UNITED NATIONS POPULATION INFORMATION NETWORK (POPIN)
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with support from the UN Population Fund (UNFPA)

A/CONF.171/L.1:(DRAFT) Programme of Action of the Conference (94/5/12)

The electronic version of this document is being made available by

the United Nations Population Information Network (POPIN) Gopher of

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Analysis, Population Division.

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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.






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