UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
Distr. GENERAL
E/CONF.84/PC/6 16
December 1992
ORIGINAL:
ENGLISH
PREPARATORY COMMITTEE FOR THE
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Second session
Item 3 of the provisional agenda*
SUBSTANTIVE PREPARATIONS FOR THE CONFERENCE
Recommendations of the Expert Group Meeting on Population
and Women
Report of the Secretary-General of the Conference
SUMMARY
In response to Economic and Social Council resolution 1991/93, the
Expert Group Meeting on Population and Women was convened in Gaborone,
Botswana, from 22/to 26 June 1992 as part of the preparations for the
International Conference on Population and Development to be held in
1994. The findings of the Expert Group are presented in the present
report for consideration by the Population Commission acting as the
Preparatory Committee for the Conference in the context of the review
and appraisal of the World Population Plan of Action. The Meeting
focused on linkages between enhancing the roles and socio-economic
status of women and population dynamics, including adolescent pregnancy
and motherhood, maternal and child health, education and employment,
with particular reference to the access of women to resources, their
role as environmental managers, and the provision of services. The
Expert Group reviewed the state of knowledge regarding those topics
and, based on that review, sought in its recommendations to identify
practical steps that could be taken to promote equality between women
and men, that would help empower women and that would also have
desirable economic and demographic effects.
* E/CONF.84/PC/3.
92-82557 3711h (E) 160293
/...
CONTENTS
Paragraphs Page
INTRODUCTION ...............................................1 - 7 3
A. Background ........................................2 - 4 3
B. Opening statements ................................5 - 7 4
I. SUMMARY OF THE PAPERS AND DISCUSSION ..................8 - 70 5
A. General issues of gender equality, population and
development ....................................... 11 - 17 6
B. Health ............................................ 18 - 31 8
C. Adolescents ....................................... 32 - 35 11
D. Family planning ................................... 36 - 38 12
E. Education and its relationship to fertility and
child health and welfare .......................... 39 - 51 13
F. Women's economic activity and demographic factors . 52 - 67 17
G. Women, population and the environment ............. 68 - 70 20
II. RECOMMENDATIONS .......................................71 - 74 21
A. Preamble .......................................... 71 - 73 21
B. Recommendations ................................... 74 22
INTRODUCTION
1. The Expert Group Meeting on Population and Women was held in
Gaborone, Botswana, from 22 to 26/June 1992. It was the third of six
expert group meetings convened to address topics of high priority for
the International Conference on Population and Development, which will
take place in Cairo from 5/to 13 September 1994.
A. Background
2. The Economic and Social Council, in resolution 1991/93 of 26 July
1991, decided to convene an International Conference on Population and
Development under the auspices of the United Nations. It was decided
that the overall theme of the Conference would be population, sustained
economic growth and sustainable development. The Council also
authorized the Secretary-General of the Conference to convene six
expert group meetings as part of the preparatory work, to address
selected topics, including "linkages between enhancing the roles and
socio-economic status of women and population dynamics, including
adolescent motherhood, maternal and child health, education and
employment, with particular reference to the access of women to
resources and the provision of services". 1/ The Expert Group Meeting
on Population and Women was held in response to the resolution.
3. The Meeting was organized by the Population Division of the
Department of Economic and Social Development, United Nations
Secretariat, in consultation with the United Nations Population Fund
(UNFPA). The participants, representing different geographical
regions, scientific disciplines and institutions, included 14 experts
invited by the Secretary-General in their personal capacities;
representatives of four of the five regional commissions (Economic
Commission for Africa (ECA), Economic Commission for Latin America and
the Caribbean (ECLAC), Economic and Social Commission for Asia and the
Pacific (ESCAP) and Economic and Social Commission for Western Asia
(ESCWA)); representatives of United Nations offices and specialized
agencies, including the United Nations Office at Vienna, the United
Nations Children's Fund (UNICEF), the United Nations Development
Programme (UNDP), the United Nations Development Programme for Women
(UNIFEM), the United Nations Centre for Human Settlements (Habitat),
the International Labour Organisation (ILO), the Food and Agriculture
Organization of the United Nations (FAO), the United Nations
Educational, Scientific and Cultural Organization (UNESCO), the World
Health Organization (WHO); and representatives of the following
non-governmental organizations: Center for Development and Population
Activities, Institute for Resource Development, the International
Planned Parenthood Federation and the International Union for the
Conservation of Nature/World Conservation Union. Two additional
non-governmental organizations were represented by experts who were
also invited in their personal capacities: the International Union for
the Scientific Study of Population and the Population Council. There
were also 19/observers.
4. As a basis for discussion, the experts prepared papers on the main
agenda items. The Department of Economic and Social Development
prepared a background paper entitled "Population and women: a review
of issues and trends". Discussion notes were provided by the
Department of Economic and Social Development, ECA, ECLAC, ESCAP,
ESCWA, the United Nations Office at Vienna, UNICEF, ILO, FAO, WHO, the
Center for Development and Population Activities, the Institute for
Resource Development, the International Planned Parenthood Federation,
the International Union for the Conservation of Nature/World
Conservation Union, the International Fund for Agricultural Development
(IFAD), the United Nations Environment Programme (UNEP) and a member of
the Australia International Development Assistance Bureau.
B. Opening statements
5. Opening statements were given by Dr. Nafis Sadik, Secretary-General
of the Conference, by the Honourable Festus Mogae, Vice-President and
Minister of Finance and Planning of the Government of Botswana, and by
Mr./Shunichi/Inoue, Deputy Secretary-General of the Conference and
Director of the Population Division.
6. After welcoming remarks by Dr. Josephine Namboze, the United
Nations Resident Coordinator in Botswana, ad interim, Dr. Sadik noted
that Botswana provided an especially fitting venue for the meeting,
citing the host country's history of attention to women's issues and
concerns at the ministerial level. Botswana was also one of the few
countries in which educational attainment of women equalled or exceeded
that of men. Mr./Mogae affirmed his Government's conviction that
gender was an essential and critical factor in development, that women
made major contributions to the wealth of nations, and that empowering
women by enhancing their productive activities, income and education
and, more generally, their right to make decisions in all spheres of
their lives would bring important benefits to society as a whole.
Mr./Inoue also stressed the long-standing and increasing attention by
the international community to women's roles and status as an important
factor for understanding demographic change and as a vital feature of
social and economic development.
7. Dr. Sadik's remarks introduced many of the themes that were
discussed at the week-long meeting. She urged the participants, in
considering population and development issues, to focus on practical
actions that recognize women's rights and autonomy and that enhance
women's participation in the development process. She stressed
particularly that women's reproductive rights were central to the
realization of women's potential in economic production and community
life. The ability to exercise free and informed choice regarding the
number and spacing of their children was the first step in enabling
women to make choices in other areas. Dr. Sadik noted that in many
societies, young women were trapped within a web of tradition that
assigned a high value to their reproductive role, taking little note of
any other role they could play, and that for too long, inequity between
women and men had been tolerated and, indeed, excused because of
so-called "customs" and "traditions". She noted further that there
were practical steps that could be taken to promote equality between
women and men. Among them were the removal of remaining legal barriers
to women's full equality; policies to improve the education of girls;
and programmes to provide reliable information about reproductive
rights and reproductive health; high quality family-planning services;
and whatever health-care services were needed to combat disease and
promote healthy childbirth. In discussing reproductive health, she
pointed out the high rates of adolescent pregnancy in both developed
and developing countries, noting particularly the elevated risks to
life and health of early childbirth and the fact that all too
frequently early motherhood foreclosed a girl's prospects for
education, employment and self-realization. Men's involvement was, of
course, essential if women's overall situation was to be improved and
their effective role as agents of socio-economic development
recognized. At the same time, it was also necessary to pursue
initiatives that would put qualified women in positions of power and
decision-making.
I. SUMMARY OF THE PAPERS AND DISCUSSION
8. In addition to a more general exchange of views and evidence on
women's roles and status in the course of development and on the
interrelations between development and population programmes and
women's status, the Meeting devoted particular attention to the
following areas: women's health, especially reproductive health, and
women's roles and status in relation to the health of children and
other family members; adolescent fertility, marriage and reproductive
health; a gender perspective on family-planning needs and programmes;
education of girls and women, and the relationship of education to
fertility and to child health and welfare; women's economic activity
and its relationship to fertility and to child health and welfare; and
women's role as environmental managers, and environmental issues in
relation to women's health and reproductive and productive roles. The
situations of both developed and developing countries were considered,
although the main emphasis was on the latter.
9. In drawing up recommendations, the Group sought to identify
practical steps that could be taken to promote equality between women
and men, that would help empower women and that would also have
desirable economic and demographic effects. The Group also reviewed
the state of knowledge on the topics mentioned above and made
recommendations regarding needs for research and data collection.
10. Gender issues have been the focus of increasing international
attention in a variety of contexts, including human rights and equity
and women's integration into processes of social and economic
development. There is now an impressive array of international
declarations and agreements concerning women's rights to equal status
in many aspects of life. These include the Convention on the
Elimination of All Forms of Discrimination against Women (1979) and
agreements on equal pay for work of equal value (1953), equal political
rights (1954), maternity protection (1955), equality in employment
(1960), equality in education (1962) and equal marriage rights (1964).
Other international agreements dealing with women's roles and status
and population include the World Population Plan of Action (1974) and
the Recommendations for Further Implementation of the Plan (1984), the
Nairobi Forward-looking Strategies for the Advancement of Women (1985),
the Safe Motherhood Initiative (1987) and the Amsterdam Declaration on
a Better Life for Future Generations (1989). The Expert Group noted
that international declarations and agreements provided sound
guidelines, but that much remained to be done in terms of implementing
them.
A. General issues of gender equality, population and
development
11. Participants noted that recommendations adopted at
intergovernmental meetings often spoke of rights and responsibilities
of families or couples, ignoring the practical reality of unequal
authority and power in gender relations (ESD/P/ICPD.1994/EG.III/5).
One need identified at the Meeting was for more attention to be
directed to men's roles in the family.
12. Paradoxically, although policy makers recognized that women's
status remained inferior and their roles restricted in many ways,
"women acting on behalf of the family are seen as agents of change
in all aspects of population policy whether it be the adoption of
family planning, the provision of health care for children or the
acquisition of independent economic livelihoods. ... [Yet] women
cannot bring about the demographic transition alone. ... Men will
have to play their part and, before that can be accomplished, much
more must be understood about men's reproductive and familial roles
and about how the costs and benefits of children are distributed"
(ESD/P/ICPD.1994/EG.III/4).
13. Population and development programmes made many assumptions/- often
implicit ones/- about interrelations and changes within families which
resulted in aggregate changes in fertility and mortality rates:
"Assumptions about the roles women and men play within the family
and the intra-family distribution of resources are implicit in the
linkage typically drawn between rising costs of children and
declining demand for children: (a)/that improvements in women's
individual livelihoods outside the family provide them with greater
individual economic mobility and thus less reliance on children and
other family members for future economic support; (b) that fathers
share with mothers joint responsibility for their children's
maintenance and upbringing; and (c)/that parents support each of
their children to the same extent. These assumptions structure the
collection and analysis of demographic data and the design of
population policy" (ESD/P/ICPD.1994/EG.III/4).
These assumptions were not justified in some settings. Researchers and
policy makers thus needed to make a more careful and critical
examination of particular social and cultural conditions if they were
to design policies that would truly benefit women and those who
depended upon them, and would also have the expected demographic
effects. That would also require gathering some types of information
from men which were currently usually obtained only from women surveyed
on fertility, family planning and child health.
14. On the basic question of whether development tended to improve
women's status, the Group saw no simple answer, since women had many
roles, and the various aspects of women's status did not change in
unison or in response to the same forces. The Group agreed, though,
that improving women's status would advance development.
"There are areas such as health and education where, sooner or
later, the economic gains do flow on to women. But equally there
are other areas such as legal rights, equal pay and treatment in
the labour force and women's political decision-making power where
there is no necessary/or clear relationship between the status of
women and the level of development. ... Equality for women
depends not on the level of development or the economic resources
available but on the political will of Governments and on the
cultural setting in which women have to live. Equality is not
attained in a zero sum game in which gains for women can only
result from losses to men. Instead, because equality for women
promotes economic growth through more effective utilization of
existing resources, poor countries which opt for equity (through
equal legal rights and access to economic resources) can thereby
speed up the pace of development" (ESD/P/ICPD.1994/EG.III/DN.15).
15. One recurrent theme of the discussions was the need for women to be
represented in much greater numbers at all levels of planning, managing
and executing population, health and development programmes/- both for
reasons of equity and as a precondition for success. Women's concerns
could not be promoted effectively through a single ministry alone. The
Group noted that those needs were currently widely recognized in a
variety of international agreements and in statements of goals and
policies issued by many international groups. However, there remained
a great divide between stated goals for involving women in programmes
and current reality.
16. Another theme was the need to devise programmes that would help
women living in poverty. Access to remunerative employment and
effective control over the resources they needed to make a living would
help poor women solve other problems, including poor access to health
care for themselves and their children. Poor women also generally had
higher fertility, including higher levels of both desired and unwanted
fertility, than the rest of the population.
17. Gender analysis/- a process of explicitly and systematically
examining gender balance among those in decision-making roles, those
involved in executing programmes, and those who receive the benefits of
programmes/- was seen as a useful means of directing attention towards
the extent to which development, health and other policies and
programmes actually involved women and met their needs.
B. Health
18. The Group agreed that the speed with which modern health services
had been embraced by the populations of developing countries was worth
noting, since it represented a break with traditions that were
resistant to change in other ways. Equally notable, though, was the
extent to which access to and use of health services was allocated
according to status determined along the traditional lines of sex, age
and familial role. In some societies that meant that women and girl
children were often denied the benefits of modern health care. Despite
their inferior position, women were commonly seen as the custodians of
family health; yet their poor education and limited authority
undermined their ability to protect their own health and that of their
families (ESD/P/ICPD.1994/EG.III/7). Recommended policy responses to
the situation included both actions aimed at improving women's access
to health care and information, and efforts to inform and involve other
family members.
19. The Group noted that reproductive and sexual health implied much
more than preventing maternal death.
"Health is defined in the Constitution of the World Health
Organization (WHO) as a state of complete physical, mental and
social well-being and not merely the absence of disease or
infirmity/... [In respect of reproductive health] this implies
that people have the ability to reproduce, that women can go
through pregnancy and childbirth safely, and that reproduction is
carried to a successful outcome, i.e., infants survive and grow up
healthy. It implies further that people are able to regulate their
fertility without risks to their health and that they are safe in
having sex" (ESD/P/ICPD.1994/EG.III/DN.8).
It was agreed that achieving positive reproductive health required
policies and programmes that included but also looked beyond prevention
of maternal death. However, given the paucity of statistical
information about many aspects of reproductive health, attention had
tended to focus on maternal mortality as an index of reproductive
health conditions more generally.
20. WHO estimated that approximately 500,000 women died each year of
causes related to pregnancy and childbirth, of which 99 per cent took
place in developing countries. Most of those deaths were preventable.
A major fraction of them were the consequence of unsafe abortion/-
estimates range from about 100,000 to over 200,000 deaths annually.
Africa remained the region where the risk of maternal death was
highest, averaging an estimated 630 per 100,000 births; 1 in 20 African
women could expect to die for pregnancy-related reasons, at prevailing
levels of maternal mortality and fertility. Major contributors to
maternal as well as infant mortality included poor nutritional status
among pregnant women/- WHO estimated that 50/per/cent of pregnant women
world wide suffered from nutritional anaemia/- and the continuing lack
of prenatal care and adequately trained birth attendants in many areas.
Births at the extremes of the reproductive ages and closely spaced
births also involved increased risks to mother and child. Since many
of such high-risk births occurred to women who did not want any more
children or who would have preferred a delay, improved access to
effective family-planning methods could also reduce risks of maternal
mortality. Better access to effective contraceptives could also
greatly reduce/- although it would not by itself eliminate/- unsafe
abortion (ESD/P/ICPD.1994/EG.III/8, DN.6, DN.8).
21. Another aspect of sexual and reproductive health that received
attention at the Meeting was the prevention and treatment of sexually
transmitted diseases. The spread of such diseases was regarded as "one
of the major disappointments in public health in the past two decades"
(ESD/P/ICPD.1994/EG.III/DN.8). Sexually transmitted diseases had
important, and often hidden, health consequences for women. They were
a major cause of infertility, for instance, and they increased the risk
of life-threatening ectopic pregnancy. Some affected the developing
foetus or were transmitted around the time of birth, often with
devastating consequences for newborns. Those that produced genital
ulcerations also heightened the risk of transmission of the human
immunodeficiency virus (HIV), which caused acquired immune deficiency
syndrome (AIDS). The risk of transmission of sexually transmitted
diseases was generally much greater from man to woman than the reverse,
and the health consequences of many of the diseases was also much more
serious for women.
22. Although up until the Meeting, AIDS had been more common among men
than women globally, from the beginning of the AIDS epidemic, the
disease had affected African men and women in roughly equal numbers,
and WHO estimated that by the year 2000 the number of AIDS cases would
be equal in men and women world wide. Infected women transmit the
infection to 30-40 per cent of their children.
23. Even though there had been a great deal of medical research into
the diagnosis and treatment of sexually transmitted diseases, and the
assessment of their prevalence in selected populations, the state of
knowledge remained very poor regarding the underlying behavioural risk
patterns in different population groups; knowledge and beliefs among
the general population regarding sexually transmitted diseases and
their treatment; how often sexual partners of those infected are, in
practice, informed of their risk; and other social barriers to
combating the spread of such diseases. The AIDS epidemic had given new
urgency to those questions, and results of social science research
undertaken in response to the AIDS crisis were beginning to appear.
The Group had before it a paper summarizing results of a number of
research projects carried out in sub-Saharan Africa under the auspices
of the WHO Global Programme on AIDS (ESD/P/ICPD.1994/EG.III/9).
24. Women were usually more at risk of sexually transmitted diseases,
including AIDS, because of the behaviour of their male partner than
through their own sexual activity. Societies with a strong double
standard regarding sexual behaviour/- such that men had numerous sexual
partners before and after marriage, while women's behaviour was
strictly controlled and limited to marriage/- were likely to place
women at a particularly high risk, greater even than in societies where
it was common for both men and women to be sexually active outside of
marriage but where the number of different partners tended to be small
(ESD/P/ICPD.1994/EG.III/9).
25. A key factor to consider in programmes to combat the transmission
of sexually transmitted diseases was whether women had the power to
refuse sex or to insist that their partner use a condom. Cultural
values regarding sexual abstinence, which predated modern concerns
about disease transmission, differed among societies and by gender.
Women's ability to negotiate regarding sexual relations was likely to
be tied to other aspects of their status, including their financial
independence. Research into that aspect of women's autonomy was only
beginning. Scattered research results pointed to marked differences
between societies in women's degree of control over sexual relations,
but in some cases had failed to confirm common preconceptions of
women's powerlessness in that regard.
26. The Expert Group agreed that combating reproductive health problems
required more vigorous action than had so far been forthcoming from
Governments and non-governmental organizations. Research was still
needed to establish basic facts about sexual behaviour and risks and to
improve the medical and pharmaceutical means available to combat risks.
There was a pressing need for public education about reproductive and
sexual health, including sexually transmitted diseases and their
prevention. In order to reach more of those at risk, educational
channels beyond the formal health system, including schools and mass
media, should be employed.
27. Family-planning services were viewed as vital for improving
reproductive and sexual health, and the Group recommended that
Governments, non-governmental organizations and the private sector
should assure women and men as individuals confidential access to safe
methods of fertility regulation within the framework of a health-care
system that could provide adequate support services and information to
users of contraception. The Group also recommended that women who
wished to terminate their pregnancies should have ready access to
reliable information, sympathetic counselling and safe abortion
services. Governments and non-governmental organizations were urged
actively to promote safer sex, including the use of condoms, and to
provide preventive, diagnostic and curative treatment to inhibit the
transmission of sexually transmitted diseases. A potential was seen
for family planning and other health programmes to become more actively
involved in relevant screening, counselling, referral and treatment.
That would increase physical access to services for those with sexually
transmitted diseases and help break down social barriers to seeking
treatment. Even for those with access to services, the risk of social
stigmatization might discourage persons needing treatment from seeking
it, and women were especially likely to be deterred. It was noted that
providers of family planning and other specialized health services had
sometimes resisted offering such services (and other types of service)
out of concern about jeopardizing their core programmes. The
representative of the International Planned Parenthood Federation, the
leading international non-governmental organization of family-planning
providers, strongly endorsed the need for family-planning programmes to
promote reproductive and sexual health more broadly
(ESD/P/ICPD.1994/EG.III/DN.4), as did representatives of the United
Nations Office at Vienna, UNFPA, and WHO, among many others.
28. Reproductive health also implied the ability to bear children that
were wanted. Although the number of women and men desiring large
families had declined in all regions, children remained universally
valued and desired. Even in societies where women's social standing
was not heavily dependent on reproduction, the large majority of women
wished to become mothers. And, where women's status remained closely
tied to motherhood, childlessness often represented a personal
disaster, and "the repudiated wife with no children, or none surviving,
may be able to support herself only by prostitution"
(ESD/P/ICPD.1994/EG.III/7).
29. Domestic violence, incest and rape were extreme consequences of
women's powerlessness. Children were also frequently victims of abuse.
Too often the most basic information regarding the extent, frequency
and severity of those problems was lacking. That contributed to a
failure to confront those issues through public debate, programmes to
help and protect victims of abuse, enforcement of social and legal
sanctions, and efforts to provide women with the resources that would
render them less vulnerable.
30. The Group strongly condemned the traditional practice of female
genital mutilation, or female circumcision. The practice entailed
serious health risks not only at the time of the surgery, which was
often done under unsterile conditions, but also later in life, when
consequences could include painful and difficult intercourse, repeated
surgery before and after each childbirth, and obstructed labour which
could lead to stillbirth and maternal death.
31. Women often encountered health-threatening conditions at the
workplace, ranging from difficulties in continuing to breast-feed
infants to sexual harassment to exposure to toxic substances, from
which pregnant women and developing foetuses often faced an elevated
risk. There were many practical actions that employers and Governments
could take to improve conditions for women at the workplace. The paper
contributed by the ILO representative summarized relevant international
agreements and recommendations (ESD/P/ICPD.1994/EG.III/DN.11).
C. Adolescents
32. Young women and men received particular attention in the Group's
discussions, because actions taken in adolescence were crucial for
later life. For young women, especially, early marriage or early
motherhood could foreclose educational and employment opportunities.
Very young mothers typically faced risks of maternal death much above
the average, and their children also fared less well.
33. Child-bearing was only one aspect of teenage reproductive health.
Adolescents were, in many countries, increasingly at high risk of
contracting and transmitting sexually transmitted diseases, including
HIV/AIDS, and they were often poorly informed about how to protect
themselves. Young women were especially vulnerable because of their
subordinate social position due jointly to young age and female sex.
The Group strongly urged Governments to promote education and provision
of employment opportunities, particularly for girls, and advised
Governments and non-governmental organizations to promote adolescent
reproductive health, including provision of family life education with
a realistic sex education component, family-planning and reproductive
health services, and enforcement of laws regarding minimum age at
marriage./2/
34. In considering adolescent motherhood and marriage, it was important
to consider what choices were actually open to adolescents of all
social and economic classes. "Poor teenage girls may correctly
perceive that attempting to achieve an alternative role will entail
facing and overcoming enormous obstacles; they will therefore drop out
of school because education is not seen as particularly useful, rather
than because they are already pregnant or because they are being
pressured into marriage" (ESD/P/ICPD.1994/EG.III/10). Even where
educational or employment opportunities existed, though, adolescents
might be poorly informed about them, and they frequently faced
conflicting pressures. Governments and non-governmental organizations
were urged to adopt policies and programmes that would provide young
women of all social classes with real alternatives to early marriage
and child-bearing.
35. Substantial declines in teenage marriage and fertility from
traditionally high levels had occurred recently in some regions/-
notably, Northern Africa, South-Eastern and Western Asia/- and levels
were also quite low in Western and Northern Europe and East Asia.
However, in South Asia, sub-Saharan Africa and Latin America and the
Caribbean, the level of teenage union formation and child-bearing was
still quite high. Even moderate levels of teenage fertility implied
that substantial fractions of women became mothers before the age of
20/years. For instance, in countries where the annual fertility rate
for women aged 15-19 years is about 80 per 1,000, roughly one third of
women were mothers by age 20; teenage fertility rates that greatly
exceeded that level were found in most countries of sub-Saharan Africa
and parts of Asia, and most Latin American and Caribbean countries had
rates of 80-140 per 1,000. Especially in areas of the world where a
large proportion of teenaged mothers were unmarried, such child-bearing
was seen to be undesirable for both the individuals concerned and the
society as a whole (ESD/P/ICPD.1994/EG.III/10,/11).
D. Family planning
36. The Group endorsed reproductive choice as a basic right and, as
such, a component of the status of women. Family-planning services
were also recognized as a means of improving reproductive health which
deserved support. Gaining control over their fertility had the
potential to open up to women a range of new choices.
37. There had been notable progress in extending at least minimal
family-planning services in developing countries. Since 1974 there had
been "a revolution" in birth control law and in administrative
procedures which had in the main served to improve access to
family-planning services (ESD/P/ICPD.1994/EG.III/12). Legal or
administrative requirements still limited access to a wide range of
family-planning methods in some countries, and in some places women
were required to obtain permission from husbands or parents before they
could obtain services. However, shortages of well-trained staff,
logistical problems and limited funds, rather than legal or
administrative obstacles, were often the current reasons for poor
access to family-planning services. Recent surveys in the primarily
African and Latin American countries covered so far through the
Demographic and Health Surveys (DHS) programme indicated that fertility
would fall by around one quarter in sub-Saharan Africa and by one third
in Latin America if the current unmet need for family planning were
fully met (ESD/P/ICPD.1994/EG.III/DN.9). Part of the reason that the
unmet need remained high was that the number of children women desired
had been declining in all regions. The number of persons in the
reproductive ages was however growing rapidly. Thus, the need for more
and better services had grown, and had in some countries outpaced the
growth in services provided.
38. Some participants strongly criticized existing family-planning
programmes for their tendency, in practice, to ignore the justifiable
concerns of women/- and men/- about side effects and other problems
with contraceptive methods, for their failure to provide complete and
accurate information to clients, for their tendency to dictate which
method women should use instead of offering a real choice and, in
general, for their concern with achieving quantitative programme
targets for numbers of "acceptors" rather than with meeting the needs
of individual women and men. There was agreement that family-planning
programmes needed to improve quality of care and to adopt the "user's
perspective" in evaluating programme services. In order to do that
effectively, it was seen as necessary that programmes involved women/-
who usually made up the large majority of clients/- much more heavily
in all levels of programme policy-making, management and service
delivery, but especially at the highest levels. Recognizing that women
and men needed methods that were both safe and effective, and that all
existing methods had drawbacks that made them unsuitable for some
people, the Group also emphasized the need for development of improved
methods, including a re-examination of traditional methods, and the
need for programmes to pay more attention to attracting men as clients.
E. Education and its relationship to fertility and child
health and welfare
39. The Group took note of the fact that literacy and enrolment rates
were increasing globally, and the difference between male and female
school enrolment rates had narrowed somewhat. In 1990, UNESCO data
indicated that just over half of the world's youth aged 6-23 years were
enrolled in school/- 56/per/cent for males, but only 48 per cent for
females. In the major developing regions, 1990 enrolment ratios for
females aged 6-23 years ranged from 32 per cent in Africa (excluding
Arab States) to 42-46 per cent in Asia and the Arab States, to 63 per
cent in Latin America; in the developed regions the ratio was 72. The
enrolment ratios for both sexes had risen considerably since 1960, with
most of the improvement taking place during the first half of the
30-year period (ESD/P/ICPD.1994/EG.III/3, 13).
40. There was a disturbing sign, however, in the recent declines in
enrolment rates for both sexes in several African countries. The Group
voiced concern that programmes for structural adjustment of poorly
performing economies could produce underinvestment or disinvestment in
education and training as well as health. The Group urged
international organizations and donors as well as Governments to
recognize them as productive sectors of the economy, vital for the
formation of a new generation of workers.
41. The overall educational gains between 1960 and 1990 were larger for
females than for males, and the gender disparity declined by over one
third. In the developed countries the gender disparity in primary and
secondary school enrolment rates, which was sizeable in 1960, had
essentially disappeared by 1990. The female disadvantage hardly
existed in Latin America, but it remained large in Africa and Asia. In
relative terms, the gender disparity in enrolment rates had been and
remained largest at the upper educational levels.
42. Despite recent gains, in Latin America over 20 per cent of women
aged 25/or over remained illiterate, over 40 per cent in Eastern and
South-eastern Asia, and as many as 70 per cent in sub-Saharan Africa
and Southern and Western Asia. Thus, there had been notable progress
in combating illiteracy, but poorly educated women would comprise the
majority in much of the developing world for many years to come
(ESD/P/ICPD.1994/EG.III/13).
43. Recent research had confirmed the strong and far-reaching
demographic effects of education on both fertility and child survival,
and had given some insight into the behavioural changes that were
responsible for those demographic effects. Much less progress had been
made in answering questions such as: does the type of education, as
well as its amount, have consequences for fertility and child health?
How does the prevailing cultural setting limit or channel the
demographic effects of women's education? There, several participants
noted that although education might indeed give women more autonomy in
some areas of household life, educated women might remain very
restricted in other ways, depending on the cultural setting. Education
might, for instance, make women better able to obtain health care for
their children but leave them with no say over major household
expenditures or the spending of their own income. There was some
evidence that in cultures where sons had traditionally been strongly
preferred, educated women generally retained those preferences
undiminished, which had implications for fertility and child health.
44. Although education had an important effect on child survival and
fertility, it was also true that if fertility and child mortality were
to continue to decline rapidly at the national level, the declines must
be spread broadly through the population and not be confined to the
highly educated. Indeed, the recent declines in both fertility and
child mortality had usually occurred across the educational spectrum,
although so far without in general diminishing the often very wide
differences between the more and the less educated in mortality risks
or in the level of fertility. While some populations showed a degree
of convergence, in others the demographic differences between education
groups had only become wider over time. Even in developed countries
education differences in fertility and child survival persisted.
45. Developing-country women with secondary or higher education almost
invariably had much lower fertility than less educated women, but in
countries where the general level of development was low or where the
general level of fertility had so far shown little decline, the impact
of primary education on fertility was not uniformly the inverse. In
almost all settings, and particularly where fertility differences
between educational groups were large, the level of unmet need for
family planning and the level of unwanted fertility were highest among
the least educated. Recent research had helped clarify the effects of
education on several important proximate fertility determinants, which
also helped explain why the relationship between education and
fertility was not always strictly negative: while education led to
later marriage and to increased use of contraceptives, both of which
reduced fertility, it also led to lesser observance of traditional
means of birth-spacing (extended breast-feeding and, in some
populations, an extended period of post-natal sexual abstinence), which
tended to raise fertility (ESD/P/ICPD.1994/EG.III/13).
46. Research on education and fertility or child survival had usually
concentrated only on the amount of formal education. The possible
effects of non-formal education on demographic factors had rarely been
considered in empirical studies, and the Group noted that there was
need to assess the demographic and other impacts of such education.
47. Other areas needing more research attention included the connection
between the child's education and parental efforts to limit family
size, and the reverse relationship - namely the impact of number of
siblings on children's education. Explanations of reasons that more
affluent and better educated parents usually desired and had smaller
families tended to focus on the trade-off between greater numbers of
children and, in economists' terms, higher "child quality", which
involved greater investment in the upbringing of each child. Direct
and indirect costs of child schooling were a major aspect of such
investment. Better educated parents tended to want educated children,
and that might be an important factor leading to lower fertility among
the better educated. At the same time, public policies that made it
easier for even uneducated parents to send their children to school
might have a wide-reaching effect on parents' evaluation of the
relative merits and feasibility of having more children, or a smaller
number of educated children. Such educational policies could in theory
have a quicker effect on fertility than the parents' own education,
since the latter could operate only after the educated children matured
and made choices about their own child-bearing.
48. New research also confirmed the strong effects of mother's
education on child survival, and there had been some progress in
understanding how education produced that beneficial effect. Education
had some effect on the prevalence/- but more especially on the
treatment/- of childhood diseases. The children of educated mothers
were more likely to be immunized against disease, and they were much
more apt to receive modern medical care when ill. Educated women were
themselves more likely to have a medically trained birth attendant and
to have received prenatal care and immunizations, which benefited both
mother and child. Educated women were also less likely to be extremely
young or old when they gave birth, or to have a large number of births,
all factors that have been associated with both maternal and child
death. Children of more educated women were also better nourished, on
average. Although better educated women also tended to be married to
husbands of higher status and to live in households that were better
off in material terms, the mother's education tended to be more
important than those other social factors in improving child health and
survival (ESD/P/ICPD.1994/EG.III/14).
49. The effects of women's education on their own health benefited
children as well, although those effects had not been as well measured
as had the relationship between maternal education and child survival.
As a consequence of their greater likelihood of using health services,
of avoiding high risk pregnancies and of experiencing fewer
pregnancies, they were considerably less likely to die in childbirth
and thereby orphan their children.
50. Even a few years of maternal education usually had a significant
effect on child survival. Results for 25 developing countries surveyed
as part of the Demographic and Health Surveys programme showed that the
odds of a child dying before age 2 if the mother had 1-3, 4-6 or at
least 7/years of schooling were, respectively, 15, 35 and 58/per/cent
lower than those of a child whose mother had no education. Even after
statistical controls for a variety of other social factors, including
the father's education and occupation, children whose mothers had seven
or more years of schooling had only about half the risk of dying faced
by the children of the uneducated. However, the latest research also
showed that the relationship between education and child survival was
weaker in most sub-Saharan African countries than in other regions.
The reasons for that remained to be determined
(ESD/P/ICPD.1994/EG.III/14).
51. Especially in developing countries, much less was known about the
effect of maternal education on broader aspects of child development
and welfare, including mental and emotional development, than about
education's effect on child survival. Positive concern for child
health/- beyond mere survival/- was seen as one area to which
researchers should devote increased attention. Doing so would require
small-scale and intensive types of investigation to supplement the
large sample surveys which had been the basis for most of the research
linking education and other social variables to child survival.
However, there was still much that could be learned through large
surveys, as had been shown in recent years by the expansion of survey
content, particularly in the Demographic and Health Surveys programme,
into health and related areas.
F. Women's economic activity and demographic factors
52. Although women's economic contribution was greatly understated in
currently available statistics, the Group noted that even the available
data indicated that in all parts of the world women made up substantial
proportions of the population employed in the formal economy.
Statistics compiled by ILO showed that, in 1985, 37 per cent of the
labour force world wide was female: 42 per cent in developed, and 35
per cent in the developing regions. In Africa, 35/per/cent of the
recorded labour force was composed of women; in Asia (exclusive of
China), 28 per cent; in China, 43 per cent; and in Latin America,
27/per cent (ESD/P/ICPD.1994/EG.III/3).
53. Increased opportunities in the paid labour force were generally
agreed to encourage lower fertility, although the reverse was also
true: lower fertility made it possible for women to participate in the
labour force. However, the types of work most commonly done by women
in many developing countries were not uniformly associated with lower
fertility. On the contrary, poor women with large families might be
driven to seek work in order to provide basic subsistence.
54. Incompatibility between modern-sector work and child care was
commonly regarded as a fundamental reason for expecting working women
to have fewer children. The types of work open to poor, uneducated
women/- such as agricultural labour, small-scale trading and domestic
labour/- could often be combined with child care to some degree, and it
was primarily among those engaged in paid work in the modern sector
that lower fertility was observed.
55. There were a number of complicating factors that made it
problematic to assign the work/fertility relationship to any single
factor such as time conflicts between work and child care. For
instance, in developing countries, alternative, affordable child care
was readily available to well-educated, higher status women, who were
typically the ones with access to well-paying jobs in the modern
sector. In such settings, incompatibility between work and child care
did not occur, or at least was greatly lessened. Yet, it was precisely
employment in the modern sector that had most consistently been
associated with lower fertility, in developing as well as developed
countries. Other factors that might be involved included less tangible
aspects of work, particularly when employment provided a separate
source of social esteem and personal fulfilment that offered women an
alternative to social status based mainly on her roles as wife and
mother. It was also difficult in practice to separate effects of
employment from other personal, social and cultural characteristics
that might jointly influence fertility and the propensity for women to
join the labour force. Characteristics such as education, which
strongly affected a woman's access to good jobs, might be more
important than employment itself in producing a relationship between
employment and fertility (ESD/P/ICPD.1994/EG.III/15).
56. Plainly not all jobs provided an attractive alternative to a
home-centred life. Access to jobs offering good pay and enhanced
status often depended on an individual woman's education and other
qualifications.
57. However, access to good jobs also depended on the broader social
and economic setting. Discriminatory practices that led to large gaps
in the wages that women and men could earn served as an incentive for
women/- at least those who were in stable marriages/- to "specialize"
in domestic work, and for the husband to specialize in earning income,
with little of his time and energy devoted to the domestic sphere. In
some societies, prevailing cultural views regarding acceptable roles
for women severely constrained the job choices of even the
well-educated. In such societies small numbers of high-status women
and some women who would otherwise be destitute might work outside the
home/- the latter in menial jobs which conferred low status in exchange
for a meagre livelihood.
58. Although some observers had pointed to women's increased
participation in the labour force as a key factor in producing the
extremely low levels of fertility (total fertility rates in some cases
below 1.5 children per woman) that were seen in some industrialized
countries, the evidence was not straightforward, and it remained
indeterminate how important growing participation in the labour force
was, as compared to other forces, in producing low fertility. Although
over the longer run rising rates of women's participation in the labour
force in developed countries had been accompanied by fertility
declines, a more detailed examination showed that trends in such
participation did not correspond well with the timing of fertility
increases and decreases. In addition, the countries where women were
most likely to be formally employed were not necessarily those with the
lowest fertility.
59. It was beyond dispute that, in both developed and developing
countries, many parents experience stress over the competing demands of
jobs and children. That was particularly true for women who continued
to do most child care and housework, whether or not they also had other
work. It was the total burden of those conflicting demands on women's
time as well as the contributions of men/- not simply the level of
participation in the labour force or economic conditions in general/-
that must be the focus of attention in order to comprehend the reasons
for exceptionally low fertility. One expert observed that some
Scandinavian countries, which had taken the lead in public policies to
harmonize work and family responsibilities and where men were more
likely to assume some of the burden of child care and housework,
currently had substantially higher fertility than countries such as
Japan, Spain and Italy, where economic opportunities had been opening
to women but where there was not much change in the traditional
division of labour within households or much commitment through
policies and programmes to easing the conflicts between formal
employment, child care and housework.
60. It was also noted that employment opportunities might in some cases
have less effect on child-bearing within marriage than on women's
decisions about when, or even whether, to marry. Japan was an example
of a society where increased employment of women during recent decades
appeared to have had a greater effect on timing of marriage than on
fertility within marriage. "While a woman's job may induce a male to
feel that he could 'afford' to marry, it could also encourage a woman
to feel that she could 'afford' not to marry"
(ESD/P/ICPD.1994/EG.III/17).
61. There was little firm evidence regarding the possible relationships
between women's economic activity and child welfare, particularly in
developing countries. On the one hand, paid work benefited children by
improving the family's economic standing. There was also evidence from
several settings that more of women's income than men's income was
spent on child-oriented expenses such as food, clothing and education,
and less on entertainment, tobacco and alcoholic beverages. However,
there was not enough evidence to tell how generally the latter findings
held. In some settings women had no control over the spending of their
earnings (ESD/P/ICPD.1994/EG.III/16).
62. A mother's involvement in market work might affect children
negatively through a reduction in the time she spent caring for
children and their exposure to alternative care which, for poor women
in many developing countries, was likely to consist of no care or care
from siblings. Yet, there was very little evidence on the point. In
fact, the literature suggested several mechanisms that attenuated the
superficially obvious relationship. In many developing countries women
engaged in work such as small-scale trading and agriculture which
allowed them to take children along to the workplace. Women might also
reduce their leisure time to meet the demands of children and work.
Additionally, the image of a home-maker as able to provide a warm
nurturing environment which her employed counterpart could not,
underestimated the demands of domestic work on women in rural areas of
many developing countries. Time lost to arduous, time-consuming tasks
of household maintenance such as gathering fuel and carrying water was
not counted as employment and indeed was nowhere reflected in commonly
available statistics. Such tasks might require poor women to leave
young children untended for long periods or tended by a slightly older
child. There was evidence that children's health suffered under such
arrangements, and there was the additional problem in the latter case
that children (frequently girls) were kept away from school in order to
care for younger siblings (ESD/P/ICPD.1994/EG.III/3, 16).
63. Actual child-care arrangements, the effects on children of
different types of child care, and the relationships of women's market
and domestic work to child care and child welfare were seen as areas
needing more research, particularly in developing countries. In
considering those issues, researchers and policy makers needed to pay
attention to the total burden on women's time and not restrict
attention to employment as reflected in current statistical systems.
64. The possibility that work away from home might impede women's
ability to breast-feed young children had prompted studies in a number
of developing countries. The studies generally found that working
women were no less likely to initiate breast-feeding than those who
were not employed, but some studies found that employed women
introduced supplementary foods earlier. Where supplements were
prepared under unsanitary conditions, early supplementation could pose
a risk to child health. Nevertheless, it was not clear from available
evidence whether the health of working women's children was affected by
work-induced changes in breast-feeding patterns. For one thing, as a
growing number of studies examined infant-feeding patterns in more
detail, it became clear that in many societies, supplements such as
water or fruit juice were traditionally given to infants starting at a
very young age, during the period that less detailed investigations
were likely to classify simply as "full" breast-feeding. Thus, the
risks posed by breast-milk supplements might be quite widespread, with
the mother's employment status being at most a minor factor. However,
at a more general level the benefits of breast-feeding for child health
and nutrition were very well documented, and efforts should continue to
encourage workplace conditions that would make it possible for women to
continue breast-feeding.
65. The Group noted that home-based and part-time employment was in
some circumstances the only available way for women to earn an income
and as such was a practical necessity for many poor women. However,
the Group also noted that work under those conditions often involved
low earnings and little or no increase in autonomy, that the equipment
and substances involved in home production were sometimes hazardous,
and that such labour conditions often resulted in exploitation by
employers.
66. Recognizing that increased economic productivity for women was
vital for their own interests and for national development, the
recommendations adopted at the meeting referred to a variety of actions
that Governments and employers could and should take in order to
increase the access of women to productive and remunerative employment
and to protect the rights of women and men at the workplace. Policies
and programmes should include measures aimed at enabling parents to
harmonize the demands of work and caring for children, elderly parents
and other dependents, and at encouraging fathers in particular to
assume more responsibility for child care and household maintenance.
Such policies should not be aimed at women employees only but should
rather be framed and applied in a gender-neutral manner.
67. Related to those concerns was the need for better data collection
about women's economic activities. Undercounting of women's employment
was common, particularly for women in rural areas and those who helped
run family enterprises. More generally, there was "need for
development that pays greater heed to the value of a poor woman's time.
Labour-saving devices are so quick to develop for men and for the
better-off population as a whole. Poor working women, on the other
hand, do an unenviable double shift of work for all practical purposes,
so that it is often the home maintenance tasks rather than the demands
of her job that take the most time and attention away from the child"
(ESD/P/ICPD.1994/EG.III/16).
G. Women, population and the environment
68. It was agreed by the Group that environmental issues were linked to
population factors in a variety of ways. While environmental issues
concerned men and women alike, some environmental problems had a
disproportionate impact on women. For example, certain substances
employed in manufacturing or in agriculture posed heightened risks to
pregnant women and to foetal development. Women's exposure to
environmental toxins might also differ from men's because the type and
location of daily activities differed by sex. Frequently, women had
also been the first to notice environmental hazards, and the first to
protest publicly about them.
69. The Group focused particular attention on environmental problems in
rural areas of developing countries, and the need to involve women
fully in programmes to solve those problems and to achieve sustainable
development. While population growth was by no means the only cause of
environmental degradation in such areas, it was inevitably a
contributing factor. As population had increased, areas suitable for
agriculture had become crowded, marginal lands had often been brought
into production, and water resources had been depleted. Soil erosion
and deforestation had resulted, and traditional ways of living in
harmony with the environment had been disrupted.
70. Those problems could not be solved without providing means for
people in those areas to escape from poverty. Nor could they be solved
without a correct understanding of women's roles as de facto
environmental managers, and without ensuring that women were involved
at all levels of planning and execution of programmes in those areas.
Particularly in poor rural areas women's work as mothers and guardians
of family health were not clearly separated in time and place from
their other work, and, as noted above, statistical indicators often
failed to reflect their economic contribution at all. Women's
statistical invisibility in labour force data for poor rural areas,
coupled with a failure to study and understand local, culturally
specific gender divisions of labour, social life and rights to assets
had often led to programmes of rural development which failed to help
women and sometimes undermined their traditional livelihoods
(ESD/P/ICPD.1994/EG.III/18, 19):
"... women must be regarded more seriously as producers, and be
given appropriate training and skills to become more productive, so
that they can contribute more effectively to alleviate the poverty
of rural families in particular. The purpose is not to remove them
from the family or create independent women's power. Rather, it is
to enhance their productivity, in ways that add to their capacity
and value within the community, giving them more 'bargaining' power
for fairer treatment by officials ... and family members"
(ESD/P/ICPD.1994/EG.III/18).
II. RECOMMENDATIONS
A. Preamble
71. Governments, intergovernmental and non-governmental organizations
have increasingly accorded high priority to women's roles and status.
It has been widely accepted that women's advancement, health, education
and family planning are mutually reinforcing and should be pursued
simultaneously and in a holistic manner. Sustainable development
cannot be achieved without the full participation of both women and men
in all aspects of productive and reproductive life, including care and
nurturing of children and maintenance of the household. It is critical
to recognize that gender roles are diverse and changing. National
economic and demographic goals cannot be attained unless the needs of
women as citizens, workers, wives and mothers are met.
72. The equality between men and women is proclaimed in the Universal
Declaration of Human Rights. The interrelationships between women and
population are affirmed in the World Population Plan of Action (1974)
and in the Recommendations for its Further Implementation (1984), the
Nairobi Forward-looking Strategies for the Advancement of Women (1985),
the Safe Motherhood Initiative (1987) and the Amsterdam Declaration on
a Better Life for Future Generations (1989).
73. While acknowledging that some progress has been made, the Expert
Group Meeting on Population and Women recognizes that there are
numerous issues concerning women and population that still need to be
addressed, both at the international and national levels. The Meeting
notes that, at the international level, there are several adequate
instruments and guidelines, but they need to be fully implemented at
the national level.
B. Recommendations
74. Reaffirming the provisions of internationally adopted instruments
that relate to the linkage between women and population and recognizing
the importance of devising practical measures that will help to empower
women, the Expert Group Meeting on Population and Women adopts the
following recommendations:
Recommendation 1
Governments, intergovernmental and non-governmental organizations
are urged in the implementation of stabilization, structural adjustment
and economic recovery programmes to recognize health and education as
productive sectors which are particularly critical for women. These
sectors play a fundamental role in human capital development and in the
formation of future generations of workers.
Recommendation 2
Gender-based analysis should become an essential instrument in the
design, implementation and evaluation of all development activities,
including economic planning and population and development policy
formulation. Sensitization to gender issues should be a priority in
all activities, including population. Programme managers are urged to
develop and utilize training materials and implement courses of
training in gender issues. Governments, donors and the private sector,
including non-governmental organizations and for-profit corporations,
should assist with and support development of such training materials
and courses.
Recommendation 3
Governments should ensure that development policies and strategies
are assessed for their impact on women's social, economic and health
status throughout the life span.
Recommendation 4
Donors, Governments and non-governmental organizations are urged to
seek culturally appropriate modalities for the delivery of services and
the integration of women into population and development initiatives.
They are urged to provide widespread access to information and services
responsive to women's concerns and needs and to stress women's
participation.
Recommendation 5
Efforts are needed to balance the representation of women and men
in all areas of population and development, particularly at the
management and policy-making levels, in both the governmental and the
private sectors.
Recommendation 6
Governments and non-governmental organizations should promote
responsible parenthood. Children are entitled to the material and
emotional support of both fathers and mothers, who should provide for
all their children of both sexes on an equitable basis. Governments
should adopt specific measures to facilitate the realization of these
rights.
Recommendation 7
Governments should strengthen efforts to promote and encourage, by
means of information, education, communication, employment legislation
and institutional support, where appropriate, the active involvement of
men in all areas of family responsibility, including family planning,
child-rearing and housework, so that family responsibilities can be
fully shared by both partners.
Recommendation 8
Women who wish to terminate their pregnancies should have ready
access to reliable information, sympathetic counselling and safe
abortion services.
Recommendation 9
Governments should adopt measures to promote and protect adolescent
reproductive health, including the teaching of family life education
with a realistic sex education component, appropriate counselling and
services to girls and boys. Governments are urged to work with
adolescents themselves and to draw upon non-governmental organizations
that have experience in this area.
Recommendation 10
So as to ensure the rights of young women to health and of young
women and men to education and employment opportunities, Governments
are urged to enforce laws pertaining to minimum age at marriage and
raise awareness of the importance of this issue through appropriate
communication strategies.
Recommendation 11
Family-planning programmes, in their efforts to reach both women
and men, should be consonant with the cultural setting and sensitive to
local constraints on women and should provide all aspects of quality
care and services, including counselling, reliable information on
contraceptive methods, informed consent and access to a wide range of
contraceptives. Family-planning programmes should also address
infertility concerns and provide information on sexually transmitted
diseases, including HIV/AIDS.
Recommendation 12
Sexually transmitted diseases have important, and often hidden,
health consequences for women, increasing the incidence of reproductive
tract infections, with consequent risks of life-threatening ectopic
pregnancy. Reproductive tract infections and genital ulcer diseases
also heighten the risk of transmission of HIV/AIDS, with potentially
fatal consequences for mothers and their children. Therefore,
Governments and non-governmental organizations must promote safer sex,
including the use of condoms, and must provide preventive, diagnostic
and curative treatment to inhibit the transmission of sexually
transmitted diseases.
Recommendation 13
Governments, non-governmental organizations and the private sector
are urged to give priority to the adoption of measures to promote the
health of women and girls. These measures should encompass the
nutrition and health needs of young girls and women, women's
reproductive health, and the implementation of the Safe Motherhood
Initiative. Priority should also be given to monitoring the impact of
these measures.
Recommendation 14
Various forms of female genital mutilation are widespread in many
parts of the world and cause great and continued suffering, impaired
fecundity and death. Governments should vigorously act to stop this
practice and to protect the right of women and girls to be free from
such unnecessary and dangerous procedures.
Recommendation 15
Governments, non-governmental organizations and the private sector
should ensure women and men as individuals of confidential access to
safe methods of fertility regulation within the framework of an
adequate health care system.
Recommendation 16
Governments and non-governmental organizations are urged to make
special efforts to improve and equalize the school enrolment and
attendance of girls and boys at all levels of education. Recognizing
the difficulty of some families in permitting their daughters or sons
to attend school, innovative strategies need to be devised which
respond to existing socio-economic and familial constraints. There is
also need for increased sensitivity to young women's reasons for
dropping out of formal education, whether as a result of early
marriage, pregnancy or economic need. Policies and programmes must be
adopted which will enable them to continue their education.
Recommendation 17
Governments and non-governmental organizations should make efforts
to ensure that women of all ages who have little or no formal schooling
are provided with special non-formal education which would assist them
to gain access to remunerative employment, knowledge of their legal
rights, information on family and child health, nutrition and fertility
regulation and information on services for which they are eligible.
This should complement/- rather than substitute for/- formal schooling.
Recommendation 18
Governments and non-governmental organizations should develop
culturally sensitive health education to increase the awareness of
health rights of all members of the family. Efforts should also be
made to achieve equal rights of access to appropriate preventive and
curative health care, regardless of age, gender or family position.
Issues such as rape, incest, child abuse, domestic violence and
exploitation based on age and gender require special attention.
Programmes that promote acceptance among men and women of equal rights
in sexual relationships are required.
Recommendation 19
Taking cognizance of the interaction between extreme poverty and
demographic trends, Governments are urged to strengthen women's access
to productive and remunerative employment.
Recommendation 20
Governments, non-governmental organizations and the private sector
are urged to develop and enforce explicit policies and practices to
ensure the protection and freedom of women from gender discrimination,
including economic discrimination and harassment, especially in the
workplace.
Recommendation 21
Governments and private-sector employers are urged to take measures
to enable parents to harmonize their economic and parental
responsibilities, including parental leave, child care, provisions to
enable working women to breast-feed children, and measures to ensure
that women and men can exercise their right to employment without being
subject to discrimination because of family responsibilities.
Recommendation 22
Governments should seek to remove all remaining legal,
administrative and social barriers to women's rights and economic
independence, such as limitations on the right to acquire, hold and
sell property, to obtain credit and to negotiate contracts in their own
name and on their own behalf.
Recommendation 23
Governments, intergovernmental and non-governmental organizations
are urged to promote awareness of the crucial role women play in
environmental and natural resource management and to provide
information and training to women on how they can promote sustainable
development. Community-based population and environment programmes
should be implemented. They should involve women's participation at
all levels and seek to reduce or alleviate women's workloads.
Recommendation 24
Governments are called upon to take measures to prevent the use of
and exposure to hazardous substances by women. Governments and
employers are urged to ensure that women doing work that is hazardous
to foetal development are offered alternative employment upon request,
without penalty.
Recommendation 25
In many countries, women take care of their husbands, children and
older relatives, often at the same time. Moreover, as a result of
population ageing in both developed and developing countries,
increasing numbers of women will be living alone or under poor
conditions or will be living with their sons and/or daughters.
Governments should develop adequate social security and medical care
systems for all women, regardless of marital status.
Recommendation 26
Violence against women and children is widespread. Governments are
required to protect women and children from all forms of violence,
including rape, incest, child abuse, domestic violence and exploitation
based on age and gender. Women refugees and those in circumstances of
war and wherever civil rights are threatened or suspended are in
special need of protection and of reproductive health care and
family-planning services.
Recommendation 27
Governments, international organizations, the pharmaceutical
industry, the medical professions and non-governmental organizations
should give urgent priority to the development and production of
improved and safe contraceptives for fertility regulation and effective
pharmaceutical products for protection against sexually transmitted
diseases. Renewed emphasis should be placed on the development of male
methods of contraception. Contraceptive research and trials of new
methods should be governed by accepted ethical principles and
internationally recognized standards. In particular, new methods
should be tested on a range of individuals in developed and developing
countries who have full information and have freely agreed to
participate in the testing.
Recommendation 28
While continuing data collection in existing areas, Governments and
funding agencies are urged to give priority to the collection of data
in areas where information is currently seriously deficient. Both
large-scale surveys and more qualitative approaches are seen as
valuable and complementary. Among the critical areas are:
(a) Structure and dynamics of the family;
(b) Women's, men's and children's diverse economic, domestic and
resource management roles, and use of time to fulfil those roles;
(c) Men's attitudes and behaviour regarding reproduction and other
topics for which data are currently obtained mainly from women;
(d) Child care arrangements;
(e) Unplanned pregnancy and abortion;
(f) Sexual abuse;
(g) Domestic and other forms of violence;
(h) Various aspects of reproductive health, including incidence of
sexually transmitted diseases.
Recommendation 29
Governments, funding agencies and research organizations are urged
to give priority to research on the linkages between women's roles and
status and demographic processes. Among the vital areas for research
are changing family systems and the interaction between women's, men's
and children's diverse roles, including their use of time, access to
and control over resources, decision-making and associated norms, laws,
values and beliefs. Of particular concern is the impact of gender
inequalities on these interactions and the associated economic and
demographic outcomes.
Recommendation 30
Governments are urged to ensure that the full diversity of women's
economic activities is properly represented in statistical systems and
national accounts.
Recommendation 31
Government statistical offices are encouraged to publish a broad
range of social, health and economic statistics and indicators on a
gender-disaggregated basis, and Governments are urged to take those
statistics into account in policy and planning.
Recommendation 32
International agencies and donors are urged to increase allocation
of resources for publication and dissemination of relevant documents in
order to promote expanded access of national research organizations,
including women's organizations, to policy-related research findings
and conceptual and methodological developments.
Notes
1/ See Council resolution 1991/93, para./4.
2/ For a discussion, see ESD/P/ICPD.1994/EG.III/11.
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