The international community has committed itself to an ambitious
goal: cutting in half the number of people living in absolute poverty
by 2015. To meet the eight MDGs (see box below), world
leaders have adopted a series of specific and detailed targets for life
expectancy (a way of measuring health), education, housing,
gender equality, openness of trade, and environmental protection.
The new goals recognize that poverty concerns dignity,
opportunity and choice as well as income. Escaping poverty is not
a purely individual act. It depends on the support of institutions-
the family, the state, civil society, the private sector, the local
community and cultural organizations-the political, economic
and social environment they create, and the support and opportunities
The most ambitious effort in human history towards human
well-being should be an inspiration, but inspiration must be underpinned
by some practical understandings.
The first condition for success is respect for national sovereignty:
each country will decide its own needs. National culture and
history, and decades of experience with international cooperation,
will inform and shape action.
Second, the Millennium Development Goals reinforce each
other; all are priorities and should be worked on together. They
are a selection from the recommendations of the international
conferences of the 1990s, whose analyses and action plans remain effective.
Third, action towards the specific goals does not exclude
and may require action in other areas. These include debt relief,
trade regimes and investment arrangements as well as
Finally, success requires commitment from all countries, and
from the private as well as the public sector.
FAMILY PLANNING PROGRAMMES WORK
Family planning programs
and population assistance encourage lower
fertility. They accounted for almost one
third of the global decline in fertility
between 1972 and 1994, over and above
the contribution of education, the share of
agriculture in the labour force, GDP per
capita, the proportion living in urban areas,
nutrition levels and time period. The effects
of programmes on fertility were particularly
strong in Asia (accounting for more than
two thirds of the decline), intermediate in
Latin America and the Arab States and
weak in Africa.
Effects on unwanted fertility are even
clearer. In some analyses, population programmes
account for 40 to 50 per cent of
the change. Programmes reduce unwanted
fertility by making reproductive health
services accessible, and involving nongovernmental
organizations (NGOs) and
the private sector. Universal access to
services would enable women and their
partners to have only the children they
want; national comparisons indicate that
absence of universal access alone makes a
difference of up to one third in modern contraceptive
Education, information and communication
are important for the success of
population programmes. Better information
makes it possible and acceptable for
communities and families to discuss and
act on all sorts of issues related to reproductive
health: how to reduce maternal,
infant and child deaths and prevent
unplanned births; how to encourage discussion
and mutual decision-making by
women and their partners; how to free
women for broader social participation; and
how to reduce the stigma and confront the
threat of HIV/AIDS.
Continued progress depends on
continued investment, domestic and international.
Since 1969, the nited Nations
Population Fund (UNFPA) has been the
largest multilateral source of population
assistance, providing some $6 billion for
population programmes. See Sources
The great series of international
conferences in the 1990s developed an agenda for social
action against poverty, centred on individual men and
women. Key aims were improvements in health and education,
both as personal goals and as public goods. In the area
of health, the recent World Health Organization (WHO)
and World Bank initiative in health and macroeconomics
strongly supports this agenda, focusing attention on
combating malaria, tuberculosis and HIV/AIDS, as well
as other infectious and environmental diseases (5).
In the area of population, the
1994 ICPD endorsed WHO's broad positive definition of
health as "not merely the absence of disease or infirmity"
but "a state of complete physical, mental and social
and agreed that the human right to health includes reproductive
health. The Conference also endorsed the goals of universal
education and closing the gender gap in education. The
international consensus, before and after the ICPD,
explicitly recognizes the importance of demographic
trends-population growth, location, movement and age
structure, fertility and mortality -on all aspects of
Increased attention has been directed to places with large
populations of refugees or displaced persons. Natural calamities,
conflict and social upheaval have left millions of people beyond
the reach of functioning institutions or systems of governance.
Emergencies can be short- or long-term. Providing immediate
services, lasting development efforts and the means of ultimate
resettlement are important contributions to combating
poverty. Progress towards the MDGs must include people in
such desperate circumstances.
The international understanding
on population has been affirmed and repeated (7)
so often that its demographic impact is often taken
for granted. Policy makers confidently build demographic
assumptions-about declining fertility, for example-into
their plans. But good demographic outcomes depend on
good policies, based on good data. Successful action
depends above all on empowering individuals and couples
to make free choices
| REPRODUCTIVE HEALTH, FAMILY PLANNING AND POPULATION PROMOTE MILLENNIUM DEVELOPMENT GOALS
Goal 1: Eradicate extreme poverty and hunger
- Voluntary family planning can help people to have as many or as few children
as they want and to decide when they will have them.
- Fertility reduction opens the "demographic window", an opportunity for
accelerated social and economic development.
- Large families dilute the assets of poorer households. Unwanted births deepen
- Smaller families allow more investment in each child's health and education.
- Improved data on people and their needs will advance policy development and
the targeting of development programmes-and improve accountability.
- Migration within and between countries can bring benefits and pose challenges
in both sending and receiving areas. Policies can help maximize the gains to
poor communities and individuals.
- Better child spacing reduces competition for food within the household and
improves children's nutrition.
Goal 2: Achieve universal primary education
- Attempts to achieve universal education have left out poor children.
Large numbers of children in poor families mean that some children get no
education. For others, education may be delayed, interrupted or shortened.
In poor families, girls are more likely than boys to be deprived of education.
Educational continuation depends on avoidance of unwanted pregnancies. Early
initiation of sexual activity increases the risk of school dropout. In sub-Saharan
Africa between 8 and 25 per cent of dropout rates are the result of pregnancy.
Early marriage interrupts girls' schooling.
Goal 3: Promote gender equality and empower women
- Progress towards gender equality starts with the common indicators of literacy
and education. It continues with health care, including personal, voluntary
control over fertility. It is important that families and societies accept women's
wider social participation, and remove obstacles to it.
- Girls and women need environments where they are safe from gender-based
violence, including on the way to, from and in school.
Goal 4: Reduce child mortallity
- Infant and child mortality are highest for the youngest mothers and after closely
- High fertility reduces the provision of health care to children.
- Unwanted children are more likely to die than wanted ones.
- A mother's death increases the risk that her children will die
Goal 5: Improve maternal health
- Care in pregnancy, during and after childbirth, and emergency obstetric care
save women's lives.
- Pregnancy is riskiest earliest in life. Over 100,000 women are at risk of obstetric
fistula each year, and over 2 million women have already been injured and
- A woman's lifetime risk of maternal death and illness depends on the number
and safety of her pregnancies.
- Family planning saves women's lives. It reduces unwanted pregnancy, unsafe
abortion and maternal death. Women's empowerment will enable them to
address the social conditions that endanger their health and lives.
Goal 6: Combat HIV/AIDS, tuberculosis, malaria and other diseases
- Half of new HIV infections are among young people. Preventing infection means
enabling young people to protect themselves from sexually transmitted diseases.
This includes teaching abstinence outside marriage, fidelity within it and
responsible behaviour at all times, including the responsible use of condoms.
Male and female condoms must be available as needed. Poor countries need
systems to guarantee an adequate supply of reproductive health commodities,
and support in establishing and supplying the system.
Integrated reproductive health programmes that serve a variety of needs
through the life cycle will encourage health service use and provide additional
opportunities to address health needs holistically. Changing age structures
will require long-term adjustments in health systems.
The pandemic has serious implications for the attainment of the other goals,
Goal 7: Ensure enviromental sustainability
- Balancing resource use and ecological requirements will depend critically on
population growth, location and movements, on patterns of resource consumption,
and management of waste.
Rapid growth of poor rural populations puts enormous stress on local environments.
Poor people need technologies to mediate their demands on resources.
They also need better education and health services, including reproductive
health, to improve well-being and bring down fertility. Appropriate policies
will reduce urban migration and promote sustainable rural population growth.
The sustainable improvement of the lives of slum and shanty dwellers will
depend on policies to address high urban growth rates, the result of natural
increase and migration.
Goal 8: Develop a global partnership for development
- Population and reproductive health programmes have lagged in the least-developed
countries, with their high levels of mortality and unwanted fertility. They
will benefit most from higher international assistance and debt forgiveness, and
domestic resources for health and education-and their effective use. They
need affordable prices for essential drugs for treating HIV/AIDS, malaria and
tuberculosis, and a secure supply of contraceptives.
Between 2000 and 2015 nearly 1.5 billion young men and women will join the
20-24 age group. They, and hundreds of millions of teenagers, will be looking
for work. If they have jobs they will drive economic growth; if not they will fuel