The 1994 International
Conference on Population and Development focused global attention on reproductive and
sexual health and rights, as well as gender issues, and stimulated widespread efforts to
carry out its recommendations. The 1995 Fourth World Conference on Women gave further
impetus to this process, which continues to gain momentum around the world.
Since the Cairo and Beijing conferences, countries have undertaken a broad
range of actions to implement the ICPD approach. Reports from UNFPA field offices cite
numerous revisions of population and development policies and related institutional
changes; legal and constitution reforms to better protect womens rights and promote
gender equality; and efforts to strengthen and reorganize health services to reduce
maternal mortality and address a comprehensive set of reproductive health concerns.
While many developing countries have made important progress in
implementing the ICPD Programme of Action, in many others a shortage of funds and trained
personnel is impeding efforts to improve family planning and reproductive health
Many countries where national population policies were in place
before the Cairo conference have modified them to embrace the ICPD approach; this group
includes countries as diverse as Indonesia, Jamaica, Kenya, Lesotho, the Marshall Islands,
St. Lucia and Zambia.
A number of governments that had no formal population policy in 1994
have since formulated comprehensive policies reflecting the Cairo agreements, or are in
the process of doing so; they include Botswana, Cambodia, Lao Peoples Democratic
Republic, Malaysia, Mongolia, Nicaragua, Namibia, South Africa, Syria, Uganda and
Brazil has established a National Commission on Population and Development, the first in
Latin America. Population commissions or units have also been created within key
ministries in Algeria, Belize, Paraguay and Tajikistan, among others. Ghana has
revitalized its Population Council. Jordan has expanded its National Population Commission
to include representatives from non-governmental organizations and academic institutions.
In some countries reproductive health and family planning issues that were once considered
too sensitive to discuss publicly are now part of the political discourse. During the 1996
election campaign in the Dominican Republic, for example, the two major political parties
included population policy in their platforms for the first time; both cited the ICPD
Programme of Action.
Reproductive Health and Family Planning
After the ICPD, many countries organized workshops and seminars for
planners and health workers on the new reproductive health approach and how to put it into
operation. A number of countries have made institutional changes to strengthen and
reorient their policies and programmes in health care and family planning. Mexico, for
instance, created a new General Directorate of Reproductive Health out of the former
Directorates of Maternal and Child Care and Family Planning. The Philippines
Department of Health has set up a Task Force on Womens Reproductive Health. El
Salvador has a Department of Reproductive Health within the Ministry of Public Health. In
Panama, the Ministry of Health created a National Commission on Sexual and Reproductive
Even more widespread are various measures to expand access to
reproductive health services, improve their quality and widen their focus. Family planning
is increasingly being integrated with other reproductive health concerns. This process has
increased public awareness of the vast unmet needs of women, especially those in the
poorest and most marginalized groups.
To improve the quality of reproductive health and family planning
services, many developing countries have begun to train health care providers in
interpersonal communications and counselling, to strengthen the health infrastructure, and
to develop medical protocols. India has started to train medical officers at primary
health centres in various states. Iran has expanded its Women Health Volunteers Programme,
using some 18,000 volunteers to provide reproductive health and family planning
information and services in urban slums; it has also established 15 new Rural
Midwives Training Centres in nine provinces.
Kenyas new Health Framework aims to integrate family planning
with other reproductive health services, including STD/HIV/AIDS control, early detection
of reproductive organ cancers and counselling on sexuality. This is intended to avoid
duplication, make services more convenient and accessible, especially in underserved
communities, and increase cost-effectiveness. Thailand and the Philippines are also moving
to integrate reproductive health services and make them more accessible.
Ghanas Ministry of Health has developed a National
Reproductive Policy and Standards, based on ICPD definitions, to improve reproductive
health service delivery, especially in marginal communities. Mali has similarly revised
service norms in accordance with the ICPD Programme of Action.
The Cairo commitments are also reflected in Chiles new Health
Programme for Women, which takes a holistic, life-span approach to sexual and reproductive
Many countries are, like India, moving away from narrowly defined
demographic targets in favour of a broader approach aimed at meeting individual needs for
reproductive health information and services.
In some countries, the ICPD approach underpins new laws and
administrative mechanisms relating to sexual and reproductive health and rights. In
Argentina, pending legislation would create a national programme to provide reproductive
health information, counselling, and government-approved contraceptives to low-income
women. Bolivias new Maternity and Child Insurance gives women free access to
prenatal care, delivery and post-natal care, including family planning, and pap smear
tests; use of maternal and child health services reportedly increased 20 per cent in the
programmes first month.
Reduction of maternal mortality, a central ICPD goal, is the focus
of reproductive health efforts and special campaigns in several countries, including
Bolivia, the Dominican Republic, Guatemala, Haiti, Indonesia, Lao Peoples Democratic
Republic and Paraguay. The Cairo conference recognized unsafe abortion as a leading cause
of maternal mortality; South Africa and Guyana have subsequently passed laws establishing
a regulatory framework for safe abortion. Draft legislation on abortion is under review in
Cambodia. Other countries, like Bolivia, now include management of complications of unsafe
abortion in their reproductive health programmes.
Improving the quality of family planning services is a principal
goal in most countries. Brazil now includes a full range of contraceptive methods in
federal budgetary allocations, broadening the choices available to clients. In the
Bahamas, the first officially sanctioned family planning project provides family planning
counselling to adolescents.
The expansion of family planning services has been a special
priority in the underserved countries of Eastern Europe and the former Soviet Union.
Ukraine recently established its first family planning programme. Kazakstan now has family
planning clinics in all its cities; in three years, abortions have been reduced by 20 per
cent and contraceptive use has increased by 28 per cent. Family planning activities are
also reported to have been strengthened in Tajikistan and Poland.
Since 1994, many governments have taken initiatives to meet
adolescents reproductive and sexual health needs, often in collaboration with NGOs.
In some countriesPapua New Guinea, for examplethe government is addressing
adolescent sexuality for the first time, motivated in part by rising rates of sexually
transmitted diseases including HIV/AIDS among young people. Sri Lankas Ministry of
Health has instituted an Adolescent Health Steering Committee.
A number of governments, particularly in Latin America, are promoting education about
reproductive health and family planning in an effort to reduce teenage pregnancies.
Institutional support for such programmes has recently increased in Cuba and Colombia, for
instance. Cuba is also using the mass media to inform young people about responsible
sexual conduct and condom use. In Ecuador, the Ministry of Public Health has designed a
plan to provide pregnant adolescents with information, counselling and quality health
In El Salvador, the National Secretariat of the Family is striving
to prevent adolescent pregnancy, sexually transmitted diseases and HIV/AIDS by promoting
healthy and responsible behaviour and providing counselling and services. Venezuelas
Ministry on the Family has launched an unprecedented National Plan for the Prevention of
Early Pregnancies, involving both the government and NGOs. In the Dominican Republic,
three regional adolescent health centres provide counselling and services in sexual and
reproductive health, family planning and responsible paternity; this is the first time the
government has addressed adolescent health issues.
As the Cairo conference recognized, non-governmental organizations
have an essential role to play in both reproductive health advocacy and service delivery.
Governments and NGOs have increased their collaboration in various ways since the ICPD; an
example of this progress is the establishment in Bangladesh of an NGO Advisory Group to
work with the government in implementing the ICPD Programme of Action. Similarly, in
Honduras, a network of 17 NGOs was formed to promote ICPD recommendations.
NGOs providing services typically have higher quality-of-care
standards than the public sector. They have traditionally shown greater flexibility in
reaching marginalized sectors of the population and addressing sensitive or controversial
issues. Consequently, governments have asked NGOs to assist in providing services,
especially to the rural and urban poor, adolescents and battered women; to test new
approaches that can be used by larger public programmes; and to assist in training of
In Maldives, a national NGO established the countrys first
family planning clinic in 1995. NGOs in Iran have become more active since the ICPD in
delivering reproductive and family planning services. In the Philippines, two womens
NGOs have started model clinics that use gender-sensitive approaches to family planning,
infertility, adolescent health and violence against women. In India, an NGO provides
regular screening and diagnostic testing for breast and cervical cancer. In Cambodia,
local womens NGOs have opened the countrys first shelters for battered women.
In Barbados and Grenada, NGOs have taken initiatives to help young
people acquire necessary skills in order to support themselves, while at the same time
helping them through counselling. In South Africa, the Planned Parenthood Association
works with socially dislocated young people, who are particularly vulnerable to sexual
health risks. In many other countries, NGOs are training adolescent peer groups in
Some of the most important initiatives since the ICPD involve
strengthening of national laws, policies and mechanisms promoting human rights,
particularly the rights to reproductive and sexual health, gender equality and freedom
from sexual violence. South Africas new constitution explicitly prohibits
discrimination on grounds of gender, sex, pregnancy, marital status, or sexual
orientation, among others. It also recognizes that everyone has the right to make
reproductive decisions and to have access to reproductive health care. Chile is
considering a constitutional reform to establish legal equality between women and men.
The government of Sri Lanka recently approved a Womens Charter
which acknowledges, among other things, womens right to control their reproductive
lives. In Colombia, the law creating a new social security system recognizes womens
rights to sexual and reproductive health. In Panama, a presidential decree forbids
discrimination against or penalization of pregnant students and guarantees their right to
continue their education.
Several countries have established institutions to safeguard the
rights of women. They include Haitis Ministry of Womens Affairs and
Womens Rights, a Commission on Gender and Social Equity in Jamaica, Colombias
Directorate for Gender Equity, and the Womens Rights Commission in Peru. Brazil has
strengthened its National Council on Womens Rights. New legislation in Nepal aims at
improving the status of women. In Maldives, national laws are being reviewed to identify
any that discriminate against women.
Both the ICPD and especially the Beijing womens conference
raised global awareness of the need to enact and enforce legislation protecting women
against sexual and domestic violence. Laws against domestic violence have already been
approved in Bolivia, Costa Rica, Ecuador and Panama, and similar measures have been
submitted to legislatures in Guyana and Mexico. In Brazil, the Ministry of Justice
launched a publicity campaign on violence against women. The Nicaraguan Womens
Institute is cooperating with the National Police and womens NGOs to prevent
violence against women and children and to support victims. Gambia has set up a
multisectoral task force on violence against women.
Cambodian NGOs are promoting awareness of domestic violence,
conducting training and counselling, and have opened the countrys first shelters for
battered women. In the Philippines, the National Commission on the Role of Filipino Women
has created a pilot hospital-based crisis intervention centre to assist survivors of
The ICPD emphasized the importance of empowering women to
participate fully in the political and development processes. While the political gender
gap is clearly evident in most developing countries, some notable advances have been made
since the Cairo conference. In Uganda, for example, the new Constitution includes an
affirmative action policy which mandates that each local council committee have a
secretary for women, and that each of the 39 districts must elect at least one woman
representative to the National Assembly; the vice-president is one of six women in the
Cabinet. In 1995, for the first time in Jordans history, 12 women ran in local
municipal council elections; one was elected mayor and nine as council members.
Role and Responsibility of Men
The ICPD Programme of Action stresses the importance of increasing
the responsibility of men in sexual and reproductive behaviour and family life. This has
led to a greater awareness of the need to involve men in reproductive health programmes,
and some countries have initiated programmes specifically directed to men. In the
Philippines, a new reproductive health centre for men is experimenting with innovative
ways to involve men in reproductive health programmes. In Indonesia, the government plans
to expand its counselling programme to include training materials on male participation in
family planning and reproductive health. In Ghana, seminars and plays have been organized
for both male and female audiences to generate discussions on partners joint
responsibility in the use of family planning, parenting and family life.
Reproductive health and family planning have traditionally addressed
womens needs and largely neglected those of men. Several NGOs are now conducting
research to assess mens reproductive health needs, and to better understand their
sexual, marital, parenting and family decision-making roles. Some studies have examined
male participation in post-partum health care for mothers and babies. A study in Bolivia
and Zimbabwe is examining mens perspectives on family planning. One in India aims at
identifying cultural and political constraints to male participation and support in
reproductive health programmes.
Global and Regional Initiatives
Since the Cairo conference, there have been various international,
regional and subregional initiatives to support national implementation efforts. In 1995,
Indonesia hosted the first Interregional Meeting on Ways and Means to Implement the ICPD
Programme of Action. Experts from 18 countries with economies in transition met in Romania
to assess the status and needs of reproductive health services in their countries. Members
of the Economic Cooperation Organization (Afghanistan, Azerbaijan, Iran, Kazakstan,
Kyrgyzstan, Pakistan, Tajikistan, Turkey, Turkmenistan and Uzbekistan) assembled in
Kazakstan to promote cooperation in implementing the Programme of Action. A post-ICPD
meeting in Ghana reviewed population activities and strategies in sub-Saharan Africa. In
the Caribbean, a 1995 inter-ministerial meeting drafted a subregional ICPD follow-up plan.
Partners in Population and Development, a technical cooperation
initiative launched at the ICPD, has established a headquarters in Dhaka, Bangladesh, and
begun to promote the exchange of information and expertise among developing countries; the
partnership is comprised of Bangladesh, Colombia, Egypt, Indonesia, Kenya, Mexico,
Morocco, Thailand, Tunisia and Zimbabwe.
There have also been various global initiatives involving
non-governmental organizations. In 1995, for example, Caribbean NGOs held a Convention on
Reproductive Health for Adolescents and Youth. UNFPA has organized two post-ICPD meetings
of an international NGO Advisory Committee established to advise the Fund on proposed
policies, programmes and strategies.
As a follow-up to ICPD, parliamentarians from both developed and
developing countries have organized various activities to promote population issues. The
Inter-American Parliamentarians Group in Population and Development convened in
Belize in January 1995. A European Parliamentary Forum for Action was held in Belgium in
May 1995; participants called on governments to mobilize resources to make reproductive
health care universally available by 2015. The first Regional Conference of African Women
Ministers and Parliamentarians was held in Burkina Faso in July 1995. Parliamentarians
from 57 countries gathered in Japan in August 1995 to address key themes of the Cairo and
Beijing conferences. In July 1996, a Forum of African and Middle Eastern Parliamentarians
on Population and Development was held in Jordan. In a number of countries, including
Ghana and Tanzania, national parliamentary groups have been established to focus on
population and development-related concerns.
After the ICPD, the United Nations established an inter-agency task
force, chaired by the UNFPA Executive Director, to strengthen country-level collaboration
in implementing the Programme of Action. In 1995 it developed a set of guidelines for the
United Nations Resident Coordinator System to facilitate cooperation among governments,
NGOs, UN agencies and other development partners. The mandate of the task force was
expanded in 1996 to include coordination of follow-up to other recent global conferences;
it is now the Task Force on Basic Social Services for All.
UNFPA has been working closely with other UN agencies and
international experts to develop a reliable, multidisciplinary set of indicators to
measure progress towards the goals and targets of different conferences. These will be
used to help design reproductive health programmes and monitor their progress. Topics
addressed include family planning, maternal health, reproductive tract infections and
sexually transmitted diseases, abortion and post-abortion care, and infertility. Besides
conventional statistics on service outputs, utilization and contraceptive practice, the
new indicators will also measure unmet demand, access, service coverage and quality of
care. They will also indicate whether the enabling legislative and administrative policies
for comprehensive reproductive health services are in place.
The ICPD was the only international conference in this decade to
agree on specific money amounts needed to implement its recommendations. The Programme of
Action estimates the costs of a basic package of population and reproductive health
programmes, including: universal, primary-level reproductive health services and STD/HIV
prevention, and related policy development, research and data collection. This will
require some $17 billion annually by the year 2000, and $21.7 billion by 2015. The
conference anticipated that about two thirds of these global costs would have to come from
domestic resources (varying according to national capacity), and about one third from the
donor community. This estimate does not include resources needed for reproductive health
services at referral hospitals, for general infrastructure (including transport and roads)
or for broader social development programmes (for example credit systems, education, other
health system improvements, trade and economic development promotion).
Success can only be achieved through concerted action by the
international community. The measures agreed by all nations in Cairo, including the
resources to be allocated, are both practical and necessary. However, while many
governments have increased their allocations for population programmes since 1994, annual
global expenditures are still well below half the $17 billion that ICPD estimated will be
required in 2000. The evidence is that developing countries are prepared to commit the
resources needed to meet the goals of the ICPD. The question remains whether richer
nations are prepared to do the same.