedandequippedfirstreferrallevelhospitals,includingtransport,andmuchstrongerinterventionstohelp'|thecommunityparticularlymalesunderstandandaccepttheirrolesandresponsibilitiesinpreventingmaternalmortality.H.` hp x (#XH& 9     PreventingandManagingUnsafeAbortion k "<   '9"PE1` hp x (#XE2qe  264  .3  ԀGovernmentsshouldtrainandequiphealthpersonneltoprovidepostabortioncareandprovidereliableinformation,compassionatecounsellingandpostabortionfamilyplanning.2qe  265  .3  ԀInternationalagenciesshoulddevelopasystemformonitoringtheimplementationofparagraph8.25oftheICPDProgrammeofAction.& x   H.` hp x (#XH  DealingwithHIV/AIDSandSTDs S +($    'x* 1-)% E1` hp x (#XE2qe   266  .3  ԀCountriesshouldincreaseaccesstofemalecondoms.Investmentsareurgentlyrequiredforresearch anddevelopmentofmicrobicides,simplerdiagnostictestsandsingledosetreatments.ServiceandcommunicationUKUS.,Ԁcampaignsmustincludesexualityandgenderpowerissues.USUK.,H.` hp x (#XHE1` hp x (#XE2qe   267  .3  ԀGovernmentsandtheinternationalcommunityshouldensurethatpreventionandmanagementofSTDs,includingHIV/AIDS,becomeanintegralpartofreproductivehealthprogrammes,particularlyattheprimaryhealthcarelevel.H.` hp x (#XHE1` hp x (#XE2qe   268  .3  ԀGovernmentsandtheinternationalcommunityshouldmakeHIV/AIDSpreventionandcontrolapriorityatthehighestpoliticallevelandimmediatelyfocustheirmajoreffortsinthemostseverelyaffectedcountriesinSouthernAfrica.     &    ChapterV.BUILDINGPARTNERSHIPS H K14 <DL!(#XKForgingPartnershipswiththeNonGovernmentalSector     2qe   269  .3  ԀTheICPDmarkedaturningpointininternationalpolicymaking.Ithasbecomesynonymouswiththespiritofinclusion,cooperationandconsensusforanewgenerationofreproductivehealthandpopulationrelatedpoliciesbasedonhumanrights,genderequalityandequity,andpartnership.TheProgrammeofActionisanintergovernmentalinstrument,adoptedby179Governments;itisalsoareflectionofunofficialdiscussionsbetweengovernmentdelegatesandNGOrepresentativesattheICPD.Itrecognizesthattoimplementtheconceptualshifttoanapproachhighlightinghumancentreddevelopmentandthelifecycleconceptofsexualandreproductivehealthwithinthefullerframeworkofsustainablehumandevelopment,abroadbasedandinteractivecollaborationamongGovernments,theinternationalcommunityandcivilsociety, 4 $  42      ׀especiallyNGOsandtheprivatesector,wouldberequired.Thus,the S   ProgrammeofActioncallsforthepromotionofaneffectivepartnershipbetweenalllevelsofGovernmentandthefullrangeofNGOsandlocalcommunitygroupsinthedesign,implementation,coordination,monitoringandevaluationofpopulationpoliciesandprogrammes.ItalsocallsforstrengtheningthepartnershipamongGovernments,internationalorganizationsandtheprivatesectortoidentifynewareasofcooperation;andforthepromotionoftheroleoftheprivatesectorinservicedeliveryandintheproductionanddistributionofhighqualityreproductivehealthandfamilyplanningcommoditiesandcontraceptives,whichareaccessibleandaffordabletolowincomesectorsofthepopulation.H. <DL!(#X(#HN1` hp x (# X(#N2qe   270  .3  ԀFouryearsafterCairo,changingdevelopmentparadigmshaveshiftedtherolesofGovernment,civilsocietyandtheinternationalcommunity.PartnershiphasemergedasabasicelementtosupportandadvancetheProgrammeofActionimplementationprocess,bothverticallyandhorizontally.SincetheICPD,importantchangeshavetakenplaceinmanypartsoftheworld,whichhavebothstrainedtheexistingpatternsof,andprovidednewopportunitiesfor,thepolitical,economicandsocialconstruct.Thechangeshavecontributedtocreatingapublicsettingthatundergirdstheideaofacivilsociety.Emergingpatternsarecreatingdifferentinstitutionalarrangementswhichhavegivenamajorthrusttotherationalefortheincreasedinclusionofcivilsocietyinanholisticdevelopmentprocess.2qe  271  .3  ԀIthasbecomeincreasinglyapparentthatGovernmentsalonecannotmanagetoprovidethedevelopmentservicestomeetthebasichumanandsocialneedsandaspirationsoftheircitizens.Theinvolvementofcivilsocietyininitiatingandsustainingsocialandeconomictransformationhasbecomeessentialinthecontextofeconomicglobalization,privatization,limitedresourcesandthedownsizinganddecentralizationofthegovernmentapparatus.Atthesametime,newinformationtechnologiesaredramaticallytransformingtheglobalcontextofinformationexchangeandthesharingofideasandexperiencesfromcitiestocommunities.Thefullparticipationofcivilsocietyorganizationsandleaderswillbecomeincreasinglycritical,particularlywithrespecttotheprovisionofreproductivehealthinformationandservicesaswellasthepromotionofadvocacyandsocialmobilizationefforts,inordertocarryforwardthegoalsoftheProgrammeofAction. .*) 2qe  272  .3  ԀAreviewofprogressoverthelastfewyearsonthescopeofcollaborativeeffortswithcivilsocietyprovidesabasisforoptimism.Majorstrideshavebeentakeninproceduralareas,suchaspositivechangesintheconceptofparticipationandtheprocessesforconsultation;recognitionofthechangingrolesofcivilsociety;increasingacceptanceofinnovativeandvarieddevelopmentapproaches,includingdecentralizedandcommunitybasedmodalities;andimprovedpartnershipamongUnitedNationsorganizationsandbodies.Similarly,thecontextforsubstantivediscourseandactionbyallpartieshasalsochanged,withincreasingawarenessofthesocietaldimensionsofdevelopmentandeconomicissues;growingrecognitionofthenecessityforahumanrightsbasedapproach;expandingacceptanceofreproductiveandsexualhealthconceptsandprogrammes;anddeepeningawarenessandacknowledgmentofgenderinequitiesandtheneedforgenderequalityandtheempowermentofwomen.   CreatinganEnablingEnvironmentforPartnershipinPolicyFormulationandProgramme H  ImplementationandMonitoring Y  B  K1` hp x (#XK2qe  273  .3  ԀAftertheICPD,most,ifnotall,Governmentsacceptedtheincreasinginvolvementofabroadrangeofcivilsocietyrepresentationinallaspectsofnationaldevelopment,includingthepromotionofreproductivehealthandrights.AlthoughNGOs,inparticular,havelongbeenactiveinthepopulationandreproductivehealthareas,theirrolesandresponsibilitiesdramaticallyexpandedaftertheICPDdueto,interalia,  economicglobalization,reductioningovernmenthumanandfinancialresources,theincreaseddemandforreproductivehealthservices,andtheneedforrealizationofhumanrights,includinggenderequalityandequity.Asofmid1998,atleast106Governmentsrecognizedand,ofthese,48GovernmentssupportedτNGO/civilsocietyinvolvementintheimplementationoftheProgrammeofAction;59GovernmentsincludedNGOsinallphasesoftheformulation,implementation,monitoringand/orassessmentofpopulationpolicies,plansandprogrammes,while28GovernmentsincludedNGOsonlyintheformulationandimplementationofprogrammesandprojects.ManyGovernmentshaveadoptedsignificantmeasuressince1994topromotetheinvolvementofNGOsatvariousstagesofpolicyand/orprogrammeimplementationinareassuchasreproductivehealthandgenderequality.ThemostgeneralnewmeasureadoptedwastoincluderepresentativesofNGOsorothercivilsocietymembersonthenationalbodiesresponsibleforformulatingpolicies.Insomeothercountries,GovernmentsmadeeffortstoinvolveNGOsinpolicyformulationthroughpolicydialogueorconsultation.Regardingprogrammeimplementation,numerousGovernmentsestablishedanofficetocoordinateprogrammeswithNGOs;inothercases,NGOsimplementedgovernmentfundedprogrammes.LittleornocooperationbetweenGovernmentsandNGOsseemedtoexistinonlyafewcountries,primarilyduetomutualmistrust,civilunrestorpoliticalinstability.Eveninmanyofthesesituations,however,theinternationalcommunityplayedaconstructiverolebyensuringtheinclusionofallappropriatepartiesintheimplementationoftheProgrammeofAction.2qe  274  .3  ԀNotwithstandingthenewpolicies,legislationorothermeasuresthathavebeenadoptedbymanyGovernmentstoenableNGOstoplayalargerroleinpopulationprogrammeimplementation,theenablingenvironmentforNGOparticipationneedstobefurtherstrengthenedinmostcountries.  *&& H.` hp x (#XH  ,8)( 2  B.` hp x (#XBXXXXXXXX      StrengtheningtheHumanResourceandInstitutionalCapacityofCivilSocietyforEffective H Partnership  B 2tiveݜC C    XXXXXXXXԛ XX    E1` hp x (#XE2qe  275  .3  ԀForthecivilsocietytobecomeanevenmoreeffectivepartnerinadvancingtheProgrammeofActionagenda,itiscrucialthatthehumanresourceandinstitutionalcapacitiesofcivilsocietyorganizationsbesignificantlystrengthened.Since1994,onlylimitedprogresshasbeenmadeinthisrespect.Insomecountries,Governmentstookstrongmeasurestostrengthentheinstitutionalcapacityofcivilsociety,including,interalia,theprovisionoffundingandtheremovalofcumbersomelegalrestrictions.Government  ` provisionoftechnicalandfinancialsupporttoNGOs,however,washamperedforvariousreasons,includingthelimitationsofgovernmentresourcesandthedifficultyofselectingrecipientsfromamongthelargenumberoflocalNGOs.H.` hp x (#XHE1` hp x (#XE2qe  276  .3  ԀAlmostallGovernmentsallowedNGOstoreceivefunding,directlyorindirectly,fromexternaldonors.Inatleast57countries,GovernmentspermitteddirectfundingofNGOsfromallexternaldonors(e.g.,internationalNGOs,bilateralandmultilateraldonors),withnorestrictions;duetotherelativelyrecentdifficulteconomicsituationandthereductionorwithdrawalofexternalbilateralassistanceinsomecases,governmentalrestrictionsonexternalfundingofNGOsseemstohaveeased.Inatleast27countries,directfunding,withsomerestrictions(e.g.,Governmenttobeinformed;limitationsonamountoffunding),waspermitted.Inatleast21countries,indirectfunding,throughgovernmentchannelsorwiththeirapproval,wasallowed.Externalfunding,however,alsoposesseveraldilemmas:increasedcompetitionamongNGOsforsuchfunding;lackofstrategicplanningregardinginstitutionalandprogrammaticobjectivesandsustainabilitybyNGOsduetotheirpredominantrelianceonexternaldonors,whichmayhavetheirownagendas;andcrisesofinstitutionalandprogrammeviabilitywhenexternalfundingiswithdrawnfromNGOs.H.` hp x (#XHE1` hp x (#XE2qe  277  .3  ԀThecontributionofcivilsocietytotheadvancementofpopulationissueshasbeenenormous.Inparticular,mostoftheachievementsinreproductivehealthandrights,especiallyintheareaoffamilyplanning,areduetoeffortsofcourageouswomenleaders,theenergyofvolunteerworkersandthecommitmentofNGOs.NGOs,atinternational,regionalandcountrylevels,continuetoplayavitalroleinthewidegamutofpopulationandreproductivehealthactivities.Theimportanceoftheirparticipationinpublicpolicyanddecisionmaking,research,advocacy,educationandtraining,serviceprovision,andmonitoringandevaluationcannotbeoverestimatedoroverstated.Nevertheless,itisclearthatalthoughcivilsociety,andNGOsinparticular,havebeeninstrumentalintheprogressachievedtodate,thevastpotentialofcivilsocietyinthepopulationfieldhasonlybeguntobetapped.H.` hp x (#XHE1` hp x (#XE2qe  278  .3  ԀForcivilsocietyinstitutionstoplaytheirfullrole,theirorganizationalcapacitiesandmanagementcapabilitiesmustbesignificantlyincreasedandenhanced.Inmanycountries,thecivilsocietyhastakeninitiativestostrengthentheirinstitutionalsustainability,buildcoalitionsandmobilizeresources.Overall,however,inmostcountries,NGOshaveachievedonlylimitedprogresstowardsstrengtheningtheirinstitutionalandfinancialsustainability,enhancingnetworkingwithotherorganizations,improvingtheirtransparency,accountabilityandresponsivenesstoconstituenciesorinmobilizingadditionalpublicandfinancialsupportforpopulationactivities.ThelimitedachievementsinthisrespecthamperthepotentialcontributionstobemadebyNGOs.Forexample,NGOsareappropriatelyrecognizedfortheinnovative t.,+* approachesthattheyundertake.Thereplicabilityandbroadadoptionoftheirinnovativeapproaches,however,haveoftenbeenstymiedbyweakornonexistentnetworkingandcoordinationamongNGOsthemselves,particularlyatthecountrylevel.Forexample,inonlyabout21countrieshaveNGOsestablishedanationalcoordinatinggrouponadvocacyand/orforimplementationoftheProgrammeofAction.Inseveralcountrieswheresuchacoordinatingmechanismhasbeeninitiated,issuesofsustainabilityhavearisen.Similarly,inonlyanestimated25countries,haveNGOstriedtocoordinatetheiractivitiesonathematicbasis(e.g.,genderequality,HIV/AIDSandadvocacy)whereasinabout12others,NGOshaveinstitutedaforumfornetworkingandinformationexchange.Incontrast,inatleast53countries,nomechanismforNGOcoordinationornetworkinghasbeenestablished.H.` hp x (#XH.& A    B.` hp x (#XBXXXXXXXX        PromotingPartnershipswiththePrivateSector  ! %.kG  N  .L onoݜC C    XXXXXXXXԛ XX'o H\       E1` hp x (#XE2qe  279  .3  ԀThecommercialprivatesectorprovidesreproductivehealthcareservicesinnearlyalldevelopingcountries.Inmostofthese,theprivatesectorhadalreadybeenactivebeforetheICPD;forexample,insomecountries,theprivatesectorhadbeenoperatingclinics,informingandeducatingthepublicorofferingaffordablecommodities.TheprivatesectorismostinvolvedinsocialmarketingprogrammesinwhichGovernmentsubsidized,lowpricedcontraceptivesaredistributedthroughcommercialchannels.MultilateralorganizationsandinternationalNGOshavestrengthenedcountrylevelactivitiesinthesocialmarketingofcontraceptives.InnovativeinitiativesarenowbeingundertakenbyinternationalorganizationssuchasUNFPAtoworkwithGovernmentsandtheprivatesectortominimizebarriersandtofacilitatecostreductionssothatreproductivehealthservices,includingcontraceptivecommodities,maybemademoreaccessiblebothmoreaffordableandmoreavailabletothemajorityofthepopulation,whileatthesametime,betterenablingthosewhocanaffordtopaytodoso.Activitieswiththeprivatesectortoprovidereproductivehealthinformation,education,counselingorservicesforemployeesorforlocalcommunitieshavebeenadditionallyundertakenorinitiated,forexample,bytheTATAFoundationinIndia.Whileprogresshasbeenmade,importantopportunitiesforcooperationwiththeprivatesectorremaintobeexplored.Proactiveinitiativesarerequiredtosensitizeandmorefullyinvolvetheprivatesector,especiallycorporateleaders,businessassociationsandtradeunions,inallappropriateaspectsofimplementationoftheProgrammeofAction..& !   H.` hp x (#XHXXXXXXXX        RecognizingtheUniqueRoleofParliamentarians *  ! .)onoݜC C    XXXXXXXXԛ$XX$'!!)      H.4 <DL!XH2qe  280  .3  ԀParliamentariansplayauniqueroleinthepartnershipbetweenGovernmentsandcivilsociety.Theyare,inessence,thebridgesbetweenthecivilsocietyandthegovernmentapparatus.SignificantprogressattheadvocacylevelhassensitizedparliamentarianstotheProgrammeofActionissues.Asaresult,intraparliamentarylobbyingactivitieshaveincreased,relevantlegislationhasbeenpromulgatedandregionalandinternationalparliamentariannetworksarethriving!forexample,theAsianForumofParliamentariansonPopulationandDevelopment,theForumofAfricanandArabParliamentariansonPopulationandDevelopment,theInterAmericanParliamentaryGroup,andtheGlobalCommitteeofParliamentariansonPopulationandDevelopment.Allpartyparliamentarycommitteesandgroups,however,needtobeestablished,wheretheydonotexist,andstrengthenedtoensurethatGovernmentsmeettheircommitmentstotheICPD.Parliamentaryadvocacyhasenabledtheleveloffundingtobemaintainedandsustainedinsomecountrieswheresuchfundingwastobedecreasedoreliminated.Anumberofdonorcountries, -** however,havenotmettheircommitmenttotheprocessofmeetingtheICPDtarget,andresourceshavenotsignificantlyincreased,whichmayresultinanoverallshortfallifcurrenttrendscontinue.Insomedevelopingcountries,Governmentshaveincreasedtheproportionoftheirallocationstothesocialsector,whileincountrieswitheconomiesintransition,healthsectorallocationshavedecreasedasaproportionofoverallnationalinvestment.  E+ 4 <DL!4XE StrengtheningCollaborationamongUnitedNations  ] andIntergovernmentalOrganizations      B.4 <DL!XB2qe  281  .3  ԀIn1994,theGeneralAssemblyadoptedaresolutionontheinternationalfollowupoftheICPDthatrequestedUnitedNationsagenciesandorganizationstoreviewandadjusttheirprogrammesinthecontextoftheProgrammeofActionobjectivesandreporttotheEconomicandSocialCouncil(ECOSOC)ontherespectivepolicyimplications.IturgedtheorganizationsandbodiesoftheUnitedNationssystemandtheRegionalCommissionstoactivelyimplementtheProgrammeofActionthroughtheUnitedNationsResidentCoordinatorsystematthefieldlevel.ThissectionhighlightspartnershipsandcollaborativeeffortsamongtheUnitedNationsspecializedagenciesandfunds,interagencyunits,regionalcommissionsandintergovernmentalorganizationstoachievethegoalsoftheProgrammeofAction.E+ 4 <DL!4XE PartnershipsandCollaborationsamongUnitedNationsAgenciesandOrganizations  > B.4 <DL!XB2qe  282  .3  ԀAsafollowuptotheICPD,variousUnitedNationsagencieshavecollaboratedonarangeofinitiativesrelatingtokeyareasoftheProgrammeofAction.UNFPAhasoftenservedasacatalysttopromoteenhancedcoordinationaswellasjointactivitiesamongsisterUnitedNationsorganizationsandotherdonorcommunitypartnersintheimplementationoftheProgrammeofAction.Theexamplessummarizedbelowareonlyanindicationofthebroadspectrumofsuchcollaborativeefforts.2qe  283  .3  ԀUnitedNationsagencieshavebeenworkingcloselyintrackingprogressinreducingchildandmaternalmortality,particularlyinhelpingcountriesbuildastatisticalbaseformonitoringandreportingonsuchprogress.Effortshavebeenmadetobringtogetherbothusersandproducersofdatatoensurethatpolicyanddecisionmakershaveaccesstounderstandableandcurrentinformationthatwillhelpthemtakeinformeddecisionsontheformulationandimplementationofpoliciesandprogrammes.IncollaborationwithWHOandUNFPA,UNICEFhasissuedGuidelinesforMonitoringtheAvailabilityandUseof $\!  ObstetricServices,whichdetailsmeasurementissues,proposesasetofprocessindicatorsandprovides %V"! optionsforcollectingneededdata.Inaddition,acoresetofreproductivehealthindicatorsandmethodologiesforgeneratingandanalysingreproductivehealthinformationhasbeendevelopedthroughajointundertakingofUNFPA,WHOandotherUnitedNationssystemagenciesandorganizations.2qe  284  .3  ԀWHO,UNICEFandUNFPArecentlyestablishedaCoordinatingCommitteeonHealth(CCH)toenhancepartnershipandconcertedactioninachievinghealthandrelatedsocialgoalsaswellasin promotingthemoreefficientuseofresources.TheCCHisatransformationoftheUNICEF/WHOJoint ,)( CommitteeonHealthPolicy,whichwasestablished50yearsago.ThefirstCCHmeetingtookplaceinGenevainJuly1998. 2qe  285  .3  ԀWHO,UNICEF,UNFPA,theWorldBankandtwoNGOsIPPFandthePopulationCouncilhavecosponsoredtheSafeMotherhoodInitiative,whichfocusesonfivekeyareasofaction:advocacy;epidemiological,socialandoperationalresearch;informationdissemination;humanresourcedevelopment;andhealthserviceimprovementmeasures(e.g.,renovationoffacilities,provisionofequipmentandsuppliesandsupportfortrainingforessentialobstetricalcare)innumerouscountries.InOctober1997,atechnicalconsultationonSafeMotherhoodwasheldinSriLankatoreviewprogressonthisaspectofreproductivehealth.E+ 4 <DL!4XEB.4 <DL!XB2qe  286  .3  ԀRegardingadolescentreproductivehealth,UNFPA,UNICEFandWHOhavedevelopedacommonagendaforactionandsupportthroughtheWHOAdolescentsHealthandDevelopment(AHD)Programme.TheAHDProgrammeaimsatusingandexpandingtheavailableknowledgebasetoachieveeffectiveandsustainableprogrammes;facilitatingactionincountries;expandinghuman,institutionalandmaterialresourcestopromoteadolescenthealthanddevelopment;andprovidingtechnicalcooperationtocountriesandkeypartners.E+ 4 <DL!4XEB.4 <DL!XB2qe  287  .3  ԀHarmfultraditionalpracticesconcernboththehealthandtherightsofwomenandchildren.UNFPA,UNICEFandWHOareundertakingconcertedactiontosupportpoliciesandprogrammesthatcanbringanendtotheharmfultraditionalpracticeofFGM.Withinthiscollaboration,WHOfocusesonincreasingknowledgethrougharesearchanddevelopmentprogrammeandpromotingtechnicallysoundpoliciesandapproaches.UNICEFemphasizestheeliminationofFGMthroughtheworkofitsfieldofficesandcountryprogrammes.UNFPAcontinuestoadvocatefortheeliminationofFGMandsupportsthereviewandrevisionofnationalpolicies,laws,regulationsandtraditionalpracticeswhichservetoperpetuatethepractice.UNFPAsponsoredatechnicalconsultationinEthiopiain1996,withrepresentativesfrom25countries,todiscuss,interalia,thetypesoftraining,researchandservicesneededtoeradicatethe r practice.ThepotentialimpactofsuchadvocacyishighlightedbythetremendoussuccessoftheUNFPAfundedReproductiveEducationandCommunityHealth(REACH)ProgrammeinKapchorwadistrict,Uganda,wherecommunitybasedagentsinvolvedcommunityleadersandotherpersonsfromallsectorsofsocietyinsensitizationseminarsabouttheharmfulaspectsofFGM.TheREACHProgrammeresultedina39percentdropinFGMinlessthanoneyear.E+ 4 <DL!4XEB.4 <DL!XB2qe  288  .3  ԀSixcosponsors!UNDP,UNESCO,UNFPA,UNICEF,WHOandTheWorldBank!havepooledandfocusedtheireffortsthroughUNAIDStostrengthenthecapacityoftheUnitedNationssystemto,interalia,assistGovernmentsandcivilsocietytoeffectivelyrespondtotheHIV/AIDSepidemic;andtoimprovethecontentof,accesstoanduseofthebodyofknowledgeneededtoacceleratepreventionandcontrolofHIV/AIDS.UNAIDSalsogivesahighprioritytodeveloping,advocatingandimplementingbestpracticesincombatingtheepidemic.Atthecountrylevel,UnitedNationsThemeGroupsonHIV/AIDShavebeenestablishedtosupportanexpandedmultisectoralresponsetotheHIV/AIDSepidemicandhavebecomeakeymechanismforcoordinatedandjointUnitedNationsactionindatacollectionandanalysis;advocacyandawarenesscampaignsandpreventionprogrammes;andprovisionoffinancialandtechnicalsupport. -l** E+ 4 <DL!4XEB.4 <DL!XB2qe   289  .3  ԀRecognizingthattheprovisionofreproductivehealthservicesisasimportantasprovidingotherservicesinrefugeeandemergencysituations,UNHCRandUNFPAhavegivenanewimpetustomeetingreproductivehealthconcernsinrefugeeandemergencysituations.Thetwoagencieshavesignedamemorandumofunderstandingestablishingaframeworkforcollaborationforthebenefitofpersonsinrefugeesituations.UNHCRandUNFPAarejointlydevelopingstrategiesandprogrammestoprovidereproductivehealthinformationandservicesforwomen,men,youthandadolescentsandtocombatsexualviolence;andorganizingjointassessment,monitoringandevaluationmissionsrelatingtoreproductivehealthinformationandservices.2qe!  290  .3  ԀTheBSSATaskForce,establishedin1995,expandedthetermsofreferenceoftheearlierInterAgencyTaskForceontheImplementationoftheProgrammeofActionoftheInternationalConferenceonPopulationandDevelopment.EighteenUnitedNationsorganizationsandagencies,includingtheBrettonWoodsinstitutions,participatedintheBSSATaskForce.ThemandateoftheTaskForceencompassedthefollowingkeyconcerns:population,withaspecialemphasisonreproductivehealthandfamilyplanningservices;basiceducation;primaryhealthcare;drinkingwaterandsanitation;shelter;andsocialservicesinpostcrisissituations.TheBSSATaskForcemandatealsoencompassedthemainparametersofthe20/20Initiative.(The20/20Initiativeisamutualcommitmentbetweeninteresteddevelopedanddevelopingcountrypartnerstostrivetoallocateonaverage20percentoftheirODAand20percentoftheirnationalbudgets,respectively,tobasicsocialservices.)TheTaskForcefactoredintoitsworkthefollowingcrosscuttingdimensions:selectionanduseofindicators;genderperspectives;resourcemobilization;policyframeworks;thetargetingofspecificgroups,includingthoseinpostcrisissituations;andtheinvolvementofcivilsociety.2qe"  291  .3  ԀTheTaskForceadoptedapragmaticandtimeboundprogrammeofworkthatwouldclearlyrespondtokeyissuesandprioritiesatthecountrylevel,usingthemodalityofworkinggroupswithleadagencies.TheseincludedtheWorkingGrouponPrimaryHealthCare(ledbyWHOandUNICEF);WorkingGrouponReproductiveHealth(ledbyWHO);WorkingGrouponBasicEducation(ledbyUNESCO);WorkingGrouponInternationalMigration(ledbyILO);andWorkingGrouponNationalCapacityBuildinginTrackingChildandMaternalMortality(ledbyUNICEF).UNFPAservedastheChairoftheBSSATaskForce.E+ 4 <DL!4XEB.4 <DL!XB2qe#  292  .3  ԀTheTaskForcemaintainedastrategicfocusonitsprimaryobjective:toprovidecoordinatedsupporttotheUnitedNationsResidentCoordinatorsysteminassistingdevelopingcountriestoimplementpoliciesandprogrammesforachievingthegoalsadoptedatrecentUnitedNationsglobalconferences.MemberorganizationsoftheBSSATaskForcealsofocusedonstrengtheningandexpandingtheircollaborationwithcivilsocietyorganizationsandtheprivatesectortomaintainstrategicpartnershipsamongalldevelopmentpartners.OneoftheprincipaloutputsoftheTaskForcewasasetofGuidelinestoenabletheResidentCoordinatorsystemtobridgethenormativeandoperationaldimensionsofsocialsectoractivities.TheTaskForcealsodevelopedindicatorstoenablecountriestobettermonitortheirprogressinachievingthegoalsagreedtoattheUnitedNationsglobalconferences.Otherendproductsincludedawallchartonbasicsocialservices;guidelinesonkeyareasoftheProgrammeofAction;areportonlessonslearned/best practicesindonorcollaborationforassistancetothesocialsector;aninformationcardonadvocacyfor -?** basicsocialservices;andacompendiumofinternationalcommitmentsrelevanttopovertyandsocialintegration. & Q E+ 4 <DL!4XE UnitedNationsRegionalCommissions  H B.4 <DL!XB2qe$  293  .3  ԀRecommendation16.16oftheProgrammeofActioncallsonregionalcommissions,organizationsoftheUnitedNationssystemfunctioningattheregionallevel,andotherrelevantsubregionalandregionalorganizationstoplayanactiverolewithintheirrespectivemandatestoimplementtheProgrammeofActionthroughsubregionalandregionalinitiativesonpopulationanddevelopmentandtocoordinatetheiractivitiesinordertoensureefficientandeffectiveactioninaddressingpopulationanddevelopmentissuesrelevanttotheirregions.E+ 4 <DL!4XE'Q 9bB.4 <DL!XB2qe%  294  .3  ԀSincetheICPD,theECAhasestablishedacommitteeofMemberStates,withtheBureauofthethirdAfricanPopulationConferenceascoremembers,toreviewprogressontheimplementationoftheDakar/NgorDeclarationandtheICPDProgrammeofAction.Someoftheprogrammedresearchstudieshavefocusedonthefollowingareas:managementoffamilyplanningprogrammes;urbanenvironmentandhealth;infant,childandmaternalmortality;populationandconflict;impactofenvironmentalpoliciesandprogrammesrelatingtopopulationandhumansettlements,andtheconveningofaRegionalWorkingGroupontheRecommendationsforthe2000RoundofPopulationandHousingCensuses.ECAhasheldseminarsandworkshopsontheintegrationofpopulationfactorsindevelopmentplanning;patterns,causesandconsequencesoffemalemigration;andadolescentfertilityinAfrica.Specialemphasisisbeinggiventopopulationpoliciesinthecontextoftheirrelationtofood,environmentandsustainabledevelopment.ArrangementsareunderwaytocreatebettercollaborativerelationsbetweenECAanditsdevelopmentpartnersinassistingMemberStates.E+ 4 <DL!4XEB.4 <DL!XB2qe&  295  .3  ԀIn1996,ECE,withsupportfromUNFPA,focuseditspopulationeffortsonthecountrieswitheconomiesintransition.Assistancewasprovidedfordatacollectionandanalysis,researchandthedisseminationofpolicyrelevantinformationinthekeyareasoffertilityandreproductivehealth,populationageingandinternationalmigration.TheECEprojectonpopulationageingandelderlypersonsisbasedoncensusesconductedcirca1990inabout15mostlycentralandeasternEuropeancountries. ! Comparativeresearchandcountryspecificanalysesarebasedonnationaldatasets,includinginformationonlivingarrangements,workandretirementpatternsandhousingconditions.ECEiscollaboratingwiththeUnitedNationsDepartmentofEconomicandSocialAffairs,theStatisticalOfficeoftheEuropeanUnion(EUROSTAT),theCouncilofEuropeandtheOrganizationforEconomicCooperationandDevelopment(OECD),tostreamlinethecollectionanddisseminationofpopulationstatisticsintheregion.E+ 4 <DL!4XEB.4 <DL!XB2qe'  296  .3  ԀECLACandtheLatinAmericanDemographicCentre(CELADE)conductedjointactivitieswithnationalstatisticalofficesandotherinstitutionstoproducenewpopulationestimatesandprojectionsatthecountrylevel.CELADEisimplementingaprojectoninternationalmigrationinLatinAmerica(IMILA),whichcomprisesadatabasewithinformationfromeachnationalcensusonpersonsbornabroad.AprojectfundedbytheInterAmericanDevelopmentBank(IDB)wasdesignedtointegratepopulationvariablesintospecificIDBinvestmentprogrammesandprojectslaunchedbyCELADE.IDB/CELADEproducedabookontheimpactofdemographictrendsonsocialsectorsandpreparedseveraltechnicalreportson .** methodologicalissuesconnectedwiththeintegrationofpopulationfactorsintosocialsectorpoliciesandprogrammes.CELADE,whichdevelopedaspecializedcomputersoftwarepackagetoanalysegeographicallydisaggregateddata,downtothecityblocklevel,hasofferedseveralworkshopsontheutilizationofanupdatedversion.Thissoftwareisnowinuseforsocialprogrammingatthemunicipalandministeriallevelsinvariouscountriesoftheregion.InclosecooperationwithPOPIN,informationhasbeenputontheInternetbytheBibliographicInformationSystemforLatinAmericaandtheCaribbean.E+ 4 <DL!4XEB.4 <DL!XB2qe(  297  .3  ԀESCAPhasfocuseditseffortsonaddressingpopulation,environmental,povertyandqualityoflifeissues;usingpopulationdataforlocalareadevelopmentplanning;strengtheningmonitoringandevaluationsystemsformeasuringprogressinreproductivehealth/familyplanningprogrammes;strengtheningpolicyanalysisandresearchonfemalemigration,employment,familyformationandpoverty;andstudyingimplicationsofageingforAsianfamiliesandtheelderlyandassistingGovernmentsindevelopingandstrengtheningpoliciesforinvolvingtheelderlyinsocialandeconomicdevelopment.E+ 4 <DL!4XEB.4 <DL!XB2qe)  298  .3  ԀESCWAorganizedanExpertGroupMeetingin1995inCairoonDemographicEstimatesandProjectionsfortheArabCountries.ItsPopulationSectionhasdevelopedregularcontactswithorganizationsspecializinginappliedsystemanalysis,withaviewtodesigningandimplementingapopulationprojectionsproject,integrating,forthefirsttime,demographicandrelatedsocioeconomicvariables.ThePopulationSectionhasundertakentwostudiesaspartoftheactivitiesoftheESCWATaskForceonPovertyAlleviationinWesternAsia,oneonpopulationdynamicsandpovertyintheregionandtheotheronPalestine.Alsoin1995,ESCWAembarkedonanUNFPAsupportedthreeyearprojectonPopulationPoliciesintheArabCountries.Theprojectprovidesfor:trainingonpopulationpolicyformulation,implementationandmonitoringforthetechnicalstaffofnationalpopulationcommittees;coordinationmeetingsfortheheadsofthecommittees;andtheestablishmentofanESCWApopulationpoliciesintegratedinformationsystem,whichwillfacilitatemonitoringtheimplementationoftherecommendationsoftheArabConferenceonPopulationandDevelopment,heldatAmman,Jordan,in1993andoftheICPDProgrammeofAction.E+ 4 <DL!4XE& *  PartnershipsamongIntergovernmentalOrganizations  f B.4 <DL!XB2qe*  299  .3  ԀTheWorldBankhassubstantiallyincreasedloanallocationsintheareaofhealth,includingreproductivehealth,gender,educationandothersocialdevelopmentareas.AsacosponsorofUNAIDS,theWorldBankisoneoftheleadersinthefundingofHIV/AIDSprogrammesandlinksitseffortstobroaderinitiativesinreproductivehealth.ThroughactivepartnershipwithseveralUnitedNationsspecializedagencies,donorcountriesandNGOs,theWorldBankissupportinghealthsectorreformandcapacitybuildinginthedevelopingcountries.'*~E+ 4 <DL!4XEB.4 <DL!XB2qe+  300  .3  ԀTheOAUadoptedaresolutionin1995requestingMemberStatestomakepolicy,institutionalandfinancialarrangementsfortheimplementationoftheICPDProgrammeofAction.Sincethen,OAUhasorganizedseveralseminars,workshopsandconferencesfordifferenttargetgroups,suchasthediplomaticcommunityinAddisAbaba.StudytourstopromotepopulationissueswillsoonbeimplementedunderthisϢprogramme.TheobjectivesincludeseekingareasofcollaborationandinformationexchangebetweenGovernmentsandNGOsonpopulationissues. .** ЇH.4 <DL!4XH2qe,  301  .3  ԀAnintergovernmentalinitiative,PartnersinPopulationandDevelopment(PPD),launchedattheϢICPDby10developingcountriesBangladesh,Colombia,Egypt,Indonesia,Kenya,Mexico,Morocco,Thailand,TunisiaandZimbabwecommencedprogrammeactivitiesin1996withsupportfromtheRockefellerFoundation,UNFPAandtheWorldBank.ChinaandPakistanjoinedthePPDin1997,andIndiaandUgandain1998.ThePPDworkplanincludesstrengtheningthecapacityofdevelopingcountriesforSouthSouthcooperation,thepromotionof"twinning"modalitiesandthedevelopmentoftraininginstitutions.PPDhasfocusedonfourpriorityareastofacilitateandcoordinateSouthSouthcollaborationinresearch,trainingandinformation:I)integrationoffamilyplanningandreproductivehealthservicesandtheestablishmentofreproductivehealthstructures;ii)promotionandintegrationofSTDandHIV/AIDSpreventionandcarewithinthereproductivehealthstructure;iii)provisionoffamilyplanning/reproductivehealthservicesaimedatthespecialneedsofbothmaleandfemaleadolescents;and,iv)reductionofmaternalmortalityandmorbidity.E+ 4 <DL!4XEB.4 <DL!XB2qe-  302  .3  ԀThroughitscountryprogrammes,UNFPAisencouragingcountriestomakeuseofSouthSouthactivities,bothasrecipientsand/orproviders,andtodrawuponthetechnicalresourcesofpublicinstitutions,NGOs,privateorganizationsandindividualsfromdevelopingcountries.UNFPARepresentativesarerequiredspecificallytoconsiderthismodalityduringprogrammereviewexercisesaswellasintheformulationofcountryprogrammesandprojects.Consequently,UNFPAissupportingSouthSouthexchangeactivitiesunderseveralcountryprogrammes,includingthoseintheDominicanRepublic,Honduras,Indonesia,Kenya,Malawi,Thailand,Tunisia,UgandaandtheUnitedRepublicofTanzania.E+ 4 <DL!4XEB.4 <DL!XB2qe.  303  .3  ԀFollowingtheICPD,theInternationalOrganizationforMigration(IOM)incorporatedintoitsstrategicplanningandoperationalprogrammestheobjectivesconcerninginternationalmigrationanddevelopmentsetforthinChapterXoftheProgrammeofAction.IOMhasalsobecomeinvolvedinsupportinggovernmenteffortstoimproveinternationaldialogueonmigrationissuesattheregionallevel,especiallywithrespecttotheCISandrelevantneighbouringcountries,allofthecountriesofCentralandNorthAmericaandcountriesinEastandSouthEastAsia.Forexample,IOM,alongwithUNHCR,wasactiveinplanningthe1996CISconferenceontheproblemsofrefugeesanddisplacedpersonsandinimplementingtheConference'sPlanofAction.InCentralandNorthAmerica,IOMhasgivensubstantiveandlogisticalsupporttoongoingregionalconsultationsamongtheparticipatingStates,knownasthe PueblaProcess.InAsia,IOMcontinuestoassistthe"ManilaProcess,"whichbringstogether17countriesforregularexchangesofinformationonirregularmigrationandtraffickingaswellasasecondregionalprocess,theAsiaPacificConsultations,whichmeetsperiodicallytodiscussabroadrangeoftopicsonpopulationmovements.AmongtheothercomponentsofIOMsprogrammesarenationalmigrationpolicyworkshops,technicalassistanceonmigrationlegislationandtrainingworkshopsformigrationofficials,includingamajornewInternationalMigrationPolicyandLawcourse,launchedinNovember1998inBudapest,asajointendeavouroftheUnitedNationsInstituteforTrainingandResearch(UNITAR),UNFPAandIOM.̜   ,E)) Constraints  H     2qe/  304  .3  ԀNumerousconstraintsfrustratecollaborationandconstituteobstaclestotheachievementofthepartnershipenvisionedbytheProgrammeofAction.GovernmentshaveincreasinglyincludedNGOsinthepopulationprogrammeprocess.However,suchinclusionhasbeenprimarilyofNGOsaspartofthegovernmentdirectedprogramme.LittlecoordinationexistsamongthereproductivehealthprogrammesdirectedbytheGovernment,NGOsandtheprivatesector;theseprogrammesoperateseparatelyandinparallel.Thus,onemajorconstrainttopartnershipfacedbybothGovernmentsandNGOsisthelackofacoordinationmechanism;anothermajorconstraintisthatofinsufficientfinancialresources.Otherconstraintsmayincludeinvaryingdegrees,dependingontherespectivecountry:insufficientNGOandGovernmentinstitutionalcapacity,humanresourcesandtrainedstaff;insufficientNGOcoordination;ahostileorconfrontationalGovernmentNGOrelationship;alackofawarenessorunderstandingoftheissuesbythecivilsociety;andalackofawarenessorunderstandingoftheimportanceofpartnershipandweakpoliticalcommitment.H.` hp x (#4XHE.4 <DL!XE2qe0  305  .3  ԀOtherbottlenecksinclude:divergentagendasandprioritiesamongpartnergroups;volatilepoliticalclimates;lackofaclearlegalframework,regulationsandguidelinesforthepartnership;unresolvedstereotypes,includingbiases,aboutpotentialpartners;lackoftrustamongpartneragentsandagencies;weakcommitmenttothepartnership,oftenevidencedbyrhetoricwhichisnotbackedbyaction;lackofcommunicationamongpartners;protectionofvestedinterests;cultural,language,classandraceaswellasreligiousbiasesandbarriers;hesitancyincollaborationbasedonhistoricallegaciesorformerexperiences;fearofperceiveddominanceofthepartnershipbysomeplayers;geographicalpreferences(theurbancentricbias);lackofhumanresourcecapacity,especiallygiventheincreasedstaffingneedsduetothedecentralizationofthegovernmentapparatus;insufficientorpoorlydescribedinformationabouttheϢProgrammeofAction;andlossofmomentumsincetheICPD.E+ 4 <DL!4XEB.4 <DL!XB2qe1  306  .3  ԀRegressionhasalsooccurredinsomeareas.Advocacywithtradeunionsandemployers'associationsforimplementationoftheProgrammeofActionhassubsided.Reducedcommitmentofbilateraldonors,bothinfinancialsupportandintheirpartnershipswithcivilsociety,anddecreasedfundingfromofficialdevelopmentassistance(ODA)forreproductivehealthhasaffectedseveralcountries.2qe2  307  .3  ԀFurthereffortsarerequiredforthebuildingofstrongdynamicpartnershipsatthenationallevel.ItiscriticalforGovernmentstotakealeadroleinestablishingapositive,supportiveenablingenvironmentforpartnershipthroughthepromulgationofappropriatepoliciesandlegislation;theinstitutionofmodalitiesforinteractivediscussionandthedevelopmentofaconsensusoncommonobjectivesandstrategiestointegratetheProgrammeofActionintoalleconomicandsocialactivities;andagreementonrespectiveroles,responsibilitiesandcomparativeinstitutionaladvantagesforprogrammeimplementation.Fortheinstitutionsofcivilsocietytoplayaneffectiveroleasdevelopmentpartners,financialandtechnicalassistanceforcapacitybuildingisessential.Human,institutionalandmanagerialstrengtheningisvitalforimprovedandenhancedaccountability,transparency,sustainability,coalitionbuildingandresponsivenesstoconstituencies.Forthebroadrangeofprivatesectorcompanies,theirrolemayencompass,interalia,theprovisionofaworkenvironmentsafeforreproductivehealth;theprovisionofreproductivehealthinformation,counsellingandservicesfortheiremployees,onsiteoraspartoftheirinsurancebenefits -l** package;andthepromotionofemploymentpracticeswhichpromotegenderequalityandequity.Privatesectorcompaniesengagedincommodityproduction,insurancecoverageorserviceprovisionhaveaspecialroleinensuringfullaccesstoawiderangeofaffordable,highqualityreproductivehealthservices.H.` hp x (#4XH2qe3  308  .3  ԀGovernmentandcivilsocietyinstitutionshaveanothercriticalroletoplayinextendingthepartnershiptoallindividualsateverylevel,ineverycity,townandvillage.Leaders,includingthoseinthepolitical,civic,business,mediaandreligiousspheres,haveaspecialobligationtotranslatetheProgrammeofActionfortheirconstituenciesandtoassisttheminadoptingtheProgrammesprovisionsastheirownpersonalagendasforaction.TheProgrammeofActionismeanttobeaPeoplesAgendaonlyinthatwaywillitsvisionbetransformedintoactiontoopenthefutureforthehopes,dreams,opportunitiesandchoicesofwomen,menandyoutheverywhere./& H   H1` hp x (#XHXXXXXXXX      H.4 <DL!XH  FurtherActionRequired D/(leg     XXXXXXXX' X4X''H8     EstablishanEnablingEnvironmentforEffectivePartnership  ) *, <XX*2qe4  309  .3  ԀInordertoestablishanenablingenvironmentforeffectivepartnership,Governments,workingcloselywithcivilsociety,should:P  P"0    institutecommonforumsfordialogueforbuildingpartnerships;P݌P(#(# Ќ  P  PV"0    adoptpolicymeasurestofacilitatetheinvolvementofcivilsociety,particularlyofNGOs,inthe w formulation,implementationandmonitoringofstrategiesandprogrammestoachievetheProgrammeofActionobjectives;PVq݌ (#(# Ќ  P  Pΰ"0    formulateacommonframeworkforworkingtogetherandestablishtheunderlyingprinciplesgoverning  theircollaborationandpartnershipsothatroleswillbeclear,expectationswillberealistic,andϢprogrammeaccountabilitycanbepromoted;Pΰ݌ (#(# Ќ  P  P["0    identifykeycommonlegislative,policyandprogrammeissuesasthebasisforfurthercollaboration;P[v݌(#(# Ќ  P  PM"0    identifykeyplayersandinstitutionstoinvolveinaddressingpopulationandsocialissuesandencourage   theadoptionofvariousapproachestoenhancecivilsocietyparticipation,suchasthefacilitationofcommunitybasedinitiatives;and,PMh݌ (#(# Ќ  P  Pٴ"0    developtransparentsystemstobecomeaccountabletotheirrespectiveconstituencies.Pٴ݌7#(#(# Ќ   StrengthentheHumanResourcesandInstitutionalCapacitiesofCivilSociety %="   2qe5  310  .3  ԀGovernmentsshouldadoptinnovativefinancialandtechnicalassistanceapproaches,includingdirectfundingtoNGOstofostereffectivepartnerships.H+ 4 <DL!, <XHB.4 <DL!XB2qe6  311  .3  ԀInordertoenhancetheinstitutionalviabilityandprogrammesustainabilityofcivilsociety,donorsshouldbroadenthescopeoftheirfinancialandtechnicalassistancetoincludecomponentstobuildand strengthenthehumanresourceandinstitutionalcapacityandsustainabilityofcivilsocietyinstitutions, -)' especiallyNGOs.Governmentsshouldconsiderearmarkingcoregrantstosupportcivilsocietyinvolvement. E+ 4 <DL!4XEB.4 <DL!XB2qe7  312  .3  ԀCivilsocietyshouldestablishmechanismstopromoteandstrengthenitshumanresourcesandinstitutionalcapacities.Suchmechanismsmightinclude,forexample,theestablishmentoftrainingandresearchcentrestobuildthemanagerialskillsandorganizationalcapacitiesofNGOsandthecreationofanindependentbodytoaccreditNGOsandtosetstandardsforNGOoperations.E+ 4 <DL!4XEB.4 <DL!XB2qe8  313  .3  ԀCivilsocietyinstitutions,especiallyNGOs,shouldgiveincreasedattentiontocoalitionbuildingandnetworkingatthenationalandregionallevelsinordertopromoteprogrammereplicability,complementarityandsynergy,inadditiontofacilitatinginformationexchangesandconcertedactionforpolicyandlegislativeinputs.E+ 4 <DL!4XE   StrengthenandIntensifySocialMobilizationEfforts      B.4 <DL!XB2qe9  314  .3  ԀGovernments,workingcloselywithcivilsociety,shouldstrengthenandintensifytheirsocialmobilizationefforts.TheyshouldformulateIECandadvocacystrategieswhicharebolderandmoreinnovativethanthoseusedinthepast,andwhicharedesigned,onthebasisofsocioculturalandeconomicresearch,toreachspecificaudienceswithinabroaderspectrumofcivilsociety.FortheProgrammeofActiontobeadoptedbyallsegmentsofthepopulation,itiscrucialthattheProgrammeofActionmessagebetranslatedintothevernacularoftheselectedaudience,explainingitintermswhichwillhavemeaningwithintheirrealmofexperienceandhopes.Inaddition,moretimeandmoneyshouldbedevotedfortheeffectiveuseofthemedia.2qe:  315  .3  ԀGovernments,assistedbycivilsociety,shouldopenupforpublicdiscoursecontroversialtopicsandculturaltaboos,inamannerwhichisculturallysensitiveandwhichpromotesjusticeandhealth. PromoteAccesstoHighQualityReproductiveHealthandFamilyPlanningServices 2qe;  316  .3  ԀGovernmentstogetherwithNGOs,theprivatesectorandinternationalorganizations,shouldsignificantlyincreasetheireffortstoidentifyareas,aswellaspromoteinnovativemodalities,forconcertedactiontoachieveprogrammecomplementarityandsynergy,particularlywithrespecttoreproductivehealth.E+ 4 <DL!4XEB.4 <DL!XB2qe<  317  .3  ԀNGOsandprofessionalorganizationsshouldtaketheleadershiproleinassistingtheGovernmentsindeterminingappropriatestandardsforqualityreproductivehealthserviceandindisseminatingthesestandardstoprovidersandclients.E+ 4 <DL!4XE EncouragetheInternationalCommunitytoMeetitsCommitments  *L'%   +s(& B.4 <DL!XB2qe=  318  .3  ԀTheinternationalcommunityneedstobeencouragedtoincreaseitstechnicalandfinancialassistancefortheimplementationofpopulationanddevelopmentprogrammesindevelopingcountries,infulfilmentofthecommitmentestablishedintheProgrammeofActionoftheICPD. E+ 4 <DL!4XEB.4 <DL!XB2qe>  319  .3  ԀUnitedNationsagenciesandorganizationsshouldpromoteandstrengtheninter-agencycoordinationandcollaborationatalllevelsonselectedpopulationanddevelopmentthemes;theyshouldprovidetheirfieldstaff,inparticular,withtechnicalandoperationalguidanceonselectedthemesinordertoenhancecoordinationandcollaborationatthecountrylevel.2qe?  320  .3  ԀTheUnitedNationsResidentCoordinatorsystemneedstoliaisewithandutilizetheexistingcountrylevelinterministrythemegroups,acounterpartoftheUnitedNationsinteragencythemegroups,tostrengthenandexpandlinkageswithNGOs,theprivatesectorandcivilsociety,andtodrawupontheircomparativeadvantagestobuildandstrengthennationalcapacity.  E+ 4 <DL!4XE̜  ) Л  ChapterVI.MOBILIZATIONOFREQUIREDRESOURCESFOR H IMPLEMENTINGTHEICPDPROGRAMMEOFACTION  o'   2qe@  321  .3  ԀFullimplementationoftheICPDProgrammeofActionenvisagesmobilizationofresourcesforavarietyofdevelopmentsectors.TheProgrammeofAction,whileprovidingspecificestimatesintheareasofreproductivehealthandotherpopulationactivities,emphasizestheneedtomobilizeadditionalresourcesforothersocialsectorgoalsandobjectives,suchasuniversalbasiceducationandcontinuedinfant,childandmaternalmortalitydeclines,improvementofthestatusofwomenandpovertyeradication.Whilealargeportionoftheadditionalfundsrequiredwillneedtocomefromdomesticresources,theProgrammeofActioncallsforasubstantialincreaseincomplementaryresourceflowsfromdonorcountries,developmentbanks,internationalNGOsandfoundations.ThecostedoutportionoftheProgrammeofActionestimatesthat,indevelopingcountriesandcountrieswitheconomiesintransition,$17billionwillbeneededin2000,including$5.7billionfromdonorsources,includingdevelopmentbanks.Thesefiguresincreaseslightlyovertheperiod20002015,reaching$18.5billionayearin2005and$21.7billionby2015.Theyreflectthelevelofresourcesrequiredtofinanceactivitiesinbasicreproductivehealth,includingthoserelatedtofamilyplanning,maternalhealthandthepreventionofsexuallytransmitteddisease(STDs)andHIV/AIDS,aswellasthecollectionandanalysisofbasicpopulationdata.B.` hp x (#XB2qeA  322  .3  ԀUNFPAregularlycollectsdataonflowsofinternationalfinancialassistanceforpopulationactivitiesandannuallypublishestheGlobalPopulationAssistanceReport,basedonthecollecteddata.      Ѣ D $  43      ףThat  reportdescribesthelevels,trendsandcharacteristicsofinternationalfinancialflowsforpopulationassistance.SinceJanuary1997,UNFPAhasworkedcloselywiththeNetherlandsInterdisciplinaryDemographicInstitute(NIDI)tocollectannualdataonbothinternationalanddomesticfinancialresourceflowsforpopulationactivities.Thischapterdrawsheavilyondatacollectedthroughthatproject.1'      B.` hp x (#XB  TheCostedICPDReproductiveHealthandPopulationPackage:DonorResponse  ;   2qeB  323  .3  ԀTheterm"externalpopulationassistance"isoftenusedtoindicatefinancialgrantsfromdonors(Governmentsorprivatefoundations)andfrommultilateralorganizationssuchasUNFPAaswellasϢconcessionaryand"regular"loansfromtheWorldBankandotherdevelopmentbanks.       E $  44      ׀Overtheperiod }#5  19901996,totalexternalassistancetodevelopingcountriesandcountrieswitheconomiesintransitionincreasedsubstantially,from$972millionin1990to$2,044millionin1996.Theincreasesin1994and1995,aroundthetimeoftheICPD,wereespeciallysteep,rising55percentoverthetwoyears.Incompletedatafor1997and1998indicatethatincreaseshavenotcontinuedandthattherehaveinsteadbeensmalldecreasesinexternalpopulationassistancetodevelopingcountries(Table6.1).  *e'&    ӛTable6.1TrendsinTotalExternalPopulationAssistance,19901997* H (inmillionsof$US)  o' 1'      B.` hp x (#XB*fJ<\d ddd @dd F<^(#(#f,dd ,ldd#,ldd#,ldd#,ldd#,ldd#,ldd#,ldd#,ldd#+   N PXX G= @1990@G1990 i_8 @1990 @ @1991@i1991 i_8 @1991 @  @1992 @i1992 i_8  @1992  @ $@1993$@i1993 i_8 $@1993 $@ (@1994(@i1994 i_8 (@1994 (@ ,@1995,@i1995 i_8  ,@1995 ,@ 0@19960@i1996 i_8  0@1996 0@ 4@19974@i1997 N<<=8  4@1997 4@ NTotalExternalPopulationAssistance M<<<  << `@972`@M972 o<<^7W `@972 `@<< h@1306h@o1,306 p<<_8W h@1306 h@<< $@1033$@p1,033 p<<_8W $@1033 $@<< x@1310x@p1,310 p<<_8W x@1310 x@<< @1637@p1,637 p<<_8W @1637 @<< ȟ@2034ȟ@p2,034 p<<_8W ȟ@2034 ȟ@<< @2044@p2,044 p<<_8W @2044 @<< @1889@p1,889#XXPi#H><W @1889  @<< H  PXX*1997figuresareprovisional   Source:UNFPA,GlobalPopulationAssistanceReport,variousyears(NewYork,UNFPA).   М  XXP2qeC  324  .3  ԛWhiletheincreasesinassistanceduring19931995shouldbeinterpretedasreflectingsupportfor   theCairoagenda,theincreasesarealsopartlytheresultofdefinitionalchangesinwhatwasmeantby"populationassistance".AsaresultofthebroaderpopulationandreproductivehealthparadigmagreedtoatCairo,thedefinitionofwhatconstitutespopulationassistancehasbeenexpanded.Additionalcomponentsofreproductivehealthhavebeenincorporatedintothedefinitionofpopulationprogrammes,andintotheaccountingofresourceflows.B.` hp x (#XB2qeD  325  .3  ԀOnereasonfortheslowdowninthegrowthofexternalaidforpopulationafter1996isthefallinthelevelsofOfficialDevelopmentAssistance(ODA). X $  45      ׀AsTable6.2indicates,ODApeakedin1992,at    almost$61billionandhassincedeclined,reaching$47.6billionin1997.1      XXXXXXXX       [ $  46     Seeninthelightofthissizeable ! downwardtrend,populationassistancehasfaredreasonablywell.PreliminaryestimatessuggestthattheshareofODAdevotedtopopulationassistanceincreasedin1997to2.8percent,duetothefastererosionofoverallassistancethanofpopulationassistance.Asdiscussedbelow,newformsandsourcesofassistancehaveemergedinthepastfewyearsthatneedsalsotobetakenintoaccountinassessingresourcetrends.1      ݜ̛fE1fft$ | ,4< ""XE   Table6.2Officialdevelopmentassistance(ODA)ofdonorcountries,19901997 [) fH.` hp x (#fftX"H(inmillionsof$US)  :* *B]Xd ddd ldd#ldd#ldd#ldd#ldd#ldd#ldd#ldd#J<\(#(#,B,B,B,B,B,B,B,B,B+  3<"  , DC3PXX %. ]<L -C< @1990C@]М1990 <nA .C3 @1990 @< @1991C@М1991 <nA /C3 @1991 @<  @1992C @М1992 <nA 0C3  @1992  @< $@1993C$@М1993 <nA 1C3 $@1993 $@< (@1994C(@М1994 <nA 2C3 (@1994 (@< ,@1995C,@М1995 <nA 3C3 ,@1995 ,@< 0@1996C0@М1996C <nA 4C3 0@1996 0@< 4@1997C4@CC <nA 4C3 0@1996 0@< 4@1997C4@C1997 ZC  ԍC  ԍ̎CC ZC  C  oeM 5C3 4@1997  D 4@< 'CoTotalODA#XXP#PXX  J@#6C  @52961C @J  52,961 mc5#7C1  @52961  @ @56678C@mQ  56,678 mc5#8C1 @56678 @ @@60850C@@m  60,850 mc5#9C1 @@60850 @@ *@55636C*@m  55,636 mc5#:C1 *@55636 *@  @59153C @m  59,153 mc5#;C1  @59153  @ `@58643C`@m  58,643 mc5#<C1 `@58643 `@ @@55114C@@m  55,114 mc5#=C1 @@55114 @@ ;@47580C;@m  47,580 i<X@#>C1 ;@47580 ' ;@ CiTotalODAforpopulation \<K;$ ?C< @669C@\  669 }<l@;$ @C1 @669 @< 0@774C0@}  774 }<l@;$ AC1 0@774 0@< @766C@}e  766C  ԍC  ԍ̎C  C  ~<mA;$ BC1 @766 @< H@777CH@~  777 }<l@;$ CC1 H@777 H@< @977C@}  977 ~<m@;$ DC1 @977 @< p@1372Cp@~  1,372 <nA;$ EC1 p@1372 p@< d@1369Cd@  1,369 <nA;$ FC1 d@1369 d@< @1316C@  1,316C  ԍC  ԍ̎CC7ݹ  PPPP        7R    PPPP  C  C  oeM%"IC1 @1316  @< CoPopulationassistanceas%ofϜODA I?'$LC )\(?1.26C)\(?I  1.26 ka49&"MC1 )\(?1.26 )\(? Q?1.37CQ?kc  1.37 ka49&"NC1 Q?1.37 Q? )\(?1.26C)\(?k  1.26 ka49&"OC1 )\(?1.26 )\(? ffffff?1.40Cffffff?k  1.40 ka49&"PC1 ffffff?1.40 ffffff? ffffff?1.65Cffffff?k  1.65 ka49&"QC1 ffffff?1.65 ffffff? Q@2.34CQ@k  2.34 ka49&"RC1 Q@2.34 Q@ Gz@2.46CGz@k  2.46 ka49&"SC1 Gz@2.46 Gz@ )\(@2.77C)\(@k  2.77J@>'#UC1 )\(@2.77  )\(@ J<(  yI x (#X< @ Source:UNFPA,GlobalPopulationAssistanceReport,variousyears(NewYork,UNFPA). (L%U K.` hp x (#  XK̜  #XXP#2qeE  326  .3  ԛTheUnitedStateshashistoricallybeenthelargestproviderofpopulationassistance,and,until1996, &*&W wasincreasingitsaidinthisareaasfastasorfasterthanothercountries.Denmark,theNetherlands,theUnitedKingdomandAustraliaalsonotablyincreasedtheirsupportforpopulationactivitiesinthe19901997period.̜ .*[ $ X'(X$2qeF  327  .3  ԛTheUnitedStatesisalsowellaheadofanyothercountryintheshareofODAallocatedforpopulationactivities.In1995,approximately9percentofitsODAwentforpopulationactivities;in1996,7percentofitsODAwasspentforpopulation.ThesepercentagesareunprecedentedinthehistoryofpopulationassistanceandarefarabovethenotionalODAtargetof4percentforpopulationassistanceusedintheearly1990s,whenthedefinitionofpopulationassistancewasnarrower.However,thelevelofODAasapercentageofthegrossnationalproduct(GNP)intheUnitedStateswas,inrecentyears,under0.3percent,lessthanhalfofthelongstandingagreedtargetof0.7percentreaffirmedattheSocialSummitin1995.TheshiftinthedefinitionofcomprehensivereproductivehealthcaretoincludesafemotherhoodandHIV/AIDSpreventionprogrammeshadasignificantimpactinincreasingthefundscountedasODAinthepopulationsector.* X'( X'*1          2qeG  328  .3  ԀItisnoteworthyandencouragingthatanumberofdonorcountrieswithexemplaryoverallODAperformancerecordsinthe1990sledbytheDanish,NorwegianandSwedishGovernmentstraditionallyallocatedarelativelylargeshareoftheirODAforpopulationand,inrecentyears,theNetherlands,theUnitedKingdomandAustraliahavebeguntodevotearelativelylargeshareofODAforpopulation.TheadoptionfollowingCairoofanexpandeddefinitionofpopulationandreproductivehealthprogrammes,however,alsosuggeststhatthepriornotionalshareofdevelopmentassistanceearmarkedforpopulationneedstobereassessedupwards,perhapsto4.5to5percent.1      H.` hp x (# X'H1          2qeH  329  .3  ԀThepoliticalwillofacountrytoprovideODAatorneartheagreedtargetlevelof0.7percentisacomplexresultofmanyfactors,includingthelevelofavailablewealth,technicalcapacity,moralsentiments,commitmenttointernationaldevelopmentandbeliefsabouttheefficacyofdifferentstrategiesforassistingdevelopingcountries.Inrelationtotheirrelativenationalwealth,theNordiccountriesandtheNetherlandshavebeenstrongsupportersofODA,includingforpopulationandreproductivehealthconcerns.1>      ̛̜  B.` hp x (#XB TheCostedICPDReproductiveHealthandPopulationPackage:DevelopingCountries  d   2qeI  330  .3  ԀTotalamountsexpendedbyGovernmentsandNGOsforthefinancingofthecostedoutcomponentsofthepopulationpackagevarygreatlyfromregiontoregionandfromcountrytocountry. ` $  47      כEstimatesof R global,regionalanddomesticresourceflowshavebeengeneratedbasedoninformationfor61countriesreportingin1996. d $  48      ׀Globally,itisestimatedthatin1996GovernmentsandnationalNGOsspentalmost !F $7billiononpopulationprogrammesfromresourcesmobilizedindevelopingcountries.Itisfurtherestimatedthatprivatechannelsinthesecountrieswereresponsibleforanother$1billion.B.` hp x (#XB1          E1` hp x (#XE2qeJ  331  .3  ԀThedata1allo      showthatcountriesinAsiaandthePacificmobilizedthemostdomesticresourcesforpopulationandreproductivehealthprogrammes($5.21billion),followedbyLatinAmericaandtheCaribbean($1.02billion).SmalleramountsweremobilizedinWesternAsiaandNorthAfrica($260million)andsubSaharanAfrica($192million).Additionally,anestimated$103millionwasmobilizedincountriesineconomictransition.1       H.` hp x (#XH2qeK  332  .3  ԀFurtherdevelopmentofthemethodologiesformonitoringnationalresourceallocationswillberequired,particularlyinprivateresourcemobilization,wherefurtherincreaseswillbeparticularlyimportant. Whilesomeprogresshasbeenmade,monitoringtheallocationofresourcestothedifferentfunctional F-)+ componentsofthepopulationandreproductivehealthpackageremainsproblematic.  $  49      ׀Datamakingsuch H distinctionscanonlybeindicative,andrelatedconclusionstentative. B.` hp x (#XB2qeL  333  .3  ԀSomeoftheregionalfindingsareskewedandmustbequalifiedinsofarasasmallnumberoflargecountriesaccountedforasizeableproportionofregionaltotals.Forinstance,thecombinedexpendituresofChina,India,Indonesia,theIslamicRepublicofIranandMexicoamountedto$5.5billion,approximately80percentoftheentireestimateof$6.8billionmobilizedfromdomesticresourcesin1996.Onapercapitabasis,theremaining56countriesforwhichdatawasavailableexpendedonly$0.35percapita,comparedwiththe61countryspendingof$2.20percapita.Therefore,althoughafewlargedevelopingcountrieswithhighlevelsofcommitmentandwellarticulatedpoliciesweremobilizinglargeamountsofresourcesdomestically,mostotherdevelopingcountrieshadlimitedcapacityand/orconstrainedfinancialresourcestoutilizeforpopulationandreproductivehealthprogrammesaswellasunderdevelopedsystemsformonitoringflows.Thepercapitaincomelevelsandtheavailablepublicresourcesinthemajorityofthesecountries,andparticularlythe51leastdevelopedcountries(LDCs),wereclearlyinadequatetomeettheirpopulationsneedsforreproductivehealthandfamilyplanningservices.B.` hp x (#XB0    (#(# 2qeM  334  .3  ԀForexample,onaverage,only26percentofresourcesweremobilizeddomesticallyinsubSaharanAfrica,andsomecountriesintheregionwereonlyabletomobilizeasmallerproportionoftheseresources.Incontrast,theregionsofAsiaandthePacific(at89percent)andLatinAmericaandtheCaribbean(at76percent)contributedfarmoretoICPDimplementationfromdomesticsources.Significantvariationsexistedwithinallregions,particularlybetweenlargecountrieswithestablishedpopulationprogrammesandcountrieswithlessdevelopedprogrammeslargelydependentonexternalsupport.Withinexternalassistance,grantsaccountedforthelargestshareofinputs(75percentintheaggregate,althoughlessthantwothirdsinAsiaandthePacificandinLatinAmerica)exceptinthecountriesineconomictransition,whereloansupportpredominated.Overallin1996approximately20percentofallpopulationresourcesexpendedindevelopingcountriesandcountriesintransition,orabout$2billionoutofatotalof$10billioncamefromtheinternationalcommunity.Thesefindingsindicatethatalthoughoverallexpendituresincreased,theexpectedoverallincreaseintheproportionofexternalsupportforpopulationandreproductivehealthdidnotmaterialize.H.` hp x (#` XH0    (#(# H.` hp x (#` XH2qeN  335  .3  ԀAlongwiththeotherfunctionalcomponentsofresourcerequirements,renewedattentionneedstobegiventomobilizingthe$1.3billionforSTD/HIV/AIDSpreventionprogrammesintheyear2000asproposedintheICPDProgrammeofAction.ThelatestUnitedNationsPopulationDivisionpopulationestimatesandprojections,basedonUNAIDSdata,suggestmoredramaticpotentialimpactsofthepandemiconlifeexpectancyandnationalgrowth(demographicandeconomic)thanhadbeenanticipatedin1994.ThenumberofpeopleinfectedwithHIV/AIDSrosefrom14millionin1994to33.4millioninNovember1998,andthenumberofwomenandchildrenwithHIVinfectionskyrocketedinthesameperiod.Morethan43percentofinfectedpeopleover15yearsofagearefemale,andhalfofallnewinfectionsareoccurringamongyoungpeopleaged1524.Thereisnoindicationyetthatthesetrendswillreverse.Thus,preventionefforts,includingthosetargetedatadolescents,requirefullfunding.Successfulmodelsforpreventioneffortshavebeenfoundtobeeffectivewherecommitmentandresourceshavebeenappropriatelymobilized.ArecentUnitedNationsreport & $  50      ׀indicatesthatyoungpeopleweremorelikely R+ () topracticeabstinenceorsafersexthanadultswhentheyhadtheinformationenablingthemtodoso. B.` hp x (#XB F-)+ 2qeO  336  .3  ԀTheprospectsforchangesinthebalanceofnationalandinternationalsupportaredifficulttoassess. InitialinformationsuggeststhattheeconomiccrisisinSouthEastAsiathreatenstheabilityofaffectedcountriestomaintainthehighproportionsofdomesticfinancialsupportfortheirpopulationprogrammestheyhadreachedintheearlyandmid1990s.Impoverishedpopulationsandtheyoungareparticularlyvulnerabletothenegativeeconomicconditionsandtopotentialprogrammeerosion.Theescalatingdemandandsizeofpopulationsrequiringservices,willcontinuetochallengebothdomesticandinternationalsupport.̜B.` hp x (#XB̛  TheRoleofthePrivateSector       2qeP  337  .3  ԀInadditiontoGovernmentandNGOexpenditures,theprivatesectorisanimportantcomponentofresourceflowsindevelopingcountriesandcountrieswitheconomiesintransition.Anincreasingamountofattentionisbeinggiventoexpandingthepotentialofprivatesectoreffortsinbothmultilateralandbilateralassistanceprogrammes.Methodologiestomonitorprivatesectorinputsrequirefurtherdevelopment.TheUNFPA/NIDIresourcesurveyhasnotyetattemptedtomeasuretheroleoftheprivatesector,butsomeinformationisavailablethroughindividualcountrystudies.Theseandotherresearcheffortsshowthatdiversemixturesofpublicandprivatefinancingandprovisionofservicesarepossible.Theseincludethefundingofprivateclinicsbyprivatefoundations,privateinvestmentinfamilyplanningeducation,theprovisionorsponsoringoffamilyplanningservicesatforprofitinstitutions,andpublicorprivateinsuranceschemescoveringreproductivehealthservices.B.` hp x (#XB2qeQ  338  .3  ԀManycountriesareencouragingtheprivateprovisionofservices,particularlyforthosewiththeabilitytopay,andassessingfeestorecoverportionsofthecostofpublicserviceprovision.Healthsectorreformprogrammesareusingthesemeanstoincreasetheefficiencyandcosteffectivenessofhealthservicedelivery.Householdexpendituresurveysconsistentlyindicatethatmanypeoplemakeoutofpocketpaymentstohealthserviceproviders(public,privateandtraditional),includingpaymentsforreproductivehealthcare.Regularassessmentsofthewillingnessandcapacityofdifferentgroupsinthepopulationtopayfeesforqualityreproductivehealthservicescouldimproveprogrammeplanning.B.` hp x (#XB2qeR  339  .3  ԀTheextensionofnationalhealthaccountsandtheinclusioninsurveysofinformationoncostsandwillingnesstopayarepositivedevelopmentsthatwillfacilitatethemonitoringoftrendsinprivateresources.Interestingnationaldevelopmentsincludetheinclusionofreproductivehealthservicesinnationalinsuranceschemes(asinBoliviaandMexico).Notwithstandingthemanytechnicalandmanagerialchallengesthatremain,especiallyforensuringequitableaccesstoservicesamongthepoorandothermarginalizedpopulations,theprospectsforanincreasedprivatesectorroleinchannellingprogrammeresourcesarepositive.UNFPAhascosponsoredmeetingstofurtherdevelopaPrivateSectorInitiativeprogramme.ANovember1998meetingrecommendedtheexpansionoftheInitiativeatthenationallevelandsupportfortechnicalstudiestoprovideinformationtofurtherencourageprivatesectorinterestandpartnership.B.` hp x (#XBӜ  X*'( &      TheRoleofNonGovernmentalOrganizationsandPrivateFoundations  H   2qeS  340  .3  ԀNongovernmentalorganizationshavebecomeincreasinglyimportantasfullpartnersofGovernmentsandkeyrecipientsofbothdomesticandinternationalresourceflowsforprogrammedevelopmentandtheimplementationofcomprehensivereproductivehealthactivities.AsrecommendedintheProgrammeofAction,theseeffortsmustcontinueandmustbuildonpastsuccessesparticularlyinHIV/AIDSpreventionandcontrol,adolescentprogrammesandthetestingofinnovativeprogrammeapproaches.Fortheirpart,privatefoundationscontributedatotalof$141millionin1996tohelpfinancepopulationprogrammesindevelopingcountries,anincreaseof66percentoverthe1995total.'HA̜2qeT  341  .3  ԛManyinternationalfoundationsanddonoragenciessupportresearchandprogrammeactivitiesinadvocacy,IECandHIV/AIDSprevention,amongotherissuesemphasizedattheICPD.ThefundsarefrequentlychanneledthroughdomesticNGOs,furtheringthedevelopmentofthelargeNGOsectorasacosteffectivealternativeprovideratthegrassrootslevelofreproductivehealthinformationandservicesandofadvocacyonpopulationissues.B.` hp x (#XB1          2qeU  342  .3  ԀIn1996,thetopfoundationdonorsweretheFordFoundation,theRockefellerFoundation,theMacArthurFoundation,theHewlettFoundationandtheMellonFoundation,1Goduc       l $  51      ׀allcontributingbetween$10  and$30millionforpopulationactivities.Inahighlyencouragingrecentdevelopment,thePackardFoundationannouncedinNovember1998thatitwillbeallocatingmorethan$300milliontointernationalpopulationandreproductivehealthprogrammesoverthenextfiveyears(19992003).1ide      1          E1` hp x (#XE2qeV  343  .3  ԀMorerecently,foundationssuchasthenewlycreatedUnitedNationsFoundation,asubsidiaryoftheTurnerFoundation,gavespecificallytargetedgrantsfocusingonpopulationandwomen,withspecialemphasisonadolescents.InitsfirstroundofgrantsinMay1998,theFoundationprovidedUNFPAwith$8millionforsixpopulationprojects.Initssecondroundofgrants,theFoundationwillgiveUNFPA$4.3millionoveratwoyearperiodfortheadvancementofadolescentreproductiveandsexualhealth.Inaddition,theWilliamH.GatesFoundationcontributed$1.7milliontotheUnitedNations,forspecificusebyUNFPAtosupportcollaborationamongdevelopingcountries.ThesegrantsexemplifythetargetedprivateresourceflowsthatwillhaveanimpactontheICPD+5review,supportingaspecialyouthforumaswellasfundingadvocacy,educationandtrainingprogrammesforadolescentreproductivehealthinLatinAmericaandtheCaribbean.1Kide        H.` hp x (#XH SectorInvestmentProgrammesandSectorWideApproaches  v%."# 1          2qeW  344  .3  ԀNewmodalitiestoimprovetheimpactandsustainabilityofdevelopmentcooperationareespeciallyrelevanttoresourceflowsandprogrammemanagement.SectorInvestmentProgrammes(SIPs)andSectorWideApproaches(SWAps)aretwosuchmodalities.Bothaddressconstraintsorweaknessesinthetraditionalmechanismsofdonorsupportforprojectsandprogrammes,includingthefragmentationofresourcemanagement,perpetuationofbudgetaryimbalancesduetorelianceonlongstandingprojectswithoutsufficientmonitoringandevaluationmechanisms,anddifferingcommitmentlevelstoprojectsviewedasexternallydriven.1~Pide       @.*, 1          2qeX  345  .3  ԀSIPsandSWAps,althoughnotnewconcepts,arenowbeingimplementedinanumberofcountriestargetingaparticularsector.SWApsdifferfromSIPsprimarilyinthattheyincludealltypesofresourcesinvolvedinasectoralprogramme,notonlyinvestment,asinthecaseofSIPs.Bothincludeclearlystatedsectoralgoalsandobjectives,pooledorparallelresourceflowsandacoherentandwelldevelopedpolicyandinvestmentframework.Akeyelementistherecipientcountry'sincreasedresponsibilityfordevelopingandarticulatingtheapproach,anditsresultantownership.AlthoughonlypreliminaryinformationisavailableontheefficacyandefficiencyofSIPsandSWAps,theydoprovidealternativedevelopmentassistancemodalitiesthatengendermorecommunicationandcollaborationbetweendevelopingcountriesanddonorswithregardtoprogrammeobjectivesandresourceallocation.TheSWApmechanismisbeingincreasinglyusedasanelementofoverallhealthsectorreforminitiatives.1Side      E1` hp x (#XE1          2qeY  346  .3  ԀNationalexperimentsinbroadparticipatoryapproachestothedeliveryofessentialservicepackagesforhealthsystemsareunderwayinavarietyofcountries(includingNepalandBangladesh).Atthesametime,thedecentralizedmanagementofhealthsectorreformsprovidesopportunitiesforthefurthergenerationandmoreefficientuseoflocalresources.Ensuringadequaterepresentationofallstakeholders,includingthoseendorsingreproductivehealthprogrammes,remainsakeyissue.1Xide      H.` hp x (#XH  ResourcesfortheBroaderICPDGoals     1          2qeZ  347  .3  ԀTheICPDProgrammeofActionviewedpopulationissuesasafundamentalpartofabroaderapproachrequiredforsustainabledevelopment,which,inadditiontointegratedreproductivehealthprogrammes,includeseffortstoprovideotherbasicsocialservices,improvethestatusofwomenandotherdevelopmentinitiatives.AlthoughtheICPDfocusedonandestimatedresourcerequirementsforthemajorreproductivehealthandpopulationcomponentsofaconcertedactionagenda,theProgrammeofActionalsomadeitclearthatotherimportantparallelactionshadtobeundertaken.Theresourcetargets,includingthe$17billionneededannuallybytheyear2000forintegratedpopulationprogrammes,wouldhavetobesupplementedbyresourcesaimedatmeetingtheothergoalsandobjectivessetforthintheactionplan,suchasthereductionofinfant,childandmaternalmortality,basiceducationforall(andespeciallygirls)andtheempowermentofwomen.1!\ide      1          2qe[  348  .3  ԀIthasbeenestimatedthatdevelopingcountriesandcountrieswitheconomiesintransitiondevoteapproximately0.2percentoftheircombinedGNPtopopulationactivitiesthatarepartofthe"costedpackage."Dataavailableforalleffortsinthehealthandeducationsectorsrevealthatfarlargersumsareexpendedinthesesectorsgenerally.Overall,andinapproximateterms,thesecountriesspendabout2percentofGNPinthehealthsectorand4percentintheeducationsector.Ifhealthandeducationaretakentogetherasthetwomainareasofsocialspending,expendituresfortheICPDcostedpackageamounttoonly3percentorlessofsocialspending.Onlyabout10percentoftotalhealthoutlaysgotoreproductivehealthandfamilyplanningactivities,despitethecontributionofreproductivehealthtotheoverallburdenofdiseaseindevelopingcountriesandthecosteffectivenessofmanyrelevantinterventions.1`ide      XXXXXXXX      1mentalpart52 31alpartntal    XXXXXXXX  E1` hp x (#XE ^)&' &    RecentAdvancesinDevelopmentPartnerships  L,)*    'L,f F-)+ 1          K1` hp x (#XK2qe\  349  .3  ԀThe20/20InitiativewhichwasendorsedattheSocialSummitin1995isamutualcommitment betweeninteresteddevelopedanddevelopingcountrypartnerstostrivetoallocate,onaverage,20percentoftheirODAand20percentoftheirnationalbudgets,respectively,tobasicsocialservices.Thefivecomponentsofbasicsocialservices,inadefinitionagreedonata20/20meetinginOsloin1996,arebasichealth;basiceducation;reproductivehealth,includingfamilyplanningandsexualhealth;nutrition;and,basicwaterandsanitation.Governmentexpenditureaccountsrarelyseparatebasicsocialservicesfromotherspending,suchasontertiaryhealthsystems,e.g.,hospitals,oreducation,includinguniversities.1Zgntal      H.` hp x (#XH1          2qe]  350  .3  ԀSince1996,effortstomeasurebasicsocialservicesexpenditureshaveledtoanumberofspecialstudiesinmanydevelopingcountries.Afollowupmeeting,attendedby29developingcountries,19donorcountries,11internationalNGOsand13multilateraldevelopmentorganizations,heldinHanoiinOctober1998ledtothe31paragraph"HanoiConsensusonthe20/20Initiative:UniversalAccesstoBasicSocialServices".Themeetingagreedthatthecurrenteconomicandfinancialcrisisunderscorestherelevanceofthe20/20Initiativetoprotectaccesstobasicsocialservicesforthemostvulnerablepeople.Themeetingalsoidentifiedthe20/20InitiativeasaddressingtheinputdimensionoftheDevelopmentAssistanceCommittee(DAC)partnershipstrategyenunciatedinShapingthe21stCentury:TheContributionof  DevelopmentCooperation,notingthatatthecountrylevelthesharedneedwillvary,dependingonlocal  circumstances.ThemeetingurgedtheDACtoprepareareportondonorsupportforbasicsocialservicesusingbothdatareportedbymembersandtheassessmentofeffortsinpeeraidreviewandtopresentittothepreparatorymeetingfortheWorldSummitforSocialDevelopment(WSSD)+5.ThemeetingagreedthattheHanoiConsensusandtheobjectiveofachievinguniversalaccesstobasicsocialservicesshouldbepresentedandpromotedinrelevantinternationalforums.1kntal      1          2qe^  351  .3  ԀTheWorldBank,throughitsInternationalBankforReconstructionandDevelopment(IBRD)facilityandInternationalDevelopmentAssistance(IDA)lendingprovidedfundingforinvestmentsintheSocialSectortotaling$8.48billioninfiscalyear1998.Thisaccountingincludesloansearmarkedforthesocialsector,forhealth,nutrition,andpopulation,foreducation,andforthesocialprotectioncomponentsofothersectoralcommitments.Banklendinghasincreasinglysupportedintegratedreproductivehealthprogrammesthatgiveprioritytopopulationissues,bothdirectlyandthroughsectorwideassistanceandhealthreformefforts.AccordingtotheBank's1998AnnualReport,anaverage$354millionayearsincefiscal1992supportedprojectscontainingthesetwocomponents.?+ ` hp x (#X?E.` hp x (#` XE2qe_  352  .3  ԀTheBank's1998AnnualReportnotessignificantallocationsinprojectstogendercomponents($2.5billion);tohealth,nutritionandpopulationsectors($2.0billion);andtoeducation($3.1billion).Anadditional$3.76billionhavebeenloanedforeffortsintheareaofsocialprotection,whichincludesprojectsdirectedtowardshelpingthepoorcopewitheconomichardshipsandchange,assistingrefugeesandotherdisplacedpersonsinemergencysituationsaswellasrelatedpolicydevelopmentandlocallygeneratedsocialdevelopmentinitiatives.?+ ` hp x (#X?E.` hp x (#` XE2qe`  353  .3  ԀItwasannouncedinNovember1998thatIDAwillhave$20.5billiontodisburseto80ormoreoftheworld'spoorestcountriesfrommid1999throughmid2002.TheBankindicatedthatitaimsatproviding50percentofIDA'sresourcesduringthatperiodtoAfricancountriesthatarecommittedtopovertyreduction,includingsocialserviceinterventions,economicreformandsustainablebroadbasedgrowth.1rntal      1ntal       @.*, 1          E1` hp x (#XE2qea  354  .3  ԀStudiesundertakenforthe20/20Initiativeprovideroughestimatesofthedevelopingcountries'currentexpenditureonbasicsocialservicesaswellastheadditionalresourcesrequired.Addingthebasicsocialservicescomponentstogether,afurther$7080billionwouldbeneededbeyondwhatiscurrentlybeingexpendedtoachieveuniversalaccesstothecompletebasicsocialservicespackage.Theshortfallinresourcesincludestheadditional$7billionneededtoimplementthecostedoutportionsoftheICPDProgrammeofAction.H.` hp x (#XHE1` hp x (#XE2qeb  355  .3  ԀTheEuropeanUnion(EU)announcedinCairothatitplannedtoincreaseitsaidinthepopulationsectorbymorethan10timesbytheendofthecentury,toreachaprojectedyearlytotalof$347millionbytheyear2000.Itsfinancialsupportofpopulationprojectsandprogrammeshasbeenincreasing;by1997,theEuropeanUnionallocatedanestimated$140millionforpopulationactivities.Withincreasedpoliticalcommitmentandthestrengtheningoftechnicalcapacitytoallocateanmonitorthesefunds,thismodalitycouldfurthersupplementexistingbilateralandmultilateralmechanisms.H.` hp x (#XHE1` hp x (#XE2qec  356  .3  ԀTechnicalcooperationbetweendevelopingcountrieshasbeenincreasingthroughtheexpandedactivitiesofthePartnersinPopulationandDevelopmentProgramme( theSouthSouthInitiative),supportedbytheUNFPAandprivatefoundationfunding.Sucheffortsprovideanadditionalcosteffectivemechanismfortechnicalassistanceandanadditionalcomponentofresourceflows.1{ntal      &    H.` hp x (#XHӜ ̛̜Constraints  DonorCountries  |   E1` hp x (#XE2qed  357  .3  ԀSincetheICPD,somepositivetrendshavebeenobserved.First,the19941995periodsawsomegrowthinexternalassistanceforpopulation.Second,severaldonorcountrieshaverespondedtotheICPDbyreassessingtheiraidpoliciesandtherolethattheProgrammeofActionshouldplayintheiroveralldevelopmentassistancestrategy.Denmark,Germany,Japan,theNetherlands,theUnitedKingdomandtheUnitedStateshaveallundertakensignificantmajorchangessothattheICPDgoalscouldbebetteraddressedintheiraidgivingstrategies.' IH.` hp x (#XH1          2qee  358  .3  ԀAdditionally,theproportionoftotalODAdestinedforpopulationhasincreasedsincetheICPDand,in1997,stoodatahistorichighlevelof3.09percent(preliminary)ofODA,demonstratingthedonorcommunity'sgreateremphasisonpopulationconcernsthaninthepast.Althoughthistrendisencouraging, #: ! totalODAhasdeclinedinrecentyears,andthereforethatpercentageactuallyreflectsamuchslower |$4!" growthorevennegativegrowthintotalresourcesallocatedtopopulationactivities.1       1          2qef  359  .3  ԀUnfortunately,althoughfundingforpopulationhasincreasedsincetheICPD,ithasnotincreasedatarateconsistentwithmeetingtheagreedupontargetof$17billionbytheyear2000.AmajorobstacletoincreasingresourcemobilizationinlinewiththeICPDresourcegoalshasbeentheslowdownwardtrendinODA.Thereasonsforthistrendareseveral.Somedonorcountrieshavereducedaidasanoveralldrivetoreducebudgetdeficits.Therehasbeenalossofconfidenceinsomecountriesastotheefficacyofdevelopmentaid.Thelargeincreasesinprivatesectorinvestmentin10or12developingcountriesinthe19931996period,aswellasthegrowingbeliefinthecentralityofmarketdrivendevelopment,mayalsohaveworkedagainstODAthatispreponderantlytiedtoprojectsinthepublicsector. @.*, 1      B.` hp x (#XBE1` hp x (#XE2qeg  360  .3  ԀThetrendsindecentralizationofbothexternalassistanceandnationalresources,alongwithoverallstructuralreform,haveposednewchallengesforprogrammemanagement,monitoringandevaluation.Theserestructuringtrends,whichwillmakeassistancemoreeffectiveinthelongterm,haveleftcountriesfacedwiththeneedtomorerapidlyexpandtheirtechnicalandfinancialcapacitytoimplementprogrammes.̛1          K1` hp x (#XKӜ2qeh  361  .3  ԛRigiddonoraidpoliciesinhibittheflexibilityneededforincreasingandefficientlyusingresourceflowsanddonormanagementinformationsystemsthatarebothdemandingandinappropriateformonitoringdecentralizedpopulationassistance.1t      H.` hp x (#XH1          E1` hp x (#XE2qei  362  .3  ԀThelevelofcommitmentofsomedonorcountriesisanotherconstrainttorealizingtheresourcetargetscontainedintheProgrammeofAction.AnumberofdonorcountriesthathaddevotedarelativelysmallpartoftheirtotalODAtopopulationbeforetheICPDarecontinuingatlowlevels,despitetheconsensusonthecentralityofpopulationtodevelopmentandtheneedtoimplementthe20yearplancontainedintheProgrammeofAction.Thus,anumberofcountriesinEuropecommitsubstantiallylessthaneven1percentoftheirODAtowardstheimplementationoftheProgrammeofAction.1Ɠ      H.` hp x (#XH1          E1` hp x (#XE2qej  363  .3  ԀFromanotherperspective,ifalldonorcountriesnotcurrentlyextendingassistanceatleastatthelevelof3.54percentofODAweretohavedonesoin1996,anadditional$902millionto$1.11billionwouldhavebeenavailabletofinanceinternationalpopulationefforts,inadditiontothe$2billionactuallyallocated.1{      XXXXXXXX      53 Йssis    XXXXXXXX  ݀Ifahigherlevel(45percent)ofODAweretobeachieved,consistentwiththeexpanded  definitionofpopulationandreproductivehealthprogrammes,furtherresourcescouldhavereachedasmuchas$1.71billion.H.` hp x (#XH&   DevelopingCountries  p 1          E1` hp x (#XE2qek  364  .3  ԀBesidesfinancialconstraints,InsufficienttechnicalandhumanresourcesareamongthemostprevalentconstraintsnotedinreportsbydevelopingcountriesregardingobstaclestoimplementingtheICPDϢProgrammeofAction.Otherobstacleshavemilitatedagainstincreasedresourceflows,suchasfinancialcrises,verylowpricesforexportcommodities,constraintsnecessitatedbyongoingstructuraladjustmentϢprogrammesandpoliticalinstability.Undersuchcircumstancespreviouspronouncementsdonotalwaystranslateintodomesticresourceflowsforpopulationprogrammes,basicsocialservicesandprogrammesaimedatfosteringgenderequityandequality.'1Ussis      H.` hp x (#XH1          E1` hp x (#XE2qel  365  .3  ԀPovertyandthenecessaryresponsestoeconomiccrisesthathaveerodedalreadymeagerpublicsectorresourcestranslateintofartoofewresourcesbeingavailableforbasicsocialprogrammes.Theanswerstoquestionsaboutwhatprioritiesshouldguidegovernanceandfinancedecisionsremaincritical.Theestimated$8billionraiseddomesticallyforpopulationisstill$3.3billionshortoftheyear2000target.Whileitwillbedifficultunderthecurrentcircumstancestototallyfillthatgap,besteffortattemptsarecalledfortobuildonthegainsandresultingprogressinthe19941997period.1bssis      H.` hp x (#XH1          2qem  366  .3  ԀOneobstaclethatmayresultinalackofpoliticalcommitmentisthelackoftimelyandaccuratepolicyrelevantinformationgeneratedwithindevelopingcountries,whichwouldshedlightonnationalpopulationissues,programmeprogressandlinkagestootherdevelopmentconcerns,andwouldhelpgarnersupportforfurtherefforts.Insufficientandincompletesystematicdataonresourceflowsandprogramme @.*, requirementsimpedeeffortstoassessandprioritizeneedsandevaluatecurrentprogrammesaswellastomobilizeandallocateresources.1ssis      1          2qen  367  .3  ԀWhilesomenoteworthyprogresshasbeenmadesincetheICPD,oppositiontopopulationϢprogrammesontraditionalorculturalgroundsremainsanobstacletothemobilizationofresourcesincertaindomesticcontexts.Suchoppositioncanalsoinfluencethescopeofthepopulationprogrammestowhichtheresourceswouldbeallocated.Attimes,misinformationcampaignsregardingtherealpurposeofpopulationprogrammeshavebeenusedtostigmatizepopulationactivitiesandcreateadversepublicopinion.IEC,trainingandadvocacyrelatedtopopulationissuesandtheirrelevancetodevelopmentstrategiescanhelpcorrectsuchmisperceptions.1%ssis      ݜ&  ̛  FurtherActionRequired      ' 1          E1` hp x (#XE2qeo  368  .3  ԀEffortsshouldberedoubledbydevelopingcountries,donors,multilateralorganizations,includingtheregionaldevelopmentbanks,foundations,theprivatesector,NGOsandothercivilsocietyrepresentativestobothadvocateforandhelpprovidethelevelofresourcesrequiredforthefullimplementationoftheICPDProgrammeofAction.1ssis      H.` hp x (#XH1          2qep  369  .3  ԀGovernmentsofdevelopingcountriesshouldincreasetheirinvestmentinbroadersocialsectorandattempttoprovideanincreasingportionoftheirresourceneedsdomestically.1ssis      1          E1` hp x (#XE2qeq  370  .3  ԀGovernmentsofdevelopingcountriesshouldcontinuetheireffortstoensuretheefficientandeffectiveuseofbothnationalandexternalresourcesbystrengtheningthetechnicalandmanagerialcapacityofreproductivehealthprogrammes,especiallyinlightofsuchdevelopmentsassectorwideapproachesanddecentralization.1!ssis      H.` hp x (#XH1          2qer  371  .3  ԀGovernmentsofdevelopingcountriesshouldstrengthenmechanismstocoordinatenationalreproductivehealthprogrammesinvolvingallpartnersincludingcivilsocietyorganizations,NGOsandtheprivatesector.Moreover,bothdonorandrecipientcountriesshouldworktoimprovetheplanningandimplementationofpopulationprogrammesandtheirrelationshiptodevelopmentstrategies.1±ssis      B.` hp x (#XB1          2qes  372  .3  ԀGovernmentsofdevelopingcountriesshouldconductstudiestocreateaknowledgebasethatiscapableofdramatizingtheinterrelationshipsamongpopulation,environment,povertyanddevelopment.Suchstudiesneedtobeundertakenonanadvancedlevelandlinkedtoanadvocacystrategysothattheirmessageswillreachthepublic,themedia,parliamentariansandopinionleaders.1Xssis      1ssis      2qet  373  .3  ԀFinally,theimplementationoftheProgrammeofActionmustbeviewedbyallcountriesandallpartnersasacollaborativeeffortinwhichallpartiescontinuetoworktogethertodomoretoattaintheϢICPDgoalsandobjectives.Allcountries,developedanddeveloping,shouldparticipateinopen,accurateandtimelysharingofinformationonprogrammeprogressandconstraintsandontheirresourcecommitmentsandexpenditures.E1` hp x (#XE0    (#(# K1` hp x (#XK2qeu  374  .3  ԀAftertwoyearsofencouraginggrowthinthelevelsofinternationalpopulationassistancein1994and1995,thelevelsofODAin1996and1997declined.Internationalpopulationassistancein1996hovered @.*, atthe1995level;provisionalfiguresshowaslightdecreasein1997.Thisisadiscouraginganddishearteningdevelopment,especiallyinlightofthesignificantnegativeimpactontheprovisionofsocialservicesengenderedbytheeconomicandfinancialcrisisofthepast18monthsinSouthEastAsia,inRussiaandinLatinAmericaandthecontinuingvulnerabilitiesinotherdevelopingcountriesandregions.ThesehighlydisruptivedevelopmentsgreatlyheightentheconcernofallofthepartiesandindividualscommittedtoreachingthegoalsandobjectivesforimprovingthequalityoflifethataresetforthintheICPDϢProgrammeofAction.Itistobehopedthat19961998willprovetobeonlyananomalyandthatincreasedmobilizationofinternationalpopulationassistancewillresumein1999andaccelerateintheyear2000andbeyond.    Л1dert      H.` hp x (#XH SELECTEDREFERENCES  B <XXE1` hp x (#XE0   #XX<#FamilyPlanningandReproductiveHealthinCCEEandCIS:workingdocument,UNFPA/WHO  Europe,December,1997.(#(# 0   InformalTripReportsfromHighLevelMeetingsinAddisAbaba,Ethiopia;Aruba,andBangkok,Thailand.UNFPA,1998. x (#(# 0   PreliminaryReportonResearchProjectExaminingFollowuptotheICPD.NewYork,Centerfor  l  InternationalCooperation,NYU,1998.f (#(# 0   PostCairoReproductiveHealthPoliciesandPrograms:AComparativeStudyofEightCountries, Z  K.Hardeeetal.,ThePOLICYProjectoftheFuturesGroup,1998.T(#(# 0   RegionalEconomicandSocialCommissionReports,ECOSOCforLACD,ESCAP,andECA,1998.H(#(# UnitedNations.PopulationandDevelopment.ProgrammeofActionadoptedattheInternational < ConferenceonPopulationandDevelopment,Cairo,513September1994.Volume1.Department ~6 forEconomicandSocialInformationandPolicyAnalysis,ST/ESA/SER.A/149.NewYork,UnitedNations,1995.UnitedNations.WorldPopulationMonitoring1996.SelectedAspectsofReproductiveRightsand f ReproductiveHealth.NewYork,UnitedNations,1998. ` 0   UNFPAFieldInquiryResponses,TPDICPD+5Secretariat,1998.T (#(# 0   UNFPANationalReports.UNFPA,TPD,1997. (#(# WHO.GlobalandRegionalEstimatesofIncidenceofMortalityDuetoUnsafeAbortionwitha