In progress at UNHQ

POP/662

PERU DENIES USING COERCIVE METHODS OF POPULATION CONTROL, IN STATEMENT TO POPULATION AND DEVELOPMENT COMMISSION

25 February 1998


Press Release
POP/662


PERU DENIES USING COERCIVE METHODS OF POPULATION CONTROL, IN STATEMENT TO POPULATION AND DEVELOPMENT COMMISSION

19980225 Responds to Media Accounts of Forced Sterilization; Commission Begins Discussion on Population Division Programme

The Peruvian Government did not use coercive methods of population control, the Commission for Population and Development was told this morning, as it concluded its discussion on national experiences with health and mortality. Referring to recent media reports about forced sterilization, Peru's representative said her Government would investigate alleged incidents and punish perpetrators.

Sweden's representative said the Commission should not only consider countries' internal conditions, but also external problems, such as debt burdens and structural adjustment programmes. A broader examination of the factors involved in development could lead to insights on health and mortality.

The elimination of poverty and the need for more equitable development continued to be Malaysia's overriding goal, its representative said. The social agenda was at the top of its development plan for the years 1996 to 2000, as it sought to achieve a more balanced development.

El Salvador's representative said the health of young people was a priority for his country. Rural schools were participating in programmes to combat malnutrition. Population education was included in school curricula, while services were being provided to promote sexual and reproductive health for young people.

The representatives of India, Jamaica, Malta, Ukraine, Iran, Turkey, Switzerland, Sudan, Indonesia, Malawi, United States, Bangladesh and the Republic of Korea also spoke this morning, as did representatives of the Holy See, Food and Agriculture Organization (FAO), and the Population Institute.

The Director of the Population Division, Joseph Chamie, introduced the item on the Commission's provisional agenda for its thirty-second session, as well as the item on the Commission's programme questions.

The Commission will meet again at 3 p.m. today, to continue discussing the Population Division's programme performance in 1997 and its programme of work for 1998-1999.

Commission Work Programme

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

Statements

P. SINGH (India) said recent demographic data indicated that India's birth rate was down to 27.4 per 1,000 population and infant mortality was also down to 72 per 1,000 live births. Following the International Conference on Population and Development (ICPD) (Cairo, 1994), India took the bold step of removing centrally determined contraceptive targets from its population and reproductive health programmes, replacing it with a system that assesses community needs. A massive exercise was undertaken to orient governmental management and service delivery systems. After only one year, there was positive feedback, and the system was now being refined.

The commencement of the ninth five-year plan in 1997 had afforded the country the opportunity to support policy reform with programme reorganization, he continued. Integration of contraceptive services and child health services had begun in 1985, when universal immunization began. That was intensified in the eighth five-year plan, from 1992 to 1997. In the ninth five-year plan, India had integrated and strengthened the move further, through a fully funded and ambitious Reproductive and Child Health Programme which now had responsibility, among others, for sustaining and strengthening the interventions started under the earlier Child Survival and Safe Motherhood programme.

Supporting non-governmental organizations (NGOs) in the implementation of the population and reproductive health programme had been a long-standing feature of his country's programme and would now be expanded, he said. In addition, the Government was considering ways of fostering active community involvement in the population and reproductive health programme. It was also continuing with the pulse polio immunization strategy, in keeping with the goal of eradicating the disease.

EASTON WILLIAMS (Jamaica) said that Jamaica shared the same mortality and morbidity characteristics with other members of the Caribbean Community (CARICOM). Describing demographic patterns in his country, he noted that Jamaica was currently implementing a wide range of health programmes that were consistent with recent world conferences, including the Cairo Conference, the United Nations Conference on Environment and Development (UNCED), and the Fourth World Conference on Women. Jamaica's approach included decentralization and a national health insurance plan.

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The decentralization plan was aimed at creating autonomous health regions, and it was expected that the local authorities would have authority for faster decision-making and more efficient use of resources. Quality assurance covered such areas as certification of clinical labs, as well as the tools for monitoring maternal deaths. The national health insurance plan addressed disparities in health-care provision and would provide universal coverage in an effort to ensure an equitable system. Family health was an attempt to integrate the concept of health care within the purview of the family system.

JOSE ROBERTO AGUILAR ALVAREZ, Technical Adviser to the National Secretary for the Family of El Salvador, said his country had achieved several health- related successes. In recent years, the number of medical consultations had increased dramatically. Prevention was now a national strategy to promote health. As a result, in the last year, there had been no recorded cases of cholera, measles or dengue fever. The health of young people was being improved through a process by which rural schools participated in efforts to combat malnutrition. The country had expanded the availability of family planning methods, and included population education in school curricula, to promote healthy behaviour in young people. The health of adolescents was a priority for El Salvador's Government, he said. Information and services were being provided to promote sexual and reproductive health for young people. A national reproductive health plan had been adopted. One year after the country's national policy for women had been launched, 90 per cent of the health-oriented actions had been taken. Victims of family violence and sexual and child abuse were being given support. He expressed appreciation for donor countries that had supported El Salvador's efforts, and invited them to increase their support.

JOSEPH CAMILLERI (Malta) said it was important to remember that the Commission was talking about real lives, not just numbers and statistics. While the Cairo Programme of Action was a valuable document, its significance depended on governments and other actors to turn recommendations into actions. In light of the global trend of demographic ageing, which would intensify in the next millennium, major challenges faced developing and industrialized countries. The seventh Conference of European Minister Responsible for Social Security, to be held in Malta from 12 to 14 May, would focus on adopting social security systems to new realities and ensure their fiscal viability.

Approximately 66 per cent of Malta's government expenditures went towards health, education and social welfare, he said. However, the country was now experiencing new forms of health problems, including diabetes and lung and breast cancers. Also, traffic accidents, drug and alcohol abuse, and mental illness were increasing. Malta's Health Department had recently published a "Health Vision 2000", outlining strategies to promote national health. International goals and the recommendations of Cairo must be implemented with full cognizance of the unique ethical, cultural and religious backgrounds of each country, he added.

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OLEXANDR G. OSAULENKO (Ukraine) said his country's population had grown by 1.5 million in the past five years. There was a significant problem with mortality, which was particularly pronounced among the working age population. Health issues that deserved particular attention were circulatory problems, cancer which was on the upswing -- and was a consequence of the Chernobyl nuclear disaster -- and tuberculosis.

The main principles of Ukraine's health plan derived from the Constitution, which had set out general values and principles, with priority given to health services and access to it, he said. A number of programmes were particularly aimed at mothers and children, and in the last three years there had been signs of improvement. Child mortality had dropped, among others, but the negative areas in the reproductive processes had not been brought under control. One response was to work on a programme to control reproduction, but a good deal of information was required before that could be done. In that connection, Ukraine was counting on the support of the Commission.

MOHAMMAD ASSAI ARDAKANI, Adviser, Ministry of Health and Medical Education of Iran, said that, according to the most recent census, conducted in 1996, over 60 per cent of Iran's 60 million inhabitants lived in urban areas. Just over 50 per cent of the population was under 20 years of age, while some 4 per cent was over 65. Following the victory of the Islamic revolution in 1979, the Ministry of Health had designed a national health system aimed towards distributing health resources in an equitable manner. Based on a national survey of health indicators, the Government had identified four priorities: implementing a health-care strategy based on prevention; allocating resources to rural and underprivileged areas; providing ambulatory services to hospitals; and promoting general and specialized health care.

From 1976 and 1986, Iran's population growth rate increased from 2.7 per cent to 3.2 per cent, he said. In response, a Fertility Regulation Council had been established, composed of governmental ministries and organizations involved in implementing fertility policies. Further, a family planning law had been promulgated. As a result of concerted efforts, the fertility rate had decreased to 2.6 per cent in 1997. Mortality rates for mothers and infants had dropped since 1985, due mainly to increased access to primary health care. Cardiovascular diseases were now the major cause of death in Iran. According to some reports, such diseases accounted for 40 per cent of the country's total deaths.

Apart from the progress achieved so far within the framework of primary health-care strategies, further challenges remained, he said. In particular, special attention was required to address the health needs of adolescents, high neonatal and maternal mortality rates, endemic diseases and increasing rates of cardiovascular diseases.

SAMIRA YENER (Turkey) said that recent mortality analysis showed that life expectancy had risen sharply in the country, and estimates for the

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present were equally optimistic. A large percentage of infant survival was attributed to the nation's widespread health programmes. In the early 1980s, infant mortality was as high as 109 per 1,000 live births, but in 1997 it was estimated at only 37 per 1,000 live births.

The Government was successful in adopting the recommendations of the Cairo Conference with a number of action plans, which were the products of collaborative intersectoral studies and the participation of NGOs and the private sector, she continued. In the seventh five-year plan, the health-care reform programme covered such areas as health-care financing, family physician and family care, and human resources and health information systems. Ensuring sectoral collaboration was important in the plan and, recently, NGOs had been organized in the area of women's health, and they would be carrying out integrated services in some areas of the country.

AMINAH ABDUL RAHMAN (Malaysia) said that the elimination of poverty and the need for more equitable development continued to be the country's overriding goal, as emphasized in the long-term outline perspective plan of 1990-2000. The thrust of the current development plan (1996-2000) had placed the social agenda as the priority, in order to achieve a more balanced development. A Cabinet Committee chaired by the Deputy Prime Minister met regularly to discuss the causes of current social problems affecting families and specific population groups, in an effort to formulate appropriate strategies.

Infant mortality had declined from 75 per 1,000 live births in 1957 to 10.3 in 1995, while maternal mortality had declined to about 20 per 100,000, she continued. Similarly, life expectancy had increased to 70 years for males and 76 for females, while total fertility rates had declined significantly. Those improvements were the direct results of: the development, upgrading, expansion and strengthening of the public health services; the integration of programmes such as family planning and nutrition into the primary health-care services; and the effort to ensure that services were accessible and affordable.

Health awareness and promotion efforts for families and communities, coupled with a sound system of management and follow-up, had been one of the most effective strategies in mortality reduction, she said. The morbidity profile indicated that Malaysia was undergoing an epidemiological transition in which diseases associated with behaviour, urbanization, sedentary occupations and a stressful lifestyle had taken precedence over the traditional communicable diseases.

As a result of a relatively youthful population, she continued, adolescent reproductive health and sexuality had become an important national agenda item and was contributing to many social and family problems. She suggested that efforts needed to be channelled towards greater understanding of psycho-social- related health problems. There was also a need to identify appropriate

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strategies and programmes for individuals and families and to be prepared to address the emerging and unmet needs of those beyond the reproductive years.

CLAUDINE SAUVAIN-DUGERDIL (Switzerland) said that Swiss authorities viewed population as part of social development. In her country, population activities had not traditionally constituted an area for specific action. However, today, new dynamics were in place, due in large part to the Cairo Conference.

The Swiss approach to population questions combined institutional efforts with overall social evolution, she said. Due to the current, less favourable economic situation and an increasingly ageing society, the country's retirement plan had just been revised. Legislation for maternity leave and the legalization of pregnancy interruptions were now being addressed. After participating in surveys coordinated by the Economic Commission for Europe (ECE), Switzerland was now addressing its national realities through private and public initiatives.

Efforts were being directed towards increasing awareness of parliamentarians and other decision makers, she continued. Non-governmental organizations were being incorporated into national efforts to implement the Cairo recommendations. Those recommendations highlighted the importance of respect, equality, and the need to improve the living conditions of the underprivileged, all of which were aspects of the Swiss policy for development. The country was allocating funds for development assistance and multilateral and bilateral programmes.

BERTIL EGERO, Associate Professor, Programme on Population and Development, Lund University, of Sweden, said that in light of current concerns about global food security, water scarcities and environmental obstacles, there was a need to reconsider methodologies for deriving population projections. While life expectancy in the most advanced societies was increasing, that was not the case in the poorest parts of the world. Overall, the gap between disadvantaged and advantaged groups was increasing.

Most of the United Nations comparative studies used countries as their smallest units, he continued. National data should be complemented with data on social groups or strata. Further, the Commission should not only consider countries' internal conditions, but also externalities, such as debt burdens and structural adjustment programmes. A broader examination of internal and external circumstances could lead to insight on differences between health and mortality. Attention should be given to the wider context within which activities to implement the Cairo Programme of Action were undertaken.

AHMED TAHA MOHAMED (Sudan) said the most important goal was to honour the human person and bring about his or her well-being. Concerning the subject of reproductive health, the Sudan was working for the freedom of both spouses in promoting the interest of the entire family. According to the 1993 census, child and maternal mortality rates had increased. In the health area,

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in general, the nation was trying to meet the best interests of all citizens. The country had suffered from war and environmental deterioration, and the Government was still working at achieving peace and establishing good- neighbourliness.

The Government supported the efforts of the donor countries and of the NGOs, he said. The assistance they were giving the Sudan was helping the nation face its problems. His country was grateful for the UNFPA's support, as well as that of the Organization of African Unity (OAU). His country aspired to achieve the desired indicators in life expectancy and to implement the decisions of the Cairo Conference.

SISWANTO AGUS WILOPO (Indonesia) said that, as a result of the ICPD, the population policies of Indonesia had shifted to that of a "people and family centred" approach. Such an approach emphasized the importance of human and family development, changing attitudes towards reproduction and client-centred provision of high-quality information and services. Indonesia's approach was rooted in the principle of achieving a small, prosperous and happy family, which would ultimately help to alleviate poverty.

Progress had been made and the positive statistics were telling, but despite serious efforts, maternal health indicators remained a cause for concern. Maternal mortality rates, which were 450 per 100,000 live births in 1986, declined to 390 per 100,000 live births by 1994. Efforts had been intensified to train midwives in the effective management of pregnancy and likely complications at delivery. The Government had, among other things, increased the training and deployment of the village midwives and increased access to maternal health and family planning services.

He said the Government had developed a National Safe Motherhood Movement, focusing on such actions as: increasing awareness of Safe Motherhood goals; improving the availability and use of information about maternal mortality and morbidity; and developing strategies and specific plans for Safe Motherhood in each province. Poverty alleviation programmes, including the provision of a small credit, could be expected to contribute to further decline in both infant and maternal morbidity rates in the immediate future. To experience lasting and significant change, however, fundamental changes in behaviour would be required. Some key issues in the health sector were: rising expectations; limited resources; management problems; and equity in the availability of services. Concerning AIDS, the Government had responded quickly, but prevention was still the most effective strategy.

ELENA CONTERNO (Peru) said that in 1996 her Government had created a Ministry for the Promotion of Women and of Human Development. The Ministry was in charge of formulating and monitoring population programmes and policies. A national programme on population had been formulated for the years 1997 to 2001, to address gaps between urban and rural regions, as well

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as between men and women. A multi-disciplinary commission was in charge of implementing that programme, with broad involvement from all social sectors.

Peru had been making concerted efforts to expand the public's access to basic health services, she said. However, the national fertility rate was 3.5 children per women, while the desired rate was 2.2 children. On the average, rural women had 2.5 more children than they wished. Recent national estimates indicated that, in 1997, 60 per cent of pregnancies were unwanted. Of that number, approximately half had been terminated through induced abortion. Peru's family planning programme sought to offer contraceptive users the widest possible variety of methods, combined with readily accessible information.

Regarding reports in the media about forced sterilization, she stressed that the Peruvian Government did not have a policy of using coercive methods or force for population control. Alleged violations would be investigated and perpetrators would be punished. She expressed appreciation to the United Nations Population Fund (UNFPA) for its technical and financial support to her Government's implementation of the Cairo Programme of Action.

CHRISSIE NANCY MWIYERIWA Malawi, Principle Secretary, Ministry of Health, of Malawi, said that Malawi's health indicators painted a disturbing picture. Fertility rates were high at 6.7 children per woman. Life expectancy stood at 51 years, while the HIV/AIDS pandemic posed a grave threat to the country's population.

Strategies for population and gender equality had been articulated in a number of national policy documents, which together provided a solid framework to address Malawi's realities, she said. Her Government had developed a national policy, even before the Cairo Conference, to lower child and maternal mortality rates and empower women. The Government was making efforts to increase awareness of population issues at all levels, with the participation of actors from all social sectors.

The promotion of population and sustainable development required substantial resources, she said. In the 1996-1997 fiscal year, the Government had established -- for the first time -- a separate budget line for resources to population and development activities. It would endeavour to make more resources available.

Since 1994, Malawi had sought to address reproductive health in a holistic manner, she continued. Despite the expansion of the country's health infrastructure, factors such as widespread poverty, high illiteracy rates and high levels of malnutrition had resulted in Malawi's citizens being among the world's least healthy. The Government was committed to implementing its national population programme and the Cairo Programme of Action.

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Bishop JAMES T. McHUGH, of the Holy See, said the correlation of poverty and disease prevented millions of people from benefiting from the achievements of medical science. It was a reminder of the need for improved systems of health care. The Holy See attempted to meet the health needs of all people worldwide, especially women and children, by supporting more than 100,000 health-care institutions, as well as hospitals, clinics, elderly-care facilities and orphanages. In many of those places, no other facilities were available.

In 1995, the Pontifical Academy of Sciences held an international meeting on breastfeeding, again emphasizing the importance of human milk for its nutritional and immunological benefits for both mothers and infants, he continued. The Holy See was aware of the disparities that existed in efforts to overcome disease and improve health. HIV/AIDS was still unchecked and had a tragic effect on persons and even the development process in some countries.

With the increase in life expectancy, more attention must be given to the health needs of older persons and the social services and recreational opportunities that enabled them to have a reasonable quality of life, he said. The Commission's meeting this year served both informational and motivational purposes. By better understanding the data, the international community was realistically prepared for the implications of improved health care and lengthened life expectancy for the development process.

Provisional Agenda for Thirty-Second Session

JOSEPH CHAMIE, Director, Population Division, introducing the subject, said that some delegates had already indicated a desire for structural changes to the proposed programme for the thirty-second session. He had himself suggested two parts to the programme. The first would deal with the regular business of the Commission and the work programme of the Secretariat concerning population. The second would involve preparatory work for the subsequent session.

The Commission decided to defer consideration of the provisional agenda until it had heard from the ongoing informal consultations on the subject.

Programme Questions

Mr. CHAMIE, Director, Population Division, defined the discussion as the work programme of the United Nations Secretariat in the field of population. He noted that other intergovernmental bodies reviewed the work of regional commissions, agencies, funds and programmes. However, representatives of those organizations were invited to the Commission to participate in its deliberations. He stressed that the Population Division was apolitical and had no advocacy role. Its perspective was strictly scientific and global.

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The Division's research and publications were often the underlying foundations for the reports, statements, meetings, conferences and databases prepared by others working in the United Nations system, in the private sector and in numerous NGOs, he continued. The Division had contributed to, and collaborated with, others within the United Nations system. Its work in urbanization and city growth, for example, had been an important and substantive contribution to the 1996 United Nations Conference on Human Settlements (Habitat II) in Istanbul. Citing examples of contributions of members of the Commission to the work of the Population Division in the past, he said they had provided guidance and inspiration, raising issues that led to specific studies and meetings, as well as changes in the Division's analyses.

He said that the work of the Division might be seen as falling into six categories: population studies and analyses; preparation of world estimates and projections; the monitoring, reviewing and appraising of world population trends and policies; organization of international conferences and expert meetings and their follow-up activities; provision of policy advisory services; and coordination and dissemination of population information.

Turning to substantive issues, he said his coverage was primarily illustrative, focusing on population change as it brought into focus fertility, mortality, migration and age structure. He then presented slides, which covered such subjects as: population policy for Africa: perception of fertility between 1974 and 1988; policy on modern contraceptive methods for 1974 to 1988; urbanization agglomerations in 1950, as well as in 1990; and trends in international migration.

He noted that his presentation was only an introduction to the work programme and had not done justice to the scope and nature of the work done by his colleagues. His Division had benefited a great deal from the presence of junior professional officers from a number of countries, and he urged other countries to consider participation in the programme.

THOMAS McDEVITT, of the Bureau of the Census, Department of Commerce, of the United States, said that the Population Commission had done excellent work, despite staffing and budgetary constraints. The Population Division's study of evolving patterns of fertility rates would prove helpful to the Commission's consideration of the issue. The Division was also conducting useful work on mortality and age distribution. Further, he noted the important work done by the Division on international migration in the Asian region.

However, the United States was disappointed by the absence of reference to technical assistance given to governments in implementing the recommendations for international migration statistics adopted at the twenty-ninth session of the Statistical Commission, he said. Those recommendations had been discussed within the context of the resolution on international migration and development adopted at the thirtieth session of the Commission on Population and Development.

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Turning next to the Division's programme of work, he said that the upcoming review of the Cairo Conference would provide an excellent opportunity to assess progress and respond to countries' constraints in meeting ICPD goals. The Division contributed to monitoring the implementation of the Programme of Action to date. The Division should continue to play that role and maintain a strong research and technical cooperation capacity.

JACQUES DU GUERNY, of the Food and Agriculture Organization (FAO), said his organization relied on the work of the Population Division. He noted with concern that the programme of work for 1998 did not include the report World Population Prospects. The information contained in that report was of great use to the FAO. He hoped the Division would include that in its programme of work.

Bishop McHUGH, of the Holy See, said the Division, since its inception, had brought together accomplished demographers. The scientific competence and objectivity of its research must be protected. The Division's studies provided the basis for research and analysis by other groups. The Commission should recognize the Division's contribution.

MUHAMMAD ALI, Secretary, Ministry of Health and Family Welfare of Bangladesh, said the most serious demographic changes in the coming years would take place in South-East Asia. India's population was going to exceed China's by the year 2050, while Pakistan would be the third largest country by that year. Those numbers came from World Population Prospects. The Division should undertake a detailed analysis of the demographics of the South Asian region, and strive to advise the governments in that region on how to address the coming realities.

NAM-HOON CHO, Vice-President of the Korean Institute for Health and Social Affairs of the Republic of Korea, stressed the importance of information on mortality. More attention should be given to improving methodology for data gathering and analysis on mortality.

PADAM SINGH (India) endorsed the statement made by the representative of Bangladesh. The Division should also include in its study information related to implications of HIV/AIDS. One of the papers circulated to the Commission had mentioned some 3 million to 5 million cases of HIV/AIDS-infected persons in his country. However, the real number was approximately 5,000 persons.

WERNER FORNOS, President of the Population Institute, said it was time to identify the successes achieved by the ICPD Programme of Action, to replicate those successes in other parts of the world and remove the constraints in its implementation. There was, he noted, good news since the last meeting of the Commission. Human growth had slowed, somewhat, and the number of countries achieving replacement-level fertility had expanded from 19 in the early 1970s to 51 last year. That positive trend must not lead to self-satisfaction and complacency, however, as there were areas requiring

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immediate attention. Reproductive health care now included breast cancer and sexually transmitted diseases such as HIV/AIDS. While he welcomed increased attention to those issues, he believed that family planning, the core of the action plan, must continue to receive priority attention in international assistance.

He said another issue of continuing concern was the failure to mobilize resources for the ICPD programmes. Three years after the Cairo conference, the international community was nowhere near reaching the Cairo target of $17 billion by the year 2000. Donor countries were expected to provide one third of the funds, but had not been forthcoming. The United States budget, in particular, used the issue of abortion and claims of budget constraints to reduce its international population assistance by $200 million a year since 1995.

Further, he continued, the world community must work to end the barbarous practice of female genital mutilation prevalent in several parts of the world. He recalled that the Cairo Programme of Action urged governments to take the necessary measures to prevent female infanticide. In spite of that, thousands of female infants were still unaccounted for.

Responding to the statements, Mr. CHAMIE, Director, Population Division, said that FAO's request fell on very sympathetic ears, noting that in the streamlining of the Division's work, that area had been dropped. Although he did not have that in the programme for 1998, he would be willing to work with others on it. Concerning the remarks of the Holy See on separation between science and advocacy, he stressed that the Division's role must remain scientific, and he was happy that the views of the Holy See supported that perspective.

Turning to the comments of Bangladesh and India concerning population growth in South-East Asia, he described the growth as "impressive", noting that India alone contributed 20 per cent of the global growth. The suggestion for a study was an attractive one, and he would be discussing it with his colleague from the Economic and Social Commission for Asia and the Pacific (ESCAP). He cautioned, however, that the UNFPA was really the organization with the resources on the ground.

On the comments of the Republic of Korea, he said he looked forward to continuing to improve the methodology being used. Also, on issue of AIDS statistics, he explained that the error would be looked into, so that it might not mislead. Concerning the remarks of the Population Institute, he said there was no secret in the methodology employed. If, at the global level, projections made in the 1950s were compared with those being made now, the difference was very small. He stressed that the numbers published were not extrapolations, and he urged delegates to reflect on the earliest global populations they could remember and compare them with current statistics.

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For information media. Not an official record.