"ICPD: Keeping the Promise", Keynote Statement at the IPPF 50th Anniversary in New Delhi
13 November 2002
13 November 2002
I would like to thank my good friend, Steven Sinding, the very capable new Director-General of the International Planned Parenthood Federation (IPPF), for inviting me to deliver the keynote speech to celebrate IPPF's 50th anniversary. It is both an honour and a pleasure to commemorate this historic occasion and to reflect on IPPF's many milestones during the past one half century and the many challenges that lie ahead. For the past 50 years, IPPF has been a champion in promoting sexual and reproductive health and rights and I am certain that this courageous work will flourish under Mr. Sinding's visionary and committed leadership.
IPPF at the Beginning
Fifty years ago, here in India, in Bombay, IPPF was formed so that women would have the right to plan their pregnancies and space their births. This was a revolutionary concept at the time and the brave advocates who championed family planning were, as I understand from IPPF history, "insulted, spat on and even imprisoned for their arrogance in asserting that women had the right to control their own fertility".
The year was 1952; and the cold war was in full swing. But another war was being waged by the national family planning associations from the United Kingdom, India, the Netherlands, Hong Kong, Singapore, Sweden, West Germany and the United States. Theirs was a war against ignorance and the idea that women were meant to remain barefoot and pregnant. Together, the eight national family planning associations formed the new International Planned Parenthood Federation to support women in their quest for better lives.
What brought them together and gave them the courage to act was the conviction that women should be able to control their bodies and their lives. They believed that women and couples had the right to know about family planning and to use contraception if they so desired. Little did they know at the time, that this simple, and yet profound, conviction would change the world.
Family Planning as a Human Right
As an international organization, IPPF was determined to make international progress.
A major breakthrough occurred in 1968. After 16 years of dedicated work, the IPPF made a case to the world's first International Conference on Human Rights, held in Tehran. IPPF submitted to delegations the groundbreaking proposal that family planning be officially recognized as a basic human right. The delegates agreed and the right was approved.
The international recognition of family planning as a basic human right marked a major victory for the International Planned Parenthood Federation and a major victory for women and families around the world. For the first time, it was universally agreed, and universally proclaimed, that all couples and individuals have the basic right to decide freely and responsibly the number, timing and spacing of their children and to have the information and means to do so.
The year was 1968, one year before the United Nations Population Fund (UNFPA) became operational. And I can tell you that the establishment of the international right to family planning laid the groundwork for the work of UNFPA in the years to come.
In the 1970s, IPPF played a leading role in documenting the unmet need for contraceptives, in encouraging the reform of restrictive laws that inhibited family planning services, and in distributing contraceptives at the community level. For its pioneering work in these and other areas, IPPF has received numerous awards, including the United Nations Population Award in 1985.
The 1990s: A Decade of Change
When the 1990s rolled around, change was brewing. UNFPA and the Population Division of the United Nations Secretariat began preparing for the International Conference on Population and Development (ICPD), scheduled to be held in Cairo in 1994. Family planning was being expanded to include sexual and reproductive health and rights. The ICPD process, which built on experience gained over two decades, provided a forum for experiences to be exchanged, concepts to be considered and an international agreement to be forged.
Here in New Delhi, one of the most important meetings of non-governmental organizations (NGOs) to provide input to the Cairo Conference took place in 1992 at the IPPF Family Planning Congress. At that meeting, Mr. Sinding, who was then with the Rockefeller Foundation, addressed the deep concern that existed about the link between demographic targets and coercion. He demonstrated that providing high-quality reproductive health and family planning services would satisfy an existing level of demand in most countries and eliminate any rationale for demographic targets. This shift and change in emphasis was reflected at the Cairo Conference of 1994.
ICPD: The Way Forward
The Cairo Conference was a massive international undertaking, with about 11,000 registered participants. The negotiations were long and difficult, with NGOs for the one of the earliest times playing an active role in a global United Nations Conference, thanks to the diligence of the Conference's Secretary-General, Dr. Nafis Sadik, and her dedicated team. In the end, world leaders managed to achieve consensus on some of the thorniest and most sensitive issues on the international agenda. They acknowledged that population is linked to development and that population dynamics such as migration, population growth, ageing, and urbanization must be factored into development plans, policies and programmes. Together, they moved global population policy away from a focus on numbers and meeting demographic targets towards a focus on human rights and meeting the needs of individual women and men. Perhaps most importantly, they called for gender equality and the empowerment of women both as highly important ends in themselves and as key to improving the quality of life for everyone.
During the Cairo Conference, governments pledged to improve the health of the world's women by transforming and funding reproductive health services. Let us make no mistake about it: the Cairo Conference was a watershed event and it continues to provide the basis for collective action in our field. We must not allow threats to the Cairo consensus to gain steam. Now as never before, we must stand united and strong in backing the Cairo consensus. The agreements reached in Cairo in 1994 and at the General Assembly's fifth-year review in 1999 are balanced and pragmatic, representing all stakeholders. These agreements are also feasible and affordable. Together, we have made great progress for women and families and we must remain on track. We must not allow a few ideologues to derail or dilute in any way international agreements that further women's rights and women's health. We must not allow a small, but determined and vocal minority, to dictate the international agenda and set back hard-won progress for poor women around the globe.
Reproductive health services are services that women and families need to plan their families, to have healthy pregnancies, to survive childbirth and to avoid HIV infection. Family planning, in particular, has proved itself to be a real lifesaver that reduces the incidence of infant mortality, child mortality and maternal mortality and also reduces the incidence of abortion. It would be nothing less than cruel to deny women these basic health services, which women in wealthy countries take for granted. Indeed, such denial would lead to the death of millions of poor and vulnerable women, infants and children around the world. My friends, we have come this far together and we must go forward together.
The world needs to save women so women can save the world.
IPPF is a true pioneer in the field of family planning and a valuable partner in providing quality reproductive health care to women around the world. I would like to take this opportunity to congratulate it for 50 years of dedicated global service that has improved the lives of millions of people. IPPF is a true pioneer in our field and is rightly known for its brave and angry spirit and going boldly where governments have feared to go. It brought national family planning associations together and gave them common purpose as well as institutional and moral support. IPPF is a pioneer in showing the way to greater community involvement in health, human rights and women's empowerment. For this, it should rightfully feel proud.
Together, we have come a long way since 1952 when IPPF was founded. At that time, relatively few women in the developing world used family planning and the subject remained extremely sensitive. Over the past five decades, the use of family planning has risen dramatically and family size has declined in many countries around the world. This represents a major historical shift and a major historic achievement. In developing countries, contraceptive use has increased from 10 per cent in the late 1960s to 62 per cent today. Overall, women are choosing to have one half as many children as they did just 40 years ago. Here in India, the second most populous country on Earth, the average woman has chosen to have three children today compared to five children two decades ago.
It is fair to say that the decline in fertility that has been brought about by women making their own reproductive choices is one of the great accomplishments of the 20th century. More than anything, it represents a huge victory for human rights and freedom. However, while we have made much progress, we have a long way to go.
Worldwide, 350 million women are denied access to a range of safe and effective contraceptives. Today, 58 million women give birth without any medical help or skilled attendants. And this lack of basic reproductive health care results in tremendous human suffering and tragedy.
Every year, nearly 175 million pregnancies are unwanted or ill timed. And every minute, one woman dies of pregnancy-related complications. Each minute, 10 people, mostly young people, are newly infected with HIV/AIDS. In developing countries, poor reproductive health is a leading cause of death and disability for women, and unsafe sex is the second leading cause of illness and death worldwide. Knowing these realities, we must strengthen our response to save and improve lives. Together we must do more.
As the Executive Director of UNFPA, I am determined to meet the many challenges ahead with an agency that is focused, effective and committed to partnership.
It is only through partnerships that we will meet our first and foremost goal-which is to ensure universal access to reproductive health, including family planning services, to all couples and individuals by the year 2015. This is a major challenge, and one to which we are fully committed. Our second challenge is to build capacity in developing countries so that they can develop effective policies and programmes to meet their populations' needs. And our third challenge is to mobilize the resources and the political will necessary to achieve these goals. This requires advocacy to raise funds and to generate policy and legal change for reproductive health, human rights and gender equality.
The priorities for UNFPA in the area of reproductive health include safe motherhood and reducing maternal mortality, preventing the spread of HIV/AIDS, and providing information and services to young people and communities in crisis.
First, let me talk about safe motherhood. It is unacceptable in this 21st century that one woman dies every minute during childbirth, one half a million women a year. No matter where a woman lives, giving birth should be a time of joy, not a sentence to death. The vast majority of women's lives can be saved. Every woman should have access to family planning so that she can time and space her births, prenatal care to ensure the pregnancy goes well, skilled attendants at birth to ensure a safe delivery and access to emergency obstetric care if complications arise. Women also need access to care to treat the complications of unsafe abortion.
Every family needs a healthy mother and every nation needs healthy citizens to prosper and thrive. UNFPA will continue to advocate and support efforts for safe motherhood, together with our partners, until motherhood is safe for all women everywhere.
By far the worst outcome of trauma during childbirth is a condition called obstetric fistula. In places where there is inadequate obstetric care, a woman may be in obstructed labour for three or four days without relief. Her baby always dies. If the mother survives, her injured pelvic tissue soon rots away and she becomes incontinent.
This condition is devastating and humiliating, causing untold suffering and even rejection by husbands and families. Yet every year, between 50,000 and 100,000 new cases occur. In almost all cases, the women are abandoned and left alone to suffer in shame. Of course, the real shame belongs to a world that allows such a condition to continue. Fistula was eliminated in wealthy countries over a century ago, yet it persists today in places where poverty is widespread and women and girls have little support.
UNFPA has joined forces with a wide range of global and local partners to prevent fistula and to treat those who have been afflicted. Corrective surgery costs only $350 and is over 90 per cent effective. This month, we launched a two-year campaign to fight fistula in Africa. No woman, no matter how poor, should be condemned to this kind of humiliation and neglect.
Another priority area is the prevention of HIV/AIDS. AIDS is more than a public health issue, it is a development and security threat that is wiping out decades of social and economic progress in hard-hit areas, and is creating demographic and political challenges which have yet to fully emerge. In the past decade, our involvement in HIV prevention has risen dramatically. We support HIV prevention projects in over 100 countries. But we must all do more and scale up the response to reach every citizen. Already, there are more than 40 million people living with AIDS and 14 million AIDS orphans. Sadly, the epidemic is still in its early stages. India now has four million confirmed cases and the number of infections could increase tenfold within a decade. In Africa, the very fabric of society in hard-hit countries is coming unravelled. Sadly, one half of new HIV infections are among young people aged 15-24-many of whom have no information or prevention services and remain ignorant about the epidemic and how to protect themselves.
But, let us not hang our heads in despair, for just as young people are most vulnerable to infection, they are also our best hope to turn the AIDS epidemic around. They need comprehensive information and services to protect their health and their futures. Large-scale prevention programmes that have the political leadership of the country and community behind them have proved their success. We have seen drops in HIV infection rates in Uganda, Thailand, Senegal, Brazil and other countries.
Reproductive Health Essentials
However, I must warn you that the shortfalls that many countries face today for condoms, contraceptives, and other supplies are enormous, and the gap between supply and demand continues to grow. Demand for contraceptives alone is expected to increase by an additional 40 per cent in the next 15 years, and condoms are urgently needed to stop the spread of HIV/AIDS. UNFPA has initiated a global strategy to close the gap between supply and demand for reproductive health commodities and we need greater support for this important initiative. Today, at least 8 billion male and female condoms are needed annually in developing countries and Eastern Europe for protection against HIV/AIDS but donor countries contribute for less than one billion-fewer even than a decade ago.
Another priority is one of the most vulnerable groups: adolescents. No longer children and not yet adults, they are caught in the middle and their needs have been largely neglected. Over the next decade, 600 million girls will become adolescents, the largest group of young women in human history. The worsening condition of women's health could be slowed or even halted if their survival became a global priority. UNFPA is working to make sure they have the information and services they need to prosper and thrive. We support programmes like the Integrated Women's Empowerment and Development project in a rural village here in India, where we met a girl named Rukshana.
She is not sure of her age, "perhaps 12 or 13", has never celebrated a birthday, never had a toy, and never had a chance to go to school. From the age of 6, she has taken care of her younger brothers. She sleeps on the kitchen floor because the boys and men occupy the only beds in the house. She works from 4 O'clock in the morning until 10 O'clock at night, gathering fuel, cooking for her family, and caring for the family's cattle. When asked what she would want, given any wish. She answered without hesitation:
"I'd rather be a boy," she said, "to be able to study as much as I like and not get married early."
Thanks to the UNFPA-funded project, Rukshana is now able to study, and village elders and parents have begun delaying marriages, which used to occur at the tender age of 12 or 13.
Yet, around the world, millions of girls continue to get married too young. There are tens of millions of child brides. Every year, 82 million 10-17 year-olds are married and every year 15 to 17 million adolescent girls get pregnant. Every day, 7,000 young people are newly infected with the deadly virus, HIV. Each day: one half a million young people are infected with a sexually transmitted infection, which increases the risk of becoming infected with HIV/AIDS.
Given these harsh realities, it is not enough to remain silent on the issues of sexuality education and reproductive health for adolescents. While these issues remain taboo in many societies, they must be addressed. And to address them effectively, we must be sensitive to local cultural realities. Young people need comprehensive information, skills and services that will allow them to make responsible decisions. Adolescence is a passage to adulthood, and we owe it to young people to help them navigate that passage safely.
Because UNFPA is a global leader for reproductive health and rights, we do come under fire. But I can assure you that we are not going to allow any funding cuts or critics to deter us from our mission of saving women's lives, promoting human rights and helping countries meet their development goals. Contrary to what some critics falsely claim, we are against coercion everywhere and we do not manage or participate in managing programmes of coercive sterilization or abortion anywhere.
All the evidence we have reviewed indicates that reproductive health and family planning programmes have saved and improved the lives of countless women and infants and significantly reduced the incidence of abortion worldwide. In the Russian Federation, where a national family planning programme was launched 11 years ago, the abortion rate has dropped by one half.
Now, let me be frank. At a time when the demand for our services is great and growing, the resources we all need to keep services intact are not keeping pace, and it is poor women, men and families who are paying the ultimate price.
At the International Conference on Population and Development, governments determined how much money was needed for population and reproductive health. They decided that the world should provide $17 billion by the year 2000 but so far, only 64 per cent of the funding goal has been reached, even though we are two years past the target date.
If governments had kept up with their commitments, UNFPA would have resources of at least $500 million at this time and IPPF would have at least $200 million. As it is, both of us combined have only about $350 million, far short of what is needed to meet current demands and international goals.
There is no doubt that these are difficult and challenging times, but we must remain courageous and committed, as Steve has said. The Cairo Programme of Action was a hard-won victory and it is a victory of which we should all be proud. It is also an international agreement that we must champion now as never before. Every woman and couple has the right to determine the number, timing and spacing of their children and to have the means to do so. As IPPF Director-General Sinding has so eloquently stated: "There is no other area of human endeavour that so liberates people as their ability to control their own fertility." Every woman also has the right to make decisions regarding reproduction free of discrimination, violence and coercion. These internationally agreed reproductive rights are basic human rights that must be upheld.
Millennium Development Goals
This is especially critical as the world mobilizes to achieve the Millennium Development Goals. We simply will not be able to reduce poverty by one half by the year 2015, reduce the spread of HIV/AIDS, lower the rates of infant and maternal mortality, and advance gender equality without paying greater attention to population and reproductive health and advancing the Cairo agenda.
The success of the 1994 Cairo Conference is a triumph for consultation and partnership and discussion and negotiation among all countries and all cultures. Let us keep our promises to women, men and families around the world. Now is the time for leadership and commitment to this shared global vision.
Together, UNFPA and IPPF will continue to move forward. We will continue to work with communities and governments around the world to keep our promise and to keep the spirit of Cairo alive and beating like the beating of our hearts.