UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
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| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
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the United Nations Population Information Network (POPIN) Gopher of
the Department for Economic and Social Information and Policy
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UNITED NATIONS
Distr. LIMITED
A/CONF.171/L.1
13 May 1994
ORIGINAL: ENGLISH
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Cairo, 5-13 September 1994
Item 9 of the provisional agenda*
PROGRAMME OF ACTION OF THE CONFERENCE
Note by the Secretariat
Draft programme of action of the International
Conference on Population and Development
The draft programme of action of the International Conference
on Population and Development, as approved by the Preparatory
Committee for the International Conference on Population and
Development at its third session (30th to 34th meetings), which was
held in New York from 20 to 22 April 1994, is being transmitted to
the Conference for further consideration.
* A/CONF.171/1.
94-21653 (E) 030694
CONTENTS
Chapter
Paragraphs Page
I. PREAMBLE ................................. 1.1 - 1.21 5
II. PRINCIPLES .............................. 11
III. INTERRELATIONSHIPS BETWEEN POPULATION,
SUSTAINED ECONOMIC GROWTH AND
SUSTAINABLE DEVELOPMENT ................ 3.1 - 3.32 15
A. Integrating population and development
strategies ........................ 3.1 - 3.9 15
B. Population, sustained economic growth and
poverty ........................... 3.10 - 3.22 16
C. Population and environment ........ 3.23 - 3.32 19
IV. GENDER EQUALITY, EQUITY AND EMPOWERMENT
OF WOMEN ................................ 4.1 - 4.29 22
A. Empowerment and status of women ... 4.1 - 4.14 22
B. The girl child .................... 4.15 - 4.23 25
C. Male responsibilities and
participation ..................... 4.24 - 4.29 27
V. THE FAMILY, ITS ROLES, COMPOSITION
AND STRUCTURE ............................ 5.1 - 5.13 29
A. Diversity of family structure
and composition ................... 5.1 - 5.6 29
B. Socio-economic support to the family 5.7 - 5.13 30
VI. POPULATION GROWTH AND STRUCTURE ......... 6.1 - 6.33 32
A. Fertility, mortality and population
growth rates ....................... 6.1 - 6.5 32
B. Children and youth ................ 6.6 - 6.15 33
C. Elderly people .................... 6.16 - 6.20 35
D. Indigenous people[s] .............. 6.21 - 6.27 36
E. Persons with disabilities ......... 6.28 - 6.33 38
VII. REPRODUCTIVE RIGHTS, [SEXUAL AND REPRODUCTIVE
HEALTH] AND FAMILY PLANNING ............ 7.1 - 7.46 40
A. Reproductive rights and reproductive
health ............................ 7.1 - 7.9 40
B. Family planning ................... 7.10 - 7.24 42
C. Sexually transmitted diseases and
HIV prevention ..................... 7.25 - 7.31 46
D. Human sexuality and gender relations 7.32 - 7.38 47
E. Adolescents ....................... 7.39 - 7.46 49
VIII. HEALTH, MORBIDITY AND MORTALITY ....... 8.1 - 8.35 52
A. Primary health care and the
health-care sector ................ 8.1 - 8.11 52
B. Child survival and health ......... 8.12 - 8.18 54
C. Women's health and [safe motherhood] 8.19 - 8.27 56
D. Human immunodeficiency virus (HIV)
infection and acquired
immunodeficiency syndrome (AIDS) .. 8.28 - 8.35 59
IX. POPULATION DISTRIBUTION, URBANIZATION AND INTERNAL
MIGRATION ............................... 9.1 - 9.25 62
A. Population distribution and sustainable
development ....................... 9.1 - 9.11 62
B. Population growth in large urban
agglomerations .................... 9.12 - 9.18 64
C. Internally displaced persons ...... 9.19 - 9.25 65
X. INTERNATIONAL MIGRATION .................. 10.1 - 10.29 67
A. International migration and
development ....................... 10.1 - 10.8 67
B. Documented migrants ............... 10.9 - 10.14 69
C. Undocumented migrants ............. 10.15 - 10.20 71
D. Refugees, asylum-seekers and
displaced persons ................. 10.21 - 10-29 72
XI. POPULATION, DEVELOPMENT AND EDUCATION 11.1 - 11.26 75
A. Education, population and sustainable
development ....................... 11.1 - 11.10 75
B. Population information, education and
communication ..................... 11.11 - 11.26 77
XII. TECHNOLOGY, RESEARCH AND DEVELOPMENT .. 12.1 - 12.26 82
A. Basic data collection, analysis and
dissemination ..................... 12.1 - 12.9 82
B. [Sexual and reproductive] health
research ........................... 12.10 - 12.18 84
C. Social and economic research ....... 12.19 - 12.26 86
XIII. NATIONAL ACTION ........................ 13.1 - 13.24 89
A. National policies and plans of
action ............................. 13.1 - 13.6 89
B. Programme management and human resource
development ........................ 13.7 - 13.10 90
C. Resource mobilization and allocation 13.11 - 13.24 92
XIV. INTERNATIONAL COOPERATION ................. 14.1 - 14.18 97
A. Responsibilities of partners in
development ........................ 14.1 - 14.7 97
B. Towards a new commitment to funding
population and development ......... 14.8 - 14.18 99
XV. PARTNERSHIP WITH THE NON-GOVERNMENTAL SECTOR 15.1 - 15.20 102
A. Local, national and international
non-governmental organizations ........15.1 - 15.12 102
B. The private sector ................. 15.13 - 15.20 104
XVI. FOLLOW-UP TO THE CONFERENCE ............. 16.1 - 16.29 107
A. National-level activities .......... 16.1 - 16.13 107
B. Subregional and regional activities 16.14 - 16.17 109
C. Activities at the international level 16.18 - 16.29 110
Chapter I 1/
PREAMBLE
1.1. The 1994 International Conference on Population and
Development occurs at a defining moment in the history of
international cooperation. With reductions in international and
regional tensions, and with the growing recognition of global
economic and environmental interdependence, the opportunity to
adopt suitable socio-economic policies to promote sustained
economic growth and sustainable development and to mobilize human
and financial resources for global problem-solving has never been
greater. Never before has the world community had so many
resources, so much knowledge and such powerful technologies at its
disposal with which it could foster socially equitable and
environmentally sustainable world development.
1.2. This is also a time of great and urgent challenges. The
decisions that the international community takes over the next
several years, whether leading to action or inaction, will have
profound implications for the quality of life for all people,
including generations not yet born, and perhaps for the planet
itself. Around the world many of the basic resources on which
future generations will depend for their survival and well-being
are being depleted and environmental pollution is intensifying,
driven by the unprecedented growth in human numbers, widespread and
persistent poverty, social and economic inequality, and wasteful
consumption. New ecological problems, such as global climate
change, largely driven by unsustainable patterns of production and
consumption, are adding to the threats to a future. At the same
time, there is emerging global consensus on the need for increased
international cooperation in regard to population, sustainable
development and the environment. Much has been achieved in this
respect, but more needs to be done.
1.3. The growth of the world population is at an all-time high in
absolute numbers, with current increments exceeding 90 million
persons annually. According to United Nations projections, annual
population increments are likely to remain above 90 million until
the year 2015. While it took 123 years for world population to
increase from 1 billion to 2 billion, succeeding increments of 1
billion took 33 years, 14 years and 13 years. The transition from
the fifth to the sixth billion, currently under way, is expected to
take only 11 years and to be completed by 1998.
1.4. During the remaining six years of this critical decade, the
world's nations by their actions or inactions will choose from
among a range of alternative demographic futures. The most likely
of those alternatives are foreseen in the low, medium and high
variants of the United Nations population projections. Looking
ahead 20 years, these alternate projections range from a low of
7.27 billion people in 2015 to a high of 7.92 billion. The
difference of 660 million people in the short span of 20 years is
nearly equivalent to the current population of the African
continent. Further into the future, the projections diverge even
more significantly. By the year 2050, the United Nations low
projection shows a world population of 7.8 billion people, and the
high projection a population of 12.5 billion people.
Implementation of the goals and objectives contained in the present
20-year Programme of Action, which address many of the fundamental
population, health, education and development challenges facing the
entire human community, would result in world population growth
during this period and beyond at levels close to the United Nations
low variant.
1.5. The International Conference on Population and Development is
not an isolated event. Its Programme of Action builds on the
considerable international consensus that has developed since the
World Population Conference at Bucharest in 1974 2/ and the
International Conference on Population at Mexico City in 1984, 3/
to consider the broad issues of population, sustained economic
growth and sustainable development, and advances in the educational
and economic status of women. The 1994 Conference was explicitly
given a broader mandate than previous population conferences,
reflecting the growing awareness of the interlinkages among
population issues, sustained economic growth and sustainable
development.
1.6. The International Conference on Population and Development
follows and builds on other important recent international
activities, including:
(a) The World Summit for Children, held in New York in 1990;
4/
(b) The United Nations Conference on Environment and
Development, held at Rio de Janeiro in 1992; 5/
(c) The World Conference on Human Rights, held at Vienna in
1993; 6/
(d) The International Year of the World's Indigenous People,
1993, 7/ which would lead to the International Decade of the
World's Indigenous People; 8/
(e) The International Year of the Family, 1994. 9/
1.7. The Conference will make significant contributions to three
major conferences in 1995 and 1996, namely, the World Summit for
Social Development, 10/ the Fourth World Conference on Women, 11/
and the Second United Nations Conference on Human Settlements
(Habitat II), as well as to the celebration of the fiftieth
anniversary of the United Nations. These events are expected to
highlight further the call of the 1994 Conference for greater
investments in people, and for a new action agenda to make women
full partners with men in the social, economic and political lives
of their communities.
1.8. Over the past 20 years, many parts of the world have
undergone remarkable demographic, social, economic and political
change. Many countries have made substantial progress in expanding
access to reproductive health care and lowering birth rates, as
well as in lowering death rates and raising education and income
levels, including the educational and economic status of women.
The dramatic success of some countries provides a basis for
optimism about what all countries can accomplish over the next 20
years. The world as a whole has changed in ways that create
important new opportunities for addressing population and
development issues. Among the most significant are the major
shifts in attitude among the world's people and their leaders in
regard to reproductive health, family planning and population
growth. A particularly encouraging trend has been the
strengthening of political commitment to population policies and
family planning programmes by many Governments.
1.9. Significant changes in attitudes, leading to much greater
demands for family planning information and services, have occurred
at the grass-roots level among individual women and men. Over the
past several decades contraceptive use in developing countries has
increased fivefold, reflecting the growing strength of organized
family-planning programmes in a large majority of developing
countries and relatively rapid reduction in family size norms.
These international trends, while highly encouraging, conceal great
demographic diversity among countries and regions. In Western
Europe, North America and much of East Asia, access to family
planning is almost universal, contraceptive use is between 65 and
80 per cent and average family size is near or below
replacement-level fertility of two children per couple. By
contrast, in most sub-Saharan African and some Pacific Island
countries, a few of which have made rapid progress recently,
family-planning services are not yet widely available,
contraceptive use is below 15 per cent and women bear an average of
six or more children. At the global level, an estimated 350
million couples do not have access to a full range of modern
family-planning information and services. At the same time, an
estimated 120 million women would be practising a modern
family-planning method if it were available, affordable and
acceptable by the husband, family and community. One indication of
the large unmet demand for more and better family-planning services
is the estimated 50 million abortions that occur every year, many
of them unsafe.
1.10. Remarkable, albeit uneven, progress has been made over the
past 20 years in reducing levels of morbidity and mortality,
especially high death rates among young children. Infant mortality
for the world as a whole has dropped by one third, from 92 to 62
deaths per 1,000 births. But much remains to be done both in
further reducing infant and child morbidity and mortality levels
and in narrowing the large gap between developing and developed
countries (infant mortality is currently 69 and 12 deaths per 1,000
births in developing and developed countries, respectively).
1.11. An even greater gap in death rates exists between regions of
the world with respect to levels of maternal mortality. Maternal
death rates are 15 to 50 times greater in the developing world than
in most developed countries. Average maternal mortality in
developing regions is about 420 deaths per 100,000 live births on
average, compared to just 30 deaths per 100,000 live births in
developed regions. At least half a million women die each year as
a consequence of pregnancy and childbirth, with 99 per cent of
those deaths occurring in developing countries. Almost all of
those deaths are preventable. In some countries, as many as half
of maternal deaths may result from unsafe abortions; many others
result from the absence of the most basic antenatal, maternity and
post-natal care.
1.12. Over the past 20 years, average life expectancy has
increased by three and a half years in the developed regions, from
71 to 74.6 years, and by eight years in the developing countries,
from 54.5 to 62.4 years. These gains are a major accomplishment.
But further gains may be jeopardized in many parts of the world by
prolonged economic recession, poorly designed structural
readjustment programmes that have reduced already low levels of
public health expenditure, and recent dislocations in the health
infrastructures of most countries with economies in transition. In
many parts of the growing environmental health problems, the
increasing prevalence of substance abuse and the acquired
immunodeficiency syndrome (AIDS) pandemic are all contributing to
high levels of morbidity and mortality.
1.13. Levels of education have risen considerably during the past
two decades and, in many parts of the world, the gap in educational
attainment between males and females has narrowed. None the less,
the estimated number of illiterate persons in the world, two thirds
of them women, is almost 960 million. Some 130 million children,
including over 90 million girls, are denied access to primary
schooling. The large remaining shortfalls in basic education and
adult literacy, particularly among girls and women, continue to be
major obstacles in many countries to progress in every sphere of
their development, including changes in patterns of human
reproduction.
1.14. Significant changes have occurred in the roles and status of
women in many countries. In addition to gains in education, women
have been entering the labour force in record numbers, many of them
in non-traditional economic roles. In many countries, women's
monetary incomes are an important source of support for families.
All of these trends are contributing to the rising demand for
family-planning services. But not all recent trends have been
positive for women and their families. In some communities the
failure of men to meet their family responsibilities means that
women are left as the principal or only source of support for
themselves and their children. Everywhere these households are the
poorest of the poor, in part because women have less access than
men to training, credit, property, natural resources and better
paid jobs.
1.15. The two decades ahead are destined to produce a further
shift of rural populations to urban areas as well as continued high
levels of migration between countries. These migrations are an
important part of the economic transformations occurring around the
world. But they also present serious new challenges. By the year
2015, nearly 56 per cent of the global population is expected to
live in urban areas, compared to under 45 per cent in 1994. The
most rapid rates of urbanization will occur in the developing
countries. The urban population of the developing regions was just
26 per cent in 1975, but is projected to rise to 50 per cent by
2015. This change will place enormous strain on existing social
services and infrastructure, much of which will not be able to
expand at the same rate as that of urbanization.
1.16. Particular challenges are presented by those countries that
are undergoing changes in population composition, resulting in the
ageing of the population. This includes both countries with very
low fertility rates and countries with high fertility rates.
Included in the latter category are those developing countries that
are undergoing very rapid demographic transition and, as a result,
will need to accommodate in the near future large numbers of
elderly persons, often with limited national resources to draw
upon. These changes have major implications for every area of
social and economic activity.
1.17. The problems and challenges outlined above indicate that
intensified efforts are needed in the coming 5, 10 and 20 years, in
a range of population and development activities, bearing in mind
the crucial contribution that early stabilization of the world
population would make towards the achievement of sustainable
development. The present Programme of Action addresses all those
issues, and more, in a comprehensive and integrated framework
designed to improve the quality of life of the current world
population and its future generations. The recommendations for
action made here are formulated in a spirit of consensus and
international cooperation, recognizing that the formulation and
implementation of population policies is the responsibility of each
country and should take into account the economic, social,
environmental, cultural and political diversity of conditions in
each country, as well as the shared responsibilities of all the
world's people for a common future.
1.18. The present Programme of Action commits the international
community to quantitative goals in three areas that are mutually
supporting and of critical importance to the achievement of other
important population and development objectives. These areas are:
education, especially for girls; infant, child and maternal
mortality reduction; and the provision of universal access to
family planning and reproductive health services.
1.19. Many of the quantitative and qualitative goals of the
present Programme of Action clearly require additional resources,
some of which could become available from a reordering of
priorities at the individual, national and international levels.
However, none of the actions required - nor all of them combined -
are expensive in the context of either current global development
or military expenditures. A few would require little or no
additional financial resources, in that they involve changes in
lifestyles, social norms or government policies that can be largely
brought about and sustained through greater citizen action and
enlightened political leadership. But to meet the resource needs
of those actions that do require increased expenditures over the
next two decades, additional commitments will be required on the
part of both developing and developed countries. This will be
particularly difficult in the case of some developing countries and
some countries with economies in transition that are experiencing
extreme resource constraints.
1.20. The present Programme of Action recognizes that over the
next 20 years Governments cannot and should not expect to meet the
goals and objectives of the International Conference on Population
and Development single-handedly. All groups in society have the
right, and indeed the responsibility, to play an active part in
efforts to reach those goals. The increased level of interest
manifested by non-governmental organizations, first in the context
of the United Nations Conference on Environment and Development and
the World Conference on Human Rights, and now in these
deliberations, reflects an important and in many places rapid
change in the relationship between Governments and a variety of
non-governmental institutions. In nearly all countries new
partnerships are emerging between Government, business,
non-governmental organizations and community groups, which will
have a direct and positive bearing on the implementation of the
present Programme of Action.
1.21. The International Conference on Population and Development
represents the last opportunity in the twentieth century for the
international community to collectively address the critical
challenges and interrelationships between population and
development. The legacy of this Conference will be measured by the
strength of the specific commitments made here, as part of a new
global compact among all the world's countries and peoples, based
on a sense of shared responsibility for each other and for our
planetary home.
Chapter II 12/
PRINCIPLES 13/
[In addressing the mandate of the International Conference on
Population and Development and its overall theme of Population,
Sustained Economic Growth and Sustainable Development, and in their
deliberations, the participants were guided by the following
principles:
Principle 1
Everyone is entitled to all the rights and freedoms set forth
in the Universal Declaration of Human Rights, without distinction
of any kind, such as race, colour, sex, language, religion,
political or other opinion, national or social origin, property,
birth or other status. (Universal Declaration of Human Rights,
art. 2)
Principle 2
Human beings are at the centre of concerns for sustainable
development. They are entitled to a healthy and productive life in
harmony with nature. [People are the most important and valuable
resources that any nation possesses. Countries should ensure that
all individuals are given the opportunity to make the most of their
potential.] In addition, they have the right to an adequate
standard of living for themselves and their families, including
adequate food, clothing and housing. (1st and 2nd sentences: Rio
Declaration, principle 1; 5th sentence: adapted from International
Covenant on Economic, Social and Cultural Rights, art. 11, para. 1)
Principle 3
Advancing gender equity and the empowerment of women is a
cornerstone of population and development-related programmes.
Women and men have the same equal right to participate fully in
policy and decision-making at all levels.
Principle 4
Population goals and policies are integral parts of social,
economic and cultural development, whose principal aim is to
improve levels of living and the quality of life of all people.
The formulation and implementation of population policies is the
sovereign right of each nation, consistent with national laws and
in conformity with international human rights standards. (1st
sentence: adapted from World Population Plan of Action, para. 14
(a); 2nd sentence: adapted from World Population Plan of Action,
para. 14)
Principle 5
To achieve sustainable development and a higher quality of
life for all people, States should reduce and eliminate
unsustainable patterns of production and consumption and promote
appropriate demographic policies [, in order to meet the needs of
current generations without compromising the ability of future
generations to meet their own needs]. (Rio Declaration, principle
8)
Principle 6
All States and all people shall cooperate in the essential
task of eradicating poverty as an indispensable requirement for
sustainable development, in order to decrease the disparities in
standards of living and better meet the needs of the majority of
the people of the world. The special situation and needs of
developing countries, particularly the least developed and those
most [environmentally] vulnerable [in the population and
development sectors], shall be given special priority. The
International Conference on Population and Development reaffirms
the need for the full integration of the countries with economies
in transition, as well as all other countries, into the world
economy. (1st sentence: Rio Declaration, principle 5; 2nd
sentence: adapted from Rio Declaration, principle 6; 3rd sentence:
based on General Assembly resolution 48/181)
Principle 7
Everyone has the right to liberty and security of person and
the right to the enjoyment of the highest attainable standard of
physical and mental health. States should take all appropriate
measures to ensure, on a basis of equality of men and women,
universal access to health-care services, including those related
to [sexual and reproductive health care and family planning]. All
couples and individuals have the basic right to decide freely and
responsibly the number and spacing of their children and to have
the information, education and means to do so. (1st sentence, part
1: International Covenant on Civil and Political Rights, art. 9,
para. 1; 1st sentence, part 2: International Covenant on Economic,
Social and Cultural Rights, art. 12, para. 1; 2nd sentence:
adapted from Convention on the Elimination of All Forms of
Discrimination against Women, art. 12, para. 1; 3rd sentence:
World Population Plan of Action, para. 14 (f))
Principle 8
[Sexual and reproductive health-care programmes, including
family-planning services, must provide the widest possible freedom
of choice. Coercion in those programmes, whether physical,
economic or psychological, is a breach of human rights and can
never be acceptable.]
Principle 9
The International Conference on Population and Development
reaffirms that the right to development is a universal and
inalienable right and an integral part of fundamental human rights,
and that the human person is the central subject of development.
The right to development must be fulfilled so as to equitably meet
the [population and development] [developmental and environmental]
needs of present and future generations. (1st sentence: Vienna
Declaration, part I, para. 10; 2nd sentence: adapted from Rio
Declaration, principle 3)
Principle 10
While various concepts of the family exist in different
social, cultural and political systems, the family is the basic
unit of society and as such is entitled to receive comprehensive
protection and support. Marriage must be entered into with the
free consent of the intending spouses. (1st sentence: based on
General Assembly resolution 47/237; 2nd sentence: International
Covenant on Economic, Social and Cultural Rights, art. 10, para. 1)
Principle 11
Everyone has the right to education, which shall be directed
to the full development of the human personality and the sense of
its dignity, and shall strengthen the respect for human rights and
fundamental freedoms. Children have the right to be cared for and
supported by parents, families and society and to be protected from
all forms of physical or mental violence, injury or abuse, neglect
or negligent treatment, maltreatment or exploitation, including
sexual abuse. (1st sentence: International Covenant on Economic,
Social and Cultural Rights, art. 13, para. 1; 2nd sentence, last
part: adapted from Convention on the Rights of the Child, art. 19,
para. i)
Principle 12
Countries receiving migrant workers should provide proper
treatment and adequate social welfare services for them and their
families, and should ensure their physical safety and security, in
conformity with the provisions of the relevant conventions and
recommendations of the International Labour Organization and other
international instruments. (World Population Plan of Action, para.
55)
Principle 13
In considering the population and development needs of
indigenous people[s], States should recognize and support their
identity, culture and interests, and enable them to participate
fully in the social and political life of the country, particularly
where their health, education and well-being are affected.
Principle 14
Economic development must be environmentally sound and
sustainable. Economic growth and social progress requires that
growth be broadly based, offering equal opportunities to all
people. The industrialized countries should continue their efforts
to promote sustained growth and to narrow imbalances in a manner
that can benefit other countries, particularly the developing
countries. (Based on Declaration on International Economic
Cooperation, in particular the Revitalization of Economic Growth
and Development of the Developing Countries, paras. 16, 18 and 22)
Principle 15
Everyone has the right to seek and to enjoy in other countries
asylum from persecution. The International Conference on
Population and Development reaffirms the responsibilities of States
with respect to refugees as described in the Geneva Convention on
the Status of Refugees.] (1st sentence: Universal Declaration of
Human Rights, art. 14, para. 1)
Chapter III
INTERRELATIONSHIPS BETWEEN POPULATION, SUSTAINED
ECONOMIC GROWTH AND SUSTAINABLE DEVELOPMENT
A. Integrating population and development strategies
Basis for action
3.1. The everyday activities of all human beings, communities and
countries are interrelated with population change, patterns and
levels of use of natural resources, the state of the environment,
and the pace and quality of economic and social development. There
is general agreement that persistent widespread poverty as well as
serious social and gender inequities have significant influences
on, and are in turn influenced by, demographic parameters such as
population growth, structure and distribution. There is also
general agreement that unsustainable consumption and production
patterns are contributing to the unsustainable use of natural
resources and environmental degradation as well as to the
reinforcement of social inequities and of poverty with the above-
mentioned consequences for demographic parameters. The Rio
Declaration on Environment and Development and Agenda 21, adopted
by the international community at the United Nations Conference on
Environment and Development, call for patterns of development that
reflect the new understanding of these and other intersectoral
linkages. Recognizing the longer-term realities and implications
of current actions, the development challenge is to meet the needs
of present generations and improve their quality of life without
compromising the ability of future generations to meet their own
needs.
3.2. Despite recent declines in birth rates in many countries,
further large increases in population size are inevitable. Owing
to the youthful age structure, for numerous countries the coming
decades will bring substantial population increases in absolute
numbers. Population movements within and between countries,
including the very rapid growth of cities and the unbalanced
regional distribution of population, will continue and increase in
the future.
3.3. Sustainable development implies, inter alia, long-term
sustainability in production and consumption relating to all
economic activities including industry, energy, agriculture,
forestry, fisheries, transport, tourism and infrastructure in order
to optimize ecologically sound resource use and minimize waste.
Macroeconomic and sectoral policies have, however, rarely given due
attention to population considerations. Explicitly integrating
population into economic and development strategies will both speed
up the pace of sustainable development and poverty alleviation and
contribute to the achievement of population objectives and an
improved quality of life of the population.
Objectives
3.4. The objectives are to fully integrate population concerns
into:
(a) Development strategies, planning, decision-making and
resource allocation at all levels and in all regions, with the goal
of meeting the needs, and improving the quality of life, of present
and future generations;
(b) All aspects of development planning in order to promote
social justice and to eradicate poverty through sustained economic
growth in the context of sustainable development.
Actions
3.5. At the international, regional, national and local levels,
population issues should be integrated into the formulation,
implementation, monitoring and evaluation of all policies and
programmes relating to sustainable development. Development
strategies must realistically reflect both the short-, medium- and
long-term implications of, and consequences for, population
dynamics as well as patterns of production and consumption.
3.6. Governments, international agencies, non-governmental
organizations and other concerned parties should undertake timely
and periodic reviews of their development strategies, with the aim
of assessing progress towards integrating population into
development and environment programmes that take into account
patterns of production and consumption and seek to bring about
population trends consistent with the achievement of sustainable
development and the improvement of the quality of life.
3.7. Governments should establish the requisite internal
institutional mechanisms and enabling environment, at all levels of
society, to ensure that population factors are appropriately
addressed within the decision-making and administrative processes
of all relevant government agencies responsible for economic,
environmental and social policies and programmes.
3.8. Political commitment to integrated population and development
strategies should be strengthened by public education and
information programmes and by increased resource allocation through
cooperation among Governments, non-governmental organizations and
the private sector, and by improvement of the knowledge base
through research and national and local capacity-building.
3.9. To achieve sustainable development and a higher quality of
life for all people, Governments should reduce and eliminate
unsustainable patterns of production and consumption and promote
appropriate demographic policies. Developed countries should take
the lead in achieving sustainable consumption patterns and
effective waste management.
B. Population, sustained economic growth and poverty
Basis for action
3.10. Population policies should take into account, as
appropriate, development strategies agreed upon in multilateral
forums, in particular the International Development Strategy for
the Fourth United Nations Development Decade, 14/ the Programme of
Action for the Least Developed Countries for the 1990s, 15/ the
outcomes of the eighth session of the United Nations Conference on
Trade and Development, and of the Uruguay Round of multilateral
trade negotiations, Agenda 21 and the United Nations New Agenda for
the Development of Africa in the 1990s. 16/
3.11. Gains recorded in recent years in such indicators as life
expectancy and national product, while significant and encouraging,
do not, unfortunately, fully reflect the realities of life of
hundreds of millions of men, women, adolescents and children.
Despite decades of development efforts, both the gap between rich
and poor nations and the inequalities within nations have widened.
Serious economic, social, gender and other inequities persist and
hamper efforts to improve the quality of life for hundreds of
millions of people. The number of people living in poverty stands
at approximately 1 billion and continues to mount.
3.12. All countries, more especially developing countries where
almost all of the future growth of the world population will occur,
and countries with economies in transition, face increasing
difficulties in improving the quality of life of their people in a
sustainable manner. Many developing countries and countries with
economies in transition face major development obstacles, among
which are those related to the persistence of trade imbalances, the
slow-down in the world economy, the persistence of the
debt-servicing problem, and the need for technologies and external
assistance. The achievement of sustainable development and poverty
eradication should be supported by macroeconomic policies designed
to provide an appropriate international economic environment, as
well as by good governance, effective national policies and
efficient national institutions.
3.13. Widespread poverty remains the major challenge to
development efforts. Poverty is often accompanied by unemployment,
malnutrition, illiteracy, low status of women, exposure to
environmental risks and limited access to social and health
services, [including reproductive health services which, in turn,
include family planning]. All these factors contribute to high
levels of fertility, morbidity, and mortality, as well as to low
economic productivity. Poverty is also closely related to
inappropriate spatial distribution of population, to unsustainable
use and inequitable distribution of such natural resources as land
and water, and to serious environmental degradation.
3.14. Efforts to slow down population growth, to reduce poverty,
to achieve economic progress, to improve environmental protection,
and to reduce unsustainable consumption and production patterns are
mutually reinforcing. Slower population growth has in many
countries bought more time to adjust to future population
increases. This has increased those countries' ability to attack
poverty, protect and repair the environment, and build the base for
future sustainable development. Even the difference of a single
decade in the transition to stabilization levels of fertility can
have a considerable positive impact on quality of life.
3.15. Sustained economic growth within the context of sustainable
development is essential to eradicate poverty. Eradication of
poverty will contribute to slowing population growth and to
achieving early population stabilization. Investments in fields
important to the eradication of poverty, such as basic education,
sanitation, drinking water, housing, adequate food supply and
infrastructure for rapidly growing populations, continue to strain
already weak economies and limit development options. The
unusually high number of young people, a consequence of high
fertility rates, requires that productive jobs be created for a
continually growing labour force under conditions of already
widespread unemployment. The numbers of elderly requiring public
support will also increase rapidly in the future. Sustained
economic growth in the context of sustainable development will be
necessary to accommodate those pressures.
Objective
3.16. The objective is to raise the quality of life for all people
through appropriate population and development policies and
programmes aimed at achieving poverty eradication, sustained
economic growth in the context of sustainable development and
sustainable patterns of consumption and production, human resource
development [and the guarantee of all human rights, taking into
account that democracy, development and respect for human rights
and fundamental freedoms, are interdependent and mutually
reinforcing.] or [and the guarantee of human rights, including the
right to development as a universal and inalienable right and an
integral part of fundamental human rights. Particular attention is
to be given to the socio-economic improvement of poor women in
developing countries.] [As women are generally the poorest of the
poor and at the same time key actors in the development process,
eliminating social, cultural, political and economic discrimination
against women is a prerequisite of eradicating poverty, promoting
sustained economic growth in the context of sustainable
development, ensuring quality family planning and reproductive
health services, and achieving balance between population and
available resources and sustainable patterns of consumption and
production.]
Actions
3.17. Investment in human resource development, in accordance with
national policy, must be given priority in population and
development strategies and budgets, at all levels, with programmes
specifically directed at increased access to information,
education, skill development, employment opportunities, both formal
and informal, and high-quality general[, and sexual and
reproductive] health services[, including family-planning
services], through the promotion of sustained economic growth
within the context of sustainable development in developing
countries and countries with economies in transition.
3.18. Existing inequities and barriers to women in the workforce
should be eliminated and women's participation in all policy-making
and implementation, as well as their access to productive
resources, and ownership of land, and their right to inherit
property should be promoted and strengthened. Governments,
non-governmental organizations and the private sector should invest
in, promote, monitor and evaluate the education and skill
development of women and girls and the legal and economic rights of
women, and in all aspects of [reproductive and sexual] health,
[including family planning], in order to enable them to effectively
contribute to and benefit from economic growth and sustainable
development.
3.19. High priority should be given by Governments,
non-governmental organizations and the private sector to meeting
the needs, and increasing the opportunities for information,
education, jobs, skill development and [reproductive health
services.], of all underserved members of society. 17/
3.20. Measures should be taken to strengthen food, nutrition and
agricultural policies and programmes, and fair trade relations,
with special attention to the creation and strengthening of food
security at all levels.
3.21. Job creation in the industrial, agricultural and service
sectors should be facilitated by Governments and the private sector
through the establishment of more favourable climates for expanded
trade and investment [on an environmentally sound basis. This will
require creating and sustaining democratic institutions, good
governance and transparency, curtailing corruption, and redirecting
domestic budget priorities to the social sectors and human resource
development.] Special efforts should be made to create productive
jobs through policies promoting efficient and, where required,
labour-intensive industries, and transfer of modern technologies.
3.22. [The international community should continue to promote a
supportive economic environment, particularly for developing
countries and countries with economies in transition in their
attempt to eradicate poverty and achieve sustained economic growth
in the context of sustainable development. In the context of the
relevant international agreements and commitments, efforts should
be made to support those countries, in particular the developing
countries, by promoting an open, equitable, secure,
non-discriminatory and predictable international trading system;
promoting foreign direct investment; reducing the debt burden;
providing new and additional financial resources from all available
funding sources and mechanisms, including multilateral, bilateral
and private sources, including on concessional and grant terms
according to sound and equitable criteria and indicators; access to
technologies; and by ensuring that structural adjustment programmes
are so designed and implemented as to be responsive to social and
environmental concerns.]
C. Population and environment
Basis for action
3.23. At the United Nations Conference on Environment and
Development, the international community agreed on objectives and
actions aimed at integrating environment and development which were
included in Agenda 21, other Conference outcomes and other
international environmental agreements. Agenda 21 has been
conceived as a response to the major environment and development
challenges, including the economic and social dimensions of
sustainable development, such as poverty, consumption, demographic
dynamics, human health and human settlement, and to a broad range
of environmental and natural resource concerns. Agenda 21 leaves
to the International Conference on Population and Development
further consideration of the interrelationships between population
and the environment.
3.24. Meeting the basic human needs of growing populations is
dependent on a healthy environment. These human dimensions need to
be given attention in developing comprehensive policies for
sustainable development in the context of population growth.
3.25. Demographic factors, combined with poverty and lack of
access to resources in some areas, and excessive consumption and
wasteful production patterns in others, cause or exacerbate
problems of environmental degradation and resource depletion and
thus inhibit sustainable development.
3.26. Pressure on the environment may result from rapid population
growth, distribution and migration, especially in ecologically
vulnerable ecosystems. Urbanization and policies that do not
recognize the need for rural development also create environmental
problems.
3.27. Implementation of effective population policies in the
context of sustainable development[, including reproductive health
and family-planning programmes,] require new forms of participation
by various actors at all levels in the policy-making process.
Objectives
3.28. Consistent with Agenda 21, the objectives are:
(a) To ensure that population, environmental and poverty
eradication factors are integrated in sustainable development
policies, plans and programmes;
(b) To reduce both unsustainable consumption and production
patterns as well as negative impacts of demographic factors on the
environment in order to meet the needs of current generations
without compromising the ability of future generations to meet
their own needs.
Actions
3.29. Governments at the appropriate level, with the support of
the international community and regional and subregional
organizations, should formulate and implement population policies
and programmes to support the objectives and actions agreed upon in
Agenda 21, other Conference outcomes and other international
environmental agreements, taking into account the common but
differentiated responsibilities reflected in those agreements.
Consistent with the framework and priorities set forth in Agenda
21, the following actions, inter alia, are recommended to help
achieve population and environment integration:
(a) Integrate demographic factors into environment impact
assessments and other planning and decision-making processes aimed
at achieving sustainable development;
(b) Take measures aimed at the eradication of poverty, with
special attention to income-generation and employment strategies
directed at the rural poor and those living within or on the edge
of fragile ecosystems;
(c) Utilize demographic data to promote sustainable resource
management, especially of ecologically fragile systems;
(d) Modify unsustainable consumption and production patterns
through economic, legislative and administrative measures, as
appropriate, aimed at fostering sustainable resource use and
preventing environmental degradation;
(e) Implement policies to address the ecological implications
of inevitable future increases in population numbers and changes in
concentration and distribution, particularly in ecologically
vulnerable areas and urban agglomerations.
3.30. Measures should be taken to enhance the full participation
of all relevant groups, especially women, at all levels of
population and environmental decision-making to achieve sustainable
management of natural resources.
3.31. Research should be undertaken on the linkages among
population, consumption and production, the environment and natural
resources, and human health as a guide to effective sustainable
development policies.
3.32. Governments, non-governmental organizations and the private
sector should promote public awareness and understanding for the
implementation of the above- mentioned actions.
Chapter IV
GENDER EQUALITY, EQUITY AND EMPOWERMENT OF WOMEN
A. Empowerment and status of women
Basis for action
4.1. The empowerment and autonomy of women and the improvement of
their political, social, economic and health status is a highly
important end in itself. In addition, it is essential for the
achievement of sustainable development. The full participation and
partnership of both women and men is required in productive and
reproductive life, including shared responsibilities for the care
and nurturing of children and maintenance of the household. In all
parts of the world, women are facing threats to their lives, health
and well-being as a result of being overburdened with work and of
their lack of power and influence. In most regions of the world,
women receive less formal education than men, and at the same time,
women's own knowledge, abilities and coping mechanisms often go
unrecognized. The power relations that impede women's attainment
of healthy and fulfilling lives operate at many levels of society,
from the most personal to the highly public. Achieving change
requires policy and programme actions that will improve women's
access to secure livelihoods and economic resources, alleviate
their extreme responsibilities with regard to housework, remove
legal impediments to their participation in public life, and raise
social awareness through effective programmes of education and mass
communication. In addition, improving the status of women also
enhances their decision-making capacity at all levels in all
spheres of life, especially in the area of sexuality and
reproduction. This, in turn, is essential for the long- term
success of population programmes. Experience shows that population
and development programmes are most effective when steps have
simultaneously been taken to improve the status of women.
4.2. Education is one of the most important means of empowering
women with the knowledge, skills and self-confidence necessary to
participate fully in the development process. More than 40 years
ago, the Universal Declaration of Human Rights asserted that
"everyone has the right to education". In 1990, Governments
meeting at the World Conference on Education for All in Jomtien,
Thailand, committed themselves to the goal of universal access to
basic education. But despite notable efforts by countries around
the globe that have appreciably expanded access to basic education,
there are approximately 960 million illiterate adults in the world,
of whom two thirds are women. More than one third of the world's
adults, most of them women, have no access to printed knowledge, to
new skills or to technologies that would improve the quality of
their lives and help them shape and adapt to social and economic
change. There are 130 million children who are not enrolled in
primary school and 70 per cent of them are girls.
Objectives
4.3. The objectives are:
(a) To achieve equality and equity based on harmonious
partnership between men and women and enable women to realize their
full potential;
(b) To ensure the enhancement of women's contributions to
sustainable development through their full involvement in policy-
and decision-making processes at all stages and participation in
all aspects of production, employment, income-generating
activities, education, health, science and technology, sports,
culture and population-related activities and other areas, as
active decision makers, participants and beneficiaries;
(c) To ensure that all women, as well as men, are provided
with the education necessary for them to meet their basic human
needs and to exercise their human rights.
Actions
4.4. Countries should act to empower women and should take steps
to eliminate inequalities between men and women as soon as possible
by:
(a) Establishing mechanisms for women's equal participation
and equitable representation at all levels of the political process
and public life in each community and society and enabling women to
articulate their concerns and needs;
(b) Promoting the fulfilment of women's potential through
education, skill development and employment, giving paramount
importance to the elimination of poverty, illiteracy and ill health
among women;
(c) Eliminating all practices that discriminate against
women; assisting women to establish and realize their rights, [...
including those that relate to sexual and reproductive health ...];
(d) Adopting appropriate measures to improve women's ability
to earn income beyond traditional occupations, achieve economic
self-reliance, and ensure women's equal access to the labour market
and social security systems;
(e) Eliminating violence against women;
(f) Eliminating discriminatory practices by employers against
women, such as those based on proof of contraceptive use or
pregnancy status;
(g) Making it possible, through laws, regulations and other
appropriate measures, for women to combine the roles of
child-bearing, breast-feeding and child-rearing with participation
in the workforce.
4.5. All countries should make greater efforts to promulgate,
implement and enforce national laws and international conventions
to which they are party, such as the Convention on the Elimination
of All Forms of Discrimination against Women, that protect women
from all types of economic discrimination and from sexual
harassment, and to implement fully the Declaration on the
Elimination of Violence against Women and the Vienna Declaration
and Programme of Action adopted at the World Conference on Human
Rights in 1993. Countries are urged to sign, ratify and implement
all existing agreements that promote women's rights.
4.6. Governments at all levels should ensure that women can buy,
hold and sell property and land equally with men, obtain credit and
negotiate contracts in their own name and on their own behalf and
exercise their legal rights to inheritance.
4.7. Governments and employers are urged to eliminate gender
discrimination in hiring, wages, benefits, training and job
security with a view to eliminating gender-based disparities in
income.
4.8. Governments, international organizations and non-governmental
organizations should ensure that their personnel policies and
practices comply with the principle of equitable representation of
both sexes, especially at the managerial and policy-making levels,
in all programmes, including population and development programmes.
Specific procedures and indicators should be devised for
gender-based analysis of development programmes and for assessing
the impact of those programmes on women's social, economic and
health status and access to resources.
4.9. Countries should take full measures to eliminate all forms of
exploitation, abuse, harassment and violence against women,
adolescents and children. This implies both preventive actions and
rehabilitation of victims. Countries should prohibit degrading
practices, such as trafficking in women, adolescents and children
and forced prostitution, and pay special attention to protecting
the rights and safety of those who suffer from these crimes and
those in potentially exploitable situations, such as migrant women,
women in domestic service and schoolgirls. In this regard,
international safeguards and mechanisms for cooperation should be
put in place to ensure that these measures are implemented.
4.10. Countries are urged to identify and condemn the systematic
practice of rape and other forms of inhuman and degrading treatment
of women as a deliberate instrument of war and ethnic cleansing and
take steps to assure that full assistance is provided to the
victims of such abuse for their physical and mental rehabilitation.
4.11. The design of family health and other development
interventions should take better account of the demands on women's
time from the responsibilities of child-rearing, household work and
income-generating activities. Male responsibilities should be
emphasized with respect to child-rearing and housework. Greater
investments should be made in appropriate measures to lessen the
daily burden of domestic responsibilities, the greatest share of
which falls on women. Greater attention should be paid to the ways
in which environmental degradation and changes in land use
adversely affect the allocation of women's time. Women's domestic
working environments should not adversely affect their health.
4.12. Every effort should be made to encourage the expansion and
strengthening of grass-roots, community-based and activist groups
for women. Such groups should be the focus of national campaigns
to foster women's awareness of the full range of their legal
rights, including their rights within the family, and to help women
organize to achieve those rights.
4.13. Countries are strongly urged to enact laws and to implement
programmes and policies which will enable employees of both sexes
to organize their family and work responsibilities through flexible
work-hours, parental leave, day-care facilities, maternity leave,
policies that enable working mothers to breast-feed their children,
health insurance and other such measures. Similar rights should be
ensured to those working in the informal sector.
4.14. Programmes to meet the needs of growing numbers of elderly
people should fully take into account that women represent the
larger proportion of the elderly and that elderly women generally
have a lower socio-economic status than elderly men.
B. The girl child
Basis for action
4.15. Since in all societies discrimination on the basis of sex
often starts at the earliest stages of life, greater equality for
the girl child is a necessary first step in ensuring that women
realize their full potential and become equal partners in
development. In a number of countries, the practice of prenatal
sex selection, higher rates of mortality among very young girls,
and lower rates of school enrolment for girls as compared with
boys, suggest that "son preference" is curtailing the access of
girl children to food, education and health care. This is often
compounded by the increasing use of technologies to determine
foetal sex, resulting in abortion of female foetuses. Investments
made in the girl child's health, nutrition and education, from
infancy through adolescence, are critical.
Objectives
4.16. The objectives are:
(a) To eliminate all forms of discrimination against the girl
child and the root causes of son preference, which results in
harmful and unethical practices regarding female infanticide and
prenatal sex selection;
(b) To increase public awareness of the value of the girl
child, and concurrently, to strengthen the girl child's self-image,
self-esteem and status;
(c) To improve the welfare of the girl child, especially in
regard to health, nutrition and education.
Actions
4.17. Overall, the value of girl children to both their family and
to society must be expanded beyond their definition as potential
child-bearers and caretakers and reinforced through the adoption
and implementation of educational and social policies that
encourage their full participation in the development of the
societies in which they live. Leaders at all levels of the society
must speak out and act forcefully against patterns of gender
discrimination within the family, based on preference for sons.
One of the aims should be to eliminate excess mortality of girls,
wherever such a pattern exists. Special education and public
information efforts are needed to promote equitable treatment of
girls and boys with respect to nutrition, health care, inheritance
rights, education and social, economic and political activity.
4.18. Beyond the achievement of the goal of universal primary
education in all countries [... before the year 2015 ...], all
countries are urged to ensure the widest and earliest possible
access by girls and women to secondary and higher levels of
education, as well as vocational education and technical training,
bearing in mind the need to improve the quality and relevance of
that education.
4.19. Schools, the media and other social institutions should seek
to eliminate stereotypes in all types of communication and
educational materials that reinforce existing inequities between
males and females and undermine girls' self-esteem. Countries must
recognize that, in addition to expanding education for girls,
teachers' attitudes and practices, school curricula and facilities
must also change to reflect a commitment to eliminate all gender
bias, while recognizing the specific needs of the girl child.
4.20. Countries should develop an integrated approach to the
special nutritional, [... reproductive and sexual health ...],
education and social needs of girls and young women, as such
additional investments in adolescent girls can often compensate for
earlier inadequacies in their nutrition and health care.
4.21. Governments should strictly enforce laws to ensure that
marriage is entered into only with the free and full consent of the
intending spouses. In addition, Governments should strictly
enforce laws concerning the minimum legal age of consent and
minimum age at marriage and should raise the minimum age at
marriage where necessary. Governments and non-governmental
organizations should generate social support for the enforcement of
laws on minimum legal age at marriage, in particular by providing
alternatives to early marriage, such as educational and employment
opportunities.
4.22. Governments are urged to prohibit female genital mutilation
wherever it exists and to give vigorous support to efforts among
non-governmental and community organizations and religious
institutions to eliminate such practices.
4.23. Governments are urged to take the necessary measures to
prevent infanticide, prenatal sex selection, trafficking in girl
children and use of girls in prostitution and pornography.
C. Male responsibilities and participation
Basis for action
4.24. Changes in both men's and women's knowledge, attitudes and
behaviour are necessary conditions for achieving the harmonious
partnership of men and women. Men play a key role in bringing
about gender equality since, in most societies, men exercise
preponderant power in nearly every sphere of life, ranging from
personal decisions regarding the size of families to the policy and
programme decisions taken at all levels of Government. It is
essential to improve communication between men and women on issues
of sex and [sexuality and reproductive health,] and the
understanding of their joint responsibilities, so that men and
women are equal partners in public and private life.
Objective
4.25. The objective is to promote gender equality in all spheres
of life, including family and community life, and to encourage and
enable men to take responsibility for their [... sexual and
reproductive behaviour ...] and their social and family roles.
Actions
4.26. The equal participation of women and men in all areas of
family and household responsibilities, including [family planning,]
child-rearing and housework, should be promoted and encouraged by
Governments. This should be pursued by means of information,
education, communication, employment legislation and by fostering
an economically enabling environment, such as family leave for men
and women so that they may have more choice regarding the balance
of their domestic and public responsibilities.
4.27. Special efforts should be made to emphasize men's shared
responsibility and promote their active involvement in responsible
parenthood, [... sexual and reproductive health and behaviour ...],
including [family planning]; prenatal, maternal and child health;
prevention of sexually transmitted diseases, including HIV;
prevention of unwanted and high-risk pregnancies; shared control
and contribution to family income, children's education, health and
nutrition; and recognition and promotion of the equal value of
children of both sexes. Male responsibilities in family life must
be included in the education of children from the earliest ages.
Special emphasis should be placed on the prevention of violence
against women and children.
4.28. Governments should take steps to ensure that children
receive appropriate financial support from their parents by, among
other measures, enforcing child- support laws. Governments should
consider changes in law and policy to ensure men's responsibility
to and financial support for their children and families. Such
laws and policies should also encourage maintenance or
reconstitution of the family unit. The safety of women in abusive
relationships should be protected.
4.29. National and community leaders should promote the full
involvement of men in family life and the full integration of women
in community life. Parents and schools should ensure that
attitudes that are respectful of women and girls as equals are
instilled in boys from the earliest possible age, along with an
understanding of their shared responsibilities in all aspects of a
safe, secure and harmonious family life, [including sexual health
and rights], and reproduction. Programmes to reach boys before
they become sexually active are urgently needed.
Chapter V
THE FAMILY, ITS ROLES, RIGHTS, COMPOSITION AND STRUCTURE
A. Diversity of family structure and composition
Basis for action
5.1. While various concepts of the family exist in different
social, cultural, legal and political systems, the family is the
basic unit of society and as such is entitled to receive
comprehensive protection and support. The process of rapid
demographic and socio-economic change throughout the world has
influenced patterns of family formation and family life, generating
considerable change in family composition and structure.
Traditional notions of gender-based division of parental and
domestic functions and participation in the paid labour force do
not reflect current realities and aspirations, as more and more
women in all parts of the world take up paid employment outside the
home. At the same time, widespread migration, forced shifts of
population caused by violent conflicts and wars, urbanization,
poverty, natural disasters and other causes of displacement have
placed greater strains on the family, since assistance from
extended family support networks is often no longer available.
Parents are often more dependent on assistance from third parties
than they used to be in order to reconcile work and family
responsibilities. This is particularly the case when policies and
programmes that affect the family ignore the existing diversity of
family forms, or are insufficiently sensitive to the needs and
rights of women and children.
Objective
5.2. The objectives are:
(a) To develop policies and laws that better support the
family, contribute to its stability and take into account its
plurality of forms, particularly the growing number of
single-parent households;
(b) To establish social security measures that address the
social, cultural and economic factors behind the increasing costs
of child-rearing;
(c) To promote equality of opportunity for family members,
especially the rights of women and children in the family.
Actions
5.3. Governments, in cooperation with employers, should provide
and promote means to facilitate compatibility between labour force
participation and parental responsibilities, especially for
single-parent households with young children. Such means could
include health insurance and social security, day- care centres and
facilities for breast-feeding mothers within the work premises,
kindergartens, part-time jobs, paid parental leave, paid maternity
leave, flexible work schedules, and [reproductive] and child health
services.
5.4. When formulating socio-economic development policies, special
consideration should be given to increasing the earning power of
all adult members of economically deprived families, including the
elderly and women who work in the home, and to enabling children to
be educated rather than compelled to work. Particular attention
should be paid to needy single parents, especially those who are
responsible wholly or in part for the support of children and other
dependants, through ensuring payment of at least minimum wages and
allowances, credit, education, funding for women's self-help groups
and stronger legal enforcement of male parental financial
responsibilities.
5.5. Governments should take effective action to eliminate all
forms of coercion and discrimination in policies and practices
related to marriage, other unions and the family. Measures should
be adopted and enforced to eliminate child marriages and female
genital mutilation. Assistance should be provided to persons with
disabilities in the exercise of their family and reproductive
rights and responsibilities.
5.6. Governments should maintain and further develop mechanisms to
document changes and undertake studies on family composition and
structure, especially on the prevalence of one-person households,
and single-parent and multigenerational families.
B. Socio-economic support to the family
Basis for action
5.7. Families are sensitive to strains induced by social and
economic changes. It is essential to grant particular assistance
to families in difficult life situations. Conditions have worsened
for many families in recent years, owing to lack of gainful
employment and measures taken by Governments seeking to balance
their budget by reducing social expenditures. There are increasing
numbers of vulnerable families, including single-parent families
headed by women, poor families with elderly members or those with
disabilities, refugee and displaced families, and families with
members affected by AIDS or other terminal diseases, substance
dependence, child abuse and domestic violence. Increased labour
migrations and refugee movements are an additional source of family
tension and disintegration and are contributing to increased
responsibilities for women. In many urban environments, millions
of children and youths are left to their own devices as family ties
break down, and hence are increasingly exposed to risks such as
dropping out of school, labour exploitation, sexual exploitation,
unwanted pregnancies and sexually transmitted diseases.
Objective
5.8. The objective is to ensure that all social and economic
development policies are fully responsive to the diverse and
changing needs and to the rights of families and their individual
members, and provide necessary support and protection, particularly
to the most vulnerable families and the most vulnerable family
members.
Actions
5.9. Governments should formulate family-sensitive policies in the
field of housing, work, health, social security and education in
order to create an environment supportive of the family, taking
into account its various forms and functions, and should support
educational programmes concerning parental roles, parental skills
and child development. Governments should, in conjunction with
other relevant parties, develop the capacity to monitor the impact
of social and economic decisions and actions on the well-being of
families, on the status of women within families, and on the
ability of families to meet the basic needs of their members.
5.10. All levels of Government, non-governmental organizations and
concerned community organizations should develop innovative ways to
provide more effective assistance to families and the individuals
within them who may be affected by specific problems, such as
extreme poverty, chronic unemployment, illness, domestic and sexual
violence, dowry payments, drug or alcohol dependence, incest, and
child abuse, neglect or abandonment.
5.11. Governments should support and develop the appropriate
mechanisms to assist families caring for children, the dependent
elderly and family members with disabilities, including those
resulting from HIV/AIDS, encourage the sharing of those
responsibilities by men and women, and support the viability of
multigenerational families.
5.12. Governments and the international community should give
greater attention to, and manifest greater solidarity with, poor
families and families that have been victimized by war, drought,
famine, natural disasters and racial and ethnic discrimination or
violence. Every effort should be made to keep their members
together, to reunite them in case of separation and to ensure
access to government programmes designed to support and assist
those vulnerable families.
5.13. Governments should assist single-parent families, and pay
special attention to the needs of widows and orphans. All efforts
should be made to assist the building of family-like ties in
especially difficult circumstances, for example, those involving
street children.
Chapter VI
POPULATION GROWTH AND STRUCTURE
A. Fertility, mortality and population growth rates
Basis for action
6.1. The growth of the world population is at an all-time high in
absolute numbers, with current increments exceeding 90 million
persons annually. According to United Nations projections, annual
population increments are likely to remain above 90 million until
the year 2015. While it had taken 123 years for world population
to increase from 1 billion to 2 billion, succeeding increments of
1 billion took 33 years, 14 years and 13 years. The transition
from the fifth to the sixth billion, currently under way, is
expected to take only 11 years and to be completed by 1998. World
population grew at the rate of 1.7 per cent per annum during the
period 1985-1990, but is expected to decrease during the following
decades and reach 1.0 per cent per annum by the period 2020-2025.
Nevertheless, the attainment of population stabilization during the
twenty-first century will require the implementation of all the
policies and recommendations in the present Programme of Action.
6.2. The majority of the world's countries are converging towards
a pattern of low birth and death rates, but since those countries
are proceeding at different speeds, the emerging picture is that of
a world facing increasingly diverse demographic situations. In
terms of national averages, during the period 1985-1990, fertility
ranged from an estimated 8.5 children per woman in Rwanda to 1.3
children per woman in Italy, while expectation of life at birth, an
indicator of mortality conditions, ranged from an estimated 41
years in Sierra Leone to 78.3 years in Japan. In many regions,
including some countries with economies in transition, it is
estimated that life expectancy at birth has decreased. During the
period 1985-1990, 44 per cent of the world population were living
in the 114 countries that had growth rates of more than 2 per cent
per annum. These included nearly all the countries in Africa,
whose population- doubling time averages about 24 years, two thirds
of those in Asia and one third of those in Latin America. On the
other hand, 66 countries (the majority of them in Europe),
representing 23 per cent of the world population, had growth rates
of less than 1 per cent per annum. Europe's population would take
more than 380 years to double at current rates. These disparate
levels and differentials have implications for the ultimate size
and regional distribution of the world population and for the
prospects for sustainable development. It is projected that
between 1995 and 2015 the population of the more developed regions
will increase by some 120 million, while the population of the less
developed regions will increase by 1,727 million.
Objective
6.3. Recognizing that the ultimate goal is the improvement of the
quality of life of present and future generations, the objective is
to facilitate the demographic transition as soon as possible in
countries where there is an imbalance between demographic rates and
social, economic and environmental goals, while fully respecting
human rights. This process will contribute to the stabilization of
the world population, and, together with changes in unsustainable
patterns of production and consumption, to sustainable development
and economic growth.
Actions
6.4. Countries should give greater attention to the importance of
population trends for development. Countries that have not
completed their demographic transition should take effective steps
in this regard within the context of their social and economic
development and with full respect of human rights. Countries that
have concluded the demographic transition should take necessary
steps to optimize their demographic trends within the context of
their social and economic development. These steps include
economic development and poverty alleviation, especially in rural
areas, improvement of women's status, ensuring of universal access
to quality primary education and primary health care, including
[reproductive health and family-planning services], and educational
strategies regarding responsible parenthood and sexual education.
Countries should mobilize all sectors of society in these efforts,
including non-governmental organizations, local community groups
and the private sector.
6.5. In attempting to address population growth concerns,
countries should recognize the interrelationships between fertility
and mortality levels and aim to reduce high levels of infant, child
and maternal mortality so as to lessen the need for high fertility
and reduce the occurrence of high-risk births.
B. Children and youth
Basis for action
6.6. Owing to declining mortality levels and the persistence of
high fertility levels, a large number of developing countries
continue to have very large proportions of children and young
people in their populations. For the less developed regions as a
whole, 36 per cent of the population is under age 15, and even with
projected fertility declines, that proportion will still be about
30 per cent by the year 2015. In Africa, the proportion of the
population under age 15 is 45 per cent, a figure that is projected
to decline only slightly, to 40 per cent, in the year 2015.
Poverty has a devastating impact on children's health and welfare.
Children in poverty are at high risk for malnutrition and disease
and for falling prey to labour exploitation, trafficking, neglect,
sexual abuse and drug addiction. The ongoing and future demands
created by large young populations, particularly in terms of
health, education and employment, represent major challenges and
responsibilities for families, local communities, countries and the
international community. First and foremost among these
responsibilities is to ensure that every child is a wanted child.
The second responsibility is to recognize that children are the
most important resource for the future and that greater investments
in them by parents and societies are essential to the achievement
of sustained economic growth and development.
Objectives
6.7. The objectives are:
(a) To promote to the fullest extent the health, well-being
and potential of all children, adolescents and youth as
representing the world's future human resources, in line with the
commitments made in this respect at the World Summit for Children
and in accordance with the Convention on the Rights of the Child;
(b) To meet the special needs of adolescents and youth,
especially young women, with due regard for their own creative
capabilities, for social, family and community support, employment
opportunities, participation in the political process, and access
to education, health, counselling and high-quality services in
[sexual and reproductive health care];
(c) To encourage children, adolescents and youth,
particularly young women, to continue their education in order to
equip them for a better life, to increase their human potential, to
help prevent early marriages and high-risk child-bearing and to
reduce associated mortality and morbidity.
Actions
6.8. Countries should give high priority and attention to all
dimensions of the protection, survival and development of children
and youth, particularly street children and youth, and should make
every effort to eliminate the adverse effects of poverty on
children and youth, including malnutrition and preventable
diseases. Equal educational opportunities must be ensured for boys
and girls at every level.
6.9. Countries should take effective steps to address the neglect,
as well as all types of exploitation and abuse, of children,
adolescents and youth, such as abduction, rape and incest,
pornography, trafficking, abandonment and prostitution. In
particular, countries should take appropriate action to eliminate
sexual abuse of children both within and outside their borders.
6.10. All countries must enact and strictly enforce laws against
economic exploitation, physical and mental abuse or neglect of
children in keeping with commitments made under the Convention on
the Rights of the Child and other relevant United Nations
instruments. Countries should provide support and rehabilitation
services to those who fall victims to such abuses.
6.11. Countries should create a socio-economic environment
conducive to elimination of all child marriages and other unions as
a matter of urgency, and should discourage early marriage. The
social responsibilities that marriage entails should be reinforced
in countries' educational programmes. Governments should act
against the discrimination against young pregnant women.
6.12. All countries must adopt collective measures to alleviate
the suffering of children in armed conflicts and other disasters,
and provide assistance for the rehabilitation of children who
become victims of those conflicts and disasters.
6.13. Countries should aim to meet the needs and aspirations of
youth, particularly in the areas of formal and non-formal
education, training, employment opportunities, housing and health,
thereby ensuring their integration and participation in all spheres
of society, including participation in the political process and
preparation for leadership roles.
6.14. Governments should formulate, with the active support of
non-governmental organizations and the private sector, training and
employment programmes. Primary importance should be given to
meeting the basic needs of young people, improving their quality of
life, and increasing their contribution to sustainable development.
6.15. Youth should be actively involved in the planning,
implementation and evaluation of development activities that have
a direct impact on their daily lives. This is especially important
with respect to information, education and communication activities
and services concerning [sexual and reproductive health], including
the prevention of early pregnancies, sex education and the
prevention of HIV/AIDS and other sexually transmitted diseases.
Access to, as well as confidentiality and privacy of, these
services, must be ensured with the support and guidance of their
parents and in line with the Convention on the Rights of the Child.
In addition, there is a need for educational programmes in favour
of life planning skills, healthy lifestyles and the active
discouragement of substance abuse.
C. Elderly people
Basis for action
6.16. The decline in fertility levels, reinforced by continued
declines in mortality levels, is producing fundamental changes in
the age structure of the population of most societies, most notably
record increases in the proportion and number of elderly persons,
including a growing number of very elderly persons. In the more
developed regions, approximately one person in every six is at
least 60 years old, and this proportion will be close to one person
in every four by the year 2025. The situation of developing
countries that have experienced very rapid declines in their levels
of fertility deserves particular attention. In most societies,
women, because they live longer than men, constitute the majority
of the elderly population and in many countries, elderly poor women
are especially vulnerable. The steady increase of older age groups
in national populations, both in absolute numbers and in relation
to the working-age population, has significant implications for a
majority of countries, particularly with regard to the future
viability of existing formal and informal modalities for assistance
to elderly people. The economic and social impact of this "ageing
of populations" is both an opportunity and a challenge to all
societies. Many countries are currently re-examining their
policies in the light of the principle that elderly people
constitute a valuable and important component of a society's human
resources. They are also seeking to identify how best to assist
elderly people with long-term support needs.
Objectives
6.17. The objectives are:
(a) To enhance, through appropriate mechanisms, the
self-reliance of elderly people, and to create conditions that
promote quality of life and enable them to work and live
independently in their own communities as long as possible or as
desired;
(b) To develop systems of health care as well as systems of
economic and social security in old age, where appropriate, paying
special attention to the needs of women;
(c) To develop a social support system, both formal and
informal, with a view to enhancing the ability of families to take
care of elderly people within the family.
Actions
6.18. All levels of government in medium- and long-term
socio-economic planning should take into account the increasing
numbers and proportions of elderly people in the population.
Governments should develop social security systems that ensure
greater intergenerational and intragenerational equity and
solidarity and that provide support to elderly people through the
encouragement of multigenerational families, and the provision of
long-term support and services for growing numbers of frail older
people.
6.19. Governments should seek to enhance the self-reliance of
elderly people to facilitate their continued participation in
society. In consultation with elderly people, Governments should
ensure that the necessary conditions are developed to enable
elderly people to lead self-determined, healthy and productive
lives and to make full use of the skills and abilities they have
acquired in their lives for the benefit of society. The valuable
contribution that elderly people make to families and society,
especially as volunteers and caregivers, should be given due
recognition and encouragement.
6.20. Governments, in collaboration with non-governmental
organizations and the private sector, should strengthen formal and
informal support systems and safety nets for elderly people and
eliminate all forms of violence and discrimination against elderly
people in all countries, paying special attention to the needs of
elderly women.
D. Indigenous people[s]
Basis for action
6.21. Indigenous people[s] have a distinct and important
perspective on population and development relationships, frequently
quite different from those of the populations with which they
interrelate within national boundaries. In some regions of the
world, indigenous people[s], after long periods of population loss,
are experiencing steady and in some places rapid population growth
resulting from declining mortality, although morbidity and
mortality are generally still much higher than for other sections
of the national population. In other regions, however, they are
still experiencing a steady population decline as a result of
contact with external diseases, loss of land and resources,
ecological destruction, displacement, resettlement and disruption
of their families, communities and social systems.
6.22. The situation of many indigenous groups is often
characterized by discrimination and oppression, which are sometimes
even institutionalized in national laws and structures of
governance. In many cases, unsustainable patterns of production
and consumption in the society at large are a key factor in the
ongoing destruction of the ecological stability of their lands, as
well as in an ongoing exertion of pressure to displace them from
those lands. Indigenous people[s] believe that recognition of
their rights to their ancestral lands is inextricably linked to
sustainable development. Indigenous people[s] call for increased
respect for indigenous culture, spirituality, lifestyles and
sustainable development models, including traditional systems of
land tenure, gender relations, use of resources and knowledge and
practice of [family planning]. At national, regional and
international levels, the perspectives of indigenous people[s] have
gained increasing recognition, as reflected, inter alia, in the
presence of the Working Group on Indigenous Populations at the
United Nations Conference on Environment and Development, and the
proclamation by the General Assembly of the year 1993 as the
International Year of the World's Indigenous People.
6.23. The decision of the international community to proclaim an
International Decade of the World's Indigenous People, to commence
on 10 December 1994, represents a further important step towards
fulfilment of the aspirations of indigenous people[s]. The goal of
the Decade, which is the strengthening of international cooperation
for the solution of problems faced by indigenous people[s] in such
areas as human rights, the environment, development, education and
health, is acknowledged as directly related to the purpose of the
International Conference on Population and Development and the
present Programme of Action. Accordingly, the distinct
perspectives of indigenous people[s] are incorporated throughout
this Programme of Action within the context of its specific
chapters.
Objectives
6.24. The objectives are:
(a) To incorporate the perspectives and needs of indigenous
communities into the design, implementation, monitoring and
evaluation of the population, development and environment
programmes that affect them;
(b) To ensure that indigenous people[s] receive population-
and development-related services that they deem socially,
culturally and ecologically appropriate;
(c) To address social and economic factors that act to
disadvantage indigenous people[s].
Actions
6.25. Governments and other important institutions in society
should recognize the distinct perspective of indigenous people[s]
on aspects of population and development and, in consultation with
indigenous people[s] and in collaboration with concerned
non-governmental and intergovernmental organizations, should
address their specific needs, including needs for primary health
care and [reproductive health services]. All human rights
violations and discrimination, especially all forms of coercion,
must be eliminated.
6.26. Within the context of the activities of the International
Decade of the World's Indigenous People, the United Nations should,
in full cooperation and collaboration with indigenous people[s] and
their relevant organizations, develop an enhanced understanding of
indigenous people[s] and compile data on their demographic
characteristics, both current and historical, as a means of
improving the understanding of the population status of indigenous
people[s]. Special efforts are necessary to integrate statistics
pertaining to indigenous populations into the national
data-collection system.
6.27. Governments should respect the cultures of indigenous
people[s] and enable them to own and manage territories, protect
and restore the natural resources and ecosystems on which
indigenous communities depend for their survival and well-being,
and, in consultation with indigenous people[s], take this into
account in the formulation of national population and development
policies.
E. Persons with disabilities
Basis for action
6.28. Persons with disabilities constitute a significant
proportion of the population. The implementation of the World
Programme of Action concerning Disabled Persons (1983-1992)
contributed towards increased awareness and expanded knowledge of
disability issues, increased the role played by persons with
disabilities and by concerned organizations, and contributed
towards the improvement and expansion of disability legislation.
However, there remains a pressing need for continued action to
promote effective measures for the prevention of disability, for
rehabilitation and for the realization of the goals of full
participation and equality for persons with disabilities. In its
resolution 47/88 of 16 December 1992, the General Assembly
encouraged the consideration by, inter alia, the International
Conference on Population and Development of disability issues
relevant to the subject-matter of the Conference.
Objectives
6.29. The objectives are:
(a) To ensure the realization of the rights of all persons
with disabilities, and their participation in all aspects of
social, economic and cultural life;
(b) To create, improve and develop necessary conditions that
will ensure equal opportunities for persons with disabilities and
the valuing of their capabilities in the process of economic and
social development;
(c) To ensure the dignity and promote the self-reliance of
persons with disabilities.
Actions
6.30. Governments at all levels should consider the needs of
persons with disabilities in terms of ethical and human rights
dimensions. Governments should recognize needs concerning, inter
alia, [sexual and reproductive health, including family planning],
HIV/AIDS, information, education and communication. Governments
should eliminate specific forms of discrimination that persons with
disabilities may face with regard to [reproductive rights],
household and family formation, and international migration, while
taking into account health and other considerations relevant under
national immigration regulations.
6.31. Governments at all levels should develop the infrastructure
to address the needs of persons with disabilities, in particular
with regard to their education, training and rehabilitation.
6.32. Governments at all levels should promote mechanisms ensuring
the realization of the rights of persons with disabilities and
reinforce their capabilities of integration.
6.33. Governments at all levels should implement and promote a
system of follow-up of social and economic integration of persons
with disabilities.
Chapter VII
REPRODUCTIVE RIGHTS, [SEXUAL AND REPRODUCTIVE HEALTH]
AND FAMILY PLANNING
A. Reproductive rights and reproductive health
Basis for action
7.1. 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
[fertility regulation] of their choice, 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 through
preventing and solving reproductive health problems. Sexual health
is the integration of somatic, emotional, intellectual and social
aspects of sexual being, in ways that are positively enriching and
that enhance personality, communication and love, and thus the
notion of sexual health implies a positive approach to human
sexuality, and the purpose of sexual health care should be the
enhancement of life and personal relations, and not merely
counselling and care related to reproduction and sexually
transmitted diseases.
7.2. [Sexual and reproductive rights embrace certain human rights
that are already recognized in various international human rights
documents and in other documents reflecting international
consensus.] The cornerstone of [sexual and reproductive health]
rests on the recognition of the basic right of all couples and
individuals to decide freely and responsibly the number, spacing
and timing of their children and to have the information and means
to do so, [and the right to the enjoyment of the highest attainable
standard of sexual and reproductive health]. It also includes
respect for [security of the person and] physical integrity of the
human body as expressed in human rights documents, [and the right
of couples and individuals to make decisions concerning
reproduction free of discrimination, coercion and violence]. In
the exercise of this right, couples and individuals should take
into account the needs of their living and future children and
their responsibilities towards the community. The promotion of the
responsible exercise of these rights for all people should be the
fundamental basis for government- and community-supported policies
and programmes in the area of [sexual and reproductive health],
including family planning. As part of their commitment, full
attention should be given to the promotion of mutually respectful
and equitable gender relations and particularly to meeting the
educational and service needs of adolescents to enable them to deal
in a positive and responsible way with their sexuality.
[Reproductive and sexual health] eludes many of the world's people
because of such factors as: inadequate levels of knowledge about
human sexuality and inappropriate or poor-quality [reproductive
health] information and services; the prevalence of high-risk
sexual behaviour; discriminatory social practices; negative
attitudes towards women and girls; and the limited power many women
and girls have over their sexual and reproductive lives.
Adolescents are particularly vulnerable because of their lack of
information and access to services in most countries. Older women
and men have distinct [reproductive and sexual health] issues which
are often inadequately addressed.
Objectives
7.3. The objectives are:
(a) To ensure that comprehensive and factual information and
a full range of [reproductive and sexual health]-care services,
including family planning, are accessible, affordable, acceptable
and convenient to the users, whether women, men or adolescents;
(b) To enable and support responsible voluntary decisions
about child-bearing and methods of [fertility regulation] and to
have the information, education and means to do so;
(c) To meet changing [reproductive and sexual health] needs
over the life cycle and to do so in ways sensitive to the diversity
of circumstances of local communities.
Actions
7.4. All countries should strive to make accessible through the
primary health-care system, [reproductive health] to all
individuals [of all ages] as soon as possible [and no later than
the year 2015]. [Reproductive health] care in the context of
primary health care should, inter alia, include: family-planning
counselling, information, education, communication and services;
education and services for prenatal care, safe delivery, [pregnancy
termination] and post-natal care, especially breast-feeding, infant
and women's health care; prevention and appropriate treatment of
infertility; prevention of abortion and the management of the
consequences of abortion; treatment of reproductive tract
infections; sexually transmitted diseases and other [reproductive
health] conditions; and information, education and counselling, as
appropriate, on human sexuality, [sexual and reproductive health]
and responsible parenthood. Referral for family-planning services
and further diagnosis and treatment for complications of pregnancy,
delivery and [abortion], infertility, reproductive tract
infections, breast cancer and cancers of the reproductive system,
sexually transmitted diseases and HIV/AIDS should always be
available, as required. Active discouragement of harmful practices
such as female genital mutilation should also be an integral
component of [reproductive and sexual health-]care programmes.
7.5. [Reproductive and sexual health]-care programmes should be
designed to serve the needs of women and adolescent females and
must involve women in the leadership, planning, decision-making,
management, implementation, organization and evaluation of
services. Governments and other organizations should take positive
steps to include women at all levels of the health-care system.
7.6. Innovative programmes must be developed to make information,
counselling and services for [sexual and reproductive health]
accessible to adolescents and adult men. Such programmes must both
educate and enable men to share more equally in family planning,
domestic and child-rearing responsibilities and to accept the major
responsibility for the prevention of sexually transmitted diseases.
Programmes must reach men in their workplaces, at home and where
they gather for recreation. Boys and adolescents, with the support
and guidance of their parents, and in line with the Convention on
the Rights of the Child, should also be reached through schools,
youth organizations and wherever they congregate. Voluntary and
appropriate male methods for contraception, as well as for the
prevention of sexually transmitted diseases and AIDS, should be
promoted and made accessible with adequate information and
counselling.
7.7. Governments should promote much greater community
participation in [reproductive and sexual health-]care services by
decentralizing the management of public health programmes and by
forming partnerships in cooperation with local non-governmental
organizations and private health-care providers. All types of
non-governmental organizations, including local women's groups,
trade unions, cooperatives, youth programmes and religious groups,
should be encouraged to become involved in the promotion of better
[reproductive and sexual health].
7.8. Without jeopardizing international support for programmes in
developing countries, the international community should, upon
request, give consideration to the training, technical assistance,
short-term contraceptive supply needs and the needs of the
countries in transition from centrally managed to market economies,
where [reproductive and sexual health] is poor and in some cases
deteriorating. Those countries, at the same time, must themselves
give higher priority to [reproductive and sexual health] services,
including a comprehensive range of contraceptive means, and must
address their current reliance on abortion for fertility regulation
by meeting the need of women in those countries for better
information and more choices on an urgent basis.
7.9. 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 and sexual health
and rights]. Services must be sensitive particularly 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.
B. Family planning
Basis for action
7.10. The aim of family-planning programmes must be to enable
couples and individuals to decide freely and responsibly the number
and spacing of their children and to have the information and means
to do so and to ensure informed choices and make available a full
range of safe and effective [fertility regulation] methods. The
success of population education and family-planning programmes in
a variety of settings demonstrates that informed individuals
everywhere can and will act responsibly in the light of their own
needs and those of their families and communities. The principle
of informed free choice is essential to the long-term success of
family-planning programmes. Any form of coercion has no part to
play. In every society there are many social and economic
incentives and disincentives that affect individual decisions about
child-bearing and family size. Over the past century, many
Governments have experimented with such schemes, including specific
incentives and disincentives, in order to lower or raise fertility.
Most such schemes have had only marginal impact on fertility and in
some cases have been counterproductive. Governmental goals for
family planning should be defined in terms of unmet needs for
information and services. Demographic goals, while legitimately
the subject of government development strategies, should not be
imposed on family-planning providers in the form of targets or
quotas for the recruitment of clients.
7.11. Over the past three decades, the increasing availability of
safer methods of modern contraception, although still in some
respects inadequate, has permitted greater opportunities for
individual choice and responsible decision-making in matters of
reproduction throughout much of the world. Currently, about 55 per
cent of couples in developing regions use some method of family
planning. This figure represents nearly a fivefold increase since
the 1960s. Family-planning programmes have considerably
contributed to the decline in average fertility rates for
developing countries, from about six to seven children per family
in the 1960s to about three to four children at present. However,
the full range of modern family-planning methods still remains
unavailable to at least 350 million couples world wide, many of
whom say they want to space or prevent another pregnancy. Survey
data suggest that approximately 120 million additional women world
wide would be currently using a modern family-planning method if
more accurate information and affordable services were easily
available, and if partners, extended families and the community
were more supportive. These numbers do not include the substantial
and growing numbers of sexually active unmarried individuals
wanting and in need of information and services. During the decade
of the 1990s, the number of couples of reproductive age will grow
by about 18 million per annum. To meet their needs and close the
existing large gaps in services, family planning and contraceptive
supplies will need to expand very rapidly over the next several
years. The quality of family-planning programmes is often directly
related to the level and continuity of contraceptive use and to the
growth in demand for services. Family-planning programmes work
best when they are part of or linked to broader [reproductive
health] programmes that address closely related health needs and
when women are fully involved in the design, provision, management
and evaluation of services.
Objectives
7.12. The objectives are:
(a) To help couples and individuals meet their reproductive
goals in a framework that promotes optimum health, responsibility
and family well-being, and respects the dignity of all persons and
their right to choose the number, spacing and timing of birth of
their children;
(b) To prevent unwanted pregnancies and reduce the incidence
of high-risk pregnancies and morbidity and mortality;
(c) To make quality family-planning services affordable,
acceptable and accessible to all who need and want them, [while
maintaining confidentiality];
(d) To improve the quality of family-planning advice,
information, education, communication, counselling and services;
(e) To increase the participation and sharing of
responsibility of men in the actual practice of family planning;
(f) To promote breast-feeding to enhance birth spacing.
Actions
7.13. [Governments and the international community should use the
full means at their disposal to support the principle of voluntary
choice in family planning.]
7.14. All countries should, over the next several years, assess
the extent of national unmet need for good-quality family-planning
services and its integration in the [sexual and reproductive
health] context, paying particular attention to the most vulnerable
and underserved groups in the population. All countries should
take steps to meet the family-planning needs of their populations
as soon as possible and should, [in all cases by the year 2015],
seek to provide universal access to a full range of safe and
reliable family-planning methods and to related [legally
permissible] [reproductive health] services. The aim should be to
assist couples and individuals to achieve their reproductive goals
and give them the full opportunity to exercise the right to have
children by choice.
7.15. Governments at all levels are urged to institute systems of
monitoring and evaluation of user-centred services with a view to
detecting, preventing and controlling abuses by family-planning
managers and providers and to ensure a continuing improvement in
the quality of services. To this end, Governments should secure
conformity to human rights, and to ethical and professional
standards in the delivery of family planning and related
[reproductive and sexual health] services aimed at ensuring
responsible, voluntary and informed consent. In-vitro
fertilization techniques should be provided in accordance with
appropriate ethical guidelines and medical standards.
7.16. Non-governmental organizations should play an active role in
mobilizing community and family support, in increasing access and
acceptability of [family- planning and reproductive health]
services, and cooperate with Governments in the process of
preparation and provision of care, based on informed choice, and in
helping to monitor public- and private-sector programmes, including
their own.
7.17. As part of the effort to meet unmet needs, all countries
should seek to identify and remove all the major remaining barriers
to the utilization of family-planning services. Some of those
barriers are related to the inadequacy, poor quality and cost of
existing family-planning services. It should be the goal of
public, private and non-governmental family-planning organizations
to remove all programme-related barriers to family-planning use [by
the year 2005] through the redesign or expansion of information and
services and other ways to increase the ability of couples and
individuals to make free and informed decisions about the number,
spacing and timing of births and protect themselves from sexually
transmitted diseases.
7.18. Specifically, Governments should make it easier for couples
and individuals to take responsibility for their own [reproductive
and sexual health]. [by removing unnecessary legal, medical,
clinical and regulatory barriers to information and to access to
family-planning services and methods.]
7.19. All political and community leaders are urged to play a
strong, sustained and highly visible role in promoting and
legitimizing the provision and use of family-planning and
[reproductive health] services. Governments at all levels are
urged to provide a climate that is favourable to good-quality
public and private family-planning and [reproductive and sexual
health] information and services through all possible channels.
Finally, leaders and legislators at all levels must translate their
public support for [reproductive health, including family
planning,] into adequate allocations of budgetary, human and
administrative resources to help meet the needs of all those who
cannot pay the full cost of services.
7.20. In support of fully responsible, informed, [legally and
permissible] reproductive choices, Governments are encouraged to
focus most of their efforts towards meeting their population and
development objectives through education and voluntary measures
rather than schemes involving incentives and disincentives.
7.21. In the coming years, all family-planning programmes must
make significant efforts to improve quality of care. Among other
measures, programmes should:
(a) Recognize that appropriate methods for couples and
individuals vary according to their age, parity, family size
preference and other factors, and ensure that women and men have
information and access to the widest possible range of safe and
effective family-planning methods in order to enable them to
exercise free and informed choice;
(b) Provide accessible, complete and accurate information
about various family-planning methods, including their health risks
and benefits, possible side effects and their effectiveness in the
prevention of the spread of HIV/AIDS and other sexually transmitted
diseases;
(c) Make services safer, affordable, more convenient and
accessible for clients and ensure, through strengthened logistical
systems, a sufficient and continuous supply of essential
high-quality contraceptives. [Privacy and confidentiality should
be ensured];
(d) Expand and upgrade formal and informal training in
[sexual and reproductive health] care and family planning for all
health-care providers, health educators and managers, including
training in interpersonal communications and counselling;
(e) Ensure appropriate follow-up care, including treatment
for side effects of contraceptive use;
(f) Ensure availability of related [reproductive health]
services on site or through a strong referral mechanism;
(g) In addition to quantitative measures of performance, give
more emphasis to qualitative ones that take into account the
perspectives of current and potential users of services, through
means including effective management information systems and survey
techniques for the timely evaluation of services;
(h) Family-planning and [Reproductive health] programmes
should emphasize breast-feeding education and support services,
which can simultaneously contribute to birth spacing, better
maternal and child health and higher child survival.
[7.22. In keeping with the policies of many nations, as agreed to
in the consensus of the 1984 International Conference on
Population, Governments should "take appropriate steps to help
women avoid abortion, which in no case should be promoted as a
method of family planning, and wherever possible, provide for the
humane treatment and counselling of women who have had recourse to
abortion".]
7.23. In order to meet the substantial increase in demand for
contraceptives over the next decade and beyond, the international
community should move, on an immediate basis, to establish an
efficient coordination system and global, regional and subregional
facilities for the procurement of contraceptive and other
commodities essential to [reproductive health] programmes of
developing countries and countries with economies in transition.
The international community should also consider measures such as
transfers of technology to developing countries enabling them to
produce and distribute high-quality contraceptives and other
commodities essential to [reproductive health] services, in order
to strengthen the self-reliance of those countries. At the request
of the countries concerned, the World Health Organization should
continue to provide advice on the quality, safety and efficacy of
family-planning methods.
7.24. Provision of [reproductive health-] care services should not
be confined to the public sector but should involve the private
sector and non-governmental organizations, in accordance with the
needs and resources of their communities, and include, where
appropriate, effective strategies for cost recovery and service
delivery, including social marketing and community-based services.
Special efforts should be made to improve accessibility through
outreach services.
C. Sexually transmitted diseases and HIV prevention
Basis for action
7.25. The world-wide incidence of sexually transmitted diseases is
high and increasing. The situation has worsened considerably with
the emergence of the HIV epidemic. Although the incidence of some
sexually transmitted diseases has stabilized in parts of the world,
there have been increasing cases in many regions.
7.26. The social and economic disadvantages that women face make
them especially vulnerable to sexually transmitted infections,
including HIV, as illustrated, for example, by their exposure to
the high-risk sexual behaviour of their partners. For women, the
symptoms of infections from sexually transmitted diseases are often
hidden, making them more difficult to diagnose than in men and the
health consequences are often greater, including increased risk of
infertility and ectopic pregnancy. The risk of transmission from
infected men to women is also greater than from infected women to
men, and many women are powerless to take steps to protect
themselves.
Objective
7.27. The objective is to prevent, reduce the incidence of, and
provide treatment for, sexually transmitted diseases, including
HIV/AIDS, and the complications of sexually transmitted diseases
such as infertility, with special attention to girls and women.
Actions
7.28. [Reproductive health] programmes should increase their
efforts to prevent, detect and treat sexually transmitted diseases
and other reproductive tract infections, especially at the primary
health-care level. Special outreach efforts should be made to
those who do not have access to [reproductive and sexual
health]-care programmes.
7.29. All health-care providers, including all family-planning
providers, should be given specialized training in the prevention
and detection of, and counselling on, sexually transmitted
diseases, especially infections in women and youth, including
HIV/AIDS.
7.30. Information, education and counselling for responsible
sexual behaviour and effective prevention of sexually transmitted
diseases and HIV should become integral components of all
[reproductive and sexual health] services.
7.31. Promotion and the reliable supply and distribution of
high-quality condoms should become integral components of all
[reproductive health]-care services. All relevant international
organizations, especially the World Health Organization, should
significantly increase their procurement. Governments and the
international community should provide all means to reduce the
spread and the rate of transmission of HIV/AIDS infection.
D. Human sexuality and gender relations
Basis for action
7.32. Human sexuality and gender relations are closely
interrelated and together affect the ability of men and women to
achieve and maintain sexual health and manage their reproductive
lives. Equal relationships between men and women in matters of
sexual relations and reproduction require mutual respect and
willingness to accept responsibility for the consequences of sexual
behaviour. Responsible sexual behaviour, sensitivity and equity in
gender relations, particularly when instilled during the formative
years, enhance and promote respectful and harmonious partnerships
between men and women.
7.33. Violence against women, particularly domestic violence and
rape, is widespread, and rising numbers of women are at risk from
AIDS and other sexually transmitted diseases as a result of
high-risk sexual behaviour on the part of their partners. In a
number of countries, harmful practices meant to control women's
sexuality have led to great suffering. Among them is the practice
of female genital mutilation, which is a violation of basic rights
and a major lifelong risk to women's [reproductive health].
Objectives
7.34. The objectives are:
(a) To promote adequate development of responsible sexuality
permitting relations of equity and mutual respect between the
genders and contributing to improving the quality of life of
individuals;
(b) To ensure that women and men have access to information,
education and services needed to achieve good sexual health and
exercise their [reproductive rights and responsibilities].
Actions
7.35. Support should be given to integral sexual education and
services for children and young people with the support and
guidance of their parents, and in line with the Convention on the
Rights of the Child, that stress male responsibility for their own
sexual health and fertility and that help them exercise those
responsibilities. Educational efforts should begin within the
family unit, in the community and in the schools [at an early age],
but must also reach adults, in particular men, through non-formal
education and a variety of community-based efforts.
7.36. In the light of the urgent need to prevent unwanted
pregnancies, the rapid spread of AIDS and other sexually
transmitted diseases, and the prevalence of sexual abuse and
violence, Governments should base national policies on a better
understanding of the need for responsible human sexuality and the
realities of current sexual behaviour.
7.37. Active and open discussion of the need to protect women,
youth and children from any abuse, including sexual abuse,
exploitation, trafficking and violence must be encouraged and
supported by educational programmes at both national and community
levels. Governments should set the necessary conditions and
procedures to encourage victims to report violations of their
rights. Laws addressing those concerns should be enacted where
they do not exist, made explicit, strengthened and enforced, and
appropriate rehabilitation services provided. Governments should
also prohibit the production and the trade of child pornography.
7.38. Governments and communities should urgently take steps to
stop the practice of female genital mutilation and protect women
and girls from all such similar unnecessary and dangerous
practices. Steps to eliminate the practice should include strong
community outreach programmes involving village and religious
leaders, education and counselling about its impact on girls' and
women's health, and appropriate treatment and rehabilitation for
girls and women who have suffered mutilation. Services should
include counselling for women and men to discourage the practice.
E. Adolescents
Basis for action
7.39. The [reproductive health] needs of adolescents as a group
have been largely ignored to date by existing [reproductive health]
services. The response of societies to the [reproductive health]
needs of adolescents should be based on information that helps them
attain a level of maturity required to make responsible decisions.
In particular, information and services should be made available to
adolescents that can help them understand their sexuality and
protect them from unwanted pregnancies, sexually transmitted
diseases and subsequent risk of infertility. This should be
combined with the education of young men to respect women's
self-determination and to share responsibility with women in
matters of sexuality and reproduction. This effort is uniquely
important for the health of young women and their children, for
women's self-determination and, in many countries, for efforts to
slow the momentum of population growth. Motherhood at a very young
age entails a risk of maternal death much greater than average, and
the children of young mothers have higher levels of morbidity and
mortality. Early child-bearing continues to be an impediment to
improvements in the educational, economic and social status of
women in all parts of the world. Overall for young women, early
marriage and early motherhood can severely curtail educational and
employment opportunities and are likely to have a long-term,
adverse impact on their and their children's quality of life.
7.40. Poor educational and economic opportunities and sexual
exploitation are important factors in the high levels of adolescent
child-bearing. In both developed and developing countries,
adolescents faced with few apparent life choices have little
incentive to avoiding pregnancy and child-bearing.
7.41. In many societies, adolescents face pressures to engage in
sexual activity. Young women, particularly low-income adolescents,
are especially vulnerable. Sexually active adolescents of both
sexes are increasingly at high risk of contracting and transmitting
sexually transmitted diseases, including HIV/AIDS, and they are
typically poorly informed about how to protect themselves.
Programmes for adolescents have shown to be most effective when
they secure the full involvement of adolescents in identifying
their [reproductive and sexual health] needs and in designing
programmes that respond to those needs.
Objectives
7.42. The objectives are:
(a) To address adolescent [sexual and reproductive health]
issues, including unwanted pregnancy, [unsafe abortion], sexually
transmitted diseases and HIV/AIDS, through the promotion of
responsible and healthy reproductive and sexual behaviour,
including voluntary abstinence, and the provision of appropriate
services and counselling specifically suitable for that age group;
(b) To substantially reduce all adolescent pregnancies.
Actions
[7.43. Countries should remove legal, regulatory and social
barriers to sexual and reproductive health information and care for
adolescents and must ensure that the programmes and attitudes of
health-care providers do not restrict the access of adolescents to
the services and information they need. In doing so, services for
adolescents must safeguard their rights to privacy,
confidentiality, informed consent and respect.]
7.44. Countries, with the support of the international community,
should protect and promote the rights of adolescents to [sexual and
reproductive health] education, information and care and greatly
reduce the number of adolescent pregnancies.
7.45. Governments, in collaboration with non-governmental
organizations, are urged to meet the special needs of adolescents
and to establish appropriate programmes to respond to those needs.
Such programmes should include support mechanisms for the education
and counselling of adolescents in the areas of gender relations and
equality, violence against adolescents, responsible sexual
behaviour, responsible family-planning practice, family life,
[reproductive and sexual health], sexually transmitted diseases,
HIV infection and AIDS prevention. Programmes for the prevention
and treatment of sexual abuse and incest and other [reproductive
health] services should be provided. Such programmes should
provide information to adolescents and make a conscious effort to
strengthen positive social and cultural values. Sexually active
adolescents will require special family-planning information,
counselling and services, including contraceptive services, and
those who become pregnant will require special support from their
families and community during pregnancy and early child care.
Adolescents must be fully involved in the planning, implementation
and evaluation of such information and services with proper regard
for parental guidance and responsibilities.
7.46. Programmes should involve and train all who are in a
position to provide guidance to adolescents concerning responsible
sexual and reproductive behaviour, particularly parents and
families, and also communities, religious institutions, schools,
the mass media and peer groups. Governments and non-governmental
organizations should promote programmes directed to the education
of parents, with the objective of improving the interaction of
parents and children to enable them to comply better with their
educational duties to support the process of maturation of their
children, particularly in the areas of sexual behaviour and [sexual
and reproductive health.]
Chapter VIII
HEALTH, MORBIDITY AND MORTALITY
A. Primary health care and the health-care sector
Basis for action
8.1. One of the main achievements of the twentieth century has
been the unprecedented increase in human longevity. In the past
half century, expectation of life at birth in the world as a whole
has increased by about 20 years, and the risk of dying in the first
year of life has been reduced by nearly two thirds. Nevertheless,
these achievements fall short of the much greater improvements that
had been anticipated in the World Population Plan of Action and the
Declaration of Alma Ata, adopted by the International Conference on
Primary Health Care in 1978. There remain entire national
populations and sizeable population groups within many countries
that are still subject to very high rates of morbidity and
mortality. Differences linked to socio-economic status or
ethnicity are often substantial. In many countries with economies
in transition, the mortality rate has considerably increased as a
result of deaths caused by accidents and violence.
8.2. The increases in life expectancy recorded in most regions of
the world reflect significant gains in public health and in access
to primary health-care services. Notable achievements include the
vaccination of about 80 per cent of the children in the world and
the widespread use of low-cost treatments, such as oral rehydration
therapy, to ensure that more children survive. Yet these
achievements have not been realized in all countries, and
preventable or treatable illnesses are still the leading killers of
young children. Moreover, large segments of many populations
continue to lack access to clean water and sanitation facilities,
are forced to live in congested conditions and lack adequate
nutrition. Large numbers of people remain at continued risk of
infectious, parasitic and water-borne diseases, such as
tuberculosis, malaria and schistosomiasis. In addition, the health
effects of environmental degradation and exposure to hazardous
substances in the workplace are increasingly a cause of concern in
many countries. Similarly, the growing consumption of tobacco,
alcohol and drugs will precipitate a marked increase in costly
chronic diseases among working age and elderly people. The impact
of reductions in expenditures for health and other social services
which have taken place in many countries as a result of
public-sector retrenchment, misallocation of available health
resources, structural adjustment and the transition to market
economies has pre-empted significant changes in lifestyles,
livelihoods and consumption patterns and is also a factor in
increasing morbidity and mortality. Although economic reforms are
essential to sustained economic growth, it is equally essential
that the design and implementation of structural adjustment
programmes incorporate the social dimension.
Objectives
8.3. The objectives are:
(a) To increase the accessibility, availability,
acceptability and affordability of health-care services and
facilities to all people in accordance with national commitments to
provide access to basic health care for all;
(b) To increase the healthy life-span and improve the quality
of life of all people, and to reduce disparities in life expectancy
between and within countries.
Actions
8.4. All countries should make access to basic health care and
health promotion the central strategies for reducing mortality and
morbidity. Sufficient resources should be assigned so that primary
health services attain full coverage of the population.
Governments should strengthen health and nutrition information,
education and communication activities so as to enable people to
increase their control over and improve their health. Governments
should provide the necessary backup facilities to meet the demand
created.
8.5. In keeping with the Declaration of Alma Ata, all countries
should reduce mortality and morbidity and seek to make primary
health care, including reproductive health care, available
universally by the end of the current decade. [Countries should
aim to achieve by 2005 a life expectancy at birth greater than 70
years and by 2015 a life expectancy at birth greater than 75 years.
Countries with the highest levels of mortality should aim to
achieve by 2005 a life expectancy at birth greater than 65 years
and by 2015 a life expectancy at birth greater than 70 years.]
Efforts to ensure a longer and healthier life for all should
emphasize the reduction of morbidity and mortality differentials
between males and females as well as among geographical regions,
social classes and indigenous and ethnic groups.
8.6. The role of women as primary custodians of family health
should be recognized and supported. Access to basic health care,
expanded health education, the availability of simple
cost-effective remedies, and the reappraisal of primary health-care
services, including [reproductive health-care services] to
facilitate proper use of women's time, should be provided.
8.7. Governments should ensure community participation in health
policy planning, especially with respect to the long-term care of
the elderly, those with disabilities and those infected with HIV
and other endemic diseases. Such participation should also be
promoted in child-survival and maternal health programmes,
breast-feeding support programmes, programmes for the early
detection and treatment of cancer of the reproductive system, and
programmes for the prevention of HIV infection and other sexually
transmitted diseases.
8.8. All countries should re-examine training curricula and the
delegation of responsibilities within the health-care delivery
system in order to reduce frequent, unnecessary and costly reliance
on physicians and on secondary- and tertiary-care facilities, while
maintaining effective referral services. Access to health-care
services for all people and especially for the most underserved and
vulnerable groups must be ensured. Governments should seek to make
basic health-care services more sustainable financially, while
ensuring equitable access, by integrating [sexual and reproductive]
health services, including maternal and child health and
family-planning services, and by making appropriate use of
community-based services, social marketing and cost-recovery
schemes, with a view to increasing the range and quality of
services available. The involvement of users and the community in
the financial management of health-care services should be
promoted.
8.9. Through technology transfer, developing countries should be
assisted in building their capacity to produce generic drugs for
the domestic market and to ensure the wide availability and
accessibility of such drugs. To meet the substantial increase in
demand for vaccines, antibiotics and other commodities over the
next decade and beyond, the international community should
strengthen global, regional and local mechanisms for the
production, quality control and procurement of those items, where
feasible, in developing countries. The international community
should facilitate regional cooperation in the manufacture, quality
control and distribution of vaccines.
8.10. All countries should give priority to measures that improve
the quality of life and health by ensuring a safe and sanitary
living environment for all population groups through measures aimed
at avoiding crowded housing conditions, reducing air pollution,
ensuring access to clean water and sanitation, improving waste
management, and increasing the safety of the workplace. Special
attention should be given to the living conditions of the poor and
disadvantaged in urban and rural areas. The impact of
environmental problems on health, particularly that of vulnerable
groups, should be monitored by Governments on a regular basis.
8.11. Reform of the health sector and health policy, including the
rational allocation of resources, should be promoted in order to
achieve the stated objectives. All Governments should examine ways
to maximize the cost- effectiveness of health programmes in order
to achieve increased life expectancy, reduce morbidity and
mortality and ensure access to basic health-care services for all
people.
B. Child survival and health
Basis for action
8.12. Important progress has been made in reducing infant and
child mortality rates everywhere. Improvements in the survival of
children have been the main component of the overall increase in
average life expectancy in the world over the past century, first
in the developed countries and over the past 50 years in the
developing countries. The number of infant deaths (i.e., of
children under age 1) per 1,000 live births at the world level
declined from 92 in 1970-1975 to about 62 in 1990-1995. For
developed regions, the decline was from 22 to 12 infant deaths per
1,000 births, and for developing countries from 105 to 69 infant
deaths per 1,000 births. Improvements have been slower in
sub-Saharan Africa and in some Asian countries where, during
1990-1995, more than one in every 10 children born alive will die
before their first birthday. The mortality of children under age
5 exhibits significant variations between and within regions and
countries. Indigenous people[s] generally have higher infant and
child mortality rates than the national norm. Poverty,
malnutrition, a decline in breast-feeding, and inadequacy or lack
of sanitation and of health facilities are all factors associated
with high infant and child mortality. In some countries, civil
unrest and wars have also had major negative impacts on child
survival. Unwanted births, child neglect and abuse are also
factors contributing to the rise in child mortality. In addition,
HIV infection can be transmitted from mother to child before or
during childbirth, and young children whose mothers die are at a
very high risk of dying themselves at a young age.
8.13. The World Summit for Children, held in 1990, adopted a set
of goals for children and development up to the year 2000,
including a reduction in infant and under-5 child mortality rates
by one third, or to 50 and 70 per 1,000 live births, respectively,
whichever is less. These goals are based on the accomplishments of
child-survival programmes during the 1980s, which demonstrate not
only that effective low-cost technologies are available but also
that they can be delivered efficiently to large populations.
However, the morbidity and mortality reductions achieved through
extraordinary measures in the 1980s are in danger of being eroded
if the broad-based health-delivery systems established during the
decade are not institutionalized and sustained.
8.14. Child survival is closely linked to the timing, spacing and
number of births and to the reproductive health of mothers. Early,
late, numerous and closely spaced pregnancies are major
contributors to high infant and child mortality and morbidity
rates, especially where health-care facilities are scarce. Where
infant mortality remains high, couples often have more children
than they otherwise would to ensure that a desired number survive.
Objectives
8.15. The objectives are:
(a) To promote child health and survival and to reduce
disparities between and within developed and developing countries
as quickly as possible, with particular attention to eliminating
the pattern of excess and preventable mortality among girl infants
and children;
(b) To improve the health and nutritional status of infants
and children;
(c) To promote breast-feeding as a child-survival strategy.
Actions
8.16. Over the next 20 years, through international cooperation
and national programmes, the gap between average infant and child
mortality rates in the developed and the developing regions of the
world should be substantially narrowed, and disparities within
countries, those between geographical regions, ethnic or cultural
groups, and socio-economic groups should be eliminated. Countries
with indigenous people should achieve infant and under-5 mortality
levels among their indigenous people that are the same as those of
the general population. [Countries should strive to reduce their
infant and under-5 mortality rates by one third, or to 50 and 70
per 1,000 live births, respectively, whichever is less, by the year
2000, with appropriate adaptation to the particular situation of
each country. By 2005, countries with intermediate mortality
levels should aim to achieve an infant mortality rate below 50
deaths per 1,000 and an under-5 mortality rate below 60 deaths per
1,000 births. By 2015 all countries should aim to achieve an
infant mortality rate below 35 per 1,000 live births and an under-5
mortality rate below 45 per 1,000. Countries that achieve these
levels earlier should strive to lower them further.]
8.17. All Governments should assess the underlying causes of high
child mortality and should, within the framework of primary health
care, extend integrated reproductive health-care and child-health
services, [including safe motherhood], child-survival programmes
and family-planning services, to all the population and
particularly to the most vulnerable and underserved groups. Such
services should include prenatal care and counselling, with special
emphasis on high-risk pregnancies and the prevention of sexually
transmitted diseases and HIV infection; adequate delivery
assistance; and neonatal care, including exclusive breast-feeding,
information on optimal breast-feeding and on proper weaning
practices, and the provision of micronutrient supplementation and
tetanus toxoid, where appropriate. Interventions to reduce the
incidence of low birth weight and other nutritional deficiencies,
such as anaemia, should include the promotion of maternal nutrition
through information, education and counselling and the promotion of
longer intervals between births. All countries should give
priority to efforts to reduce the major childhood diseases,
particularly infectious and parasitic diseases, and to prevent
malnutrition among children, especially the girl child, through
measures aimed at eradicating poverty and ensuring that all
children live in a sanitary environment and by disseminating
information on hygiene and nutrition. It is also important to
provide parents with information and education about child care,
including the use of mental and physical stimulation.
8.18. For infants and children to receive the best nutrition and
for specific protection against a range of diseases, breast-feeding
should be protected, promoted and supported. By means of legal,
economic, practical and emotional support, mothers should be
enabled to breast-feed their infants exclusively for four to six
months, without food or drink supplementation and to continue
breast-feeding infants with appropriate and adequate complementary
food up to the age of two years or beyond. To achieve these goals,
Governments should promote public information on the benefits of
breast-feeding; health personnel should receive training on the
management of breast-feeding; and countries should examine ways and
means to implement fully the WHO International Code of Marketing of
Breast Milk Substitutes.
C. Women's health and [safe motherhood]
Basis for action
8.19. Complications related to pregnancy and childbirth are among
the leading causes of mortality for women of reproductive age in
many parts of the developing world. At the global level, it has
been estimated that about half a million women die each year of
pregnancy-related causes, 99 per cent of them in developing
countries. The gap in maternal mortality between developed and
developing regions is wide: in 1988, it ranged from more than 700
per 100,000 live births in the least developed countries to about
26 per 100,000 live births in the developed regions. Rates of
1,000 or more maternal deaths per 100,000 live births have been
reported in several rural areas of Africa, giving women with many
pregnancies a high lifetime risk of death during their reproductive
years. According to WHO, the lifetime risk of dying from pregnancy
or childbirth-related causes is 1 in 20 in developing countries,
compared to 1 in 10,000 in some developed countries. The age at
which women begin or stop child-bearing, the interval between each
birth, the total number of lifetime pregnancies and the
socio-cultural and economic circumstances in which women live all
influence maternal morbidity and mortality. At present,
approximately 90 per cent of the countries of the world,
representing 96 per cent of the world population, have policies
that permit abortion under varying legal conditions to save the
life of a woman. However, a significant proportion of the
abortions carried out are self-induced or otherwise unsafe, leading
to a large fraction of maternal deaths or to permanent injury to
the women involved. Maternal deaths have very serious consequences
within the family, given the crucial role of the mother for her
children's health and welfare. The death of the mother increases
the risk to the survival of her young children, especially if the
family is not able to provide a substitute for the maternal role.
Greater attention to the reproductive health needs of female
adolescents and young women could prevent the major share of
maternal morbidity and mortality through prevention of unwanted
pregnancies and any subsequent poorly managed abortion. [Safe
motherhood], a notion which does not include the [promotion] of
abortion as a method of family planning, has been accepted in many
countries as a strategy to reduce maternal morbidity and mortality.
Objectives
8.20. The objectives are:
(a) To promote women's health and [safe motherhood]; to
achieve a rapid and substantial reduction in maternal morbidity and
mortality and reduce the differences observed between developing
and developed countries and within countries. On the basis of a
commitment to women's health and well-being, to reduce greatly the
number of deaths and morbidity from unsafe abortion;
(b) To improve the health and nutritional status of women,
especially of pregnant and nursing women.
Actions
8.21. Countries should strive to effect significant reductions in
maternal mortality by the year 2015; [a reduction in maternal
mortality by one half of the 1990 levels by the year 2000 and a
further one half by 2015. The realization of these goals will have
different implications for countries with different 1990 levels of
maternal mortality. Countries with intermediate levels of
mortality should aim to achieve by the year 2005 a maternal
mortality rate below 100 per 100,000 live births and by the year
2015 a maternal mortality rate below 60 per 100,000 live births.
Countries with the highest levels of mortality should aim to
achieve by 2005 a maternal mortality rate below 125 per 100,000
live births and by 2015 a maternal mortality rate below 75 per
100,000 live births.] However, all countries should reduce
maternal morbidity and mortality to levels where they no longer
constitute a public health problem. Disparities in maternal
mortality within countries and between geographical regions,
socio-economic and ethnic groups should be narrowed.
8.22. All countries, with the support of all sections of the
international community, must expand the provision of maternal
health services in the context of primary health care. These
services, based on the concept of informed choice, should include
education on [safe motherhood], prenatal care that is focused and
effective, maternal nutrition programmes, adequate delivery
assistance that avoids excessive recourse to caesarean sections and
provides for obstetric emergencies; referral services for
pregnancy, childbirth and abortion complications; post-natal care
and family planning. All births should be assisted by trained
persons, preferably nurses and midwives, but at least by trained
birth attendants. The underlying causes of maternal morbidity and
mortality should be identified, and attention should be given to
the development of strategies to overcome them and for adequate
evaluation and monitoring mechanisms to assess the progress being
made in reducing maternal mortality and morbidity and to enhance
the effectiveness of ongoing programmes. Programmes and education
to engage men's support for maternal health and [safe motherhood]
should be developed.
8.23. All countries, especially developing countries, with the
support of the international community, should aim at further
reductions in maternal mortality through measures to prevent,
detect and manage high-risk pregnancies and births, particularly
those to adolescents and late-parity women.
8.24. All countries should design and implement special programmes
to address the nutritional needs of women of child-bearing age,
especially those who are pregnant or breast-feeding, and should
give particular attention to the prevention and management of
nutritional anaemia and iodine-deficiency disorders. Priority
should be accorded to improving the nutritional and health status
of young women through education and training as part of maternal
health and [safe motherhood programmes]. Adolescent females and
males should be provided with information, education and
counselling to help them delay early marriage and unions, premature
sexual activity and first pregnancy.
8.25. [All Governments, intergovernmental organizations and
relevant non-governmental organizations are urged to deal openly
and forthrightly with [unsafe abortion] as a major public health
concern. Particular efforts should be made to obtain objective and
reliable information on the policies on, incidence of and
consequences of abortion in every country. Unwanted pregnancies
should be prevented through sexual health education and through
expanded and improved family-planning services, including proper
counselling to reduce the rate of abortion. Governments are urged
to assess the health and social impact of induced abortion, to
address the situations that cause women to have recourse to
abortion and to provide adequate medical care and counselling.
[Governments are urged to evaluate and review laws and policies on
abortion so that they take into account the commitment to women's
health and well-being in accordance with local situations, rather
than relying on criminal codes or punitive measures. Although the
main objective of public policy is to prevent unwanted pregnancies
and reduce the rate of abortion, women should have ready access to
quality health-care services that include reliable information,
counselling and medical care to enable them to terminate
pregnancies in those cases where it is allowed by law, if they so
decide, and that provide for the management of complications and
sequelae of unsafe abortion.] Post-abortion counselling, education
and family-planning services should be offered promptly so as to
prevent repeat abortions].
[ALTERNATIVE 8.25. All Governments and intergovernmental and
non-governmental organizations are urged to deal openly and
forthrightly with unsafe abortion as a major public health concern.
Governments are urged to assess the health impact of unsafe
abortion and to reduce the need for abortion through expanded and
improved family-planning services. Prevention of unwanted
pregnancies must always be given the highest priority and all
attempts should be made to eliminate the need for abortion. In no
case should abortion be promoted as a method of family planning.
In circumstances where abortion is legal, women who wish to
terminate their pregnancies should have ready access to reliable
information and compassionate counselling and such abortion should
be safe. In all cases, women should have access to services for
the management of complications arising from unsafe abortions. Any
measures to provide for safe and legal abortion within the health
system can only be determined at the national level through policy
changes and legislative processes which reflect the diversity of
views on the issue of abortion.]
8.26. Programmes to reduce maternal morbidity and mortality should
include information and [reproductive health services], including
family-planning services. In order to reduce high-risk
pregnancies, maternal health and [safe motherhood] programmes
should include counselling and family-planning information.
8.27. All countries, as a matter of some urgency, need to seek
changes in high-risk sexual behaviour and devise strategies to
ensure that men share responsibility for [sexual and reproductive
health], including family planning, and for preventing and
controlling sexually transmitted diseases, HIV infection and AIDS.
D. Human immunodeficiency virus (HIV) infection and
acquired immunodeficiency syndrome (AIDS)
Basis for action
8.28. The AIDS pandemic is a major concern in both developed and
developing countries. WHO estimates that the cumulative number of
AIDS cases in the world amounted to 2.5 million persons by mid-1993
and that more than 14 million people had been infected with HIV
since the pandemic began, a number that is projected to rise to
between 30 million and 40 million by the end of the decade, if
effective prevention strategies are not pursued. As of mid-1993,
about four fifths of all persons ever infected with HIV lived in
developing countries where the infection was being transmitted
mainly through heterosexual intercourse and the number of new cases
was rising most rapidly among women. As a consequence, a growing
number of children are becoming orphans, themselves at high risk of
illness and death. In many countries, the pandemic is now
spreading from urban to rural areas and between rural areas and is
affecting economic and agricultural production.
Objectives
8.29. The objectives are:
(a) To prevent, reduce the spread of and minimize the impact
of HIV infection; to increase awareness of the disastrous
consequences of HIV infection and AIDS and associated fatal
diseases, at the individual, community and national levels, and of
the ways of preventing it; to address the social, economic, gender
and racial inequities that increase vulnerability to the disease;
(b) To ensure that HIV-infected individuals have adequate
medical care and are not discriminated against; to provide
counselling and other support for people infected with HIV and to
alleviate the suffering of people living with AIDS and that of
their family members, especially orphans; to ensure that the
individual rights and the confidentiality of persons infected with
HIV are respected; to ensure that sexual and reproductive health
programmes address HIV infection and AIDS;
(c) To intensify research on methods to control the HIV/AIDS
pandemic and to find an effective treatment for the disease.
Actions
8.30. Governments should assess the demographic and development
impact of HIV infection and AIDS. The AIDS pandemic should be
controlled through a multisectoral approach that pays sufficient
attention to its socio-economic ramifications, including the heavy
burden on health infrastructure and household income, its negative
impact on the labour force and productivity, and the increasing
number of orphaned children. Multisectoral national plans and
strategies to deal with AIDS should be integrated into population
and development strategies. The socio-economic factors underlying
the spread of HIV infection should be investigated, and programmes
to address the problems faced by those left orphaned by the AIDS
pandemic should be developed.
8.31. Programmes to reduce the spread of HIV infection should give
high priority to information, education and communication campaigns
to raise awareness and emphasize behavioural change. Sex education
and information should be provided to both those infected and those
not infected, and especially to adolescents. Health providers,
including family-planning providers, need training in counselling
on sexually transmitted diseases and HIV infection, including the
assessment and identification of high-risk behaviours needing
special attention and services; training in the promotion of safe
and responsible sexual behaviour, including voluntary abstinence,
and condom use; training in the avoidance of contaminated equipment
and blood products; and in the avoidance of sharing needles among
injecting drug users. Governments should develop guidelines and
counselling services on AIDS and sexually transmitted diseases
within the primary health-care services. Wherever possible,
reproductive health programmes, including family-planning
programmes, should include facilities for the diagnosis and
treatment of common sexually transmitted diseases, including
reproductive tract infection, recognizing that many sexually
transmitted diseases increase the risk of HIV transmission. The
links between the prevention of HIV infection and the prevention
and treatment of tuberculosis should be assured.
8.32. Governments should mobilize all segments of society to
control the AIDS pandemic, including non-governmental
organizations, community organizations, religious leaders, the
private sector, the media, schools and health facilities.
Mobilization at the family and community levels should be given
priority. Communities need to develop strategies that respond to
local perceptions of the priority accorded to health issues
associated with the spread of HIV and sexually transmitted
diseases.
8.33. The international community should mobilize the human and
financial resources required to reduce the rate of transmission of
HIV infection. To that end, research on a broad range of
approaches to prevent HIV transmission and to seek a cure for the
disease should be promoted and supported by all countries. In
particular, donor and research communities should support and
strengthen current efforts to find a vaccine and to develop
women-controlled methods, such as vaginal microbicides, to prevent
HIV infection. Increased support is also needed for the treatment
and care of HIV-infected persons and AIDS patients. The
coordination of activities to combat the AIDS pandemic must be
enhanced. Particular attention should be given to activities of
the United Nations system at the national level, where measures
such as joint programmes can improve coordination and ensure a more
efficient use of scarce resources. The international community
should also mobilize its efforts in monitoring and evaluating the
results of various efforts to search for new strategies.
8.34. Governments should develop policies and guidelines to
protect the individual rights of and eliminate discrimination
against persons infected with HIV and their families. Services to
detect HIV infection should be strengthened, making sure that they
ensure confidentiality. Special programmes should be devised to
provide care and the necessary emotional support to men and women
affected by AIDS and to counsel their families and near relations.
8.35. Responsible sexual behaviour, including voluntary sexual
abstinence, for the prevention of HIV infection should be promoted
and included in education and information programmes. Condoms and
drugs for the prevention and treatment of sexually transmitted
diseases should be made widely available and affordable and should
be included in all essential drug lists. Effective action should
be taken to further control the quality of blood products and
equipment decontamination.
Chapter IX
POPULATION DISTRIBUTION, URBANIZATION AND INTERNAL MIGRATION
A. Population distribution and sustainable development
Basis for action
9.1. In the early 1990s, approximately half of the Governments in
the world, mostly those of developing countries, considered the
patterns of population distribution in their territories to be
unsatisfactory and wished to modify them. A key issue was the
rapid growth of urban areas, which are expected to house more than
half of the world population by 2005. Consequently, attention has
mostly been paid to rural-urban migration, although rural-rural and
urban-urban migration are in fact the dominant forms of spatial
mobility in many countries. The process of urbanization is an
intrinsic dimension of economic and social development and, in
consequence, both developed and developing countries are going
through the process of shifting from predominantly rural to
predominantly urban societies. For individuals, migration is often
a rational and dynamic effort to seek new opportunities in life.
Cities are centres of economic growth, providing the impetus for
socio-economic innovation and change. However, migration is also
prompted by push factors, such as inequitable allocation of
development resources, adoption of inappropriate technologies and
lack of access to available land. The alarming consequences of
urbanization visible in many countries are related to its rapid
pace, to which Governments have been unable to respond with their
current management capacities and practices. Even in developing
countries, however, there are already signs of a changing pattern
of population distribution, in the sense that the trend towards
concentration in a few large cities is giving way to a more
widespread distribution in medium-sized urban centres. This
movement is also found in some developed countries, with people
indicating preference for living in smaller places. Effective
population distribution policies are those that, while respecting
the right of individuals to live and work in the community of their
choice, take into account the effects of development strategies on
population distribution. Urbanization has profound implications
for individuals' livelihood, way of life and values. At the same
time, migration has economic, social and environmental implications
- both positive and negative - for the places of origin and
destination.
Objectives
9.2. The objectives are:
(a) To foster a more balanced spatial distribution of the
population by promoting in an integrated manner the equitable and
ecologically sustainable development of major sending and receiving
areas, with particular emphasis on the promotion of economic,
social and gender equity based on respect for human rights,
especially the right to development;
(b) To reduce the role of the various push factors as they
relate to migration flows.
Actions
9.3. Governments formulating population distribution policies
should ensure that the objectives and goals of those policies are
consistent with other development goals, policies and basic human
rights. Governments, assisted by interested local, regional and
intergovernmental agencies, should assess on a regular basis how
the consequences of their economic and environmental policies,
sectoral priorities, infrastructure investment and balance of
resources among regional, central, provincial and local authorities
influence population distribution and internal migration, both
permanent and temporary.
9.4. In order to achieve a balanced spatial distribution of
production employment and population, countries should adopt
sustainable regional development strategies and strategies for the
encouragement of urban consolidation, the growth of small or
medium-sized urban centres and the sustainable development of rural
areas, including the adoption of labour-intensive projects,
training for non-farming jobs for youth and effective transport and
communication systems. To create an enabling context for local
development, including the provision of services, Governments
should consider decentralizing their administrative systems. This
also involves giving expenditure responsibility and the right to
raise revenue to regional, district and local authorities. While
vast improvements to the urban infrastructure and environmental
strategies are essential in many developing countries to provide a
healthy environment for urban residents, similar activities should
also be pursued in rural areas.
9.5. To reduce urban bias and isolated rural development,
Governments should examine the feasibility of providing incentives
to encourage the redistribution and relocation of industries and
businesses from urban to rural areas and to encourage the
establishment of new businesses, industrial units and income-
generating projects in the rural areas.
9.6. Governments wishing to create alternatives to out-migration
from rural areas should establish the preconditions for development
in rural areas, actively support access to landownership or use and
access to water resources, especially for family units, make and
encourage investments to enhance rural productivity, improve rural
infrastructure and social services and facilitate the establishment
of credit, production and marketing cooperatives and other
grass-roots organizations that give people greater control over
resources and improve their livelihoods. Particular attention is
needed to ensure that these opportunities are also made available
to migrants' families remaining in the areas of origin.
9.7. Governments should pursue development strategies offering
tangible benefits to investors in rural areas and to rural
producers. Governments should also seek to reduce restrictions on
international trade in agricultural products.
9.8. Governments should strengthen their capacities to respond to
the pressures caused by rapid urbanization by revising and
reorienting the agencies and mechanisms for urban management as
necessary and ensuring the wide participation of all population
groups in planning and decision-making on local development.
Particular attention should be paid to land management in order to
ensure economical land use, protect fragile ecosystems and
facilitate the access of the poor to land in both urban and rural
areas.
9.9. Countries are urged to recognize that the lands of indigenous
people[s] and their communities should be protected from activities
that are environmentally unsound or that the indigenous people[s]
concerned consider to be socially and culturally inappropriate.
The term "lands" is understood to include the environment of the
areas which the people concerned traditionally occupy.
9.10. Countries should increase information and training on
conservation practices and foster the creation of sustainable
off-farm rural employment opportunities in order to limit the
further expansion of human settlements to areas with fragile
ecosystems.
9.11. Population distribution policies should be consistent with
such international instruments, when applicable, as the Fourth
Geneva Convention Relative to the Protection of Civilian Persons in
Time of War (1949), including article 49.
B. Population growth in large urban agglomerations
Basis for action
9.12. In many countries, the urban system is characterized by the
overwhelming preponderance of a single major city or agglomeration.
The tendency towards population concentration, fostered by the
concentration of public and private resources in some cities, has
also contributed to the rising number and size of mega-cities. In
1992, there were 13 cities with at least 10 million inhabitants and
their number is expected to double by 2010, when most mega-cities
will be located in the developing countries. The continued
concentration of population in primate cities and in mega-cities in
particular poses specific economic, social and environmental
challenges for Governments. Yet, large agglomerations also
represent the most dynamic centres of economic and cultural
activity in many countries. It is therefore essential that the
specific problems of large cities be analysed and addressed, in
full awareness of the positive contribution that large cities make
to national economic and social development. The challenges faced
by cities are often exacerbated by weak management capacities at
the local level to address the consequences of population
concentration, socio-economic development, environmental impacts
and their interrelations.
Objective
9.13. The objective is to enhance the management of urban
agglomerations through more participatory and resource-conscious
planning and management, review and revise the policies and
mechanisms that contribute to the excessive concentration of
population in large cities, and improve the security and quality of
life of both rural and urban low-income residents.
Actions
9.14. Governments should increase the capacity and competence of
city and municipal authorities to manage urban development, to
safeguard the environment, to respond to the needs of all citizens,
including urban squatters, for personal safety, basic
infrastructure and services, to eliminate health and social
problems, including problems of drugs and criminality, and problems
resulting from overcrowding and disasters, and to provide people
with alternatives to living in areas prone to natural and man-made
disasters.
9.15. In order to improve the plight of the urban poor, many of
whom work in the informal sector of the economy, Governments are
urged to promote the integration of migrants from rural areas into
urban areas and to develop and improve their income-earning
capability by facilitating their access to employment, credit,
production, marketing opportunities, basic education, health
services, vocational training and transportation, with special
attention to the situation of women workers and women heads of
households. Child-care centres should be established, and special
protection and rehabilitation programmes should be established for
street children.
9.16. To finance the needed infrastructure and services in a
balanced manner, taking into account the interests of the poor
segments of society, local and national government agencies should
consider introducing equitable cost-recovery schemes and increasing
revenues by appropriate measures.
9.17. Governments should strengthen the capacity for land
management, including urban planning at all levels, in order to
take into account demographic trends and encourage the search for
innovative approaches to address the challenges facing cities, with
special attention to the pressures and needs resulting from the
growth of their populations.
9.18. Governments should promote the development and
implementation of effective environmental management strategies for
urban agglomerations, giving special attention to water, waste and
air management, as well as to environmentally sound energy and
transport systems.
C. Internally displaced persons
Basis for action
9.19. During the past decade, awareness about the situation of
persons who are forced to leave their places of usual residence for
a variety of reasons has been rising. Because there is no single
definition of internally displaced persons, estimates of their
number vary, as do the causes for their migration. However, it is
generally accepted that those causes range from environmental
degradation to natural disasters and internal conflicts that
destroy human settlements and force people to flee from one area of
the country to another. Indigenous people[s] in particular are in
many cases subject to displacement. Given the forced nature of
their movement, internally displaced persons often find themselves
in particularly vulnerable situations, especially women who may be
subjected to rape and sexual assault in situations of armed
conflict. Internal displacement is often a precursor to outflows
of refugees and externally displaced persons. Returning refugees
may also be internally displaced.
Objectives
9.20. The objectives are:
(a) To offer adequate protection and assistance to persons
displaced within their country, particularly women, children and
the elderly, who are the most vulnerable, and to find solutions to
the root causes of their displacement in view of preventing it and,
when appropriate, to facilitate return or resettlement;
(b) To put an end to all forms of forced migration, including
"ethnic cleansing".
Actions
9.21. Countries should address the causes of internal
displacement, including environmental degradation, natural
disasters, armed conflict and forced resettlement, and establish
the necessary mechanisms to protect and assist displaced persons,
including, where possible, compensation for damages, especially
those who are not able to return to their normal place of residence
in the short term. Adequate capacities for disaster preparedness
should be developed. The United Nations, through dialogue with
Governments and all intergovernmental and non-governmental
organizations, is encouraged to continue to review the need for
protection and assistance to internally displaced persons, the root
causes of internal displacement, prevention and long-term
solutions, taking into account specific situations.
9.22. Measures should be taken to ensure that internally displaced
persons receive basic education, employment opportunities,
vocational training and basic health-care services, including
[reproductive health services and family planning].
9.23. In order to reverse declining environmental quality and
minimize conflict over access to grazing land, the modernization of
the pastoralist economic system should be pursued, with assistance
provided as necessary through bilateral and multilateral
arrangements.
9.24. Governments, international organizations and
non-governmental organizations are encouraged to strengthen
development assistance for internally displaced persons so that
they can return to their places of origin.
9.25. Measures should be taken, [nationally and internationally,]
to find lasting solutions to questions related to internally
displaced persons, including their right to voluntary and safe
return to their home of origin.
Chapter X
INTERNATIONAL MIGRATION
A. International migration and development
Basis for action
10.1. International economic, political and cultural
interrelations play an important role in the flow of people between
countries, whether they are developing, developed or with economies
in transition. In its diverse types, international migration is
linked to such interrelations and both affects and is affected by
the development process. International economic imbalances,
poverty and environmental degradation, combined with the absence of
peace and security, human rights violations and the varying degrees
of development of judicial and democratic institutions are all
factors affecting international migration. Although most
international migration flows occur between neighbouring countries,
interregional migration, particularly that directed to developed
countries, has been growing. It is estimated that the number of
international migrants in the world, including refugees, is in
excess of 125 million, about half of them in the developing
countries. In recent years, the main receiving countries in the
developed world registered a net migration intake of approximately
1.4 million persons annually, about two thirds of whom originated
in developing countries. Orderly international migration can have
positive impacts on both the communities of origin and the
communities of destination, providing the former with remittances
and the latter with needed human resources. International
migration also has the potential of facilitating the transfer of
skills and contributing to cultural enrichment. However,
international migration entails the loss of human resources for
many countries of origin and may give rise to political, economic
or social tensions in countries of destination. To be effective,
international migration policies need to take into account the
economic constraints of the receiving country, the impact of
migration on the host society and its effects on countries of
origin. The long-term manageability of international migration
hinges on making the option to remain in one's country a viable one
for all people. Sustainable economic growth with equity and
development strategies consistent with this aim are a necessary
means to that end. In addition, more effective use can be made of
the potential contribution that expatriate nationals can make to
the economic development of their countries of origin.
Objectives
10.2. The objectives are:
(a) To address the root causes of migration, especially those
related to poverty;
(b) To encourage more cooperation and dialogue between
countries of origin and countries of destination in order to
maximize the benefits of migration to those concerned and increase
the likelihood that migration has positive consequences for the
development of both sending and receiving countries;
(c) To facilitate the reintegration process of returning
migrants.
Actions
10.3. Governments of countries of origin and of countries of
destination should seek to make the option of remaining in one's
country viable for all people. To that end, efforts to achieve
sustainable economic and social development, ensuring a better
economic balance between developed and developing countries and
countries with economies in transition, should be strengthened. It
is also necessary to increase efforts to defuse international and
internal conflicts before they escalate; to ensure that the [human]
rights of [individuals belonging to] minorities, and indigenous
people are respected; to respect the rule of law, promote good
governance, strengthen democracy and promote human rights.
Furthermore, greater support should be provided for the attainment
of national and household food security, for education, nutrition,
health and population-relevant programmes, and to ensure effective
environmental protection. Such efforts may require national and
international financial assistance, reassessment of commercial and
tariff relations, increased access to world markets and stepped-up
efforts on the part of developing countries and countries with
economies in transition to create a domestic framework for
sustainable economic growth with an emphasis on job creation. The
economic situation in those countries is likely to improve only
gradually and, therefore, migration flows from those countries are
likely to decline only in the long term; in the interim, the acute
problems currently observed will cause migration flows to continue
for the short-to-medium term, and Governments are accordingly urged
to adopt transparent international migration policies and
programmes to manage those flows.
10.4. Governments of countries of origin wishing to foster the
inflow of remittances and their productive use for development
should adopt sound exchange rate, monetary and economic policies,
facilitate the provision of banking facilities that enable the safe
and timely transfer of migrants' funds, and promote the conditions
necessary to increase domestic savings and channel them into
productive investment.
10.5. Governments of countries of destination are invited to
consider the use of certain forms of temporary migration, such as
short-term and project-related migration, as a means of improving
the skills of nationals of countries of origin, especially
developing countries and countries with economies in transition.
To that end, they should consider, as appropriate, entering into
bilateral or multilateral agreements. Appropriate steps should be
taken to safeguard the wages and working conditions of both migrant
and native workers in the affected sectors. Governments of
countries of origin are urged to facilitate the return of migrants
and their reintegration into their home communities, and to devise
ways of using their skills. Governments of countries of origin
should consider collaborating with countries of destination and
engaging the support of appropriate international organizations in
promoting the return on a voluntary basis of qualified migrants who
can play a crucial role in the transfer of knowledge, skills and
technology. Countries of destination are encouraged to facilitate
return migration by adopting flexible policies, such as the
transferability of pensions and other work benefits.
10.6. Governments of countries affected by international migration
are invited to cooperate, with a view to integrating the issue into
their political and economic agendas and engaging in technical
cooperation to aid developing countries and countries with
economies in transition in addressing the impact of international
migration. Governments are urged to exchange information regarding
their international migration policies and the regulations
governing the admission and stay of migrants in their territories.
States that have not already done so are invited to consider
ratifying the Convention on the Rights of All Migrant Workers and
Members of Their Families.
10.7. Governments are encouraged to consider requests for
migration from countries whose existence, according to available
scientific evidence, is threatened by global warming and climate
change.
10.8. In cooperation with international and non-governmental
organizations and research institutions, Governments should support
the gathering of data on flows and stocks of international
migrants, factors causing migration, and the monitoring of
international migration. The identification of strategies to
ensure that migration contributes to development and international
relations should also be supported. The role of international
organizations with mandates in the area of migration should be
strengthened so that they can deliver adequate technical support to
developing countries, advise in the management of international
migration flows and promote intergovernmental cooperation through,
inter alia, bilateral and multilateral negotiations, as
appropriate.
B. Documented migrants
Basis for action
10.9. Documented migrants are those who satisfy all the legal
requirements to enter, stay and, if applicable, hold employment in
the country of destination. In some countries, many documented
migrants have, over time, acquired the right to long-term
residence. In such cases, the integration of documented migrants
into the host society is generally desirable, and for that purpose
it is important to extend to them the same social, economic and
legal rights as those enjoyed by citizens, in accordance with
national legislation. The family reunification of documented
migrants is an important factor in international migration. It is
also important to protect documented migrants and their families
from racism, ethnocentrism and xenophobia, and to respect their
physical integrity, dignity, religious beliefs and cultural values.
Documented migration is generally beneficial to the host country,
since migrants are in general concentrated in the most productive
ages and have skills needed by the receiving country, and their
admission is congruent with the policies of the Government. The
remittances of documented migrants to their countries of origin
often constitute a very important source of foreign exchange and
are instrumental in improving the well-being of relatives left
behind.
Objectives
10.10. The objectives are:
(a) To ensure the social and economic integration of
documented migrants, especially of those who have acquired the
right to long-term residence in the country of destination, and
their equal treatment before the law;
(b) To eliminate discriminatory practices against documented
migrants, especially women, children and the elderly;
(c) To ensure protection against racism, ethnocentrism and
xenophobia;
(d) To promote the welfare of documented migrants and members
of their families;
(e) To ensure the respect of the cultural and religious
values, beliefs and practices of documented migrants, in so far as
they accord with national legislation and universally recognized
human rights;
(f) To take into account the special needs and circumstances
of temporary migrants.
Actions
10.11. Governments of receiving countries are urged to consider
extending to documented migrants who meet appropriate
length-of-stay requirements and to members of their families whose
stay in the receiving country is regular treatment equal to that
accorded their own nationals with regard to the enjoyment of basic
human rights, including the equality of opportunity and treatment
in respect of religious practice, working conditions, social
security, participation in trade unions, access to health,
education, cultural and other social services and to the judicial
system and equal treatment before the law. Governments of
receiving countries are further urged to take appropriate steps to
avoid all forms of discrimination against migrants, including
eliminating discriminatory practices concerning their nationality
and the nationality of their children, and to protect their rights
and safety. Women and children who migrate as family members
should be protected from abuse or denial of their human rights by
their sponsors, and Governments are asked to consider extending
their stay should the family relationship dissolve, within the
limits of national legislation.
10.12. In order to promote the integration of documented migrants
having the right to long-term residence, Governments of receiving
countries are urged to consider giving them civil and political
rights and responsibilities, as appropriate, and facilitating their
naturalization. Special efforts should be made to enhance the
integration of the children of long-term migrants by providing them
with educational and training opportunities equal to those of
nationals, allowing them to exercise an economic activity, and
facilitating the naturalization of those who have been raised in
the receiving country. Governments of receiving countries must
ensure the protection of migrants and their families, [and
recognize the right to family reunification], giving priority to
programmes and strategies that combat religious intolerance,
racism, ethnocentrism, xenophobia and gender discrimination and
that generate the necessary public sensitivity in that regard.
10.13. Governments of countries of destination should respect the
basic human rights of documented migrants as those Governments
assert their right to regulate access to their territory and adopt
policies that respond to and shape immigration flows. With regard
to the admission of migrants, Governments should avoid
discriminating on the basis of race, religion, sex, [age] and
disability, while taking into account health and other
considerations relevant under national immigration regulations.
Governments are urged to promote, through family reunion, the
normalization of the family life of legal migrants who have the
right to long-term residence.
10.14. Governments should consider providing assistance and
cooperation for programmes that would address the adverse social
and economic consequences of forced migration.
C. Undocumented migrants
Basis for action
10.15. It is the right of every nation State to decide who can
enter and stay in its territory and under what conditions. Such
right, however, should be exercised taking care to avoid racist or
xenophobic actions and policies. Undocumented or irregular
migrants are persons who do not fulfil the requirements established
by the country of destination to enter, stay or exercise an
economic activity. Given that the pressures for migration are
growing in a number of developing countries, especially since their
labour force continues to increase, undocumented or irregular
migration is expected to rise.
Objectives
10.16. The objectives are:
(a) To address the root causes of undocumented migration;
(b) To reduce substantially the number of undocumented
migrants, while ensuring that those in need of international
protection receive it; to prevent the exploitation of undocumented
migrants and to ensure that their basic human rights are protected;
(c) To prevent all international trafficking in migrants,
especially for the purposes of prostitution;
(d) To ensure protection against racism, ethnocentrism and
xenophobia.
Actions
10.17. Governments of countries of origin and countries of
destination are urged to cooperate in reducing the causes of
undocumented migration, safeguarding the basic human rights of
undocumented migrants including the right to seek and to enjoy in
other countries asylum from persecution, and preventing their
exploitation. Governments should identify the causes of
undocumented migration and its economic, social and demographic
impact as well as its implications for the formulation of social,
economic and international migration policies.
10.18. Governments of both receiving countries and countries of
origin should adopt effective sanctions against those who organize
undocumented migration, exploit undocumented migrants or engage in
trafficking in undocumented migrants, especially those who engage
in any form of international traffic in women, youth and children.
Governments of countries of origin, where the activities of agents
or other intermediaries in the migration process are legal, should
regulate such activities in order to prevent abuses, especially
exploitation, prostitution and coercive adoption.
10.19. Governments, with the assistance of appropriate
international organizations, should deter undocumented migration by
making potential migrants aware of the legal conditions for entry,
stay and employment in host countries through information
activities in the countries of origin.
10.20. Governments of countries of origin of undocumented migrants
and persons whose asylum claims have been rejected have the
responsibility to accept the return and reintegration of those
persons, and should not penalize such persons on their return. In
addition, Governments of countries of origin and countries of
destination should try to find satisfactory solutions to the
problems caused by undocumented migration through bilateral or
multilateral negotiations on, inter alia, readmission agreements
that protect the basic human rights of the persons involved [in
accordance with international law].
D. Refugees, asylum-seekers and displaced persons
Basis for action
10.21. In less than 10 years, from 1985 to 1993, the number of
refugees has more than doubled, from 8.5 million to 19 million.
This has been caused by multiple and complex factors, including
massive violations of human rights. Most of those refugees find
asylum in developing countries, often imposing great burdens on
those States. The institution of asylum is under severe strain in
industrialized countries for a variety of reasons, including the
growing numbers of refugees and asylum-seekers and the misuse of
asylum procedures by migrants attempting to circumvent immigration
restrictions. While two thirds of all countries in the world have
ratified the 1951 Convention relating to the Status of Refugees or
the 1967 Protocol, which establish standards for the protection of
refugees, there is a need to strengthen the support for
international protection of and assistance to refugees, especially
refugee women and refugee children who are particularly vulnerable.
Displaced persons, who do not qualify for refugee status and are in
some cases outside their country, are also vulnerable and need
international assistance. Regional agreements to provide
protection to persons fleeing war should be considered.
Objectives
10.22. The objectives are:
(a) To reduce pressures leading to refugee movements and
displacement by combating their root causes at all levels and
undertaking related preventive action;
(b) To find and implement durable solutions to the plight of
refugees and displaced persons;
(c) To ensure effective protection of and assistance to
refugee populations, with particular attention to the needs and
physical security of refugee women and refugee children;
(d) To prevent the erosion of the institution of asylum;
(e) To provide adequate health, education and social services
for refugees and displaced persons;
(f) To integrate refugee and returnee assistance and
rehabilitation programmes into development planning, with due
attention to gender equity.
Actions
10.23. Governments are urged to address the root causes of
movements of refugees and displaced persons by taking appropriate
measures, particularly with respect to conflict resolution; the
promotion of peace and reconciliation; respect for human rights,
including those of persons belonging to minorities; respect for
independence, territorial integrity and sovereignty of States.
Moreover, factors that contribute to forced displacements need to
be addressed through initiatives related to the alleviation of
poverty, democratization, good governance and the prevention of
environmental degradation. Governments and all other entities
should respect and safeguard the right of people to remain in
safety in their homes and should refrain from policies or practices
that force people to flee.
10.24. Governments are urged to strengthen their support for
international protection and assistance activities on behalf of
refugees and, as appropriate, displaced persons and to promote the
search for durable solutions to their plight. In doing so,
Governments are encouraged to enhance regional and international
mechanisms that promote appropriate shared responsibility for the
protection and assistance needs of refugees. All necessary
measures should be taken to ensure the physical protection of
refugees - in particular, that of refugee women and refugee
children - especially against exploitation, abuse and all forms of
violence.
10.25. Adequate international support should be extended to
countries of asylum to meet the basic needs of refugees and to
assist in the search for durable solutions. Refugee populations
should be assisted in achieving self-sufficiency. Refugees,
particularly refugee women, should be involved in the planning of
refugee assistance activities and in their implementation. In
planning and implementing refugee assistance activities, special
attention should be given to the specific needs of refugee women
and refugee children. Refugees should be provided with access to
adequate accommodation, education, health services, [including
family planning,] and other necessary social services. Refugees
are invited to respect the laws and regulations of their countries
of asylum.
10.26. Governments should create conditions that would allow for
the voluntary repatriation of refugees in safety and dignity.
Rehabilitation assistance to repatriating refugees should, where
possible, be linked to long-term reconstruction and development
plans. The international community should provide assistance for
refugee repatriation and rehabilitation programmes and for the
removal of land mines and other unexploded devices that constitute
a serious threat to the safety of returnees and the local
population.
10.27. Governments are urged to abide by international law
concerning refugees. States that have not already done so are
invited to consider acceding to the international instruments
concerning refugees - in particular, the 1951 Convention and the
1967 Protocol relating to the Status of Refugees. Governments are
furthermore urged to respect the principle of non-refoulement
(i.e., the principle of no forcible return of persons to places
where their lives or freedom would be threatened because of race,
religion, nationality, membership in a particular social group, or
political opinion). Governments should ensure that asylum-seekers
in the Government's territory have access to a fair hearing and
should facilitate the expeditious processing of asylum requests,
ensuring that guidelines and procedures for the determination of
refugee status are sensitive to the particular situation of women.
10.28. In cases of sudden and massive arrivals of refugees and
displaced persons in need of international protection, Governments
of receiving countries should consider according to them at least
temporary protection and treatment in accordance with
internationally recognized standards and with national law,
practices and regulations, until a solution to their plight can be
found. Persons in need of protection should be encouraged to stay
in safe areas and, to the extent possible and as appropriate, near
their countries of origin. Governments should strengthen
protection mechanisms and provide aid to assist the population in
such areas. The principles of collective cooperation and
international solidarity should be followed in assisting host
countries, upon their request.
10.29. The problems of refugees and displaced persons arising from
forced migration, including their right to repatriation, should be
settled in accordance with the relevant principles of the Charter
of the United Nations, the Universal Declaration of Human Rights,
other international instruments and relevant United Nations
resolutions.
Chapter XI
POPULATION, DEVELOPMENT AND EDUCATION
A. Education, population and sustainable development
Basis for action
11.1. In the past 20 years, the world has experienced a rise in
educational levels. Although the differences in educational
attainment between males and females have shrunk, 75 per cent of
illiterate persons in the world are women. Lack of basic education
and low levels of literacy of adults continue to inhibit the
development process in every area. The world community has a
special responsibility to ensure that all children receive an
education of improved quality and that they complete primary
school. Education is an indispensable tool for the improvement of
the quality of life. However, it is more difficult to meet
educational needs when there is rapid population growth.
11.2. Education is a key factor in sustainable development: it is
at the same time a component of well-being and a factor in the
development of well-being through its links with demographic as
well as economic and social factors. Education is also a means to
enable the individual to gain access to knowledge, which is a
precondition for coping, by anyone wishing to do so, with today's
complex world. The reduction of fertility, morbidity and mortality
rates, the empowerment of women, the improvement in the quality of
the working population and the promotion of genuine democracy are
largely assisted by progress in education. The integration of
migrants is also facilitated by universal access to education,
[taking into account religious and cultural values of migrants.]
11.3. The relationship between education and demographic and
social changes is one of interdependence. There is a close and
complex relationship among education, marriage age, fertility,
mortality, mobility and activity. The increase in the education of
women and girls contributes to greater empowerment of women, to a
postponement of the age of marriage and to a reduction in the size
of families. When mothers are better educated, their children's
survival rate tends to increase. Broader access to education is
also a factor in internal migration and the make-up of the working
population.
11.4. The education and training of young people prepare them to
cope with their world and their future, including for professional
life. It is on the content and educational curricula and nature of
the training received that the prospects of first-time job-seekers
and their mid-career retraining possibilities depend.
Discrepancies between the educational system and the production
system lead to graduate unemployment, a devaluing of qualifications
and, in some cases, an exodus of qualified people. It is therefore
essential to work to adapt the educational and training systems to
the economic and social systems, in particular employment or vice
versa, where appropriate.
[ALTERNATIVE 11.4. The education and training of young people
should prepare them (to cope with today's complex world), for their
career development and professional life. It is on the content of
the educational curricula and the nature of the training received
that the prospects of gainful employment opportunities depend.
Inadequacies in and discrepancies between the educational system
and the production system can lead to unemployment and
underemployment, a devaluing of qualifications and, in some cases,
an exodus of qualified people from rural to urban areas and to
"brain drain". It is therefore essential to promote a good
adaptation of educational systems to economic and social systems
conducive to sustainable development.]
Objectives
11.5. The objectives are:
(a) To achieve universal access to quality education, with
particular priority being given to primary and technical education
and job training, to combat illiteracy and to eliminate gender
disparities in access to retention in, and support for, education;
(b) To promote non-formal education for young people,
guaranteeing equal access for women and men to literacy centres;
(c) To introduce and improve the content of the curriculum so
as to promote greater responsibility and awareness on the
interrelationships between population and sustainable development;
health issues, including reproductive and sexual health, and gender
equity.
Actions
11.6. The eradication of illiteracy is one of the prerequisites of
human development. All countries should consolidate the progress
made in the 1990s towards providing universal access to primary
education, as agreed upon at the World Conference on Education for
All, held at Jomtien, Thailand, in 1990, notably in ensuring
universal access to primary education. All countries should
further strive to ensure the complete access to primary school or
an equivalent level of education by both girls and boys as quickly
as possible, and in any case before the year 2015. Attention
should also be given to the quality and type of education,
including recognition of traditional values. Countries that will
have achieved the goal of universal primary education are urged to
extend education and training to, and facilitate access to and
completion of education at, secondary and higher school levels.
11.7. Investments in education and job training should be given
high priority in development budgets at all levels, and should take
into account the range and level of future workforce skill
requirements.
11.8. Countries should take affirmative steps to keep girls and
adolescents in school by building more community schools, training
teachers to be more gender sensitive, providing scholarships and
other appropriate incentives and by sensitizing parents to the
value of educating girls, with a view to closing the gender gap in
primary and secondary school education by the year 2005. Countries
should also supplement those efforts by making full use of
non-formal education opportunities. Pregnant adolescents should be
enabled to continue their schooling.
11.9. To be most effective, education about population issues must
begin in primary school and continue through all levels of formal
and non-formal education, taking into account the rights and
responsibilities of parents and the needs of children and
adolescents. Where such programmes already exist, curricula should
be reviewed, updated and broadened with a view to ensuring adequate
coverage of important concerns such as gender sensitivity,
reproductive choices and responsibilities, and sexually transmitted
diseases, including HIV/AIDS. To ensure acceptance of population
education programmes by the community, population education
projects should emphasize consultation with parents and community
leaders.
11.10. Efforts in the training of population specialists at the
university level should be strengthened and the incorporation of
contents relating to demographic variables and their
interrelationships with development planning in the social and
economic disciplines, as well as those relating to health and the
environment, should be encouraged.
B. Population information, education and communication
Basis for action
11.11. Greater public knowledge, understanding and commitment at
all levels, from the individual to the international, are vital to
the achievement of the goals and objectives of the present
Programme of Action. In all countries and among all groups,
therefore, information, education and communication activities
concerning population and sustainable development issues must be
strengthened. This includes the establishment of gender- and
culturally sensitive information, education and communication plans
and strategies related to population and development. At the
national level, more adequate and appropriate information enables
planners and policy makers to make more appropriate plans and
decisions in relation to population and sustainable development.
At the most basic level, more adequate and appropriate information
is conducive to informed, responsible decision-making concerning
health, sexual and reproductive behaviour, family life, and
patterns of production and consumption. In addition, more and
better information about the causes and benefits of migration can
create a more positive environment for societies to address and
respond to migration challenges.
11.12. Effective information, education and communication are
prerequisites for sustainable human development and pave the way
for attitudinal and behavioural change. Indeed, this begins with
the recognition that decisions must be made freely, responsibly and
in an informed manner, on the number and spacing of children and in
all other aspects of daily life, including sexual and reproductive
behaviour. Greater public knowledge and commitment in a democratic
setting create a climate conducive to responsible and informed
decisions and behaviour. Most importantly, they also pave the way
for democratic public discussion and thereby make possible strong
political commitment and popular support for needed action at the
local, national and international levels.
11.13. Effective information, education and communication
activities include a range of communication channels, from the most
intimate levels of interpersonal communication to formal school
curricula, from traditional folk arts to modern mass entertainment,
and from seminars for local community leaders to coverage of global
issues by the national and international news media. Multichannel
approaches are usually more effective than any single communication
channel. All these channels of communication have an important
role to play in promoting an understanding of the
interrelationships between population and sustainable development.
Schools and religious institutions, taking into account their
values and teachings, may be important vehicles in all countries
for instilling gender and racial sensitivity, respect, tolerance
and equity, family responsibility and other important attitudes at
all ages. Effective networks also exist in many countries for
non-formal education on population and sustainable development
issues through the workplace, health facilities, trade unions,
community centres, youth groups, religious institutions, women's
organizations and other non-governmental organizations. Such
issues may also be included in more structured adult education,
vocational training and literacy programmes, particularly for
women. These networks are critical to reaching the entire
population, especially men, adolescents and young couples.
Parliamentarians, teachers, religious and other community leaders,
traditional healers, health professionals, parents and older
relatives are influential in forming public opinion and should be
consulted during the preparation of information, education and
communication activities. The media also offer many potentially
powerful role models.
11.14. Current information, education and communication
technologies such as global interlinked telephone, television and
data transmission networks, compact discs and new multimedia
technologies can help bridge the geographical, social and economic
gaps that currently exist in access to information around the
world. They can help ensure that the vast majority of the world's
people are involved in debates at the local, national and global
levels about demographic changes and sustainable human development,
economic and social inequities, the importance of empowering women
[sexual and reproductive health and family planning], health
promotion, ageing populations, rapid urbanization and migration.
Greater public involvement of national authorities and the
community ensure the widespread diffusion of such technologies and
the freer flow of information within and between countries. It is
essential that parliaments have full access to the information
necessary for decision-making.
Objectives
11.15. The objectives are:
(a) To increase awareness, knowledge, understanding and
commitment at all levels of society so that families, couples,
individuals, opinion and community leaders, non-governmental
organizations, policy makers, Governments and the international
community appreciate the significance and relevance of
population-related issues and will take the responsible actions
necessary to address such issues within sustained economic growth
in the context of sustainable development;
(b) To encourage attitudes in favour of responsible behaviour
in population and development, especially in areas such as
environment, family, sexuality, reproduction, gender and racial
sensitivity;
(c) To ensure political commitment to population and
development issues by national Governments in order to promote
participation at all levels from both public and private sectors in
the design, implementation and monitoring of population and
development policies and programmes;
(d) To enhance the ability of couples and individuals to
exercise their basic right to decide freely and responsibly on the
number and spacing of their children, and to have the information,
education and means to do so.
Actions
11.16. Information, education and communication efforts should
raise awareness through public education campaigns on priority
issues such as: [safe motherhood], [sexual and reproductive health
and rights], maternal and child health [and family planning],
discrimination against and valorization of the girl child and
persons with disabilities; child abuse; violence against women;
male responsibility; gender equality; sexually transmitted diseases
and HIV/AIDS; responsible sexual behaviour; teenage pregnancy;
racism and xenophobia; ageing populations; and unsustainable
consumption and production patterns.
11.17. Elected representatives at all levels, the scientific
community, religious, political, traditional and community leaders,
non-governmental organizations, parents' associations, social
workers, women's groups, the private sector, qualified
communication specialists and others in influential positions
should have access to information on population and sustainable
development and related issues. They should promote understanding
of the issues addressed in this programme of action and mobilize
public opinion in support of the actions proposed.
11.18. Members of Parliament are invited to continue to promote
wide awareness on issues related to population and sustainable
development and to ensure the enactment of legislation necessary
for effective implementation of the programme of action.
11.19. A coordinated strategic approach to information, education
and communication should be adopted in order to maximize the impact
of various information, education and communication activities,
both modern and traditional, which may be undertaken on several
fronts by various actors, and with diverse audiences. It is
especially important that information, education and communication
strategies be linked to, and complement, national population and
development policies and strategies and a full range of services in
[sexual and reproductive health and family planning] in order to
enhance the use of those services and improve the quality of
counselling and care.
11.20. Information, education and communication activities should
rely on up-to-date research findings to determine information needs
and the most effective culturally acceptable ways of reaching
intended audiences. To that end, professionals experienced in the
traditional and non-traditional media should be enlisted. The
participation of the intended audiences in the design,
implementation and monitoring of information, education and
communication activities should be ensured so as to enhance the
relevance and impact of those activities.
11.21. The interpersonal communication skills - in particular,
motivational and counselling skills - of public, private and
non-governmental organization service providers, community leaders,
teachers, peer groups and others should be strengthened, whenever
possible, to enhance interaction and quality assurance in the
delivery of [family planning and sexual and reproductive health]
services. Such communication should be free from coercion.
11.22. 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 between population,
consumption, production and sustainable development.
11.23. Governments, non-governmental organizations and the private
sector should make [greater] use of the entertainment media,
including radio and television soap operas and drama, folk theatre
and other traditional media to encourage public discussion of
important but sometimes sensitive topics related to the
implementation of this programme of action. When the entertainment
media - especially dramas - are used for advocacy purposes or to
promote particular lifestyles, the public should be so informed,
and in each case the identity of sponsors should be indicated in an
appropriate manner.
11.24. Age-appropriate education, especially for adolescents,
about the issues considered in this Programme of Action should
begin in the home and community and continue through all levels and
channels of formal and non-formal education, taking into account
the rights and responsibilities of parents and the needs of
adolescents. Where such education already exists, curricula and
educational materials should be reviewed, updated and broadened
with a view to ensuring adequate coverage of important
population-related issues and to counteract myths and
misconceptions on them. Where no such education exists,
appropriate curricula and materials should be developed. To ensure
acceptance, effectiveness and usefulness by the community,
education projects should be based on the findings of
socio-cultural studies and should involve the active participation
of parents and families, women, youth, elders and community
leaders.
11.25. Governments should give priority to the training and
retention of information, education and communication specialists,
especially teachers, and of all others involved in the planning,
implementation, monitoring and evaluation of information, education
and communication programmes. It is necessary to train specialists
who can contribute to the important conceptual and methodological
development of education concerning population and related issues.
Therefore, systems for professional training should be created and
strengthened with specializations that prepare them to work
effectively with Governments and with non-governmental
organizations active in this field. In addition, there should be
greater collaboration between the academic community and other
entities in order to strengthen conceptual and methodological work
and research in this field.
11.26. To enhance solidarity and to sustain development
assistance, all countries need to be continuously informed about
population and development issues. Countries should establish
information mechanisms, where appropriate, to facilitate the
systematic collection, analysis and dissemination, and utilization
of population-related information at the national and international
levels, and networks should be established or strengthened at the
national, subregional, regional and global levels to promote
information and experience exchange.
Chapter XII
TECHNOLOGY, RESEARCH AND DEVELOPMENT
A. Basic data collection, analysis and dissemination
Basis for action
12.1. Valid, reliable, timely, culturally relevant and
internationally comparable data form the basis for policy and
programme development, implementation, monitoring and evaluation.
While there have been marked improvements in the availability of
population and related development data following important
advances made during the past two decades in the methodologies and
technology for data collection and analysis, many gaps remain with
regard to the quality and coverage of baseline information,
including vital data on births and deaths, as well as the
continuity of data sets over time. Gender and ethnicity-specific
information, which is needed to enhance and monitor the sensitivity
of development policies and programmes, is still insufficient in
many areas. Measurement of migration, particularly at the regional
and international levels, is also among the areas least valid and
least adequately covered. As a matter of principle, individuals,
organizations and developing countries should have access, on a
no-cost basis, to the data and findings based on research carried
out in their own countries, including those maintained by other
countries and international agencies.
Objectives
12.2. The objectives are:
(a) To establish a factual basis for understanding and
anticipating the interrelationships of population and
socio-economic, including environmental, variables, and for
improving programme development, implementation, monitoring and
evaluation;
(b) To strengthen national capacity to seek new information
and meet the need for basic data collection, analysis and
dissemination, giving particular attention to information
classified by age, sex, ethnicity and different geographical units,
in order to use the findings in the formulation, implementation,
monitoring and evaluation of overall sustainable development
strategies and foster international cooperation, including such
cooperation at the regional and subregional levels;
(c) To ensure political commitment to, and understanding of,
the need for data collection on a regular basis and the analysis,
dissemination and full utilization of data.
Actions
12.3. Governments of all countries, particularly developing
countries, assisted as appropriate through bilateral cooperation
and international organizations and, where necessary, through
interregional, regional and subregional cooperation, should
strengthen their national capacity to carry out sustained and
comprehensive programmes on collection, analysis, dissemination and
utilization of population and development data. Particular
attention should be given to the monitoring of population trends
and the preparation of demographic projections and to the
monitoring of progress towards the attainment of the health,
education, gender, ethnic and social-equity goals, and of service
accessibility and quality of care, as stated in the present
Programme of Action.
12.4. Programmes for the collection, processing, analysis and
timely dissemination and utilization of population and related
development data should include disaggregation, including gender
disaggregation, coverage and presentation compatible with the needs
of effective programme implementation on population and
development. Interaction between the community of data users and
data providers should be promoted in order to enable data providers
to respond better to user needs. Research should be designed,
taking into account legal and ethical standards, and carried out in
consultation and partnership with, and the active participation of,
local communities and institutions, and the findings thereof should
be made accessible and available to policy makers, decision makers,
planners and managers of programmes for their timely use.
Comparability should be ensured in all research and data collection
programmes.
12.5. Comprehensive, reliable, qualitative as well as quantitative
databases, allowing linkages between population, education, health,
poverty, family well-being, environment and development issues and
providing information dissaggregated at appropriate and desired
levels, should be established and maintained by all countries to
meet the needs of research as well as those of policy and programme
development, implementation, monitoring and evaluation. Special
attention should be given to assess and measure the quality and
accessibility of care through the development of suitable
indicators.
12.6. Demographic, socio-economic and other relevant information
networks should be created or strengthened, where appropriate, at
the national, regional and global levels to facilitate monitoring
the implementation of programmes of action and activities on
population, environment and development at the national, regional
and global levels.
12.7. All data collection and analysis activities should give due
consideration to gender-disaggregation, enhancing knowledge on the
position and role of gender in social and demographic processes.
In particular, in order to provide a more accurate picture of
women's current and potential contribution to economic development,
data collection should delineate more precisely the nature of
women's social and labour force status and make that a basis for
policy and programme decisions on improving women's income. Such
data should address, inter alia, women's unpaid economic activities
in the family and in the informal sector.
12.8. Training programmes in statistics, demography and population
and development studies should be designed and implemented at the
national and regional levels, particularly in developing countries,
with enhanced technical and financial support through international
cooperation and greater national resources.
12.9. All countries, with the support of appropriate
organizations, should strengthen the collection and analysis of
demographic data, including international migration data, in order
to achieve a better understanding of that phenomenon and thus
support the formulation of national and international policies on
international migration.
B. [Sexual and reproductive] health research
Basis for action
12.10. Research, in particular biomedical research, has been
instrumental in giving more and more people access to a greater
range of safe and effective modern methods of [fertility
regulation]. However, not all persons can find a family-planning
method that suits them and the range of choices available to men is
more limited than that available to women, and the growing
incidence of sexually transmitted diseases, including HIV/AIDS,
demands substantially higher investments in new methods of
prevention, diagnosis and treatment. In spite of greatly reduced
funding for [sexual and reproductive health] research, prospects
for developing and introducing new contraceptive and [fertility
regulation] methods and products have been promising. Improved
collaboration and coordination of activities internationally will
increase cost-effectiveness, but a significant increase in support
from Governments and industry is needed to bring a number of
potential new, safe and affordable methods to fruition, especially
barrier methods. This research needs to be guided at all stages by
gender perspectives, particularly women's, and the needs of users,
and be carried out in strict conformity with internationally
accepted legal, ethical, medical and scientific standards for
biomedical research.
Objectives
12.11. The objectives are:
(a) To contribute to the understanding of factors affecting
universal [sexual and reproductive health, and to expand
reproductive choice];
(b) To ensure the initial and continued safety, quality and
health aspects of [fertility regulation methods];
(c) To ensure that all people have the opportunity to achieve
and maintain sound [sexual and reproductive health], the
international community should mobilize the full spectrum of basic
biomedical, social and behavioural and programme-related research
on [reproductive health and sexuality].
Actions
12.12. Governments, assisted by the international community and
donor agencies, the private sector, non-governmental organizations
and the academic community, should increase support for basic and
applied biomedical, technological, clinical, epidemiological and
social science research to strengthen reproductive health services,
including the improvement of existing and the development of new
[fertility regulation] methods that meet users' needs and are
acceptable, easy to use, safe, free of long- and short-term side
effects and second generation effects, effective, affordable,
suitable for different age and cultural groups and for different
phases of the reproductive cycle. Testing and introduction of all
new technologies should be continually monitored to avoid potential
abuse. Specifically, areas that need increased attention should
include barrier methods, both male and female, for fertility
control and the prevention of sexually transmitted diseases,
including HIV/AIDS, as well as microbicides and viricides, which
may or may not prevent pregnancy.
12.13. Research on sexuality and gender roles and relationships in
different cultural settings is urgently needed, with emphasis on
such areas as abuse, discrimination and violence against women;
genital mutilation, where practised; sexual behaviour and mores;
male attitudes towards sexuality and procreation, fertility, family
and gender roles; risk-taking behaviour regarding sexually
transmitted diseases and unplanned pregnancies; women's and men's
perceived needs for [fertility regulation methods and sexual health
services]; and reasons for non-use or ineffective use of existing
services and technologies.
12.14. High priority should also be given to the development of
new [fertility regulation methods] for men. Special research
should be undertaken on factors inhibiting male participation in
order to enhance male involvement and responsibility in family
planning. In conducting [sexual and reproductive] health research,
special attention should be given to the needs of adolescents in
order to develop suitable policies and programmes and appropriate
technologies to meet their [sexual and reproductive] health needs.
Special priority should be given to research on sexually
transmitted diseases, including HIV/AIDS, and research on
infertility.
12.15. To expedite the availability of improved and new methods of
[fertility regulation], efforts must be made to increase the
involvement of industry, including industry in developing countries
and countries with economies in transition. A new type of
partnership between the public and private sectors, including women
and consumer groups, is needed that would mobilize the experience
and resources of industry while protecting the public interest.
National drug and device regulatory agencies should be actively
involved in all stages of the development process to ensure that
all legal and ethical standards are met. Developed countries
should assist research programmes in developing countries and
countries with economies in transition with their knowledge,
experience and technical expertise and promote the transfer of
appropriate technologies to them. The international community
should facilitate the establishment of manufacturing capacities for
contraceptive commodities in developing countries, particularly the
least developed among them, and countries with economies in
transition.
12.16. All research on [fertility regulation and sexual and
reproductive health] products must be carried out in adherence to
internationally accepted ethical and technical standards and
cultural conditions for biomedical research. Special attention
needs to be given to the continuous surveillance of contraceptive
safety and side effects. Users', in particular women's,
perspectives and women's organizations should be incorporated into
all stages of the research and development process.
12.17. [Since unsafe abortion is a major threat to the health and
lives of women,] research to understand and better address the
determinants and consequences of induced abortion, including its
effects on subsequent fertility, reproductive and mental health and
contraceptive practice, should be promoted, as well as research on
treatment of complications of abortions and post-abortion care.
12.18. There should be enhanced research on natural [fertility
regulation methods], looking for more effective procedures to
detect the moment of ovulation during the menstrual cycle and after
childbirth.
C. Social and economic research
Basis for action
12.19. During the past several decades, the formulation,
implementation, monitoring and evaluation of population policies,
programmes and activities have benefited from the findings of
social and economic research highlighting how population change
results from and impacts on complex interactions of social,
economic and environmental factors. Nevertheless, some aspects of
these interactions are still poorly understood and knowledge is
lacking, especially with regard to developing countries, in areas
relevant to a range of population and development policies,
particularly concerning indigenous practices. Social and economic
research is clearly needed to enable programmes to take into
account the views of their intended beneficiaries, especially
women, the young and other less empowered groups, and to respond to
the specific needs of those groups and of communities. Research
regarding the interrelations between global or regional economic
factors and national demographic processes is required. Improved
quality of services can be achieved only where quality has been
defined by both users and providers of services and where women are
actively involved in decision-making and service delivery.
Objectives
12.20. The objectives are:
(a) To promote socio-cultural and economic research that
assists in the design of programmes, activities and services to
improve the quality of life and meet the needs of individuals,
families and communities, in particular all underserved groups;*
(b) To promote the use of research findings to improve the
formulation of policies and the implementation, monitoring and
evaluation of programmes and projects that improve the welfare of
families and the needy to enhance their
________________________
* [Children, adolescents, women, the aged, the disabled,
indigenous people[s], rural populations, urban populations,
migrants, refugees, displaced persons and slum-dwellers.] quality, efficiency and client-sensitivity, and to increase the
national and international capacity for such research;
(c) To understand that sexual and reproductive behaviour
occurs in varying socio-cultural contexts, and to understand the
importance of that context for the design and implementation of
service programmes.
Actions
12.21. Governments, funding agencies and research organizations
should encourage and promote socio-cultural and economic research
on relevant population and development policies and programmes,
including indigenous practices, especially with regard to
interlinkages between population, poverty alleviation, environment,
sustained economic growth and sustainable development.
12.22. Socio-cultural and economic research should be built into
population and development programmes and strategies in order to
provide guidance for programme managers on ways and means of
reaching underserved clients and responding to their needs. To
this end, programmes should provide for operations research,
evaluation research and other applied social science research.
This research should be participatory in character. Mechanisms
should be established with a view to ensuring that research
findings are incorporated into the decision- making process.
12.23. Policy-oriented research, at the national and international
levels, should be undertaken on areas beset by population
pressures, poverty, over-consumption patterns, destruction of
ecosystems and degradation of resources, giving particular
attention to the interactions between those factors. Research
should also be done on development and improvement of methods with
regard to sustainable food production and crop and livestock
systems in both developed and developing countries.
12.24. Governments, intergovernmental organizations,
non-governmental organizations concerned, funding agencies and
research organizations are urged to give priority to research on
the linkages between women's roles and status and demographic and
development processes. Among the vital areas for research are
changing family structures; family well-being; the interactions
between women's and men's diverse roles, including their time use,
access to power and decision-making and control over resources;
associated norms, laws, values and beliefs; and the economic and
demographic outcomes of gender inequality. Women should be
involved at all stages of gender research planning, and efforts
should be made to recruit and train more female researchers.
12.25. Given the changing nature and extent of the spatial
mobility of population, research to improve the understanding of
the causes and consequences of migration and mobility, whether
internal or international, is urgently needed. To provide a sound
foundation for such research, special efforts need to be made to
improve the quality, timeliness and accessibility of data on
internal and international migration levels, trends and policies.
12.26. In the light of the persistence of significant mortality
and morbidity differentials between population subgroups within
countries, it is urgent to step up efforts to investigate the
factors underlying such differentials, in order to devise more
effective policies and programmes for their reduction. Of special
importance are the causes of differentials, including gender
differentials, in mortality and morbidity, particularly at younger
and older ages. Increased attention should also be paid to the
relative importance of various socio-economic and environmental
factors in determining mortality differentials by region or
socio-economic and ethnic group. Causes and trends in maternal,
perinatal and infant morbidity and mortality also need further
investigation.
Chapter XIII
NATIONAL ACTION
A. National policies and plans of action
Basis for action
13.1. During the past few decades, considerable experience has
been gained around the world on how government policies and
programmes can be designed and implemented to address population
and development concerns, enhance the choices of people and
contribute to broad social progress. As is the case with other
social development programmes, experience has also shown, in
instances where the leadership is strongly committed to economic
growth, human resource development, gender equality and equity and
meeting the health and [in particular the [sexual and] reproductive
health] needs of the population, [including family planning,]
countries have been able to mobilize sustained commitment at all
levels to make population and development programmes and projects
successful.
13.2. While such success can be facilitated by developments in the
overall social and economic context, and by success in other
development efforts, population and development are intrinsically
interrelated and progress in any component can catalyse improvement
in others. The many facets of population relate to many facets of
development. There is increased recognition of the need for
countries to consider migration impacts, internal and
international, in developing their relevant policies and
programmes. There is also growing recognition that
population-related policies, plans, programmes and projects, to be
sustainable, need to engage their intended beneficiaries fully in
their design and subsequent implementation.
13.3. The role of non-governmental organizations as partners in
national policies and programmes is increasingly recognized, as is
the important role of the private sector. Members of national
legislatures can have a major role to play, especially in enacting
appropriate domestic legislation for implementing the present
Programme of Action, allocating appropriate financial resources,
ensuring accountability of expenditure and raising public awareness
of population issues.
Objectives
13.4. The objectives are:
(a) To incorporate population concerns in all relevant
national development strategies, plans, policies and programmes;
(b) To foster active involvement of elected representatives
of people, particularly parliamentarians, concerned groups,
especially at the grass-roots level, and individuals, in
formulating, implementing, monitoring and evaluating strategies,
policies, plans and programmes in the field of population and
development.
Actions
13.5. Governments, with the active involvement of
parliamentarians, locally elected bodies, communities, the private
sector, non-governmental organizations and women's groups, should
work to increase awareness of population and development issues and
formulate, implement and evaluate national strategies, policies,
plans, programmes and projects that address population and
development issues, including migration, as integral parts of their
sectoral, intersectoral and overall development planning and
implementation process. They should also promote and work to
ensure adequate human resources and institutions to coordinate and
carry out the planning, implementation, monitoring and evaluation
of population and development activities.
13.6. Governments and parliamentarians, in collaboration with the
international community and non-governmental organizations, should
make the necessary plans in accordance with national concerns and
priorities and take the actions required to measure, assess,
monitor and evaluate progress towards meeting the goals of the
present Programme of Action. In this connection, the active
participation of the private sector and the research community is
to be encouraged.
B. Programme management and human resource development
Basis for action
13.7. Building the capacity and self-reliance of countries to
undertake concerted national action to promote sustained economic
growth, to further sustainable national development and to improve
the quality of life for the people is a fundamental goal. This
requires the retention, motivation and participation of
appropriately trained personnel working within effective
institutional arrangements, as well as relevant involvement by the
private sector and non-governmental organizations. The lack of
adequate management skills, particularly in the least developed
countries, critically reduces the ability for strategic planning,
weakens programme execution, lessens the quality of services and
thus diminishes the usefulness of programmes to their
beneficiaries. The recent trend towards decentralization of
authority in national population and development programmes,
particularly in government programmes, significantly increases the
requirement for trained staff to meet new or expanded
responsibilities at the lower administrative levels. It also
modifies the "skill mix" required in central institutions, with
policy analysis, evaluation and strategic planning having higher
priority than previously.
Objectives
13.8. The objectives are:
(a) To improve national capacities and the
cost-effectiveness, quality and impact of national population and
development strategies, plans, policies and programmes, while
ensuring their accountability to all persons served, in particular
the most vulnerable and disadvantaged groups in society, including
the rural population and adolescents;
(b) To facilitate and accelerate the collection, analysis and
flow of data and information between actors in national population
and development programmes in order to enhance the formulation of
strategies, policies, plans and programmes and monitor and evaluate
their implementation and impact;
(c) To increase the skill level and accountability of
managers and others involved in the implementation, monitoring and
evaluation of national population and development strategies,
policies, plans and programmes;
(d) To incorporate user and gender perspectives in training
programmes and ensure the availability, motivation and retention of
appropriately trained personnel, including women, for the
formulation, implementation, monitoring and evaluation of national
population and development strategies, policies, plans and
programmes.
Actions
13.9. Countries should:
(a) Formulate and implement human resource development
programmes in a manner that explicitly addresses the needs of
population and development strategies, policies, plans and
programmes, giving special consideration to the basic education,
training and employment of women at all levels, especially at
decision-making and managerial levels, and to the incorporation of
user and gender perspectives throughout the training programmes;
(b) Ensure the nationwide and efficient placement of trained
personnel managing population and development strategies, policies,
plans and programmes;
(c) Continuously upgrade the management skills of service
delivery personnel to enhance the cost-effectiveness, efficiency
and impact of the social services sector, including [family
planning and sexual and reproductive health programmes];
(d) Rationalize remuneration and related matters, terms and
conditions of service to ensure equal pay for equal work by women
and men and the retention and advancement of managerial and
technical personnel involved in population and development
programmes, and thereby improve national execution of these
programmes;
(e) Establish innovative mechanisms to promote
experience-sharing in population and development programme
management within and among countries at subregional, regional,
interregional and international levels in order to foster relevant
national expertise;
(f) Develop and maintain databases of national experts and
institutions of excellence in order to foster the use of national
competence, giving special consideration to the inclusion of women
and youth;
(g) Ensure effective communication with, and the involvement
of, programme beneficiaries at all levels, in particular at rural
levels, in order to ensure better overall programme management.
13.10. Governments should give special attention to the
development and implementation of client-centred management
information systems for population and development, [and
particularly for sexual and reproductive health, including
family-planning programmes], covering both governmental and
non-governmental activities and containing regularly updated data
on clientele, expenditures, infrastructure, service accessibility,
output and quality of services.
C. Resource mobilization and allocation
Basis for action
13.11. Allocation of resources for sustained human development at
the national level generally falls into various sectoral
categories. How countries can most beneficially allocate resources
among various sectors depends largely on each country's social,
economic, cultural and political realities as well as its policy
and programme priorities. In general, the quality and success of
programmes benefit from a balanced allocation of resources. In
particular, population-related programmes play an important role in
enabling, facilitating and accelerating progress in sustainable
human development programmes, especially by contributing to the
empowerment of women, improving the health of the people (and
particularly of women and children, and especially in the rural
areas), slowing the growth rate of demand for social services,
mobilizing community action and stressing the long-term importance
of social sector investments.
13.12. Domestic resources provide the largest portion of funds for
attaining development objectives. Domestic resource mobilization
is, thus, one of the highest priority areas for focused attention
to ensure the timely actions required to meet the objectives of
this Programme of Action. Both the public and the private sectors
can potentially contribute to the resources required. Many of the
countries seeking to pursue the additional goals and objectives of
the Programme of Action, and especially the least developed
countries and other poor countries that are undergoing painful
structural adjustments, are continuing to experience recessionary
trends in their economies. Their domestic resource mobilization
efforts to expand and improve their population and development
programmes will need to be complemented by a significantly greater
provision of financial and technical resources by the international
community [, as indicated in chapter XIV]. In the mobilization of
new and additional domestic and donor-source resources, special
attention needs to be given to adequate measures to address the
basic needs of the most vulnerable groups of the population,
particularly in the rural areas, and to ensure their access to
social services.
13.13. Based on the current large unmet demands for [reproductive
health, including family-planning] services and the expected growth
in numbers of women and men of reproductive age, demand for
services will continue to grow very rapidly over the next two
decades. This demand will be accelerated by growing interest in
delayed child-bearing, better spacing of births and earlier
completion of desired family size, and by easier access to
services. Efforts to generate and make available higher levels of
domestic resources, and to ensure their effective utilization, in
support of service-delivery programmes and of associated
information, education and communication activities, thus, need to
be intensified.
13.14. Basic [reproductive health, including family-planning]
services, involving support for necessary training, supplies,
infrastructure and management systems, especially at the primary
health-care level, would include the following major components,
which should be integrated into basic national programmes [for
population and reproductive health]:
(a) In the [family-planning services component -
contraceptive commodities and service delivery;] capacity-building
for information, education and communication regarding [family
planning and] population and development issues; national
capacity-building through support for training; infrastructure
development and upgrading of facilities; policy development and
programme evaluation; management information systems; basic service
statistics; and focused efforts to ensure good quality care;
(b) In the basic [reproductive health services] component -
information and routine services for prenatal, normal and safe
delivery and post-natal care; [safe abortion (as permitted by the
laws of individual countries);] information, education and
communication about [reproductive health], including sexually
transmitted diseases, human sexuality and responsible parenthood,
and against harmful practices; adequate counselling; diagnosis and
treatment for sexually transmitted diseases and other reproductive
tract infections, as feasible; prevention of infertility and
appropriate treatment, where feasible; and referrals, education and
counselling services for sexually transmitted diseases, including
HIV/AIDS, and for pregnancy and delivery complications;
(c) In the sexually transmitted disease/HIV/AIDS prevention
programme component - mass media and in-school education
programmes, promotion of voluntary abstinence and responsible
sexual behaviour and expanded condom distribution;
(d) In the basic research, data and population and
development policy analysis component - national capacity-building
through support for demographic as well as programme-relevant data
collection and analysis, research, policy development and training.
13.15. It has been estimated that, in the developing countries and
countries with economies in transition, the implementation of
programmes in the area of [reproductive health, including those
related to family planning], maternal health and the prevention of
sexually transmitted diseases, as well as other basic actions for
collecting and analysing population data, will cost: [$17.0
billion in 2000, $18.5 billion in 2005, $20.5 billion in 2010 and
$21.7 billion in 2015]. Of this, approximately 65 per cent is for
the delivery system. Programme costs in the closely related
components which should be integrated into basic national
programmes for population and reproductive health are estimated as
follows:
(a) The family-planning component is estimated to cost:
[$10.2 billion in 2000, $11.5 billion in 2005, $12.6 billion in
2010 and $13.8 billion in 2015]. This estimate is based on census
and survey data which help to project the number of couples and
individuals who are likely to be using family-planning information
and services. Projections of future costs allow for improvements
in quality of care. While improved quality of care will increase
costs per user to some degree, these increases are likely to be
offset by declining costs per user as both prevalence and programme
efficiency increase.
(b) The [reproductive health] component [(not including the
delivery- system costs, which are summarized under the
[family-planning] component)] is estimated to [add/cost]: [$5.0
billion in 2000, $5.4 billion in 2005, $5.7 billion in 2010 and
$6.1 billion in 2015]. The estimate for reproductive health is a
global total, based on experience with maternal health programmes
in countries at different levels of development, selectively
including other reproductive health services. The full maternal
and child health impact of these interventions will depend on the
provision of tertiary and emergency care, the costs of which should
be met by overall health sector budgets.
(c) The sexually transmitted disease/HIV/AIDS prevention
programme is estimated by the WHO Global Programme on AIDS to cost:
$1.3 billion in 2000, $1.4 billion in 2005 and approximately $1.5
billion in 2010 and $1.5 billion in 2015.
(d) The basic research, data and population and development
policy analysis programme is estimated to cost: [$500 million in
2000, $200 million in 2005, $700 million in 2010 and $300 million
in 2015].
13.16. It is tentatively estimated that up to two thirds of the
costs will continue to be met by the countries themselves [and up
to one third from external sources]. However, the least developed
countries and other low-income developing countries will require a
greater share of external resources on a concessional and grant
basis. Thus, there will be considerable variation in needs for
external resources for population programmes, between and within
regions. The estimated global requirements for international
assistance are outlined in chapter XIV, paragraph 14.8.
13.17. Additional resources will be needed to support programmes
addressing population and development goals, particularly
programmes seeking to attain the specific social and economic
sector goals contained in this Programme of Action. The health
sector will require additional resources to strengthen the primary
health-care delivery system, child survival programmes, emergency
obstetrical care, and broad-based programmes for sexually
transmitted disease/HIV/AIDS control, as well as the humane
treatment and care of those infected with sexually transmitted
disease/HIV/AIDS, among others. The education sector will also
require substantial and additional investments in order to provide
universal basic education and to eliminate disparities in
educational access owing to gender, geographical location, social
or economic status etc.
13.18. Additional resources will be needed for action programmes
directed to improving the status and empowerment of women and their
full participation in the development process (beyond ensuring
their basic education). The full involvement of women in the
design, implementation, management and monitoring of all
development programmes will be an important component of such
activities.
13.19. Additional resources will be needed for action programmes
to accelerate development programmes; generate employment; address
environmental concerns, including unsustainable patterns of
production and consumption; provide social services; achieve
balanced distributions of population; and address poverty
eradication through sustained economic growth in the context of
sustainable development. Important relevant programmes include
those addressed in Agenda 21.
13.20. The resources needed to implement this Programme of Action
require substantially increased investments in the near term. The
benefits of these investments can be measured in future savings in
sectoral requirements; sustainable patterns of production and
consumption and sustained economic growth in the context of
sustainable development; and overall improvements in the quality of
life.
Objective
13.21. The objective is to achieve an adequate level of resource
mobilization and allocation, at the community, national and
international levels, for population programmes, and for other
related programmes, all of which seek to promote and accelerate
social and economic development, improve the quality of life for
all, foster equity and full respect for individual rights and, by
so doing, contribute to sustainable development.
Actions
13.22. Governments, non-governmental organizations, the private
sector and local communities, assisted upon request by the
international community, should strive to mobilize and effectively
utilize the resources for population and development programmes
that expand and improve the quality of [sexual and reproductive
health care, including [family-planning] and sexually transmitted
disease/HIV/AIDS prevention efforts. In line with the goal of the
present Programme of Action to ensure universal availability of and
access to high- quality [reproductive health and family-planning]
services, particular emphasis must be put on meeting the needs of
underserved population groups, including adolescents [taking into
account the rights and responsibilities of parents and the needs of
adolescents], the rural and the urban poor and on ensuring the
safety of services and their responsiveness to women, men and
adolescents. In mobilizing resources for these purposes, countries
should examine new modalities such as increased involvement of the
private sector, the selective use of user fees, social marketing,
cost-sharing and other forms of cost recovery. However, these
modalities must not impede access to services and should be
accompanied with adequate "safety net" measures.
13.23. Governments, non-governmental organizations, the private
sector and local communities, assisted upon request by the
international community, should strive to mobilize the resources to
meet reinforcing social development goals, and in particular to
satisfy the commitments Governments have undertaken previously with
regard to Education for All (the Jomtien Declaration), the
multisectoral goals of the World Summit for Children, Agenda 21 and
other relevant international agreements, and to further mobilize
the resources to meet the goals in this Programme of Action. In
this regard, Governments are urged to devote [at least 20 per cent]
or [an increased proportion] of public sector expenditures to the
social sectors, as well as [20 per cent] or [an increased
proportion] of official development assistance, stressing, in
particular, poverty eradication within the context of sustainable
development.
13.24. Governments, international organizations and
non-governmental organizations should collaborate on an ongoing
basis in the development of precise and reliable cost estimates,
where appropriate, for each category of investment.
Chapter XIV
INTERNATIONAL COOPERATION
A. Responsibilities of partners in development
Basis for action
14.1. International cooperation has been proved to be essential
for the implementation of population and development programmes
during the past two decades. The number of financial donors has
steadily increased and the profile of the donor community has
increasingly been shaped by the growing presence of
non-governmental and private-sector organizations. Numerous
experiences of successful cooperation between developing countries
have dispelled the stereotyped view of donors being exclusively
developed countries. Donor partnerships have become more prevalent
in a variety of configurations, so that it is no longer unusual to
find Governments and multilateral organizations working closely
together with national and international non-governmental
organizations and segments of the private sector. This evolution
of international cooperation in population and development
activities reflects the considerable changes that have taken place
during the past two decades, particularly with the greater
awareness of the magnitude, diversity and urgency of unmet needs.
Countries that formerly attached minimal importance to population
issues now recognize them at the core of their development
challenge. International migration and AIDS, for instance,
formerly matters of marginal concern to a few countries, are
currently high-priority issues in a large number of countries.
14.2. The maturing process undergone by international cooperation
in the field of population and development has accentuated a number
of difficulties and shortcomings that need to be addressed. For
instance, the expanding number and configuration of development
partners subjects both recipients and donors to increasing
pressures to decide among a multitude of competing development
priorities, a task which recipient Governments in particular may
find exceedingly difficult to carry out. Lack of adequate
financial resources and effective coordination mechanisms have been
found to result in unnecessary duplication of efforts and lack of
programme congruency. Sudden shifts in the development policies of
donors may cause disruptions of programme activities across the
world. Re-establishing and adhering to national priorities
requires a new clarification of, and commitment to, reciprocal
responsibilities among development partners.
Objectives
14.3. The objectives are:
(a) To ensure that international cooperation in the area of
population and development is consistent with national population
and development priorities centred on the well-being of intended
beneficiaries and serves to promote national capacity-building and
self-reliance;
[(b) To ensure that the international community adopt
favourable macroeconomic policies for promoting sustained economic
growth and development in developing countries;]
(c) To clarify the reciprocal responsibilities of development
partners and improve coordination of their efforts;
(d) To develop long-term joint programmes between recipient
countries and between recipient and donor countries;
(e) To improve and strengthen policy dialogue and
coordination of population and development programmes and
activities at the international level, including bilateral and
multilateral agencies;
[(f) To ensure that all population and development programmes
adhere to basic human rights recognized by the international
community and the present Programme of Action and adhere to the
specific conditions of each country.]
Actions
14.4. At the programme level, national capacity-building for
population and development and transfer of appropriate technology
and know-how to developing countries, including countries with
economies in transition, must be core objectives and central
activities for international cooperation. In this respect,
important elements are to find accessible ways to meet the large
commodity needs, of [family-planning] programmes, through the local
production of contraceptives of assured quality and affordability,
for which technology cooperation, joint ventures and other forms of
technical assistance should be encouraged.
14.5. The international community should promote a supportive
economic environment by adopting favourable macroeconomic policies
for promoting sustained economic growth and development.
14.6. Governments should ensure that national development plans
take note of anticipated international funding and cooperation in
their population and development programmes, including loans from
international financial institutions, particularly with respect to
national capacity-building, technology cooperation and transfer of
appropriate technology, which should be provided on favourable
terms, including on concessional and preferential terms, as
mutually agreed, taking into account the need to protect
international property rights, as well as the special needs of
developing countries.
14.7. Recipient Governments should strengthen their national
coordination mechanisms for international cooperation in population
and development and in consultations with donors clarify the
responsibilities assigned to various types of development partners,
including intergovernmental and international non-governmental
organizations, based on careful consideration of their comparative
advantages in the context of national development priorities and of
their ability to interact with national development partners. The
international community should assist recipient Governments to
undertake these coordinating efforts.
B. Towards a new commitment to funding population
and development
Basis for action
14.8. There is a strong consensus on the need to mobilize
significant additional financial resources from both the
international community and within developing countries and
countries with economies in transition for national population
programmes in support of sustainable development. The Amsterdam
Declaration on a Better Life for Future Generations, adopted at the
International Forum on Population in the Twenty-first Century, held
at Amsterdam in 1989, called upon Governments to double the total
global expenditures in population programmes and donors to increase
their contribution from 2 per cent of official development
assistance to 4 per cent, in order to meet the needs of millions of
people in developing countries in the fields of [family planning]
and other population activities by the year 2000. However, since
then, international resources for population activities have come
under severe pressure, owing to the prolonged economic recession in
traditional donor countries. Also, developing countries face
increasing difficulties in allocating sufficient funds for their
population and related programmes. Additional resources are
urgently required to better identify and satisfy unmet needs in
issues related to population and development, including [sexual and
reproductive health care and family-planning information and
services], as well as to respond to future increases in demand, to
keep pace with the growing demands that need to be served, and to
improve the scope and quality of programmes.
14.9. To assist the implementation of population and [sexual and
reproductive health care, including family-planning programmes],
financial and technical assistance from bilateral and multilateral
agencies have been provided to the national and subnational
agencies involved. As some of these began to be successful, it
became desirable for countries to learn from one another's
experiences, through a number of different modalities (e.g., long-
and short- term training programmes, observation study tours,
consultant services).
Objectives
14.10. The objectives are:
(a) To increase substantially the availability of
international financial assistance in the field of population and
development in order to enable developing countries and countries
with economies in transition to achieve the goals of the present
Programme of Action as they pursue their self-reliant and
capacity-building efforts;
(b) To increase the commitment to, and the stability of,
international financial assistance in the field of population and
development by diversifying the sources of contributions, [while
striving to avoid as far as possible a reduction in the resources
for other development areas.] Additional resources should be made
available for short-term assistance to the countries with economies
in transition;
(c) To increase international financial assistance to direct
South-South cooperation and to facilitate financing procedures for
direct South-South cooperation.
Actions
14.11. The international community should strive for the
fulfilment of the agreed target of 0.7 per cent of GNP for overall
ODA and endeavour to increase the share of funding for population
and development programmes commensurate with the scope and scale of
activities required to achieve the objectives and goals of the
present Programme of Action. A crucially urgent challenge to the
international donor community is therefore the translation of their
commitment to the objectives and quantitative goals of the present
Programme of Action into commensurate financial contributions to
population programmes in developing countries and countries with
economies in transition. Given the magnitude of the financial
resource needs for national population and development programmes
[as identified in chapter XIII], and assuming that recipient
countries will be able to generate sufficient increases in
domestically generated resources, the need for complementary
resource flows from donor countries would be (in 1993 US dollars):
[$5.7 billion in 2000; $6.1 billion in 2005; $6.8 billion in 2010;
and $7.2 billion in 2015.] [Donor agencies and the recipient
Governments concerned are further invited to devote at least 20 per
cent of ODA funds to the social sectors, including the requirements
mentioned above, along with a similar level of domestic
expenditure.]
14.12. Recipient countries should ensure that international
assistance for population and development activities is used
effectively to meet national population and development objectives
so as to assist donors to secure commitment to further resources
for programmes.
14.13. The United Nations Population Fund, other United Nations
organizations, multilateral financial institutions, regional banks
and bilateral financial sources are invited to consult, with a view
to coordinating their financing policies and planning procedures to
improve the impact, complementarity and cost-effectiveness of their
contributions to the achievement of the population programmes of
the developing countries [and countries with economies in
transition].
14.14. Criteria for allocation of external financial resources for
population activities in developing countries [and countries with
economies in transition] should include:
(a) Coherent national programmes, plans and strategies on
population and development;
(b) The recognized priority to the least developed countries;
(c) The need to complement national financial efforts on
population;
(d) The need to avoid obstacles to, or reversal of, progress
achieved thus far;
(e) Problems of significant social sectors and areas that are
not reflected in national average indicators.
[14.15. Countries with economies in transition should receive
temporary assistance in the light of the difficult economic and
social problems these countries face at present.]
14.16. In devising the appropriate balance between funding
sources, more attention should be given to South-South cooperation
as well as to new ways of mobilizing private contributions,
particularly in partnership with non-governmental organizations.
The international community should urge donor agencies to improve
and modify their funding procedures in order to facilitate and give
higher priority to supporting direct South-South collaborative
arrangements.
[14.17. Innovative financing, including new ways of generating
public and private financing resources, inter alia, various forms
of debt relief, including greater use of debt forgiveness in
exchange for government investment in population and development
programmes, should be explored.]
14.18. International financial institutions are encouraged to
increase their financial assistance, particularly in population and
[sexual and reproductive health and family planning].
Chapter XV
PARTNERSHIP WITH THE NON-GOVERNMENTAL SECTOR
A. Local, national and international
non-governmental organizations
Basis for action
15.1. As the contribution, real and potential, of non-governmental
organizations gains clearer recognition in many countries and at
regional and international levels, it is important to affirm its
relevance in the context of the preparation and implementation of
the present Programme of Action. To address the challenges of
population and development effectively, broad and effective
partnership is essential between Governments and non-governmental
organizations (comprising not-for-profit groups and organizations
at the local, national and international levels) to assist in the
formulation, implementation, monitoring and evaluation of
population and development objectives and activities.
15.2. Despite widely varying situations in their relationship and
interaction with Governments, non-governmental organizations have
made and are increasingly making important contributions to both
population and development activities at all levels. In many areas
of population and development activities, non-governmental groups
are already rightly recognized for their comparative advantage in
relation to government agencies, because of innovative, flexible
and responsive programme design and implementation, including
grass-roots participation, and because quite often they are rooted
in and interact with constituencies that are poorly served and hard
to reach through government channels.
15.3. Non-governmental organizations are important voices of the
people, and their associations and networks provide an effective
and efficient means of better focusing local and national
initiatives and addressing pressing population, environmental,
migration and economic and social development concerns.
15.4. Non-governmental organizations are actively involved in the
provision of programme and project services in virtually every area
of socio-economic development, including the population sector.
Many of them have, in a number of countries, a long history of
involvement and participation in population- related, [particularly
family-planning], activities. Their strength and credibility lies
in the responsible and constructive role they play in society and
the support their activities engender from the community as a
whole. Formal and informal organizations and networks, including
grass-root movements, merit greater recognition at local, national
and international levels as valid and valuable partners for the
implementation of the present Programme of Action. For such
partnerships to develop and thrive, it is necessary for
governmental and non-governmental organizations to institute
appropriate systems and mechanisms to facilitate constructive
dialogue, in the context of national programmes and policies,
recognizing their distinct roles, responsibilities and particular
capacities.
15.5. The experience, capabilities and expertise of many
non-governmental organizations and local community groups in areas
of direct relevance to the Programme of Action is acknowledged.
Non-governmental organizations, [especially sexual and reproductive
health, including family-planning organizations], women's
organizations and immigrant and refugee support advocacy groups,
have increased public knowledge and provided educational services
to men and women which contribute towards successful implementation
of population and development policies. Youth organizations are
increasingly becoming effective partners in developing programmes
to educate youth on [sexual and reproductive health], gender and
environmental issues. Other groups, such as organizations of the
aged, migrants, organizations of persons with disabilities and
informal grass-roots groups, also contribute effectively to the
enhancement of programmes for their particular constituencies.
These diverse organizations can help in ensuring the quality and
relevance of programmes and services to the people they are meant
to serve. They should be invited to participate with local,
national and international decision-making bodies, including the
United Nations system, to ensure effective implementation,
monitoring and evaluation of the present Programme of Action.
15.6. In recognition of the importance of effective partnership,
non-governmental organizations are invited to foster coordination,
cooperation and communication at the local, national, regional and
international levels and with local and national governments, to
reinforce their effectiveness as key participants in the
implementation of population and development programmes and
policies. The involvement of non-governmental organizations should
be seen as complementary to the responsibility of Governments to
provide full, safe and accessible [sexual and reproductive health
services]. Like Governments, non-governmental organizations should
be accountable for their actions and should offer transparency with
respect to their services and evaluation procedures.
Objective
15.7. The objective is to promote an effective partnership between
all levels of Government and the full range of non-governmental
organizations and local community groups, in the discussion and
decisions on the design, implementation, coordination, monitoring
and evaluation of programmes relating to population, development
and environment in accordance with the general policy framework of
Governments, taking duly into account the responsibilities and
roles of the respective partners.
Actions
15.8. Governments and intergovernmental organizations, in dialogue
with non-governmental organizations and local community groups, and
in full respect for their autonomy, should integrate them in their
decision-making and facilitate the contribution that
non-governmental organizations can make at all levels towards
finding solutions to population and development concerns and, in
particular, to ensure the implementation of the present Programme
of Action. Non-governmental organizations should have a key role
in national and international development processes.
15.9. Governments should ensure the essential roles and
participation of women's organizations in the design and
implementation of population and development programmes. Involving
women at all levels, especially the managerial level, is critical
to meeting the objectives and implementing the present Programme of
Action.
15.10. Adequate financial and technical resources and information
necessary for the effective participation of non-governmental
organizations in the research, design, implementation, monitoring
and evaluation of population and development activities should, if
feasible and if requested, be made available to the
non-governmental sector by Governments, intergovernmental
organizations and international financial institutions in a manner
that will not compromise their full autonomy. To ensure
transparency, accountability and effective division of labour,
these same institutions should make available the necessary
information and documents to those non-governmental organizations.
International organizations may provide financial and technical
assistance to non-governmental organizations in accordance with the
laws and regulations of each country.
15.11. Governments and donor countries, including
intergovernmental organizations and international financial
institutions, should ensure that non-governmental organizations and
their networks are able to maintain their autonomy and strengthen
their capacity through regular dialogue and consultations,
appropriate training and outreach activities, and thus play a
greater partnership role at all levels.
15.12. Non-governmental organizations and their networks and local
communities should strengthen their interaction with their
constituencies, ensure the transparency of their activities,
mobilize public opinion, participate in the implementation of
population and development programmes and actively contribute to
the national, regional and international debate on population and
development issues. Governments, where appropriate, should include
representation of non-governmental organizations on country
delegations to regional and international forums where issues on
population and development are discussed.
B. The private sector
Basis for action
15.13. The private, profit-oriented sector plays an important role
in social and economic development, including production and
delivery of [sexual and reproductive health commodities and
services], including appropriate education and information relevant
to population and development programmes. In a growing number of
countries, the private sector has or is developing the financial,
managerial and technological capacity to carry out an array of
population and development activities in a cost-efficient and
effective manner. This experience has laid the groundwork for
useful partnerships which the private sector can further develop
and expand. Private-sector involvement may assist or supplement
but must not mitigate the responsibility of Governments to provide
full, safe and accessible [reproductive health services] to all
people. The private sector must be held accountable to all human
rights and ethical standards and principles recognized by the
international community and in this Programme of Action.
15.14. Another aspect of the private sector's role is its
importance as a partner for economic growth and sustainable
development. Through its actions and attitudes, the private sector
can make a decisive impact on the quality of life of its employees
and often on large segments of society and their attitudes.
Experience gained from these programmes is useful to Governments
and non-governmental organizations alike in their ongoing efforts
to find innovative ways of effectively involving the private sector
in population and development programmes. A growing consciousness
of corporate responsibilities increasingly is leading
private-sector decision makers to search for new ways in which
for-profit entities can constructively work with Governments and
non-governmental organizations on population and sustainable
development issues. By acknowledging the contribution of the
private sector, and by seeking more programme areas for mutually
beneficial cooperation, Governments and non-governmental
organizations alike may strengthen the efficiency of their
population and development activities.
Objectives
15.15. The objectives are:
(a) To strengthen the partnership between Governments,
international organizations and the private sector in identifying
new areas of cooperation;
(b) To promote the role of the private sector in service
delivery and in the production and distribution, within each region
of the world, of high- quality [reproductive health and
family-planning] commodities and contraceptives, which are
accessible and affordable to low-income sectors of the population.
Actions
15.16. Governments and non-governmental and international
organizations should intensify their cooperation with the private,
for-profit sector in matters pertaining to population and
sustainable development in order to strengthen the contribution of
this sector in the implementation of population and development
programmes, including the production and delivery of quality
contraceptive commodities and services with appropriate information
and education, in a socially responsible, culturally sensitive,
acceptable and cost-effective manner.
15.17. Non-profit and profit-oriented organizations and their
networks should develop mechanisms whereby they can exchange ideas
and experiences in the population and development fields with a
view to sharing innovative approaches and research and development
initiatives. The dissemination of information and research should
be a priority.
15.18. Governments are strongly encouraged to set standards for
service delivery and review legal, regulatory and import policies
to identify and eliminate those policies that unnecessarily prevent
or restrict the greater involvement of the private sector in
efficient production of [sexual and reproductive health, including
family planning] and commodities, and in service delivery.
Governments, taking into account cultural and social differences,
should strongly encourage the private sector to meet its
responsibilities regarding consumer information dissemination,
[particularly on sexual, reproductive and health-related products
and services].
15.19. The profit-oriented sector should consider how it might
better assist non-profit non-governmental organizations to play a
wider role in society through the enhancement or creation of
suitable mechanisms to channel financial and other appropriate
support to non-governmental organizations and their associations.
15.20. Private-sector employers should continue to devise and
implement special programmes that help meet their employees' needs
for information, education and [reproductive health services], and
accommodate their employees' needs to combine work and family
responsibilities. Organized health-care providers and health
insurers are also including [family planning and reproductive
health services] in the package of health benefits they provide.
Chapter XVI
FOLLOW-UP TO THE CONFERENCE
A. National-level activities
Basis for action
16.1. The significance of the International Conference on
Population and Development will depend on the willingness of
Governments, local communities, the non-governmental sector, the
international community and all other concerned organizations and
individuals to turn the recommendations of the Conference into
action. This commitment will be of particular importance at the
national and individual levels. Such a willingness to truly
integrate population concerns into all aspects of economic and
social activity and their interrelationships will greatly assist in
the achievement of an improved quality of life for all individuals
as well as for future generations. All efforts must be pursued
towards sustained economic growth within the context of sustainable
development.
16.2. The extensive and varied preparatory processes at the
international, regional, subregional, national and local levels
have constituted an important contribution to the formulation of
this Programme of Action. Considerable institutional development
has taken place in many countries in order to steer the national
preparatory process; greater awareness of population issues has
been fostered through public information and education campaigns,
and national reports have been prepared for the Conference. The
great majority of countries participating in the Conference
responded to an invitation to prepare comprehensive national
population reports. The complementarity of those reports to others
commissioned by recent international conferences and initiatives
relating to environmental, economic and social development is
noteworthy and encouraging. The importance of building on these
activities in the follow-up to the Conference is fully
acknowledged.
16.3. The main functions related to Conference follow-up include
policy guidance, including building strong political support at all
levels for population and development; resource mobilization;
coordination and mutual accountability of efforts to implement the
Programme of Action; problem solving and sharing of experience
within and between countries; and monitoring and reporting of
progress in the implementation of the Programme of Action. Each of
these functions requires concerted and coordinated follow-up at the
national and international levels, and must fully involve all
relevant individuals and organizations, including non-governmental
and community-based organizations. [Implementation, monitoring and
evaluation of the Programme of Action at all levels requires
qualitative and quantitative indicators consistent with human
rights and ethical principles recognized by the international
community and endorsed in the Programme of Action]. OR
[Implementation, monitoring and evaluation of the Programme of
Action at all levels requires appropriate indicators]. OR
[Implementation, monitoring and evaluation of the Programme of
Action at all levels should be conducted in a manner consistent
with its principles and objective.]
16.4. The implementation of this Programme of Action at all levels
must be viewed as part of an integrated follow-up effort to major
international conferences, including the present Conference, the
World Conference on Health for All, the World Conference on
Education for All, the World Summit for Children, the Conference on
Least Developed Countries, the United Nations Conference on
Environment and Development, the International Conference on
Nutrition, the World Conference on Human Rights, the Global
Conference on the Sustainable Development of Small Island
Developing States, the World Social Summit, the Fourth World
Conference on Women and Habitat II.
16.5. The implementation of the goals, objectives and actions of
this Programme of Action will in many instances require additional
resources.
Objective
16.6. The objective is to encourage and enable countries to fully
and effectively implement the Programme of Action, through
appropriate and relevant policies and programmes at the national
level.
Actions
16.7. Governments should (a) commit themselves at the highest
political level to achieving the goals and objectives contained in
this Programme of Action and (b) take a lead role in coordinating
the implementation, monitoring and evaluation of follow-up actions.
16.8. Governments, organizations of the United Nations system and
major groups, in particular non-governmental organizations, should
give the widest possible dissemination to this Programme of Action
and should seek public support for the goals, objectives and
actions of this Programme of Action. This may include follow-up
meetings, publications and audio-visual aids and both print and
electronic media.
16.9. All countries should consider their current spending
priorities with a view to making additional contributions for the
implementation of the Programme of Action, taking into account the
provisions of chapters XIII and XIV of the Programme of Action, and
the economic constraints faced by developing countries.
16.10. All countries should establish appropriate national
follow-up, accountability and monitoring mechanisms, in partnership
with non-governmental organizations, community groups and
representatives of the media and the academic community, as well as
with the support of parliamentarians.
16.11. The international community should assist interested
Governments in organizing appropriate national-level follow-up,
including national capacity-building for project formulation and
programme management, as well as strengthening of coordination and
evaluation mechanisms to assess the implementation of the present
Programme of Action.
16.12. Governments, with the assistance of the international
community, where necessary, should as soon as possible set up or
enhance national databases to provide baseline data and information
that can be used to measure or assess progress towards the
achievement of the goals and objectives of this Programme of
Action, and other related international documents, commitments and
agreements. For the purpose of assessing progress, all countries
should regularly assess their progress towards achieving the
objectives and goals of this Programme of Action and other related
commitments and agreements and report, on a periodic basis, in
collaboration with non-governmental organizations and community
groups.
16.13. In the preparation of those assessments and reports,
Governments should outline successes achieved, as well as problems
and obstacles encountered. Where possible, such national reports
should be compatible with the national sustainable development
plans that countries will prepare in the context of the
implementation of Agenda 21. Efforts should also be made to devise
an appropriate consolidated reporting system, taking into account
all relevant United Nations conferences having national reporting
requirements in related fields.
B. Subregional and regional activities
Basis for action
16.14. Activities undertaken at both the subregional and the
regional levels have been an important aspect of preparations for
the Conference. The outcome of subregional and regional
preparatory meetings on population and development has clearly
demonstrated the importance of acknowledging, alongside both
international and national actions, the continuing contribution of
subregional and regional action.
Objective
16.15. The objective is to promote implementation of the Programme
of Action at the subregional and regional levels, with attention to
specific subregional and regional strategies and needs.
Actions
16.16. Regional commissions, organizations of the United Nations
system functioning at the regional level, and other relevant
subregional and regional organizations should play an active role
within their mandates regarding the implementation of this
Programme of Action, through subregional and regional initiatives
on population and development. Such action should be coordinated
among the organizations concerned at the subregional and regional
levels, with a view to ensuring efficient and effective action in
addressing specific population and development issues relevant to
the regions concerned, as appropriate.
16.17. At the subregional and regional levels:
(a) Governments in the subregions and regions and relevant
organizations are invited, where appropriate, to reinforce existing
follow-up mechanisms, including meetings for the follow-up of
regional declarations on population and development issues;
(b) Multidisciplinary expertise should, where necessary, be
utilized to play a key role in the implementation and follow-up of
the Programme of Action;
(c) Cooperation in the critical areas of capacity-building,
the sharing and exchange of information and experiences, know-how
and technical expertise should be strengthened with the appropriate
assistance of the international community, taking into account the
need for a partnership with non-governmental organizations and
other major groups, in the implementation and follow-up of the
Programme of Action at the regional level;
(d) Governments should ensure that training and research in
population and development issues at the tertiary level are
strengthened, and that research findings and implications are
widely disseminated.
C. Activities at the international level
Basis for action
16.18. The implementation of the goals, objectives and actions of
this Programme of Action will require new and additional financial
resources, from the public and private sectors, non-governmental
organizations and the international community. While some of the
resources required could come from the reordering of priorities,
additional resources will be needed. In this context, developing
countries, particularly the least developed countries, will require
additional resources, including on concessional and grant terms,
according to sound and equitable indicators. Countries with
economies in transition may also require temporary assistance in
the light of the difficult economic and social problems these
countries face at present. Developed countries, and others in a
position to do so, should consider providing additional resources,
as needed, to support the implementation of the decisions of this
Conference through bilateral and multilateral channels, as well as
non-governmental organizations.
16.19. South-South cooperation at all levels is an important
instrument of development. In this regard such cooperation -
technical cooperation among developing countries - should play an
important part in the implementation of this Programme of Action.
Objectives
16.20. The objectives are:
(a) To ensure full and consistent support, including
financial and technical assistance by the international community,
including from the United Nations system, for efforts at all levels
directed at the implementation of this Programme of Action, at all
levels;
(b) To ensure a coordinated approach and a clearer division
of labour in population-relevant policy and operational aspects of
development cooperation. This should be supplemented by enhanced
coordination and planning in the mobilization of resources;
(c) To ensure that population and development issues receive
appropriate focus and integration in the work of the relevant
bodies and entities of the United Nations system.
Actions
16.21. The General Assembly is the highest intergovernmental
mechanism for the formulation and appraisal of policy on matters
relating to the follow-up to this Conference. To ensure effective
follow-up to the Conference, as well as to enhance
intergovernmental decision-making capacity for the integration of
population and development issues, the Assembly should organize a
regular review of the implementation of this Programme of Action.
In fulfilling this task, the Assembly should consider the timing,
format and organizational aspects of such a review.
16.22. The General Assembly and the Economic and Social Council
should carry out their respective responsibilities, as entrusted to
them in the Charter of the United Nations, in the formulation of
policies and the provision of guidance to and coordination of
United Nations activities in the field of population and
development.
16.23. The Economic and Social Council, in the context of its role
under the Charter, vis-…-vis the General Assembly and in accordance
with Assembly resolutions 45/264, 46/235 and 48/162, should assist
the General Assembly in promoting an integrated approach and in
providing system-wide coordination and guidance in the monitoring
of the implementation of the Programme of Action and making
recommendations in this regard. Appropriate steps should be taken
to request regular reports from the specialized agencies regarding
their plans and programmes related to the implementation of this
Programme of Action, pursuant to Article 64 of the Charter.
16.24. The Economic and Social Council is invited to review the
reporting system within the United Nations system regarding
population and development issues, taking into account the
reporting procedures that are required in follow-up to other
international conferences, with a view to establishing, where
possible, a more coherent reporting system.
16.25. Within their respective mandates and in accordance with
General Assembly resolution 48/162, the Assembly, during its
forty-ninth session and the Economic and Social Council, in 1995,
should review the roles, responsibilities, mandates and comparative
advantages of both the relevant intergovernmental bodies and the
organs of the United Nations system addressing population and
development, with a view to:
(a) Ensuring the effective and efficient implementation,
monitoring and evaluation of the United Nations operational
activities that will be undertaken on the basis of this Programme
of Action;
(b) Improving the efficiency and effectiveness of the current
United Nations structures and machinery responsible for
implementing and monitoring population and development activities,
including strategies for addressing coordination and for
intergovernmental review;
(c) Ensuring clear recognition of the interrelationships
between policy guidance, research, standard-setting and operational
activities for population and development, as well as the division
of labour between the bodies concerned.
16.26. As part of this review, the Economic and Social Council
should, in the context of Assembly resolution 48/162, consider the
respective roles of the relevant United Nations organs dealing with
population and development, including the United Nations Population
Fund and the Population Division, regarding the follow-up to this
Programme of Action.
16.27. The General Assembly, at its forty-ninth session, in
accordance with its resolution 48/162, is invited to give further
consideration to the establishment of a separate Executive Board of
the United Nations Population Fund, taking into account the results
of the above-mentioned review and bearing in mind the
administrative, budgetary and programme implications of such a
proposal.
16.28. The Secretary-General of the United Nations is invited to
consult with the various bodies of the United Nations system, as
well as with international financial institutions and various
bilateral aid organizations and agencies, with a view to promoting
an exchange of information among them on the requirements for
international assistance of reviewing on a regular basis the
specific needs of countries in the field of population and
development, including emergency and temporary needs, and
maximizing the availability of resources and their most effective
utilization.
16.29. All specialized agencies and related organizations of the
United Nations system are invited to strengthen and adjust their
activities, programmes and medium-term strategies, as appropriate,
to take into account the follow-up to the Conference. Relevant
governing bodies should review their policies, programmes, budgets
and activities in this regard.
Notes
1/ This is the revised draft of the Preamble, prepared by
the Chairman. As there was not enough time for adequate discussion
of the chapter, it was agreed that the Chairman's draft should be
brought to the attention of the Conference, where further
discussion will take place.
2/ See Report of the United Nations World Population
Conference, Bucharest, 19-30 August 1974 (United Nations
publication, Sales No. E.75.XIII.3).
3/ See Report of the International Conference on Population,
Mexico City, 6-14 August 1984 (United Nations publication, Sales
No. E.84.XIII.8 and corrigenda).
4/ See First Call for Children (New York, United Nations
Children's Fund, 1990).
5/ See Report of the United Nations Conference on
Environment and Development, Rio de Janeiro, 3-14 June 1992
(A/CONF.151/26/Rev.1 (vol. I and vol. I/Corr.1, vol. II, vol. III
and vol. III/Corr.1)) (United Nations publication, Sales No.
E.93.I.8 and corrigenda).
6/ See Report of the World Conference on Human Rights,
Vienna, 14-25 June 1993 (A/CONF.157/24, (Part I)).
7/ General Assembly resolution 47/75.
8/ General Assembly resolution 48/163.
9/ General Assembly resolution 44/82.
10/ General Assembly resolution 47/92.
11/ Resolutions 36/8 and 37/7 of the Commission on the Status
of Women (Official Records of the Economic and Social Council,
1992, Supplement No. 4 (E/1992/24), chap. I, sect. C, and ibid.,
1993, Supplement No. 7 (E/1993/27), chap. I, sect. C).
12/ This is the revised draft of chapter II, prepared by the
Chairman. As there was not enough time for adequate discussion of
the chapter, it was agreed that the Chairman's draft should be
brought to the attention of the Conference, where further
discussion will take place.
13/ Where applicable, references are given to the original
source(s).
14/ General Assembly resolution 45/199, annex.
15/ See Report of the Second United Nations Confrence on the
Least Developed Countries, Paris, 3-14 September 1990
(A/CONF.147/18), part one.
16/ General Assembly resolution 46/151, annex, sect. II.
17/ Children, adolescents, women, the aged, the disabled,
indigenous people[s], rural populations, urban populations,
migrants, refugees, displaced persons and slum-dwellers.