GENERAL ASSEMBLY'S 1999 SPECIAL SESSION ON POPULATION SHOULD OFFER GUIDE TO FUTURE ACTION, POPULATION AND DEVELOPMENT COMMISSION TOLD

24 February 1998

Press Release
POP/660

GENERAL ASSEMBLY'S 1999 SPECIAL SESSION ON POPULATION SHOULD OFFER GUIDE TO FUTURE ACTION, POPULATION AND DEVELOPMENT COMMISSION TOLD

19980224 Executive Director of UN Population Fund Describes Review Process for 1994 International Conference on Population and Development

The 1999 special session of the General Assembly, as a five-year review of the International Conference on Population and Development (ICPD) held in Cairo, should offer a clear and authoritative guide to future action, including mobilizing the resources necessary for implementation of the Cairo Programme of Action on Population and Development, Dr. Nafis Sadik, Executive Director of the United Nations Population Fund (UNFPA), told the Commission on Population and Development this morning.

Offering suggestions on how the process might unfold in the coming months, Dr. Sadik said the landmarks in the preparatory process were: this year's session of the Economic and Social Council; the International Forum on Population and Development to be held in February next year; the 1999 session of the Commission, as the preparatory committee for the special session; and the special session. The main document for consideration by the special session should be a report of the Secretary-General on the implementation of the Cairo Programme of Action, she stressed, which should be short, concise and action-oriented.

Also this morning, delegations described their countries' successful efforts to implement the Cairo Programme of Action in such areas as population growth rates, maternal and child health, life expectancy and control of HIV/AIDS. Areas of weakness and difficulty were also highlighted.

Comments on Dr. Sadik's presentation were made by representatives of Japan, United Kingdom, Sudan, Indonesia, United States, Brazil, India, and Sweden.

Statements on national experiences in population matters were made by the representatives of Bangladesh, China, Thailand, Kenya, Algeria, Canada, Pakistan, Mexico and the Russian Federation. Representatives of the Food and Agriculture Organization (FAO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) also spoke.

The Commission will meet again at 3 p.m. today to continue its general debate on national experience in population matters.

Commission Work Programme

The Commission on Population and Development met this morning to begin its general debate on national experiences in population matters: health and mortality. (For background information on the session, see Press Release POP/657 of 23 February.)

Statements

Dr. NAFIS SADIK, Executive Director of the United Nations Population Fund (UNFPA), said that preparations for the Technical Symposium on Migration and Development were progressing, participants had been identified, and invitations had been sent out. Austria and Norway had agreed to support the Symposium, which would be held in the Netherlands with the support of the Government of the Netherlands. Congratulating the Commission for its work over the past four years, she said that body was the keystone of the three- tier structure set up to maintain the momentum of the 1994 International Conference on Population and Development (ICPD). It had become the primary arena for discussion of progress in implementing the ICPD Programme of Action, and had succeeded beyond expectations in focusing both national and international attention on population and development issues.

The current session was very important because it would begin the process of preparation for the special session of the General Assembly scheduled for 30 June to 2 July 1999, to review implementation of the ICPD Programme of Action, she said. The special session should offer a clear and authoritative guide to future action, including mobilizing the resources necessary for implementation of the ICPD Programme of Action. Such an outcome called for a thorough and focused process of preparation.

In her roles as Secretary-General of the ICPD, Chairman on the Inter- Agency Task Force on Implementation of the Programme of Action, and of the Inter-Agency Task Force on Basic Social Services for All, she offered tentative suggestions on how the process might unfold in the coming months. The landmarks were: this year's session of the Economic and Social Council; the International Forum on Population and Development, to be held in February next year; the 1999 session of the Commission as the preparatory committee for the special session; and the Assembly's special session. The main document for consideration by the special session should be a report of the Secretary- General on the implementation of the ICPD Programme of Action. It should be short, concise and action-oriented.

She said the preparatory process in 1999 would begin with an annotated outline for the Secretary-General report, which would be presented to the Economic and Social Council at its 1998 session. She offered to take the responsibility for preparing the draft annotated outline and subsequently the full report for the Commission's consideration, in full and close cooperation

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with the Population Division of the Department of Economic and Social Affairs. With regard to the International Forum on Population and Development, she said UNFPA had been in close consultation with governments. Some 120 countries, as well as international organizations and certain non-governmental organizations (NGOs), would participate. The consultation process would include regional commissions, as well as NGOs, especially women's groups, parliamentarians, media institutions and other civil society organizations.

Describing the structure of the Forum, she said it would be an opportunity for frank and open discussion of both the positive and negative aspects of the ICPD outcome implementation. Its recommendations should be of an operational nature and should point clearly to future action. Its report would be presented to the Commission for consideration at its 1999 session and would be one of the major inputs to the Secretary-General's report to the special session.

YUTAKA YOSHINO (Japan) said his delegation attached great importance to the quinquennial review. He also supported the draft review of the Secretary- General's report for the special session as outlined yesterday by the Director of the Population Division, Joseph Chamie. He supported the role of NGOs and the private sector in the process, specifically recognizing the role of UNFPA in building partnerships in the private sector. Drawing attention to the difficulties that countries were facing in the implementation of the Programme of Action, he stressed that the goal was to learn from each other in the ICPD process, noting that attention should be paid to the experiences at the national level.

He underlined the importance of quantitative and qualitative indicators, as there ought to be measurement of achievement in the implementation of the Programme of Action since 1994. Appreciating the contributions of the World Bank and the Basic Social Services Task Force, he reiterated that others outside the United Nations system -- such as the NGOs -- must be encouraged to do the same. In addition, ICPD+5 should not stand alone as an independent exercise, but complement other efforts.

PHIL MASON (United Kingdom), speaking on behalf of the European Union and Bulgaria, Estonia, Hungary, Lithuania, Poland, Romania, Slovakia, Slovenia, Cyprus and Norway, said that it was important to have clear by the end of the thirty-first session the role of the Commission on the review exercise, noting that the parameters for the special session had already been set out in a resolution. Also, the focus on progress at the national level was important, as global figures tended to be limiting. The success stories needed to be documented, as well as ways in which they could be shared. The issue of resources was important, but it was also important to look at areas of synergy. Whether the proposed five days would be enough was debatable, maybe more time should be considered. He added that the European Union had elements of a resolution which would be circulated later today.

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AHMED TAHA MOHAMED (Sudan) suggested the need to pinpoint the institution at the national or regional level to which the implementation of the ICPD outcome was assigned. He noted that the Programme of Action was working across sectors within countries and regions, and different countries had different approaches to implementing it. The process of implementation was not yet clear, and he requested a paper reviewing different institutional level or apparatus, including governments, NGOs and intergovernmental agencies that work in the implementation of the ICPD outcome.

MOCHAMAD SLAMET HIDAYAT (Indonesia), speaking on behalf of the "Group of 77" developing countries and China, said the review was important as an opportunity to discuss constraints in the implementation of the Programme. His Group was convinced that such a review would help move the Programme of Action forward. He reaffirmed that the review should be put to good use and focus on lessons learned. He underlined the importance of the UNFPA in the process of implementation, supporting the suggestion for close synergy between the Commission and the UNFPA. He looked forward to discussing the preparatory session and to the outline of the report, suggesting some extension of the duration planned for the review session to ensure that it would enjoy a successful outcome.

MARGARET POLLACK (United States) stressed the importance of the collaborative spirit for achieving progress in the review process -- including the participation of NGOs in the whole process. She supported the outline for the review process proposed by Mr. Chamie, the Director of the Population Division. Gender and population and development issues should be overarching themes in the process. She supported Dr. Sadik's outline of the approach to the preparation of the Secretary-General's report.

Because of the limited time available for a thorough analysis of the results achieved since Cairo, she suggested that the report should document and describe issues such as policy changes on the part of national governments, the allocation of resources to implement the Programme of Action, and the lessons learned since Cairo. The review should also attempt to understand the systems to monitor progress in implementation, including the development of indicators. It was also important not to renegotiate the outcome of Cairo. The outcome of the review should move the international community forward to implement the Cairo outcome. The proposal for an extended session of the Commission next year would have budgetary implications and would require the necessary follow-up action in the General Assembly.

BRUNO DE RISIOS BATH (Brazil) asked for clarification on aspects of the International Forum to be held in February next year. He asked what would be the status of the outcome of the Forum; whether that outcome would be an input to the review process; its relation to the other reports the Commission would consider; and how far advanced was the UNFPA with preparations for the Forum. He expressed concern about the extent of UNFPA's contacts at the national

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level with organizations responsible for policy setting. It was important to avoid the situation by which some authorities might not be fully informed of the preparations for the Forum.

PADAM SINGH (India) said he supported the ideas of the Group of 77 and China on the review process. Dr. Sadik's proposals would provide a useful outline of the process that lay ahead. From past experience, there was need for close involvement of the UNFPA in the review process. The report being prepared for the review should be a collaborative effort of all the concerned bodies.

BERTIL EGERO (Sweden) welcomed the decision to use in the special session the same cooperative arrangements that had proved to be successful in the ICPD itself. He associated himself with the statement of the United Kingdom on behalf of the European Union, but wanted to address the issue of the actual role of the Commission in the work leading up to the special session. In that connection, he suggested an extended session for the Commission next year. Up to that time, the Commission would be represented by the Population Division. The length of the next session did not resolve the issue of the dynamic role the Commission should play in the preparatory process. He asked if consideration could be given to an intersessional meeting that could take place in relation to the UNFPA Executive Board meeting, to allow the Commission an opportunity to discuss the extent of the preparations needed for the special session. Noting that an additional session would have budgetary implications, he said the issue was important enough to warrant special attention. He was sure that the "New York colleagues" would find ways of dealing with that issue.

Dr. SADIK, responding to the comments, said she had noted the comments on the role NGOs and the private sector could play, and pointed out that a round table proposal would focus on that. The UNFPA was also considering how some of the successful programmes, as well as changes in policy and programmes, could be documented. She was heartened by the efforts of countries to implement the recommendations of the ICPD. On the issue of NGOs, she announced that the UNFPA was meeting with NGOs next week.

Concerning the Forum, she said it was outside the United Nations system and that all the programme countries the UNFPA worked with would be invited. There would also be one representative from civil society, and she hoped that funding would be received for it. All of those ideas would be input into the Secretary-General's report. The invitations to the meeting had not been sent out, as preliminary arrangements had also just been concluded, but they would go out in the next month.

She also agreed that the modalities for the preparation were not just the outline but also the annotation, noting that the review probably needed more than three-and-a-half days, but she was sure that the special session would be adequate if the preparation for it was properly done. She said that

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the word "recommendations" was not being used in the review process, but "key future actions" to separate it from the work of the ICPD.

JOSEPH CHAMIE, Director of the Population Division, said note had been taken of the suggestions made regarding the preparations of documents for next year. Concerning the duration of the meeting, however, he pointed out that the budget for the United Nations was approved last year, and any change in the duration of the meeting would have to be reviewed as the provision for it was fixed.

Dr. SADIK said that some foundations had commissioned some Harvard University and European economists to look at population and development linkages and how they really interfaced. Another angle of interest was the idea of involving government ministers in looking at those issues so that they would have a lot of information when they were making policy. She noted that there had been support received from some governments for the review process, and hoped that for the special session resources would be found for the participation of some of the least developed countries.

Statements on National Experiences

MUHAMMED ALI (Bangladesh) said his country had made remarkable progress in its population programme. It was the only country among the least developed countries in which sustained fertility reduction had taken place over the last decade, despite slow socio-economic development. The country was now moving into the phase of demographic transition, in which action was required to prevent unwanted fertility and to counteract the effect of increased population. Providing details of achievements in the field of health, he said the reduction in the infant and child mortality had been attributed mainly to services such as immunization, outreach clinics and diarrhoeal control, as well as better spacing of births. Life expectancy had improved and maternal mortality had dropped. However, he also highlighted some of the problems still faced in the area of health and population, such as the re-emergence of some infectious diseases, increasing urbanization and major shifts in disease patterns prevailing in the country.

His Government had now given the highest priority to the formulation of a National Health Policy to provide strategic direction to major issues of the health and population sector, he said. The country had been relatively successful in transforming its family planning programme into a reproductive health programme following the ICPD Programme of Action. In the Bangladesh context, health and population issues were closely interlinked and needed to be addressed through an integrated sector-wide approach. In addition to significant and broad policy initiatives in the form of a Health Policy, a Population Policy, a National Policy on Food and Nutrition and a National Plan of Action on Nutrition, the Government had been implementing a number of specific programmes/projects to expedite reduction in infant, child and

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maternal mortality and morbidity rates and to further slowdown the population growth rate.

LI HONGGUI (China) said that China had set up a national health-care system. At present, there were 189,000 different kinds of health-care establishments with 5,420,000 medical and health personnel. The number of hospital beds per 1,000 persons had reached 2.34, while the number of doctors per 1,000 had gone up to 1.58. Concerning rural health, over 64 per cent of the counties had either satisfied or were approaching the minimum standard set by the Primary Health Care (PHC) Plan. The health-care insurance system in urban and rural areas had also been expanded, and the Government provided free medical services to employees working in administrative and institutional sectors, while enterprises offered health-insurance coverage to their employees. Prevention and treatment of diseases had yielded noticeable achievement: among other strides, the planned immunity rate and the vaccine inoculation rate had reached 85 per cent of the townships; measles had declined by more than 90 per cent; and a total of 2,957 "Baby-Friendly Hospitals" had been established so far.

In spite of all that, he stressed that China was still a developing country with a very large population. Many regions were still underdeveloped and the production force in those regions had not been fully utilized. In 1997, however, the Government promulgated measures concerning health reform and development, which set the objectives of the health programme for the new era and the specific plan for achieving them. The medical coverage system for urban employees would also be reformed and rural medical coverage continuously developed and improved. He noted that population had a global nature, and China, with its large population, shared great responsibility in the stabilization of world population. Many developing countries had, since the ICPD, made great efforts and obtained good experience in implementing the Programme of Action, but were confronted with various problems, especially lack of funds. It was depressing that some developed countries had failed to keep the promise they made at the ICPD to increase international assistance, but were instead reducing official assistance in that area.

DAMRONG BOONYOEN (Thailand) said his country had been very successful in family planning in the past two decades. That success, in combination with rapid economic growth and development, had resulted in dramatic changes in the demographic composition, and changes in many social and family values. The Government had been able to expand its medical care and other social services. All major indicators had increased satisfactorily, except those relating to the social security and public welfare programmes, which remained limited. He pointed out that the causes of deaths had changed in a notable manner reflecting a combination of both diseases of poverty and of affluence. Globalization also seemed to have had a negative effect on Thailand in terms of general health and death attributable to the spread of HIV/AIDS.

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He said overall death rate of the Thai population had decreased continuously over the last 30 years, male deaths having been reduced more rapidly than female, thus reducing the statistical difference between genders. Infant mortality rate had fallen at a slower pace, but had shown a significant decline in the past three decades. A new Reproductive Health Policy had been formulated that would integrate every aspect of health care.

S.B.A. BULLUT (Kenya) said that policy implementation in Kenya would be through a multifaceted approach, and the Government would provide the necessary enabling environment. He recalled that the Cairo Programme of Action called for collaboration among countries, and that 10 countries had launched the South-South initiative to facilitate exchange of experience in areas of reproductive health and family planning. Kenya was an active member of that initiative and had been working with partners and had set up a forum for its activities. His country was committed to implementing the ICPD Programme of Action, he added, noting that it would continue to collaborate with other actors towards realizing shared objectives in the coming years.

RACHIDA BENKHELIL (Algeria) described the most recent demographic trends in her country. A demographic transition was on the way and was characterized by the decrease in population growth due to the decline in the number of births. There had been some success in controlling fertility. The prevailing approach had been a voluntary acceptance of principles of family planning aimed at the broadest sections of the populations. There had been a multisectoral approach to the ICPD follow-up. Non-governmental organizations were represented on the national body formed to follow up the Programme of Action because they had an important role to play in that process.

Family planning was integrated into general health care, she said. Primary health care was an important focus of health policy. Improvement in health conditions had led to an increase in life expectancy. The progress had been attributed to increased health coverage and the improvement of social services. Nonetheless, there were some drawbacks to the progress made to date. One such problem was the high rate of maternal mortality. Such indicators showed a need to strengthen programmes for children and women to improve maternal and child health care, an area that needed sustained attention. Stressing that concerns related to health were integral to population policies, she said there was need to improve the survival rates of children and to ensure better health for all.

MARY JANE GREEN (Canada) said the Canadian health-care system was a source of national pride and reflected accessibility, availability and affordability. Outlining the progress in health care, she said the system was facing the challenges of fiscal restraint of an ageing population, the increasing cost of new technologies and drugs, and an increasing reliance on uninsured home care. Measures to reform the system included the establishment of a transition fund to finance projects in primary care, integrated health-

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care delivery and possible expansion of the system to include home care and pharmacare. The health care of children, among other sectors, had been given special attention last year. Some of the most urgent health problems Canada faced were in the aboriginal communities. However, work was progressing in that area. There was a commitment to women's health and to people with HIV/AIDS. The health needs of an ageing population were also a priority.

Canada's commitment to health was not limited to its own population, she said. It had made strides in developing its international population and health strategies. The Government had tried to ensure that its foreign policy and development assistance contributed to improving the health and well-being of people in partner countries -- despite the constraints imposed by a reduction in government spending. Following a policy review in 1995, the Government had committed 25 per cent of its official development assistance (ODA) to basic human needs, including primary health care and family planning. It had contributed $50 million towards population assistance in the 1995-1997 period, including for HIV/AIDS in Africa, in support of family planning and safe motherhood in Asia, and for assistance to the International Planned Parenthood Federation affiliates in Latin America. She stressed the need for an integrated approach that would address a variety of factors that affected the health of populations.

HASSAN MAHMOUD (Pakistan) said his country's population, now 140 million, was growing at an annual rate of 2.7 per cent, which meant it could increase to 149 million in the year 2000, and to about 400 million in 2050. That had serious implications for the social and economic well-being of the people and the overall progress of the country. The achievements of the Government in the socio- economic field had been neutralized by rapid population growth. In response, between 1991 and 1993, a Population Programme was linked to the Social Action Programme as a strategic component. Family planning services were being provided nationwide, and the efforts were showing results. The population growth rate was expected to decline to 2.6 by mid-1998, down from 2.9 per cent in 1992-1993. To sustain those achievements, the Government was committed to accelerating the programme in the ninth Five-Year Plan (1998-2003). That programme would ensure universal coverage to bring the growth rate down to 1.7 per cent by the end of the plan period.

On the follow-up to the ICPD, he said that Pakistan endorsed the Programme of Action and ensured wide circulation of it in the country. The Government had taken several steps to provide comprehensive reproductive health services, including the provision of about 30,000 female health workers and 11,718 village-based female family-planning workers; increasing the number of contraceptive surgery centres from 34 to 101; setting up 12 Regional Training Institutes to train paramedics for the programme; and the involvement of private medical practitioners in the provision of family planning and reproductive health services. Other approaches involved the empowerment of women through appointments to public office; using NGOs to cover selected

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areas on priority basis for advocacy of the ICPD outcome; and involving the private sector to supplement government efforts. The Ministry of Population Welfare, with assistance from the UNFPA, had initiated an exercise aimed at formulating a population policy, designing an effective administrative set-up and devising a mechanism for active involvement of the NGOs in population welfare activities.

RODOLFO TUIRAN (Mexico) said his country had experienced a steady reduction of mortality levels in this century. Life expectancy was 73.6 years in 1997; it had been 62 years in 1970. Infant mortality had also changed from 77.5 deaths per 1,000 children under one year of age to 25 deaths in 1997. Mortality changes had also been followed by a reduction in fertility levels. Under the Constitution, health care was a priority to which the Government must devote special attention. Consequently, the most important institutional reform under President Ernesto Zedillo was in health care, where the Health Sector Reform Programme (1995-2000) was the instrument for the fulfilment by Mexico's Government of that mandate and the General Health Law. It placed special attention on preventive intervention rather than curative and, on the idea that good health started at home, was reinforced at school and continued in the work place.

Mexico recognized the crucial role of children for the future of the society, he said. Intense and continuous vaccination campaigns had resulted in a significant reduction of diseases susceptible to control by those methods. In the area of women's health, he said that one of the biggest challenges of the reproductive health services was to continue to reduce maternal mortality. Between 1980 and 1996, it was estimated that the maternal mortality had declined from 9.5 per 10,000 live births to 4.8. Other areas of ongoing work included HIV/AIDS, the elderly, and people with disabilities.

IGOR A. ZLOKAZOV (Russian Federation) described a number of troubling trends in demographic indicators in his country. It was a population crisis characterized by trends such as a rapid fall in births and increased mortality, including a higher death rate among men. The existing socio-economic situation in the country had a direct impact on the population. The Government's population programme had taken account of the ICPD Programme of Action and the limited resources of the country. Referring to the issue of depopulation, he said, between 1993 and 1996 there had been a natural population decline in many regions of the country. Reproduction levels had not been enough to ensure the replenishment of the population.

There had been an increase in deaths attributable to non-infectious diseases, he said. Circulatory system diseases were the highest cause of death; the second largest cause of death was due to tumours. At the same time, in recent years there continued to be an increase in deaths from tuberculosis. Providing more details of statistics on mortality rates, he referred to the high increase in deaths among men and the high rate of

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mortality among children. However, a downward trend in youth mortality had begun to emerge. He stressed the importance of improved, reliable data collection on population issues as a basis for proper population policy. His Government was developing a programme of action to take the country out of its population crisis, he concluded.

JACQUES DU GUERNY, of the Food and Agriculture Organization (FAO), said his organization had always been concerned with health. In a world in which over 800 million people suffered from hunger and many hundred million more from malnutrition, there could not be health for all. The FAO concern for health had evolved significantly from a very productivist and commodity- oriented perspective, as defined by the 1974 World Food Conference under the concept of "food security", to the definition endorsed by the 1996 World Food Summit, "food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life". He stressed that rural populations had generally less access to health services, often due to an insufficiently developed infrastructure in rural areas and to other factors such as poverty.

Focusing on HIV/AIDS, he said the FAO had noted in case studies in East and in West Africa changes in agricultural production and in household food security. Citing studies which had shown negative impacts on food security, he said livestock and food reserves were usually sold to cover medical costs. That resulted in periods of hunger before new crops were available, a general decline in the quantity of food available at household level and a loss of diversity in food intake, more starchy food stuff, and less animal protein in the dietary intake. Such declines not only could hamper the development of children, but also reduced the resistance of individuals to other diseases. The FAO was now beginning to examine the existing responses of the public and private agricultural sector to HIV/AIDS and the possibilities to improve those responses as part of the overall struggle against the epidemic.

GUSTAVO LOPEZ OSPINA, of the United Nations Educational, Scientific and Cultural Organization (UNESCO), said the organization's work in population education had been directed towards primary and secondary school students and teachers, as well as out-of-school youth. It also gave priority attention to family life and gender relations, as well as adolescent reproductive health and counselling. Preventive education was one of the most important priorities to strengthen the awareness of teachers and educational personnel of the importance of developing health and HIV/AIDS prevention in school curricula. The aim was to encourage the development of effective educational strategies, internationally and regionally. He went on to outline recent UNESCO initiatives in the area of population and health, particularly inter-agency activities. The UNESCO was fully committed to the five-year review and appraisal process of the ICPD Programme of Action.

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