| Women are having fewer children than ever before, and
population growth has slowed—from 2.4 to 1.3 per cent in 30 years. But large families
in the recent past mean that there are many more women of childbearing age. Global
population is still rising by about 78 million people a year. Half the world is under 25
and there are over a billion young people between 15 and 24, the parents of the next
generation. Most population growth is taking place in the world’s poorest and
least-prepared countries. Whether population growth continues to slow and whether it is
accompanied by increasing well-being or increasing hardship will depend on the decisions
and action taken in the next decade—and in particular on action to increase
education, promote gender equality and ensure the universal exercise of the right to
health, including reproductive health.
The fastest growing regions are sub-Saharan Africa, and parts of South Asia and Western
Asia. Meanwhile, population growth has slowed or stopped in Europe, North America and
Japan. The United States is the only industrial country where large population increases
are still projected, largely as the result of immigration. As we enter the 21st century,
over a billion people are still deprived of basic needs. Of the 4.8 billion people in
developing countries, nearly three fifths lack basic sanitation. Almost a third have no
access to clean water. A quarter do not have adequate housing and a fifth have no access
to modern health services. In less-developed regions, a fifth of children do not attend
school to grade 5.
There is also increasing pressure on the planet due to wasteful and unbalanced
consumption patterns and growing numbers of people, raising demand for food and water. In
addition, the effect of global warming remains to be seen. Possible changes, such as sea
level rise, increased storms and floods, could affect billions of people.
The cumulative effects of continuing poverty, gender discrimination, HIV/AIDS,
environmental change and shrinking resources for development have the potential to wipe
out the benefits of lower birth rates.
The Cairo Consensus
Fortunately, there is a global consensus on what needs to be done. At the 1994
International Conference on Population and Development (ICPD) 179 countries agreed that
population and development are inextricably linked, and that empowering women and meeting
people’s needs for education and health, including reproductive health, are necessary
for both individual advancement and balanced development. Advancing gender equality,
eliminating violence against women and ensuring women’s ability to control their own
fertility are acknowledged as corner-stones of population and development policies.
Concrete goals centre on providing universal education and reproductive health care,
including family planning; and reducing infant, child and maternal mortality.
A review of progress since the Cairo Conference has provided growing evidence that the
ICPD agenda is practical and realistic, and that despite all obstacles, it is being put
into practice. The review included reports on national implementation efforts, global
expert meetings and an international forum at The Hague, organized by UNFPA; it culminated
in a special session of the United Nations General Assembly, from 30 June to 2 July 1999,
which identified key actions needed for further progress.
Demographic factors—such as today’s unprecedented numbers of young people,
ageing populations, urbanization and international migration—are crucial to plans for
alleviating poverty, providing basic social services, ensuring food security, conserving
resources and protecting the environment. In the five years since the ICPD, many countries
have adopted new development policies incorporating population concerns. Nearly half have
reviewed their policies on population and development; more than a third have updated
policies to be consistent with ICPD goals.
Two thirds of all countries have introduced policy or legislative measures to promote
gender equality and the empowerment of women. Nearly all countries in Latin America have
introduced policy measures, legislation or institutional changes to protect women’s
rights. More than half the Asian countries and a number of African countries have acted to
protect women’s rights in areas like inheritance, property and employment. A number
of countries have taken steps to increase men’s responsibility for their sexual and
reproductive behaviour and social and family roles.
There are growing efforts to eliminate gender-based violence and harmful traditional
practices. Many countries have revised laws and family codes to strengthen measures
against female genital mutilation (FGM), rape, forced marriage, domestic violence, dowry
murder, and "honour" killings. Fifteen African countries have outlawed FGM.
Demographic Trends
A demographic transition from high to low fertility and mortality is under way and has
already occurred in much of the world. Improvements in preventive health and medical care
have dramatically reduced mortality—especially infant mortality, which has fallen by
two thirds. As a result, global life expectancy has risen from 46 to 66 years in the past
half-century. Progress varies widely within regions and countries, however.
Fertility has also declined, but unevenly. In 61 countries, with about 44 per cent of
the world’s population, couples are having fewer children than the two they need to
"replace" themselves. But even if "replacement fertility" were reached
immediately, populations would continue to grow for several decades because of the large
number of people now entering their peak childbearing years. This population momentum will
account for up to two thirds of the projected growth of world population, more in
countries where fertility decline has been fastest. Raising mothers’ age at first
birth from 18 to 23 would reduce population momentum by over 40 per cent.
In the early 1950s, couples in developed countries were having an average of 2.8
children; today the average is 1.6. In the less-developed regions, fertility rates have
dropped from 6.2 children per woman in 1950 to slightly less than 3 today, and are
projected to fall to less than 2.1 by 2045. Fertility has declined most rapidly in the
last 50 years in Latin America (from 5.9 to 2.7) and Asia (from 5.9 to 2.6), less rapidly
in North Africa and the Middle East (from 6.6 to 3.5) and much more slowly in sub-Saharan
Africa (from 6.5 to 5.5).
Declining birth rates create the possibility of economic gains, as a "bulge"
of young people grow up and become part of the work force while fewer children are born.
East Asia has already taken advantage of its "demographic bonus", which led to
increased household and national savings and investment, and particularly social spending.
South Asia and Africa are expected to have a similar opportunity in the next couple of
decades. To get the benefits, countries will have to strengthen education and health care,
including reproductive health, and adopt other supportive policies.
Gains made as a result of increased social sector investment may be vulnerable to
global financial turmoil, however. A UNFPA study indicates that the financial crisis that
began in South-east Asia in 1997 has thrown millions into poverty and deep distress, and
that resulting cuts in social programmes have had a severe social impact, particularly on
women’s rights and reproductive health. For example, there have been cutbacks in
health promotion and medical service activities, including HIV/AIDS and STD prevention and
treatment programmes.
Overall, due to improved health care and increased options, global fertility rates have
declined more rapidly than expected. The Population Division of the United Nations
Department for Economic and Social Affairs now projects that world population will be
around 8.9 billion in 2050, rather than the 9.4 billion predicted in 1996. However, the
news is not all good: about one third of the reduction in long-range projections is due to
increasing mortality rates in sub-Saharan Africa and parts of the Indian subcontinent due
to HIV/AIDS, which is spreading faster than previously anticipated.
In 29 African countries, the average life expectancy at birth is currently seven years
less than it would have been without AIDS. However, the population is not expected to
decline in these countries because of continuing high fertility. In Botswana, where one of
every four adults is infected, life expectancy has fallen from 61 years in the late 1980s
to 47 today, and is expected to plunge to 38 by 2005-2010. Nevertheless, the population is
still expected to nearly double by 2050.
Slowing and stopping the spread of infection will require improvements in comprehensive
reproductive health care, as well as better public education about the risks and
consequences of HIV infection. And with over half of all new infections occurring among
young people under 24, there is an urgent need to provide services that meet their needs.
Shifting Population
Patterns
The distribution of world population is changing, with growth differing between regions,
urbanization increasing and international migration becoming more visible and important.
In 1960, 70 per cent of the world’s people lived in the developing countries; today
the figure is 80 per cent, and these countries account for 95 per cent of population
growth.
Africa’s population has tripled since 1960 and continues to grow the fastest. In
1960, Europe had twice as many people as Africa; by 2050 it is estimated that there will
be three times as many Africans as Europeans. Asia, by far the most populous region, has
more than doubled in population since 1960, as has Latin America and the Caribbean. In
contrast, Northern America’s population has grown by 50 per cent, while Europe’s
has increased by only 20 per cent and is now roughly stable.
Cities are engines of social change; they continue to grow throughout the developing
world. In 1960, one in three people lived in a city; today almost half of all people do,
and by 2030, it is predicted that more than 60 per cent of the population will live in
urban areas. And more and more of these will be megacities with more than 10 million
people. The number of such cities has grown from two in 1960 to 17 today and is projected
to reach 26 by 2015: 22 in less-developed regions, 18 in Asia.
In all regions, international migration is moving near the top of the policy agenda, as
the numbers of migrants increase and the issues they raise become more important. Between
1965 and 1990, migration expanded from 75 million to 120 million people. Migrant workers
send more than $70 billion home each year in remittances, and industries in some countries
depend on their labour and skills. More and more migrants are women, almost 50 per cent in
1990, and many are vulnerable to exploitation and harassment.
How to provide food and water for a growing population remains another vital concern.
Global per capita grain output has been stagnant for more than a decade and crop land is
shrinking. Access to water will also be critical. According to a recent study, one fourth
of the world’s people are likely to live in countries facing chronic or recurring
shortages of fresh water by the year 2050.
Reproductive Health
and Rights
Reproductive rights endorsed by the Cairo Conference include the right to make free
choices about marriage and the number, timing and spacing of children on a basis of
equality between men and women; the right to attain the highest standard of sexual and
reproductive health; and freedom from sexual violence and coercion.
The need for universal access to quality reproductive health care is as pressing as
ever. Just as important is the creation of social, cultural and economic conditions in
which women and men can make free and informed choices about their lives.
More than 585,000 women in developing countries die each year and at least 7 million
women suffer infection or injury as a result of pregnancy; 70,000 women die from unsafe
abortion. There are over 330 million cases of treatable sexually transmitted diseases
annually and 11 new HIV infections every minute. Up to half of the nearly 175 million
pregnancies each year are unwanted or ill-timed. Over 350 million women do not have access
to a range of safe and effective contraceptive methods. Nearly half of the 130 million
births annually are not assisted by a trained delivery attendant. More than half of all
women will suffer some form of gender-based violence in their lives. Each year two million
girls and young women are at risk of FGM. And 960 million people cannot read or write, two
thirds of whom are women.
As agreed in Cairo, many countries are working to improve the quality, scope and
availability of reproductive health services, and are training staff to provide better
information, wider choices and client-centred care.
Contraceptive use in developing countries increased by 1.2 per cent annually between
1990 and 1995, but the needs of 20-25 per cent of couples are still not being met. Unmet
need is highest in sub-Saharan Africa (29 per cent) and lowest in Latin America and the
Caribbean (18 and 20 per cent). At the same time, more investment is needed in research
and development of new fertility regulation methods for men, as well as female-controlled
barrier methods to prevent both sexually transmitted infections and pregnancy.
One of the most difficult areas to tackle has been reducing maternal mortality. Studies
and experience show that improving maternal health calls for better health facilities,
emergency care provision, and trained health care providers to ensure appropriate and
effective care—which requires policy priority and the necessary resources.
Providing appropriate information and services for unmarried adolescents and young
adults—both married and unmarried—has also been difficult in many countries.
The 1999 fifth-year review of the ICPD urged governments to take concrete action to
increase skilled attendance in childbirth; review laws affecting reproductive health,
increase spending on reproductive health; involve communities, non-governmental
organizations (NGOs) and the private sector in programmes; promote male responsibility;
ensure availability of services; and provide testing and counselling for sexually
transmitted diseases, including HIV/AIDS, as part of primary health care.
The review also called on governments to promote responsible sexual behaviour based on
mutual respect and gender equity; prevent the sexual exploitation of children; ensure that
refugees receive sexual and reproductive health care and information; eliminate harmful
traditional practices such as FGM; and ensure that adolescents have information and
services to help them lead healthy, responsible lives.
Partnership and
Empowerment
NGOs, parliamentarians, religious leaders, the private sector and community groups have
key roles to play in carrying out the Cairo agenda. Many governments are working more
closely with civil society partners in designing programmes and providing services,
especially for hard-to-reach sectors of the population.
In the years since the ICPD, the relationship between civil society organizations and
governments has continued to grow. The number of NGOs working on reproductive health and
rights has grown, as has the number of NGO networks, strengthening impact overall. In many
countries, NGOs, especially health and family planning advocates and women’s groups,
not only champion reproductive health and rights and gender equity, but also provide
services to improve women’s status. NGOs also play a vital role in monitoring
governments’ progress in implementing the ICPD Programme of Action.
However, success depends on setting up partnerships that are mutually supportive,
managing existing partnerships effectively, and getting government officials to support
collaboration. A 1998 survey found that only 49 of 114 developing countries responding had
taken significant measures to promote the involvement of NGOs at various stages of policy
and programme implementation.
Finding the Resources
The goals of the ICPD are universally accepted as necessary to promote human rights and
personal well-being, fight poverty and improve national and global security. Yet funding
is falling short and governments now face critical decisions about whether they will
commit the resources to realize their vision.
It was estimated in Cairo that $17 billion would be required annually by the year 2000
for population and reproductive health activities, about two thirds ($11.3 billion) from
within developing countries and one third ($5.7 billion) from international donors.
As of 1997, developing countries were spending about $7.7 billion annually, but five
large countries (China, India, Indonesia, the Islamic Republic of Iran and Mexico)
accounted for a large majority of that total. Most other developing countries,
particularly the 51 least developed, had neither the public resources nor private income
to meet their domestic needs.
International assistance in 1997 was less than $2 billion—far short of the goal.
Leading donors in the 1990s such as the Netherlands, Norway and Denmark have allocated a
relatively large share of their gross national product to development assistance including
the share to population. Others, notably Australia, Finland and the United Kingdom, have
begun to increase the population share. On the other hand, the United States, while still
the leading donor for population activities, has significantly reduced its level of
support.
Unless funding increases substantially, the shortfall could spell continued high rates
of unwanted pregnancy, abortion, maternal and child deaths, and an even faster spread of
HIV/AIDS. The shortage of funding also means that progress towards human rights and
equality in health care will be slower than ever.
The private sector, including NGOs and foundations, is helping to bridge the assistance
gap, and user fees for services are generating some resources in developing countries.
Expanding the level and variety of committed resources and better managing their use is
an urgent priority. Whether we seize the opportunity by acting decisively and providing
the necessary funding will have a major impact on life in the 21st century. The decisions
taken in the next decade will determine how fast the world adds the next billion people
and the billion after that, whether the new billions will be born to lives of poverty and
deprivation, whether equality will be established between men and women, and what effect
population growth will have on natural resources and the environment.
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For more information:
United Nations Population Fund
Information and External Relations Division
220 E. 42nd Street, New York, NY 10017, U.S.A.
Tel. 212-297-5020; fax: 212-557-6416.
E-mail: ryanw@unfpa.org. Web site: www.unfpa.org.
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