UNFPA EXECUTIVE DIRECTOR SAYS APPROACH SENSITIVE TO MEETING INTEGRATED NEEDS FAVOURED SINCE CAIRO CONFERENCE

26 February 1996

Press Release
POP/608*

UNFPA EXECUTIVE DIRECTOR SAYS APPROACH SENSITIVE TO MEETING INTEGRATED NEEDS FAVOURED SINCE CAIRO CONFERENCE

19960226 Commission on Population and Development Begins Twenty-Ninth Session

Since the 1994 International Conference on Population and Development in Cairo, quotas and targets have been dropped in favour of an approach sensitive to meeting an integrated set of needs, Nafis Sadik, Executive Director of the United Nations Population Fund (UNFPA), told the Commission on Population and Development, as it opened its twenty-ninth session this morning. The session, the second since the renaming of the of the Commission in 1994, is scheduled to focus on the theme of reproductive rights and reproductive health, including population information, education and communication.

Dr. Sadik told the Commission that programmes were becoming more sensitive to the needs of women and girls, and efforts were also being made to make men aware of their responsibilities in the area of reproductive health. While in some places, cultural attitudes towards women and girls and the refusal of some men to accept their responsibilities held back progress, she believed that those obstacles could be overcome.

Joseph Chamie, Director of the Population Division, urged the Commission to address the complex issues surrounding abortion; the ageing of populations; and the HIV/AIDS pandemic. Another issue of concern to many governments was international migration. "Most recently, international migration has become one of the most contentious topics of debate in the elections of those seeking government office", he said.

Also addressing the issue of migration was Jean-Claude Milleron, Under- Secretary-General for Economic and Social Information and Policy Analysis, who said that the number of international migrants had increased by more than 50 per cent in the past 25 years, and in many countries, more than one fourth of all population growth was due to international migration. Particularly acute was the large increase in the number of refugees and asylum seekers, at a time when many countries were less willing to accept them.

* Press Releases POP/581 to POP/591 are for the twenty-eighth session of the Commission

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The representative of the United States said his country was acutely aware of its own population problems, including the fact that there were large pockets of poverty and many women still lacked access to adequate health care. With respect to the role of the United States as a donor, he said that unfortunately, the Congress had made a 35 per cent cut in funds for international population assistance. Although he could not predict future budgets, he said he could assure the Commission that the Clinton Administration remained committed to the goals of the Cairo Programme of Action and was determined to continue to provide leadership in the population sector.

The representative of China said that the incidence of sexually transmitted diseases had increased in that country in recent years, and HIV/AIDS had also spread to a certain extent. Sex education had been strengthened to advocate responsible sexual behaviour. Public education, through television and other mass media, had been used to increase awareness of the harmful and disastrous consequences of HIV/AIDS. While China had made great strides in stabilizing its population growth rate, it could not for a moment forget its ever-growing population size and the problems that it would entail.

Other statements were made by the representatives of Japan, Mexico, Canada, Italy (on behalf of the European Union), India, Pakistan, Russian Federation and France.

Also this morning, Andras Klinger (Hungary) was elected Chairman of the Commission. The following were elected Vice-Chairmen: Marie Cecille Juaquin- Yasay (Philippines), R.L. Clique (Belgium) and Elza Berquo (Brazil). The election of a Rapporteur was postponed to a later date.

The Commission on Population and Development will meet again at 3 p.m. today to continue its general debate and to consider follow-up actions to the recommendations of the Cairo Conference concerning reproductive rights and reproductive health.

Commission Work Programme

The Commission on Population and Development begins its second session this morning by holding its general debate on national experience in population matters. (For background information on the session, see Press Release POP/607, of 23 February.)

Statements

JEAN-CLAUDE MILLERON, Under-Secretary-General for Economic and Social Information and Policy Analysis, said important trends framed the deliberations of the Commission, including the fact that the current population growth rate was the lowest recorded since the Second World War and was continuing to decline. Recent data showed that the demographic transition might be more advanced than previously expected. "There is evidence that population could be a success story for the United Nations", he said. Despite slower population growth, however, the annual increments were at an all-time high. It would be necessary to reinforce efforts in the years to come to ensure that world population growth was compatible with sustainable economic and social development.

Another trend, he said, was that 45 per cent of the world's population lived in urban areas and by 2025, three fifths of the world population might be urban dwellers. They were living in mega-cities which lacked the resources and infrastructure to shelter, employ and in other ways accommodate the large increases. There was, however, evidence that policies and programmes could influence those trends. Some policies could guide the location of industry and improve the chances of orderly economic growth. Those issues would be a major feature of the United Nations Conference on Human Settlements (Habitat II).

He said the world international migrant population was increasing rapidly. It seemed that the number of international migrants had increased by more than 50 per cent in the past 25 years and in many countries, more than one fourth of all population growth within countries was due to international migration. Particularly acute was the large increase in the number of refugees and asylum seekers, at a time when many countries were less willing to accept them.

The Programme of Action adopted by the International Conference on Population and Development (Cairo, 1994) was being responded to at both the intergovernmental and Secretariat level, he went on. The Commission had been charged with providing guidance to the United Nations system regarding all activities in the area of population and development. That provided the major focus of the new terms of reference of the Commission. Having completed all the reports and studies requested of it, the future work of the Population Division of his departure was in line with the thematic approach adopted by

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the Commission. The Division had also contributed to the success of other United Nations conferences in the social and economic fields. Now that the decade of international conferences was coming to an end, much needed to be done to implement the decisions of those conferences.

Dr. NAFIS SADIK, Executive Director of the United Nations Population Fund (UNFPA), gave a brief overview of her agency's activities, which, over the past year, centred on the theme of reproductive rights and reproductive health, including population information, education and communication. The Fund's work has been guided by the Programme of Action adopted at the Cairo Conference. She stressed that action to implement the Programme of Action was not limited to developing countries. "Population and development is a global issue."

An important principle for action was the freedom of individual choice, she said. Since the Cairo Conference, quotas and targets had been dropped in favour of a sensitive approach based on meeting an integrated set of needs. "This is a matter of human rights, but it is also a matter of practical effectiveness." Even where resources were limited, respect for the individual increased the impact of reproductive health programmes and improved their effectiveness.

She said that UNFPA was working together with experts to develop guidelines on the quality of reproductive health care with a view to creating a system which would be objective and applicable in a wide variety of cultures and economic situations while also being sensitive to local and individual conditions. In order to achieve the goals set out in Cairo, the Fund was working with other agencies, such as the World Health Organization (WHO), to operationalize the reproductive health concept, develop indicators and provide technical assistance to countries.

Gender concerns were increasingly being taken into account in programme design and implementation, she said. Programmes were becoming more sensitive to the needs of women and girls, but efforts were also being made to make men aware of their responsibilities. "This is important at all stages of life, but it is especially important for the young." Many countries had initiated programmes to meet the reproductive health needs of adolescents and had put their needs on the political agenda.

A shortage of resources was the major obstacle impeding implementation of the Programme of Action, she went on. Despite unfavourable economic circumstances, however, some countries were increasing domestic resources for population programmes. The UNFPA was assisting in that process. There has also been a growing involvement of non-governmental organizations in the reproductive health field.

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She said that in some places, cultural attitudes towards women and girls still held back programmes to improve their health and education and raise their status in society, and some men still refused to accept their responsibility to the family and the community with respect to reproductive health. "But I believe that these obstacles are less formidable than they sometimes appear." Experience showed that change could be rapid and permanent.

Over the past year, the UNFPA had adjusted its operational guidelines to conform with the recommendations of the Programme of Action, she went on. It would concentrate on three new programme areas: reproductive health, including family planning and sexual health; population and development strategies; and advocacy. The Inter-Agency Task Force was working to coordinate system-wide follow-up to the Programme of Action. The challenge to transform the consensus achieved in Cairo into action had been taken up not only by developing countries, but also by industrialized countries, regional groupings and multilateral agencies and organizations.

JOSEPH CHAMIE, Director, Population Division, Department for Economic and Social Information and Policy Analysis, recalled that when the Commission had been founded in 1946, the Population Division had attempted to make projections for the year 2000. It had estimated that the world's population at that time would be 6.3 billion people. Some delegates and observers in 1946 had thought that such unprecedented growth -- almost a tripling of what was then the world population -- to be inconceivable. "As many of you are aware, our latest figures confirm these earlier projections; the world's population four years from now will be approximately 6.2 billion people."

Current projections estimated that the world's population in the year 2050 would reach nearly 10 billion, he said. The 42 countries on the Commission would represent some 7 billion people, well over the world's current population level of 5.7 billion. "Today there are few delegates or observers who would believe that such projections are demographic exercises with little policy relevance."

The low variant projection, however, which assumed accelerated progress in the implementation of population programmes, showed that the world's population could reach slightly less than 8 billion by the year 2050. "In this sense, I believe the challenge ahead is clear for all concerned", he said.

Among the controversial and sensitive problems which the Commission would face in the coming years was the issue of abortion, he continued. Currently, there were some 45 million abortions taking place globally -- nearly one abortion for every three live births. A second complex issue was the ageing of populations. "Although this does not readily capture the headlines of today's media, its consequences are none the less significant."

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The sharp rise in the number and proportion of elderly persons would continue to have serious economic, social and political consequences.

The HIV/AIDS pandemic was an extremely serious health problem desperately in need of a concerted international response, he went on. It was estimated that there were currently 20 million persons infected with HIV. In addition to the growing number of deaths caused by AIDS, the epidemic was having devastating consequences on families and communities.

Another critical issue was that of international migration, he stated. The growing numbers of undocumented migrants, refugees, asylum seekers, labour migrants, guests and seasonal workers and other migrants were increasingly encountering difficulties and barriers. The issue was posing challenges for governments around the world. "Most recently, international migration has become one of the most contentious topics of debate in the elections of those seeking government office." The Commission must deal with such issues in an objective and comprehensive manner.

MASAKI KONISHI (Japan) said his Government attached great importance to the integration of family planning into the framework of reproductive health and was conducting training courses for counsellors on family planning. Japan intended to strengthen reproductive health-care services by disseminating basic information about diseases to which women were vulnerable and their prevention, counselling on infertility and other reproductive health conditions, and providing education programmes for adolescents.

He said that the Government and non-governmental organizations had traditionally worked in tandem in the delivery of family planing services in Japan and the interaction between the two was critical to the formulation, implementation and evaluation of reproductive health-care programmes, particularly those relating to infectious diseases. In the area of international cooperation, Japan was committed to strengthening the assistance it provided to developing countries in implementing the Programme of Action. To that end, it had been implementing the "Global Issues Initiative on Population and AIDS". Under that Initiative, Japan would provide assistance amounting to $3 billion to developing countries in its official development assistance programme during the fiscal year periods from 1994 to 2000. Japan had undertaken intensive policy dialogue with developing countries, major donors, international organizations and non-governmental organizations and had sent project formulation missions on population and AIDS to a number of developing countries. Since 1986, Japan had also been the largest donor to the UNFPA and the International Parenthood Federation. In the fiscal year 1994, it had provided $465 million under the Global Issues Initiative.

To fulfil its task, he said, the Commission should develop indicators to measure progress in achieving the goals of the Cairo Conference, which in many cases were linked to the problem of data collection. He shared the view

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expressed in the Secretary-General's report which pointed to the need to develop indicators in key areas such as gender equality, reproductive health, women's participation, male involvement and resource mobilization.

He went on to say that the progress of the Conference follow-up should be assessed on a country basis or at least on a sub-regional basis so as to highlight the progress made and problems encountered by a specific country or sub-region. The coverage of countries and non-governmental organizations in the Secretary-Generals's report should be more universal. While the Secretary-General's report on the activities of those organizations had provided a unique perspective, it was based on responses from a limited number of organizations from a limited number of countries.

PENG YU (China) said the promotion of family planning was the major pillar of China's reproductive health programme, which was part of an integrated approach to such issues as rural development, the eradication of poverty and education. Local offices were being directed to make concerted efforts to help small families who preferred fewer children to become better off by providing them with preferential treatment for such benefits as loans.

She stressed the importance of raising the status of women by eliminating discrimination, helping them economically and providing them with education. China's Mother and Infant Health-Care Law strictly banned the abortion of female foetuses through the use of technologies which could determine the sex of the foetus. Efforts were also under way to raise the rate of girls' enrolment in school.

The majority of couples were making informed choices in a voluntary manner, she continued. Sex education was being promoted in urban and rural areas. Health-care services for gynaecological diseases had been improved, with consequent improvements in the health of women and children. China's laws aimed to improve people's reproductive health, ensure safe motherhood, gradually lower the abortion rate, and reduce and avoid genetic and birth defects so as to ameliorate the condition of the population.

She said that the incidence of sexually transmitted diseases had increased in recent years, and HIV/AIDS has also spread to a certain extent. Sex education had been strengthened to advocate responsible sexual behaviour. Public education, through television and other mass media, had been used to increase awareness of the harmful and disastrous consequences of HIV/AIDS.

Over the past two decades, China had made great strides, with the active support of the masses of people, in the area of family planning, she continued. The total fertility rate had gone from 5.81 births per woman in 1970 to the replacement level in 1995. "With this achievement, China has, to some extent, made her due contribution to the stabilization of the world population." Nevertheless, China would still be confronted with a grave

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population situation in the future. Its current population of 1.2 billion was expected to reach 1.3 billion by the year 2000 and 1.4 billion by the year 2010. While strengthening its reproductive health care services in accordance with the recommendations of the Programme of Action, China could not for a moment forget its ever-growing population size and the problems that it would entail.

JOSE GOMEZ DE LEON (Mexico) said Mexico's population numbered 92 million. By the year 2000, with an annual growth rate of 2.2 per cent, population figures were projected to increase to 100 million.

He said Mexico was pursuing a vigorous and active demographic policy. The President of Mexico had launched a national population programme which embodied the guidelines and principles agreed on at the Cairo Conference. The national programme also took account of the results of the Fourth World Conference on Women (Beijing, 1995). Mexico sought to implement a change in family planing programmes in order to take account of the global approach to reproductive health. The Government had taken several measures in that area.

Drawing attention to an issue that he said worried his Government, he said that although there was evidence of a decline in population growth in Mexico, it was a country of different regions and the national averages concealed great differences among those regions. Such differences should be taken into account in presenting situations. That issue was also important in considering multilateral and bilateral assistance.

RICHARD CORNELIUS (United States) stressed the importance of continued attention to the recommendations of the Programme of Action. The United States was acutely aware of its own population problems, including its rapid population growth rate which added nearly 3 million persons to the country each year through immigration as well as births. The United States still had large pockets of poverty. "Many women in the United States still lack access to adequate health care, including family planning and other reproductive health-care services." Teen pregnancy in the United States was among the highest in the industrialized world. In addressing its problems, the United States knew that it did not have a monopoly on knowledge and would seek the advice and experience of other countries.

He went on to say that the United States was also aware of its role as a donor country. Unfortunately, the United States Congress had made a 35 per cent cut in funds for international population assistance. "I wish that I could assure this Commission that this is a one-year setback. But unfortunately, I cannot predict the 1996-1997 budget or beyond." He said he could assure the Commission that the Clinton Administration remained committed to the goals of the Cairo Programme of Action and was determined to continue to provide leadership in the population sector. Close to $1 billion of United States development assistance was committed to programmes addressing the key

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aspects of population and development, including education, child survival and women's empowerment. Even with the budget cuts, United States spending in those areas would still exceed the level it had been three years ago. All members of the international community must redouble their efforts to implement the Cairo Programme of Action.

RUTH ARCHIBALD (Canada) said that although the sexual and reproductive health care that Canadians received was among the best in the world, some issues remained to be addressed. Despite access to services, certain sectors of the population required special attention if they were to improve that area of their health.

She said that in the past year "Health Canada" had developed a comprehensive framework to guide the future planning of policies and programmes to enhance the sexual and reproductive health of Canadians. It addressed societal values, sexual violence, risky sexual behaviour, sexual relationships, preconception health, pregnancy and childbirth, sexually transmitted diseases, infertility, menopause and other issues. The framework was expected to strengthen current activities and motivate the development of new approaches to specific sexual and reproductive needs.

As part of a larger reproductive and child health initiative, she said, Canada was developing a national perinatal surveillance system to monitor trends over time and allow the comparison of regional outcomes. It launched its first Canada Prenatal Nutrition Programme in 1994 and was also encouraging young women to put off pregnancy until they could be responsible about it.

The Government had implemented several initiatives to reduce the incidence of sexually transmitted diseases, including AIDS, she said. One programme was targeted to women who used contraceptives to prevent pregnancy but with no control of sexually transmitted diseases. Health Canada had recently produced guidelines for sexual and reproductive health education which offered clear direction on the further development of sexual health education by local, regional and national groups, organizations and government bodies concerned with education and community health. Health Canada also promoted research and information on women's health, a large component of which was sexual and reproductive health.

She said the era of fiscal restraint had led to a review of programming in order to focus efforts and to utilize available resources efficiently and effectively. Canada would commit 25 per cent of its official development assistance to basic human needs; family planning and primary health care were the key components. Women, development and the environment were also priority areas. That focus would allow flexibility for funding programmes which supported the goals outlined in the Programme for Action. The Canadian International Development Agency intended to maintain funding for population programming at the current levels despite overall fiscal restraints. Support

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for basic human needs, including reproductive health care, remained a priority for Canadians.

ANTONIO GOLINI (Italy), speaking on behalf of the European Union, welcomed the decisions of the Economic and Social Council regarding the recommendations made by the Commission of Population and Development last year. It also welcomed the new format of the Commission and hoped that it would be able to play its role in the effective implementation of the commitments adopted at the Cairo Conference.

He said that the central theme of the current session was among the most important at national and multilateral levels and the Commission needed to "keep concentrating our focus on this theme".

The European Union was pleased that progress was being made in implementing the Programme of Action, but further effort must be made to satisfy the unmet needs related to population and development, and particularly reproductive health programmes, he said. He welcomed the comprehensive report on the monitoring of reproductive health and reproductive rights.

J.C. PANT (India) said his country had a long history of officially sponsored population programmes which had achieved reasonably good progress. The fertility rate had declined from an average of 5.2 births per woman to 3.5 in recent decades, and the infant mortality and death rates had also fallen. The population growth rate was declining, and the rate of decline was expected to speed up in the coming years. The people affected by India's population programmes had been involved in a dialogue process, which had included dialogue with non-governmental organizations, that had resulted in setting the goal of improving the quality of care rather than focusing on population targets.

India had been working to address maternal and child health problems for many years, he said. A special campaign, launched in 1995, to vaccinate all children against polio had reached tens of millions of girls and boys. That campaign would be expanded to address other health concerns and to reach all children in primary schools. Plans were geared towards the promotion of mother and child health as well as the prevention and management of reproductive tract infections, sexually transmitted diseases and HIV/AIDS. Through decentralization, efforts were being focused on local health centres. The UNFPA had provided valuable support to India's population efforts, especially in the country's current transitory phase.

AHMAD JAZ (Pakistan) said his country's commitment to population programmes was evidenced by its increased funding for them. The population of Pakistan had grown greatly in recent years, reaching an estimated 130 million. Pakistan's growth rate was one of the highest in the world. If the population

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continued to grow at the current rate, it would reach 229 million by the year 2012. On the average, each woman in Pakistan had five to six children. Some 41 per cent of the population was under 15 years of age, so the high population growth rate was expected to continue in the future.

High priority had been accorded to accelerating social and economic development, he said. Pakistan had greatly expanded its family planning services in both rural and urban areas. Contraceptive prevalence was around 22 per cent, with 82 per cent of people having knowledge of modern methods. In other words, there was a great deal of unmet need in Pakistan. Efforts were being made to disseminate the Cairo Programme of Action at all levels throughout the country. The population problem could not be solved in isolation; it must be viewed in the context of economic and social development. Pakistan appreciated the contribution of the UNFPA to that effort, as well as the support of non-governmental organizations. An enabling environment for development was a prerequisite for the success of any population programme.

EROSHINA LYOUDMILA (Russian Federation) said the population of the Russian Federation had continued to decline in 1995, dropping to 148.1 million people from 164 million in the previous year. The decline was mainly due to the drop in the number of births. The number of marriages registered had declined and the number of divorces had risen as had the number of incomplete families. Births out of wedlock and the number of children born to minors had also increased, bearing witness to unfavorable conditions in family and marriage relationships.

She said the Government was taking steps to strengthen the family as an institution. In reforming the social and economic sphere, measures were being adopted to protect mothers. Maternity leave had been extended to 140 days and the number of women who were now examined early in pregnancy was increasing. Grants given to children and to men who looked after children less than 18- months old had been increased. The impact of those measures was lessened, however, because of the lack of control over their implementation.

The Russian Federation did not limit the freedom to decide on the number of children one could have or on the spacing of those children, she said. The reproductive health of women was such that there had been an increase in infertility, anaemia, and diseases of the bladder and sexual organs of pregnant women. Births among women between 15 and 17 were increasing and there were indications that reproductive health problems arose when pregnant women were teenagers. A great number of women had problems with their menstrual cycle and that number was also growing. Those figures were increasing despite the fact that most young women had not been examined by a gynaecologist. Although the number of abortions had been decreasing, it was still the main form of family planning.

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Today's picture was also marked by risky forms of sexual activity, she continued. Preventive programmes were aimed at providing contraceptive information and to ensure that all women of child-bearing age had access to contraception. Unfortunately, few women took advantage of contraceptive pills. To carry out the programme proposed by the Cairo Conference, the Russian Federation had declared 1994 to be the Year of the Family. A number of federal programmes were established, including those aimed at decreasing infant mortality. To provide contraceptive information, attention should be paid to the most vulnerable groups. To that end, one third of the budget had been devoted to those groups. Programmes had been developed to assist a number of medical and educational institutions in disseminating appropriate information. Information was also disseminated through television and radio. Unfortunately, too little work was being done given the size of the country which was now living through a difficult period and experiencing great economic problems.

JACQUES VERON (France) said that among the initiatives being taken in his country was the setting up of a phone service to inform adolescents of matters related to sexuality. France was also working to eliminate genital mutilation among certain communities. On cooperation with developing countries, he said that France was allocating 47 billion francs for international assistance. France was committed to global assistance that went beyond purely population matters and that addressed such issues as education. It was critical to integrate population considerations into the economic and social aspects of development programmes. France was supporting actions in developing countries through regional programmes in various countries in Africa. In the context of democratization in Africa, it was necessary to recognize that technical structures were not enough; all segments of society must be involved.

An integrated approach must be taken to issues concerning maternal and child health, sexually transmitted diseases and fertility, among other issues, he said. Programmes must be implemented in both urban and rural areas. France also called for concerted action to combat the HIV/AIDS pandemic. While taking account of the diversity of cultures, efforts must focus on education as a tool to deal with population-related issues.

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