From Africa Recovery, Vol.13#2-3 (September 1999), page 6
Africa reconfirms Cairo population goals
Five years later, much progress despite financial constraints
By Sumana Raychaudhuri
Five years after the 1994 International Conference on Population and Development (ICPD) in Cairo, Egypt, African nations have reaffirmed their commitment to the programme of action. In a special session of the UN General Assembly, held in New York in June 1999, the 179 signatories to the Cairo plan assessed the progress made so far and examined problems dogging the implementation of the programme of action, which argued that the best way to slow down population growth is through enabling the individual to attain his or her reproductive rights. The plan also affirmed that achieving universal adult literacy is a crucial tool for empowerment (see box, below).
"In Cairo, everyone agreed on the need to mobilize new financial resources -- from within developing countries, and also from the international community," said UN Secretary-General Kofi Annan, addressing the "Cairo plus five" conference in New York.
Financial gap
So far, roughly four-fifths of the funds spent on population programmes have come from the developing countries themselves, though industrialized nations had originally promised to bear a third of the costs. "There remains an enormous difference between what was pledged [by developed countries] and what has been provided. Indeed, some of this assistance has declined," Ms. Mervat Tallawy, Minister of Social Affairs of Egypt, reminded the conference. Egypt had a century-old history of cooperation between government, the private sector and civil society, which had enabled it to reduce its birthrate from 3.18 per cent in 1997 to 2.75 per cent at present, she said. During the same period, the use of family-planning methods rose from 24.2 per cent to 54.5 per cent, and fertility declined from 4.4 to 3.3 children per woman. "Social expenditures now account for 39 per cent of Egypt's general budget," she said, "double the level recommended by the 20/20 initiative... Developing countries have conscientiously fulfilled their own responsibilities and more in order to maintain what they already have." Further improvements would require increased assistance, she stressed.
The 20/20 initiative, originally launched by the UN Children's Fund (UNICEF) and other agencies, asks developing countries to allocate 20 per cent of their national budgets to basic social sectors, and says that at least 20 per cent of international aid should be allocated to meeting the minimum needs of the world's poorest people.
While developing countries have largely integrated the Cairo Plan into developmental and demographic programmes, their efforts have been partly stymied by a number of unforeseen circumstances. Natural disasters like prolonged drought in sub-Saharan Africa; continued economic stagnation and resulting financial crises in many poor countries, including some with ongoing structural adjustment programmes; plummeting prices of primary export commodities; and social instability, regional wars, and civil strife in various parts of the continent; spending on arms; and debt servicing all have limited the funds available to population programmes. Predictably, these have affected development and health negatively, especially for women.
The chronic shortage of funds was, in fact, the common concern of countries with active population programmes. "Ghana is determined to continue to implement the ICPD Programme of Action to the letter and in this regard we are committing as much resources as we can to the social sector," said Mr. Kwamena Ahwoi, Ghana's Minister of Local Government and Rural Development. He noted, however, that Ghana has serious resource constraints resulting from policies that try to juggle the inconsistent demands of macro-economic stability and unsustainable external debt servicing in the face of limited economic potential. Moreover, he said, there are shortages of trained personnel, inadequate health care services -- especially in rural areas -- and certain traditional socio-cultural beliefs and practices. Such problems are typical across Africa.
Another pervasive African problem is the impact of large-scale human displacement. Mr. Christon S. Tembo, the Vice-President of Zambia, stated that his country has a population growth rate of 3.1 per cent coupled with a stagnant economy. Poverty levels are estimated at 70 per cent, and 48.3 per cent of the population is under 15 years old. All this creates an enormous pressure on the government's already scant resources. Moreover, he said, "Being a stable and peaceful country, Zambia has provided a natural sanctuary for displaced persons fleeing from civil strife in their countries. In addition, my country's involvement in resolving regional conflicts has put tremendous pressure on our meagre resources."
One of the greatest concerns of African nations is the HIV/AIDS pandemic. It has knocked years off the lives of large sections of the populace, implying a corresponding setback in developmental gains. The safety and survival of an entire generation of children is also affected. "South Africa's demographic profile is expected to be severely affected by the HIV/AIDS onslaught which will also have devastating socio-economic consequences," said the permanent representative of South Africa to the UN, Mr. Dumisani S. Kumalo. "Having been recognized as more than just a health issue, the HIV/AIDS campaign is a national priority, led at the presidential level and is aimed at changing behaviour and attitudes, beyond mere awareness." Problems remain, however, as medicines can be prohibitively expensive. Yet, Uganda has been especially successful in combating this epidemic. The UN Programme on HIV/AIDS (UNAIDS), UN agencies, bilateral donors, and African countries have been aggressively battling this disease.
For many African countries, as with most of the developing world, another concern has been the inordinately high number of women who die every year as a result of pregnancy and childbirth. To reverse this trend, many argue that comprehensive programmes for reproductive health education are as necessary as trained nurses and easily accessible health services. Family size has declined as access to safe contraception has improved, but millions of couples still lack access to contraceptive methods. The demand for reproductive health services like family planning, sexual health, and infertility treatment remains largely unmet in these countries, where population programmes are severely hampered by inadequate funds. Development practitioners worry about these shortcomings since the choices that young people make regarding the timing and spacing of their children will determine the pace of future population growth.
African achievements
While most of the country reports stressed the problems, the follow-up committee on the implementation of the Dakar/Ngor Declaration (adopted by African countries before the 1994 Cairo conference) and the ICPD Programme of Action reported some of the best practices in different fields:
Reproductive health and rights: Countries like Burkina Faso, Burundi, Côte d'Ivoire, Guinea, Niger, São Tomé and Príncipe, Senegal, Tanzania and Togo have integrated family planning and safe motherhood into their public health care system. Ethiopia and Guinea have abolished antiquated laws on abortion, while Ghana and Kenya no longer require spousal consent for the supply of contraceptives or sterilization. The Central African Republic, Ethiopia, Niger, and Togo have undertaken health education campaigns to prevent sexually transmitted diseases and harmful traditional practices. Uganda has drastically reduced the incidence of AIDS, maternal mortality rates, and the number of girls who have undergone female genital mutilation, the latter by 36 per cent.
Family, youth and adolescents: A number of countries have adopted the approach of the World Health Organization and UNICEF for an integrated management of childhood diseases. Non-governmental organizations (NGOs) have set up crises centres and legal clinics for counseling and research in Uganda and Southern African countries to address dangerous practices like wife beating. Uganda has launched a Programme for Enhancing Adolescent Life to counsel out-of-school adolescents on reproductive health while providing recreational facilities and mobilizing political and community support. Botswana too has similar programmes.
Gender equality, empowerment of women, male involvement: Most countries have created sensitization programmes to reduce discrimination against women, and about 71 per cent are conducting gender-oriented surveys and research. Countries like Kenya, Uganda and Mozambique are encouraging equal participation of men and women in decision-making processes. Ghana has formulated a national action plan with time-bound targets for implementation.
Role of NGOs: A number of NGOs are trying to help hard-to-reach groups like refugees, prostitutes, and persons in remote areas. Many are providing "one-stop" clinics, involving males, and forming "umbrella" organizations.
Advocacy: People are being made aware of their reproductive rights and responsible parenthood; safe sexual behaviour is being promoted; men are being mobilized to participate in reproductive health programmes.
In New York, the assembled nations reaffirmed the Cairo consensus, namely, that the key to solving demographic problems is to create socio-economic conditions that enable individuals to exercise their basic human rights, including reproductive rights. "The Cairo Programme of Action was a landmark," said Ms. Clare Short, the UK Secretary of State for International Development. "It was based on the link between sustainable development and human development. It gave us the right agenda for population. An agenda focused on people and their health, poverty elimination and the sustainable economic growth necessary to reduce poverty." Among donor countries, the UK, Japan, Denmark, and Norway urged developed countries to reverse the trend of shrinking aid to developing countries. The conference ended on a note of consensus that much remains to be done before the world becomes a more equitable place for all.
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BOX 1:
Highlights of the 1994 ICPD Programme of Action
The Cairo action plan was based on the consensus opinion among the world's nations that the growth of the world population -- from 2 billion people at the beginning of the century to 6 billion at the end of the century -- has created inordinate demands on limited resources, and that this trend needs to be reversed. It stated that, rather than continue the traditional approaches that depended principally on coercion, any strategy to stabilize world population growth and achieve sustainable development should address the following points:
-- Reproductive rights are an intrinsic part of human rights. Health services should be improved and made readily available so that women possess greater control over matters relating to their sexuality, including sexual and reproductive health. Rights of vulnerable groups like women, migrants, and people suffering from HIV/AIDS require special attention.
-- National policies need to shift from top-down approaches to family planning that depend on coercion to ones that emphasise overall reproductive health care.
-- The question of gender inequality needs to be addressed as a basic step towards sustainable development.
-- Achieving universal adult literacy is an essential step for a better future for all.
-- Governments and NGOs need to share the responsibility for implementing the ICPD Programme of Action.
-- Developed countries would provide one-third of the funds that developing countries need to provide basic reproductive health care to their citizens.
-- Different countries need to take into account their specific economic, cultural, social, religious, and environmental contexts when implementing the Programme of Action to achieve their common goals.
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