UNFPAState of World Population 2002
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Chapter 6:

Policies, Strategies and Issues for Improving Cities

Making cities sustainable will require integrated plans that link balanced development of rural and urban areas to the alleviation of poverty. The empowerment of women through education, greater involvement in decision-making, participation in government and community institutions, and better entrepreneurial opportunities for both urban and rural women must be central to any such plans. Also vital will be enabling environments which encourage all elements of civil society to participate.

Meeting the urban challenge

In the most recent United Nations assessment1 fully three quarters of the 190 governments surveyed were dissatisfied with the distribution of their populations; 110 said they wanted to slow or reverse existing trends. Most of these were concerned about rapid urbanization. This concern has been a consistent feature of national policy and action for the past 20 years, yet the cities have continued to grow.

The more successful policies, however, offer some pointers for the future. In recent decades the dominant strategies2 have been directed either at the distribution of population between rural and urban areas; or at improving the quality of life in cities and strengthening urban institutions. Preparations for the HABITAT II Conference have further refined these alternatives.

ICPD and Urban Strategies

Underlying HABITAT II are aims shared with the other inter-governmental conferences of the 1990s: forging new partnerships; creating the social conditions for accelerated economic development; emphasizing social investments such as health and education, especially for girls and women; alleviating poverty; and mobilizing resources to improve settlements and services.

Particular emphasis is given in current policies to strengthening urban management systems; to promoting national development; and to integrating national economies into the international system of exchange and finance. All the conferences emphasized improving urban management and the financing of services.

Urban Issues at the World Summit for Social Development

Economic constraints and structural adjustment programmes have forced policy changes aimed at limiting public sector expenditure and extracting greater efficiency from what remains. The need for economy has influenced a trend towards administrative decentralization and the concept of "civil society", the mobilization and broad participation in government of the combined forces of business, non-governmental service organizations, and community and advocacy groups.

Beijing and Urban Issues

Policies on population distribution

Strategies adopted to slow urbanization have included investments in rural development; incentives promoting urban alternatives to primary cities; establishment of new towns; and the relocation of ministries and legislatures to new capital cities. These attempts have been hampered by a lack of investment in infrastructure outside the urban centres, and have usually failed to overcome the drawing power of urban magnets.

Newly created urban centres may provide employment and housing but little else, making it difficult to attract and retain skilled labour. Even when workers move, employment does not necessarily follow, as has been the case with the new towns around Cairo which have failed to reduce commuting.

Cities gain their economic advantage from the concentration of skills, capital, industrial activity, manufacturers' suppliers, energy supplies, transport and educational infrastructure. Demand results in competition among suppliers and efficiency. Concentration of suppliers, services and customers within certain districts promotes further efficiencies, stimulating further concentration. New urban centres lack these advantages, which have developed over time in response to diverse market stimuli rather than central planning.

Investing in rural areas so that they may retain population has had only mixed success. It requires vast amounts of financial and human resources because rural infrastructure development is more costly than that in cities. Policies and regulations meant to generate non-farm employment are only beginning to be effective, and are not readily transplanted to new settings.3

Rural development is important in its own right. Higher agricultural productivity increases rural incomes and helps meet growing urban demand. Higher rural incomes do not necessarily stem the flow of people to the cities, however, as the experience of sub-Saharan Africa shows. Productivity gains may turn part of the rural population into surplus labour, ripe for migration. Better social and economic infrastructure in rural areas can stimulate increased economic activity, leading to development in smaller cities. This increases overall urbanization, but may take some pressure off primary cities.

Experience suggests that limited resources are better used to raise rural living standards than to attempt deliberately to counter the attractions of dominant cities.4 Over the last decade, however, there have been successful efforts in Latin America and in Asia to distribute economic development and populations within complexes of primary and secondary cities. Growth in small and medium-sized cities can help reduce the growth of the biggest ones,5 although this has more often been a natural consequence of stronger links between large cities and surrounding areas than a result of deliberate policy.

Reproductive health

The biggest factor in urban population growth in most regions and in many countries is natural increase. Reducing this component will require substantial progress in social development. Central to this effort will be the empowerment of women and the guarantee of their human rights, including the right to reproductive and sexual health. Providing high- quality reproductive health services, including family planning, is an essential element. Access to services for both women and men – whether offered by government, private suppliers or NGOs – must be equitable; the disparity between accessibility to the poor and the non-poor urgently needs to be redressed. Better reproductive health for all is a link in a virtuous circle connecting the autonomy and equality of women with slower, more balanced population growth, the viability of urban areas and a better overall quality of life.

In cities, access to quality services is higher than in rural areas. But there is still considerable unmet demand for reproductive health services, including family planning, and fertility levels among the poor are generally higher than among other groups, indicating that barriers to service use persist. In rural areas, unwanted fertility reduces families' ability to provide for their children, and puts stress on local resources and local environments. These conditions help push people into migration.

Employment

Half the new urban jobs in the past decade were in the informal sector, the major source of employment for many city dwellers. Policies in this area seek to improve wages and working conditions; to revise regulations and codes to increase access to services, infrastructure, credit and markets; and to strengthen links to the formal sector.

Many Asian and Latin America countries are using tariff exemptions, tax benefits and other export-driven policies to promote manufacturing, assembly plants and service industries. This approach creates employment, but experience has shown that it can lead to exploitation of the workers, who are often young women desperate for work on any terms. Competition for jobs discourages protest or organization and keeps wages low; employers' attempts to maximize output result in employee dissatisfaction and high turnover. This is not only unjust but also inefficient.

Housing

Tightening public budgets and changing attitudes about government's role in social services have affected national strategies to improve housing. In the 1960s, the emphasis was on public works including housing construction and slum clearance. As understanding of the scale of need increased, Latin America in the early 1970s and, later, countries in Asia began to emphasize organized self-help, encouraging future tenants to build their own homes with materials provided by the public sector. This eliminated overheads and profits, but overestimated both labour's contribution to total costs and the degree to which unskilled workers could replace skilled ones.

In most of the developing world in the late 1970s and 1980s, government's role was further limited to providing land and access to water and waste disposal. This approach overestimated residents' ability or willingness to pay for shelter after meeting basic food and energy needs. Service provision remained outside residents' control, and conditions often deteriorated rapidly. Residents of informal settlements frequently faced eviction due to public and private efforts to use the land more profitably.

These experiences led increasingly to a belief that government's proper role is an enabling one, mobilizing the particular strengths of various actors, rather than providing inputs directly.

Shelter provision is increasingly recognized as a means not only to meet housing needs but also to generate employment and contribute to economic restructuring. Homes are the site of many informal-sector activities including self-employment. Community involvement in the provision of services and infrastructure can also play an important role in political and social cohesion.6

Global economic trends and structural adjustment

Economic shifts and increasing global competition are profoundly restructuring national economies. In the developed countries, changes in the competitiveness of different industries have shifted tens of thousands of workers from manufacturing to other sectors, contributing to temporary or longer-term unemployment. Some service industries are moving from developed countries to developing countries which have increasing technological sophistication and lower wages; the rapid growth of computer software development activities in India, supported by national and international financing, is a recent example.

At the same time, inefficient policies are impeding some countries' participation in international markets. As they seek to revise such policies, many countries have negotiated programmes of assistance with international lending institutions, giving them access to resources and credit. Following economic stagnation and rising debt in the 1980s, lending institutions encouraged governments to undertake programmes of structural adjustment to try to effect economic renewal. These programmes as initially devised and implemented are believed to have seriously affected the quality of life in cities. The elements varied from country to country but generally included:

  • Reductions in social-sector budgets including health and education and public-sector employment; less support for social development initiatives such as basic literacy and other programmes aimed at empowering women;
  • elimination of subsidies for food and other basic commodities;
  • privatization and decentralization;
  • imposition of school fees, charges for health services and other cost recovery options;
  • liberalization of trade policies to facilitate external investment and encourage manufacture and services for export; and currency revaluations.

These policies fell heavily on urban populations. Public sector investment is concentrated in capital cities and other large cities, and in many countries governments account for a large proportion of formal employment – as much as 10 to 25 per cent in some sub-Saharan African countries; layoffs often exacerbated already severe unemployment.

Increased school fees, combined with governments' earlier retreat from policies guaranteeing employment for all graduates, have eroded confidence in the value of education. UNESCO statistics7 indicate that in sub-Saharan Africa a decreasing proportion of boys are attending school beyond the earliest grades, and the ratio of girls to boys in education is not growing.

Charges for health services fell especially hard on preventive services such as child immunization and family planning. Many hopeful initiatives aimed at reducing poverty and closing the gender gap were inadequately funded and implemented.

Elimination of food subsidies also fell hardest on the urban poor, who grow less of their food than the rural poor and spend more of their incomes on food than the urban middle class. This has had the effect of increasing malnutrition, especially among those last in line for food and the most vulnerable to shortage – girl children and mothers of young families.

In many developing countries, real wages of urban residents fell in the early stages of the adjustment process, before the anticipated benefits could be felt. Deteriorating economic conditions make low-income families more liable to fall further into poverty, and escape more difficult.8 Fewer are able to save, diets worsen and housing becomes more crowded with relatives forced to share lodgings and pool dwindling resources.9 Women must stretch and supplement household income to provide food, water, clothing and basic necessities for children. Conflicts over food, shelter, clothing, education and health intensify. Increasing desperation often leads to domestic violence.

The international financial community understands that reducing investment in health and education cuts away the foundations for long- term development; it recognizes the need to lighten the burden of structural adjustment programmes on the social sector and to include better safeguards for vulnerable populations. Increasing attention is being given to improving access to credit, particularly for women, to facilitate entrepreneurial activity and lessen the shock of disruptions. Some steps are being taken to ensure that essential health and education services remain in place.

Reductions in public sector employment and shifts in the structure of national economies are natural responses to increasing global economic integration. In rapidly growing economies, notably in East Asia, the transformation has been more rapid than elsewhere, and higher incomes and resources have mitigated the impact; in fact, the proportion of people living in relative or absolute poverty has declined.10 This success reflects substantial earlier public investment in education, health and family planning programmes: today's urban challenge is to maintain these necessary investments in the face of resource constraints and rising populations.

Decentralization

A mass global experiment in decentralization is in progress. Policy making, programme development, implementation and monitoring functions are being shifted from central governments to local authorities, parastatal organizations or the private sector. Various arrangements for delivering basic services are being explored and tested. "Of the 75 developing and transitional countries with populations greater than 5 million, all but 12 claim to be embarked on some form of transfer of political power to local units of government." 11

From the brief experience of decentralization to date, despite varying local circumstances, some tentative conclusions may be offered:

(1) Before administrative and financial authority is delegated, the functions and responsibilities at each level should be delineated.12 Decisions about responsibilities for finances and fundraising should be made only after the roles of the various actors are defined.13

(2) Systems for transferring funds need to be clear, workable, targeted to the most responsive areas, and transparent in operation.14 People must have assurances that resources are being distributed and used effectively.

(3) Implementers must be accountable to programme beneficiaries and the public.15 No matter who is executing the programme, the beneficiaries should be fully involved in programme design, implementation and monitoring, and there need to be mechanisms to ensure that shortcomings are corrected. Electoral accountability, public decision making, transparency in financing and administration, and openness to innovations and "bottom-up" management are essential. Non-governmental organizations have an important role to play in monitoring programme performance.

Decentralized approaches to health care programme design. A number of countries, particularly in southern and eastern Africa, now allow health programme priorities to be determined locally. In Zambia, for instance, a district-level consultative process identifies local service delivery priorities, within a central framework specifying minimum service levels which must be maintained. Such flexible strategies maximize the input of local administrators and programme beneficiaries.

The consultations leading up to the HABITAT II conference have stressed the importance of community-based and participatory initiatives. Mayors, local NGOs and the private sector have been actively involved in the process. Regional and international meetings have allowed the sharing of information about successful local programmes.

Urban Conferences of the Past Decade

Best Practices

In November 1995, as part of the preparations for the HABITAT II conference, an International Conference on Best Practices was held in Dubai. Participants exchanged information and experiences on successful initiatives to address settlement problems, particularly in urban areas.

Featured programmes in industrialized countries dealt with: pollution reduction (United States); housing planning, addressing renewal, modernization and tenants' rights (Austria, the Netherlands and Sweden); collaborative efforts to improve housing for the immigrant population (France); and overall urban/regional planning involving a wide range of community actors (Finland).

The conference recognized a diverse range of projects in developing countries. Several involve innovative approaches to forging new partnerships which empower women, contribute to education and improve health:

  • Aqaba, Jordan: national, regional and municipal authorities joined with local NGOs and community-based organizations to upgrade public housing. Inputs from heads of households, both men and women, were emphasized in determining priorities for interventions.
  • Bombay, India: The Society for Promotion of Area Resource Centres, in collaboration with other NGOs, has shown that pavement dwellers, mostly women with children, can save up for better housing and can avert or cope with the demolition of their squatter homes. Working with government, area committees headed by women conducted surveys and planned for alternate settlements. Women collaborated with architects and engineers in the design of new dwellings.
  • Kisumu, Kenya: The Citizen's Social Care Centre has reduced the number of street children by assisting those who have run away from home. It trains teenage women and single mothers to be environmental educators, holds counselling sessions with parents and guardians, and presents dramas on the needs of street children and youth.
  • State of Orissa, India: The Friends' Association for Rural Reconstruction met with the Government and community-based women's groups to confront alcohol-related problems, because men's drinking was diverting money from family needs including education and contributing to domestic violence. The resultant mobilization led to a ban on alcohol sales and showed the Government the strength of women's organizations.
  • Delhi, India: Action for Securing Health for All (ASHA, "hope" in Hindi) has developed an intersectoral, participatory health model to ensure the accessibility of health facilities and improve living conditions in slum areas. Working with the Delhi Development Authority and women's groups, the NGO links training of health workers with service delivery, community health education (including prenatal care), efforts to keep children in school, and income-generating activities.
  • São Paulo/Rio de Janeiro, Brazil: Police Stations in Defence of Women, staffed by women, have since 1985 provided specialized attention to female victims of domestic violence, sexual assault and rape, to ensure appropriate counselling, care and requested legal follow-up. Though victims are often reluctant to seek legal remedy, the expansion of the service to more locations is changing public perception of such crimes.

Since programmes must be implemented in a variety of economic, social, political and administrative contexts, successful models need to be adapted to local conditions. Parallel to the HABITAT II process, a wide variety of technical exchanges and cooperative efforts are under way at local levels.

Numerous international organizations support projects aimed at improving human settlements. For example, the Urban Management Programme of the United Nations Development Programme and the World Bank helps local administrations remedy management deficiencies and strengthen local governance mechanisms. UNCHS (Habitat) and the Danish International Development Agency offer a training programme for community participation in improving human settlements. UNDP and the International Labour Organization are collaborating on employment generation in urban works programmes. UNCHS, ILO, UNDP and the United Nations Volunteers support a programme on improvement of living conditions and expanding employment opportunities in urban low-income communities. And UNDP in collaboration with the Netherlands, Sweden and Germany are networking with other programmes and local institutions in the Local Initiative Facility for Urban Environment (LIFE) programme.

International networks of city planners, administrators and researchers have been formed to facilitate the exchange of information and urban management strategies. The MEDURBS programme links participating urban centres in developed and developing Mediterranean countries. Networks funded by the European Community maintain databases, jointly implement and monitor projects, and exchange technical materials on urban issues. Networks of non-governmental organizations are sharing experiences with community action programmes.

UNFPA and the urban future

The United Nations Population Fund, in collaboration with the rest of the United Nations system, continues to play an important role in addressing urban problems and urban–rural balances and encouraging sustainable development and settlement policies. Its programme activities aim to eliminate urban bias and gender bias in development efforts, to foster participation and partnership, and to ensure that urban and rural development strategies pay attention to population concerns.

Reproductive health including family planning and sexual health

UNFPA supports governments and collaborates with national and local administrations, NGOs, community organizations and the private sector to promote high-quality reproductive health services including family planning and sexual health, for both men and women. The ICPD Programme of Action calls for universal access to these services, provided through effective primary health care systems, by 2015. Organizations – public, private (including enterprise-based), voluntary and community-based – which can provide such services are being strengthened, and barriers to their efficient functioning removed.

Linking Reproductive Health Services to Community Outreach

Reproductive and sexual health is more than the absence of disease; it includes the positive exercise of reproductive rights and the enjoyment of healthy and enriching sexual lives. Reproductive rights imply that women's role in reproduction must not be used to deny them other social, economic and political roles at a level equal to those of men.

As the ICPD recognized, promoting reproductive rights and reducing infant, child and maternal mortality and morbidity requires the provision of a broad range of reproductive health services. Making these universally available will entail, among other things:

  • Improving education and services for prenatal care, safe delivery and post-natal care for both mothers and children, particularly for the rural and urban poor.
  • Providing high-quality voluntary family planning, including counselling, information, education, communication and services, to all who are interested. Meeting the expressed demand for services to better space and limit births will improve health and further reduce both natural urban growth and the high rural fertility which contributes to migration.
  • Improving services for other reproductive and sexual health conditions, including the treatment of reproductive tract infections and sexually transmitted diseases including HIV/AIDS.
  • Protecting women from sexual and other violence and preventing harmful traditional practices such as female genital mutilation.
  • Eliminating disparities in service coverage and outreach that are related to gender, geographical, social and economic differences. This includes extending quality health services to residents of urban slums and peri-urban areas.

UNFPA support will aim to help countries attain all of these goals. The Fund will also support biomedical, social and cultural research to assess reproductive health-related conditions, perceptions and behaviours, to assist in the design of programmes.

Advocacy

UNFPA will directly and indirectly advocate for the empowerment of women. A cornerstone of this effort will be the expansion of educational access and support for girls and women. Education enables individuals to lead healthier lives, improve their opportunities, assimilate new ideas and play productive social roles. It is also key to improving countries' productive capacity, enabling them to compete in international markets.

The exercise of reproductive rights is fundamental to women's educational progress. Teenage pregnancies, which often interrupt or interfere with women's schooling, can be reduced by providing better family planning information and services to youth, educating men on responsible sexual behaviour and involving families and communities in reproductive health programmes. Together with programmes to discourage female genital mutilation and other harmful practices, advocacy on behalf of women will produce greater discussion and understanding of unequal gender relationships and barriers which impede women's contributions to sustainable development.

Many if not most societies assign less value to girl children than to boys. At its most extreme, this can result in selective abortion favouring boys, to infanticide and abandonment of girl children. Discrimination persists throughout childhood and into adolescence. It helps to perpetuate a secondary status for women, ensuring not only that women are trapped in their reproductive role but that they are offered little support in performing it.

UNFPA's advocacy, in cooperation with all its partners in government and non-governmental organizations, is dedicated to establishing the equality and autonomy of women by ensuring that girl children are welcomed in the family on the same basis as boys; that parents accept the equal value and the special needs of girl children; and that the empowerment of women has the support of teachers, health personnel, political leaders, policymakers, religious and moral leaders and others in authority.

Policy support

UNFPA will continue to support policy analyses and to strengthen national and international policy institutions addressing urbanization and other population concerns. The fund is working to ensure a consistent flow of reliable information on the conditions of life and on basic demographic and social information. Improving the quality and coverage of gender-sensitive social information is a high priority. Basic data collection and special research efforts assist the design and implementation of programmes, particularly for the rural and urban poor and other disadvantaged groups. The United Nations system as a whole is improving its ability to coordinate assistance to governments, for the measurement of progress and the design and implementation of programmes to attain the objectives of the international conferences taking place in this decade.

Understanding Urban Population Distribution and Service Needs

The changing dynamics of migration and its impacts on both sending and receiving areas are poorly understood. Clearer identification of those aspects of population movement which require policy interventions will prevent futile or counterproductive efforts and help to alleviate hardship among affected groups. A UNFPA-sponsored Symposium on Internal Migration and Urbanization in Developing Countries: Implications for HABITAT II, held in New York in January 1996, helped identify research questions that are key to improved policy advice. UNFPA support of the International Organization for Migration and regional institutions also helps promote improved understanding of internal and international migration and their relation to development.

UNFPA has long supported the Asian Urban Information System of Kobe (Japan) which conducts policy studies on population dynamics and urban conditions and provides technical support to regional and local institutions addressing information needs for urban planners and administrators. Data on population, health and education are needed to monitor progress in improving the quality of life. The Fund assists local and municipal institutions in improving databases related to provision of basic social services.

Integrating Population into Decentralized Urban Planning

UNFPA will also continue to support activities to integrate population groups into social development strategies, plans and programmes (particularly those for the delivery of basic social services). It will work with the rest of the United Nations system to effect the efficient mobilization and use of resources for integrated population and development programmes, and particularly those for the improvement of basic social services to urban and rural populations.

Technical support

UNFPA will collaborate with governments to strengthen the technical capacities of non-governmental organizations that deliver reproductive health services and information and conduct communication programmes and advocacy efforts. Local NGOs and the international networks in which they participate including the International Women's Health Coalition and the International Planned Parenthood Association are actively working to address needs in all aspects of reproductive health including sexual health and family planning.

As a number of the Best Practices projects have demonstrated, primary health components, including reproductive health care, can be successfully included in local and community efforts to improve settlements and services. Slum improvement programmes may provide opportunities to improve primary health care service delivery.16 Such efforts can work to ensure that the design, implementation and monitoring of these programmes incorporate women's perspectives.

Reproductive Health for the Marginalized Community

UNFPA will support institutions which collect, analyse and disseminate basic data on population and social development. It will support research at national and international centres of excellence on population and development linkages to advance the policy dialogue on population issues.

UNFPA will also support programmes of South-South cooperation to ensure that developing countries share successful models and technical capacities in the area of reproductive health and population programmes.