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with support from the UN Population Fund (UNFPA)
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the United Nations Population Information Network (POPIN) Gopher of
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UNITED NATIONS
Distr.
GENERAL
A/CONF.171/13
18 October 1994
ORIGINAL:
ENGLISH/FRENCH/SPANISH
REPORT OF THE INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT*
(Cairo, 5-13 September 1994)
________________________
* The present document is a preliminary version of the
report of the International Conference on Population and
Development. Annexes I to IV will appear in an addendum to the
present document.
94-40486 (E) 091194
CONTENTS
Page
I. RESOLUTIONS ADOPTED BY THE CONFERENCE 4
1. Programme of Action of the International
Conference on Population and Development 4
2. Expression of thanks to the people and Government
of Egypt 119
3. Credentials of representatives to the International
Conference on Population and Development 119
II. ATTENDANCE AND ORGANIZATION OF WORK 120
A. Date and place of the Conference 120
B. Pre-Conference consultations 120
C. Attendance 120
D. Opening of the Conference and election of
the President 124
E. Messages from heads of State 124
F. Adoption of the rules of procedure 124
G. Adoption of the agenda 124
H. Election of officers other than the President 125
I. Organization of work, including the
establishment of the Main Committee of the
Conference 126
J. Accreditation of intergovernmental organizations 126
K. Accreditation of non-governmental organizations 126
L. Appointment of the members of the Credentials
Committee 126
M. Other matters 127
III. GENERAL DEBATE 128
IV. REPORT OF THE MAIN COMMITTEE 131
V. ADOPTION OF THE PROGRAMME OF ACTION 135
VI. REPORT OF THE CREDENTIALS COMMITTEE 152
VII. ADOPTION OF THE REPORT OF THE CONFERENCE 154
VIII. CLOSURE OF THE CONFERENCE 155
-------------------------------------------------------------------
Annexes*
I. LIST OF DOCUMENTS
II. OPENING STATEMENTS
III. CLOSING STATEMENTS
IV. PARALLEL AND ASSOCIATED ACTIVITIES
________________________
* To be issued as an addendum to the present document.
=================================================================
Chapter I
RESOLUTIONS ADOPTED BY THE CONFERENCE
Resolution 1
Programme of Action of the
International Conference on Population and Development*
The International Conference on Population and Development,
Having met in Cairo from 5 to 13 September 1994,
1. Adopts the Programme of Action of the International
Conference on Population and Development, which is annexed to the
present resolution;
2. Recommends to the General Assembly at its forty-ninth
session that it endorse the Programme of Action as adopted by the
Conference;
3. Also recommends that the General Assembly consider at its
forty-ninth session the synthesis of national reports on population
and development prepared by the secretariat of the Conference.
________________________
* Adopted at the 14th plenary meeting, on 13 September
1994; for the discussion, see chap. V.
=================================================================
Annex
PROGRAMME OF ACTION OF THE INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT*
CONTENTS
Chapter
Paragraphs Page
I. PREAMBLE .................................. 1.1 - 1.15 9
II. PRINCIPLES .................................. 14
III. INTERRELATIONSHIPS BETWEEN POPULATION, SUSTAINED
ECONOMIC GROWTH AND SUSTAINABLE DEVELOPMENT 3.1 - 3.32 18
A. Integrating population and development
strategies ............................. 3.1 - 3.9 18
B. Population, sustained economic growth and
poverty ................................3.10 - 3.22 19
C. Population and environment ........... 3.23 - 3.32 22
IV. GENDER EQUALITY, EQUITY AND EMPOWERMENT OF
WOMEN ................................... 4.1 - 4.29 25
A. Empowerment and status of women ..... 4.1 - 4.14 25
B. The girl child ...................... 4.15 - 4.23 28
C. Male responsibilities and participation 4.24 - 4.29 30
V. THE FAMILY, ITS ROLES, RIGHTS, COMPOSITION
AND STRUCTURE ............................ 5.1 - 5.13 32
A. Diversity of family structure and
composition ......................... 5.1 - 5.6 32
B. Socio-economic support to the family 5.7 - 5.13 33
VI. POPULATION GROWTH AND STRUCTURE ......... 6.1 - 6.33 35
A. Fertility, mortality and population
growth rates ........................ 6.1 - 6.5 35
B. Children and youth .................. 6.6 - 6.15 36
C. Elderly people ...................... 6.16 - 6.20 38
D. Indigenous people ................... 6.21 - 6.27 39
E. Persons with disabilities ........... 6.28 - 6.33 41
VII. REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTH 7.1 - 7.48 43
A. Reproductive rights and reproductive
health .............................. 7.2 - 7.11 43
B. Family planning ..................... 7.12 - 7.26 46
C. Sexually transmitted diseases and
prevention of human immunodeficiency
virus (HIV) ......................... 7.27 - 7.33 50
D. Human sexuality and gender relations 7.34 - 7.40 51
E. Adolescents ......................... 7.41 - 7.48 52
VIII. HEALTH, MORBIDITY AND MORTALITY ......... 8.1 - 8.35 55
A. Primary health care and the health-care
sector .............................. 8.1 - 8.11 55
B. Child survival and health ........... 8.12 - 8.18 57
C. Women's health and safe motherhood .. 8.19 - 8.27 60
D. Human immunodeficiency virus (HIV)
infection and acquired immunodeficiency
syndrome (AIDS) ..................... 8.28 - 8.35 62
IX. POPULATION DISTRIBUTION, URBANIZATION
AND INTERNAL MIGRATION ............... 9.1 - 9.25 65
A. Population distribution and sustainable
development ........................ 9.1 - 9.11 65
B. Population growth in large urban
agglomerations ...................... 9.12 - 9.18 67
C. Internally displaced persons ....... 9.19 - 9.25 68
X. INTERNATIONAL MIGRATION ................ 10.1 - 10.29 70
A. International migration and development 10.1 - 10.8 70
B. Documented migrants .................. 10.9 - 10.14 72
C. Undocumented migrants ............... 10.15 - 10.20 74
D. Refugees, asylum-seekers and displaced
persons ............................. 10.21 - 10.29 75
XI. POPULATION, DEVELOPMENT AND EDUCATION ... 11.1 - 11.26 79
A. Education, population and sustainable
development ......................... 11.1 - 11.10 79
B. Population information, education and
communication ....................... 11.11 - 11.26 81
XII. TECHNOLOGY, RESEARCH AND DEVELOPMENT .... 12.1 - 12.26 86
A. Basic data collection, analysis and
dissemination ....................... 12.1 - 12.9 86
B. Reproductive health research ........ 12.10 - 12.18 88
C. Social and economic research ........ 12.19 - 12.26 90
XIII. NATIONAL ACTION ......................... 13.1 - 13.24 93
A. National policies and plans of action 13.1 - 13.6 93
B. Programme management and human resource
development .......................... 13.7 - 13.10 94
C. Resource mobilization and allocation . 13.11 - 13.24 96
XIV. INTERNATIONAL COOPERATION ................. 14.1 - 14.18 101
A. Responsibilities of partners in
development ......................... 14.1 - 14.7 101
B. Towards a new commitment to funding
population and development .......... 14.8 - 14.18 103
XV. PARTNERSHIP WITH THE NON-GOVERNMENTAL SECTOR 15.1 - 15.20 106
A. Local, national and international
non-governmental organizations ....... 15.1 - 15.12 106
B. The private sector ................... 15.13 - 15.20 108
XVI. FOLLOW-UP TO THE CONFERENCE .............. 16.1 - 16.29 111
A. Activities at the national level .......16.1 - 16.13 111
B. Subregional and regional activities .. 16.14 - 16.17 113
C. Activities at the international level 16.18 - 16.29 114
________________________
* The official language of the Programme of Action is
English, with the exception of paragraph 8.25, which was negotiated
in all six official languages of the United Nations.
=================================================================
Chapter I
PREAMBLE
1.1. The 1994 International Conference on Population and
Development occurs at a defining moment in the history of
international cooperation. With the growing recognition of global
population, development and environmental interdependence, the
opportunity to adopt suitable macro- and socio-economic policies to
promote sustained economic growth in the context of sustainable
development in all countries 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 which, if
suitably redirected, could foster sustained economic growth and
sustainable development. None the less, the effective use of
resources, knowledge and technologies is conditioned by political
and economic obstacles at the national and international levels.
Therefore, although ample resources have been available for some
time, their use for socially equitable and environmentally sound
development has been seriously limited.
1.2. The world has undergone far-reaching changes in the past two
decades. Significant progress in many fields important for human
welfare has been made through national and international efforts.
However, the developing countries are still facing serious economic
difficulties and an unfavourable international economic
environment, and the number of people living in absolute poverty
has increased in many countries. 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
degradation is intensifying, driven by unsustainable patterns of
production and consumption, unprecedented growth in population,
widespread and persistent poverty, and social and economic
inequality. Ecological problems, such as global climate change,
largely driven by unsustainable patterns of production and
consumption, are adding to the threats to the well-being of future
generations. There is an emerging global consensus on the need for
increased international cooperation in regard to population in the
context of sustainable development, for which Agenda 21 1/ provides
a framework. Much has been achieved in this respect, but more
needs to be done.
1.3. The world population is currently estimated at 5.6 billion.
While the rate of growth is on the decline, absolute increments
have been increasing, currently exceeding 86 million persons per
annum. Annual population increments are likely to remain above 86
million until the year 2015. 2/
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 low, medium
and high variants of the United Nations population projections for
the coming 20 years range from a low of 7.1 billion people to the
medium variant of 7.5 billion and a high of 7.8 billion. The
difference of 720 million people in the short span of 20 years
exceeds the current population of the African continent. Further
into the future, the projections diverge even more significantly.
By the year 2050, the United Nations projections range from 7.9
billion to the medium variant of 9.8 billion and a high of 11.9
billion. 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 below the
United Nations medium projection.
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 3/ and the
International Conference on Population at Mexico City in 1984, 4/
to consider the broad issues of and interrelationships between
population, sustained economic growth and sustainable development,
and advances in the education, economic status and empowerment of
women. The 1994 Conference was explicitly given a broader mandate
on development issues than previous population conferences,
reflecting the growing awareness that population, poverty, patterns
of production and consumption and the environment are so closely
interconnected that none of them can be considered in isolation.
1.6. The International Conference on Population and Development
follows and builds on other important recent international
activities, and its recommendations should be supportive of,
consistent with and based on the agreements reached at the
following:
(a) The World Conference to Review and Appraise the
Achievements of the United Nations Decade for Women: Equality,
Development and Peace, held in Nairobi in 1985; 5/
(b) The World Summit for Children, held in New York in 1990;
6/
(c) The United Nations Conference on Environment and
Development, held in Rio de Janeiro in 1992; 7/
(d) The International Conference on Nutrition, held in Rome
in 1992; 8/
(e) The World Conference on Human Rights, held in Vienna in
1993; 9/
(f) The International Year of the World's Indigenous People,
1993, 10/ which would lead to the International Decade of the
World's Indigenous People; 11/
(g) The Global Conference on the Sustainable Development of
Small Island Developing States, held in Barbados in 1994; 12/
(h) The International Year of the Family, 1994. 13/
1.7. The Conference outcomes are closely related to and will make
significant contributions to other major conferences in 1995 and
1996, such as the World Summit for Social Development, 14/ the
Fourth World Conference on Women: Action for Equality, Development
and Peace, 15/ the Second United Nations Conference on Human
Settlements (Habitat II), the elaboration of the Agenda for
Development, as well as 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 investment in
people, and for a new action agenda for the empowerment of women to
ensure their full participation at all levels 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, environmental
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. While the advances of the past two
decades in areas such as increased use of contraception, decreased
maternal mortality, implemented sustainable development plans and
projects and enhanced educational programmes provide a basis for
optimism about successful implementation of the present Programme
of Action, much remains to be accomplished. 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, resulting, inter alia, in the new
comprehensive concept of reproductive health, including family
planning and sexual health, as defined in the present Programme of
Action. A particularly encouraging trend has been the
strengthening of political commitment to population-related
policies and family-planning programmes by many Governments. In
this regard, sustained economic growth in the context of
sustainable development will enhance the ability of countries to
meet the pressures of expected population growth; will facilitate
the demographic transition in countries where there is an imbalance
between demographic rates and social, economic and environmental
goals; and will permit the balance and integration of the
population dimension into other development- related policies.
1.9. The population and development objectives and actions of the
present Programme of Action will collectively address the critical
challenges and interrelationships between population and sustained
economic growth in the context of sustainable development. In
order to do so, adequate mobilization of resources at the national
and international levels will be required as well as new and
additional resources to the developing countries from all available
funding mechanisms, including multilateral, bilateral and private
sources. Financial resources are also required to strengthen the
capacity of national, regional, subregional and international
institutions to implement this Programme of Action.
1.10. The two decades ahead are likely 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, and they present serious new challenges. Therefore, these
issues must be addressed with more emphasis within population and
development policies. 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.
1.11. 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 are made in a spirit of consensus and international
cooperation, recognizing that the formulation and implementation of
population-related policies is the responsibility of each country
and should take into account the economic, social and environmental
diversity of conditions in each country, with full respect for the
various religious and ethical values, cultural backgrounds and
philosophical convictions of its people, as well as the shared but
differentiated responsibilities of all the world's people for a
common future.
1.12. The present Programme of Action recommends to the
international community a set of important population and
development objectives, as well as qualitative and quantitative
goals that are mutually supportive and of critical importance to
these objectives. Among these objectives and goals are: sustained
economic growth in the context of sustainable development;
education, especially for girls; gender equity and equality;
infant, child and maternal mortality reduction; and the provision
of universal access to reproductive health services, including
family planning and sexual health.
1.13. 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 -
is 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 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.
1.14. The present Programme of Action recognizes that over the
next 20 years Governments are not expected to meet the goals and
objectives of the International Conference on Population and
Development single-handedly. All members of and 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.
1.15. While the International Conference on Population and
Development does not create any new international human rights, it
affirms the application of universally recognized human rights
standards to all aspects of population programmes. It also
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 Programme of Action will require the
establishment of common ground, with full respect for the various
religious and ethical values and cultural backgrounds. The impact
of this Conference will be measured by the strength of the specific
commitments made here and the consequent actions to fulfil them, as
part of a new global partnership among all the world's countries
and peoples, based on a sense of shared but differentiated
responsibility for each other and for our planetary home.
================================================================
Chapter II
PRINCIPLES
The implementation of the recommendations contained in the
Programme of Action is the sovereign right of each country,
consistent with national laws and development priorities, with full
respect for the various religious and ethical values and cultural
backgrounds of its people, and in conformity with universally
recognized international human rights.
International cooperation and universal solidarity, guided by
the principles of the Charter of the United Nations, and in a
spirit of partnership, are crucial in order to improve the quality
of life of the peoples of the world.
In addressing the mandate of the International Conference on
Population and Development and its overall theme, the
interrelationships between population, sustained economic growth
and sustainable development, and in their deliberations, the
participants were and will continue to be guided by the following
set of principles:
Principle 1
All human beings are born free and equal in dignity and
rights. 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. Everyone has the right to life,
liberty and security of person.
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
resource of any nation. Countries should ensure that all
individuals are given the opportunity to make the most of their
potential. They have the right to an adequate standard of living
for themselves and their families, including adequate food,
clothing, housing, water and sanitation.
Principle 3
The right to development is a universal and inalienable right
and an integral part of fundamental human rights, and the human
person is the central subject of development. While development
facilitates the enjoyment of all human rights, the lack of
development may not be invoked to justify the abridgement of
internationally recognized human rights. The right to development
must be fulfilled so as to equitably meet the population,
development and environment needs of present and future
generations.
Principle 4
Advancing gender equality and equity and the empowerment of
women, and the elimination of all kinds of violence against women,
and ensuring women's ability to control their own fertility, are
cornerstones of population and development- related programmes.
The human rights of women and the girl child are an inalienable,
integral and indivisible part of universal human rights. The full
and equal participation of women in civil, cultural, economic,
political and social life, at the national, regional and
international levels, and the eradication of all forms of
discrimination on grounds of sex, are priority objectives of the
international community.
Principle 5
Population-related goals and policies are integral parts of
cultural, economic and social development, the principal aim of
which is to improve the quality of life of all people.
Principle 6
Sustainable development as a means to ensure human well-being,
equitably shared by all people today and in the future, requires
that the interrelationships between population, resources, the
environment and development should be fully recognized, properly
managed and brought into harmonious, dynamic balance. 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 policies,
including population-related policies, in order to meet the needs
of current generations without compromising the ability of future
generations to meet their own needs.
Principle 7
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, shall be
given special priority. Countries with economies in transition, as
well as all other countries, need to be fully integrated into the
world economy.
Principle 8
Everyone has 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 reproductive health care, which includes family
planning and sexual health. Reproductive health-care programmes
should provide the widest range of services without any form of
coercion. 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.
Principle 9
The family is the basic unit of society and as such should be
strengthened. It is entitled to receive comprehensive protection
and support. In different cultural, political and social systems,
various forms of the family exist. Marriage must be entered into
with the free consent of the intending spouses, and husband and
wife should be equal partners.
Principle 10
Everyone has the right to education, which shall be directed
to the full development of human resources, and human dignity and
potential, with particular attention to women and the girl child.
Education should be designed to strengthen respect for human rights
and fundamental freedoms, including those relating to population
and development. The best interests of the child shall be the
guiding principle of those responsible for his or her education and
guidance; that responsibility lies in the first place with the
parents.
Principle 11
All States and families should give the highest possible
priority to children. The child has the right to standards of
living adequate for its well-being and the right to the highest
attainable standards of health, and the right to education. The
child has the right to be cared for, guided and supported by
parents, families and society and to be protected by appropriate
legislative, administrative, social and educational measures from
all forms of physical or mental violence, injury or abuse, neglect
or negligent treatment, maltreatment or exploitation, including
sale, trafficking, sexual abuse, and trafficking in its organs.
Principle 12
Countries receiving documented migrants should provide proper
treatment and adequate social welfare services for them and their
families, and should ensure their physical safety and security,
bearing in mind the special circumstances and needs of countries,
in particular developing countries, attempting to meet these
objectives or requirements with regard to undocumented migrants, in
conformity with the provisions of relevant conventions and
international instruments and documents. Countries should
guarantee to all migrants all basic human rights as included in the
Universal Declaration of Human Rights.
Principle 13
Everyone has the right to seek and to enjoy in other countries
asylum from persecution. States have responsibilities with respect
to refugees as set forth in the Geneva Convention on the Status of
Refugees and its 1967 Protocol.
Principle 14
In considering the population and development needs of
indigenous people, States should recognize and support their
identity, culture and interests, and enable them to participate
fully in the economic, political and social life of the country,
particularly where their health, education and well-being are
affected.
Principle 15
Sustained economic growth, in the context of sustainable
development, and social progress require that growth be broadly
based, offering equal opportunities to all people. All countries
should recognize their common but differentiated responsibilities.
The developed countries acknowledge the responsibility that they
bear in the international pursuit of sustainable development, and
should continue to improve their efforts to promote sustained
economic growth and to narrow imbalances in a manner that can
benefit all countries, particularly the developing countries.
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 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, 16/ the Programme of
Action for the Least Developed Countries for the 1990s, 17/ 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. 18/
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, 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
developed and 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 reproductive health
services, including family planning and sexual health care, 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 health, including family
planning and sexual health, 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 relevant reproductive health
services, of all underserved members of society. 19/
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, greater
investment in human resource development and the development of
democratic institutions and good governance. 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; by
promoting foreign direct investment; by reducing the debt burden;
by 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; by
providing 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.
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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 reproductive and sexual 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 exploitation through 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
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 equal treatment of girls
and boys with respect to nutrition, health care, education and
social, economic and political activity, as well as equitable
inheritance rights.
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
to 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, general and reproductive 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 the
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 the minimum legal age at marriage, in particular by
providing 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 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 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. Relevant 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 forms 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.
Objectives
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.
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.
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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 approaching 90 million
persons annually. According to United Nations projections, annual
population increments are likely to remain close to 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 reproductive
health services;
(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 the 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 take action to eliminate 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 reproductive and sexual 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
Basis for action
6.21. Indigenous people 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, 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 believe that recognition of their
rights to their ancestral lands is inextricably linked to
sustainable development. Indigenous people 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 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. The goal of
the Decade, which is the strengthening of international cooperation
for the solution of problems faced by indigenous people 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 are incorporated throughout the
present 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 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.
Actions
6.25. Governments and other important institutions in society
should recognize the distinct perspective of indigenous people on
aspects of population and development and, in consultation with
indigenous people 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 and
their relevant organizations, develop an enhanced understanding of
indigenous people 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. 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
and enable them to have tenure and manage their lands, 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, 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, reproductive health, including family planning and sexual
health, 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.
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Chapter VII
REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTH
7.1. This chapter is especially guided by the principles
contained in chapter II and in particular the introductory
paragraphs.
A. Reproductive rights and reproductive health
Basis for action
7.2. Reproductive health is a state of complete physical, mental
and social well-being and not merely the absence of disease or
infirmity, in all matters relating to the reproductive system and
to its functions and processes. Reproductive health therefore
implies that people are able to have a satisfying and safe sex life
and that they have the capability to reproduce and the freedom to
decide if, when and how often to do so. Implicit in this last
condition are the right of men and women to be informed and to have
access to safe, effective, affordable and acceptable methods of
family planning of their choice, as well as other methods of their
choice for regulation of fertility which are not against the law,
and the right of access to appropriate health-care services that
will enable women to go safely through pregnancy and childbirth and
provide couples with the best chance of having a healthy infant.
In line with the above definition of reproductive health,
reproductive health care is defined as the constellation of
methods, techniques and services that contribute to reproductive
health and well-being by preventing and solving reproductive health
problems. It also includes sexual health, the purpose of which is
the enhancement of life and personal relations, and not merely
counselling and care related to reproduction and sexually
transmitted diseases.
7.3. Bearing in mind the above definition, reproductive rights
embrace certain human rights that are already recognized in
national laws, international human rights documents and other
consensus documents. These rights rest 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 attain
the highest standard of sexual and reproductive health. It also
includes their right to make decisions concerning reproduction free
of discrimination, coercion and violence, as expressed in human
rights documents. In the exercise of this right, they 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 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 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 relevant
services in most countries. Older women and men have distinct
reproductive and sexual health issues which are often inadequately
addressed.
7.4. The implementation of the present Programme of Action is to
be guided by the above comprehensive definition of reproductive
health, which includes sexual health.
Objectives
7.5. The objectives are:
(a) To ensure that comprehensive and factual information and
a full range of reproductive health-care services, including family
planning, are accessible, affordable, acceptable and convenient to
all users;
(b) To enable and support responsible voluntary decisions
about child-bearing and methods of family planning of their choice,
as well as other methods of their choice for regulation of
fertility which are not against the law and to have the
information, education and means to do so;
(c) To meet changing reproductive health needs over the life
cycle and to do so in ways sensitive to the diversity of
circumstances of local communities.
Actions
7.6. All countries should strive to make accessible through the
primary health-care system, reproductive health to all individuals
of appropriate 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 and post-natal care,
especially breast-feeding and infant and women's health care;
prevention and appropriate treatment of infertility; abortion as
specified in paragraph 8.25, including 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, 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, including 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 primary health care, including reproductive
health-care programmes.
7.7. Reproductive health-care programmes should be designed to
serve the needs of women, including adolescents, 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.
7.8. Innovative programmes must be developed to make information,
counselling and services for reproductive health accessible to
adolescents and adult men. Such programmes must both educate and
enable men to share more equally in family planning and in 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, including AIDS, should
be promoted and made accessible with adequate information and
counselling.
7.9. Governments should promote much greater community
participation in reproductive 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 health.
7.10. 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 health is poor and in some cases deteriorating.
Those countries, at the same time, must themselves give higher
priority to reproductive 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.
7.11. Migrants and displaced persons in many parts of the world
have limited access to reproductive health care and may face
specific serious threats to their reproductive health and rights.
Services must be particularly sensitive to the needs of individual
women and adolescents and responsive to their often powerless
situation, with particular attention to those who are victims of
sexual violence.
B. Family planning
Basis for action
7.12. 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 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.
7.13. 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 contributed
considerably to the decline in average fertility rates for
developing countries, from about six to seven children per woman 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
7.14. 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 the 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
7.15. Governments and the international community should use the
full means at their disposal to support the principle of voluntary
choice in family planning.
7.16. 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 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 reproductive health services
which are not against the law. 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.
7.17. 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 health services aimed at ensuring responsible,
voluntary and informed consent and also regarding service
provision. In-vitro fertilization techniques should be provided in
accordance with appropriate ethical guidelines and medical
standards.
7.18. Non-governmental organizations should play an active role in
mobilizing community and family support, in increasing access and
acceptability of reproductive health services including family
planning, 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.
7.19. 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.
7.20. Specifically, Governments should make it easier for couples
and individuals to take responsibility for their own reproductive
health by removing unnecessary legal, medical, clinical and
regulatory barriers to information and to access to family-planning
services and methods.
7.21. 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 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.
7.22. 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.
7.23. 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
such means as 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.
7.24. Governments should take appropriate steps to help women
avoid abortion, which in no case should be promoted as a method of
family planning, and in all cases provide for the humane treatment
and counselling of women who have had recourse to abortion.
7.25. 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 contraceptives and other
commodities essential to reproductive health programmes of
developing countries and countries with economies in transition.
The international community should also consider such measures as
the transfer of technology to developing countries to enable 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.
7.26. 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 prevention
of human immunodeficiency virus (HIV)
Basis for action
7.27. 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.
7.28. 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
7.29. 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
7.30. Reproductive health programmes should increase their efforts
t