What needs to be done to halve the numbers of the poor by 2015?
For countries, overall economic growth is not enough: it requires
directing development efforts to the poor. The international
community should take account of the context of poverty, going
beyond market forces to create an international environment that
FRAMEWORK The international conferences of the 1990s, the
Millennium Summit in 2000 and the International Conference
on Financing for Development in 2002 agreed on a series of
goals intended to halve poverty by 2015. Many of the Millennium
Development Goals, including health goals, depend on agreed
population goals, including the universal availability of family
planning and other reproductive health services, on empowering
women, and on achieving gender equity and equality.
The WHO/World Bank Commission on Macro-economics and
Health recognized that population and reproductive health are
central to the attainment of the health goals of the Millennium
Summit and to the entire development agenda. Improving health
goes further than identifying and treating disease. Preventive
health efforts, including reproductive health, must have
The MDGs include reduction in maternal,
infant and child mortality. Improved reproductive health
services will help meet these goals through direct service
provision and the indirect benefits of better birth
spacing (22). Reproductive
health services also deliver education, counselling
and condom distribution that help fight HIV/AIDS. These
services can go directly to the poor.
Population trends will affect prospects for sustained improvement
in poverty beyond the 15-year horizon of the MDGs. Lower
fertility and slower population growth will temporarily increase
the relative size of the workforce, opening a historic one-time
demographic window, an opportunity for investment in economic
growth; but in the poorest countries population momentum and
high levels of unwanted fertility delay this opportunity. The
HIV/AIDS pandemic may close the demographic window before it
opens, because the death of young adults stunts the growth of
the working-age population. The disease both devastates the present
and steals the future.
RECOMMENDATIONS The essential requirements are to target
assistance directly to the poor, to reduce their costs and to give
them a voice in policies and programmes that affect them.
Governments, communities, the private sector and the international
community must cooperate more closely, to make the best
use of limited domestic and international resources and exploit
comparative advantage. Closer coordination among the different
parts of the United Nations system will be an important part
of the process.
Donors should encourage partnerships among governments
and NGOs, with particular attention to incorporating the views of
the poor in the design, implementation and monitoring of programmes.
This participatory approach allows feedback on priorities
Reproductive health-pre- and post-natal care, safe delivery,
family planning and prevention of sexually transmitted infections
(STIs) and HIV/AIDS-is most effective as part of an
integrated package. Health sector reform in many poor countries
includes integrated health service packages, but special care is
needed during the transition to protect services for the poor and
ensure that they have a voice. This is especially important for
women, who have most to gain from effective reproductive health
services. Programmes must address the special needs of especially
vulnerable groups such as the young, migrants and refugees.
The diverse needs of the poor are often best addressed in integrated
programmes. Empowering women by granting small loans
through microcredit arrangements has shown its effectiveness,
especially when other services such as literacy and reproductive
health are included in the package.
In all population-related programmes, better data systems
mean better information, awareness, effectiveness and feedback.
Countries need better data on the benefits and costs of
programmes, where the resources for them come from, and how
to use them most effectively. They need data on demographic
conditions and trends to improve policy-making for development.
Universal education is a goal on which there is universal
agreement. But the aim will be thwarted without the enrolment
and continuation of poor children, especially girls. These should
include special efforts to avoid early marriage, unwanted pregnancy
and HIV infection.
Investments in education bring substantial returns. Female
education, apart from empowering the woman herself and
widening her life choices, is particularly cost-effective because
benefits pass on to her children. However, the investment can
be dissipated if lack of choice about the number, timing and
spacing of children and rigid gender roles reduce women's social
and economic participation.
RESOURCES The International Conference on Population and
Development agreed on the cost of a package of reproductive health
and other needs-$17.0 billion a year in the year 2000, to increase
to $18.5 billion in 2005, $20.5 billion in 2010 and $21.7 billion
in 2015. The international community would provide one third of
these amounts. Additional resources would be required for basic
health infrastructure development, tertiary care, emergency obstetrical
care, specialized HIV/AIDS prevention interventions, and the
treatment and care of those living with HIV/AIDS.
Further resources would be needed for other population-related
development goals in the Programme of Action. Among these are:
- universal basic education;
- the empowerment of women;
- environmental concerns;
- employment generation;
- poverty eradication.
Donor countries are contributing less than a quarter of current
expenditure towards the goal of universal access to reproductive
health by 2015. Developing countries have contributed $8.3 billion,
76 per cent of the total and about 73 per cent of their commitment.
A few large countries account for much of this expenditure.
COSTS AND BENEFITS The cost of denying health care, education
and empowerment to the world's poorest people cannot only be
counted in money. Gender violence alone, in the industrial countries
alone, is estimated to reduce by 20 per cent the number of
healthy life years experienced by women aged 15-44. The imagined
economic cost, or the foregone benefits, must be multiplied by the
impact on children, families and communities, over generations.
Decades of social and economic research show that reproductive
health programmes, including family planning, are among
the most cost-effective health and social development programmes.
Education offers unquestionable benefits, especially for women.
Moves towards the empowerment of women and gender equality
have enriched the lives and increased the contribution of
Universal access to reproductive health care, universal education,
and women's empowerment are development goals in their
own right, but they are also conditions for ending poverty, closing
the gaps between richer and poorer in the world, and creating
a global society that is both stable and just.
Recommendations and resources are discussed in Chapter 8.