Purpose and Framework
9 This report was prepared by the United Nations Population Fund (UNFPA) as a background document for the Hague Forum, to be held in The Hague, the Netherlands, from 8 to 12 February 1999. The Forum will assess the progress made and constraints encountered in the implementation of the Programme of Action of the International Conference on Population and Development (ICPD), held in Cairo, Egypt, in 1994. A report on the outcome of the Forum will be sent to the March 1999 session of the Commission on Population and Development and will be taken into account in the preparation of the Report of the Secretary-General to the United Nations General Assembly Special Session on the Implementation of the ICPD Programme of Action, to be held from 30 June through 2 July 1999.
10 This report takes into account the findings of a series of extensive reviews, including:
- A series of round-table and technical meetings organized by UNFPA during 1998;
- Consultations organized by the United Nations regional commissions;
- A global field inquiry conducted by UNFPA in mid-1998 in which information was collected from 114 developing countries and countries with economies in transition through UNFPA Field Offices, and to which 18 donor countries also responded;
- Progress reports on the implementation of the ICPD Programme of Action from UN specialized agencies and other UN organizations; and,
- Reviews, including case studies, conducted by international organizations, non-governmental organizations and academic institutions.
11 The ICPD Programme of Action, adopted by 179 countries, underscores the integral and mutually reinforcing linkages between population and development and endorses a new rights-based strategy focused on meeting the needs of individual women and men rather than on achieving demographic targets.1 The ICPD Programme of Action sets out a number of time-bound population and development goals for a 20-year period, from 1995 to 2015, including: the provision of universal access to reproductive health services, including family planning and sexual health; a reduction in infant, child and maternal mortality; and the provision of universal access to education, especially for girls. It stresses the empowerment of women both as a highly important end in itself and as a key to improving the quality of life for everyone.
Organization of Report
12 Following the overview of the major themes presented in the ICPD Programme of Action and consideration of the population situation contained in this chapter, Chapter II discusses policy initiatives taken by countries since 1994 towards creating an enabling environment for the implementation of the Programme of Action. Chapter III focuses on reproductive health, including family planning and sexual health, and reproductive rights. Chapter IV discusses progress in the area of gender equality, equity and the empowerment of women. Chapter V examines partnerships between Governments and civil society and among United Nations organizations. Chapter VI examines issues pertaining to the resources required to implement fully the ICPD Programme of Action, including financial resource flows in both developing and donor countries. Each chapter analyses progress made in achieving the goals and objectives of the ICPD Programme of Action as well as the constraints and challenges in population and development. The chapters conclude with further actions required to accelerate progress in implementing the ICPD Programme of Action.
13 In 1960, the world's population stood at 3 billion and the growth rate was 2 per cent; in 1980, the population was 4.4 billion and the growth rate was 1.7 per cent. World population today stands at 5.9 billion and is growing at 1.33 per cent annually. Favourable demographic trends give rise to the hope of an eventual stabilization of global population at a level the earth can support. However, the demographic momentum will continue to lead to large growth in numbers for at least the next two decades. According to United Nations global population and demographic estimates and projections, the world's population will exceed 6 billion for the first time in 1999. Of this total, some 80 per cent will be living in developing countries. Global population is expected to reach somewhere between 7.0 and 7.5 billion by the year 2015 and will continue to grow until at least the middle of the next century. Although the rate of population growth has declined, world population is currently increasing by some 78 million persons a year, compared with 63 million a year in 1960, because of the legacy of high fertility levels in the recent past. Approximately 97 per cent of the increase in world population is occurring in the least developed regions, which are growing at 2.6 per cent annually, and the less developed regions, which are growing at a rate of 1.7 per cent annually. The more developed countries are increasing by only 0.3 per cent annually, and in some of the more developed countries population is declining.
14 The available evidence suggests that reductions in infant and child mortality have continued in the 1990s broadly consistent with the goals of the ICPD. Average life expectancy at birth is projected to rise by 2 years between 1990-1995 and 1995-2000, that is, from 64 years to 66 years. However, the overall figures conceal wide disparities between regions and countries. For example, the average life expectancy at birth in 1995-2000 is 74.5 in the more developed countries, 63.6 in the less developed countries and just 52 in the least developed countries (LDCs). Moreover, at the country level, it is estimated that life expectancy has declined in parts of sub-Saharan Africa, where the impact of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic has significantly affected mortality rates, and among a few of the countries with economies in transition. Average life expectancy at birth ranges from 70.6 for men and 78.4 for women in the more developed regions to 50.9 years for men and 53.0 years for women in the least developed countries (LDCs).
15 Overall improvements in mortality, coupled with advances in educational attainment and increased implementation of the right to reproductive choice, have resulted in women marrying at a later age and bearing significantly fewer children than in the past. Globally, women are now having an average of 2.8 children, compared with 3.0 five years earlier. However, as with mortality, the overall figures conceal wide disparities between regions and countries. For example, the average number of live births per woman in 1995-2000 is 1.6 children in the more developed countries, 3.1 in the less developed countries and 5.3 in the least developed countries (LDCs).
16 The age structure of the world's population is changing rapidly, particularly in the developing countries. As countries continue to reduce their birth rates, the relative share of children decreases and the population of working age increases. Increases in the proportion of persons of working age provide an excellent opportunity for countries who take advantage of it to increase saving and investment in productive assets, as well as to make greater human-capital investments in education and health. While the proportion of children is declining, the numbers and proportions of young persons are growing. Today's generation of young people between the ages of 15 and 24 is the largest ever, numbering more than 1 billion.
17 Over the past two decades or so, in all but the least developed countries (LDCs), the growth rate for the population aged 60 and over has been increasing at, or faster than, the growth rate for the total population. Worldwide, the growth rate for those aged 60 and over is double the overall rate. Even more noteworthy, however, is the rate of growth in the population aged 80 years and over. Rates for these ages worldwide exceed 3 per cent, reflecting increased life expectancy for the oldest ages. In much of Europe, Northern America and Japan, the proportion of older people is increasing more rapidly than any other age group.
18 Population ageing is thus becoming a feature of populations worldwide as fertility rates decline and life expectancy increases. This trend -- evidenced, at first, in reduced proportions of children and enlarged groups of adults of working age -- is rapidly extending its impact beyond the countries of established low fertility. By the year 2015, it will result in about 13 per cent of the world's population being aged 60 and over. A major feature is the increased speed with which this ageing will occur in developing countries compared with the earlier experience of more developed countries. Developing countries which currently account for 80 per cent of the world's population overall already have more than 60 per cent of persons 60 years or older. By 2015, this share is expected to increase to almost 70 per cent of older persons. Because of higher male mortality rates, females predominate at older ages, and the discrepancy between the sexes becomes greater with advancing age. This trend will result in a large proportion of older women spending many years without partners.
19 There remains a substantial gap in the data and research on the conditions among older persons, and the relationships between shifts in age structure and current and future social and economic development issues. These data and research provide the basis for policies and programmes addressing the particular needs of the elderly, including the economic and social security of the elderly, especially of older women and the frail; affordable, accessible and appropriate health care services; increased recognition of the productive and useful roles the elderly can play; and support systems to enhance the ability of families to care for their older family members.
20 Continuing high levels of internal migration and urbanization are key issues in socio-economic development. The unprecedented movement of people within the borders of their own countries is one of the greatest transformations witnessed in the twentieth century. There continue to be large movements of people from rural to urban areas in most developing countries, with dramatic rates of urbanization, which have led to the creation of a growing number of mega-cities that have in many cases overwhelmed the social and environmental resources and spawned huge peri-urban slums. Many developing-country cities are growing far faster than economic opportunities are being generated. The high rates at which movements to urban centres are taking place are often due to the unsustainable growth of rural populations.
21 The international flow of people between countries is a complex result of economic, political and cultural interrelations and forces. Such movements of people affect, and are affected by, the developmental processes taking place in both the sending and the destination countries. International economic imbalances combined with the absence of peace and security, including gross human rights violations, exacerbated by the effects of widespread poverty and environmental degradation have led to rising numbers of international migrants.
22 Since the ICPD, the need to address the problems, issues and challenges raised by various forms of international migration have prompted Governments to increase cooperation at bilateral, subregional and regional levels. Some of the initiatives undertaken are beginning to show results. At the multilateral level, two processes merit mention: that initiated by the 1996 Regional Conference to Address the Problems of Refugees, Displaced Persons, Other Forms of Involuntary Displacement and Returnees in the Countries of the Commonwealth of Independent States and Neighbouring States (and its resulting Programme of Action); and the Puebla Process, which began in 1996 and which entails consultation between the countries of Northern and Central America. In addition, the international community has continued to consider the interrelations between international migration and development. The Technical Symposium on International Migration and Development, held in The Hague in 1998, under the auspices of the United Nations Administrative Committee on Coordination (ACC) Task Force on Basic Social Services for All (BSSA), served as a forum to discuss the many ways in which international migration interacts with development issues and to assess the effectiveness of policies in that regard.
23 Africa has a population of almost 780 million and a total fertility rate (TFR) of just over 5.3 compared with 282 million in 1960 and a TFR of 6.7. With an average annual growth rate of 2.6 per cent, the region is currently growing by 17 million a year and is expected to increase to just over 1.5 billion by the year 2025. Infant mortality is 86 per 1,000 live births, and overall life expectancy is 52.3 years for males and 55.3 years for females. However, regional figures mask great variations among individual countries. Notwithstanding their achievements in the area of population and development in recent years -- primarily because an increased number of countries in Africa have formulated population policies and because collaboration has increased among Governments, NGOs, women and youth groups, and local communities in population-related activities -- most African countries continue to face high population growth rates, high levels of mortality and the spread of HIV/AIDS. Among the chief constraints to achieving the goals of the ICPD Programme of Action in the region are limited access to reproductive health services, insufficient numbers of trained personnel, inadequate financial resources and ineffective advocacy strategies.
24 Asia's population numbers almost 3.6 billion and currently has an average annual growth rate of 1.4 per cent. Excluding China, the growth rate stands at 1.6 per cent. Given the very large population base of the region, the annual increase in absolute numbers is staggering: over 50 million people are being added annually to the region's population. The countries of Asia are characterized by extreme diversity in the levels of fertility and mortality. In some countries in the region, fertility has declined to below replacement levels, whereas in others it remains high. Later female age at marriage, a decline in the age at menarche and a decline in the age difference between spouses raise important policy issues relating to the provision of reproductive health services for unmarried adolescents and young adults. Population is generally considered an integral component of government planning efforts, with most countries in the region trying to integrate population factors into their development plans. However, there are varying degrees of success in implementing the ICPD Programme of Action. The chief constraints include the lack of political commitment and limited human and financial resources. Moreover, the 1997/98 financial and economic crisis affecting a number of Asian countries continues to compound the challenges.
25 Europe has a population of just over 729 million and a zero average population growth rate. Its population is expected to decline to just over 700 million by the year 2025. The region's TFR, at 1.5, is the lowest in the world. Almost all countries in the region are at below replacement level of fertility. Within the region, infant mortality is highest in eastern Europe, at 17 per 1,000 live births, and lowest in northern and western Europe, at 6 per 1,000. Life expectancy in Europe is 68.3 years for men and 77.0 years for women.
26 Countries with economies in transition of the former USSR are experiencing simultaneous declines in fertility and life expectancy. Among the contributing factors are the political transformation and economic transition that these countries are undergoing, which to date has adversely effected the standard of living of large segments of the population, a deterioration of public infrastructure and a decline in the quality and range of health-care services. In addition, civil unrest and armed conflicts have contributed to a health crisis in a number of countries in the region.
27 Latin America and the Caribbean region has a population of almost 500 million and an average annual growth rate of 1.5 per cent. Although a rapid decline in fertility has been the distinguishing feature of demographic trends in Latin America and the Caribbean over the past three decades, major differences in fertility and mortality rates exist within the region, and the variations within countries themselves are considerable. This is due chiefly to the existence of social inequalities, which translate into high proportions of people living in poverty, exhibiting higher fertility rates and experiencing higher infant and maternal mortality rates. The decline in fertility has been especially noticeable among women over the age of 35; teen fertility has also declined, but at a slower rate. The region's TFR of almost 2.7 masks large differences between countries. Mortality levels and life expectancy also vary significantly across the region. Latin American and Caribbean countries have agreed on a strategy of offering access to high-quality safe motherhood services and family planning, taking into account the sociocultural identity of the users and giving priority to the most vulnerable groups in the population. To implement this strategy successfully, countries will have to address such constraints as the lack of adequate human and financial resources and the lack of institutional experience in implementing integrated reproductive health services in a region where traditional family planning and mother and infant health programmes predominate. Further account will need to be taken of sociocultural barriers to the acceptance of reproductive health services, particularly those relating to sexual behaviour and fertility regulation.
28 Northern America, the most highly urbanized region, has a population of just over 304 million, which is expected to reach 369 million by the year 2025. It has an average annual growth rate of 0.8 per cent. Infant mortality stands at 7 per 1,000 live births and life expectancy is 73.6 years for men and 80.3 years for women. Low fertility and long life-spans have resulted in a rapid increase in the proportion of the population aged 65 and over.
29 Oceania, the smallest region, has a population of just under 30 million and an average annual growth rate of 1.3. The TFR for the region is almost 2.5. The infant mortality rate varies from 6 per 1,000 live births in the lowest mortality country to 61 per 1,000 in the highest.