United Nations

E/CN.9/1996/4


Economic and Social Council

 Distr. GENERAL
10 January 1996
ORIGINAL: ENGLISH


Commission on Population and Development
Twenty-ninth session
26 February-1 March 1996
Item 4 of the provisional agenda*

  FOLLOW-UP ACTIONS TO THE RECOMMENDATIONS OF THE INTERNATIONAL
  CONFERENCE ON POPULATION AND DEVELOPMENT:  REPRODUCTIVE RIGHTS
                     AND REPRODUCTIVE HEALTH

   Work of the Inter-Agency Task Force for the Implementation
    of the Programme of Action of the International Conference
                  on Population and Development

              Report of the Inter-Agency Task Force


                             SUMMARY


        The present report has been prepared in response to Economic
and Social Council resolution 1995/55, in which the Council endorsed
the topic-oriented and prioritized multi-year work programme proposed
by the Commission on Population and Development at its twenty-eighth
session, including the preparation of an annual report on the work
of the Inter-Agency Task Force for the Implementation of the
Programme of Action of the International Conference on Population and
Development.  The topic for 1996 is "Reproductive rights and
reproductive health, including population information, education and
communication".  As noted by the Council in the same resolution, the
Task Force has been established by the Secretary-General to ensure
system-wide coordination, collaboration and harmonization in the
implementation of the Programme of Action.

        The present report reflects the observations of 12 members
of the Task Force regarding the implementation of the Programme of
Action.  It presents an overview of the Task Force; describes the
activities of Task Force members in the area of reproductive rights
and reproductive health; highlights critical issues; and emphasizes
that effective implementation of the reproductive health programming
approach is predicated on the identification of national needs and
priorities at the country level, and will require a redoubling of
collaboration within the United Nations system to meet the needs of
countries.



                       CONTENTS


                                               Paragraphs  Page

INTRODUCTION. . . . . . . . . . . . . . . . .    1 - 2      4

  I.   OVERVIEW OF TASK FORCE ACTIVITIES  . .    3 - 8      4
 II.   THE TASK FORCE AND REPRODUCTIVE RIGHTS
       AND REPRODUCTIVE HEALTH, AND POPULATION
       INFORMATION EDUCATION AND COMMUNICATION.  9 - 39     7

       A.   Working Group on Reproductive Health 9  - 18    7
       B.   Population information, education
            and communication . . . . . . . . . .19 - 23   10
       C.   Reproductive rights and reproductive
            health and population information,
            education and communication
            activities undertaken by member
            organizations of the Task Force   . .24 - 39   11

III.   ADDITIONAL COLLABORATION IN               40 - 52   18
        IN REPRODUCTIVE HEALTH
       A.   Reproductive rights and reproductive
            health and women's empowerment . . . 43 - 44   19
       B.   Reproductive rights and reproductive
            health and refugee/emergency . . .   45 - 50   19
            situations
       C.   Reproductive rights and reproductive health and
            HIV/AIDS prevention . .     . . . . .51 - 52   21

 IV.   CRITICAL ISSUES AND CHALLENGES . . . .    53 - 55   21
  V.   CONCLUSION . . . . . . . . . . . . . .    56 - 58   25

Table.      Inter-Agency Task Force for the Implementation of the
            Programme of Action of the International Conference on
            Population and Development:  activities of working groups
            during 1995

                             Annexes

 I.  List of members of the Inter-Agency Task Force for the
     Implementation of the Programme of Action of the International
     Conference on Population and Development                    27

II.  International Conference on Population and Development:
     commitments to reproductive rights and reproductive health  28


                          INTRODUCTION

1.   In the new terms of reference of the Commission on Population
and Development (E/1995/27, annex I, sect. I.A), which were
endorsed by the Economic and Social Council in its resolution
1995/55, the Commission is called upon to consider the reports of
the meetings of inter-agency mechanisms established by the
Secretary-General to ensure coordination, collaboration and
harmonization in the implementation of the Programme of Action of
the International Conference on Population and Development.  In
the same resolution, the Council noted that the Secretary-General
had established an Inter-Agency Task Force for the Implementation
of the Programme of Action, and it welcomed the intention of the
Secretary-General to report to it through the Commission on the
work of the Task Force so as to ensure system-wide cooperation in
the implementation of the Programme of Action.  Under the topic-
oriented and prioritized multi-year work programme of the
Commission, which was endorsed by the Council in the same
resolution, the topic for 1996 is "Reproductive rights and
reproductive health, including population information, education
and communication".

2.   The present report has been prepared in accordance with the
above-mentioned mandates and reflects the responses of 12 members
of the Task Force (see annex I for list) to a questionnaire on the
implementation of the Programme of Action, which specifically
asked Task Force members to identify any areas where collaboration
had met with difficulties.  The responses indicate that a high
level of collaboration has taken place and no problems have been
encountered so far, and that collaboration is continuing in the
field of reproductive rights and reproductive health.


              I.  OVERVIEW OF TASK FORCE ACTIVITIES


3.   In its resolution 49/128, the General Assembly stressed the
importance of continued and enhanced cooperation and coordination
among all relevant organs, organizations and programmes of the
United Nations system, including the specialized agencies, in the
implementation of the Programme of Action of the International
Conference on Population and Development.  In response to
paragraphs 20 and 22 of the same resolution, the Administrator of
the United Nations Development Programme (UNDP), on behalf of the
Secretary-General, asked the Executive Director of the United
Nations Population Fund (UNFPA), who had served as Secretary-
General of the International Conference on Population and
Development, to convene and chair an inter-agency task force to
address the implementation of the Programme of Action of the
Conference.  The Inter-Agency Task Force for the Implementation of
the Programme of Action of the International Conference on
Population and Development held its first meeting on 13 December
1994 and its second meeting on 25 July 1995; both meetings were
held in New York.  The Task Force has 14 members (see annex I).
Five working groups were set up by the Task Force to address key
areas for action corresponding to the objectives of the Programme
of Action.  An additional working group was established in
response to the request of the Commission, at its twenty-eighth
session, that the work of the Task Force be expanded to include
migration issues.  The working groups of the Task Force, together
with the lead agencies and output of each group are listed in the
table.

 Table 1.  Inter-Agency Task Force for the Implementation of the
           Programme of Action of the International Conference
            on Population and Development activities of
                 working groups during 1995

Title of working group/
Place and dates of meeting           Lead agency       Output

                                                     Report of the
Working Group on                United Nations       meeting
 Basic Education, with          Educational 
 Special Attention to           Scientific and       Guidelines on basic
 Gender Disparities             Cultural             education with
 (Paris, 7 March)               Organizations        special attention
                                                     to gender
                                                     disparities
                                                     Agency profiles and
                                                     selected
                                                     bibliography
Working Group on Policy-related
Issues  (New York, 3 May)           United Nations   Report of the
                                    Population Fund  meeting
                                                     Common advocacy
                                                     statement


Working Group on                   United Nations    Report of the
Common Approach to                 Children's        meeting
National Capacity-building         Fund              Guidelines on a
in Tracking Child                                    common approch
and Maternal Mortality                               to national
   (New York, 4 May)                                 capacity building
                                                     in tracking
                                                     child and maternal
                                                     mortality
                                                     Agency profile and
                                                     selected bibliography


Working Group on                   United Nations    Report of the
 Women's Empowerment               Development Fund  meeting
   (New York, 16 May)              for Women         Guidelines on women's
                                                     empowerment
                                                     Agency profiles and
                                                     selected bibliography

Working Group on Reproductive 
Health   (Geneva, 29 June)         World Health      Report of the
                                   Organization      meeting
                                                     Guidelines on
                                                     reproductive
                                                     health
                                                     Agency profiles and
                                                     selected
                                                     bibliography
Working Group on               International         Report of the
International Migration        Labour                meeting
   (Geneva, 19 October)        Organization          Guidance notes
                                                     Agency profiles
                                                     and selected
                                                     bibliography



4.   In the first year of its existence, the Task Force has
demonstrated a collaborative and participatory approach.  The
working groups have functioned in a responsive and coordinated
manner with a commitment to producing results in a timely fashion.
The central focus of the work of the the Task Force has been to
enhance United Nations system-wide collaboration at the country
level.  To that end, the Task Force has prepared and disseminated
a set of guidelines for the United Nations resident coordinator
system, and has developed a common advocacy statement on
population and development.  The Task Force has not encountered
any problems in collaboration so far.

5.   The guidelines address the following key areas of the
Programme of Action:  reproductive health; empowerment of women; a
common approach to national capacity-building in tracking child
and maternal mortality; and basic education with special attention
to gender disparities.  The common advocacy statement, which
underscores that population is an integral component of
development strategies, was adopted by the Task Force and endorsed
by the Administrative Committee on Coordination (ACC) at its
second regular session of 1995 (see ACC/1995/23).

6.   The main objective of the guidelines is to provide mechanisms
in the field, particularly the resident coordinator system, with
guidance on operationalizing the Programme of Action at the
country level.  The guidelines will facilitate more integrated
planning and coordination of United Nations inputs for achieving
the goals of the Programme of Action within a national development
framework, and will help foster closer dialogue and collaboration
between the United Nations system, Governments and other
development partners, including bilateral agencies, non-
governmental organizations and civil society.  The guidelines
build on arrangements that are already in place:  throughout,
their underlying concern is to seek ways to foster the enabling
environment that is called for in the Programme of Action.

7.   In September 1995, on the occasion of the first anniversary
of the International Conference on Population and Development, the
guidelines were distributed to all United Nations resident
coordinators.  The guidelines and the common advocacy statement
have been widely disseminated within the United Nations system,
with the recommendation that agencies and organizations ensure
wide circulation among all their staff, particularly field staff;
they are also available on the Internet. United Nations resident
coordinators have been asked to share the documents with all
interested parties, including representatives of Governments,
donor agencies, non-governmental organizations and the private
sector.  Guidance notes on international migration, which discuss
the principal substantive dimensions and activities of key
organizations active in that area, have since been completed and
disseminated.

8.   Themes found in both the guidelines and the common advocacy
statement include putting people first; promoting sustainable
human development; reducing gender inequality and inequity;
fostering accountability and transparency; developing common
indicators that are critical to the monitoring of programme
impact; strengthening country-level collaboration; enhancing
national capacity-building; and facilitating dialogue between and
among the United Nations resident coordinator system, Governments,
non-governmental organizations, the private sector and civil
society.  The Task Force views feedback as essential to
strengthening the collaborative process:  by maintaining an open-
ended information exchange, such as through feedback on the
guidelines and the collection of information on lessons learned,
the Task Force intends to develop a set of best practices that
have been tested in the field and can be replicated in other
settings, with adjustments to take account of local needs and
priorities.


   II. THE TASK FORCE AND REPRODUCTIVE RIGHTS AND REPRODUCTIVE
          HEALTH, AND POPULATION INFORMATION, EDUCATION
                     AND COMMUNICATION

            A.  Working Group on Reproductive Health

9.   Reproductive rights and reproductive health are critical to
human well-being and human development.  The Task Force
established a Working Group on Reproductive Health, with the World
Health Organization (WHO) as the lead agency, to address the key
issues in the area and to develop a set of guidelines for the
United Nations resident coordinator system to strengthen and
facilitate reproductive health programming at the country level.
The Working Group used the clear and comprehensive definition of
reproductive health contained in the Programme of Action of the
International Conference on Population and Development 1/ as the
starting point for its work:

     "Reproductive health is a state of complete physical,
     mental and social well-being and not merely the absence
     of disease or infirmity, in all matters relating to the
     reproductive system and to its functions and processes.
     Reproductive health therefore implies that people are
     able to have a satisfying and safe sex life and that
     they have the capability to reproduce and the freedom to
     decide if, when and how often to do so.  Implicit in
     this last condition are the right of men and women to be
     informed and to have access to safe, effective,
     affordable and acceptable methods of family planning of
     their choice, as well as other methods of their choice
     for regulation of fertility which are not against the
     law, and the right of access to appropriate health-care
     services that will enable women to go safely through
     pregnancy and childbirth and provide couples with the
     best chance of having a healthy infant.  In line with
     the above definition of reproductive health,
     reproductive health care is defined as the constellation
     of methods, techniques and services that contribute to
     reproductive health and well-being by preventing and
     solving reproductive health problems.  It also includes
     sexual  health, the purpose of which is the enhancement
     of life and personal relations, and not merely
     counselling and care related to reproduction and
     sexually transmitted diseases."

10.  During its discussions, the Working Group emphasized that
reproductive health is a crucial part of general health and is
hence central to human development.  It reflects health during
childhood and adolescence, sets the stage for health beyond the
reproductive years for both women and men, and has pronounced
effects on the health of the next generation.  The health of the
newborn is largely a function of its mother's health, nutritional
status and access to health care.  Although reproductive health is
a universal concern, it is of special importance to women,
especially during the reproductive years.  At each stage of life
individual needs differ.  However, there is a cumulative effect
across the course of life and events at each phase have important
implications for future well-being.  The Working Group emphasized
that reproductive health always includes family planning and
sexual health, and family planning will continue to be a central
component of reproductive health care.

11.  Other critical issues in reproductive health that emerged
from discussions included the importance of basing strategies for
the attainment of reproductive health on the underlying principles
of human rights and gender equity, as well as on the operational
principles of national ownership; the involvement of multiple
perspectives and multiple actors, including service providers,
users, planners, researchers and scientists; the use of
participatory processes in the planning, implementation and
evaluation of programmes, including close involvement of non-
governmental organizations, community and youth groups and the
private sector; and the importance of multisectoral action, with
key partners contributing on the basis of their respective
comparative advantages.

12.  In developing the guidelines on reproductive health, the Task
Force has recognized that the United Nations resident coordinator
system is uniquely positioned to promote the recognition of the
concept of reproductive health as central to general health and
human development.  The approach to development and the
eradication of poverty must be holistic, just as the approach to
reproductive health must, inevitably, be holistic and integrated.
Thus, at the country level, the resident coordinator system must
ensure that concerns pertaining to reproductive rights and
reproductive health are integrated into all related development
priorities and programmes.

13.  Many factors influence reproductive health, and its
attainment is not determined by interventions in the health sector
alone.  Socio-economic factors, including education, employment,
living conditions, family environment, social relations, gender
relations and legislation, as well as cultural and traditional
practices, all impact reproductive health.  As a result, it is
critical that reproductive health programmes adopt an
intersectoral as well as a multisectoral and multidisciplinary
approach.

14.  In amplifying what a reproductive health approach
encompasses, the Task Force emphasizes in the guidelines that such
an approach is people-centred and represents a shift from the
earlier paradigm which emphasized increasing the number of
acceptors of family planning methods.  In the new paradigm, the
aim of interventions is to enhance reproductive rights and promote
reproductive health rather than fertility control.  That implies
empowering women, including providing them with better access to
education; involving women and young people in the development and
implementation of programmes and services; reaching out to the
poor, the marginalized and the excluded; and that men will assume
greater responsibility for reproductive health.

15.  The Working Group emphasized that countries need to assess
their requirements through a wide-ranging, participatory process
of national consultation involving all relevant constituencies;
concomitantly, the identification of gaps and inadequacies as well
as the need to strengthen linkages between programmes should be
stressed.  Based on such a consultative process, a list of
national reproductive health priorities should be drawn up.
National priorities create the framework for reproductive health
programming.  Striving for an integrated reproductive health
approach does not imply that every service delivery point will be
equipped to deal with every aspect of reproductive health:  that
is neither feasible nor practical.  Instead, programmes must build
on what they have and then proceed, guided by what people need
most.

16.  The precise configuration of reproductive health needs and
concerns, as well as the programmes and policies adopted to
address them, will vary from country to country and will depend
upon an assessment of each country's situation and the
availability of appropriate interventions.  Globally, however,
both the epidemiological data and the expressed wishes of diverse
constituencies indicate that reproductive health interventions are
most likely to include attention to the issues of family planning,
the prevention and management of sexually transmitted diseases,
and the prevention of maternal mortality and morbidity.
Reproductive health should also address such issues as harmful
practices; unwanted pregnancy; unsafe abortion; reproductive tract
infections, including sxually transmitted diseases/acquired
immunodeficiency syndrome (AIDS); gender-based violence;
infertility; malnutrition and anaemia; and reproductive tract
cancers.  Appropriate services must be accessible and must include
information, education, counselling, the prevention, detection and
management of health problems, care and rehabilitation.  To
translate the reproductive health concept into a reality, a
minimum package of reproductive health services should be offered
in the context of primary health care.

17.  The International Conference on Population and Development
was unique in the emphasis that it placed on reproductive rights
and reproductive health.  In addition, in both the Programme of
Action and General Assembly resolution 49/128, Governments have
emphasized the need for greater collaboration and cooperation.
The Task Force has played a key role in promoting collaboration
and cooperation among United Nations organizations and agencies in
implementing the Programme of Action.  One of the main reasons
that the Task Force has worked well is that its members have been
fully involved in deciding its work programme and the modalities
for accomplishing it.  The meetings of the Task Force have
demonstrated the commitment of members to producing results by
focusing on a work programme of specific, action-oriented tasks
that are achievable in a relatively short period of time.  Thus,
the guidelines and common advocacy statement were developed in a
timely manner, with an emphasis on providing pragmatic guidance to
the United Nations resident coordinator system on the
implementation of the Programme of Action at the country level.
Early reports suggest that the guidelines are proving especially
useful at the country level, since they provide a shared basis for
United Nations organizations and agencies to collaborate on and
coordinate their programming activities.

18.  Although the guidelines on reproductive health focus on three
different topics, "Women's empowerment", "Basic education with
special attention to gender disparities" and "A common approach to
national capacity-building in tracking child and maternal
mortality", all three topics emphasize the following issues:
identification of national priorities; empowerment of women;
quality of care; advocacy; research and training; resource
mobilization; monitoring and evaluation; enhancing the role of
non-governmental organizations; and collaboration and
coordination.  Those issues constitute the key challenges facing
both countries and international organizations as they seek to
achieve the goals and objectives of the Programme of Action.  The
task of meeting them is complex; however, the Task Force is an
effective mechanism for coordinating the response of developing
countries and the United Nations system to those challenges.


     B.  Population information, education and communication

19.  Population information, education and communication is a key
instrument for attaining the goals of the Programme of Action of
the International Conference on Population and Development, and is
essential for empowerment, mobilization and behavioural change.
It also plays a critical role in generating demand for further
information and services and in increasing awareness among people
of their rights and responsibilities, including their reproductive
rights and responsibilities with respect to parenting, gender
relations and safe sexual behaviour.  Effective population
information, education and communication, which requires
understanding the target audience and the specific cultural
context, forms the basis of any sound advocacy campaign, and must
closely involve target groups, in in particular, youth and
community groups, in its design, development, testing,
implementation and evaluation.

20.  The Task Force emphasizes that, in addressing the sexual and
reproductive health needs of young people, reproductive health
programmes should ensure that youth and adolescents have access to
information, counselling and appropriate services.  Young people
of both sexes are especially vulnerable to reproductive health
problems because of a lack of information and services.  By
targeting youth, population information, education and
communication can play a key role in educating and raising
awareness about reproductive rights and reproductive health and
about individual and social responsibilities.

21.  The Task Force, through the resident coordinator system,
seeks to encourage Governments to increase resources for
population information, education and communication, with a
special emphasis on reaching young girls and adolescents and other
underserved or neglected groups.  Information, education and
communication strategies that employ a multi-channel approach have
proved effective, since information can be disseminated through
various channels, traditional and modern, and can be packaged in
various forms so as to allow both literate and illiterate
audiences to understand key messages.

22.  In paragraph 11.22, the Programme of Action notes that the
tremendous potential of print, audiovisual and electronic media,
including databases and networks such as the United Nations
Population Information Network (POPIN), should be harnessed to
disseminate technical information and to promote and strengthen
understanding of the relationships among population, consumption,
production and sustainable development.  Within a week of its
release, the guidelines for the United Nations resident
coordinator system were placed on the POPIN gopher, the global
headquarters of which is the Population Division of the United
Nations Secretariat.  The guidelines can be accessed through the
Internet.  The Task Force will continue, as appropriate, to
electronically disseminate any relevant information that it
develops on reproductive rights and reproductive health,
population information, education and communication, and other key
areas of interest.

23.  In another instance of inter-agency collaboration, the World
Bank, WHO and UNFPA, together with an international non-
governmental organization have produced an information card on
reproductive health, which summarizes the commitments of the
International Conference on Population and Development to
reproductive rights and reproductive health; the goals for the
year 2015; special needs; rights and principles; actions for
implementation; and the importance of working together in
implementing the Programme of Action.  The card, which is
reproduced in annex II, has been widely distributed and is proving
to be a useful information, education and communication tool.

 C.  Reproductive rights and reproductive health and population
information, education and
communication activities undertaken by member organizations of the
Task Force

24.  The International Conference on Population and Development
has provided new impetus to advocacy and programming in the areas
of reproductive rights and reproductive health and population
information, education and communication, and United Nations
bodies are adjusting their programmes and activities to conform
with the Programme of Action of the Conference.  In addition to
the collaborative efforts undertaken in the context of the Task
Force, many of the its members have intensified their activities
in reproductive health in keeping with their respective mandates.
All Task Force members are emphasizing collaboration and
coordination with other United Nations bodies as well as with
other development partners, particularly non-governmental
organizations.  The present section is based on the information
supplied by members of the Task Force, and reviews their
reproductive health and related activities.

                 1.  United Nations Secretariat

25.  The Department for Economic and Social Information and Policy
Analysis and the Department for Policy Coordination and
Sustainable Development of the United Nations Secretariat, as well
as the Economic Commission for Europe (ECE), representing all the
regional commissions, participate in the Task Force.  Through its
Population Division, the Department for Economic and Social
Information and Policy Analysis regularly monitors fertility
trends, contraceptive practice and mortality levels, by sex, as
well as government policies related to population concerns.  Every
two years, the Population Division produces population estimates
and projections, by age and sex, for all countries and areas of
the world.  It publishes gender-disaggregated statistics, conducts
a variety of analytical studies that have a gender dimension,
monitors population policies and organizes expert group meetings
dealing with gender issues.  The Population Division serves as the
global headquarters for POPIN, which facilitates Internet access.
With both global and regional support from UNFPA, POPIN is a
decentralized information and communication network for regional,
national and non-governmental population information activities,
including reproductive health and gender issues.  The Population
Division also serves as the substantive secretariat for the
Commission on Population and Development, and is responsible for
the preparation of the annual World Monitoring Report.

26.  Within the Department for Policy Coordination and Sustainable
Development, the Division for the Advancement of Women served as
the secretariat for the Fourth World Conference on Women (Beijing,
4-15 September 1995), and the Division for Social Policy and
Development served as the secretariat for the World Summit for
Social Development (Copenhagen, 6-12 March 1995).  The Copenhagen
Declaration, 2/ the Programme of Action of the World Summit for
Social Development 3/ and the Beijing Platform 4/ for Action
contain important provisions for reproductive health, and amplify
the message of the International Conference on Population and
Development; recent conferences also call for the development of
comprehensive national strategies for improving reproductive
health care and child health-care services, in keeping with the
Programme of Action of the Conference.  The Division for
Sustainable Development is responsible for monitoring and
facilitating the implementation of Agenda 21 5/ and other outcomes
6/ of the United Nations Conference on Environment and
Development. Agenda 21 sets out reproductive health objectives,
including the provision of safe and effective health care and
affordable, accessible services, as appropriate, in keeping with
freedom, dignity and personally held values.

27.  ECE, which for the past year has served on the Task Force as
the focal point for all the regional commissions, has been
conducting research on fertility and the family.  With funding
from UNFPA, ECE has initiated a series of activities leading to
the collection and analysis of comparable survey data on fertility
and the family in various ECE member States, including 10
countries with economies in transition.  Although ECE has only a
small demographic research unit working on reproductive health,
the area is of special concern in Central and Eastern Europe,
where there is a need for much more research on reproductive
health issues, particularly family planning, and on the
supervision and supply of services, including the transition from
abortion to the use of contraceptive services.  ECE has been
collaborating with WHO in this work, and plans to intensify its
collaboration with other international organizations with
expertise in reproductive rights and reproductive health, and
population information, education and communication.

               2.  United Nations Children's Fund

28.  In its follow-up to the International Conference on
Population and Development, the United Nations Children's Fund
(UNICEF) is pursuing close collaboration with partners in a
variety of sectors, with a special focus on girls' education;
women's empowerment; primary health care, including reproductive
health; and the tracking of progress in reducing child and
maternal mortality.  UNICEF support for women's health activities
emphasizes working with women's organizations at the community
level and assisting women's organizations in implementing efforts
on information, education and communication, and in developing
financing mechanisms for purchasing health care.  UNICEF efforts
in the area of adolescent health care seek to build stronger
dialogue and partnership among young people, parents, educators,
health providers and community leaders on health, including
reproductive health.  They also seek to help ensure that
adolescents have access to the information, skills and services
that they need to protect and promote their own health and,
eventually, the health of their children.  UNICEF supports school
health programmes that emphasize skills-based health education,
including reproductive health education.  UNICEF works closely
with WHO, UNFPA and non-governmental organizations in
strengthening approaches to youth and women's health.  UNICEF
served as the lead agency of the Task Force Working Group on a
Common Approach to National Capacity-building in Tracking Child
and Maternal Mortality, and is also a co-sponsor of UNAIDS.

            3.  United Nations Development Programme

29.  UNDP focuses attention on mainstreaming gender in all its
programmes and on furthering the advancement of women.  By fully
mainstreaming gender concerns, UNDP seeks to empower women and
contribute to an enabling environment for their advancement,
especially by achieving gender equity in decision-making;
developing capacity; recognizing women's power as agents of
change; improving access to economic resources and assets; halting
the feminization of poverty; assisting women in crises; and
creating legal frameworks that facilitate gender equality and
equity.  Although UNDP has only a modest direct involvement in
reproductive rights and reproductive health, it makes an important
indirect contribution to the achievement of such goals through
advocacy and support for the eradication of povertyand the
mainstreaming of gender into development programmes and policies.
UNDP is involved in supporting education in all regions, and
collaborates with UNFPA and other organizations in addressing the
special needs of youth and adolescents. In human immunodeficiency
virus/acquired immunodeficiency syndrome (HIV/AIDS) prevention,
UNDP has helped strengthen not only the capacity of Governments to
respond to the epidemic but also that of non-governmental
organizations and community-based organizations, by enhancing
their capacity to monitor, document, evaluate and enhance
programme design and implementation.  UNDP is also a co-sponsor of
the Joint United Nations Programme on HIV/AIDS (UNAIDS).

          4.  United Nations Development Fund for Women

30.  The United Nations Development Fund for Women (UNIFEM) serves
as a catalyst for ensuring the appropriate involvement of women in
mainstream development activities, and supports innovative and
experimental activities benefiting women in line with national and
regional priorities.  To foster the political empowerment of
women, UNIFEM advocates for gender equity and the reform of legal
and policy frameworks, codes and instruments.  Since the
Conference, at which the empowerment of women was recognized as
fundamental to the success of population-related programmes,
UNIFEM has become more involved in women's health-related issues,
although it is only indirectly involved in reproductive health
programmes and issues. UNIFEM served as the lead agency for the
Task Force Working Group on Women's Empowerment.  At the Fourth
World Conference on Women, UNIFEM, in partnership with UNFPA,
sponsored a youth day workshop on the reproductive health of
African adolescents.  In a joint effort with UNFPA, UNIFEM is also
developing programmes that link the human rights framework to
women's reproductive rights.

               5.  United Nations Population Fund

31.  UNFPA support for reproductive health is based on a public-
health, pragmatic and participatory approach.  Since the
Conference, UNFPA has, with the approval of its Executive Board,
oriented its programme focus and operational strategies to three
main areas:  reproductive health, including family planning and
sexual health; population and development strategies; and
advocacy.  UNFPA will support all aspects of family planning at
primary, secondary and tertiary levels.  Support for other
components of reproductive health will be concentrated at the
primary health-care level. Recognizing the need to strengthen
referral services for the evaluation and treatment of reproductive
health problems that cannot be managed at the primary health-care
level, UNFPA will promote appropriate strengthening of
reproductive health services at the secondary and tertiary levels.
Specifically, UNFPA will support the following information and
service-delivery components of reproductive health programmes:
the full spectrum of family planning information and services,
including counselling and follow-up services aimed at couples and
individuals; prenatal, delivery and postnatal care of mothers at
the primary health-care level, with appropriate referral for the
management of obstetric complications; the prevention of abortion,
management of consequences of abortion and post-abortion
counselling and family planning; prevention of reproductive tract
infections, including sexually transmitted diseases and the
treatment of symptomatic infections, as part of primary health
care, with appropriate referral for follow-up; prevention of
HIV/AIDS as part of primary health care, with appropriate referral
for follow-up; prevention of infertility and sub-fecundity, as
part of primary health care, with appropriate referral for follow-
up; routine screening and referral for other conditions of women's
reproductive health; and active discouragement of harmful
practices, such as female genital mutilation.  In order to assist
countries in the development of effective reproductive health
programmes, UNFPA strongly encourages further strengthening of
collaboration and coordination with partners in the United Nations
system, bilateral agencies and non-governmental organizations.
UNFPA has integrated HIV/AIDS-prevention components in its ongoing
reproductive health and family planning programmes in 103
countries.  It supports a wide spectrum of HIV/AIDS prevention
activities, including information, education and communication
activities, in-school and out-of-school education, counselling,
distribution of condoms, and training for medical staff and other
health-service providers.  Several of these activities have been
undertaken in collaboration with non-governmental organizations
and other United Nations organizations and agencies.  UNFPA served
as the lead agency for the  Task Force Working Group on Policy-
related Issues, and is a co-sponsor of UNAIDS.

                    6.  World Food Programme

32.  Many World Food Programme (WFP) activities directly concern
reproductive rights and reproductive health, although WFP has no
specific programme in those areas.  WFP supports mother and child
health programmes in countries throughout the world, providing
food aid not only as a nutritional supplement but also as an
incentive for women to attend education sessions on health,
including reproductive health and family planning, and nutrition.
In emergency and refugee situations, to which a major portion of
its resources are directed, WFP has a special commitment to
meeting the needs of women, including their reproductive health
needs.  WFP is also supporting pilot projects to assist HIV/AIDS
victims and their dependants in Uganda and the United Republic of
Tanzania.  Increasingly, non-governmental organizations are
involved in the execution of WFP activities.

 7.  Office of the United Nations High Commissioner for Refugees

33.  With the new impetus provided by the Programme of Action, the
Office of the United Nations High Commissioner for Refugees
(UNHCR) is working jointly with United Nations organizations and
non-governmental organizations in promoting, advocating and
implementing reproductive health activities in refugee and
emergency situations.  In June 1995, UNHCR, in collaboration with
UNFPA, UNICEF and WHO, organized an inter-agency symposium on
reproductive health (see also paras. 46-50 below).  The symposium
underscored the need to coordinate reproductive health activities
among all groups so as to ensure complementarity and cost
effectiveness, and highlighted the importance of community
participation in the planning and delivery of reproductive health
services.  With UNHCR as coordinator, an inter-agency working
group will organize and facilitate reproductive health services in
refugee situations, including information exchange, advocacy,
planning, training, assessment, monitoring, coordination, research
and evaluation.  Among its priority will be the operationalization
of a field manual on reproductive health in refugee situations.
To strengthen coordination, the working group will also
collaborate with other bodies, such as the WHO Consultative Group
on Reproductive Health, the Reproductive Health for Refugees
Consortium and the Working Group on Reproductive Health Kits.

              8.  International Labour Organization

34.  The International Labour Organization (ILO) policies and
programmes are based on the premise that success in protecting and
promoting reproductive health is linked to social and economic
factors, including education, training, employment, working
conditions and gender equality in labour markets. The ILO promotes
and provides technical support to its constituents in order to
enable them to design, develop and implement comprehensive
policies and programmes that link population and reproductive
health concerns to social and economic goals and achievements.
Employers are assisted in adopting appropriate workplace rules and
mechanisms both to eliminate reproductive health hazards and to
promote family welfare and planning through education and access
to services.  Workers' organizations are strengthened to promote
and implement the education of workers on population, reproductive
health and gender issues.  The special needs of youth are being
addressed by integrating modules on reproductive rights and
reproductive health, population issues and family life in the
curricula of vocational training programmes.  A priority issue for
the ILO is the design, development and dissemination of training
materials on women workers' rights and resources for women's
organizations in the informal and rural sectors.  The ILO will
continue to strengthen and build national capacity to develop,
execute, monitor and evaluate programmes.

   9.  Food and Agriculture Organization of the United Nations

35.  The Food and Agriculture Organization of the United Nations
(FAO) promotes food security, nutrition and improvement of the
quality of life for rural populations and stresses the linkages
between population issues and reproductive health.  FAO has
emphasized the need for ensuring that reproductive health services
are available to rural people, and that both women and men are
included in the design of reproductive health services.  FAO is
collaborating with other United Nations organizations and
agencies, along with non-governmental organizations, in
implementing its programmes.  Under the UNFPA-funded project
"Integration of population education into programmes for rural
youth", FAO is supporting population education in the jungle area
of Iquitos, Peru, and among the H'mong ethnic minority youth and
rural youth in Viet Nam.  Rural youth population activities are
also being expanded to other countries in Africa, Asia and South
America.  Training for youth leaders covers issues pertaining to
the relationship between population and the environment, as well
as reproductive health and responsible parenthood.  FAO was the
first agency to initiate detailed sectoral analysis of the socio-
economic impact of HIV/AIDS on rural economies, and has identified
both specific and general characteristics of vulnerable households
and farming systems. It has demonstrated the importance of home
remittances from migrant workers and for household food security,
food production and nutritional well-being, and consequently the
importance of their loss due to HIV/AIDS-related morbidity and
mortality.

    10.  United Nations Educational, Scientific and Cultural
         Organization

36.  The United Nations Educational, Scientific and Cultural
Organization (UNESCO) plays a critical role in supporting the
educational, cultural and scientific aspects of reproductive
health.  Emphasis is on collaboration with the United Nations
system and non-governmental organizations in enhancing the quality
of life.  The importance of attitudinal change on the basis of
multicultural differences is stressed, together with the need to
reach out to the public to advocate for reproductive health.
UNESCO emphasizes the importance of networking among countries to
share expertise and experiences in national capacity-building.  In
collaboration with UNFPA, UNESCO has promoted population
information, education and communication projects in Africa, the
Arab States and Asia, most of which have a component on
reproductive rights and reproductive health.  UNESCO has also
provided support to Governments of developing countries for policy
and planning in school-based HIV/AIDS-prevention education.
UNESCO served as the lead agency for the Task Force Working Group
on Basic Education with Special Attention to Gender Disparities.
It is also a co-sponsor of UNAIDS.

                 11.  World Health Organization

37.  WHO has a unique role within the United Nations system with
respect to advocacy, normative functions, research and technical
cooperation in reproductive health.  In its advocacy role, WHO
promotes understanding of the universality of reproductive health
needs and their crucial importance in human development.  As the
main agent for health research within the United Nations system,
WHO will continue to conduct, support, promote and evaluate
research in reproductive health, and to  coordinate the global
research efforts in this field.  In the area of reproductive
health technologies, particular emphasis is being given to methods
that match women's perceived needs and priorities, including user-
controlled methods that can also protect against sexually
transmitted diseases, post-ovulatory methods, and safe male
methods that enable men to share responsibility for fertility
regulation and disease prevention.  The normative functions of WHO
include the development of policies, strategic approaches, norms,
standards and guidelines.  WHO will also continue to develop
technical, managerial and policy guidelines on various aspects of
reproductive health.  WHO has also developed innovative
methodologies for countries to identify national and district-
level reproductive health needs.  In collaboration with other
organizations, WHO will develop methodologies for assessing
reproductive health, and will both qualitative and quantitative
indicators for measuring the reproductive health status and
behaviour of populations as well as the effectiveness of
programmes and interventions.  WHO will provide technical support
to developing countries, and will strengthen their national
capacity for formulation, implementation, monitoring and
evaluation of comprehensive national reproductive health policies
and programmes.  WHO collaborates with a number of United Nations
organizations and non-governmental organizations, particularly in
reproductive health and adolescent health programmes.  WHO
supports numerous activities in the area of HIV/AIDS and sexually
transmitted diseases, and is a co-sponsor of UNAIDS.

38.  In advancing the Programme of Action, the Pan American Health
Organization (PAHO) has focused primarily on activities related to
quality of care.  Two major initiatives undertaken in this area
during 1995 were (a) the planning and execution of a regional
meeting in San Salvador on incorporating a gender perspective in
the quality of care in reproductive health services in Latin
America, and (b) the mobilization of funding for conducting
operational research in two countries in Latin America on gender
differences in health-care quality.  The San Salvador meeting,
inter alia, proposed criteria and indicators for measuring the
degree to which quality of care in reproductive health services
incorporates a gender perspective.  The operational research is
aimed at providing comparative information on the response of
public health services to both gender-specific and non-gender-
specific health needs of men and women in relation to illness
prevention, health promotion and  and social behaviour.

                         12.  World Bank

39.  Reproductive health activities constitute a significant
portion of all World Bank lending for population, health and
nutrition activities.  During fiscal 1994, more than 40 per cent
of all lending for population, health and nutrition supported
reproductive health activities.  The operations research,
situation analyses and field-based pilot projects of the World
Bank assist programme managers in assessing needs, instituting or
modifying services, and in determining the effects of
interventions on health systems and health status.  In addition to
providing support for reproductive health activities through
project lending, the World Bank Economic Development Institute
organizes training activities that strengthen national capacities
to design and implement policies and programmes in this field.
The World Bank actively seeks and supports collaboration among
donor agencies and local non-governmental organizations in
promoting awareness of reproductive health issues and improving
effectiveness of projects with reproductive health components.
The World Bank is the single largest source of external funding
for the prevention and control of HIV/AIDS/sexually transmitted
diseases in the developing world.  The principal mechanism for the
direct support of the World Bank to HIV/AIDS prevention activities
is through its lending, most of which is done at highly
concessional terms.  The World Bank has sponsored several studies
on the social and economic impact of HIV/AIDS and the cost-
effectiveness of prevention and care interventions, is also a co-
sponsor of UNAIDS.


      III.  ADDITIONAL COLLABORATION IN REPRODUCTIVE HEALTH


40.  The present section reviews of certain joint and
collaborative activities undertaken by United Nations
organizations and agencies in reproductive rights and reproductive
health, and population information, education and communication.
Some of these fall outside the immediate purview of the Task
Force; nevertheless, they underscore the wide scope of
collaboration and coordination in the United Nations system.

41.  Discussions are under way concerning two collaboration
mechanisms involving UNICEF, UNFPA and WHO.  To strengthen
cooperation among the three organizations, UNFPA has proposed that
the three organizations agree on a joint health policy framework
and institute a high-level inter-secretariat consultative
mechanism to promote the coordination of policy approaches,
strategies and activities; ensure regular exchange of information
on key developments; and help ensure that an overall policy
framework, as defined by WHO, guides the strategies and activities
of the three organizations.  The consultative mechanism will help
to ensure maximum synergy and complementarity of the programmes of
UNICEF, UNFPA and WHO, and will enhance, through collaboration,
the effective delivery of assistance at the country level.  UNFPA
has proposed the consultative mechanism independent of its other
proposal concerning membership of the UNDP/UNFPA Executive Board
in the UNICEF/WHO Joint Committee on Health Policy (JCHP).

42.  JCHP, inter alia, helps guide UNICEF and WHO on the types of
health programmes that should most appropriately receive their
complementary or joint support.  A tripartite intergovernmental
committee on health policy composed of representatives from the
executive boards of UNICEF, UNFPA and WHO would have several
distinct advantages.  Such a committee would provide the only
venue where members of all three executive boards could meet
jointly to discuss health policy issues common to the three
organizations.  It would also help to sharpen the focus of
collaborative activities in the areas of child and reproductive
health, and would enhance inter-agency collaboration in achieving
the health and related social goals of recent international
conferences and summits, including the World Summit for Children
and the International Conference on Population and Development.
Such a committee would also strengthen activities in advocacy,
population and development strategies and in reproductive health
programmes.  Finally, it would ensure that policy advice and
strategies are complementary, in harmony and have a synergistic
effect, especially at the country level.

   A.  Reproductive rights and reproductive health
             and women's empowerment

43.  Women, by far bear the greatest burden of reproductive health
problems.  Among women of reproductive age, 36 per cent of the
healthy years of life lost are lost due to reproductive health
problems, such as unregulated fertility, maternal mortality and
morbidity, and sexually transmitted diseases, including HIV/AIDS.
By contrast, the equivalent figure for men is 12 per cent. 7/
Biological factors alone do not explain women's disparate burden:
their social, economic and political disadvantages and the denial
of their reproductive rights have a detrimental impact on their
reproductive health.  The empowerment of women is a fundamental
prerequisite for their reproductive health, which will not be
significantly improved in the absence of gender equity and
equality.  Because men's social and sexual behaviour affects
women's reproductive health directly, reproductive health
programmes, while catering for the specific needs of women, will
also need to pay special attention to the roles and
responsibilities of men and the need for them to assume greater
responsibility for their sexual and reproductive behaviour and
their social and family roles.

44.  The Task Force, in addition to developing the guidelines on
reproductive health, has developed guidelines on women's
empowerment for the United Nations resident coordinator system.
With the aid of the guidelines and in conjunction with guidelines
on basic education and tracking child and maternal mortality, the
United Nations Resident Coordinator system can both promote and
facilitate programming that increases women's access to resources,
education and employment, and protects and promotes their human
rights and fundamental freedoms so that they are able to make
choices free from coercion or discrimination.  At the same time,
greater effort is needed to facilitate women's involvement in
programme development and implementation so that they become
participants rather than the objects of intervention.

       B.  Reproductive rights and reproductive health and
           refugee/emergency situations

45.  The important issue of the reproductive health-care needs of
refugees, migrants and displaced persons is highlighted in
paragraph 7.11 of the Programme of Action of the Conference:

     "Migrants and displaced persons in many parts of the
     world have limited access to reproductive health care
     and may face specific serious threats to their
     reproductive health and rights.  Services must be
     particularly sensitive to the needs of individual women
     and adolescents and responsive to their often powerless
     situation, with particular attention to those who are
     victims of sexual violence."

46.  Arising from the recognition that the provision of
reproductive health services is as important as providing food,
clean water, shelter, sanitation and primary health care in
refugee and emergency situations, a new impetus has been given to
reproductive health concerns in refugee and emergency situations,
including the convening of an inter-agency symposium on
reproductive health in refugee situations.  Organized by UNHCR and
UNFPA in collaboration with UNICEF and WHO, the symposium took
place in Geneva from 28 to 30 June 1995, and was attended by
representatives of 50 governmental, non-governmental and private
organizations.

47.  The symposium identified the main reasons for the lack of a
systematic strategy for the provision of comprehensive health care
in refugee situations:  the low priority accorded to it by
organizations specialized in emergency response; insufficient
field staff with appropriate training; limited funding and
resource allocation; insufficient coordination among national
authorities, non-governmental organizations and United Nations
organizations and agencies in the country of asylum; and
consideration of family planning as a sensitive issue in post-
conflict situations without seeking the views and support of
refugee women.

48.  To overcome these limitations, the recommendations offered
included the following:  essential minimum reproductive health
services should be made available at the outset of all refugee
operations through the Minimum Initial Service Package;
reproductive health activities and services should be implemented
in full and integrated within existing primary health care
services, as soon as possible; if needed and to the extent
possible, reproductive health services should also be made
available to the local population surrounding the refugee
settlements; and close collaboration should be established with
local authorities to facilitate the harmonization and
sustainability of services.  In addition, adequate training and
cultural sensitivity on the part of service providers need to be
recognized as essential to the quality of reproductive health
care, together with respect for confidentiality and privacy.
Services should be located appropriately and adequate equipment as
well as continuous and regular supplies should be provided.
Community participation in the planning and delivery of
reproductive health services is essential, and should be ensured.
The coordination of reproductive health activities among all
groups providing services is critical to ensuring complementarity
and cost effectiveness; hence, a focal point on reproductive
health should be identified as early as possible in all refugee
operations.

49.  The existence of basic human rights in the area of health,
including reproductive health, was highlighted, and various
provisions relative to reproductive health contained in
international and regional human rights instruments were
illustrated.  It was emphasized that refugees are often in need of
complete health care owing to the risks of marginalization in the
local community and their inability to pay for care during exile.
The symposium also emphasized the protection of human rights as a
means of promoting public health, and stressed the key role of
appropriate information, education and communication strategies in
achieving it.

50.  In conjunction with the above-mentioned symposium, UNHCR and
UNFPA signed a memorandum of understanding establishing a
framework for collaboration for the benefit of persons in refugee
situations.  UNHCR and UNFPA will jointly develop strategies and
programmes of advocacy for reproductive health information and
service needs, and for combating sexual violence; develop
strategies to promote reproductive health among adolescents and
young people; organize joint assessment, monitoring and evaluation
missions relating to reproductive health information and services;
develop field manuals on the provision of reproductive health
information and services, including reproductive health
counselling and clinical activities; facilitate coordination at
the field level through the establishment of coordination
committees with the participation of UNHCR, UNFPA, other concerned
United Nations bodies, and non-governmental organizations for the
purpose of enhancing the provision of reproductive health
information and services; and develop strategies to ensure the
integration of reproductive health information and services into
the relevant programmes of other organizations.

  C.  Reproductive rights and reproductive health and HIV/AIDS
      prevention

51.  An effective reproductive health approach is closely linked
with an HIV/AIDS-prevention component.  Research indicates that
biologically, epidemiologically and socially, women are more
vulnerable to HIV than are men.  Women's generally subordinate
role in the family and society renders them especially at risk of
HIV infection.  Thus, it is essential that reproductive health
programmes provide women with the information, services and
support necessary to protect themselves.  At the same time,
countries need to develop multisectoral programmes and strategies
targeting those factors that maintain the social, cultural and
sexual subordination of women and girls.  In the absence of a cure
for HIV, knowledge plays a key role in HIV/AIDS prevention.  HIV
transmission can be significantly reduced through informed and
responsible behaviour.  Thus, effective information, education and
communication is critical in HIV/AIDS-prevention and control
strategies.

52.  Recognizing that inter-agency cooperation is vital in
ensuring the mobilization of resources and effective
implementation of a coordinated programme of activities throughout
the United Nations system, UNAIDS will draw upon the experience
and strengths of its six co-sponsors and will build on their
comparative advantages to develop its strategies and policies,
which will be incorporated in turn into their programmes and
activities.  Several members of the Task Force have already
established close linkages with UNAIDS; and some have already
seconded staff to it.  The six co-sponsors of UNAIDS (UNICEF,
UNDP, UNFPA, UNESCO, WHO and the World Bank) are also integrally
involved in the work of the Task Force.


               IV.  CRITICAL ISSUES AND CHALLENGES


53.  Based on the foregoing discussion of reproductive rights and
reproductive health, including population information, education
and communication, several key issues and challenges can be
distinguished that the Task Force needs to address in implementing
the Programme of Action of the Conference and, more specifically,
in attaining the goal of enabling all countries to make
reproductive health accessible through the primary health-care
system to all individuals of appropriate ages as soon as possible
and no later than the year 2015.  All agencies and sectors have
roles and responsibilities in promoting and enhancing reproductive
health.  In its advocacy work, the Task Force, through the United
Nations resident coordinator system, can emphasize that the
determinants of poor reproductive health include poverty, gender
and other forms of inequity, social injustice, marginalization and
development failures, as well as the lack of access to quality
health services.  A multisectoral and multidisciplinary approach
is essential if the objective of the Programme of Action of
providing reproductive health care for all by the year 2015 is to
be met.

54.  Some of the key challenges for meeting that goal include the
identification of national priorities; the empowerment and
involvement of women; quality of care; advocacy; research and
training; resource mobilization; monitoring and evaluation; the
enhancement of the role of non-governmental organizations; and
collaboration and coordination.  The Task Force mechanism could be
drawn upon to address those challenges as follows:

     (a)  Identification of national priorities:  the Task Force,
through the United Nations resident coordinator system, will
continue to emphasize the need to assist countries in assessing
and identifying their reproductive health needs and priorities.
The process should be participatory, involving all key
organizations, and should ensure the inclusion of non-governmental
organizations, community and youth groups, women's organizations,
the private sector and civil society.  Additionally, an
incremental, integrated and pragmatic programming approach based
on national needs and available resources should be encouraged;

     (b)  Empowerment and involvement of women:  the empowerment
of women is a fundamental prerequisite for their reproductive
health.  As already noted, the greatest burden of reproductive
ill-health falls on women.  It is critical that reproductive
health programmes emphasize the empowerment of women, and ensure
that they specifically address the special needs of girls and
women, as well as those of other underserved groups, such as youth
and adolescents; the rural and urban poor; persons in remote or
neglected areas; and migrants, refugees and displaced persons.
Increasing the role and responsibility of men in reproductive
health, parenting and the prevention of AIDS and sexually
transmitted diseases will also have a positive impact on the
health of women.  Attention must also continue to be focused on
eradicating gender-based violence and other harmful practices
detrimental to the health and well-being of girls and women.
Women must also be afforded opportunities to be involved in the
design, development, implementation and evaluation of reproductive
health programmes.  The Task Force, through the United Nations
resident coordinator system, can play a key role in ensuring that
development programmes emphasize the empowerment of women and
focus attention on promoting and enhancing their reproductive
health;

     (c)  Quality of care:  the people-centred focus of the
Programme of Action emphasizes the provision of high quality of
care with regard to reproductive health information and services;
in particular, the Task Force, through the United Nations resident
coordinator system, must work to ensure that a constellation of
services is easily accessible, and takes into account and is
responsive to the user perspective, especially that of women,
youth and adolescents.  In focusing on the delivery of high-
quality services and care, the United Nations resident coordinator
system should draw upon the comparative advantages of non-
governmental organizations and other concerned groups and
organizations.  Non-governmental organizations have a special
contribution to make in monitoring the quality of care and
progress towards achieving national goals, as well as in
introducing new and innovative methodologies, including
qualitative indicators for measuring the quality of care and user
satisfaction.  Effective information, education and communication,
targeted to meet the needs of specific audiences and counselling,
are also key elements of reproductive health programmes that
emphasize quality of care;

     (d)  Advocacy:  in keeping with the Programme of Action, the
Task Force and the United Nations Resident Coordinator system will
continue vigorous advocacy for sustained political commitment to
reproductive health, including, as appropriate, the promotion of
legislation and cultural practices beneficial to reproductive
health.  A shared understanding of reproductive health will need
to be developed and promoted through national and local consensus-
building to lay the foundation for dialogue and programme
development.  The purpose of advocacy is to draw the attention of
the community to the challenges of reproductive health, and to
point decision makers towards nationally relevant solutions.  One
key objective of advocacy is to create a supportive and enabling
cultural, social and political environment for reproductive
health.  The United Nations resident coordinator system has a key
role to play in promoting the concept of reproductive health as
central to general health and human development.  Advocacy can
also provide the rationale for greater allocation of resources for
action in reproductive health;

     (e)  Research and training:  action-oriented research
responsive to country needs is essential.  In addition to being
responsive to national priorities, the global research agenda
should also focus on the development and transfer of reproductive
health technologies suited to local conditions.  To ensure the
effective implementation of the reproductive health approach,
adequate training is required for programme managers and service
providers.  Training for reproductive health workers will need to
focus on improving both technical and interpersonal skills.  The
adoption of a reproductive health approach may require changes in
attitudes, as well as new skills and training.  Managerial and
administrative changes will also be needed, since integrated
services, at least initially, can impose greater burdens on
already overworked staff and will require attention to planning
and logistics in order to ensure the availability and continuity
of services;

     (f)  Resource mobilization:  in order to assist countries in
implementing reproductive health programmes, the United Nations
system will need to assist in the mobilization of additional
resources, both financial and human.  To do so, non-traditional
sources of funding will need to be explored.  At the same time,
innovative approaches will be needed, such as combining programmes
to maximize use of resources, sharing costs with users, creating
employer-based reproductive health programmes, and adopting
community-based service delivery and social marketing.  Many of
these approaches have already been used and have proved
successful.  The Task Force can play a role in encouraging
experimental and innovative schemes, as well as in disseminating
the lessons learned from approaches that have succeeded.  Because
the demands for official development assistance are ever
increasing and competing, countries and agencies alike need to
build on available resources while continually exploring new
avenues;

     (g)  Monitoring and evaluation:  close monitoring and
evaluation of programmes, together with course corrections as
appropriate, will ensure the effective delivery of reproductive
health services and care.  The United Nations resident coordinator
system should support national capacity-building for monitoring
progress in country programmes in ways that are helpful to
programme management and useful at the point of delivery of the
intervention.  The international community has already defined a
number of indicators relevant to reproductive health, and WHO is
working on additional qualitative and quantitative indicators for
global monitoring;

     (h)  Enhancement of the role of non-governmental
organizations:  non-governmental organizations and private
organizations have a major contribution to make in the development
and implementation of strategies for reproductive health.
Governments and international agencies need to capitalize on areas
of comparative advantage of non-governmental organizations as they
look for partners to complement and supplement their development
efforts.  Frequently, through their innovative, flexible and
responsive programme design and implementation, non-governmental
organizations have been able to ensure grass-roots participation
as well as to interact with and serve constituencies that may be
underserved or difficult to reach through government channels.
The United Nations resident coordinator system can play a lead
role in increasing the involvement and participation of non-
governmental organizations and private-sector organizations in
reproductive health programming, by supporting networking,
information sharing and the establishment of councils or
committees that facilitate and enhance dialogue and joint
programming efforts among United Nations organizations,
Governments and non-governmental organizations;

     (i)  Collaboration and coordination:  In order to effectively
and harmoniously implement the reproductive health programming
approach in a strategic and holistic manner, United Nations
agencies and organizations will need to redouble their efforts in
collaborating and coordinating their activities.  This will
include increasing the involvement of non-governmental
organizations, the private sector, youth and community groups,
women's organizations and civil society in the planning,
implementation, monitoring and evaluation of reproductive health
programmes.  Another area for the support of the Task Force and
the resident coordinator system is strengthening the role and
contribution of regional institutions, including the regional
commissions and the regional banks, in reproductive health
advocacy and programming.  It is essential that, in translating
the concept of reproductive health, consistency and
complementarity guide the United Nations system.  In particular,
it should be ensured that national counterparts do not receive
conflicting messages from different United Nations agencies and
organizations.  Greater information sharing, networking,
coordinated planning and harmonization of programming cycles will
contribute substantially to enhancing collaboration, coordination
and complementarity among United Nations agencies and
organizations.

55.  As indicated in paragraph 54 above, the challenges that lie
ahead are both complex and numerous.  Perhaps the most important
challenge facing the United Nations system, the one on which
success will depend, is that of achieving and sustaining close
collaboration and coordination among all United Nations agencies
and organizations and, indeed, with all other development
partners.  Thus far, the Task Force has encountered no
collaboration problems.  However, it will continue to emphasize
the need for the United Nations system to work in a collaborative
and coordinated manner with Governments, non-governmental
organizations, the private sector, community and youth groups,
and civil society.


                         V.  CONCLUSION


56.  In producing the guidelines for the United Nations resident
coordinator system and the common advocacy statement, the Task
Force has taken a major step forward. In many respects, however,
the work of the Task Force has only just begun.  The challenge
ahead will include close monitoring and ensuring that the United
Nations resident coordinator system continues to work effectively
to assist countries in implementing the Programme of Action,
including rapidly advancing to meet the goal of the Programme of
Action of making reproductive health care accessible to all by the
year 2015.

57.  This must be a joint endeavour:  no organization can single-
handedly meet the goals and objectives of the Programme of Action.
In just over a year, the Task Force has demonstrated that United
Nations organizations and agencies can collaborate and coordinate
their activities in meeting a common goal, and furthermore, that
they can do so harmoniously while capitalizing on their areas of
comparative advantage.  The guidelines prepared by the Task Force
do not conflict with the individual mandates of member
organizations; rather, they enhance complementarity and aim at
strengthening coordination while promoting an enabling environment
for the effective implementation of the Programme of Action.  The
Task Force will continue its commitment to ensuring that all its
development efforts in implementing the Programme of Action remain
people-centred.

58.  A system-wide action plan to provide coordinated assistance
to countries in translating the outcomes of recent United Nations
global conferences into concrete national policies and programmes
has been agreed by all the United Nations agencies.  The unifying
theme of the action plan agreed by ACC to follow up on those
conferences is the provision of assistance to countries in a
concerted attack on poverty.  As part of this action plan, inter-
agency task forces will be established to address:  (a) basic
social services, (b) employment and sustainable livelihoods, and
(c) an enabling environment for social and economic development.
The existing Inter-Agency Task Force for the Implementation of the
Programme of Action, chaired by UNFPA, will be expanded to cover
social services for all and to help further the commitments to
strengthening health and basic education services made at the
above-mentioned conferences.  The other two task forces--covering
items (b) and (c) above--will be chaired, respectively, by the ILO
and the World Bank.


                              Notes


     1/   Report of the International Conference on Population and
Development, Cairo, 5-13 September, 1994 (United Nations
publication, Sales No. E.95.XIII.18), para. 7.2.

     2/   Report of the World Summit for Social Development,
Copenhagen, 6-12 March 1995 (A/CONF.166/9), chap. I, resolution 1,
annex I.

     3/   Ibid., annex II.

     4/   Report of the Fourth World Conference on Women, Beijing,
4-15 September 1995 (A/CONF.177/20), chap. I, resolution 1,
annex I.

     5/   Report of the United Nations Conference on Environment
and Development, Rio de Janeiro, 3-14 June 1992, vol. I,
Resolutions Adopted by the Conference (United Nations publication,
Sales No. E.93.I.8 and corrigenda), resolution 1, annex II.

     6/   Ibid., annexes I and III.

     7/   See Inter-Agency Task Force for the Implementation of
the Programme of Action, "Guidelines on reproductive health", in
Guidelines for the United Nations Resident Coordinator System (New
York, United Nations Population Fund, 1995).
                             Annex I

LIST OF MEMBERS OF THE INTER-AGENCY TASK FORCE FOR THE
IMPLEMENTATION OF THE PROGRAMME OF ACTION OF THE INTERNATIONAL
CONFERENCE ON POPULATION AND DEVELOPMENT

United Nations Secretariat a/
     Department for Policy Coordination and Sustainable
     Development
     Department for Economic and Social Information and
     Policy Analysis
     Economic Commission for Europe b/

United Nations Children's Fund a/

United Nations Development Programme

United Nations Development Fund for Women a/

United Nations Environment Programme

United Nations Population Fund a/

World Food Programme

Office of the United Nations High Commissioner for Refugees a/

International Labour Organization a/

Food and Agriculture Organization of the United Nations a/

United Nations Educational, Scientific and Cultural Organization a/

World Health Organization a/
     Pan American Health Organization

World Bank a/

International Monetary Fund


     a/ Replied to the questionnaire sent out by the Task Force
secretariat.
     b/ Representing the regional commissions.                            


                          Annex II


    INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT:
COMMITMENTS TO REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTHa


                              Facts

     1.   Every year, 500,000 women die, one every minute, from
pregnancy-related causes, 99 per cent of them in developing
countries.

     2.   There are 120 million women who say they do not want to
be pregnant but are not using family planning.

     3.   Each year, 20 million unsafe abortions occur, resulting
in tens of thousands of deaths and millions of disabilities.

     4.   More than 15 million girls, ages 15-19, give birth every
year.

     5.   Over 300 million new cases of sexually transmitted
diseases occur every year, affecting 1 of every 20 adolescents.

     6.   By the year 2,000, up to 40 million people could be HIV-
infected.

          Reproductive health for all by the year 2015

     Reproductive health, including family planning and sexual
health, through the primary health-care system, should include:

     1.   Quality family planning, including a full range of
contraceptives.

     2.   Maternal care, including prenatal, delivery and post-
partum care, as well as essential obstetric care.

     3.   Prevention and treatment of reproductive tract
infections, including sexually transmitted diseases, prevention of
HIV/AIDS and availability of affordable condoms.

     4.   Access to quality services for the management of
complications from unsafe abortion; in circumstances where
abortion is not against the law, such abortion should be safe; and
post-abortion family planning counselling and services.

     5.   Information, education and counselling on human
sexuality.

     6.   Referral for these and other conditions, such as breast
cancer, cancers of the reproductive system, and infertility.

                      Rights and principles

     Reproductive rights should be a fundamental basis of all
programmes and policies.  Reproductive rights include:

     1.   The right to freely decide the number and spacing of
children, and to have the information and means to do so;

     2.   The right to attain the highest standard of sexual and
reproductive health; and

     3.   The right to make decisions concerning reproduction free
of coercion, discrimination or violence.

                          Special needs

     1.   Eliminate discrimination against girls and women;

     2.   End all harmful practices, including female genital
mutilation;

     3.   Ensure quality care for victims of sexual abuse or
violence;

     4.   Provide adolescents with appropriate sexual and
reproductive health information and services.

     5.   Develop innovative sexual and reproductive health
programmes to reach them.

                             Actions

     1.   Promote reproductive health and rights throughout
national policies and programmes.

     2.   Give reproductive health high priority in national
agendas and budgets.

     3.   Launch education programmes to increase gender
sensitivity, eliminate violence against women and children, and
raise awareness of sexual and reproductive health and reproductive
rights.

     4.   Empower women from a young age to exercise their rights,
especially through education, and enable pregnant adolescents to
continue their schooling.

     5.   Improve the quality of services, including better
training and interpersonal skills, availability of reliable
supplies and equipment, monitoring and supervision, and expanded
reproductive choices;

     6.   Stress sensitivity to gender issues and the needs and
perspective of adolescents in the training of health-care
providers.

     7.   Integrate services to maximize use of resources and
improve access.

     8.   Support research to improve sexual and reproductive
health.

                        Working together

     1.   Involve all levels of society in making reproductive
health and rights for all a reality.

     2.   Mobilize partnerships between Government and civil
society, including non-governmental organizations and the private
sector.

                         Implementation

     In September 1994, at the International Conference on
Population and Development, Governments reached consensus and
committed themselves to a Programme of Action that places
reproductive health and rights at the centre of the population and
development agenda.  The implementation of the Programme of Action
is the right and responsibility of each country, in accordance
with its national priorities, needs and cultural context.



     a/ Issued jointly by the United Nations Population Fund, the
World Bank and the World Health Health Organization.                  

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