Commission on Population and Development

Forty-third Session

6^th & 7^th Meetings (AM & PM)

Despite Drops in Mortality, Rise in Life Expectancy, Efforts to Combat HIV/AIDS

Have Not Profoundly Altered Course of Epidemic, Population Commission Told

Prevalence of HIV among Young Women in Southern Africa Three Times Greater

Than Men, While Unequal Power Relations Impede Women’s Access to Health Care

While mortality had declined and life expectancy had risen across the world ‑‑ trends underpinned by a shift in the “disease burden” from communicable to non-communicable diseases –- the HIV pandemic had halted progress and, in some regions, reversed it, health experts told the Commission on Population and Development today, as it continued its general debate.

In Southern Africa, the hardest-hit by HIV, several countries had registered dramatic declines in life expectancy, said Marine Davtyan of the Joint United Nations Programme on HIV/AIDS (UNAIDS).  Worldwide, 2 million deaths were due to AIDS-related illnesses.  People receiving antiretroviral treatment had increased 10-fold between 2003 and 2008, but despite its expanded use, particularly in low- and middle-income countries, more than half of all people still could not access it.

Equally worrisome, she said, was that progress made had not profoundly altered the course of the epidemic:  for every two persons starting antiretroviral treatment, five more were becoming infected.  The AIDS response must be leveraged with efforts to achieve other Millennium Development Goals, and vice versa.  “These synergies can -– and must -— be fully leveraged,” she said.

Forcefully echoing that call, Swaziland’s delegate said her country was in the “unenviable” position of having the highest HIV-prevalence in the world.  Population growth had declined significantly in the last 10 years, owing to HIV/AIDS related mortality.  The maternal mortality ratio had doubled, from 229 per 100,000 live births in 1995 to 589 in 2007, due to HIV-related complications.  Forty-two per cent of women receiving antenatal care were HIV-positive.  A main challenge lay in dealing with the increased demand for health care.  More research money for HIV/AIDS and better coordination of HIV response and programme management were needed.

Indeed, prevalence among women aged 15 to 24 years in Southern Africa alone was three times higher than their male counterparts, said Gro Lindstad, Chief of Section, Intergovernmental Relations, United Nations Development Fund for Women (UNIFEM).  Worldwide, women represented 50 per cent of people living with HIV, and more than 60 per cent of HIV infections in Africa.  Their vulnerability stemmed from physiological factors, as well as the social, legal and economic disadvantages they confronted.

“Unequal power relations between men and women are a major obstacle for women and girls in accessing health care and support,” she said, adding that women often could not travel to access free treatment and care, and did not control household income, which lessened their ability to pay costs associated with access.  Health systems must be improved, women’s rights fully realized and their involvement in policy-making, planning and budgeting promoted.

Rounding out that point, Burkina Faso’s representative underscored that developing countries’ debt clearly created an unfortunate situation:  medicines were in the global North, while the sick people were in the South.  That situation must be remedied.

Such a scenario was set against the backdrop of an increased prevalence of non-communicable diseases -– diabetes, cancer and obesity among them -- whose financial, mortality and morbidity impacts were on the rise, many speakers stressed.

In a keynote address, Barry Popkin, Carla Smith Chamblee Distinguished Professor of Global Nutrition at the University of North Carolina, said diabetes symbolized the nature of the changes at hand, with half of all new cases estimated to come from India and China by 2030.  What was once a predominantly developed-world problem was now shifting into the developing world.

Obesity was also on the rise, with 1.5 billion more people overweight or facing that challenge in developing countries.  “We are becoming a very heavy world,” he said.  However, the politics of dealing with chronic obesity were complex.  From an economics point of view, price changes were effective in changing behaviour.   Denmark, for example, had placed a high tax on sugar-sweetened beverages, an idea that could be replicated globally to reduce the risk of diabetes and obesity.  But many countries had to first provide clean water before a ban or tax on caloric beverages could come into effect.

In other business, the Commission began discussion of item 5, on programme implementation and future programme of work of the Secretariat in the field of population.  The Assistant Director and Chief of the Population Studies Branch of the Population Division of the Department of Economic and Social Affairs (DESA) introduced two documents on the work of the Population Division (E/CN.9/2010/6 and E/CN.9/2010/7).  A representative of the Economic Commission for Latin America and the Caribbean (ECLAC) also presented the report of activities of the Latin American and Caribbean Demographic Centre (CELADE).

Participating in the discussion on the Division’s work programme were representatives of the United States, Belarus, Norway, Brazil, China, Cuba, and Israel.

The Director of the United Nations Population Division also spoke.

The representatives of Malta and Jamaica spoke in the general debate on national experience in population matters.  

Speakers from the United Nations University, United Nations Environment Programme, and the Food and Agriculture Organization also commented.

Representatives from the Economic and Social Commission for Asia and the Pacific (ESCAP) and the Economic Commission for Latin America and the Caribbean also spoke.

A representative of Partners in Population and Development also participated, as did speakers from the American Association of Retired Persons, International Planned Parenthood Federation, International Union for the Scientific Study of Population, International Women’s Health Coalition, National Right to Life Educational Trust Fund, World Population Foundation and Youth Coalition for Sexual and Reproductive Rights, Ipas, Global Helping to Advance Women and Children, and Endeavour Forum.

Brazil’s representative joined the interactive discussion following the Keynote address.

A speaker from the World Youth Alliance also spoke.

The Commission will reconvene at 10 a.m. on Thursday, 15 April, to hear an address by the President of the Economic and Social Council and to consider the contribution of population and development issues to the theme of that body’s Annual Ministerial Review in 2010.

Background

The Commission on Population and Development today continued its general debate on “national experience in population matters:  health, morbidity, mortality and development”.  The Commission, a functional body of the Economic and Social Council (ECOSOC), monitors, reviews and assesses the implementation of the Programme of Action of the International Conference on Population and Development at the national, regional and international levels, and advises the Council thereon.  Its forty-third session is being held from 12 to 16 April.  (For more information on the session, please see Press Release POP/979.)

DER LAURENT DABIRE ( Burkina Faso), endorsing the remarks made on behalf of the Group of 77 developing countries and China, as well as those made for the least developed countries, said the Millennium Development Goals could only be obtained when the goals of the Cairo Conference were met.  Towards that end, his Government had adopted a strategy on family planning.  Nevertheless, the general health situation in Burkina Faso was characterized by high mortality and morbidity due to the prevalence of lethal and water-borne diseases, as well as the HIV/AIDS epidemic.  Current programmes aimed to curtail the number of unwanted pregnancies and to reduce tobacco and alcohol abuse.  He cited, among other achievements, better vaccination coverage and reductions in the rate of excision of girls.

Yet, Burkina Faso still faced several challenges, he said, pointing to continued gaps in the provision of neonatal and obstetric services, family planning and programmes for the elderly.  Strategies that targeted teenagers in ways tailored to their circumstances were also needed.  Moreover, parents should be able to talk to their teenagers about sex.  Finally, he emphasized that the level of debt of developing countries clearly created an unfortunate situation:  the medicines were in the global North, while the sick people were in the South.  That situation must be remedied.

DUDUZILE DLAMINI (Swaziland), aligning herself with the statements of the Group of 77 and China and the African Group, said the Cairo Action Programme, and its strong emphasis on human rights, was as relevant today as when it was first crafted.  As long as large segments of her country’s people were marginalized, aspirations to reduce poverty would not be realized.  The Government had developed various policies, including Poverty Reduction Strategy Papers, national health and youth policies, but implementation remained a challenge, due to human and financial resource constraints.

A total population of 1.02 million represented a modest increase from 0.98 million in 1997, she said, pointing out that the population growth rate had declined in the past 10 years, owing to increased HIV/AIDS-related mortality.  The fertility rate had also dropped, from 6.4 in 1986 to 3.8 in 2007.  At the same time, maternal, child and infant mortality rates were increasing.  The maternal mortality ratio had doubled, from 229 per 100,000 live births in 1995 to 589 per 100,000 live births in 2007, due to HIV-related complications.  About 42 per cent of women receiving antenatal care were HIV-positive.

She said the country had made progress on Millennium Development Goal 4, on reducing child mortality, including by integrating reproductive health services into all levels of the health system; integrating prevention and treatment of sexually-transmitted infections (STIs) into health delivery; and increasing distribution of antiretroviral therapies.  Despite such successes, Swaziland was in the unenviable position of having the highest HIV-prevalence rate in the world.  Challenges included rising HIV infections; ensuring the sustainability of HIV/AIDS programmes; dealing with the increased demand for health care; and weak health facilities.  More research money for HIV/AIDS and better coordination of HIV response and programme management were needed.

SAVIOUR BORG (Malta) reaffirmed his country’s position that its interpretation of any positions taken or recommendations made with regard to sexual and reproductive health, rights, services and recommendations should be taken in the context of the Cairo Conference, its Programme of Action and the reservations made therein.  Turning to Malta’s public health care system, he said a basket of services were provided to all persons residing in Malta who were covered by the country’s social security legislation.  The country also provided for all necessary care to special groups, such as irregular immigrants and workers with valid work permits.  No user charges or co-payments applied except for a few special services such as elective dental procedures.  The private sector acted as a complementary mechanism for heath-care coverage, and it functioned independently of the State health service.   Malta had nearly achieved self-sufficiency in providing most tertiary care, and patients were only sent overseas in cases of rare diseases.  Universal coverage was also in place for long-term care.

Reiterating his country’s long-standing commitment to supporting initiatives aimed at reducing preventable maternal mortality, he underlined the Government’s desire to respect the dignity and rights of both the mother and the unborn child.   Malta was further committed to making high quality health care freely accessible to all mothers and infants before, during and after childbirth.  Consequently, maternal mortality was low, with only four maternal deaths between 1998 and 2007.  Moreover, all initiatives to improve maternal mortality and morbidity were considered, so long as they did not imply or lead to induced abortion, which was illegal in Malta.  In the face of changing demographics and the country’s ageing population, a revision and re-evaluation of the health status and needs of the population was required.  The Government was taking an incremental approach to health sector reform, which balanced its commitment to keeping health care free.

EASTON WILLIAMS (Jamaica), aligning himself with the Group of 77 and China, said the principles contained in the Cairo Action Programme had contributed significantly to legislative, institutional and programmatic realities in his country.  However, progress in implementation had not been consistent.  While some of the Cairo targets and Millennium Development Goals had been achieved, others risked not being realized.  Growth in gross domestic product (GDP) had remained low or negative over the past decade and, as a result, Jamaica had resumed a borrowing relationship with the International Monetary Fund (IMF).  Gains in social and human development could be compromised without international development assistance, which would help cushion the negative effects of impending structural adjustment programmes.

Despite that, Jamaica had made progress in its demographic transition, he said, noting that it was at the threshold of entering the “advanced stage”, characterized by large increases in the elderly population.  It had also made an epidemiological transition, from a predominantly infectious-disease profile to one characterized by chronic non-communicable diseases.  While on track to achieve universal access to reproductive health and reverse the spread of HIV/AIDS, the country lagged behind in targets relating to gender equality.  To achieve those goals, Jamaica would need substantial development assistance.  A major concern was the burden on health services created by morbid conditions resulting from intentional and unintentional injuries.  Deaths from motor vehicle accidents, gangs and drug-related violence consumed a large part of the annual health budget.  The Government had placed greater emphasis on primary health care and removing user fees from all public health institutions.  The HIV/AIDS prevalence rate had remained stable, at 1.5 per cent of the adult population since 2005.

GRO LINDSTAD, Chief of Section, Intergovernmental Relations, United Nations Development Fund for Women (UNIFEM), said HIV/AIDS was of particular concern, as HIV infection significantly increased the risk of maternal mortality and morbidity.  Women represented 50 per cent of people living with HIV worldwide, and more than 60 per cent of HIV infections in Africa.  In Southern Africa, prevalence among women aged 15 to 24 years was on average three times higher than among men of the same age.  Prevalence of 43 per cent in the Caribbean in 2007 was up from 37 per cent in 2001, and also up in Asia, from 19 per cent in 2000 to 35 per cent in 2008.  Antiretroviral therapy started in pregnancy could reverse the toll of HIV-related maternal mortality.  Women’s vulnerability to HIV stemmed, not only from their physiological susceptibility, but also from the social, legal and economic disadvantages they confronted.

“Unequal power relations between men and women are a major obstacle for women and girls in accessing health care and support,” she said, adding that women often could not travel distances to access free treatment and care, and did not control household income, which lessened their ability to pay costs associated with access, such as user fees.  It was necessary to develop and enhance implementation of national strategies to promote women’s advancement, encourage shared responsibility to prevent HIV, and eliminate the violence women and girls faced in the context of the pandemic.  While there was no “quick fix”, key actions could be taken to help stem prevalence among women and girls.  Health systems must be strengthened, women’s rights must be fully realized and greater involvement of women in policy-making, planning and budgeting must be promoted.

JYOTI SHANKAR SINGH, Permanent Observer to the United Nations of Partners in Population and Development, a South-South Initiative, expressed disappointment that support for family planning had declined from 55 per cent of international population assistance in 1995 to less than 5 per cent in 2008, even as allocations for HIV/AIDS programmes had grown several-fold during the same period.  While nobody would argue in favour of reducing support for HIV/AIDS programmes, he believed there was a clear case for a much larger allocation for family planning, in order to meet the unmet need for family planning and to support the integrated implementation of Millennium Development Goals 4, 5 and 6.

He also noted that many of the Partners in Population and Development members, especially those in Southern Asia and sub-Saharan Africa that had addressed the session, had reported on their continuing efforts to reduce maternal mortality and increase access to family planning and other reproductive health services.  Increased global support for such programmes would help them to accelerate progress towards achieving the Cairo Conference aims, as well as the Millennium Development Goals by 2015.  In that regard, he fully endorsed the appeal by Thoraya Obaid, Executive Director of the United Nations Population Fund (UNFPA) that countries double the funding for family planning and pregnancy-related care so Millennium Development Goal 5 could be achieved.

CORRINE WALLACE, of the United Nations University, said the provision of safe water was the key to global health, and drinking water, sanitation and sound hygiene played a critical role in achieving all of the Millennium Development Goals.  As one of the fundamental pillars of primary health care, access to safe water was also critical for child and maternal health.  Under changing global environmental scenarios, the global distribution of water was highly likely to also change in terms of how, when, where and how precipitation occurred.  That, in turn, would significantly impact food security, water quality and social capital ‑‑ all of which were drivers of health and development.  Attention, therefore, should be focused on building resilience, particularly for small, rural, remote or otherwise marginalized communities.  Education, access to electivity, diverse economic activities and cohesive communities all played a role in building that resilience.

Emphasizing the significant benefits to human health and well-being of safe water and sanitation, she said the United Nations University was advocating for a global commitment to provide 100 per cent coverage by 2025, at an annual cost of 0.002 percent of GDP from donor countries.  There was a particular need for the smart investment of those funds, specifically for initiatives that developed the market at the bottom of the pyramid and that facilitated local business development, since those efforts were not merely a question of providing safe water but of strengthening local economies.  Moreover, there was a moral, civil, political and economic need to bring sufficient sanitation to the global population in ways that were adequate for human health and the integrity of the ecosystem.

RICARDO SANCHEZ SOSA, Principal Officer, United Nations Environment Programme (UNEP), New York Office, acknowledged the significant drop in mortality and reduction in the incidence of infectious and parasitic diseases.  However, with improvements in nutrition, hygiene and infrastructure, and advances in vaccines and medical treatments -- the challenges remained formidable.  While it was known that environmental conditions had pervasive and multiple impacts on human health, it was also true that an estimated 60 per cent of the world’s ecosystems were degraded, compromising the health and life-sustaining services they provided.  Compounding those challenges were the health implications of climate change.  The United Nations Intergovernmental Panel on Climate Change predicted that the principal effects would be increased malnutrition, deaths, disease and injury due to extreme weather events; increased burden of diarrhoeal disease; higher concentrations of ground-level ozone; and altered spatial distribution of infectious disease transmission.

He said that UNEP, for its part, had made important contributions in the field of environmental health, both to practitioners, as well as to collaborative activities -– often with the World Health Organization (WHO).  Those had led to progress by, among other things, generating scientific research and addressing specific issues of vulnerable populations.  For instance, UNEP and WHO jointly implemented the Health and Environment Linkages Initiative, with a view to harnessing existing knowledge to make the case for linkage between the two sectors at the country level.  That initiative had demonstrated a management method for national ministries to make better use of available evidence, through linked assessments and health and environment impacts, and costs and benefits, which supported evidence-based economic development policies.  At the regional level, UNEP and WHO had worked to support ministerial processes.  As another example of UNEP’s inputs, he pointed to the GEO-Health project, under which the agency and the Pan-American Health Organization (PAHO) had worked together to integrate environment and health assessments.

LILA RATSIFANDRIHAMANANA, Director, Food and Agriculture Organization (FAO) Liaison Office with the United Nations, New York, said her agency was fully aware of the devastating impact that poor health was having on human development in a growing number of countries.  Morbidity and mortality also constituted particularly serious threats to agricultural production and the food security of millions of people around the globe.

She said that as Governments took stock of the progress towards achieving the Millennium Development Goals, more attention should be given to the fundamental connection between health and food security.  FAO estimated that the total number of undernourished people in the world had now reached 1.02 billion.  By 2050 the world’s population would reach 9.1 billion, an increase of more than 30 per cent from today.  In order to feed that larger, more urban and richer global population, FAO estimated that food production had to increase by 70 per cent.  Efforts to raise agricultural productivity would require massive investment in rural infrastructure, increased skills among food producers and operators, and the construction of effective food safety systems. 

Urging that food safety policies needed to aim at achieving the highest possible levels of protection for human health and consumers’ interests, she stated that the close link between human health, agriculture and development presented several opportunities to foster intersectoral collaboration.  FAO was convinced that nutrition and food security were critical elements of public health and central components of human, social, and economic development.  It was fully committed to addressing those linkages in its areas of competence.

In his statement on behalf of the Economic and Social Commission for Asia and the Pacific (ESCAP), SRINIVAS TATA, reiterating a point stressed by many speakers previously, said that despite good overall progress on reducing poverty in the region, progress on health-related Millennium Development Goals and Cairo Conference goals had been slow and variable.  A large part was due to inadequate public investment in health systems, which resulted in poor infrastructure, inadequate human resources and high out-of-pocket expenditures on health care.  In many countries in the region, those high health care costs were a significant cause of impoverishment.

He said that no matter how good the infrastructure and human resources, the full value of increased and full public investment in health could only be realized if the economic, social and cultural barriers to accessing health care were addressed.  In an increasingly globalized world, with large-scale internal and international migration and booming tourism, health systems were increasingly acquiring cross-border dimensions.  Issues such as disease surveillance, ensuring affordable access to drugs, and even human resources utilization were becoming cross-border concerns.  There was a growing realization in the region that building strong health systems in one country could not protect the health of the citizens if the neighbouring country was not also protected.  Clearly, one could protect the health of citizens in the long-term only if the lives of the people living in the region were also protected.

That amplified the need for cooperation on a global, regional and subregional basis, he explained, noting that that new reality was already evident in the way the world came together to fight the threat of H1N1.  He added:  “This is only the beginning and much more needs to be done.  As the regional arm of the United Nations in the Asia-Pacific, ESCAP is committed to working closely with all [United Nations] agencies at the regional level, to implement the mandates given by the Member Sates through the resolutions adopted at this session of the Commission on Population and Development”.

PAULO SAAD, Director, Latin American and Caribbean Demographic Centre, Population Division, Economic Commission for Latin America and the Caribbean (ECLAC), said that ageing in Latin America and the Caribbean had been accompanied by increased prevalence of chronic and degenerative diseases.  At the same time, a significant portion of the population continued to die from infectious and parasitic diseases.  That double burden posed serious challenges to regional health-care systems.  In view of that, a background study detailed the region’s situation in terms of health, sexual and reproductive health, and mortality, and examined achievements as measured by established goals.  Three considerations were proposed to guide policy:  the need to strengthen universal primary health care; to eliminate inequalities in health services access; and to gradually create and enact human rights-based legislation.

He said that in some countries, the risk of dying before the first year of life was almost three times higher in rural than urban areas, and up to four times higher among indigenous children than among non-indigenous children.  Children in the richest quintile had access to medical care for acute respiratory disease twice that of those in the poorest quintile.  The study identified emerging issues including, among others, ageing and its implications for health-care demand, and residential segregation in urban areas.  Consideration of such trends in health cost projections indicated that regional countries would require a substantial increase in health spending as a percentage of GDP over the next three decades.  The study concluded with the notion that the risk of stagnation or decline in progress towards equal access to health care, including for sexual and reproductive health, could be exacerbated in the context of the current crisis.  As such, social and economic policies to address the crisis should focus on increasing public health spending, extending coverage of transfer programmes and strengthening “solidarity” components of social protection systems.

MARINE DAVTYAN, Joint United Nations Programme on HIV/AIDS (UNAIDS), said the HIV pandemic had halted, and in some regions, reversed progress made in reducing mortality and morbidity.  Some 2 million deaths worldwide were due to AIDS-related illnesses.  While life expectancy had increased tremendously in many regions, in Southern Africa, the hardest-hit by HIV, several countries had registered dramatic declines.  HIV had had a disproportionate impact on women and girls, and was the leading cause of death among women of reproductive age worldwide.  As of December 2008, an estimated 33.4 million people were living with HIV.  People receiving antiretroviral treatment increased 10-fold between 2003 and 2008, slowing HIV-related mortality, which had peaked in 2004.  The expansion of antiretroviral treatment in low- and middle-income countries was a major achievement in modern global health history, but despite its increased use, more than half of all people still could not access it.

She said it was equally worrisome that progress made had not profoundly altered the course of the epidemic:  for every two persons starting antiretroviral treatment, five more were becoming infected.  Stigma and a lack of human rights undermined efforts to achieve universal access to HIV prevention, treatment, care and support.  The AIDS response must be leveraged with efforts to achieve other Millennium Development Goals, and, in turn, progress in the Goals would help move a multisectoral response to AIDS.  By way of example, he said reducing HIV infections and providing treatment helped reduce poverty and hunger (Goal 1), while efforts to promote gender equality (Goal 3) were essential in reducing the vulnerability of women and girls to HIV infection.  “These synergies can -– and must -— be fully leveraged,” she said.

LOIS GAETA, of the American Association of Retired Persons, said the association had, since its founding in 1958, served as a source of information on ageing populations, including how it impacted global health concerns.  It strove to strengthen the network of policy leaders and advocates who believed that people should age with dignity, and it worked towards that goal.  Today, the world was ageing rapidly.  By 2040, older people would outnumber children for the first time in history.  Despite life expectancy gaps between developed and developing countries, the populations of several developing countries were poised to age rapidly -– in some cases, five-fold.  Coincident with that trend was the rapid urbanization of global populations.  The implications of that dual aging and urbanization were immense.  Indeed, life expectancy could be 35 years where urban governance was poor and over 70 where it was best.

Although global life expectancy was at unprecedented levels, she said that in too many cases older people still did not receive appropriate health care because of their age.  Treatment could be denied or provided in a discriminatory manner.  That must change, she said, underlining how international demographic trends presented challenges to people of all ages.  Indeed, addressing the needs of older persons would allow them to contribute to the well-being of their societies.  It was important to invest the benefits to all society that accrued from improving the medical care of the elderly.  She said the health insurance reform signed into law in the United States in March 2010 had brought new hope for improvements in the care of older Americans.  Her association supported all efforts by States to improve provision of primary care to all citizens and particularly the elderly. 

MIRELLISE VAZQUEZ, of the International Planned Parenthood Federation, said pregnancy and childbirth claimed the lives of 536,000 women annually and was the leading cause of death for girls aged 15 to 19.  The adult lifetime risk of maternal death in Africa was 1 in 26, while in developed countries, it was 1 in 7,300.  Yet, the non-fatal consequences of pregnancy and childbirth were frequently overlooked:  current estimates suggested that more than 54 million women worldwide suffered from diseases or complications during pregnancy and childbirth, including complications from unsafe abortion.  Moreover, WHO estimated that poor sexual reproductive health accounted for up to 18 per cent of the global disease burden, including 32 per cent of the total disease burden of women of reproductive age.  Poor sexual and reproductive health also perpetuated poverty by affecting those in the prime of their economically productive lives.  Indeed, family members with HIV/AIDS often curbed a woman’s ability by forcing her to be an unpaid caregiver rather than participating in economic activities.

She said family planning was, along with emergency obstetric care and skilled attendants, one of three pillars of maternal health.  The benefits of family planning for a woman and her family’s health made it one of the most successful and cost-effective international development stories.  Still, some 215 million women -– the vast majority of them in developing countries -– did not have access to contraception.  If that need was met, 52 million unintended pregnancies would be avoided.  Contraception fundamentally enabled women to reduce the number of pregnancies experienced in a lifetime, thus reducing women’s morbidity and mortality.  It also prevented unsafe abortions, which account for 13 per cent of women’s morbidity.  She further underlined how gender-based violence increased morbidity and was a key risk factor for HIV/AIDS.  The target of providing universal access to reproductive health by 2015 was unachievable in light of the fact that funding for family planning had been nearly halved from 1995 to 2007.  Without significant increases in financial and political support for family planning, maternal health and safe abortion services, the Millennium Development Goals on maternal and child health and gender equality would be limited.

PETER MACDONALD, President of the International Union for the Scientific Study of Population, said the twenty-sixth International Population Conference, held in 2009 in Morocco, had been the most successful thus far, attracting nearly 2,000 participants and offering a chance to discuss cutting-edge research.  The twenty-seventh Conference would be held in the Republic of Korea in 2013.  In addition to organizing conferences, the International Union had a programme of research activities conducted through scientific panels, which would hold some 30 meetings between 2010 and 2013.  Eduardo Rios-Neto, a member of the Commission’s Bureau, had agreed to chair a new panel on “New Challenges in Population and Development”, which would be useful for the Commission’s future work.  The organization also had started a project to improve demographic analysis via a web-based platform for disseminating training materials, which aimed to support analysts of the 2010 round of censuses in developing nations.

NEHA SOOD, of International Women’s Health Coalition, said that every year, more than half a million women died and an untold number suffered temporary or long-term disabilities from preventable pregnancy-related causes and complications during childbirth.  The majority of maternal deaths worldwide were due to haemorrhage, infections, unsafe abortion, eclampsia and obstructed labour.  The provision of high-quality reproductive health services, including ante-natal care, skilled attendants at delivery, emergency obstetric services and post-natal care, could prevent most of those deaths.  Those services must be provided as one element of the comprehensive sexual and reproductive health package needed to curb maternal mortality.

Saving women’s lives also required a functioning health system to deliver that package of sexual and reproductive health services, she said, stressing that single, targeted interventions were necessary, but not sufficient for reducing deaths and injuries related to pregnancy and childbirth.  Investments must be made in women’s health and in youth and human rights organizations to advocate for comprehensive sexual and reproductive health services and to hold Governments accountable for providing them.  Similarly, building community support and demand for comprehensive education could also provide the basis for high-quality and affordable reproductive health care.  Efforts to strengthen the weakest health-care systems should be the priority.  The connections between procedural human rights obligations and maternal health must also be recognized as another crucial aspect of providing comprehensive reproductive health care.

JEANNE E. HEAD, National Right to Life Educational Trust Fund, said her organization viewed a woman’s life as a continuum deserving compassionate protection and support from her conception to the end of her lifecycle.  She pleaded with delegations to direct greater resources and emphasis to improving health care in the developing world, particularly maternal health.  She noted that WHO had been saying until yesterday that the world’s goal of reducing maternal morality had not been met.  Indeed, despite today’s reports in the Lancet that global maternal deaths had dropped, the world had failed to reach the goals set in Cairo because they were directed towards decreasing the number of children delivered rather than making the delivery of their children safe. 

Expressing further grave concern over “false and dangerous” claims that the way to reduce maternal mortality in the developing world was to legalize abortion, she said the lack of modern medicine and quality health care, and not the ban on abortion, led to high maternal mortality rates.  Legalized abortion actually led to more abortions.  In the developing world, where maternal health care was poor, legalization would only increase the number of women who died or were harmed by abortion.  In fact, legal abortion did not mean safe abortion; evidence showed that a country’s maternal mortality rate was determined to a much greater extent by the quality of medical care than by the legal status of abortion.  Abortion complications were not a function of the procedure’s legality, but by the overall medical circumstances in which it was performed.  Moreover, nations with a strong abortion restriction actually had lower maternal death rates than countries that permitted them on demand.  The key, therefore, to reducing maternal rates from all causes, including abortion, was improved maternal health care, and not legalized abortion.  It was also important to remember that abortion had been rejected as a fundamental right or as a method of family planning by the Cairo Conference.

Keynote address

BARRY POPKIN, Carla Smith Chamblee Distinguished Professor of Global Nutrition at the University of North Carolina, speaking on “Global and Economic Health Change:  Problems and Solutions”, said there had been a shift in the causes of morbidity and mortality, marked by an increased prevalence of non-communicable disease.  Diabetes symbolized the nature of the changes, with half of all new cases estimated to come from India and China by 2030.  The problem had shifted from the developed to the developing world, and countries where diabetes posed great concern were in the Middle East, North Africa and Central Asia, home to 98 per cent of cases in the coming years.  “We need to find ways to give people healthier diets,” he said, or people would live longer but would be increasingly disabled.

Related to that, obesity was on the rise, he said.  Developing countries had seen an increase of 1.5 billion people who were overweight or facing that challenge.  Indeed, modern technology afforded cheap food and sugar, and options for maintaining a sedentary lifestyle.  There were more than 30 countries where over half of the adult population was overweight. In a decade, that number would increase to 45 to 50 countries. “We are becoming a very heavy world,” he said.  In the last five to seven years, the rate of change was higher in rural than in urban areas.

What were the implications of eating food and drinking water on the energy balance? he asked.  In the past 40 to 50 years, the world had shifted en masse from drinking water to caloric beverages, a main source of weight increase.  A British study found that education alone reduced caloric beverage consumption and led to an 8 per cent difference in the prevalence of overweight.  Another study of 20,000 families in China showed a tripling of snacking from 2004 to 2006.

Among the culprits was vegetable oil, he explained.  All countries in Asia, Africa and the Middle East had seen a doubling, tripling or quadrupling in its use.  It was cheap and getting cheaper, and prices mattered.  Also, more people were consuming meat and poultry in low- and middle-income countries.  In recent decades, global beef prices had dropped, which added to a shift in diet.  Another factor was global inactivity, in both urban and rural areas.  Technology had changed how people lived and moved.  That would not change, nor should it, and countries had to look to food changes to help solve problems of diabetes, cancer and obesity.

However, he pointed out that the politics of dealing with chronic obesity were complex, and England provided the best example of how to tackle the problem.  The Government had held meetings with a range of actors, including with the food industry, to develop consensus programmes for measuring and weighing children, banning television junk food ads aimed at children under age 16, labelling food products, promoting activity, and importantly, funding the installation of kitchens in schools to teach 12-year olds how to cook.  Elsewhere, many European countries had banned soft drinks in schools, while others had replaced whole milk with reduced-fat milk.

Turning to the food system, he said the mentality of food production had greatly affected peoples’ lives.  After the Second World War, trillions of dollars had been spent to create an agricultural system focused on producing grain. Today, 30 to 40 per cent of plant food was used for animal feed, which would create problems as the global population increased.  It was becoming cheaper to buy dairy, beef and poultry than legumes.  Sugar had been subsidized for the last century.

From an economics point of view, price changes were effective in changing behaviour.   Denmark, for example, had placed a high tax on sugar-sweetened beverages, an idea that could be replicated globally to reduce the risk of diabetes and obesity.  Many countries, however, had to provide clean water first before a ban or tax on caloric beverages could come into effect.

In closing, he pointed out that the global food industry was not as omnipresent as people believed.  In almost all countries, at least 50 to 60 per cent of all processed foods were locally produced.  Large producers were willing to make changes, but without Government regulation, meaningful agreements would not be possible.

Interactive Discussion

When the floor was opened for questions, the representative of Brazil asked about the difficulty of changing tastes.  To that end, he noted how in his country, people, especially the poor, said “I don’t take sugar with my coffee, I take coffee with my sugar.”  When asked about that, people explained that life was bitter enough.  Their coffee should be sweet.

In terms of economics, he said the emphasis on price in presentation made sense, but he wondered about the effect of income on food quality.  In Brazil, people moved from bad quality meat to higher-quality meat as soon as they increased their income.  During Brazil’s stabilization period, being able to eat chicken more than once a week became quite an achievement.  What was behind that kind of taste formation and how could it be changed?

Responding, Mr. POPKIN said that, as some of the world’s biggest sugar producers, Brazilians clearly loved it.  Tastes certainly mattered, but it was also true that when sugar was very cheap, it was put in most processed foods.  A survey of any supermarket today showed that sugar was used, not just in flavouring, but in processing food, and that nearly two thirds of the food in any store contained sugar.  Globally, sugar consumption per capita was increasing every decade.  Even in China, where sugar had never been a part of the diet, its consumption was now exploding.

Despite that, it was clear that tastes could change and had in some countries, he went on.  For example, obesity was being cut in places like the United Kingdom, Singapore and Mauritius.  While it was a global truth that as incomes rose, the desire for higher quality food increased, the important question was whether that trend would continue indefinitely.  It was also clear that when prices changed, people’s behaviour changed.  In that respect, he noted that when beef prices rose, people ate horse meat. 

A representative from the World Youth Alliance, expressing support for the ban on junk food in schools, asked whether there were regulations on the kind of oil used in foods or rules that required the provision of the calorie content of foods.

Mr. POPKIN said regulations were very complex, and only a few countries provided those types of rules to measurable effect.  In his view, it was not a matter just of junk food or even considering how and what food was provided in schools.  Certainly, the complexities involved in both scenarios had to be considered, but the discussion should be conducted at the community, state and national levels.  Indeed, if countries did not start talking about caloric consumption, the rate of diabetes would explode.

Statements

IVENS REYNER, speaking on behalf of the World Population Foundation and Youth Coalition for Sexual and Reproductive Rights, said the commitment in the Cairo Programme of Action to making sexual and reproductive health services and education available to adolescents and young people had not been met.  Young women commonly faced obstacles in accessing contraceptives.  Every year, approximately 16 million adolescent girls gave birth, representing nearly 11 per cent of births worldwide.  Young women aged 15 to 19 also accounted for at least one fourth of the estimated 20 million unsafe abortions and nearly 70,000 abortion-related deaths each year.  Moreover, 2.5 million unsafe abortions occurred among women younger than 20 years of age in developing countries, accounting for 14 per cent of all unsafe abortions in those nations.  Despite trends towards later marriage, over the next 10 years, more than 100 million young women would be married before age 18.  Several laws still existed that required young women to have written consent from their parents or husband in order to access HIV testing, contraceptive services or safe abortion are.

To improve that situation, he said health and reproductive information, services and supplies must be provided and service providers should be trained on their provision.  Legal and social barriers to access must be removed and States must provide comprehensive sex education to schoolchildren, adolescents and young people, especially girls and young women.  States must also involve, empower and equip young people to participate in planning, developing, monitoring and evaluating sexual and reproductive health programmes and services.

KARI POINTS delivered a joint statement on behalf of her organization, Ipas, as well as on behalf of the following organizations:  Catholics for Choice; the Center for Reproductive Rights; Human Rights Watch; Irish Family Planning Association; Population Action International; Red Activas in Spain; RFSU in Sweden; World Population Foundation; and Youth Coalition.  She said that most women who died from unsafe abortions were resource-poor and had been denied the ability to make decisions about their health and lives.  The women most harmed by lack of access to safe reproductive choices were those without financial means or social connections; they were poor, young, HIV-positive, survivors of sexual violence, refugees or otherwise vulnerable.

She said that when women were able to make safe reproductive choices, they could take better advantage of opportunities for education and employment.  Economic class clearly affected reproductive and sexual health; higher-income women more consistently used contraception, were better able to negotiate circumstances of sex, and had better access than poor women to health services, including safe abortion, regardless of its legal status.  She believed legalizing abortion could decrease financial barriers to health care, including by reducing the prevalence of black-market services, which were often exorbitantly priced.  Also, making safe, elective abortion widely available could dramatically reduce costs associated with managing complications of unsafe abortion.

Unsafe abortion, she asserted, was one of the easiest causes of maternal mortality and morbidity to address, through improved access to family planning information and services, high-quality post abortion care, and safe, legal abortion.  Meeting Millennium Development Goal 5 on maternal mortality and achieving universal access to reproductive health care could only be met if unsafe abortion was fully and effectively addressed in that way, she added.

SHARON SLATER, President, Global Helping to Advance Women and Children, drew attention to the Commission’s deliberations of last year when a proposal had been made to call Governments in its annual resolution to provide “comprehensive education on human sexuality”.  That new, undefined term was a departure from the traditional “sex education” language used in past United Nations consensus documents, she said.  A few months later, the United Nations Educational, Scientific and Cultural Organization (UNESCO), in cooperation with the United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), WHO and UNAIDS related a draft copy of its new “International Guidelines on Comprehensive Sexuality Education”.  Those extremely controversial guidelines, which had been created to drive sexuality education worldwide, promoted a theme of sexual pleasure that had been found in a number of sex education guides published by the United Nations.

Describing a number of other manuals for children and youth that were published by the United Nations or provided at United Nations events, she said many of the details were “too graphic to repeat in a forum such as this”.  Worse, one booklet, published by the International Planned Parenthood Foundation and made available at a side event during this year’s Commission on the Status of Women, told HIV-infected youth that laws requiring them to disclose their status with their sexual partners violated their human rights.  That should not be tolerated at the United Nations or anywhere else, she said, asking why the draft document currently being negotiated included numerous references to sexuality and sexual rights.  Why was the issue of abortion, disguised under multiple euphemistic terms, also being forced on developing nations against their will?  That push for sexual rights undermined the institution of the family, which the Universal Declaration of Human Rights said was “the natural and fundamental unit of society”.  She called on Member States and United Nations agencies to cease the promotion of abortion and sexual rights through the United Nations.

DENISE MOUNTENAY, Endeavour Forum, focusing on unsafe abortions, discussed the little progress made in reducing maternal mortality.  United Nations delegates had quoted “huge horrendous” numbers of annual maternal mortality.  In August 2009, International Planned Parenthood had acknowledged the surge in maternal deaths in South Africa, a portion of which were due to complications from legal induced abortions.  Guyana had a maternal morality rate 30 times higher than Chile, whose Constitution protected unborn children and was the country with the lowest maternal mortality rate in South America.  Conversely, Nepal had no restrictions on abortions, and the region’s highest maternal mortality rates.

She said that “legal” abortion did not equal “safe” abortion -- abortion was never safe for the living baby inside the womb.  Article 3 of the Universal Declaration on Human Rights stated that everyone had the right to life, liberty and security of person, while the Convention on the Rights of the Child said that the child needed special safeguards and care, including legal protection, before and after birth.  Women in developing nations needed access to sanitary medical services, clean birthing kits, skilled birthing doctors, and access to both basic and emergency obstetric care.  Governments must invest in essential obstetric care that valued both the lives of mother and child.  Abortion was a violent form of birth control.

Introduction of Report

THOMAS BUETTNER, Assistant Director, and Chief of the Population Studies Branch of the Population Division of the Department of Economic and Social Affairs (DESA), in his introduction of two documents on the work of the Population Division of DESA (documents E/CN.9/2010/6 and E/CN.9/2010/7), said the overall objective of the subprogramme on population was “to enable the international community to better understand and effectively address current and foreseeable population issues and population dimensions of development at the national and international levels”.  In order to meet that objective, the strategic framework for 2008-2009 identified three accomplishments for the subprogramme, the first of which was to effectively facilitate the review by Member States of progress made in the implementation of the Cairo Action Programme and the outcome of the twenty-first special session of the General Assembly.

The second, he said, was to enhance awareness of new and emerging population issues and to increase knowledge and understanding at the national level, particularly in the areas of fertility, mortality, migration, HIV/AIDS, urbanization, population growth and population ageing.  The third was to improve the accessibility and timeliness of population information and data for use by Member States, civil society and academia.  In order to raise awareness about population issues, the Population Division had been producing newsletters, briefs and fact sheets which allowed the rapid dissemination of findings about current or emerging issues.  In addition, the Division continued to prepare a number of in-depth and comprehensive reports.  They included recurring publications such as World Population Ageing, World population Prospects:  The 2008 Revision, and World Population Policies:  The 2009 Revision, each of which presented a global review of the latest information available on a general topic.

He stressed that because a major part of the output of the Population Division’s work involved the preparation of estimates and projections of population indicators and because users of that information usually wished or needed to manipulate them further for analytical purposes, an essential means of dissemination of such information was in electronic format, either through databases accessible online or through CD-ROMs containing files in Excel format.  Also, as part of its programme on technical cooperation, the Population Division continued to support the development of the web-based multilingual demographic encyclopaedia, “Demopaedia”, which enabled collaborative work across borders in different languages, he added.

Statements

PETER O. WAY ( United States) said the Population Division continued to play an absolutely essential role as a source of policy-neutral expertise, producing analytical reports, compendia of data and policies, and other information products that were widely used by policymakers, programme planners, technical experts in Government and academia and the general public.  Its products represented definitive international references on a wide range of population-related topics.  It had also organized an Expert Group Meeting on Recent and Future Trends in Fertility, at which innovative approaches to techniques for fertility projections were explored.  The United States delegation looked forward to that meeting’s report and indications from the Population Division on what changes, if any, it was making to its methods in producing fertility projections. It also looked forward to the report from the Expert Group Meeting on Health, Mortality and Development, which had been organized by the Population Division last year.

While commending the Population Division for its work on international migration, he noted that its current updated data set covered less than 15 per cent of the world’s countries.  He hoped that that was due merely to the state of data available rather than to the Division’s work.  Referring to the new version of the World Population Prospects, which was released every two years, he expressed further hope that annual and single-year age data would be issued as direct outputs in future releases.  He also noted the continued work on the in-house demographic database, which would hopefully support and enable more detailed demographic projections in coming years.  Turning to the Proposed Strategic Framework for the period 2012-2013, presented in the Secretary-General’s note, he highlighted the conformity between the Secretariat’s expected accomplishments and the performance indicators on one hand and the list of expected outputs on the other. 

IGOR MISHKORUDNY ( Belarus) welcomed the activities of the Secretariat in implementing the programme of work in 2009.  His delegation was satisfied that the published sources took on board the information of the various regions.  He drew particular attention to the database on fertility, which, in today’s world, was a very useful source of information for countries.  He noted with satisfaction that a side event had been set up on population dynamics in the context of climate change during the Copenhagen Summit last December.  He called on the Commission’s member States to adopt the Belarusian amendments to the Kyoto Protocol.  Speaking plainly, he said his country did not understand why they had not been adopted since they would create binding obligations.

Noting that Belarus had just completed its second census as a democratic country, he thanked the Population Division for its contribution towards analyzing the subsequent data.  He further noted the regional forum recently hosted by Belarus, which had addressed best practices in population analysis, among other topics.  He pointed out that his country’s Ministry of Health would hold a conference with UNFPA later this year.   Belarus would also hold an exhibition later this year on medical practice and services.

HELGE BRUNBORG ( Norway) lauded the Population Division for its high-quality estimates and analyses, as well as for producing web pages that had become better and easier to use, though there was still room for improvement.  It should be possible to download all data made available to the public, provided that the technological and resource constraints could be solved.  “Your data are an important public good,” he said, commending the Division for the large number of user-friendly publications.  The Division was also active in developing new research methods, he said, citing means to estimate adult mortality, which was difficult in countries with deficient vital statistics systems.  Regarding population projections, Norway looked forward to having results by single years of age for each calendar year, and to an update on long-range projections, which most recently had been made in 2002.  Examining new areas of demographic analysis, such as child adoption, was also valuable.

EDUARDO RIOS-NETO ( Brazil) said the Division regularly provided high-quality analysis, and Governments had become accustomed to its publications.  They expected them every year.  The Division’s data was valuable for comparative analysis among countries and regions.  He underscored the importance of developing alternative scenarios for fertility, and highlighted fertility rates in middle-income countries in that regard.   Brazil also stressed the importance of producing data on international migration, a priority theme in the Division, which played an active role in meetings attended by scientists and Governments.   Brazil underscored current efforts to develop alternative methods for morbidity and mortality.

Introduction of Report

DIRK JASPERS FAIJER, Director, Economic Commission for Latin America and the Caribbean (ECLAC), presented the report of activities of the Latin American and Caribbean Demographic Centre (CELADE) -- the Population Division of ECLAC, for the period 2009-2010.  He said that in the framework of the fifteenth anniversary of the Cairo Conference, the Centre, with the support of UNFPA, had organized a seminar in October 2009 in Santiago, Chile to analyze regional progress towards implementing the Cairo Action Programme and consider its relationship to the Millennium Development Goals.  That seminar, which had brought together more than 200 experts from Governments, civil society, parliaments and universities from all Latin American countries, as well as specialists from the Caribbean subregion, concluded that despite important advances, the region still faced impressive challenges to fulfil the Cairo goals, the most important being to eliminate the high levels of poverty and inequality that still prevailed in the region.

He said that the seminar, thinking beyond 2014, had stressed the immediate need to prepare a population and development agenda for subsequent decades, at the global, regional, subregional and national levels.  Towards that goal, the centre, as the technical secretariat of the ECLAC Ad Hoc Committee on Population and Development, and again with UNFPA’s support, was preparing a draft agenda to present at the next meeting of Committee, to be held in Chile in May.  As the ECLAC focal point on ageing and as the technical secretariat for the Regional Intergovernmental Conference on Ageing, the centre provided technical support to countries on the application of the Regional Strategy for the Implementation in Latin America and the Caribbean of the Madrid International Plan of Action on Ageing as well as the Brasilia Declaration.

Noting that an important element of its work had been to incorporate the ethnic perspective in censuses and other data sources, he pointed out that the Division prepared a number of technical documents and provided extensive technical assistance and training to the countries of the region.  Additionally, the centre had continuously updated its database on indigenous peoples, now with the inclusion of information on Afro-descendant people.  He pointed out that an issue of permanent concern in his Division’s work had been to incorporate the effects of the financial crisis in the analyses of the demographic dynamics in the region.  One document examined the effects of the crisis on international migration, prepared for the high-level meeting of Government representatives on migration, held in Brussels in 2009.

In conclusion, he reported that his Division had maintained cooperation with the Population Division of the Department of Economic and Social Affairs with regard to the population estimates and projections that were updated every two years.  In addition, the Division was continuing to strengthen its relationship with the countries of the region through increased provision of technical assistance in response to their requests.

HU HONGTAO ( China) expressed appreciation for the way the Population Division had helped his country analyze its own data.  In terms of the Division’s programme work, it was necessary to pay attention to emerging questions and research, including on the structural change in populations and its impact on development.  The impact of climate change on populations should also be addressed.  That would allow policy-makers to better utilize the data.  Finally, it was necessary to strengthen the countries’ ability to collect relevant data.

ALFONSO FRAGA ( Cuba) said the strengthening of capacity and use of national statistics was a priority.  Demographic analysis had improved, but there were problems with evaluations made by other United Nations agencies, due to all the social and economic indicators calculated.  The Office of Statistics, in accordance with ECLAC, prepared population projections. They were not always the same as those of the Population Division, which caused confusion.

GABRIELA SHALEV ( Israel) thanked the Division for its important work, which served a crucial role in fulfilling the Millennium Development Goals, particularly Goal 5.  As a member of the Commission on Population and Development, Israel had worked with the Division and enjoyed its invaluable information.

Responding, HANIA ZLOTNIK, Director of the Population Division, said that single-age year projections would mean changing the programme used by the Division.  The Division’s insufficient programming support caused a bottleneck.  There was no professional programming staff, which impacted how much it could advance. “We do the best we can with demographers who tried to be programmers,” she said.

She appreciated China’s comments, saying that a change in the Department of Economic and Social Affairs had been made.  A decision had been made to reallocate resources to areas with higher priority than population.

To Cuba’s point, she said it would be interesting to hold discussions to understand how to interpret projections.

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For information media • not an official record