Introduction

	Putting People at the Centre
	From Words to Action
	Countries Report on Progress
	National Ownership and Culture
	Birth of a New Global Consensus
	Wide-ranging Impact
	Long Way to Go
	The Way Forward

Long Way to Go

The progress countries have made to date in putting the ICPD’s recommendations into practice has laid the groundwork for further advances in ensuring reproductive health and rights. But the challenges remaining to be addressed are daunting:

• Migration continues from rural areas of developing countries to fast-growing cities. By 2007, half the world’s population will be urban. Providing social services including reproductive health care in poor urban areas is a major challenge, as is meeting the needs of underserved rural communities.



• Population growth is contributing, along with high resource consumption by affluent populations, to increasing stress on the global environment. Global warming, deforestation, growing scarcity of water and diminishing crop land will make it harder to address poverty and gender inequality.



• More than 350 million couples still lack access to a full range of family planning services. Some 137 million women want to delay their next birth or avoid another but are not using family planning; 64 million more are using less-effective methods. Services are reaching many more women than ever before, but are not expanding fast enough to close existing gaps or to keep pace with population growth and rising demand. Demand for family planning services will increase by 40 per cent by 2025.



• Complications of pregnancy and childbirth are among the leading causes of death and illness among women of reproductive age in many parts of the developing world. Some 8 million women each year suffer life-threatening pregnancy-related complications; over 529,000 die as a consequence, 99 per cent of them in developing countries.(6) Many times that number suffer infection or injury.



• In the developing world as a whole, one third of all pregnant women receive no health care during pregnancy; 60 per cent of deliveries take place outside of health facilities; and skilled personnel assist only half of all deliveries.



• There were an estimated 5 million new HIV infections during 2003, an average of 14,000 per day; 40 per cent were in women and nearly 20 per cent in children. In mid-2004, about 38 million people were living with HIV/AIDS. In 2003, some 3 million people died of AIDS: 2.5 million adults, and 500,000 children under 15.(7)

RESOURCES FALL SHORT. In the face of these challenges, the response of the international community has been inadequate. After an initial surge following Cairo, resource levels have remained static.

Donor countries have made available only about half of the external resources that the ICPD agreed would be needed to implement the Programme of Action. Donors agreed to provide $6.1 billion a year for population and reproductive health programmes by 2005, a third of the total resources needed. Between 1999 and 2001 their contributions stayed at around $2.6 billion; in 2002 they increased to $3.1 billion.(8)

In the face of the HIV/AIDS pandemic, there are additional needs, particularly for a reliable and sufficient supply of reproductive health commodities, including male and female condoms.

2 POPULATION GROWTH IS STILL AN ISSUE Global population, now 6.4 billion, is still growing rapidly—currently by 76 million persons per year. By 2050, the United Nations projects the world will add some 2.5 billion people, an amount equal to the world’s total population in 1950. Growth has slowed since it peaked in the mid-1990s at around 82 million annually. The average family size has declined from six children per woman in 1960 to around three today, as family planning has become more accessible and widely used. Projections suggest total population will start to level off by the middle of this century, as fertility drops to replacement level or lower. But some countries will reach that point much later than others. Those with young populations (due to high fertility in the recent past) will continue to grow for decades even with small families as the norm. The number of adolescents, aged 10-19, is at an all-time high of 1.2 billion. And in the poorest countries, where fertility and mortality remain high and access to family planning is limited, the transition to smaller families is only just beginning. The 50 least-developed countries are expected to grow by 228 per cent, to 1.7 billion by 2050. Countries where fertility has fallen sharply will see a dramatic ageing of their populations in the decades ahead, a trend already well under way in developed countries and a major policy concern. Ninety-six per cent of the projected growth will be in developing countries. The populations of Europe and Japan are now declining and the pace of decline is projected to double by 2010-2015; North America continues to grow at about 1 per cent annually, mostly because of immigration. Today’s population estimates and growth projections are lower than those made a decade ago, largely because the impact of HIV/AIDS in Africa has been worse than previously projected and growth in the developed countries has declined faster. The 38 African countries most affected by HIV/AIDS are projected to have 823 million people in 2015, 91 million fewer than if no AIDS deaths had occurred but over 50 per cent more than today (without HIV/AIDS they would have grown by 70 per cent). The United Nations’ projections of slower population growth assume that more couples will be able to choose to have smaller families; this will require greater investments to ensure wider access to reproductive health information and services, including family planning. See Sources Figure 1: World Population, 1950-2050 (projected) Click here to enlarge image Source: UN Population Division

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