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A NEW START FOR POPULATION POLICIES IN THE PACIFIC ISLAND COUNTRIES

"All States now understand that, if they are to provide adequately for the future health and education of their citizens, they need to incorporate population policies into their development strategy." Secretary-General Kofi Anan, speakinf at the Opening Ceremony of the UN Special Session of the General Assembly on 30 June 1999

Population Policy: Pre-ICPD 1994
In the period leading up to the International Conference on Population and Development (ICPD) in Cairo in 1994, "population policy" might well have been defined as:

"A deliberate attempt by government to influence one or more of the key demographic parameters, fertility, mortality and migration" (Isaacs, Cairns and Heckel, 1991).

In theory, such an effort at social engineering might be attempted through a whole range of direct and indirect policy interventions, including nutrition and health programmes to raise life expectancy and lower mortality. Patterns of fertility could be influenced by efforts to change desired family size and through the establishment of family planning services to meet the contraceptive needs of individuals and couples wanting to space or limit the size of their families.

In practice, however, a specific fertility goal – especially reduced fertility in order to lower the national population growth rate – often became the prime objective of early national population policies. Invariably they became identified with the provision of family planning services and responsibility for implementation vested in Ministries of Health. These policies, in turn, were ‘sold’ to an often suspicious and skeptical public as part of a Maternal and Child Health (MCH) programme, whereby the use of contraceptives to space children – but not necessarily to limit childbearing – would have beneficial effects for the health of mothers and their children. Yet, couples who maintain strong desires to produce large families are unlikely to adopt family planning methods despite their ample provision. Thus, population policies incorporated activities to change family size attitudes through information dissemination to the public at large, stressing the health and economic benefits to the family from the adoption of family planning. The introduction of a population education syllabus in schools also attempted to form smaller-size family norms in children at an impressionable age. Trade unions, cooperatives, workplaces and women’s groups became the targets of IEC activities in many countries.

Post-ICPD
The ICPD and its Programme of Action (PoA) is credited with marking a paradigm shift in the emphasis given by the international community and national governments to the importance of improving the state of individual well-being, especially women’s reproductive health. Although mention is made in the ICPD’s PoA of "the crucial contribution that early stabilization of the world population would make towards the achievement of sustainable development" (UN, 1994 para. 1.11), reduced population growth does not feature as a major objective of the PoA.

'There is now a universal understanding of the centrality of population in development in the Pacific Island countries. However, because of the past and current high levels of fertility, population momentum will ensure that population growth will continue to be significant well into the new millenium.' From the Keynote Address by Honorable Baron Vaea of Houma, Prime Minister of Tonga, at the Hague Forum 8 February 1999.

The result has been that the principal goal of population policies, at least for the major UN population and development agencies, has now shifted to an enhancement of individual well-being. A reduced rate of population growth, perhaps induced through an improved reproductive health status of women, via greater gender equity, equality and the empowerment of women, and the availability of a wider, more informed choice and greater uptake of modern contraceptive methods, is conceived to be an intermediary objective, automatically following on from the attainment of these health and gender goals, all of which contribute to the overriding goal of improved individual well-being. And implementation of programmes to attain the latter – most notably reproductive health and family planning programmes, which may have the incidental effect of reducing rates of population growth – must respect basic human rights. Because reproductive health is conceived to be a basic human right, under no circumstances should quotas for service providers, demo-graphic targets for policy makers and planners, and incentives for clients, be employed in population policies and reproductive health and family planning progra-mmes.

The PoA recognizes women’s education, equality and empower-ment as paramount and family planning should be provided within the context of full sexual and reproductive health care. Coercion, violence against women and discrimination are to be eradicated. In addition, the PoA recognises the central role of sexuality and gender relations in women’s health and rights. It assets that men should be fully involved, without veto powers, in decisions involving fertility, sexual behavi-our, sexually transmitted disease prevention and the welfare of their partners and children, and recognises unsafe abortion as a major public health issue. The neglected sexual and reproductive health needs of adolescents must be addressed and they should become prime targets in reproductive health programmes.

How can the newer vintage population policies incorporate such a worthy and ambitious agenda? To what extent should a reproductive health programme actively encourage individuals to have fewer children in the context of improving their reproductive health status, rather than merely providing the services for birth control and informing them about the mechanics of safe and effective birth control?

Towards Holistic Policies
The ICPD strategy implies the need for a more balanced, comprehensive, and humane approach to the reduction of fertility and population growth. At the heart of the strategy to ultimately stabilize the size of world population is the realisation of gender equality. Development policies which reduce gender disparities in society need to become the primary goal. At the same time, the ICPD emphasized the need to provide a wider choice of contraceptive methods within a broader range of reproductive health services. Yet, the ICPD PoA stressed that public policies to establish gender equity and improved reproductive health services should be justified as basic human rights and desirable ends in themselves, and it did not directly link these goals to national and international concerns with reducing population growth.

It is also important to attempt to embed and integrate such population-related concerns into overall development policies and strategies in line with the philosophy behind the ICPD which was, after all, the International Conference on Population and Development. Population policies, reproductive health programmes and family planning programmes cannot be implemented as distinct and separate programmes; they should be viewed as key ingredients and components of national development policies. Therefore, they should follow the holistic and comprehensive approach of the ICPD PoA and address aspects of population dynamics and its interface with sustainable development, environmental change, poverty alleviation, employment creation, urban-rural population distribution, migration as well as population ageing. This would reinforce the PoA’s holistic approach and strengthen aspects of reproductive health programmes as part of overall national development policies and help to enhance the implementation of other aspects of the ICPD PoA. Of course, all are constrained by national development budgetary alloca-tions but the comprehensive approach would ensure that the sum total of benefits from sectoral interventions exceeds the sum of the benefits of the individual parts. And reproductive health and family planning programmes would be the beneficiaries of this comprehensive approach.

After five years of advocacy efforts, PoA concepts have been accepted by all Pacific island countries and the operational implications are well understood by national programme managers and service providers. The integration of reproductive health is already occurring in the practical stages in varying degrees at the primary care level, but more needs to be done at the secondary and tertiary or national levels. To this end, increasing elements of the reproductive health concept are being incorporated into the new cycle of various donor projects. However, most countries need financial and technical assistance from their development partners in the interpretation and implementation of the ICPD PoA to meet local conditions.

Conclusions
With the new emphasis on reproductive health, where does that leave the demographic concerns of the earlier versions of population policy? Will the purveyors of the new reproductive health approach be able to galvanize the support of national political and religious leaders in the Pacific island countries in order to attract their blessing and financial and moral commitment, when the earlier and narrower family planning programmes sometimes failed to do so? If their principal concern remains too rapid population growth – but not all political leaders have identified this as a national problem – in relation to natural and other resources, then the reproductive health agenda emanating from the Cairo PoA must be shown to have a significant demographic effect. But can this linkage be adequately demonstrated to the political leadership which may still treat the too rapid growth in numbers as the priority concern for development expenditure and planning?

"So Cairo was not just a population conference. It was a conference on population and development. It was part of a process, going back twenty-five years or more, during which we have all learned that every society's hopes of social and economic development are intimately linked to its demography." Secretary -General Kofi Annan, speaking at the Opening Ceremony of the UN Special Session of the General Assembly on 30 June 1999.

This writer would propose that high and middle level political and bureaucratic commitment to address national population-related problems, including extensive reproductive health concerns, are more likely to be attained if broad-based national population problems and multi-sectoral strategies to deal with them are expressed in a national population policy. To the political elite, seemingly esoteric reproductive health and gender concerns will not be adequately appreciated if they are treated as independent health issues. They are much more likely to receive the support and expanded budgetary allocations of national exchequers and international donors if they are conceived to be integral parts of broad-based national efforts to deal with population and development problems in a holistic manner.

References

House, W.J. and Lewis, L. (1998), "Population Policies in the Post-ICPD Era: Can the Pacific Island Countries Meet the Challenge?" UNFPA Country Support Team, Suva, Discussion Paper No. 16.

Isaacs, S., Cairns, G. and Heckel, N. (1991), Population Policy 2^nd Edition, Columbia University and the Futures Group.

UN, (1994), "Programme of Action Adopted at the International Conference on Population and Development, Cairo, 5-12 September", New York.

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