REPRODUCTIVE HEALTH INFORMATION FOR YOUNG PEOPLE, AIDS IMPACT ON DEVELOPMENT, DEATH BY PREGNANCY-RELATED CAUSES AMONG ISSUES CONSIDERED

24 March 1999

Press Release
POP/715

REPRODUCTIVE HEALTH INFORMATION FOR YOUNG PEOPLE, AIDS IMPACT ON DEVELOPMENT, DEATH BY PREGNANCY-RELATED CAUSES AMONG ISSUES CONSIDERED

19990324 As Population and Development Commission, Acting as Preparatory Committee for Assembly Special Session on Cairo + 5, Continues Deliberations

Global reproductive health lay in the hands of young people, who were critically dependent on the information and services with which the current generation of adults chose to equip them, a representative of the World Health Organization told the Commission on Population and Development this afternoon as it continued its preparations for the upcoming five-year review of the International Conference on Population and Development (Cairo, 1994).

Of the 5.2 million people infected by HIV each year, more than half of them were young people less than 24 years old, she told the 47-member body, acting as the preparatory committee for the special session of the General Assembly. As much as 15 per cent of the global burden of disease was associated with failures to address reproductive health needs, which had burdened people, particularly women in the prime of their lives. In parts of Africa, women faced a one in 16 risk of death because they did not receive the care they needed when they were pregnant.

A representative of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said that, in the second decade of fighting the epidemic, the world had seen the enormous impact of AIDS not only on the personal lives of millions of men and women but also on the social, economic and political development of nations. In the most affected countries AIDS was responsible for dramatic decreases in life expectancy and declining per capita incomes. The social and economic losses due to AIDS were creating a spiralling negative momentum, reversing hard-won development gains.

"We must stop this needless tragedy", the United States representative said in reference to the more than two and one-half million women who died of pregnancy-related causes, and the millions more who had suffered permanent negative health damage in the five years since the Cairo Conference. When 179

countries had committed themselves in 1994 to ensuring a better quality of life for all, they had not fully anticipated the devastating and global impact of the HIV/AIDS pandemic. Care for people living with HIV/AIDS must be improved; the wide access of condoms must be ensured, and more female- controlled methods, such as microbicides and vaccines, should be developed.

The representative of Croatia drew the Commission's attention to the particular challenges facing a country emerging from conflict. The recent war had worsened all population structures and components; it had caused a natural decline in population, the direct loss of human life, and a great number of displaced persons and refugees. Under the present conditions of unemployment, low income, housing problems and other economic and social and financial constraints, it would be difficult to reduce the outmigration of younger and educated people and markedly improve overall demographic trends.

Statements were also made by the representatives of Canada, Argentina, Guatemala, Zambia and Colombia, and by the observers for Switzerland and the Holy See. The Chairman of the Commission for Social Development, Aurelio Fernandez (Spain) also spoke, as did a representative of the United Nations Educational, Scientific and Cultural Organization (UNESCO).

Representatives of non-governmental organizations also addressed the Commission: Asian Forum of Parliamentarians on Population and Development; Center for Reproductive Law and Policy; Park Ridge Center for the Study of Health, Faith and Ethics; World Population Foundation; and Catholics for a Free Choice.

The Commission will meet again as preparatory committee at 10 a.m. tomorrow, 25 March, to continue its deliberations.

Commission Work Programme

The Commission on Population and Development met this afternoon to continue its session as the preparatory committee for the special session of the General Assembly for reviewing implementation of the Programme of Action of the International Conference on Population and Development (Cairo, 1994). (For background information see Press Release POP/709 of 18 March.)

Statements

JULIA V. TAFT (United States) recalled that in Cairo, 179 Governments had committed themselves to ensuring a better quality of life for all by building on the principles of basic human rights, gender equity and equality, and sustainable development. They had affirmed that women's rights were human rights, and that those were inextricably linked to their right to the highest attainable health standard. Those countries had also committed themselves to encouraging men to respect women's human rights.

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In 1994, however, those countries had not fully anticipated the devastating and global impact of the HIV/AIDS pandemic, which required higher priority, she said. The wide access of condoms to men and women must be ensured, and more female-controlled methods, such as microbicides and vaccines, must be developed. Care for people living with HIV/AIDS must also be improved. Everything possible must also be done to address the continuing high levels of maternal mortality and morbidity. In the five years since the Cairo Conference, more than two and one-half million women had died of pregnancy-related causes. Millions more had suffered permanent negative health consequences. "We must stop this needless tragedy", she said.

Universal access to quality sexual and reproductive health services, full information, free and informed choices, and the treatment of all persons with respect and dignity must also be ensured, she said. The committed countries must also ensure that essential obstetric services are accessible to women everywhere, as well as a range of safe and effective family planning methods, including emergency contraception. Unsafe abortion remained a major public health concern in many countries, for which implementation of the relevant paragraphs in the Action Programme must be attained. The number of unintended pregnancies must be reduced, and the safe management of unsafe abortions must be ensured. Wherever legal, abortion must be safe and accessible.

The world was only beginning to understand the true magnitude and severity of gender-based violence across all countries and socio-economic classes, she said. There must be "zero-tolerance" of all forms of violence against women and children. More must be done to implement the call from the ICPD for the prohibition of harmful traditional practices, such as female genital mutilation.

Since Cairo there had been serious economic challenges in a number of countries, she said. The United States supported efforts under way in other international forums to develop effective and creative responses to those challenges. In the long run, stabilizing population would also improve a nation's investment potential and economic growth prospects. The world community was far behind in meeting the financial goals set in Cairo. Simply put, more resources from all sources needed to be mobilized. The United States remained the world's largest donor of population and reproductive health assistance, but as the First Lady Hillary Rodham Clinton promised in The Hague, it would try to do more.

ROSS HYNES (Canada) said that the review process had clearly demonstrated that in order to achieve the goals of the ICPD, the international community, governments and civil society must adopt a sustained and harmonized approach to population and development issues. An integrated approach based on individual and collective experiences was a lesson worth remembering in the current deliberations, and the Programme of Action was a baseline for those

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negotiations, which should not be renegotiated. Efforts should focus instead on reinforcing its implementation and identifying those areas which required follow-up, while taking into account the consolidated gains made in subsequent world conferences and summits.

He said the participants must seek to negotiate a text that was focused, results-oriented and meaningful to a broad audience. Greater emphasis was needed, not only on the problems related to population and development, but also on their root causes, such as poverty, human rights abuses, gender inequality, social and economic inequity, migration and the absence of good governance. In order to effectively monitor progress, benchmarks should be established and statistical data and indicators identified. It was surprising that important recommendations from The Hague, for example in the area of resource mobilization, were absent from the Secretary-General's report.

He said the final document should reinforce the view that women's health was a human rights issue. Methodologies must be developed to promote those rights, including in the area of sexual and reproductive health. In addition, issues of women's equality, equity and empowerment must be integrated throughout the negotiated text, as well as language that reflected the need to develop effective strategies to promote gender mainstreaming. The changing age structure should also be addressed, especially considering that the largest generation ever of adolescents were presently making its transition from childhood to adulthood, creating unprecedented demands.

The diversity and complexity of migration and its links to development should be also given substantial consideration, he said. The text for the special session should include actions in the area of migration that underscored the importance of addressing the root causes, upholding the right of asylum and the principle of non-refoulement, as well as providing for the particular needs of refugee women. Equally important was the adoption of approaches for integrating documented migrants into their host societies, and emphasizing the assistance and protection needs of internally displaced persons.

The agreed text must also address the need for new mechanisms to generate additional resources to meet ICPD goals, he said. Those could include South-South cooperation, more efficient mechanisms to reduce the burden of external debt, increased funding from international financial institutions, and strengthened partnerships to mobilize resources. Attention must also be given to increasing the role of private sector institutions in the mobilization of resource flows.

JACQUES MARTIN, observer for Switzerland, said questions of rights and reproductive health were given extensive treatment in the documents before the Commission, however mortality and migration had been given less priority. There should be efforts to give them the place they deserve. Also the role of

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families should be given more emphasis as well as the link between social and economic developments. There were other issues that remained contentious. The documentation seemed to give little attention to the modes of consumption and production in developed countries. However, they placed considerable stress on the population growth of developing countries. In the future, there should be more consideration of the need to use the world's resources with efficiency and care.

On the topic of resources flows, he said there was still much to be done. The international community was not sure how to measure the results of efforts that had been undertaken in that regard. The sparsity of data available made it difficult to evaluate resource flows and their effectiveness. The individual should remain the cornerstone of development activities and considerable human as well as financial resources would be needed in that regard.

ALDO OMAR CARRERAS (Argentina) said that population and development goals should be aligned with national policies, in the context of respect for human dignity and free choice. Population policy should be conceived in accordance with the ethical and moral standards of a society. Development assistance should not depend on the adoption of certain programmes, or on quotas of any kind, demographic or otherwise. Similarly, the complete absence of coercion in family planning programmes was a basic principle of the Cairo consensus.

He said the protection and promotion of the family was also vital. Social policies should always been oriented towards affording an enabling framework for development. It was essential in the family to maintain the right of parents to educate their children. Equity was one of goals associated with population and development; the great disparities between demographies were the result of a lack of social equality. The relationship between development and education was also indisputable.

Population growth was not the primary reason for environmental degradation, he said. Rather, that was the result of irrational development styles and inappropriate consumption patterns. Future implementation of the Cairo goals should consider the link between population policies and environmental protection plans. In addition, policies to lengthen lifespans and improve individuals' health must be strengthened. Decreasing maternal and infant mortality, dealing appropriately with abortions, and combating sterility, infertility and sexually transmitted diseases were also vital.

In all countries -- developing and developed -- international migration was a crucial factor in the design of population policies, he went on. That topic deserved a central role in any discussion of implementation of the Cairo goals. Argentina was receiving regional migration flows. It was guided by a pluralist social and cultural philosophy, and, therefore, would do everything

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possible to achieve an appropriate migration framework. Migratory policies should be effectively regulated, and migratory flows should be reasonably channelled. Progress must be continued in elaborating concrete measures to protect the rights of documented immigrants, and at same time, fight against those people illegally profiting from migration.

MARIA ROSE NODA (Guatemala) said that her country was involved in the implementation of the Programme of Action at many levels including the areas of education and health. Its efforts, however, had been hindered by long years of civil war as well as the damage caused by recent natural disasters. Her country was now looking optimistically into the future. The Cairo Programme of Action focused on the well-being of human beings instead of numbers and the human being should be the centre of all efforts for international development. With that in mind, her country had redesigned its education system to bring it into accordance with multi-ethnic and multicultural needs. New impetus had also been given to the new integrated health care system.

She said that elderly people in 50 years would be one quarter of the population and her country supported efforts to address the needs of older persons. Respect for and care of older persons was a priority for Guatemala. In addition, particular attention had also been paid to the enabling of women and improvement of their role in society. New opportunities had been opened for women and the value of their work inside and outside the home was being recognized. Everyone wanted a new Guatemala in the next century, one that was deeply democratic with prosperity and equality for its people.

JIM CARMICHAEL, Joint United Nations Programme on HIV/AIDS (UNAIDS), said that, in the second decade of fighting the epidemic, the world had seen the enormous impact of AIDS not only on the personal lives of millions of men and women but also on the social, economic and political development of nations. It threatened countries already struggling with high poverty levels, limited government resources and deficient social services. In the most affected countries, AIDS was responsible for dramatic decreases in life expectancy and declining per capita incomes. The social and economic losses due to AIDS were creating a spiralling negative momentum, reversing hard-won development gains.

Each member of the international community had a stake in transforming that grim picture, he said. There had already been some positive developments in Asia and Africa, where national responses had increased in scope, effectiveness and commitment. While some countries had not fully confronted the truth of the epidemic, many others were now demonstrating the political will to mount a concerted response to the disease. There must be increased efforts to redouble efforts to eliminate the stigma and discrimination which was all to often associated with AIDS and other sexually transmitted diseases

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(STDs). It was silence that reinforced the culture of silence -- a silence that became a barrier to prevention and care.

GODFREY SIMASIKU (Zambia) said that the population of his country had grown rapidly over the years and that growth was attributed to natural factors. In 1990, nearly half of the population was under 15 years of age and females of reproductive ages (15-49) comprised 24 per cent of the nation's population. Also, levels of infant and maternal mortality, which declined considerably between 1963 and 1980, had been rising. The recent increases in mortality had led to substantial declines of life expectancy, which had dropped from 52 years in 1980 to 42.5 years in 1996 for both men and women.

Efforts should be made to support Zambia in its quest to eradicate poverty, he said. That could be done by stimulating direct investment, cancellation of debt, and ensuring that structural adjustment programmes had a human face and were responsive to social and environmental concerns. Efforts by the international community towards sustainable development should be the cornerstone of assistance to the developing countries. That assistance should be designed in a manner that also encourages South-South cooperation.

CARLA ABOUZAHR, of the World Health Organization (WHO), said that as the lead international technical agency in the field of public health, WHO was concerned with the health aspects of sexuality and reproduction. The organization's objectivity, neutrality and scientific and technical expertise enabled it to provide the normative framework and technical support within which reproductive health issues could be addressed.

Today, 120 million women in the world did not want to become pregnant yet had no means to prevent it, she said. Every year, 20 million women put their health and lives at risk because they sought unsafe abortions. There were 333 million new cases of curable sexually transmitted diseases annually. Every year, one in 20 adolescents contracted a sexually transmitted disease. Of the 5.2 million people who were infected by the HIV virus each year, more than half of them were young people less than 24 years old. Every year, there were 450,000 new cases of cancer of the cervix, and every minute of the day, a woman dies from pregnancy-related complications.

Continuing, she said that in parts of Africa, women faced a one in 16 risk of death because they did not receive the care they needed when they were pregnant. WHO estimated that between 5 per cent and 15 per cent of the global burden of disease was associated with failures to address those kinds of reproductive health needs. Those failures burdened people, particularly women in the prime of their lives, at a time when their potential, responsibilities and productivity were at their highest. No country could afford not to address those issues.

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The future reproductive health of the world lay in the hands of young people and was critically dependent on the information, skills and services with which the current generation of adults chose to equip them, she said. Evidence from around the world had shown beyond a doubt that ensuring that young people could reach, and have the skills to use, reproductive health information and services helped avert health problems and create mature and responsible attitudes to sexuality and reproduction, not irresponsible lifestyles or promiscuous sexual behaviour, as some would believe.

JAMES MCHOUGH, observer for the Holy See, said that during the five years since the Cairo Conference, the Holy See had continued to insist that dignity of the person and basic human rights, especially the right to life, should be promoted and protected. It had recognized that human beings were at the centre of concerns for development. It had also held firmly to the call for the full respect for various religious and ethical values and cultural backgrounds of each woman and man. True development could never be reduced to a merely physical dimension and an overall concern for education and well- being must be recognized. In some ways a disproportionate amount of attention had been given to a very limited understanding of reproductive health.

He said the Cairo Conference enabled governments to discuss a wide range of topics including the improvements in the status of women throughout the world, particularly regarding: access to education; their full and equal participation in development; rejection of all forms of coercion in the implementation of population policies; and the recognition of the family as the fundamental unit of society based on marriage. The role of the family as the basic unit of society was recognized and supported by the United Nations. The responsibility of men and women regarding their sexuality could only be expressed in the family. The individualistic concept of sexuality, at times advocated at the Cairo Conference, was a rejection of the role of the family.

ALICA WERHEIMER BALETIC (Croatia) said that the trends in population growth, structure and distribution constituted a challenging dichotomy of large numbers of young and ageing persons. Croatia belonged to a group of countries concerned with a low population growth rate and its consequences for long-term human and socio-economic development. The dynamic components of its population growth were similar to that of western European countries. A specific feature of Croatia's population growth, however, was that for the last two decades it had roughly the same below replacement total fertility rate as many developed countries, yet it continued to be at a considerably lower level of economic and social development.

By itself, she said, that fact would not be alarming, but it did have important consequences for further ageing, increased dependency burden and loss of innovative capacity of the population. The declining population growth rate was the result of a steady decrease in the birth rate and a slightly rising death rate combined with a constant negative migration

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balance. The recent war had worsened all population components and structures; it had caused a natural decrease of population, the direct loss of human life, and a great number of displaced persons and refugees.

The age structure of the population was also deteriorating, she said. The population projections for the year 2021, excluding the migration component, showed a total population decline of 7 per cent, a decline in the population of the young by 17 per cent, a decline in the population of working age of 12 per cent and an increase in the ageing segment of the population by 28 per cent. Ageing in the next decade would increase, thereby putting more pressure on pension funds, health care and other social services.

Recent demographic trends and the general conditions of sustainable development in Croatia were slowly improving, but the rate of population reproduction was still well below replacement level. The process of depopulation and progressive ageing would increase into the foreseeable future. For future population development, the crucial issue would be the extent and direction of migration flows. Under the present conditions of unemployment, low income, housing problems and other economic and, social and financial constraints, it would be difficult to reduce the outmigration of younger and educated people and markedly improve overall demographic trends. Faster economic growth and better social services would stabilize the situation.

Those were the challenges her country was facing in implementing the national population policy, she said. Population rehabilitation and its social integration were a strategic priority of the country's overall development. In view of the numerous unfavourable population changes, the Parliament adopted in 1996 a national demographic development programme, aimed at reviving population growth and making more balanced the spatial distribution of population. It would attempt to reverse outmigration and stimulate returns from abroad. The urgent task was to return displaced persons and refugees to their homes. Towards that end, Croatia needed international assistance which, although promised, was still being awaited.

AURELIO FERNANDEZ (Spain), speaking in his capacity as the Chairman of the Commission for Social Development, discussed the work of the Commission's last session. He said a major topic of discussion was social services for all, which had been taken up at the Copenhagen Conference. Particularly, discussions centred on providing access for social services to the most neglected groups. The Commission adopted a set of agreed conclusions on that topic and delegates agreed on the need to strengthen the commitment in regard to social services for all. There were also discussions on how to bring social services up to date and in line with the Copenhagen goals.

Another important topic of discussion during the Commission's session was coordination with other functional commissions reporting to the Economic

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and Social Council, he said. It was agreed that further work was needed in that regard and common issues in the Cairo and Copenhagen platforms should be stressed. There were currently three review processes going on at the United Nations -- Cairo, Copenhagen and Beijing -- and coordination was needed in order to make those processes effective and efficient.

GUSTAVO LOPEZ OSPINA, of the United Nations Educational, Scientific and Cultural Organization (UNESCO), said the organization was keenly aware of the fact that its actions could only complement the various efforts by Member States. Five years after the Cairo Conference was a relevant opportunity for serious analysis of the concrete role of education in the implementation of the Programme of Action. For that reason, the Director-General of UNESCO had prepared a special monograph on the subject, as the organization's contribution to the five-year review.

He said that education, of course, was more than schooling. It included all efforts aimed at conveying knowledge and know-how, shaping attitudes, values and behaviours, and teaching skills, techniques and procedures, both in school and out. The Action Programme had emphasized the importance of achieving universal access to quality education, with particular priority being given to primary and secondary technical education and job training; to combat illiteracy and to eliminate gender disparities. Those goals were far from being achieved. In particular, progress in closing the gender gap -- a factor of critical importance in accelerating the demographic transition -- had been excruciatingly slow.

The education of women was particularly important to maternal and child mortality and morbidity, he said. Indeed, it was among the most effective means of eroding traditional attitudes and creating more egalitarian values. Education influenced the number of children parents desired, the measures they took to achieve family planning. Education played a critical and multifaceted role in development, which was why UNESCO's educational priority over the last five years had been the promotion of access to all levels of education, as well as improvement of its quality and relevance.

Continuing, he said that population education programmes provided a setting for developing and testing methods and materials, and responding to adolescents' reproductive health needs. In that context, UNESCO was promoting preventive education as one of the best means of combating HIV/AIDS and drug abuse. In the past five years, it had been working towards managing the relationship between population resources, environment and development, and enhancing the full participation of all relevant groups, especially women and youth.

JAIRO MONTOYA (Colombia) said that important progress had been made since the Cairo Conference, in terms of population structure, gender issues, reproductive health and international partnerships, but a renewed political

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commitment was needed in order to overcome different constraints in the financial, institutional and human resources fields. Of particular importance was the revitalization of international cooperation as a fundamental component of population policies, and domestic efforts, including the active participation of civil society.

He said that priorities for further implementation should include intensified efforts for appropriate linkages between population and other dimensions of development, in particular poverty alleviation, international migration, environmental preservation and sustainable resource management. A positive world economic environment was a necessary prelude to overcoming the recent financial turmoil, continued declining commodity prices, growing gaps in income distribution and the social consequences derived from natural disasters.

He said that efforts in the area migration should be based on safeguarding migrants' basic human rights. Resources and international support should be channelled into the design and implementation of policies aimed at addressing the special needs of the elderly, with specific measures for older and poor women. Measures to eradicate all forms of violence against women and children should also be promoted. Likewise, international assistance should be geared towards supporting the capacity-building efforts of developing countries in their efforts at ensuring reproductive health programmes.

Other priorities including monitoring market functioning and prices formation with regard to medications demanded by developing countries to address HIV/AIDS and STDs, he said. Mobilizing external funding was also necessary to fully realize the vast potential of South-South cooperation in the population field. Reversing the negative trend in ODA was an essential perquisite for achieving the minimum target of 4 per cent of ODA for population activities. Similarly, increasing voluntary contributions to UNFPA should help countries meet their population and reproductive health goals.

SHIN SAKURAI, Asian Forum of Parliamentarians on Population and Development, said the issue of population lied at the heart of all other global issues. The Forum called on governments to increase budget allocation to the problems of population. Members also decided to work to enact laws in their own countries to promote effective population policies. In addition, it was concerned about the shortage of food and freshwater resources, which were essential to support human life. That shortage was threatening man's very existence. Any commitment to population, therefore, must be made within the context of the global environment, food and water resources. The Forum called on the United Nations members and specialized agencies to draw together their wisdom to solve population problems so that the world's children may inherit a healthy planet.

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ANITA RAHAMAN, Center for Reproductive Law and Policy, said reproductive rights was a broad concept implying the link between reproductive rights, equality and empowerment. Such rights often meant the difference between life and death for millions of the world's women. Coercion had no place in reproductive rights programmes and all practices that did not allow women to make full, informed decisions regarding their reproductive function should be rejected. There was a human right to safe motherhood as well as to have control over the number and frequency of children. Also, women's rights clearly encompassed the right to have access to emergency contraception. It was not a form of abortion because abortion terminates pregnancy while emergency contraception prevents pregnancy. Emergency contraception must be made available to women, especially those forced to have sex against their will. In that regard, high quality and safe abortion services should be in place for those women who were permitted by law to have an abortion. The Center also recommend the termination of laws that make abortion illegal.

LAURENCE O'CONNELL, Park Ridge Center for the Study of Health, Faith and Ethics, said religious practice had a crucial impact on population and other policies. Religious ideology had been used to rationalize abusive policies and practices throughout the world. It was important to realize the real power of religion and its capacity to uphold or undermine the Cairo process. It was also essential that the vast diversity of religious opinion had equal hearing in the ICPD review process.

WOUTER MEIJER, World Population Foundation, said a youth and NGO forum immediately preceded The Hague Forum last month. About 800 NGO representatives participated, including many young people and government ministers. Among the items discusses were: partnerships between governments and NGOs; the importance of financial resources for development; and the relationship between population, development and the environment. A set of agreed conclusions were adopted on those issues and presented at The Hague Forum. The international community was now realizing the importance of NGOs and governments working together to promote development and there was a new opportunity to reaffirm that in the ICPD review process.

FRANCES KISSLING, Catholics for a Free Choice, said her organization enjoyed strong support among the world's nearly 1 billion Catholics. Many Catholics supported fully the goals of the Cairo Conference, particularly the respect given to marginalized groups such as the poor and women. All women had a right to health care and sanitary living conditions and their rights should continue to be considered human rights. Her organization respected a women's right to reproductive health and the moral right to follow one's conscience on the difficult decision of abortion. Catholics for a Free Choice stood in support of all those women who faced unsafe or unsanitary conditions and risked their lives because local laws prohibited abortions.

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