Population, Poverty and Global Development Goals: the Way Ahead
Since 1969, UNFPA has been the largest multilateral source
of population assistance, providing some $6 billion for
ICPD RESOURCE GOALS In
1994, at the International Conference on Population
and Development, nations committed themselves to the
goal of universal access to reproductive health by the
year 2015(25). The
five-year review of the ICPD and subsequent international
and regional conferences reaffirmed this goal (26).
The goal remains a priority for the international community.
It figures in the monitoring standards of bilateral assistance
agencies (including the development agencies of the United States
and the United Kingdom), the World Bank and the evolving efforts
of developing countries.
As part of the ICPD consensus, the international community
accepted expert estimates of the cost of a package of services
towards the goal of universal access to reproductive health. The
package included family planning; safe delivery; prevention
of sexually transmitted diseases; other reproductive health services;
and population data collection and analysis. These estimates
were reaffirmed at the UN General Assembly's five-year review of
ICPD implementation in 1999.
This commitment was directed to seeing that every pregnancy
would be a wanted pregnancy and every child a wanted child,
born with care assuring that both the mother and the baby would
be healthy and free from sexually transmitted diseases.
Estimated needs were $17.0 billion a year in the year 2000.
The requirement was projected to increase to $18.5 billion in 2005,
$20.5 billion in 2010, and $21.7 billion in 2015. The international
community was called on to provide one third of these amounts.
The services included in the package
can be delivered through primary health care systems.
Additional resources will be required for basic health
infrastructure development, tertiary care, emergency
obstetrical care, specialized HIV/AIDS prevention interventions
(27), and the treatment
and care of those living with HIV/AIDS.
ADDITIONAL RESOURCES NEEDED Further resources are 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.
More detailed costing for the Millennium Development Goals
will elaborate some of these additional requirements.
Some reproductive health needs were not fully foreseen in
1994, and call for additional resources. Among these are much
broader and more urgent efforts to prevent HIV/AIDS infection;
and expanded information, care and services for people in emergency
PROGRESS IN MOBILIZING THE RESOURCES Donor countries
are contributing less than a quarter of current expenditure towards
the goal of universal access to reproductive health by 2015. Their
commitment was one third of a much larger total.
At the ICPD, countries agreed that one third of the $17 billion
annual requirement for basic reproductive health and population
programmes in 2000, or $5.7 billion, was to come from the international
community; two thirds, or $11.4 billion, was to be provided
by developing countries and other countries needing assistance.
In the year 2000, total expenditure was $10.9 billion. Assistance
totalled $2.6 billion. This is less than a quarter (24 per cent) of
total expenditure, and less than half (46 per cent) of the commitment.
Developing countries contributed $8.3 billion, 76 per cent of
the total spent and about 73 per cent of their commitment. A few
large countries account for much of this expenditure. Africa is the
region with the largest share (70 per cent) of allocations coming
from international sources.
BROADER FOCUS NEEDED The Millennium Summit adopted
a disease-oriented approach to health. Issues such as unwanted
pregnancy and family planning, which are not diseases, did
not figure prominently in the Summit decisions, and thus not in
the Millennium Development Goals.
The Commission on Macro-economics
and Health (28)
did not fully cost family planning, a key element in
reproductive health, when estimating needs for essential
health interventions. It included only the cost of family
planning commodities, for one year after the birth of
a child, though WHO standards suggest that the health
gains for children and for mothers of spacing births
24 to 30 months apart are considerable.
Resources are therefore needed
to ensure an adequate supply of temporary methods of
contraception, such as condoms. The United Nations Population
Division estimates for less-developed regions (29)
indicate that over 100 million couples-over 20 per cent
of all users-use temporary methods. IUD users, an additional
27 per cent, also need resupply, but at longer intervals.
The excellent foundation provided
by the Commission can be further elaborated as the follow-up
process continues, recognizing these additional needs
and acknowledging the importance of universal access
to reproductive health, including family planning, for
reaching the Millennium Development Goals (30).
NEW INVESTMENTS IN FAMILY PLANNING In the area of
family planning, the necessary programme investments-all as
part of strengthening health infrastructure-include:
- commodities and logistic systems;
- management and quality control;
- counselling and follow-up (including adjustments in method
choice, if indicated);
- sociocultural research to address barriers to effective or proper
use, and to facilitate introduction of new methods or options for
- introduction of both cost-sharing and equity systems;
- establishing appropriate public-private partnerships;
- operations research and contraceptive development.
Research is needed on effective, user-friendly and culturally
acceptable methods of family planning, especially those a woman
herself can control. Preventing sexually transmitted diseases,
including HIV/AIDS, calls for additional investment in contraceptives
that are also microbicides.
This should be part of the response
to the Commission's call for "a significant scaling
up of financing for global R&D [research and development]
on the heavy disease burdens of the poor ...." (31)
Contraceptive development, supply, logistics and management
should also be included in the estimates of capital
and recurrent investments needed.