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 SLOWING POPULATION GROWTH AND ACCELERATING SUSTAINABLE DEVELOPMENT A Call to Action An Address to the International Conference on Population and Development Lewis T. Preston President The World Bank Group Cairo, Egypt September 6, 1994 SLOWING POPULATION GROWTH AND ACCELERATING SUSTAINABLE DEVELOPMENT A Call to Action Introduction: Difficult Questions I think it is important to keep reminding ourselves why we are here. Most of us have attended this kind of large conference before. We meet; we highlight the issues; we reach a consensus; we make promises. Then we go home -and, all too often, there is very little action. We cannot afford to let that happen in Cairo. The stakes are too high. Putting it bluntly: if we do not deal with rapid population growth, we will not reduce poverty-and development will not be sustainable. A billion people already struggle to survive on a dollar a day. Two billion people are without clean water. Three million children die each year from malnutrition. And yet, population in the developing countries will increase more during this decade than ever before-by some 80 million people a year. Within the next thirty-five years, global population will increase by about half. South Asia's population will grow by two-thirds. Sub-Saharan Africa's will more than double. Who will feed and house the additional numbers? How will they be educated and employed? And what will be done to relieve the inevitable stresses on the environment? These are difficult questions. But to a great extent, we know the answers. The problem is that we are not doing enough-quickly enough-to implement the basic actions that experience has shown to be effective. Critical Actions The Cairo Program of Action offers us the proper perspective on rapid population growth: it is a symptom of poverty-and an obstacle to poverty reduction. We know that as incomes increase-and people lead longer, healthier lives- fertility decreases. Rapid fertility declines in East Asia, for example, went hand-in-hand with steady economic growth and improved living standards. In Sub-Saharan Africa, by contrast, the population growth rate of more than 3 percent over the past decade has been running far ahead of the economic growth rate of less than 2 percent. Africa's people have paid the price in terms of declining incomes and increasing poverty. Our approach to population policy, therefore, must be part of a broader strategy to reduce poverty-through sustainable growth and investments in people. Three types of investment are particularly important: - First is basic health care, especially for women and children. In many of the poorest nations, one in every ten children dies before its first birthday. Reducing these appallingly high infant mortality rates-so that parents do not have to worry so much about their children's survival-is essential to reducing fertility rates. - Second, we know that birth rates decline when women are given access to education. An educated woman is more likely to delay marriage, space her pregnancies, and have fewer and healthier children. She is also likely to earn more if she works and to invest more in her children's education. Yet, nearly 100 million girls are currently denied education. The goal of universal primary education is something that we can-and must-achieve within the next generation. - Access to family planning services is a third critical investment. Combined with economic growth and social investment, access to family planning has shown remarkable results in countries as diverse as Indonesia, Mexico, and Zimbabwe. Even in very poor countries where income growth and investment in people have lagged, family planning has made a big difference. Average fertility rates in Bangladesh, for example, have declined from seven births per woman in the mid-1970s to close to four in the 1990s. Cost Effectiveness These kinds of investments ate highly cost effective, but not high cost: - The Bank estimates, for example, that a basic preventive health care package-including maternal and child care-can be provided at an annual cost of about $8 per person in the poorest countries. - Raising girls' primary school enrollment rates to equal boys' would cost just under $1 billion-or only 2 percent of annual education spending by the developing world. - Resources needed for family planning services are also relatively modest. Around $ 5 billion per year is currently spent on family planning in the developing countries-which is less than 5 percent of military expenditures. Clearly, financing is not the main issue. Much of the money required can be generated trough redirecting resources toward priorities-and making sure that they are used efficiently. Nor need all the additional investment come from government budgets. There is ample evidence that people are willing to pay for family planning services, provided they have access to them. The role of Donors and the Bank Donors support, of course, remains important, particularly in the poorest countries. But it must be better tailored to meet individual country needs-and to offer people a range of appropriate choices. The proportion of couples using some kind of fertility regulation has increased from 10 percent thirty years ago to more than 50 percent today. Further and faster progress depends on making those services even more responsive to people's needs. That means listening even more to what people want-and we donors are not always very good at listening. The World Bank's support for poverty reduction focuses on the same investments required for a broad approach to fertility reduction. About half of the projects that we finance, for example, now include specific components aimed at empowering women. Last year, we committed almost 2 $ billion for education alone-much of it focused on keeping girls in school. Over the last five years, the Bank has also become one of the largest financiers of family planning and reproductive health services. Close to $ 200 million was committed last years- and this is projected to increase by 50 percent over the next three years. Quality, however, matters more than quantity. The Bank-and all of us-must do more to ensure the effective implementation of the programs we support: - by better targeting our resources, so that they reach the poor - by strengthening partnerships among all those engaged in this effort to enhance overall impact - by keeping population issues at the forefront of the policy dialogue. Conclusion: A Shared Responsibility The world's rapid population growth rate affects us all. Addressing it is a responsibility that we all share-which brings me back to why we are here. The issue cannot be resolved around the conference table. It can only be resolved when individuals decide that it is in their own best interest to have smaller families, so that more resources can become available for education, health, and poverty reduction. The international community must help to create the conditions in which they can make that choice. If this conference is to have any meaning beyond words and good intentions, we must act-now. Thank you.