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Report of the International Forum for the Operational Review and Appraisal of the Implementation of the Programme of Action of the International Conference on Population and Development (ICPD) FINDINGS AND PROPOSED ACTIONS Background 20. The Hague Forum was convened during 8-12 February 1999 to conduct an operational review of the implementation of the Programme of Action of the ICPD. The Hague Forum was immediately preceded by three other international gatherings on ICPD also held in The Hague: the Parliamentarians' Forum, the NGO Forum and the Youth Forum. These meetings have included many stakeholders - government officials, parliamentarians, non-governmental organisations, youth and private foundations - and have led to a sharing of the lessons learned during nearly five years of experience in implementing the ICPD Programme of Action. As the Programme of Action defined objectives and goals and a strategy for achieving these ends for the twenty-year period following its adoption in 1994, and since the Programme is being implemented in a dynamic environment, it is necessary to take stock periodically in order to adapt activities to evolving circumstances. 21. Considerable progress has been made in policy, programme redesign, increased partnership and collaboration directed toward implementation of the ICPD. Many countries had made policy, legislative and/or institutional changes in the areas of population and development and reproductive health and rights. In the countries with economies in transition there has been particular progress in the area of reproductive health and rights. In addition, in many settings, democratization and improved transparency in governance, expanded activity of voluntary associations, improvements in communications and legal and policy modifications have advanced the prospects for the participatory approach which is at the centre of successful implementation of the Programme of Action. 22. A review of progress over the last five years on the scope of collaborative efforts with civil society provides a basis for optimism. The devolution of public responsibilities, decentralization of public administrations and other institutional changes have also greatly accelerated and have created new opportunities and challenges for development activities. In addition, major strides have been taken in procedural areas, such as positive changes in the concept of participation and the processes for consultation; recognition of the enhanced role of civil society; increasing acceptance of innovative development approaches; and improved partnership among United Nations organizations and bodies. 23. Since 1994, however, the world has also faced a series of adverse occurrences and developments that have had major impacts on the implementation of the Programme of Action. These have included: the severe financial crises in many countries that began in Asia in mid-1997 and now affects many other areas including the Russian Federation and other countries with economies in transition and Latin America; a series of natural disasters, including prolonged drought in sub-Saharan Africa, devastating storms in Central America and the Caribbean and large-scale floods in Asia; continued economic stagnation and financial crises in many poor countries, including several with on-going structural adjustment programmes; a steep drop in the prices of oil and other commodities; and social instability and civil and sub-regional wars and conflicts in all regions. All of these have had major consequences for health and development, in particular women's health. 24. Global population has doubled since 1960 and 97 per cent of future projected growth will occur in developing countries where the exercise of reproductive rights is in many places far more precarious. As people have been given greater choice, rates of population growth have continued to decline. However, the world is still growing by 77 million people a year and population stabilization will not be reached for fifty years at the earliest. Later this year, on 12 October, the world population will reach 6 billion people. 25. At the approach of the new millennium there are over 1 billion young people between the ages of 15 and 24, the largest cohort at these ages ever. The sexual and reproductive health needs of these young people are not yet adequately addressed. Many do not have access to information and services to protect their health and make choices freely and responsibly. Young women are particularly vulnerable to unwanted pregnancy, sexual violence and susceptible to infection with sexually transmitted diseases (STDs), including HIV/AIDS. Young women, especially those under age 18, are at the highest risk of maternal mortality and morbidity. The choices the young make about the timing and spacing of their children will determine the pace of future population growth. The education and opportunities they are given from a young age will determine the quality of their lives. 26. The number and proportion of older persons throughout the world is increasing because of mortality and fertility reductions in the past four decades. Yet in many countries policies and programmes to provide the services they need or reinforce family and community support do not exist. Women make up the highest proportion of older people, particularly the very old, and many carry the burden of a history of poverty, illiteracy, ill health, gender violence, and discriminatory treatment. 27. Mortality decline has been uneven. In some countries there have been reversals of gains in life expectancy. In countries with economies in transition in Eastern Europe, life expectancy has particularly declined in the context of increased social stress, poor nutrition and deteriorating health services. Countries most severely affected by the HIV/AIDS pandemic, such as in parts of sub-Saharan Africa, face significant decreases in life expectancy and severe losses among young adults in their peak productive years. Maternal mortality is also a critical area for attention and action. It takes the lives of almost 600,000 women each year. 28. As the demand for smaller families has increased and the access to safe and accessible contraception has improved, fertility level have declined. Over 150 million couples still have an unmet need for contraception. Other unmet needs for reproductive health, including family planning and sexual health, services remain extremely high, including the need for infertility services. In countries where significant increases in contraceptive access and acceptance have been effected, recourse to abortion has declined dramatically. However, recourse to unsafe abortion still remains a serious problem. 29. International migration and its impact on society have taken on greater importance and are drawing increased attention from the international community. The multi-faceted aspects of migration, which include issues related to the integration of documented migrants, trafficking of people, and refugee movements, have prompted Governments to undertake a series of actions to address the phenomenon. Among actions designed to address the situation of migrants are assistance to refugee women and children, promotion of the integration of migrants and specific sanctions to combat illegal migration. The remaining challenge is to understand the root causes of migration in order to fully address the linkages between migration and development. 30. The contexts for implementation of population and development programmes are varied. The Programme of Action recognises the need to take fully into account the economic, social, religious, cultural and environmental diversity of conditions in each country, as well as the shared but differentiated responsibilities of all people to forge a better common future. The discussions at the Forum reaffirmed both the common threads and the variety of national experiences and provided an opportunity for information exchange and the rediscovery and reaffirmation of shared perspectives. 31 . The discussions and conclusions of the Hague Forum resoundingly reaffirmed the ICPD Programme of Action: Human rights and reproductive health 32. In the past five years there has been a growing acceptance of a human rights-based perspective. This approach has served to enhance the quality and accessibility of reproductive health services, based upon the human rights of women to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. The international human rights treaty bodies, national human rights offices and non-governmental organizations have increasingly taken note of reproductive health, including family planning and sexual health, in policy and programme documents, decisions and recommendations. Rights in the area of sexual and reproductive health have received increasing recognition, including the rights of migrants, refugees, displaced persons and people living with HIV/AIDS. The reproductive health approach 33. Policy changes in many countries demonstrate a clear commitment to move from a preponderance of vertical family planning programmes to a comprehensive sexual and reproductive health approach with an emphasis on quality of care. As a start to reform, many countries have adjusted their policies, terminology and institutional structures. Other countries have gone even further, and have started implementing the paradigm shift by integrating and linking services. The challenge now is how to implement broad strategies of sexual and reproductive health which emphasise comprehensive services without losing the specialised skills that are provided in successful vertical programmes, and how to achieve this in the context of weak health service infrastructure and health sector reform. Women's empowerment 34. The ICPD and the subsequent Fourth World Conference on Women have enhanced national attention and debate on the centrality of gender equity, equality and the empowerment of women in sustainable development. Governments have made important strides toward implementing international conventions such as the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). Many countries have enacted gender action plans aimed at promoting and protecting the rights of women as fundamental human rights. Legislation on gender-based violence and the integration of gender in sustainable development policies have reinforced the primacy of gender issues. The heightened public awareness of women's rights issues is increasing pressure to convert policy statements and legislation into effective action. Partnerships 35. Over the past five years there has been an increase in the number and variety of partnerships that are being established. There has been a clear movement toward partnerships in which NGOs, in particular women's groups, share responsibility with government institutions for implementing the ICPD Programme of Action. National coordination mechanisms have been set up that involve different sectors of civil society in shared responsibility for programme development, implementation and accountability. In this process, the importance of transparency and good governance is increasingly recognised. Where communities have been involved in policy development and implementation, dramatic progress has been made in furthering the ICPD Programme of Action. Parliamentarian groups have been taking an increasingly active role. There has also been a growing recognition of the need to fully involve youth. 36. While touching on all parts of the ICPD Programme of Action, The Hague Forum focussed particularly on the operational review of the following major issues for its further implementation:
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