IMPLEMENTING GOALS OF CAIRO POPULATION AND DEVELOPMENT CONFERENCE DIFFICULT PROCESS, SOUTH AFRICA TELLS POPULATION AND DEVELOPMENT COMMISSION

24 February 1998

Press Release
POP/661

IMPLEMENTING GOALS OF CAIRO POPULATION AND DEVELOPMENT CONFERENCE DIFFICULT PROCESS, SOUTH AFRICA TELLS POPULATION AND DEVELOPMENT COMMISSION

19980224 National Experiences on Population Matters Described; Role of Education in Population Control, Decentralized Health Care Also Addressed

Implementation of the Programme of Action of the International Conference on Population and Development, held in Cairo in 1994, was a slow and difficult process, especially in countries where resources were limited, the representative of South Africa told the Commission on Population and Development this afternoon.

The representative said that the South African Government was firmly committed to attaining the targets of the Cairo Programme of Action and success depended on strong political leadership and commitment. To that end, it had adopted policies to promote primary health care, offer free health care for pregnant mothers and protect rights to reproductive health.

As the Commission continued hearing descriptions of national experiences on population matters, representatives addressed issues relating to the role of education in population control, decentralization of health care, training of health care personnel, fertility rates, the rate of ageing, an integrated approach to population and family planning.

The representative of Brazil said that his country had been reforming and decentralizing its health policies, within the context of its goal of providing universal and comprehensive health care. As part of the country's decentralization process, a network of health councils had been established, which fostered community participation.

Representatives of Poland, United States, Republic of Korea, Egypt, Niger and Ethiopia also spoke.

Also this afternoon, Ousmane Mohamane Tandina (Niger) was elected Vice- Chairman of the thirty-first session.

The Committee will meet again at 10 a.m. Wednesday, 25 February, to conclude consideration of the agenda item on national experience in population matters. It will then begin consideration of programme questions and the provisional agenda for the thirty-second session.

Commission Work Programme

The Commission on Population and Development met this afternoon to continue 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

JERZY HOLZER (Poland) said the rate of natural population increase was permanently declining in his country and had reached its lowest level in 1996. The main causes had been changing patterns of marriage and significant declines in fertility. The number of contracted first marriages had been declining. In the face of high levels of unemployment, more young people were seeking to improve their education and achieve economic stability before getting married and having children.

He said the poor housing situation also seemed to be a contributing factor to the decline in marriages. In recent years there had been an increase in the number of divorces, as well as an increase in births outside of marriage. Such births had doubled from the 1980s to 1997. The scale of that increase, however, was small compared to other European countries.

The level of mortality in Poland was relatively high, but was declining slowly, he said. The average life expectancy for women in 1996 was 76.6 years and 68.2 years for men. The main causes of death were the same as in developed countries, including circulatory diseases and injuries. In the area of health, the Government had introduced a new version of the national health programme at the end of 1996, which involved local authorities. A bill had been introduced in the Polish Parliament on a common health insurance system, which would be introduced on 1 January 1999. The pension system was also being revised, he said.

BETTY KING (United States) said she would address the issue of national experiences in population matters from a domestic policy perspective and from the perspective of an international donor. In her country, the emphasis had been on family planning and reproductive health. There had been some improvement in the trends in unwanted pregnancies, but the number was still high. Abortion rates had showed a pronounced decline. Experts had attributed the changes to education and the effective use of contraception.

She said international migration issues had been of increasing importance over the last few years. The United States had continued a dialogue on that issue with countries in the region. The issue of trafficking in women required support from domestic and international agencies. The United States continued to work with other countries to prevent, and eventually stop, that development.

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From the perspective of an international donor, she welcomed the progress made in population matters in many countries. In the area of family planning, she said the principles of voluntarism and informed choice must be encouraged. Her country would work towards clarifying the technical challenges for improving reproductive health. It would support research in the area of reproductive health, which would help many countries address many of the problems they faced.

NAM-HOON CHO (Republic of Korea) said that over the past decade, the fertility rate in his country had dropped to 1.7 per cent, which was far below replacement level. Owing to improvements in health care, infant mortality and maternal mortality had also fallen sharply, to the level of the advanced countries. The other side of the coin was that, among other developments, the labour force had shrunk, while the population of the elderly had increased.

To keep up with developments, the Government decided to review its population policy, he said. In 1996, it announced the new population policy, with emphasis on such areas as: enhancing the quality of life; maintaining proper population size and structure; contributing to the advancement of the quality of life through welfare-oriented strategies; and incorporating the major objectives of programmes of the International Conference on Population and Development (ICPD) in Cairo.

The fertility rate of his country had continued to decrease because of the rise in the contraceptive rate, he said. Another area of concern, the speed in the ageing rate, which was without precedent in the history of the country, was being addressed through various initiatives, including the provision of health service for the elderly. The success of population measures in his country was partly owed to non-governmental organizations and private organizations. His country had been and continued to be willing to share its experience in population policy with other countries, and it would also extend its cooperation with United Nations organizations on population issues.

MOSHEERA EL SHAFEE (Egypt) said her country had adopted an integrated approach to population, beginning with the child at a very young age. Because they were vulnerable, a lot of attention was paid to girls. At childbirth and marriage, it was important to protect girls, as well as their unborn babies. In the area of family planning, many health clinics had been established, a lot of them in the countryside, operating alongside mobile clinics. Many of those programmes had played a role in eliminating dangerous practices for girls.

She thanked international organizations which had helped with programmes designed to help those children and eliminate dangerous practices such as the circumcision of girls. Those practices would not end overnight. It was necessary to continue the process of awareness and education. Her country had

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been participating in the international forums and conferences relating to population, and supported next year's review of the Cairo Conference. She hoped for solidarity in areas where countries such as her own faced new challenges in the form of new diseases.

OUSMANE MAHAMANE TANDINA (Niger) said his country's population had been increasing very rapidly. With that rapid growth -- 3.3 per cent -- one of the world's fastest, the country faced great challenges in returning to sustainable development. With poverty affecting about 60 per cent of the population, the situation could only be exacerbated. His Government's health policy stressed an integrated comprehensive thrust and was supported by several policies and programmes and a health development plan. He noted, however, that family planning and reproductive health was a big problem, pointing out that the proportion of assisted births was only 20 per cent for the whole country. Health personnel were inadequate and suffered certain deficiencies, water was scarce, most households had no toilets and there was pervasive malnutrition.

The Government was aware of the need for an integrated approach in order to provide adequate response, he continued. He said that progress was being made in the area of generating awareness concerning health services. One approach involved the training of local opinion leaders and others who were disseminating information in groups and neighbourhoods. Various sectoral plans had been spelled out in the struggle against poverty, in which area the government had operationalized its policy.

AYANDA NTSALUBA (South Africa) said that his country's political transition had necessitated comprehensive policy reviews. South Africa's population policy process began soon after the successful conclusion of the Cairo Conference, making it possible to completely rethink the Government's approach to population policy on the basis of the recommendations that emerged from the Cairo Programme of Action.

Turning to the focus of the current session, he said that South Africa's data on mortality and morbidity was inadequate. The available data, however, revealed significant inequalities between races and among many African women and children, especially the rural poor. Like fertility, the mortality rate for the country was declining. The life expectancy rate had also risen.

However, the increase masked the large disparities between Africans and the white population. For example, the infant mortality rate for African children was six times that of white children. Furthermore, the scourge of HIV/AIDS put the country's limited gains to the "sternest challenge". Some three per cent of the overall South African population was infected by the HIV virus, and there was a particularly rapid increase in infection rates among young women.

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A number of gains aimed at implementing the Cairo Programme of Action had been made, he said. Those included the addition of 400 health clinics throughout the country and free health care for pregnant mothers and children under six years of age. Reproductive health services and the introduction of life skills programmes in the schools were also being undertaken. Despite such progress, the implementation of the Programme of Action was a "slow and difficult process". That was especially true in countries like South Africa, where resources were limited and there was a need to balance fiscal imperatives with the so-called social deficit. Success would depend on strong political leadership, as well as the mobilization of resources by the international community.

BRUNO BATH, Director of the Division of Social Affairs of the Ministry of External Relations of Brazil, said that Brazil had been reforming and decentralizing its health policies, within the context of its goal of providing universal and comprehensive health care. As part of the country's decentralization process, a network of health councils had been established, which fostered community participation. The Ministry of Health allocated funds to finance municipalities' public health activities. Congress had approved a tax on all banking transactions to finance the health system, adding some $6 billion to that sector's budget. However, the amount of financial resources for health remained insufficient to fulfil the country's needs.

The rate of infant mortality was steadily declining in Brazil, he said. The Government was implementing a project to bring sanitation, mother and child health care, nutrition and community health care activities to the 914 municipalities where children were most at risk. The rate of maternal mortality remained unacceptably high: 114 deaths per 100,000 live births. Maternal mortality was related to the lack of access to and quality of maternal health care, particularly in rural areas. The Government was currently implementing a national plan for reducing maternal mortality and a safe motherhood project, sponsored by the Ministry of Health, the United Nations Children's Fund (UNICEF) and the Brazilian Federation of Gynaecology and Obstetrics.

Turning next to the condition of adolescents, he said most young people died from "external causes", including automobile accidents, homicides, suicides and other forms of violence. Adolescent pregnancy and the spread of sexually transmitted diseases among young people was a cause for concern. In 1996, women ages 15 to 19 years accounted for some 30 per cent of the overall fertility rate. In Brazil, one in every three women age 19 years had been pregnant and one in every 10 women of that age had two children. While much remained to be done to promote health for adolescents and to address public health problems, Brazil's Government was fully committed to overcoming those problems, he added.

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MEKONNEL MANYAZEWAL (Ethiopia) said population and development and health and mortality issues touched every aspect of peoples' lives. In a population of about 60 million, fertility in Ethiopia was still high, at the level of 7.7 children per woman. The 1990 census, however, pointed to a decline in that fertility rate. The country's high mortality rates for children and women reflected the level of social and economic development, which had to be addressed in a long-term context.

He said there were three forces at work in the country's development process: the democratization process; the devolution of authority to local authorities and local communities; and the transition to a market economy. Economic and social development was important to sustain peace. The challenge was to reinforce social and economic development.

A range of national efforts -- population policy for Ethiopian women, education policy and food and environmental policies -- had a direct bearing on the country's development problems, he said. In the new health sector programmes, the emphasis would be on communicable diseases. The health system would be decentralized, stressing the importance of primary health care units to promote improved health services, as well as family planning services. Community-based systems were developing at the grassroots level. Nevertheless, there were few health care services, in comparison to the size of the population.

Emphasis was being placed on the training of health care personnel, including a reorientation of the curriculum to make it more relevant to basic health services. Noting the need for a gender perspective in promoting health services, he said Ethiopia's national population policy provided for full participation of women in the economic and social life of the country on equal terms with men. Recognition had been given to the new concept of reproductive health. The decentralization process had led to more effective grassroots participation. The trend had been to integrate population issues into the socio-economic dynamics of the country.

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