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.