UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
************************************************************************ The electronic preparation of this document has been done by the Population Information Network(POPIN) of the United Nations Population Division in collaboration with the United Nations Development Programme ************************************************************************ AS WRITTEN Cairo Conference September 1994 Dr. Nafis Sadik invited me to speak at this forum today and I am honored to be here with you. Many of you in this room are population professionals who were among the first to see that unwanted pregnancies posed risks and problems for women, as well as for countries trying to provide a better life for their people. Without your early efforts and understanding, fewer countries would have articulated population policies, family planning programs would be far less evolved,and many more women would have suffered the consequences of unwanted pregnancies. Others of you here today have longed been involved in women's health and development issues. The fact that you have all joined together here to forge a common agenda, each adding a new perspective, shedding a new light from a different angle on the issues of population and development is what makes this conference so significant and so unique We owe you all a debt of thanks for what you've done to prepare for this conference and especially for your consensus building work; for making your voices heard and then listening to each others voices. With the perhaps inevitable but sad tendency the world has to focus on discord and controversy, not enough has been said about the ground breaking consensus that marks this conference. In addition, I want to thank the Clinton Administration for returning the United States to its historic leadership role on this issue. It is fortunate for all of us that Secretary Tim Wirth has the vision that allows him to see that non-governmental organizations bring all kinds of new energies, skills and knowledge to the table;that without the participation and input of women in the field whose lives are most affected by this issue, international population policies could never have moved beyond a narrow focus on quotas to address human rights, women and child health and appreciate the breadth of cultural differences. This new, inclusive approach to policy-setting is a long time in coming, and I hope it will be a model for future initiatives of all kinds. In the relatively short period of time that I have been trying to understand these issues, I have seen the landscape change dramatically. In fact, it's hard to believe how differently people think about and talk about population today as compared to even two or three years ago. What are some of the things that have been learned: that providing contraception is critical but not sufficient Why? -Because women do not control their sexual or reproductive lives; -Because women with no education, no legal status and no financial independence are in no position to negotiate issues like the planning and spacing of their children, and are often at risk of violence from uncooperative spouses; -Because in many countries where women have no secure social and economic roles apart from motherhood, large families are necessary to uphold their status and provide them with assistance with work as well as old age security; -Because too often there are limited forms of contraception available which may not be medically appropriate or personally acceptable to a particular woman; -Because sometimes a family planning provider's interest in her client does not extend beyond reducing fertility and neglects other aspects of the woman's reproductive health needs as well as the concern she has for her children's health. Under these circumstances, it is unlikely that the woman will develop trust in the provider and become a consistent contraceptive user. Fortunately, today there are ample examples of well run, successful family planning programs that exemplify the principles espoused in the Cairo Plan of action. Many of these programs have certain key features which are achievable by mainstream programs. I think these features have been best and most charmingly described by Dr. Mahmoud Fathalla, director of ob-gyn at Assiut University, Egypt who presented them in February at the Population Council's Symposium on "Family, Gender and Population Policy." He calls them "The Ten Commandments of Reproductive Health Care: A Signpost For All Clinics." "As a woman-friendly service: 1. We uphold the principle that family planning is a dignified and voluntary informed choice. 2. We are open to serve you at times of your convenience, not ours. Our outreach services will knock at your door. We need your business. 3. We excel in counseling. We not only listen to you, we hear you. 4. We offer you a broad choice of the good "oldies" as well as the very newest contraceptive technologies. we seek to meet your needs and preferences. 5. We are not in the business of promoting contraceptive methods for their demographic impact. We do not subscribe to demographic targets or quotas. Your safety and convenience is our primary concern. 6. We only add to our inventory methods that our service can deliver which insure your safety and with full respect for your voluntary choice. 7. We encourage and promote men's participation and responsibility. 8. In the event you are faced with the possibility of or are burdened by an unwanted pregnancy, you will find us sympathetic and caring. 9. We care as much about protecting you from sexually transmitted diseases as we care about protecting you from unwanted pregnancy. We will not miss an opportunity to help you with other reproductive health needs or problems. 10. Our demographic competitors are running out of business. We are in business. We are the future." I would like to point out that programs offering these features often do not cost more than other programs, and because they tend to attract and keep a larger clientele, their fixed costs are spread over larger numbers making them more cost effective than programs which neglect these vital elements. What else have we learned? We've learned that educating girls, economic and legal empowerment of women, things which are important in and of themselves, also have a provable effect on fertility decline. When a woman is educated, when she is able to earn some money outside her home, money over which she has control, when she has access to credit and training, she gains status, wants and needs fewer children, can negotiate family planning with her partner from a position of strength and the children she does have will tend to be healthier and better prepared for the emerging economy. In addition, the improved health, education and earning capacity of women leads to better management of natural resources. About 50% of the world's food is grown by women. It is estimated that two - third's of women in developing countries who work, work in agriculture, mostly unpaid subsistence farming. They hoe, plant, weed, harvest, store, process, cook and take care of livestock, including cattle, sheep and goats. They are the ones who walk miles and spend hours, sometimes days, collecting water, fire wood and fodder. All this has provided women with profound knowledge about crop diversity, soil conditions and water quality. They are the ones who are most impacted by environmental degradation and have the most to gain by protecting the local ecosystems. Sustainable development begins and ends with women. To give this a real voice, I'd like to quote a Hill woman from Nepal. I found this quote in a pamphlet called "Seeds," dealing with forest conservation in Nepal. "By law, we villagers are only allowed to collect what has fallen on the ground in the forest. The trees are used for timber for building for those lucky enough to be sold a permit by the forest officers. Women are left with the leaves, branches and twigs. Once, it too difficult to find wood on the ground, but now there is not even enough leftover to fill one headland, unless you walk for miles and miles, and no fodder unless you cut the branches. Even when I travel a long way into the forest, I still have to cut branches illegally to get a large enough headland to cook for my family. If I'm caught by a forest guard, he takes my cutting tool, or tells me I have to pay a stiff fine, but what can I do? As it is now, I must bring my daughter with me to help collect fuel and fodder, so she often skips school to help me. I would rather that she got a good education so she would have a good chance in life, but I have no choice. There are too many other chores to complete. I now go to the forest everyday that I have no work in the fields or grain to thresh or grind, and one headload (about 35 pounds) lasts only a few days. If fuel gets even more scarce, I will have to take my daughter out of school completely so she can help me with my other tasks." In addition to the fact that women produce the food and fodder for their families, evidence from numerous studies done in developing countries show that when women are able to earn and control their money, they spend it in ways that benefit their families' health and welfare. Men, on the other hand, tend to spend their incomes on entertainment and consumer goods. In addition, women in developing countries deliver basic health care to their families and communities. Given all this, why is it then that women in these countries are discriminated against when it comes to education, inheritance, land ownership, jobs, training and resources; girls receive less health care and food than boys; women do not fully participate in or benefit from development policies? Why is it that too often women are not consulted and listened to when programs are being put in place? Over and over again, experience shows that when women are involved from the outset,programs stand a far better chance of succeeding, the lives and status of women and children are improved. and often this is linked to fertility decline. Too often governments and lending institutions undermine women with poorly defined economic programs on the one hand, while at the same time actively trying to engage them in limiting fertility, thus wiping out with one program what is being attempted with another. There are numerous examples of development approaches in Africa and other parts of the world which give priority to men even when women are the primary producers. For example, when cooperatives are formed, only one member of the family (which will turn out to be the male) isallowed to participate, freezing the women out of new input, training and access to land, making her subsistence work more difficult and increasing her need for more helpinq hands. Another example is the large-scale agricultural intensification projects which put more demand on women's time and energy without compensation, reducing her ability to farm sustainably. Just as natural resources are not infinite, neither is women's energy. Both can only be stretched so far. By increasing women's need for children to help with the work, we also undermine women's desire to reduce child numbers. But in some countries, Zimbabwe for example, there are active efforts to improve women's access to land and credit, modernize their livelihoods, and this is reflected not only in economic returns but in high contraceptive use. Disinvestment in women can be avoided, and our approach to aid and development can be made more coherent, if development plans, social and economic investment policies and national budgetary guidelines are reviewed at a high government level by some coordinating body in light of their fertility as well as their justice implications. Population policy cannot solely be in the purview of Health Ministries. Likewise, the policies of the international lending institutions should not compartmentalize population concerns, separating them from education,from promotion of livelihood, health and so forth. If population is important, this concern should be spread throughout the development portfolio. We mustn't permit our development policies to be driven by politics or special interests or even altruism for that matter. They should be driven by enlightened self-interest. To quote Janice Jiggins in her book changing the Borders, "Protecting and strengthening the capacities of girls and women is the bottom line in the survival of humankind as a species dependent on its environment. It is thus essential for human survival that economic theory, policy and practice in both rich and poor countries begin to measure, value and reward the services provided by women and by the environment." The good news is that there is a slow but steadily growing appreciation that it makes economic, social and demographic sense to invest in women. This new direction is being lead by innovative, smaller institutions such as Women's World Banking, ACCION International, and Grameen Bank in Bangladesh, who have fostered women's economic entrepreneurship and independence. Following their lead, the larger bilateral and multilateral donors are beginning to direct more and more of their funds towards women. Why is this happening? Because the banks always hard to impress ... are impressed. They've seen that women can manage their finances better and that support for women's economic activities is more likely to benefit the community at large and the health and education of the next generation. These lending institutions have begun to recognize that women in developing countries are agents of change. We've begun to learn that, just as we can foster economic growth and fertility decline by investing in women, we can promote a more humane and equitable relationship between men and women which, as a byproduct, encourages voluntary fertility decline. When a father shares the rearing of and support for his children, he may be more prone to share the mother's desire to limit family size. But there are countries which will agree to the Cairo Plan of Action where children still only have effective claims to their father's resources if the father wishes, or where the father's name appears on the birth certificate. There are countries in which the father's name only appears on the birth certificate if the parents are married. Even countries with "good laws" do not implement their ideal of shared parental responsibility. There is much default in enforcing child maintenance policy. We must encourage men to be emotionally and financially responsible for their children. Laws, norms of behavior and media images all have vital roles to play. Let us hope that the young men of today grow up with a sense of responsibility about their sexuality, about their fertility and about parenting. Can we afford to properly expand and improve our family planning programs world-wide? Can we afford to reproduce economic empowerment programs and education for women? You bet! In fact, we can't afford not to. It's a question of priorities and of developing a new understanding of national and global security. If the United States and the former Soviet Union could spend over 10 trillion dollars during the Cold War to prepare for a possible threat, we can surely find enough money and resources to deal with dangers that are actually occurring. Cairo will soon be over. The Plan of Action will have to be put into action. We need to walk our talk," and we particularly need the help of the world's media to do this. It is true that changing our laws and institutions can alter human behavior, but to alter people's consciousness and do it fast, the media will need to play its role. We've all experienced the media's power to change things, whether its through the use of popular soap operas in Mexico, India and the Philippines which have helped make family planning acceptable to a wide audience or in the United States with the acceptance of seat belts, recycling and other life style changes. You don't see movie characters showing their cool by heading straight for the bar and lighting up at the beginning of a scene anymore. Like it or not, television and movies in particular have become powerful sources of education about how to live and behave and raise families for people who have no formal education. In addition, people will need to understand what has been decided here in Cairo, the importance of these problems and the need to be involved in their solutions. All of us In whatever way we can have to help create a critical mass for family planning and reducing consumption so that if a boy or girl is asked, "What will you do to help heal the world?", they would start by saying, "I will live more simply and only have the number of children I feel I can support and care for." We need to communicate to people the value that life is sacred, that children have the right to be wanted and that it's irresponsible to have more children than you can support. But parents here in the developing countries or in the north for that matter cannot do this alone, individually. We must have commitments from our national governments to also invest in women and children and make them the center of our economic planning. In a sense, we're asking ourselves to start doing what comes unnaturally. Throughout human history, we've been exhorted to go forth and multiply. All the western religious doctrines have encouraged this. In part, it's because countries and churches needed bodies to fill the ranks of their armies as they went forth to fight the infidel. But it goes back even farther, hundreds of thousands of years to our ancestors, Homo Erectus, when the human brain evolved to what it is today. At that time, evolutionary advantage went to those who were most adept at seeing and reacting to the most immediate danger and screening out the rest. to those who spread their sperm wide and fast and early. The Homo Erectus, who sat there pondering the implication of slaughtering all the Woolly Mammoths, most likely had his head bit off before he could reproduce. As the biologist E. O. Wilson said, "Prophets never enjoyed a Darwinian edge." Our brains may not have evolved since those days, but reality has changed, and so must our thinking. We are not prisoners of our biology. We must reconceputualize the way we live in light of limited resources and a limited capacity to invest in the next generation. Quality, not quantity, is the path to the future. All of us have important and difficult things to do. Change is always difficult and entails some discomfort and inconvenience. Population numbers is only part of the equation. The other part is what kind of consumers we are in the industrialized world and what kind of consumers we will become in the developing world. We in the highly consuming countries must change our patterns of consumption, invest in the forgiving, energy efficient, low waste producing technologies and share these technologies with the developing countries. We need to learn that enough is enough, that "more" doesn't necessarily translate into"happier." People in the developing countries, with bilateral and multilateral support from aid-giving nations, must change their social investment patterns to support their women and children. This is essentially what the Cairo Plan of Action is all about. It will require a shifting of gears, making some tough adjustments, but if we make them now, they can be humane and good, not especially jarring. If we don't, adjustments will be made for us by nature and they will be brutal and pitiless. If that occurs, we will not be the first species to have weakened and disappeared, nor the first civilization. History is littered with civilizations who fell victim to short-term definitions of self-interests. Let us learn from history.