by
William J House
Adviser on Population Policies & Development Strategies
UNFPA Country Support Team, Suva


The views and opinions contained in this Report
have not been officially cleared and thus do not
necessarily represent the position of the
United Nations Population Fund

December 1999

Preface

Executive Summary

Introduction

ICPD Goals: Performance of the PICs

Quantitative Goals of ICPD PoA

Qualitative Goals of the ICPD PoA

• Reproductive Health/Family Planning - Sexual Health

• Gender Equality and the Advancement of Women

• Integration of Population Concerns into Development Strategies

• Population and the Environment

• The Implications of Changing Population Dynamics for Achieving ICPD Goals

Conclusions

References

Preface

The UNFPA Country Support Team for the South Pacific, based in Suva, Fiji, is one of eight regional technical support teams established by the United Nations Population Fund to provide countries with technical assistance and information to meet country needs in the population field. In fulfilling this function, apart from field missions, the Country Support Teams also try to foster active communication and open discussion with national experts to promote a more holistic approach to population programmes.

This Discussion Papers series has been initiated by the CST (Suva) in an attempt to establish a dialogue among national population programme personnel on the integrated and co-ordinated multidisciplinary approach to population. Hence, CST Discussion Papers are not particularly addressed to academic audiences but to practitioners.

This paper assessed the progress made by the Pacific Island Countries in meeting some of the principal quantitative and qualitative goals of the ICPD PoA in the face of prevailing constraints that the island nations face. It offers some suggestions as to how progress could be accelerated to overcome these constraints on policy and programme implementation addressed to meet the ambitious agenda of the ICPD PoA.

The purpose of this paper is to assess the progress made by the Pacific Island Countries (PICs) in meeting some of the principal quantitative and qualitative goals of the ICPD PoA in the face of certain constraints they face. It offers some suggestions as to how progress could be accelerated to overcome the identified constraints on policy and programme implementation addressed to meet the ambitious agenda of the ICPD PoA.

The ICPD PoA lays out three specific long-term goals in three major areas to be met over the next two decades, as well as intermediate goals to be achieved within one decade, i.e. by the year 2005. Using these goal indicators and threshold levels as benchmarks, according to the data available, most of the Pacific island countries have already met the quantitative goals of the PoA in almost all the major dimensions.

Yet, all 14 countries fail to meet the threshold for the contraceptive prevalence rate (CPR), a result which seems paradoxical and warrants further investigation. Indeed, fertility is widely recognized to have declined sharply across the sub-region over the past two decades, although, admittedly, the total fertility rate (TFR) remains at 5 children or more in four out of the 12 countries. Yet, as demonstrated in the paper, the actual CPRs in most countries must surely be higher than the reported rates in order to support the reported TFRs. The latter are much more likely to have a greater degree of reporting accuracy, invariably from the decennial census, than the CPRs, which are usually derived from service statistics.

While the success of the family planning programmes in the sub-region may be slightly better than the reported CPRs would lead us to believe, complacency is certainly not warranted. Fertility remains significant, while contraceptive usage still remains very low, especially in the Solomon Islands, Vanuatu, FSM, Marshall Islands and Tokelau. Some progress has been made over the longer term in raising the number of couples using contraception, in no small part due to the joint interventions of the Governments of the countries and UNFPA. Yet, the goal of attaining universal access to quality RH/FP-SH services in the sub-region still remains unrealized and presents a formidable challenge for the future. Meanwhile, I am in no position to gauge the pace of progress in the most recent years, but it could be that the rate has decelerated and tapered off as more conservative and traditional socio-economic and demographic groups are confronted with the need to change their behaviour.

If the prevailing ICPD PoA goal attainments in the PICs are to survive in the new millennium, innovative policies are required in the island nations across a broad spectrum of issues. The newer concepts of reproductive health, adolescent reproductive health and gender equity and equality need to be disseminated across all social groups and influential leaders. New service facilities, staffed with well-trained providers, will need to be constructed and strategically located to meet the needs of a burgeoning number of potential clients. Therein lies the greatest challenge. How can they improve the quality of standards already achieved and, concurrently, expand the quantity of services to provide for a growing population at a time when the economies of the PICs experience increasing strains, and public sector budgets and staff are being curtailed as part of adjustment and reform programmes triggered by the Asian economic crisis? Economic growth must be revitalized to satisfy the job aspirations of the new generation of better educated younger workers; labour market and other macro-economic policies must be introduced that will attract new investments; vocational training opportunities must be expanded to raise the human resources base of these economies and retraining schemes introduced to cater for the needs of older workers whose skills have become obsolete. And capital markets must be created or reformed to enable small-scale, informal sector entrepreneurs to gain access to investible funds that will contribute to solving the employment challenge. Without such changes the capacity of countries to maintain their prevailing social, reproductive health and demographic indicators will be severely strained.

The ICPD+5 assembly reconfirmed the duty of governments, civil society at the national level, and the international community to focus on human resources development and on building and strengthening national capacity to implement sustainable population and reproductive health programmes. The ICPD+5 assembly called for increased investments designed to improve the quality and availability of sexual and reproductive health services. Unfortunately, as the meeting recognised, the translation of the commitment made to achieving the ICPD goals into commensurate levels of donor funding has not been forthcoming at the global level.

There is no assurance of continued growth in national currency contributions of the two major bilateral organizations in the region, AusAID and NZODA. Therefore, efforts to increase contributions to the multi-lateral population programme, including initiatives in RH, need to be stepped up. This should entail approaches to other non-traditional donors, including private foundations.

Clearly, without increased efforts to garner enhanced international donor support for population activities, it will become more difficult to maintain the achievements already made in meeting some of the quantitative and qualitative goals of the ICPD PoA in the PICs and to improve on others not yet attained. Above all, radical approaches are needed to improve the quality and quantity of information and data available in the PICs. The glaring statistical gaps presently existing must be closed in order that quality data are available to monitor on-going progress in meeting the ICPD PoA goals and to prioritize the areas to where scarce resources need to be directed.

The Programme of Action (PoA) of the International Conference on Population and Development (ICPD) of 1994 is widely acclaimed as a landmark multi-country agreement, signifying the dawn of a new era in how the world community views the interface between population and development. The overriding objective of the Cairo PoA is to raise the quality of life and individual well-being, and to promote human development by recognizing the complexity of interrelationships between population and development policies and programmes. The ambitious aim is to achieve poverty eradication, sustained economic growth in the context of sustainable development, wider access to education, especially for girls, gender equity and equality, the reduction of infant, child and maternal mortality, the provision of universal access to reproductive health services, including family planning and sexual health, sustainable patterns of consumption and production, food security, human resources development and the guarantee of all human rights, including the right to development as a universal and inalienable right and an integral part of fundamental human rights (UN, 1994 and UN, 1999).

The PoA recognises that the goal of empowering women to give them greater autonomy and to improve their political, social, economic and health status is inheritantly important and is a prerequisite for national sustainable development. The right to education, especially of women and the girl child, must be promoted to meet basic human needs. In particular, the PoA calls for the elimination of all practices that discriminate against women and affirms that advancing gender equality and equity and the empowerment of women, and the limitation of all forms of violence against women, are the cornerstones of all population and development-related programmes. The ability of women to control their own fertility is an important and strategic human right and is highlighted throughout the PoA.

The PoA affirms that reproductive rights embrace certain human rights which rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health.

The implementation of the PoA is closely related to other major UN conferences held in the 1990s, especially the Fourth World Conference on Women held in Beijing in 1995 and its Platform for Action. Progress in implementing the PoA should be supportive of and consistent with the integrated follow-up to all major UN conferences and summits.

In November 1998 Ministers of Health from 15 Pacific Island countries, including Papua New Guinea, met in Nadi, Fiji to survey the progress made since the ICPD and then identified a range of outstanding issues and the required actions needed to address them. Their conclusions and recommended actions were taken to the ICPD+5 meeting at The Hague earlier this year (UNFPA, 1998).

The purpose of this paper is to assess the progress made by the Pacific Island Countries (PICs) in meeting some of the principal quantitative and qualitative goals of the ICPD PoA in the face of certain constraints they face. It offers some suggestions as to how progress could be accelerated to overcome the identified constraints on policy and programme implementation addressed to meet the ambitious agenda of the ICPD PoA.

Compared with many other parts of the developing world, some of the Pacific islands are well developed and generously endowed with resources. The Pacific island countries are generally politically stable, relatively peaceful and have social structures which are still able to cater for the basic needs of their populations. During recent years, throughout the sub-region, improvements in life expectancy, health and education reveal that much progress has been made. The countries enjoy a relatively high standard of living compared with many other developing countries. Some of the positive indicators include the following:

• Annual income levels in the Pacific island countries are relatively high compared with other developing countries, ranging from about US$700 in Kiribati to US$8,000 in Palau;
• Average life expectancy is relatively high by world standards, at over 60 years in almost all the countries, and rising to 70 years in some countries;
• Absolute poverty is virtually non-existent, although growing relative poverty is a concern in some countries;
• Overall literacy rates are generally higher than the average for developing countries;
• Early primary education is virtually universal in all the island countries, although school dropout rates are high;
• Access to health services and qualified medical staff is comparable to that in many middle-income countries;
• Infant mortality rates are low compared with those in many developing countries;
• Modern transport and communications infrastructures are readily available;
• Large parts of the population have access to safe water supplies.

The ICPD PoA lays out three specific long-term goals in three major areas to be met over the next two decades, as well as intermediate goals to be achieved within one decade, i.e. by the year 2005. These goal indicators and their threshold levels for the year 2005 are portrayed in Table 1.

Using these goal indicators and threshold levels as benchmarks, according to the data available, most of the Pacific island countries have already met the quantitative goals of the PoA on almost all the above-mentioned dimensions, as reflected in Table 2.

The Solomon Islands fails to meet 4 of the 7 thresholds while Kiribati fails to meet 3 of them. Five countries fail to meet the threshold for the maternal mortality rate (MMR), the second most under-achieved indicator. While the size of the MMR is cause for concern in Solomon Islands, FSM and Kiribati, and likely reflects relatively poor maternal health conditions in these countries, it must be stressed that this statistic is particularly unreliable in such small populations¹. Six or fewer maternal deaths in any year would raise all but two of the 14 countries beyond the threshold (UNDP, 1999).

While only three countries fail to meet the threshold for the infant mortality rate (IMR), significant progress has been made over the years in most countries in reducing this indicator. While life expectancy has, therefore, improved, it has not increased by as much as might have been expected. Offsetting the fall in the IMR has been an upsurge in the prevalence of some non-communicable lifestyle diseases, such as diabetes, hypertension, accidents, etc. particularly in middle-aged men. Such diseases and accidents are often fuelled by unhealthy eating (a diet high in fats and sugar), alcohol and drug abuse, sedentary life-styles and dangerous driving. The situation has also deteriorated in the face of rising populations, stagnating or declining public sector health budgets, and the consequent retardation in the quality of health services.

All 14 countries fail to meet the threshold for the contraceptive prevalence rate (CPR), a result which seems paradoxical and warrants further investigation. Indeed, fertility is widely recognized to have declined sharply across the sub-region over the past two decades, although, admittedly, the total fertility rate (TFR) remains at 5 children or more in four out of the 12 countries in Table 3. Yet, as we demonstrate in Table 3, the actual CPRs in most countries must surely be higher than the reported rates in order to support the reported TFRs. The latter are much more likely to have a greater degree of reporting accuracy, invariably from the decennial census, than the CPRs, which are usually derived from service statistics.

Using international cross-country data, both Westoff (1990) and Ross and Frankenberg (1993), the latter utilising more recent DHS data, have estimated the linear regression relationship between the TFR and the CPR. Ross and Frankenberg estimated the basic equation to be:

TFR = 7.2931 - .07 CPR (R² = .88) – (1)

such that a 15-point increase in the CPR implies that the TFR would fall by about one child.

Since a country’s fertility level tends to correspond closely to the proportion of couples using contraception, a TFR of, for example, 3.3 in the case of Fiji, would be hard to achieve when only 31% of women are using contraception. It seems very unlikely that service statistics can provide an accurate indication of national contraceptive prevalence rates since they do not include traditional method usage, which might be quite high. No doubt, the share of contraception due to traditional methods falls once the TFR falls below 4 to 5 births. Nor do service statistics usually account for contraceptives provided from outside the public health sector, from NGO suppliers and the private sector.

Using equation (1), but reformulating it and treating the CPR as the dependent variable, I have re-estimated the "predicted" CPR according to the reported TFR in each country. The results are reported in Table 3 and demonstrate that the achieved CPR in 10 of 12 countries where the comparison can be made is most likely to be significantly greater than that reported from service statistics. Of course, not all countries will be at the "predicted" level since there will be variation around the regression line. Still, the explanatory power of the model is very high (R² = .88) such that we feel confident in asserting that the true current levels of the CPR are grossly under-reported in the PICs.

Using these calculations, four countries (Fiji, Palau, Niue and Tuvalu) now surpass the threshold level for the CPR (above 55%) and all but Tuvalu climb above all seven thresholds in Table 2². Another five countries (Kiribati, Nauru, Cook Islands, Tonga and Samoa) now come within a 15 percentage points deficit, equivalent to about one child in the TFR, of the threshold for the CPR.

While the success of the family planning programmes in the sub-region may be slightly better than the reported CPRs would lead us to believe, complacency is certainly not warranted. Fertility remains significant, while contraceptive usage still remains very low, especially in the Solomon Islands, Vanuatu, FSM, Marshall Islands and Tokelau. Some progress has been made over the longer term in raising the number of couples using contraception, in no small part due to the joint interventions of the Governments of the countries and UNFPA. Yet, the goal of attaining universal access to quality RH/FP-SH services in the sub-region still remains unrealized and presents a formidable challenge for the future. Meanwhile, I am in no position to gauge the pace of progress in the most recent years, but it could be that the rate has decelerated and tapered off as more conservative and traditional socio-economic and demographic groups are confronted with the need to change their behaviour.

Indications are that the age-specific fertility rates of adolescents have declined appreciably in the last two decades, suggesting some success in expanding the reach of the family planning programmes (House and Nasiru, 1999). Again, however, great challenges remain outstanding for policy makers and programme managers. Early sexual activity among adolescents is believed to be growing, as reflected in rising rates of sexually transmitted infections (STIs), and growing public concern with teenage pregnancy outside of marriage. Yet, in general, adolescents do not visit public health clinics or service providers for family planning counselling and supplies because of the lack of confidentiality and the unfriendly nature of these services. Thus, major efforts are needed to improve RH/FP-SH services for the adolescent clientele throughout the Pacific sub-region.

Given that family planning programmes in the past concentrated on dealing with the "maternal and child health" (MCH) problems of mothers and their offspring, an issue arises as to whether the continuing high fertility of women in some Pacific island countries may have been inadequately addressed. Or, perhaps this relatively high fertility is wanted fertility? Where it is unwanted, a strong case can be made for public sector and NGO interventions to address the problems of those women experiencing an "unmet need" for family planning as a group deserving of priority concern. Indeed, estimates of unmet need for family planning have taken on new greater importance after the ICPD, since they provide the way to reconcile an emphasize on reproductive rights and client needs with the aggregate goals of fertility reduction that many developing countries have officially adopted (National Research Council, 1997, p. 101). Unmet need is usually defined on the basis of women’s responses to survey questions. The standard formulation was developed by Westoff (1988a, 1988b) who defined the group with unmet need as all fecund women who are married or living in union – thus presumed to be sexually active – who are not using any method of contraception but they either do not wish to bear any more children or wish to postpone their next birth for at least two more years. Those who wish to bear no more children are said to have an unmet need for limiting births; those who do not want another child for at least two more years are considered to have an unmet need for spacing births.

Some of the common causes of unmet need include inconvenient or unsatisfactory services, ignorance and lack of information about their fecund state and the need to use reliable contraception and about what services are available, fear of the side-effects of contraceptive methods, a lack of long-term methods for couples who have completed their family formation, and opposition from husbands and other members of the extended family. Other important reasons include lack of access, high cost and fatalism (Bongaarts and Bruce, 1995).

Obviously, the identification of the nature and characteristics of unmet need in each country in the Pacific sub-region could help the reproductive health and family planning programmes to respond better to the demands of these women. A programme strategy focusing on such women as a distinct audience and clientele requires a comprehension of the reasons underlying the unmet need; the determination of the size, geographic location and composition of sub-groups classified according to their socio-economic characteristics; the prioritizing of certain sub-groups which the programme would be capable of reaching; and the design of a strategy to deliver information and services to meet the essential and specific needs of the various sub-groups.

Few surveys are available from the Pacific island countries which attempt to gauge the size of the unmet need of women, and then only the unmet need for limiting births. Clearly this is a major lacunae which governments and donors in the sub-region need to address. From a 1995 knowledge, attitude and practice (KAP) survey in Vanuatu, House (1998) estimated that at least 24 percent of all adult women of childbearing age and 30 per cent of women with a husband or partner, have an unmet need for contraception for limiting the size of their families because they claim they do not want another child but are not using any form of family planning.

It is revealing to note that 47 per cent of women in the age group 35-49 years in Vanuatu are estimated to have an unmet need for family planning. This would suggest about 4,800 ni-Vanuatu women in this age category had an unmet need in 1995. Of course, some of the oldest women in this group may have experienced, or were in the process of experiencing, menopause and would not need contraception. And some, perhaps, were not sexually active. Nevertheless, despite these reservations, we can assert that the unmet need of a large number of women, especially older women, for limiting additional births in Vanuatu is significant and worthy of special consideration by planners, policy makers and donors in the family planning sector.

It is also very revealing to note that over 63 percent of older women in Vanuatu with an unmet need for limiting further childbearing have already had five children or more. Evidently, an additional pregnancy – especially when they did not want it – would place their health and their families’ socio-economic status in grave danger. The scope for information dissemination and education on family planning is large, since 20 per cent of this group have not heard of family planning and only 36 per cent have ever used family planning before.

It could well be that, in addition to Vanuatu, the other high fertility – low contracepting countries, Solomon Islands, FSM, Marshall Islands and Tokelau have comparable levels of unmet need which should be addressed by re-invigorated reproductive health and family planning programmes. Given the requisite data, the programmes could become more focused and targeted towards more vulnerable socio-economic and demographic groups. In addition to documenting the extent of unmet need of women, particularly older women, from the Vanuatu KAP survey House (1998) was also able to identify underserved geographic areas of the country where knowledge and the usage of contraception is unsatisfactory, information essential for programme planners to prioritize interventions with scarce budgetary and human resources. More of this kind of analysis of survey data is urgently needed in the PICs to prioritize the disbursement of scarce financial and human resources.

Ross and Frankenberg (1993) found a number of countries in Asia and Latin America had succeeded in maintaining an annual two percentage points increase in the CPR for over a decade or more. If the low-contracepting countries in the Pacific identified here could sustain such a rate of increase in the use of contraceptives, it would still take Marshall Islands and Tokelau, countries with the lowest CPRs, over 15 years to exceed the threshold level of 55 per cent. For the other countries currently below the threshold, the time it would take to exceed this cut-off level is much less. Still, the challenge remains formidable.

In their recent paper House and Ibrahim (1999) have demonstrated that the reproductive health, and especially family planning, needs of many older women in the sub-region may have been inadvertently overlooked. The authors demonstrate that fertility for the over – 35s in the PICs continues to be relatively high compared with elsewhere in the world. Such high-risk behaviour by older women can be the cause of profound life-endangering reproductive health problems for such women and their families, and particularly for their children. Yet the persistently higher fertility of older women in the PICs does not appear to attract anywhere near enough attention from planners, policy-makers, donors and the media. If the threshold level of the ICPD PoA for the CPR of 55 per cent is to be surpassed by all countries in the sub-region in the near future, more attention must be given to the prevailing high levels of fertility of older women in the PICs.

The poor quality of family planning service statistics already demonstrated requires the United Nations and other donors to address the sad state of information and data in the sub-region³. More DHS and KAP type surveys need to be conducted to expand our understanding of the nature and size of contraceptive prevalence and the causes of unmet need for use by programme managers. In-depth assessments of the ‘quality of care’ are long overdue in the sub-region. Such an approach calls for more financial outlays from donors and enhanced training to construct national capacity to collect and interpret such data. And much more training of providers at the service delivery points is required for them to improve the quality and usefulness of the statistics they currently collect. Again, donor support for all aspects of this endeavor is essential.

Meanwhile, UNFPA has taken the lead in recently attempting to construct a common data base for use by UN and other agencies, since much of the demographic-related data comes from national and secondary sources and evidently is unreliable.

In terms of reproductive ill-health, most of the PICs have recognised the advantages of RH/FP-SH approaches in the context of primary health care which may have contributed to improvements in various aspects of RH status, some of which have been quantified above. Furthermore, much training of health care providers has taken place and the quality of equipment and supplies has improved. Yet, the extent of an integrated approach to RH/FP-SH and subsequent achievement varies significantly across the countries. Certain major problems remain for women who continue to suffer from high morbidity, much of which goes undocumented. Some recently reported data for Fiji are revealing. Cervical and breast cancer account for 56% of all female cancers, perhaps because little routine screening takes place. The incidence for women over 35 is four times that found in Thailand and 5 times that in the Philippines, demonstrating key unresolved reproductive health problems in the most developed PIC (UNDP, 1999). Furthermore, the incidence of reproductive tract infections and sexually transmitted diseases are believed to be on the increase in the sub-region while unwanted pregnancies of teenagers, believed to be on the rise, often end in abortion, all indicative of how far we have to go to attain universal access to reproductive health services.

The ICPD PoA made a call for men to display greater responsibility and involvement in reproductive health. UNFPA is currently undertaking activities in this area but it is impossible at this time to determine how much progress has been made. Still, this is a very positive initiative that supports the call made in the ICPD PoA.

The Beijing Platform for Action, the ICPD PoA, as well as the UN General Assembly review of the ICPD+5 process, called upon governments to sign, ratify and implement the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and to introduce measures aimed at achieving gender equality and equity in a systematic and comprehensive manner.

A recently conducted review of the implementation of the Beijing Platform for Action (PFA) has concluded that the past decade has seen significant progress in the move to greater gender equity in the PICs (Pacific Regional YWCA, 1999). Greater recognition has emerged of the need for gender equity and greater consistency in the integration of gender issues in key policy and planning documents. The review concluded that many governments seem to have made changes to national legislation or policies in order to improve the status of women and the pace of change has accelerated since 1995. New legislation or national policies have entailed changes in family law and implementation of procedures to punish gender violence, as well as policies to raise girls’ and women’s access to education and training. Efforts to sensitize decision-makers about gender issues and the production of gender disaggregated data have had some impact in most countries. The review concludes that while the climate for gender equity has improved, efforts to build greater awareness must be intensified until changes filter through to all social institutions.

In education, gender gaps at primary and secondary school have now been reduced, as demonstrated in Table 4. In some countries, including Tonga and Fiji, the number of girls now marginally exceed boys at school as well as their mean years spent at school. For tertiary or vocational education, however, males still have more opportunities than females. Gender bias in curricula and available courses, as well as placement policies, limit the choices and opportunities available to girls and women. Overall, too few resources are given to vocational and non-formal education, despite their obvious relevance for both men and women.

Apart from such commendable progress, much remains to be done. There is a particular need for enhancing the greater economic empowerment of women. The lower proportion of women than men in paid employment is one of several possible indicators of women’s economic disadvantage. The gender gap is everywhere large in terms of differences in income and in women’s access to productive resources, credit, training and business or livelihood opportunities⁴. Given the economic and social trends prevalent in the sub-region, this inequity contributes to the feminization of poverty and detracts from the advancement of women in other respects.

While hard data are scarce, House (1999) has demonstrated that women made little headway in diversifying into male occupational preserves in Fiji over the 1986-96 decade, despite a significant rise in their rate of labour force participation. The gender concentration of the distribution of occupations remains extreme, impacting significantly on male-female earnings differences. Rather than suggest that women receive lower rewards for performing the same job side-by-side with men, it is much more likely that specific gender-based occupational assignments explain much of the overall pay differential. Indeed, using multivariate regression analysis only 40% of the overall mean male-female difference in earnings can be attributed to a compositional effect (advantages in education, experience, sector of employment, training and occupation) while a large part of the remainder may be due to various aspects of "discrimination" against women, particularly in the assignment of high status and better paying occupations.

More of this kind of analysis of the operations of labour markets in the sub-region is required to assess the employment status of women and to identify interventions which can address their disadvantages and elements of discrimination which they experience.

The comprehensive review (Pacific Regional YWCA, 1999) of the implementation of the Beijing PFA identifies critical areas of concern, including:

• Women and poverty
• Education and training
• Health
• Violence against women
• Women and the economy
• Women in power and decision-making
• Institutional mechanisms
• Human rights of women
• Women and the environment; and
• The girl child.

Its overall conclusion is that while there has been progress in most of these areas, many impediments to progress remain, including:

• Insufficient political will on the part of governments;
• Insufficient sharing of information within governments. Discussion about the Beijing and Pacific Platforms has been concentrated in the women’s ministries or departments and among women’s NGOs;
• The limited institutional and administrative capacity of both government agencies and NGOs in regard to implementing the Beijing Platform;
• Insufficient NGO capacity and training, which in turn reflect the lack of training facilities and opportunities; and insufficient NGO resources, largely because of their inability to present proposals to potential funding agencies or access funds from government;
• The ad hoc nature of donor assistance together with the limited information that is available to NGOs about funds or sources of support;
• Insufficient cooperation between governments and NGOs in implementing the Beijing PFA including some competition for resources;
• Lack of institutional memory within NGOs, which is also a consequence of high staff turnover and volunteerism;
• Poor monitoring mechanisms for the Beijing PFA, including insufficient appreciation of the linkages between national legislations and practices and international commitments and conventions;
• The very limited availability of gender sensitive statistics and indicators, which has both hampered progress in implementing the PFA, and is a major constraint on more gender sensitive planning and programme implementation and monitoring throughout the region. The scarcity of information, especially in regard to women’s work and economic contributions, is ubiquitous. Urgent measures are needed to redress this situation, including more financial, technical and human resources.

The report concludes with suggestions for further action:

• For NGOs, the limitations on action stem not from a lack of political will but rather from a lack of adequate resources to achieve the objectives and to realise the commitments made at Beijing. This needs redressing.

• Compilation of national profiles – entailing sex disaggregated data – which will assist negotiations with funding agencies to support plans of action, in the political education that is necessary in order for the public to understand the problems and prospects in each area, and in analysing national and regional trends.

• Integration of Population Concerns Into Development Strategies

The ICPD PoA emphasizes the need to fully integrate population concerns into development strategies and planning, taking into account the interrelationship between population issues with the goals of poverty eradication, food security, adequate shelter, employment and basic social services, in order to achieve the objective of improving the quality of life of present and future generations through appropriate population and development policies and programmes.

Many of the PICs have formulated comprehensive population policies over the past decade, and the process has accelerated since 1994, often with technical assistance from UNFPA (see Table 5). Unfortunately, effective implementation has been less than satisfactory for a number of reasons.

One major impediment has been the lack of high-level political commitment to address the issues highlighted in national population policies, which, in turn reflect ICPD goals. How many Presidents and Prime Ministers in the PICs have made public statements in support of the key features of the PoA? If support is measured by commitment from Ministries of Finance and national budgetary allocations, perhaps not enough has been done to raise awareness and convince key economic planners and decision makers of the efficacy of programmes in RH/FP-SH, gender equity, etc. and their contribution to the goal of attaining sustainable economic growth and development.

As the recently published Pacific Human Development Report observes:

It should also be stressed that such social sector budgetary reductions will jeopardize the progress already made and lessen the likelihood of meeting the longer term goals of the ICPD PoA, particularly where populations to be served are rapidly increasing.

One explanation for the failure to raise broad-based population issues to the top of the policy agenda, and to implement relevant holistic programmes effectively, is that a strong institutional structure and identified coordinating unit to oversee the implementation of the policies has been lacking. Another reason has been the absence of a detailed implementation plan with full budgetary and human resources costing of the needs of the various sectors to carry out the policies. Perhaps a major reason has been the apparent lack of political commitment to the allocation of scarce financial resources and high-level manpower to ensure that the implementation strategies are being carried out in a systematic and coordinated manner. In many instances, the population policy implied that there was a population programme with overriding national goals and objectives. In reality the "programme" often consisted of component parts or sectoral interventions which were implemented in an uncoordinated fashion with no assurance that they were not conflicting with the overriding national goals. This danger continues where the RH/FP-SH programme, housed in the Ministry of Health, is implemented independently of other population – related interventions, all of which might be conceived of as falling under the umbrella of a national population policy.

The lack of a coordinated approach to implementing all the elements of a population programme has been readily apparent. In some instances an awareness-raising campaign for family planning has effectively raised the demand for contraceptive services and a binding constraint has emerged on the supply side as service facilities, staffing positions or contraceptive supplies have been less than adequate. On the other hand, reproductive health/family planning service clinics sometimes have been erected and staffed without an appreciation of the need to create the requisite demand for such facilities. Often, population policies have, as an explicit objective, the intention to retard the rate of rural-to-urban migration because of the deleterious social and economic consequences of too rapid urbanization. At the same time, rural development policies have been negated by a definite urban bias towards national development programmes as social infrastructure and industrial development have continued to be concentrated in urban centres despite public pronouncements of intentions to reverse this pattern. Other key areas, such as human resources development and labour force planning, international migration, food security, environmental degradation and land tenure, in the absence of a rigid policy framework, have been almost totally neglected as population accommodating or population-influencing factors.

More recently, however, a new more holistic and comprehensive approach has been taken throughout the sub-region and has the potential to redress past mistakes. Population awareness-raising workshops and seminars have been organized in various countries. These have served important purposes in initiating the complex process of designing a national population policy and programme, and of helping to identify the nature of population-related problems, formulating broad based strategies to address them, and establishing the institutional and other requirements for drafting formal population policies. As a result, many Pacific island countries are currently preparing to draft policy statements or are revising existing policies to be endorsed by the political leadership. At the same time, the on-going UNFPA/Secretariat of the Pacific Community (SPC) initiatives in advocacy and IEC aim to gain high level political commitment and individual behaviour change in line with the ICPD PoA goals and the newer RH/FP-SH strategies. However, human and financial resources to implement them will remain a binding constraint, as will the lack of the requisite data and information to target their interventions and to monitor their progress.

• Population and the Environment

The ICPD PoA calls for intensified efforts to implement legislative and administrative measures as well as to promote public education about the need for sustainable production and consumption patterns, foster sustainable natural resource use and work concertedly to prevent environmental degradation.

As with formal population policies, many countries in the sub-region have formulated National Environmental Management Strategies (NEMS) in recent years, although the degree to which they have been acted upon has yet to be extensively reviewed. Inherent natural disasters constitute a significant part of vulnerability of the island countries and contributing factors include the fragility of island environments, the dispersed populations and their remoteness, rapid urbanisation, and degradation of traditional coping measures. Increasing environmental degradation through human actions adds to this vulnerability. Indiscriminate burning, deforestation, unsustainable cropping patterns and the incursion of animals are taking their toll on the island countries (UNDP, 1999).

As MacGregor (1999) has demonstrated, in recent years agricultural development in the PICs has brought with it some degree of environmental degradation, and thereby increased vulnerability to disasters. This is evident in Fiji where cash cropping of ginger and sugar has extended to steeply sloping land without any soil conservation efforts. In recent decades, communities throughout the region have become increasingly dependent on government for food relief after cyclones, droughts and floods. They have become more vulnerable to disaster because of their increasing dependence on cash to obtain food, the decline in importance of traditional food crops, the virtual disappearance of traditional food preservation, and the critical disappearance of village owned sea-going transport. In some places, the growing dependence on government has coincided with a decline in the government’s ability to deliver services to rural areas.

Meanwhile, environmental degradation is evident in a number of countries, particularly in urban areas, as population influx and natural growth exert pressure on clean water supplies, sanitation and coastal reefs and in-shore fishing grounds. The quest to generate economic growth and foreign exchange has led to the unsustainable depletion of natural resources, particularly fish stocks and forests. Evidently, an in-depth review of the state of the environment in the PICs in the post-UNCED years is called for to gauge the sustainability of current consumption and production patterns and the redistribution of populations.

Work underway at the South Pacific Applied Geoscience Commission (SOPAC) to develop an environmental vulnerability index will eventually assist in quantifying and assessing the level and trends in vulnerability in the PICs. The recent Pacific Human Development Report shows that, with an index of economic vulnerability – terms of trade, net capital flows and vulnerability to national disasters – six countries in the sub-region rank substantially lower after GDP per capita is adjusted for these forms of vulnerability (UNDP,1999).

• The Implications of Changing Population Dynamics for Achieving ICPD Goals

The ICPD PoA calls upon governments to examine the economic and social implications of demographic change and how they relate to development planning concerns and the needs of individuals. Indeed, the rate of population growth has exceeded the rate of economic expansion in the majority of island countries in the past decade with the result that per capita income has stagnated or declined. Prospects for dynamic economic growth in some of the poorly endowed countries remain bleak. Set beside the fatigue of traditional donors and the curtailing of their aid disbursements, prospects for raising real incomes in the PICs, a prerequisite for maintaining the ICPD PoA indicators above their thresholds, do not look promising. Along with stagnating real incomes, evidence is emerging of growing relative inequality and poverty, environmental degradation, rapid urbanisation, increasing un – and underemployment and concomitant social problems that reflect the consequences of the sub-regions’ demographic dynamics and rapid population growth.

The structure of the island populations is such that it is broad at the base of population pyramids and through the childbearing years, ensuring that population growth will be substantial for the foreseeable future. At the same time, the pyramids, like those in the rest of the world, are changing shape, with growing numbers of people over age 60, which will affect development prospects for the twenty-first century. Furthermore, child dependency (the ratio of the young dependent population under 15 years of age to the population in the working ages of 15-64 years) will remain significant. Currently, the share of the under 15 years age group in the total population exceeds one third in all the Pacific island countries; every 100 persons in the working age group must support 50 or more dependants, i.e. those aged under 15 and those 65 and older.

School-age populations are anticipated to increase very substantially in several countries, particularly in Melanesia. Yet, in recent years, the share of education spending both in terms of GDP and in government budgets has been declining. The rising school intakes will place an intolerable burden on the financing of education. Moreover, it seems likely that insufficient employment opportunities will be created to cope with the rise in the number of working-age people, in view of the recent poor economic growth rates. Currently, several PICs are unable to provide for universal primary education or are not attempting to absorb all qualified primary leavers into secondary school as a matter of policy. Given the known relationship between rising girls’ educational attainments and subsequent declines in rates of fertility, infant mortality, morbidity and women’s social and economic status, such constraints are likely to impede further demographic behavioural change and jeopardize the key social indicators which have been already attained.

Meanwhile, it seems that not nearly enough is currently being made of population projection techniques to influence policy-makers and to direct scarce resources to where their social rate of return is greatest. This is probably due to numerous factors, some of which include inadequate awareness and national capacity to perform the projections. One informative case study undertaken by a senior civil servant in the Solomon Islands is illustrative of what can be achieved in order to demonstrate how dire the situation can be for maintaining the social gains already made.

In Vanuatu it is anticipated that the high growth rate of school-age students will require the doubling of primary school enrolments by 2010 (UNDP, 1999). More generally, for many other countries in the sub-region, the combination of increasingly tight public funding and rapidly rising numbers of the school age population will mean that quantitative enrolment targets are met only by allowing the quality of instruction to decline drastically (Gannicott, 1993). The consequences for prospective economic growth, rising girls’ educational attainments, gender equality, further demographic change, and prospects for maintaining ICPD indicators above the thresholds could well be negative.

On the employment front, the challenge is equally daunting. The number of younger job seekers – or youth – coming into the labour markets of the island countries will increase dramatically in the near future. By 2010 their numbers will have growth by 300,000. Often school leavers are ill-prepared in terms of the skills they acquire at school to take up the few wage jobs that become available and end up unemployed or under-employed in the rural non-cash economy. While this kind of expansion in the labour force has the potential to be a demographic "bonus" if the newcomers find remunerative employment and help to expand national production of goods and services, and thus, induce economic growth, the situation in the island countries may be radically different. Despite generous amounts of overseas aid and significant rates of public investment, economic growth has been less than impressive in most of the PICs in the recent past. Low rates of economic output have meant that employment growth in the highly remunerative formal sector has stagnated. At the same time as female labour force participation rates have increased, swelling the numbers of female job-seekers, many governments have put a brake on public sector employment expansion. The result is that labour markets have become much tighter, employers have become much more selective about whom their hire, often using educational attainment as a screening device, and young persons have sought to accumulate such credentials by staying on longer in school in order to appear more employable in the intensely competitive labour markets of the region. Without dynamic economic growth and job expansion, the buoyant ‘young new generation’ will become a burden rather than a bonus.

In the Solomon Islands, in 1986, the number of new jobs required annually to employ school-leavers in the labour force was 5.6 thousand; by 1996 this had grown to ten thousand and for every available wage job at least 10 people were unemployed (UNDP, 1999). Only about 500 new jobs are created annually in the formal sector in the Solomon Islands, the majority coming in the public sector. Thus, over 90% of new entrants are absorbed into the subsistence or informal sectors, or become unemployed. In Fiji, the net annual addition to labour supply exceeds 6,000 while the net increase in new openings in formal employment barely exceeds 2,000. Most of the other high fertility countries in the region face comparable challenges. Their capacity to absorb the rapidly growing new generation of job seekers is hindered in the short run by the downsizing of public sectors as part of economic reform programmes, the lack of private sector investment and poor economic growth prospects. Only if and when on-going economic liberalization and labour market reforms induce new investment activity and employment expansion can we expect an improvement in the job market prospects of the rapidly growing number of school leavers. Growth in the number of youths seeking employment, together with a rising proportion of younger women, may well have deleterious effects on the job prospects of the expanding number of older workers, particularly those over 45 years of age. As evidenced in Europe and elsewhere, because of more intense competition from younger workers, older workers are often pressured to retire earlier and drop out of the labour market. With often inadequate social security and pension coverage in the island nations, the impact on the older generations may well be profound, with rising rates of unemployment, job and income insecurity and a growing sense of despair.

If the prevailing ICPD PoA goal attainments in the PICs are to survive in the new millennium, innovative policies are required in the island nations across a broad spectrum of issues. The newer concepts of reproductive health, adolescent reproductive health and gender equity and equality need to be disseminated across all social groups and influential leaders. New service facilities, staffed with well-trained providers, will need to be constructed and strategically located to meet the needs of a burgeoning number of potential clients. Therein lies the greatest challenge. How can they improve the quality of standards already achieved and, concurrently, expand the quantity of services to provide for a growing population at a time when the economies of the PICs experience increasing strains, and public sector budgets and staff are being curtailed as part of adjustment and reform programmes triggered by the Asian economic crisis? Economic growth must be revitalized to satisfy the job aspirations of the new generation of better educated younger workers; labour market and other macro-economic policies must be introduced that will attract new investments; vocational training opportunities must be expanded to raise the human resources base of these economies and retraining schemes introduced to cater for the needs of older workers whose skills have become obsolete. And capital markets must be created or reformed to enable small-scale, informal sector entrepreneurs to gain access to investible funds that will contribute to solving the employment challenge. Without such changes the capacity of countries to maintain their prevailing social, reproductive health and demographic indicators will be severely strained.

The ICPD+5 assembly reconfirmed the duty of governments, civil society at the national level, and the international community to focus on human resources development and on building and strengthening national capacity to implement sustainable population and reproductive health programmes. The ICPD+5 assembly called for increased investments designed to improve the quality and availability of sexual and reproductive health services. Unfortunately, as the meeting recognised, the translation of the commitment made to achieving the ICPD goals into commensurate levels of donor funding has not been forthcoming at the global level.

A comprehensive assessment of changes over time in the levels of official development assistance (ODA) in the PICs is difficult to make although it is likely that decline in donor support here reflects the trend at the global level. RH/FP-SH programmes supported by UNFPA are facing dangerous cutbacks attributable to a four-year decline in donor contributions. Indeed, for 1999, available funds cover only two thirds of the Fund’s commitments to country programmes, equivalent to a US$72 million shortfall that is projected to lead to an additional 1.4 million unwanted pregnancies, almost 600,000 induced abortions and almost 700,000 unwanted births. This crisis will imperil developing countries’ efforts to provide family planning, reduce maternal mortality and prevent HIV/AIDS. UNFPA has felt the pressure on the amount of financial support it is able to offer in the PICs, with the size of its assistance falling from US$14.8 million (in expenditures) for the period 1992-1997 to US$7.2 million (in allocation) under its second programme cycle for the period 1998-2001 (under regular resources). Contributions to the core resources of UNFPA from the government of New Zealand have steadily increased over the years, and remarkably so between 1995 and 1996, from NZ$600 thousand to NZ$1 million. They have remained at NZ$1.3 million since 1998. However, because of unfavourable exchange rate fluctuations, the US$ value of these contributions has declined from a peak of US$821 thousand in 1997 to US$683 thousand in 1999.

Australia’s total ODA worldwide has fallen from A$1.562b in 1995-1996 to A$1.465b in 1997-98 while support to health and population programmes fell from A$102.5m in 1995-96 to A$91.7m in 1996-97 but rose again to A$116m in 1997-98. Contributions to the core resources of UNFPA rose dramatically from A$1.7 million (US$1.3 million) in 1992 to peak at A$3 million (US$2.2 million) in 1996, only to decline to A$2.1 million (US$1.4 million) in 1999.

There is no assurance of continued growth in national currency contributions of the two major bilateral organizations in the region, AusAID and NZODA. Therefore, efforts to increase contributions to the multi-lateral population programme, including initiatives in RH, need to be stepped up. This should entail approaches to other non-traditional donors, including private foundations.

Clearly, without increased efforts to garner enhanced international donor support for population activities, it will become more difficult to maintain the achievements already made in meeting some of the quantitative and qualitative goals of the ICPD PoA in the PICs and to improve on others not yet attained. Above all, radical approaches are needed to improve the quality and quantity of information and data available in the PICs. The glaring statistical gaps presently existing must be closed in order that quality data are available to monitor on-going progress in meeting the ICPD PoA goals and to prioritize the areas to where scarce resources need to be directed.

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1. Indeed, more generally reflecting the poor state of demographic data in the sub-region. "few social, health or economic statistics for the region can be used with real confidence ... Good information is an indispensable part of good governance" (UNDP, 1999, p.32)

2. Tuvalu still falls marginally below the threshold for the infant mortality rate

3. "The United Nations system and donors should be specifically urged to strengthen the capacity of developing countries, particularly the least developed countries, and those with economies in transition, to undertake censuses and surveys on a regular basis so as to improve vital registration systems, and to develop innovative and cost-effective solutions for meeting data requirements, especially for regular monitoring if the implementation of the goals of the Conference" (united Nations, 1999). At a time when the call for data and information has never been louder, the sorry state of statistics in the PICs and the absence of donor support has never been greater. Vital registration systems in many countries are unreliable and almost non-existent.

4. Women's share of places in rural training centres in 1995 amounted to only 700 out of 1900 in Solomon Islands and 90 out of 300 in Vanuatu (UNDP, 1999).