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) |
|
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This document has been prepared by the Secretariat of the United
Nations Inter-Agency Task Force on the Implementation of the ICPD
Programme of Action. For further information please contact the
United Nations Population Fund, Task Force on ICPD Implementation,
220 East 42nd Street, New York, NY 10017 USA or send E-mail to:
pierce@unfpa.org
*****************************************************************
ICPD United Nations
Inter-Agency Task Force on the Implementation
of the ICPD Programme of Action
GUIDELINES FOR THE UNITED NATIONS
RESIDENT COORDINATOR SYSTEM
September 1995
===============================================================
ICPD/IATF
11 September 1995
Dear Colleague,
As part of the follow-up to the International Conference on
Population and Development (ICPD), an Inter-Agency Task Force has
been established to enhance system-wide collaboration in the imple-
mentation of the ICPD Programme of Action at the country level
under the leadership of the United Nations Resident Coordinator.
This Task Force will also help to delineate a common framework for
follow-up to other United Nations conferences dealing with social
issues.
The Task Force set up six working groups addressing the key
areas for action corresponding to the goals and objectives of the
Programme of Action -- education, empowerment of women, repro-
ductive health, the development of a common data system for infant,
child and maternal mortality, international migration and policy
related issues in the social sector. The Working Groups in the
first four of the areas listed have produced a set of "Guidelines"
for use by Resident Coordinators.
These Guidelines are designed to facilitate the task of the
Resident Coordinators in supporting the implementation of the
recommendations of recent United Nations conferences in an
integrated manner and improving the efficiency and effectiveness of
operational activities of the UN system at the field level. The
Guidelines delineate the basic issues in a given area, provide key
reference materials and, in some cases, a sketch of the mandates of
the various UN organizations in the respective sectors. The
priority given to each sector will, of course, depend on the needs
and particular situation of each country. We would like to
emphasize that these "Guidelines" are in essence "guidance notes"
and are not meant to supersede technical guidelines. Sources of
technical support can be identified from the listing at the end of
each set of guidelines. Such expertise may be sought from the
relevant parts of the United Nations system and other appropriate
entities. It is hoped that the information provided will better
equip Resident Coordinators in their dialogues with Governments
and in the overall effort to strengthen national capacity to
effectively manage development assistance.
We would also like to remind you that the UNDP/UNFPA Executive
Board, at its recent session, approved the use of 1.7 per cent of
UNDP's overall resources by the Resident Coordinators to support
the UN system's coordination activities from 1997 onwards. UNDP
is now actively pursuing an arrangement to make part of that
funding available earlier and you will be advised about when the
resources can be drawn on to enhance country-level coordination in
implementing the Programmes of Action from Cairo, Copenhagen and
Beijing, as part of an integrated follow-up of major UN
conferences.
These Guidelines should be regarded as a "work in progress";
hence, they are being sent to you in a loose leaf binder. Ideally,
we would like to prepare a document on "success stories/lessons
learned" for selected sectors and would draw on your experiences as
the basis for such a piece.
We look forward to receiving your reaction to the usefulness
of this material. We shall utilize your comments to modify existing
guidelines and as input for future work.
With kind regards,
James Gustave Speth Nafis Sadik
Administrator Executive Director, UNFPA
UNDP and Chairperson
ICPD Inter-Agency Task Force
=================================================================
Inter-Agency Task Force on the Implementation
of the ICPD Programme of Action
GUIDELINES FOR THE UNITED NATIONS
RESIDENT COORDINATOR SYSTEM
September 1995
=================================================================
TABLE OF CONTENTS
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 1
GUIDELINES ON REPRODUCTIVE HEALTH. . . . . . . . . . . RH 1
I. Key Facts about Reproductive Health. . . . . RH 1
II. Key Actions for the Resident Coordinator
system to improve Reproductive Health. . . . RH 7
SELECTED BIBLIOGRAPHY. . . . . . . . . . . . . . . . . RH 10
AGENCY PROFILES. . . . . . . . . . . . . . . . . . . . RH 12
1. World Health Organization (WHO). . . . . . . RH 12
2. United Nations Population Fund (UNFPA) . . . RH 14
3. The World Bank . . . . . . . . . . . . . . . RH 16
4. International Labour Organisation (ILO). . . RH 18
5. United Nations Childrenžs Fund (UNICEF). . . RH 19
6. Office of the United Nations High
Commissioner for Refugees (UNHCR). . . . . . RH 20
7. United Nations Educational, Scientific
and Cultural Organization (UNESCO) . . . . . RH 22
GUIDELINES ON WOMENžS EMPOWERMENT. . . . . . . . . . . WE 1
I. Background . . . . . . . . . . . . . . . . . WE 1
II. Women's Empowerment: A Definition. . . . . . WE 2
III. Strategy for Coordination. . . . . . . . . . WE 2
IV. Specific Areas for Action. . . . . . . . . . WE 3
SELECTED BIBLIOGRAPHY. . . . . . . . . . . . . . . . . WE 11
-------------------------------------------------------------------
AGENCY PROFILES. . . . . . . . . . . . . . . . . . . . WE 14
1. Food and Agriculture Organization
of the United Nations (FAO). . . . . . . . . WE 14
2. International Labour Organisation (ILO). . . WE 16
3. United Nations, Department for Economic
and Social Information and Policy Analysis
(DESIPA)/The Population Division . . . . . . WE 18
4. United Nations Development Programme/Gender
in Development Programme (UNDP/GIDP) . . . . WE 19
5. United Nations Educational, Scientific
and Cultural Organization (UNESCO) . . . . . WE 20
6. United Nations Population Fund (UNFPA) . . . WE 22
7. Office of the United Nations High
Commissioner for Refugees (UNHCR). . . . . . WE 24
8. United Nations Childrenžs Fund (UNICEF). . . WE 26
9. United Nations Development Fund for
for Women (UNIFEM) . . . . . . . . . . . . . WE 27
GUIDELINES ON A COMMON APPROACH TO
NATIONAL CAPACITY BUILDING IN TRACKING
CHILD AND MATERNAL MORTALITY . . . . . . . . . . . . . CM 1
Introduction. . . . . . . . . . . . . . . . . . . CM 1
I. Child Mortality . . . . . . . . . . . . CM 1
II. Maternal Mortality. . . . . . . . . . . CM 9
SELECTED BIBLIOGRAPHY. . . . . . . . . . . . . . . . . CM 15
Child Mortality . . . . . . . . . . . . . . . . . CM 15
Maternal Mortality. . . . . . . . . . . . . . . . CM 17
ANNEX TO BIBLIOGRAPHY. . . . . . . . . . . . . . . . . CM 19
AGENCY PROFILES. . . . . . . . . . . . . . . . . . . . CM 23
1. The World Bank . . . . . . . . . . . . . . . CM 23
2. United Nations Population Fund (UNFPA) . . . CM 24
3. United Nations Childrenžs Fund (UNICEF). . . CM 25
4. World Health Organization (WHO). . . . . . . CM 26
-------------------------------------------------------------------
GUIDELINES ON BASIC EDUCATION WITH
SPECIAL ATTENTION TO GENDER DISPARITIES. . . . . . . . BE 1
I. Introduction . . . . . . . . . . . . . . . . BE 1
II. The Strategies for Coordinating Basic
Education. . . . . . . . . . . . . . . . . . BE 2
SELECTED BIBLIOGRAPHY. . . . . . . . . . . . . . . . . BE 6
AGENCY PROFILES. . . . . . . . . . . . . . . . . . . . BE 9
1. United Nations Educational, Scientific
and Cultural Organization (UNESCO) . . . . . BE 9
2. United Nations Population Fund (UNFPA) . . . BE 11
3. International Labour Organisation (ILO). . . BE 12
4. World Food Programme (WFP) . . . . . . . . . BE 13
5. United Nations Childrenžs Fund (UNICEF). . . BE 14
APPENDIX
I. Report of the First Meeting of the Inter-Agency
Task Force on the Implementation of the ICPD
Programme of Action (13 December 1994) . . . I- 1
II. Report of the Second Meeting of the Inter-Agency
Task Force on the Implementation of the ICPD
Programme of Action (25 July 1995) . . . . .II- 1
==================================================================
INTRODUCTION
The 1994 International Conference on Population and
Development (ICPD) focused global attention on the close
interrelationships between population, sustained economic growth
and sustainable development. It marked the start of a new era in
thinking about population and development by explicitly placing
human beings at the centre of development activities. Investing in
people, in their health and education, is central to sustained
economic growth and sustainable development. The ICPD Programme of
Action recommended to the international community a set of
important population and development objectives, as well as
qualitative and quantitative goals. Among these objectives and
goals are: sustained economic growth in the context of sustainable
development; education, especially for girls; gender equity and
equality; infant, child and maternal mortality reduction; and the
provision of universal access to reproductive health services,
including family planning and sexual health. The challenge for the
United Nations is to truly assist developing countries in
integrating population concerns into all aspects of economic and
social policies and programmes and to sustain cooperation among the
United Nations organizations and agencies in achieving the ICPD
goals and objectives, as well as those of other recent United
Nations conferences in the social sectors.
The Programme of Action, which was endorsed by the United
Nations General Assembly through its resolution 49/128, calls on
all specialized agencies and related organizations of the United
Nations system to strengthen and adjust their activities,
programmes and medium-term strategies, as appropriate, to take into
account the follow-up to the Conference. In keeping with this, the
Administrator of the United Nations Development Programme (UNDP),
on behalf of the Secretary-General of the United Nations, requested
the Executive Director of the United Nations Population Fund
(UNFPA), who had served as Secretary-General of the ICPD, to
convene and chair an Inter-Agency Task Force to develop a
coordinated approach for implementation of the ICPD Programme of
Action, as well as a framework for reporting on the progress of the
implementation.
The Inter-Agency Task Force (IATF) on the Implementation of
the ICPD Programme of Action, with UNFPA as the lead agency, held
its first meeting on 13 December 1994. The IATF focuses on
country-level cooperation, particularly, with regard to policy
development, coordination and monitoring of progress achieved in
the implementation of the Programme of Action. Five working groups
were set up by the Task Force addressing the key areas for action
corresponding to the goals and objectives of the Programme of
Action. Recently, a new working group was established in response
to a request from the Commission on Population and Development that
the work of the Task Force be expanded to include migration issues.
The working groups and lead agencies are as follows: (1)
Working Group on Reproductive Health -- Lead Agency: World Health
Organization (WHO); (2) Working Group on Women's Empowerment --Lead
Agency: United Nations Development Fund for Women (UNIFEM); (3)
Working Group on Basic Education with Special Attention to Gender
Disparities -- Lead Agency: United Nations Educational, Scientific
and Cultural Organization (UNESCO); (4) Working Group on A Common
Approach to National Capacity Building in Tracking Child and
Maternal Mortality -- Lead Agency: United Nations Children's Fund
(UNICEF); (5) Working Group on Policy-Related Issues -- Lead
Agency: United Nations Population Fund (UNFPA); and (6) Working
Group on International Migration (this newly established working
group is scheduled to meet on 19 October 1995) -- Lead Agency:
International Labour Organisation (ILO). The first four working
groups have produced Guidelines for use by the United Nations
Resident Coordinators.
The Terms of Reference of each Working Group were as follows:
(a) to develop proposals for inter-agency collaboration in the
different areas, to be implemented at the country level; (b) to
identify and mobilize the comparative advantages of the specialized
agencies, organizations and programmes of the United Nations active
in the different areas; and (c) to develop and disseminate a set of
practical guidelines for use at the country level by United Nations
Resident Coordinators, to facilitate collaborative efforts in the
different areas. Each working group held a meeting following which
the lead agency produced the guidelines based on the discussions
and recommendations of the working group. Thus, the Guidelines
have benefitted from a wide-ranging process of collaboration and
interaction amongst the United Nations agencies and organizations
that constitute the IATF. It was also agreed to attach to the
guidelines: (1) a short selected bibliography of key documents in
the specific area, including citations of appropriate audio-visual
materials; and (2) agency profiles which provide a brief
description of what each agency does in the specific area.
The main objective of the Guidelines is to provide the field,
particularly, the Resident Coordinator System, with guidance on
operationalizing the ICPD Programme of Action at the country level.
The Guidelines build on arrangements that are already in place, in
particular, the role of the United Nations Resident Coordinators in
coordinating the development efforts of the United Nations agencies
and organizations at the country level. Throughout, the underlying
concern has been to seek ways to build an enabling environment as
called for by the ICPD Programme of Action. The Guidelines are not
meant to be prescriptive and will not hinder individual agencies or
organizations from pursuing their respective mandates. Rather,
they will enhance the complementarity of agencies' programmes and
allow the United Nations system to contribute more effectively. In
essence, the Guidelines will facilitate more integrated planning
and coordination of United Nations inputs for achieving ICPD goals,
within a national development framework, and will help foster
closer dialogue and collaboration between the United Nations
system, Governments and other development partners, including
bilateral agencies, non-governmental organizations (NGOs) and civil
society.
Common themes that echo in the Guidelines include the
following:
o Putting people first
o Reducing gender inequality and inequity
o Promoting sustainable human development
o Accountability and transparency
o Development of common indicators which are critical to
monitor programme impact
o Strengthening country-level collaboration
o Enhancing national capacity building
o Facilitating dialogue between the United Nations Resident
Coordinator, the Government, non-governmental
organizations and civil society
It is hoped that the Guidelines will make a key contribution
in assisting Resident Coordinators in their dialogue with
Governments and national counterparts and in furthering
collaboration with NGOs and the private sector. The ICPD Programme
of Action underscored that NGOs are important voices of the people
and their associations and networks provide an effective and
efficient means of better focusing local and national initiatives
and addressing pressing population and development concerns. The
Guidelines encourage Resident Coordinators to build partnerships
with NGOs, the private sector and civil society, in addressing the
challenges of population and development effectively.
The Guidelines can also provide the Resident Coordinators with
a basis for advocacy and furthering work in each of the key
sectors, including by drawing on the comparative advantage of each
United Nations agency and organization. Additionally, the
Guidelines may be drawn on for preparing the Country Strategy Note
and other planning and programming tools. It is envisioned that
the Resident Coordinator will establish a modality for inter-agency
coordination which would serve as a catalyst for national
initiatives in the key areas. The Statement on the Role and
Functioning of the Resident Coordinator System already provides a
framework in which the coordination of these substantive areas can
be accommodated.
Resident Coordinators are encouraged to share the Guidelines
with all interested parties and, additionally, to use them, as
appropriate, in national and regional training sessions, workshops
and seminars. While the focus is on country-level cooperation, it
is expected that under the leadership of the Resident Coordinator
a broader collaboration can take place in association, as
appropriate, with regional institutions, including, the regional
commissions and regional banks.
The Economic and Social Council (ECOSOC) of the United
Nations, in its resolution E/1995/L.61 of 28 July 1995, welcomed
the intention of the Secretary General to report to it, through the
Commission on Population and Development, on the work of the Task
Force, so as to ensure system-wide cooperation in the
implementation of the Programme of Action.
The IATF views feedback as essential to strengthening the
Guidelines and enhancing the collaborative process. Comments and
suggestions on the Guidelines are welcomed from Resident
Coordinators, national counterparts, bilateral agencies, NGOs and
other interested parties in the field. At the same time, the IATF
is also interested in receiving information on success stories,
effective strategies, lessons learned and other meaningful
country/organization experiences with regard to implementation of
the ICPD Programme of Action. The IATF plans to disseminate such
information to all interested parties with the objective of further
strengthening collaboration and coordination through effective
information-sharing and networking. Through maintaining such an
open-ended information-exchange process, the IATF hopes to gather
key information that will help catalyze the development of "best
practices" that have been tested in the field, proven valuable and
can be replicated in other countries and settings, with specific
attention to local needs and priorities.
It is anticipated that at a later date the Guidelines will be
made available electronically, thereby, facilitating wider
dissemination.
==================================================================
GUIDELINES ON REPRODUCTIVE HEALTH
FOR THE UN RESIDENT COORDINATOR SYSTEM
I. KEY FACTS ABOUT REPRODUCTIVE HEALTH
1. Definition of reproductive health
Reproductive health is a state of complete physical, mental
and social well-being, and not merely the absence of reproductive
disease or infirmity. Reproductive health deals with the
reproductive processes, functions and system at all stages of life.
The International Conference on Population and Development
Programme of Action states that "reproductive health ... implies
that people are able to have a satisfying and safe sex life and
that they have the capability to reproduce and the freedom to
decide if, when and how often to do so. Implicit in this last
condition are the right of men and women to be informed and to have
access to safe, effective, affordable and acceptable methods of
family planning of their choice, as well as other methods of their
choice for regulation of fertility which are not against the law,
and the right of access to appropriate health care services that
will enable women to go safely through pregnancy and childbirth and
provide couples with the best chance of having a healthy infant.
... Reproductive health includes sexual health, the purpose of
which is the enhancement of life and personal relations, and not
merely counselling and care related to reproduction and sexually
transmitted diseases."
2. The importance of reproductive health
Reproductive health is a crucial part of general health and a
central feature of human development. It is a reflection of health
during childhood, and crucial during adolescence and adulthood,
sets the stage for health beyond the reproductive years for both
women and men, and affects the health of the next generation. The
health of the newborn is largely a function of the mother's health
and nutrition status and of her access to health care.
Reproductive health is a universal concern, but is of special
importance for women particularly during the reproductive years.
Although most reproductive health problems arise during the
reproductive years, in old age general health continues to reflect
earlier reproductive life events. Men too have reproductive health
concerns and needs though their general health is affected by
reproductive health to a lesser extent than is the case for women.
However, men have particular roles and responsibilities in terms of
women's reproductive health because of their decision-making powers
in reproductive health matters.
At each stage of life individual needs differ. However, there
is a cumulative effect across the life course ž events at each
phase having important implications for future well-being. Failure
to deal with reproductive health problems at any stage in life sets
the scene for later health and developmental problems.
Because reproductive health is such an important component of
general health it is a prerequisite for social, economic and human
development. The highest attainable level of health is not only a
fundamental human right for all, it is also a social and economic
imperative because human energy and creativity are the driving
forces of development. Such energy and creativity cannot be
generated by sick, tired people, and consequently a healthy and
active population becomes a prerequisite of social and economic
development.
3. What is new about the concept of reproductive health
Reproductive health does not start out from a list of diseases
or problems - sexually transmitted diseases, maternal mortality -or
from a list of programmes - maternal and child health, safe
motherhood, family planning. Reproductive health instead must be
understood in the context of relationships: fulfilment and risk;
the opportunity to have a desired child ž or alternatively, to
avoid unwanted or unsafe pregnancy. Reproductive health contributes
enormously to physical and psychosocial comfort and closeness, and
to personal and social maturation ž poor reproductive health is
frequently associated with disease, abuse, exploitation, unwanted
pregnancy, and death.
The most significant achievement of the Cairo Conference was
to place people firmly at the centre of development efforts, as
protagonists in their own reproductive health and lives rather than
as objects of external interventions. The aim of interventions is
to enhance reproductive health and promote reproductive rights
rather than population policies and fertility control. This
implies the empowerment of women (including through better access
to education); the involvement of women and young people in the
development and implementation of programmes and services; reaching
out to the poor, the marginalized and the excluded; and assuming
greater responsibility for reproductive health on the part of men.
4. How this concept of reproductive health differs from existing
family planning and maternal and child health programmes
Programmes dealing with various components of reproductive
health exist in some form almost everywhere. But they have usually
been delivered in a separate way, unconnected to programmes dealing
with closely interdependent topics. For example, the objectives,
design and evaluation of family planning programmes were largely
driven by a demographic imperative, without due consideration to
related health issues such as maternal health or STD prevention and
management. Evaluation was largely in terms of quantity rather
than quality - numbers of contraceptive acceptors as opposed to the
ability and opportunity to make informed decisions about
reproductive health issues. In general, such programmes
exclusively targeted women, taking little account of the social,
cultural and intimate realities of their reproductive lives and
decision-making powers. They tended to serve only married people,
excluding, in particular, young people. Services were rarely
designed to serve men even though they have reproductive health
concerns of their own, particularly with regard to sexually
transmitted diseases. Moreover, the involvement of men in
reproductive health is important because they have an important
role to play as family decision-makers with regard to family size,
family planning and use of health services.
A reproductive health approach would differ from a narrow
family planning approach in several ways. It would aim to build
upon what exists and at the same time to modify current narrow,
vertical programmes to ones in which every opportunity is taken to
offer women and men a full range of reproductive health services in
a linked way. The underlying assumption is that people with a need
in one particular area - say treatment of a sexually transmitted
diseases - also have needs in other areas - family planning or
antenatal/postpartum care. Such programmes would recognize that
dealing with one aspect of reproductive health can have synergistic
effects in dealing with others. For example, management of
infertility is difficult and expensive but it can be largely
prevented through appropriate care during and after delivery and
prevention and management of STDs. Promotion of breast-feeding has
an impact on reproductive health in many ways - it helps prevent
certain postpartum problems, delays the return to fertility, may
help prevent ovarian and breast cancer, and improves neonatal
health.
Another important difference between existing programmes and
those developed to respond to the new concept of reproductive
health is the way in which people - particularly women and young
people who are the most affected by reproductive health concerns -
are involved in programme development, implementation and
evaluation. When women become more involved in programmes it
becomes clearer that they have health concerns beyond motherhood
and also that dealing with reproductive health involves a profound
rethinking of the behavioural, social, gender and cultural
dimensions of decision-making which affect women's reproductive
lives.
5. What reproductive health services include
The precise configuration of reproductive health needs and
concerns, and the programmes and policies to address them, will
vary from country to country and will depend on an assessment of
each country's situation and the availability of appropriate
interventions. Globally, however, both the epidemiological data and
the expressed wishes of diverse constituencies indicate that
reproductive health interventions are most likely to include
attention to the issues of family planning, STD prevention and
management and prevention of maternal and perinatal mortality and
morbidity. Reproductive health should also address issues such as
harmful practices, unwanted pregnancy, unsafe abortion,
reproductive tract infections including sexually transmitted
diseases and HIV/AIDS, gender-based violence, infertility,
malnutrition and anaemia, and reproductive tract cancers.
Appropriate services must be accessible and include information,
education, counselling, prevention, detection and management of
health problems, care and rehabilitation.
Reproductive health strategies should be founded first and
foremost on the health of individuals and families. In the
operationalization of the strategies all reproductive health
services must assume their responsibility to offer accessible and
quality care, while ensuring respect for the individual, freedom of
choice, informed consent, confidentiality and privacy in all
reproductive matters. They should focus special attention on
meeting the reproductive health needs of adolescents.
6. Factors affecting reproductive health
Reproductive health affects, and is affected by, the broader
context of people's lives, including their economic circumstances,
education, employment, living conditions and family environment,
social and gender relationships, and the traditional and legal
structures within which they live. Sexual and reproductive
behaviours are governed by complex biological, cultural and
psychosocial factors. Therefore, the attainment of reproductive
health is not limited to interventions by the health sector alone.
Nonetheless, most reproductive health problems cannot be
significantly addressed in the absence of health services and
medical knowledge and skills.
The status of girls and women in society, and how they are
treated or mistreated, is a crucial determinant of their
reproductive health. Educational opportunities for girls and women
powerfully affect their status and the control they have over their
own lives and their health and fertility. The empowerment of women
is therefore an essential element for health.
7. Who is most affected by reproductive health problems
Women bear by far the greatest burden of reproductive health
problems. Women are at risk of complications from pregnancy and
childbirth; they also face risks in preventing unwanted pregnancy,
suffer the complications of unsafe abortion, bear most of the
burden of contraception, and are more exposed to contracting, and
suffering the complications of reproductive tract infections,
particularly sexually transmitted diseases (STDs). Among women of
reproductive age, 36% of all healthy years of life lost is due to
reproductive health problems such as unregulated fertility,
maternal mortality and morbidity and sexually transmitted diseases
including HIV/AIDS. By contrast, the equivalent figure for men is
12%.
Biological factors alone do not explain women's disparate
burden. Their social, economic and political disadvantages have a
detrimental impact on their reproductive health. Young people of
both sexes, are also particularly vulnerable to reproductive health
problems because of a lack of information and access to services.
8. How countries can identify reproductive health needs and
assess priorities
A number of countries have expressed the desire to move
forward with a new and comprehensive approach to reproductive
health. Support to national authorities in carrying out a
systematic review of reproductive health needs at country level
should focus on the importance of adding innovative and
participatory approaches to more familiar epidemiological
methodologies in which the process tends to be directed by experts
and framed by biomedical approaches and indicators. The
identification of reproductive health needs, the determination of
priorities and the development of programmatic responses to those
needs should be conducted through an inclusive process, soliciting
the perspectives of a range of groups concerned with reproductive
health including, for example, women's health advocates, youth
groups, health care providers at the periphery as well as at the
central level, health planners, researchers, and non-governmental
organizations.
Several instruments have already been developed for situation
analysis and needs assessment in different components of
reproductive health, for example, family planning and safe
motherhood. However, in the context of the new approach to
reproductive health it is necessary to ensure that assessment and
prioritization reflect people's concerns as agreed at national and
local levels and not the priorities of agencies or donors. It is
important to avoid duplication and to develop tools that are
appropriate for countries themselves. A number of such instruments
already exist and are widely used. However, it is important to
ensure compatibility and consistency among the various instruments
currently available.
Similar considerations apply to the selection of priorities
for action in reproductive health. Criteria for identification of
priority problems should include not only importance - prevalence,
severity, public concern, government commitment, impact on family,
community and development - but also the feasibility of addressing
them - known interventions, cost-effectiveness, availability of
financing, human resources and adequate equipment and supplies.
9. Human resources for reproductive health
The operationalization of the new concept of reproductive
health will mean changes in skills, knowledge, attitudes and
management. People will have to work together in new ways. Health
care providers will have to collaborate with others, including
NGOs, women's health advocates, and young people. Managerial and
administrative changes will also be needed because integrated
services can impose, at least initially, greater burdens on already
over-stretched staff and require attention to planning and
logistics in order to ensure availability and continuity of
services.
Training for reproductive health workers will need to focus on
improving both technical and interpersonal skills. Additional
training, particularly in counselling skills and in ways of
reaching out to under-served groups will be essential elements of
such training. The back-up and support of functioning referral
systems will be essential elements if the full range of
reproductive health concerns is to be adequately addressed.
10. Monitoring and evaluation
Monitoring and evaluation of reproductive health takes place
at two levels - the country and the global level. Globally, the
international community has already defined a number of indicators
relevant to reproductive health, including:
Maternal mortality
% pregnant women who have at least one antenatal visit
% of pregnant women who have a trained attendant at delivery
% of pregnant women immunized against tetanus
contraceptive prevalence rate
% of infants weighing less than 2500 g at birth (a newborn
indicator that reflects maternal reproductive health)
WHO is working on additional indicators for global monitoring
in reproductive health, including indicators on incidence and
prevalence of sexually transmitted diseases, quality of family
planning services, access to and quality of maternal health
services, prevalence of female genital mutilation and prevalence
and nature of obstetric and gynaecological morbidities.
Reproductive health indicators should cover not only
quantitative indicators such as those listed above, but also some
qualitative indicators, such as women's satisfaction with services,
perceptions of quality, maternal discomfort and dissatisfaction,
perceived reproductive morbidities, opportunities for choice, and
enabling environments. Particular attention will be paid to
indicators that identify disparities within countries - between
population groups and/or regions, for example.
Data collection should be seen as a means towards an end
rather than an end in itself. It will, therefore, be necessary to
focus increasingly on performance-based measures such as maternal
audit, surveillance and other process measures. Such programme
indicators should be useful for policy-making and be generated
through data collection procedures that are useful for programme
management at the level at which the data are collected. All data
collection efforts should be sustainable by the national
authorities and able to take into account new developments in terms
of strategic thinking and implementation. In addition, all
indicators should be valid, objectively measurable and reliable.
II. KEY ACTIONS FOR THE RESIDENT COORDINATOR SYSTEM
TO IMPROVE REPRODUCTIVE HEALTH
1. Advocate for the concept of reproductive and sexual health
The Resident Coordinator system can promote recognition of the
concept of reproductive health as central to general health and
human development. This implies the integration of reproductive
health and reproductive rights into all related development
priorities and programmes. Resident Coordinators should be aware
that reproductive health is a dynamic and continuously evolving
concept. Therefore, information sharing and collaboration will be
needed to ensure that the approaches developed and implemented are
based on the most recent and relevant information available and on
the evolving experiences of those working in the field. The
Country Strategy Note should be used as a vehicle to promulgate
this vision more widely.
2. Promote multi-sectoral action
Reproductive health is a health issue but encompasses more
than biomedical aspects and goes beyond the health sector. The
determinants of reproductive ill-health lie in poverty, gender and
other forms of inequity, social injustice, marginalization and
development failures. All sectors affect and are affected by
reproductive health. The Resident Coordinator system can advocate
that all agencies and all sectors have roles and responsibilities
in promoting reproductive health.
One of the key actions needed to improve reproductive health
is the empowerment of women especially through education. The UN
Resident Coordinator system can mobilize increased energies and
resources for women's education both in-school and out-of-school
(youth groups, workplaces, adult literacy and income generation
groups etc.).
3. Stimulate adherence to essential principles
The Resident Coordinator system can disseminate the underlying
principles which must serve as a guide to action in reproductive
health. These are the guiding principles of human rights, equality
and gender equity, and placing people at the centre of development
efforts. Operational principles for the implementation of
reproductive health policies and programmes include participatory
processes, involvement of multiple perspectives and multi-sectoral
action. The Resident Coordinator system is well-placed to ensure
the involvement of different sectors and the participation of all
those concerned with reproductive health. Where there are major
regional, ethnic, religious or cultural variations within
countries, these must be taken into account in the development of
reproductive health strategies. Where certain groups have
difficulties in making their voices heard, the Resident Coordinator
system can play a role in providing a forum for the exchange of
ideas and experiences.
4. Foster national ownership
A global reproductive health strategy must be translated into
approaches that are country-driven. Implementation of reproductive
health programmes is the sovereign right of each country, in a way
that is consistent with national laws and development priorities,
with full respect for religious, cultural and ethical values and in
harmony with universally recognized human rights. The Resident
Coordinator system can ensure that the development of strategies,
policies and programmes is a nationally owned process and that
decisions taken reflect national priorities and are not dictated by
external agencies.
5. Ensure consistency and complementarity
Translating the concept of reproductive health into actions
means ensuring a shared understanding of the concept and
consistency and complementarity in the application of approaches.
It is critically important to avoid conflicting messages from UN
agencies to national counterparts. The Resident Coordinator system
can help to ensure consistency and bring together different parties
in order to avoid duplication and make best use of resources. One
practical way of doing this would be the creation in countries of
a database of information from all in-country agencies on project
design, implementation, monitoring, evaluation, lessons learned and
future programme plans. This could be drawn upon by all agencies
and would help avoid duplication while ensuring greater
information-sharing and networking among agencies.
6. Coordinate agency, regional, bilateral and NGO activities
Each agency has specific mandates and comparative advantages
which need to be incorporated into the concept of reproductive
health. Some agencies, including WHO, UNAIDS, UNFPA, UNICEF, and
UNHCR are likely to have a deeper involvement than others in
reproductive health issues. While subscribing to the overall broad
concept of reproductive health, agencies select priorities in a
focused way on the basis on capacities and resources. Resident
Coordinators should be well aware of agency mandates, capacities
and resources and be able to assess where there are gaps and
duplications and recommend strategies to overcome them.
Resident Coordinators can promote harmony between the
activities of international agencies, bilateral donors and NGOs
working to support government and regional strategies in
reproductive health. The Resident Coordinator system should gather
and disseminate information about the resources available at
country, regional and global levels, in terms of funding, knowledge
and expertise.
7. Assist in the identification of reproductive health needs
The Resident Coordinator system can help countries in the
identification of national reproductive health needs and the
selection of priorities, in the evaluation of current programmatic
responses to the needs identified and in assessing potential for
improvement and avoidance of overlap. The Resident Coordinators
should promote the need for appropriate guidance and training for
all agency, regional and national representatives in the
reproductive health approach.
8. Support national planning
The resident coordinator system should support national
planning through making the most effective use of specific agency
plans and programmes, making the best use of the comparative
advantages of each agency, and through seeking to achieve an
appropriate balance in the response of country and agency
activities and promoting an incremental improvement in programmes
bearing the overall reproductive health vision in mind. Of
particular importance in the national planning process is the
development of decision-making tools and the improvement of
managerial capacities. The overall objective is to increase
national capacity for planning and implementation of reproductive
health policies and programmes within national constraints,
objectives and approaches.
9. Promote integrated approaches
The Resident Coordinator system can ensure integration of all
aspects of reproductive health, especially those delivered in the
past through vertical programmes such as family planning. The
Resident Coordinator can encourage the incorporation into
reproductive health programmes of such concerns as the eradication
of harmful practices affecting women's health, as well as various
forms of violence.
The Resident Coordinator system can integrate follow-up to the
various international conferences on related issues such as
population, reproductive health and development, including the
World Summit for Children, the United Nations Conference on
Environment and Development, the World Social Summit, the United
Nations Conference on Human Rights and the forthcoming Fourth World
Conference on Women.
10. Support monitoring and evaluation
The Resident Coordinator system has an important role to play
in monitoring and evaluation. Global monitoring should be limited
and not impose additional burdens on national reporting systems.
The Resident Coordinator should support national capacity-building
for monitoring progress in country programmes in a way which is
helpful to programme management and useful at the point of delivery
of the intervention.
=================================================================
SELECTED BIBLIOGRAPHY
Berer M. Population and family planning policies: women-centred
perspectives. Reproductive Health Matters, 1993, 1:4-12.
Cook R. International law and women's health. In: Gomez E. ed.
Gender, Women and Health in the Americas. Washington DC, PAHO,
1993:272-77
Dixon-Mueller R. Population Policy and Women's Rights: Transforming
Reproductive Choice. Westport, CN, Praeger, 1993.
Dixon-Mueller R. The sexuality connection in reproductive health.
Studies in Family Planning. 1993, 24:269-82.
Faundes A, Hardy E, Pinotti JA. Commentary on women's reproductive
health: means or end? International Journal of Gynecology and
Obstetrics. 1989, (supp)3:115-8.
Freedman LP, Isaacs SL. Human rights and reproductive choice.
Studies in Family Planning, 1993, 24:18-30.
Germain, A. and Kyte, R. The Cairo Consensus, International
Women's Health Coalition, New York, 1995
Graham WJ, Reproductive health in developing countries:
measurement, determinants, and consequences: overview. In:
International Population Conference. Liege, Belgium: IUSSP. 1993,
571-7.
Graham WJ, Campbell OM. Maternal health and the measurement trap.
Social Science and Medicine, 1992, 35(8):967-77.
IWHC and WHO. Creating common ground. Geneva, WHO, 1991.
Jacobson, J. The silent emergency: Women's reproductive health,
Worldwatch Institute, 1991.
Jain A, Bruce J. Implications of reproductive health for objectives
and efficacy of family planning programs. New York, The Population
Council. (Programs Division Working Papers No. 8). 1993
Koblinsky M, Timyan J, Gay J. eds. The Health of Women: a Global
Perspective. Boulder, Westview Press, 1993:33-62.
Lane, S. From population policy to a reproductive health agenda.
Social Science and Medicine 39 (9), 1994
Mazur LA, ed. Beyond the Numbers: A reader on Population,
Consumption, and the Environment. Washington DC, Island Press.
1994:150-7.
Rockefeller Foundation. Improving the quality and reach of
reproductive health service delivery: a strategy paper. New York,
The Rockefeller Foundation, 1994.
Sen G, Germain A, Chen L, eds. Population Policies Reconsidered:
Health, Development, and Human Rights. Cambridge, Harvard
University Press, 1994:1-17
Tinker A et al. Women's health and nutrition: Making a difference.
Washington, DC, World Bank (Discussion Paper No. 256), 1994.
UNFPA. Reproductive Health and Family Planning: Directions for
UNFPA Assistance. Report on Expert Consultation. New York, 1995.
World Bank. World Development Report 1993. New York, Oxford
University Press, 1993.
World Bank. Population in Developing Countries: Implications for
the World Bank. Washington DC, World Bank, 1994.
World Bank. Improving Reproductive Health: The Role of the World
Bank. Washington DC, World Bank, 1995
World Health Organization. Care of mother and Baby at the health
centre: a practical guide. WHO/FHE/MSM/94.2. Geneva, WHO, 1994.
World Health Organization. Health, Population and Development,
WHO/FHE/94.1. Geneva, WHO, 1994.
World Health Organization. Mother-Baby Package: Implementing Safe
Motherhood in Countries. WHO/FHE/MSM/94.11. Geneva, WHO, 1994.
World Health Organization. Achieving Reproductive Health For All.
The Role of WHO. WHO/FHE/95.6. Geneva, WHO, 1995.
World Health Organization. Women's Health: Improve our health -
improve the world. WHO/FHE/95.8. Geneva, WHO, 1995.
===============================================================
AGENCY PROFILES
World Health Organization (WHO)
WHO was an active contributor throughout the ICPD process and
fully subscribes and is committed to the implementation of the
Programme of Action, and to reinforcing the central role of health
and human development in the global agenda for sustainable
development. In following up ICPD WHO is committed to further
build upon the existing collaboration within the UN system to
support countries in their efforts to take on the challenges of
Cairo. WHO will foster its relationship with UNICEF, UNFPA, UNDP
and the World Bank in particular, at both global and country
levels.
WHO will continue to affirm that to bring about the necessary
changes and improve health and quality of life, health policies
must reach beyond the health sector while remaining rooted in the
health-for-all principles of primary health care. A primary health
care approach includes promotive and preventive aspects as well as
care and rehabilitation and comprises actions at the community
level supported by referral to a higher level of care when needed.
WHO stimulates and supports research in reproductive health,
particularly in the area of fertility regulation, safe motherhood,
and reproductive tract infections including STDs and HIV/AIDS
prevention. WHO's research is aimed at identifying gaps in
addressing reproductive health needs, at adapting technologies and
applying existing knowledge, and at developing new approaches and
interventions for better reproductive health. WHO works with a
worldwide network of collaborating centres to build national
research capabilities, develop innovative methodologies and
disseminate the results of research to policy-makers, planners,
health care providers, women's health advocates, non-governmental
organizations and scientists.
As part of its normative function WHO develops policies,
strategic approaches, norms and standards. WHO has developed a
range of guidelines dealing with technical, managerial and clinical
aspects of reproductive health, including family planning
guidelines, maternal health care, management of obstetric
complications, prevention and management of abortion complications,
prevention and treatment of STDs including HIV/AIDS, and detection
and management of cervical cancers. The objective is to
disseminate appropriate and relevant up-to-date information to
those working in the field and to promote adherence to the highest
attainable standards of quality health care.
WHO's normative work includes guidance on the elimination of
harmful practices such as female genital mutilation and the
development of standard definitions and guiding protocols on data
collection and analysis.
WHO provides support to the development of training materials,
and works with national and international professional and
educational bodies on different aspects of health curriculum
development. Such training materials must now be adapted to
incorporate the concept of reproductive health and to assist the
many categories of health care providers in responding to
reproductive and sexual health needs in a more integrated way.
Within the broader reproductive health framework WHO is
currently paying increased attention to ethical issues in
reproductive health; appropriate technologies; gender equity,
women's perspectives and the roles and responsibilities of men; the
particular needs of women and young people; the interrelationships
between reproductive health and other public health issues such as
nutrition and the environment; indicators for assessing progress
and monitoring and evaluation of reproductive health programmes.
In its technical support to Member States WHO's underlying
philosophy is that policies, strategies and programmes must be
country-owned, build national capacity and self-reliance, and be
sustainable. WHO promotes and supports programme development that
is based on a consultative process which brings together all
concerned constituencies in reproductive health, particularly those
whose voices have hitherto remained unheard -women, young people,
the poor, the marginalized, refugees and the displaced.
WHO's governing bodies have given increased attention to
reproductive and women's health, and have requested a greater role
for the Organization. WHO has started a series of specific
activities as follow-up to the Programme of Action of ICPD. The
goals and objectives of the Programme of Action of Cairo are being
integrated into WHO's 9th General Programme of Work which runs from
1996 to 2001.
WHO has identified reproductive health a priority for the
Organization. This will be reflected in the 1996-97 programme
Budget and the area of reproductive health will receive increased
resources effected by a 5% shift of Regular Budget funds. The
World Health Assembly has requested the Director-General to develop
a coherent programmatic approach for research and action in
reproductive health and reproductive health care within WHO.
United Nations Population Fund (UNFPA)
ln its support for reproductive health, UNFPA will continue to
underscore a number of basic programming concepts including, in
particular, efforts to:
o involve women, women's organizations, and other groups
working for women's needs in the planning, implementation
and monitoring of reproductive health services and
programmes;
o promote men's participation in reproductive health
programmes and responsibility for their sexual and
reproductive behaviour;
o assure the highest level of quality of care in providing
information and services;
o promote an approach that provides a constellation of
linked or integrated services to meet the needs of
clients;
o make available as wide a range as possible of safe and
effective modern methods of family planning technically
approved by the World Health Organization (WHO);
o create a better understanding of the social, cultural and
behavioural context within which reproductive ill-health
occurs; and
o promote the coordination of national reproductive health
programmes among Governments, multinational and bilateral
agencies, NGOs and the private sector.
UNFPA supports the concept of sexual and reproductive health as
a human right. Women and men must therefore be provided with the
necessary information and services to exercise this right. UNFPA
support for reproductive health will be based on a public-health,
pragmatic and participatory approach. Such an approach: (a)
responds to the reproductive health needs of individuals and
involves them in the programming process; (b) promotes
sustainability: and (c) identifies interventions that have the
greatest impact for the most people at an affordable price. It also
encourages partnerships between Governments, NGOs, and the private
sector to maximize both coverage and quality of services and to
stimulate innovative ideas. This will best be achieved, in
practice, through an incremental approach that builds on the system
that is currently in place, identifies gaps and inadequacies in
that system and strengthens links between programmes in order to
respond better to the reproductive health needs of individuals.
The rationale for using such an incremental approach is that it
makes the most efficient and cost-effective use of existing staff
and health-care facilities. In fact, it is often the same primary
care worker, working out of the same facility, who provides family
planning care and many of the other components of reproductive
health. UNFPA will thus work to integrate reproductive health care
information and services into the various other services provided
at the service-delivery level and to assure that the health-care
personnel working in such facilities receive training in integrated
reproductive health care.
Activities supported by UNFPA in reproductive health include:
o the full spectrum of family planning information and
services, including counselling and follow-up services,
aimed at all couples and individuals;
o prenatal, delivery (including assisted delivery) and
postnatal care of mothers at the primary health care
level with appropriate referral for the management of
obstetric complications;
o prevention of abortion, management of the consequences of
abortion, and post-abortion counselling and family
planning;
o prevention of reproductive tract infections (RTIs)
including STDs and HIV/AIDS through preventive
counselling, condom distribution and treatment of
symptomatic infections, as part of primary health care,
with appropriate referral for follow-up;
o prevention of infertility and sub-fecundity, as part of
primary health care, with appropriate referral for
follow-up;
o routine screening for other women's reproductive health
conditions such as urinary tract infections, cervical
infections, and cervical and breast cancer, where primary
level treatment is available or referral for follow-up
exists;
o active discouragement of harmful practices such as female
genital mutilation.
The fund strongly encourages the further strengthening of
collaborative and coordination arrangements with WHO, UNICEF, other
UN systems partners, bilateral agencies and non-governmental
organisations, in order to assist countries in the development of
reproductive health programmes in the most effective and effective
manner.
The World Bank
Reproductive health activities constitute a significant portion of
all World Bank lending for population, health and nutrition
activities:
o In the Bank's 1994 fiscal year, over 40 percent of all
lending for population, health and nutrition supported
reproductive health activities.
o Over the past 25 years, the Bank has lent more than $2.5
million to support reproductive health components of more
than 130 projects in almost 70 countries. Although the
number of new commitments have varied from year to year,
the trend has been steadily upward.
o In recent years, Bank lending has Integrated reproductive
health projects with its population programmes, financing
an average of nearly $400 million in such programmes each
year since 1992.
Research sponsored by the Bank also often provides the
analytical basis for reproductive health policy and action:
o Bank operations research, situation analyses, and field-
based pilot projects aid program managers in assessing
needs, instituting or modifying services, and in
determining the effects of interventions on health
systems and health status.
o The Bank's Special Grants programs represent another
mechanism for support of large-scale, long-term efforts
that are too costly for most developing countries to
undertake independently. For example, the Bank already
has contributed $18 million to the Special Programme of
Research, Development and Research Training in Human
Reproduction (HRP) which is being co-sponsored by UNFPA
and WHO.
o The Bank is also involved in sector work, in which Bank
staff analyse data that enable more informed policy
decisions and program development Sector analyses in
Brazil, India and Uganda have helped identify the
dimensions of women's health problems, as well as
constraints on their use of health services.
o In addition to support provided for reproductive health
activities through project lending, the Bank's Economic
Development Institute organizes training activities that
strengthen national capacities to design and implement
policies and programs in the field. These activities
serve to foster the exchange of ideas and experiences
that support the improvement of reproductive health
information and services.
Importantly, the World Bank actively seeks and supports
collaboration among donor agencies and local non-governmental
organizations (NGOs) to spread awareness of reproductive health
issues and improve the effectiveness of projects with reproductive
health components:
o Special Grants Programs for Population NGOs and Safe
Motherhood, for example, provide a coordinating mechanism
for safe motherhood programs.
o Bank projects in Bangladesh, Indonesia, and Zimbabwe have
strengthened collaboration among multilateral, bilateral,
and NGOs, thereby improving the delivery of maternal
health and family planning services.
International Labour Organisation (ILO)
Relevant ILO policies and programmes are based on the premise
that success in protecting and promoting reproductive health is
linked to social and economic factors including education,
training, employment, working conditions and gender equality in
labour markets. It is accordingly affected by the adequacy of
measures designed to protect workers; the levels of success
achieved by attempts to promote and ensure equality of opportunity
and treatment and the effectiveness of policies to promote
employment opportunities. Each of these policies, measures and
programmes in various ways promotes the empowerment of women -
through legal protection (standard setting and application); all
improved access to resources and opportunities, including
education, information, employment and incomes. At the same time
the ILO recognizes that reproductive health and related outcomes
(in terms of timing of births and levels of morbidity and
mortality) are important factors affecting gender equality; the
levels of living of workers and their families; family
responsibilities and workers' ability to cope with them; employment
opportunities and career development; and the viability and
profitability of enterprises.
ILO promotes and provides technical support to its
constituents to enable them to design, develop and implement
comprehensive policies and programmes which link population and
reproductive health concerns to social and economic goals and
achievements. Accordingly governments are assisted to analyse,
identify and address the relevant aspects of population,
development and employment policies and to ratify and apply
existing International Labour Standards relevant to maternity
protection, safety and health at work, and promotion of equality
and employment opportunities. Employers are helped to adopt
appropriate workplace rules and mechanisms, both to eliminate
reproductive health hazards in places of work and to promote family
welfare and planning through education and access to supports and
services. Workers' organizations are strengthened to promote and
implement workers' education on population, reproductive health and
gender issues.
United Nations Children's Fund (UNICEF)
UNICEF has been active in developing appropriate strategies
and programming interventions in the area of reproductive health,
specifically safe motherhood, family planning and in the prevention
of HIV/AIDS and other STDs. UNICEF support to women's health
activities emphasises working with women's organisations at the
community level. The focus is on promoting linkages with the health
sector, assisting women's organisations in implementing
information, education, communication efforts and in developing
financing mechanisms for purchasing health care. UNICEF programmes
of assistance will also include support to national-level
mobilization on safe delivery. National commissions or task forces
on safe delivery will serve to monitor progress toward reducing
maternal mortality, rationalise medical practices, and mobilize
political and community commitment to women's health. In close
collaboration with WHO, UNICEF support is provided to strengthen
essential obstetric care services and referral of women with
complications in pregnancy and delivery, including the life-
threatening complications of unsafe abortion. Increasing emphasis
will be placed on the role of nurses and midwives, specifically
training in life-saving skills, maternal and newborn care, pre- and
post-natal counselling diagnosis and treatment of reproductive
tract infections, and family planning.
UNICEF efforts in the area of adolescent health seek to build
stronger dialogue and partnership among young people, parents,
educators, health providers and community leaders on health,
including reproductive health. They also seek to help assure that
adolescents have access to the information, skills and services
they need to protect and promote their own health and eventually
the health of their children. UNICEF supports school health
programmes which emphasise skills-based health education, including
reproductive health education, health and nutrition services, water
and sanitation on school premises, and extra-curricular activities
which promote the health of school-age children. Working closely
with parents and community organisations, increasing emphasis will
be placed on expanding adolescents' access to and utilisation of
quality health care and counselling services. UNICEF will work with
governments and NGOs to support increased outreach to vulnerable
adolescents, training of health workers on adolescent health, and
strengthening linkages between the health sector and NGOs. The
health needs of girls and young women, specifically preventing
early and unwanted pregnancy, eliminating harmful traditional
practices, like female genital mutilation and nutrition are
becoming an increasingly important part of UNICEF efforts. IEC
efforts with boys and young men will emphasise healthy practices,
including responsible sexual behaviour.
Office of the United Nations High Commissioner for Refugees (UNHCR)
The mission of the United Nations High Commissioner for
Refugees (UNHCR) is to assist and protect refugees worldwide.
Based in Geneva, Switzerland, UNHCR was created by the UN General
Assembly and began work in 1951, aiding millions of European
refugees in the aftermath of World War II. Since then, the agency
was twice awarded the Nobel Prize - has aided tens of millions of
desperate and needy people who have been forced to flee their
countries because of persecution, war, or massive human rights
abuse. The total number of people who come under UNHCR's concern
has risen from 17 million in 1991 to more than 27 million at
January 1, 1995: one out of every 205 people on this planet.
Roughly three-quarters of those destitute displaced people are
women and their dependent children. Their role within their family
and their community is pivotal. But, in areas of the world often
deeply scarred by suffering, exploitation and ill-health these
refugee women and children - deprived, by definition of the
protection of their state are hard-hit by the violence and
uncertainty of displacement. Many have already survived situations
of extreme pain. They are among society's most vulnerable members.
For them, food, water, shelter, sanitation and preventive
health care are a priority. So is protection: refugees need to be
protected from being returned against their will to a country where
their lives and fundamental rights are under threat. However,
reproductive health care is also among the crucial elements that
can give refugees the basic human welfare and dignity that they
deserve. The key issues are safe and adequate maternity care;
access to family planning and child spacing, treatment and
prevention of sexually transmitted diseases (including HIV/AIDS);
prevention of - and response to - sexual violence; gynaecological
care; and prevention and treatment of complications arising from
the genital mutilation of girls and unsafe abortion.
The range of reproductive health services required by refugees
are similar to those needed by any other population. The
differences: refugees' needs are likely to be more influenced by
trauma, in part because, amid the chaos of displacement and exile,
refugees are more vulnerable to abuse. Compared to those of other
populations, the reproductive health care needs of refugees are
therefore likely to be both more urgent and more acute.
UNHCR is committed to improving the reproductive health
situation of refugees, particularly of women and adolescents.
Recently, UNHCR and UNFPA jointly sponsored an inter-agency
symposium specifically to address the reproductive health of
refugees. It has also issued guidelines on the prevention and
follow-up of rape and has taken a series of steps to better empower
and assist refugee women. Together with the non-governmental
organizations that operate as UNHCR partners in many refugee
situations. UNHCR field staff in areas as far-flung as Tanzania
and Nepal have set up medical services specifically intended to
begin work on improving reproductive health.
Staff are also working to develop a field manual, grounded in
the practical experience of hundreds of refugee aid-workers. The
manual will define the how, where and what of future reproductive
health services to refugees. This basic guide should be an
invaluable practical tool for UNHCR's more than 3000 field workers.
It will be completed before the end of 1995.
United Nations Educational, Scientific and Cultural Organization
(UNESCO)
UNESCO continues to work in close co-operation and
collaboration with UN agencies and its partners including NGOs to
enhance the quality of life of human populations through effective
educational, scientific and cultural development policies and
programmes.
UNESCO supports the educational, scientific and cultural
dimensions of reproductive health. The interdisciplinary project
on environment, population and development (EPD) has drawn
expertise from all the relevant sectors of UNESCO to enrich and
enhance the EPD programmes. It is believed that EPD will develop
its programme further to include the present and emerging issues
related to reproductive health in its various population
environment, and other educational programmes through effective
training and communication strategies to meet the needs of
developing and developed countries. Much success has been achieved
in human sexuality education, adolescent/youth participation in
development programmes.
EPD has focussed through its various programmes and projects
on the development of relevant education, training and information
activities that deal with the complex and interlinked issues of
population, environment and development. There has been growing
emphasis on integrated activities and on national capacity building
UNESCO supports and also actively participates to better understand
the multicultural aspect of social development that includes
reproductive health, because it is crucial to the improvement of
quality of life and human resources development programmes.
Reproductive health issues involve active participation of
individuals, communities and societies and this can be successfully
achieved through UNESCO continued support through its education,
information, communication training and research policies and
programmes at the global, regional and country level.
In the current biennium (1994-1995) and in the forthcoming
biennium (1996-1997), EPD proposes enhanced activities in relevant
reproductive health issues, through it inter-agency, inter-
disciplinary and inter-sectoral projects/programmes in all regions.
This task is being and will continue to be achieved in closely
collaboration with the UNFPA TSS/CST programme. New programmes are
under preparation that will focus on the follow-up on the
reproductive health aspects as stated in ICPD and efforts are being
made to focus on those areas where best results can be expected
through collaborative expertise and activities of UNESCO and its
partners in the UN system, NGOs and others.
==================================================================
GUIDELINES ON WOMEN'S EMPOWERMENT
FOR THE UN RESIDENT COORDINATOR SYSTEM
BACKGROUND
1. The 1990's have seen increasing recognition of the centrality
of women's empowerment to the success of development programmes.
The empowerment of women was essential to the declarations and
platforms for action of the 1990 World Conference on Education for
All, the 1992 United Nations Conference on Environment and
Development, the 1993 Human Rights Conference, the 1994
International Conference on Population and Development, the 1995
World Summit for Social Development, and the Regional Preparatory
Conferences for the 1995 Fourth World Conference on Women. This
increased appreciation for and understanding of women's pivotal
role in the development process has also been reflected in the
goals and priorities of organizations and agencies in the United
Nations system. In this regard, the United Nations Resident
Coordinators are being called upon to play a key role in
facilitating inter-agency cooperation on gender equality and equity
and the empowerment of women, with particular emphasis on
operational activities at the country level.
2. The Programme of Action of the International Conference on
Population and Development stresses that the empowerment and
autonomy of women and the improvement of their political, social,
economic and health status is both a highly important end in itself
and necessary for the achievement of sustainable human development.
It states further that "Advancing gender equality and equity and
the empowerment of women, and the elimination of all kinds of
violence against women, and ensuring women's ability to control
their own fertility ...are priority objectives of the international
community" (Principle 4 of the ICPD Programme of Action).
3. The Programme of Action further recognizes that in all parts
of the world, women are facing threats to their lives, health and
well-being. They receive less education than men and are over-
represented among the poor and powerless. Achieving change
requires policy and programme actions that will improve women's
access to the scarce and valued resources of their societies
(particularly secure livelihoods and economic resources), alleviate
their disproportionate household responsibilities, remove legal and
social impediments to their participation in the public sphere,
eliminate the spectre of domestic and sexual violence from their
daily lives and raise social awareness through effective programmes
of education and mass communication.
WOMEN'S EMPOWERMENT: A DEFINITION
4. Clearly, a common thread uniting each of the major
international conferences of the 1990's is women's empowerment.
Furthermore, the international community is now accountable to the
world's women for fulfilling the significant commitments it has
made to help make empowerment a reality of women's lives. What,
then, is women's empowerment? Women's empowerment has five
components: women's sense of self-worth; their right to have and
to determine choices; their right to have access to opportunities
and resources; their right to have the power to control their own
lives, both within and outside the home; and their ability to
influence the direction of social change to create a more just
social and economic order, nationally and internationally.
STRATEGY FOR COORDINATION
5. Recognizing that the successful implementation of the
Programme of Action at the national level depends upon an inter-
disciplinary approach, paragraph 10 of General Assembly Resolution
49/128, Report on the International Conference on Population and
Development, "calls upon the organs of the United Nations system
and the specialized agencies to undertake the actions required to
give full and effective support to the implementation of the
Programme of Action." In response to this resolution, the Inter-
Agency Task Force on the Implementation of the ICPD Programme of
Action proposed that efforts to further the empowerment of women be
pursued within the United Nations coordination system led by the
Resident Coordinator.
6. The Resident Coordinator is expected to establish a modality
for inter-agency cooperation that would serve as a catalyst for
national initiatives designed to further the economic, social,
political and legal empowerment of women. The Guidelines are not
intended to hinder agencies from pursuing their respective
mandates. Rather, they will enhance the complementarity of
programmes; facilitate integrated planning within a national
development framework; foster dialogue among agencies and between
the United Nations system and governments, provide space for, and
legitimize the participation of NGOs and other actors of civil
society, and allow the United Nations system to contribute more
effectively to the achievement of women's empowerment. The
Statement on the Role and Functioning of the Resident Coordinator
System provides the framework in which this coordination will take
place.
7. Among suggested modalities for coordination and collaboration
among United Nations agencies and between the United Nations system
and its government and civil society partners are:
o standing inter-agency working groups on gender equality
and women's empowerment;
o training sessions in gender analysis and gender-sensitive
programming for national-level United Nations staff, as
well as government, NGO partners and individuals likely
to act as national consultants to the UN system;
o multi-donor coordination mechanisms;
o joint working sessions and planning meetings with
national officials and representatives of NGOs and
grassroots women's groups;
o standing advisory groups made up of gender experts from
government, NGOs, women's groups, and academia; and
o the establishment of national-level goals for, and
indicators of, gender equality and women's empowerment.
8. Heterogeneous groupings of representatives from different
disciplines, the public and private sectors, and a range of civil
society associations allow for the dynamic exchange of ideas,
sharing of lessons learned, consolidation of objectives,
rationalization of activities, coordination of funding and
identification of priorities. The inclusion of a range of civil
society actors will ensure that the voices and visions of women at
the grassroots level are brought into the policy-making process.
The inclusion of regional bodies in this expanded partnership is
also a necessity.
9. Given the resistance that still exists in many quarters to the
promotion of women's empowerment and the use of gender analysis in
development programming, as well as the widespread lack of
technical expertise in this area, inter-agency working groups,
particularly those that include government and civil society
representatives, will serve to consolidate a critical mass of
support for gender-sensitive programming. Often gender concerns
are handled by relatively junior staff, reflecting and reinforcing
the historical marginality of women's concerns to the development
process. When called by the Resident Coordinator, the highest
ranking United Nations official at the national level, however,
such meetings will highlight the seriousness with which the United
Nations system now seeks to promote gender equality and empowerment
of women. This high-level advocacy, which serves to legitimize
gender issues in the eyes of United Nations staff and development
partners alike, is among the most effective strategies available to
the Resident Coordinator seeking to foster women's empowerment at
the national level.
SPECIFIC AREAS FOR ACTION
Research, statistics and situational analysis
10. The creation of gender-sensitive development policies at the
national level is impeded by the lack of accurate and accessible
information about women at both the national and international
levels. In this regard, it is vital that a common data base of
gender and age-disaggregated statistics be available to all United
Nations agencies, and also that common methodologies and
statistical indicators be used in data-gathering. This
disaggregation is vital to follow-up actions targeted at the well-
being of girls, adolescents and women and to identify areas in the
life-cycle of women during which gender disparities are greatest.
The new volume of the World's Women, to be issued in August 1995,
can serve as a model. In addition, there is also a great need to
collate, analyse and make accessible statistics and data that
already exist. The Resident Coordinator has a key role to play in
coordinating multi-disciplinary national-level data-gathering; in
discovering what information is already available at the national
level (through United Nations and government studies, as well as
academia and research institutions) and ensuring its dissemination;
in pinpointing the information gaps; in establishing priority areas
for research; and in identifying areas where gender disparities are
greatest.
11. Areas for which sound statistical information is known to be
scarce are the effects of environmental degradation on women;
causes and effects of migration; adolescent pregnancy and
reproductive health; male roles and responsibilities in promoting
women's empowerment and reproductive health; and the socio-economic
implications of changing gender roles. There is also a great need
to promote research; gather facts and compile statistics concerning
domestic violence; encourage research about the causes, nature,
gravity and consequence of violence against women; and test and
analyse the effectiveness of measures to thwart gender-based
violence and document its recovery process.
12. Creating a roster of gender experts -- national consultants
with expertise in different fields, such as agriculture,
appropriate technology and health, including reproductive health
from a gender perspective -- for use by the United Nations system,
government ministries and NGOs, as well as compiling a directory of
studies and data bases available at the national level, are useful
first steps.
Training in Gender Analysis and Gender-Sensitive Development
Planning
13. A key area of concentration for Resident Coordinators should
be gender training. This training should be required of all United
Nations field staff, including the Resident Coordinator himself or
herself. In addition, the Resident Coordinator should work with UN
agencies and national-level ministries (not just ministries for
women, welfare or social services, but also finance, planning,
agricultural, energy and other "hard" sectoral ministries) to train
staff to help ensure that gender is more fully understood and
gender issues are incorporated within the scope of country- and
region-wide development initiatives. It will also ensure that
there are systematic plans at national levels to avoid duplication
and overlapping of the training efforts of various UN agencies.
The importance of ensuring high-quality gender training cannot be
overstated; those already sceptical of the value of gender training
find their worse fears confirmed and can become entrenched in their
opposition after a poorly designed or poorly run training session.
The relevance and practical applications of gender analysis to the
audience's day-to-day work must be stressed. Resident Coordinators
should take advantage of the methodologies that are being developed
collaboratively by several agencies (including FAO, ILO, UNDP,
UNIDO and UNIFEM).
Reproductive Health and Reproductive Rights
14. The Resident Coordinator has a key role to play in promoting
the reproductive and sexual health and well-being and reproductive
rights of women, adolescents and girls at the national level.
Included under the rubric of reproductive health are the
traditional concerns of family planning, as well as issues coming
to the forefront of international attention more recently, such as
AIDS and other STDs, unsafe abortion, adolescent pregnancy,
practices that are harmful to the health of women and children
(such as female genital mutilation), discriminatory nutritional and
other practices based on male child preference, and early marriage.
Also included in the concept of reproductive health is women and
adolescents' control over their sexuality. Reproductive and sexual
health are affected by the economic, social, cultural and
educational environment in which girls are born, grow to womanhood,
marry and repeat the process in starting their own families. The
Resident Coordinator's interventions in this area should be
imbedded in a human rights framework and informed by several key
principles:
o Women have the right to autonomy and reproductive choice.
o Women have the right and social responsibility to decide
whether, how and when to have children and how many to
have; no woman can be compelled to bear a child or
prevented from doing so against her will.
o Men also have a personal and social responsibility for
their own sexual behaviour and fertility and for the
effects of that behaviour on the health and well-being of
their partners and children.
o Reproductive health issues should be addressed in the way
women and men experience them; not as isolated,
biomedical phenomena or matters of public policy, but as
an integrated part of everyday life.
o The fundamental sexual and reproductive rights of women
cannot be subordinated against a woman's will to the
interests of partners, family members, policy-makers, or
any other actors.
o Women must be respected to make their own reproductive
decisions; they must have both the information and the
authority to make decisions about reproduction and the
services that will enable them to satisfy their
reproductive health needs.
15. The goals of reproductive health programmes should be to
increase women and adolescents' control over their bodies, their
sexuality and ultimately their lives; to improve women's health,
including their reproductive and sexual health; and to change
socio-economic structures and norms that impede women's free
exercise of their human rights, including their reproductive rights
(such as women's legal status, access to education, decision-making
powers, poverty level, choice regarding marriage partners and
rights within marriage).
16. In practice, these goals and principles require that the
Resident Coordinator support reproductive health programming rather
than "target-oriented" population programmes by focusing on meeting
the needs of individual women and men; expanding standard services
to include prevention and treatment of AIDs, sexually transmitted
diseases, and violence against women; responding to women and girls
at all stages of the life-cycle; and emphasizing safe, effective
and affordable contraceptive methods that women themselves control
and that are of high quality.
Women's Human Rights and the Convention on the Elimination of all
Forms of Discrimination Against Women (CEDAW)
17. Since the International Conference on Human Rights, held in
June 1993 in Vienna, and the subsequent General Assembly
ratification in December 1993 of the Declaration on the Elimination
of Violence against Women, political will and mobilization around
the issue of women's human rights has increased tremendously. The
debate has led to an expanded conception of human rights that
explicitly recognizes that women's rights are human rights. In
response to this expanded definition of human rights, in March
1994, the United Nations Commission on Human Rights agreed to
appoint a Special Rapporteur on violence against women and to
integrate the rights of women into the human rights mechanisms of
the United Nations. These advances have shown the potential of the
human rights framework for improving the status of women and the
condition of their lives.
18. Despite these substantial legal and procedural changes at the
international level, however, the majority of the world's girls and
women remain outside this enlarged vision of human rights due to
the pervasive, structural and systemic denial of their liberty at
the national and community levels worldwide. The Convention on the
Elimination of all Forms of Discrimination Against Women, approved
in 1979, provides concrete ways to bring these international
principles to bear at the national level. Unlike other human
rights treaties, CEDAW specifically obliges states that ratify the
Convention to take all appropriate measures to eliminate
discrimination against women by any person, organization or
enterprise. In addition, it provides a legal framework for women's
empowerment and participation in the development process. It not
only guarantees basic human rights and fundamental freedoms, it
also lays out policy measures and targets areas of particular
concern to women (such as sex roles and stereotyping, affirmative
action, trafficking in women, access to health care, education and
benefits, and the special needs of rural women).
19. Resident Coordinators can become involved with CEDAW at the
national level in several ways. They can play an advocacy role in
supporting the lobbying and public education efforts of NGOs in
countries that have not yet ratified CEDAW, working to generate
awareness and support, to build partnerships and to assist others
in their lobbying efforts.
20. In countries that have ratified CEDAW, the Resident
Coordinator can assist NGOs and parliamentarians in lobbying for
greater support to the CEDAW Committee, aid the Committee in
disseminating its important findings to a larger audience, work
with appropriate partners to produce materials that make the
Convention accessible and usable at the grassroots level, and
establish task forces of legal experts to design innovative uses of
the Convention and advise women and other groups on its
application. The Resident Coordinator can also support efforts to
revise the legal code to protect and promote the rights of women,
using CEDAW as a basis. Since women worldwide would be well served
by a strengthening of the Convention's mandate and power, Resident
Coordinators should also support the efforts of those seeking to
"give teeth" to the Convention.
Culture and tradition
21. It is important to make note of one of the concerns most
frequently raised regarding efforts to further gender equality and
the empowerment of women, i.e., that such efforts constitute undue
interference in the culture, religion, or traditional practices of
a country. Resident Coordinators have a special responsibility to
address these concerns and to draw distinctions among traditional
practices that harm women and girls and deprive them of their
universally recognized human rights, such as gender-based violence,
forced early marriage, and female genital mutilation, and those
that are socially valuable and benefit women.
22. Several points are key in addressing this issue of culture in
relation to efforts to foster gender equality and women's
empowerment. First, all development efforts, including those that
seek "merely" to introduce new technologies or promote economic
growth, imply social change, for, as the nature, modes, goals and
social relations of production are altered, structures of work and
family life are transformed. Second, women's empowerment was first
articulated and championed as an approach to development by
Southern women seeking to improve their lives and those of their
families. Third, culture is not a static, fixed entity, but a
confluence of beliefs and values continuously undergoing processes
of change and redefinition in response to external and internal
economic, political and social forces.
23. Fourth, cultures and societies are not monolithic; they are
made up of groups of people who often hold conflicting and
competing ideologies, beliefs and practices. What is called
"culture" can sometimes be more accurately understood as the ideas
and practices valued by the dominant group, often men. Social
movements that pose a particular threat to women (and which are, in
turn, particularly threatened by women's empowerment) often appeal
to this concept of cultural or religious tradition as a basis for
their attempt to extend their social control. Finally, the
argument that gender discrimination is a country or cultural matter
(which mirrors the claim that domestic violence is a private act
rather than a public crime) falls apart when one substitutes "race"
for "gender"; South Africa's past policies of apartheid demanded
and received an international response, as should policies and
practices of gender discrimination.
Education
24. The role of equality in education in bringing about equality
in all walks of life is well known and discussed in detail in the
Basic Education Guidelines. Girls' education is fundamental to
gender equality and women's empowerment. Key areas for the
Resident Coordinator's attention include life-long education and
training, including pre-school provision, the elimination of
stereotyped teaching and education materials, diversification of
the educational and training opportunities available to women and
girls, and the promotion of self-esteem and leadership in girls.
Providing employment and job training, as well as literacy
training, for women past traditional school age should be an area
of special focus, as should enabling pregnant adolescents to
continue their schooling. The Resident Coordinator could work to
raise awareness about the ancillary advantages of educating girls
and women, such as a reduction in fertility rates and a more
skilled labour force, as well as advocating for the right of women
and girls to equality and quality in education.
Violence Against Women
25. Violence against women is not the issue of any particular
region or group; it is an ugly universal, crossing the frontiers of
ideology, social class and ethnic identity. At the individual
level, violence disrupts the lives of women, limits their options,
undermines their confidence and self-esteem, and impairs their
health psychologically as well as psychically. It denies them
their human rights and hinders their full participation in society.
Violence against women deprives society of the full participation
of women in all aspects of development, not just in terms of hours
of labour missed due to violence, but also in terms of the cost of
services to the victims. It also has serious consequences for the
mental and bodily health of dependent children.
26. Despite its prevalence, some of the manifestations of gender-
based violence respond to, and are determined and patterned by, the
specific characteristics of different national and community
contexts. Therefore, the Resident Coordinator should ensure that
the design and execution of programmes are specifically attuned to
respond appropriately at the local, national and regional levels.
The Resident Coordinator has a key role to play in countering
violence against women by supporting advocacy, social mobilization,
institution-building and network strengthening. He or she can also
play a key role in coordinating multi-disciplinary approaches to
the problem, as well as multi-agency responses.
Women's NGOs and Networks
27. Among the best ways to aid the poor of the developing world
and to reach women at the grassroots level is to provide technical
and financial assistance to the organizations that they themselves
create and control. In this regard, the importance of local
institution-building to the process of development cannot be
overstated; no matter what problem a project seeks to address, its
ultimate success or failure often hinges upon the strength of the
implementing agency. Although strong organizations occasionally
fail, institutionally weak organizations seldom succeed.
28. The Resident Coordinator can play an important role in
strengthening the capacity of NGOs, particularly those at the
grassroots level, by providing them information regarding the
nature, norms and requirements of the international development
cooperation system. The United Nations Resident Coordinator can
also support networking of like-minded or complementary
organizations by calling meetings, conferences and seminars. By
advocating for the inclusion of NGO representatives in government
policy-setting dialogue and facilitating NGO participation in the
meetings he or she convenes, the Resident Coordinator can help
build partnerships, strengthen alliances between NGOs and
governments, and serve to legitimize the participation of civil
society. The Resident Coordinator should support NGOs in the areas
in which they have a comparative advantage, particularly reaching
women at the grassroots level, bringing women's concerns to the
attention of policy-makers and fostering the political
participation and leadership of women. Finally, the Resident
Coordinator's efforts to ensure that women and their concerns are
incorporated into NGOs that do not focus specifically on women are
also key.
Refugee, Displaced and Returnee Women
29. Refugee, returnee and displaced women and girls have two sets
of special needs: the first, because they have been displaced; the
second, because they are female. Refugee, returnee and displaced
women are particularly disadvantaged, as they are almost entirely
dependent on external sources of assistance. Programmes for them
must be targeted to ensure that women are not unintentionally
marginalized or further disempowered. When a gender perspective is
not employed in the design and implementation of projects and
efforts are not made to compensate for the power, status and income
differentials between men and women, these gender disparities can
actually be sharpened or further entrenched. Initiating gender-
sensitive programming in the first stages of an emergency is
particularly important and yet can too easily be given lower
priority in the very difficult first stages of large population
movements requiring immediate life-sustaining support. Given that
at least 80 per cent of the total current number of the refugee
population worldwide are women and their dependent children and
that a high proportion of refugee women are heads-of-household, any
negative impacts of development and reconstruction policies and
projects on women pose a serious threat to the overall success of
such policies.
30. Although they have been removed from their usual social
support systems and economic resource bases, and are often
emotionally devastated by fear and grief, refugee women are still
required to care for the sick, old, injured and young. Because the
health of migrant populations, including that of care-taking women
themselves, is generally poor, this burden is worsened. Physical
security is a particular problem for refugee women and girls.
They often face sexual violence (including the increasing
deliberate use of systematic rape to terrorize civilian
populations), sexual exploitation by guards and so-called
peacekeepers, and increased domestic violence triggered by
escalating stress and uncertainty.
31. Resident Coordinators must ensure that policies designed to
aid refugee, displaced and returnee women and girls are informed by
the reality of their lives. They must ensure that policy-makers
recognize that most refugee families are headed by women and so do
not limit distribution of resources to male heads-of-household,
that women are protected from sexual violence and exploitation, and
that the basic needs of women (physical safety, reproductive health
information and services) are provided within the context of
emergency operations. While refugee life might sometimes
reinforce cultural restrictions on women's empowerment, it may also
provide opportunities for development that might not have otherwise
occurred. Refugee workers are encouraged to be aware of these
opportunities and support whenever possible the efforts of refugee
women and girls to pursue these new opportunities. Resident
Coordinators should be familiar with the policies, guidelines and
training programmes developed to assist and protect refugee women
and use them when possible and appropriate.
Mainstreaming
32. The points set out above are examples of how a concern for
gender can be fully incorporated, or "mainstreamed," into tasks and
responsibilities at a senior management level. Resident
Coordinators should seek to ensure that the tasks of all staff
reflect gender mainstreaming in an appropriate form, and foster
similar efforts among senior United Nations system colleagues.
Instruments to ensure that gender mainstreaming occurs include: the
performance appraisal process; the programme review process; gender
training for staff; on-going consultation and dialogue with
representatives of civil society; and inter-agency workshops on the
mainstreaming of key concerns such as gender, the environment,
poverty, governance and the like.
==================================================================
SELECTED BIBLIOGRAPHY
Women, Ink., a project of the IWTC, markets women and development
resource materials. Supported by its own sales and a grant from
UNIFEM, it is a source of both scholarly studies and practical
guidelines, training manuals and resource materials for policy and
programme design and implementation. Women, Ink. catalogue is
available through the IWTC at 777 United Nations Plaza, New York,
NY 10017: telephone: (212) 687-8633; fax: (212) 661-2704.
1. After Cairo: A Handbook on Advocacy for Women Leaders
(CEDPA). Organized as a simple, clear guide to help advocates shape
effective campaigns after ICPD, this Handbook presents advocacy
strategies in four sections: planning for advocacy; taking your
message to the public; forging alliances; and advocating for
resources. Renamed "Cairo, Beijing and Beyond: A Handbook on
Advocacy for Women Leaders", for the Fourth World Conference on
Women, the English version has been reprinted; language versions in
Chinese, French and Spanish are being issued.
2. JCGP-WID: Building National Capacity to Develop Gender
Statistics (UN/DESIPA). A gender statistics publication,
incorporating methods of computing and interpreting statistics and
formats of presentation. (UN/DESIPA). Work in Progress:
Publication date: In time for FWCW.
3. Incorporating Women into Population and Development: Knowing
Why and Knowing How (UNFPA).
A practical guide to enable those associated with UNFPA programming
to amplify the participation of women in the design and management
of population and development initiatives.
4. Gender Analysis for Project Design, prepared for UNFPA by J.E.
Austin Associates and The Collaborative for Development Action Inc.
A training manual designed as an educational and practical tool,
which can be used either as part of training workshops on gender
analysis or as a vehicle for self-education and reference by
individuals. The material is both conceptual and applied and
organized to maximize learning opportunities for the readers. 1989.
5. Gender Analysis in Development Planning by Aruna Rao,
Catherine Overhold and Mary B. Anderson. 1991. 102 pages (book);
25 pages (teaching notes). Available from: Kumarian Press, 630
Oakwood Avenue, Suite 119, West Hartford, CT 06110-1529, USA.
Price: Gender analysis book - US$18.25; Teaching notes - US$10.95.
Useful on an individual basis, as well as in workshops, this book
describes a framework for gender analysis, followed by case studies
designed specifically for gender training. The Teaching Notes
provide guidelines for using the cases and questions for
discussion.
6. Gender Planning and Development: Theory, Practice and
Training by Caroline O. Moser. 1993. 285 pages. Available from
Women, Ink. Price US$17.95 This book focuses on the inter-
relationship between gender and development, the formulation of
gender policy and the implementation of gender planning practices.
7. Population Policies Reconsidered: Health, Empowerment, and
Rights, by Harvard Center for Population and Development Studies
and IWCH. Gita Sen, Adrienne Germain and Lincoln C. Chen, Editors.
Published under an arrangement with the Swedish International
Development Authority and with 30 contributors, the book's 17
chapters address the cutting edge of current debates on population
policies. Throughout the volume, three major themes recur that
challenge the fundamental premises of current population policies -
- ethics, human rights and human development; women's empowerment;
and reproductive and sexual health. These themes together present
a new approach to population, based on a solid ethical foundation
and aimed at sustainable human development. Distributed by Harvard
University Press, 1994. Price: US$14.95.
8. The World's Women: Trends and Statistics - A joint effort of
UNICEF/UNFPA/UNIFEM/CSDHA, executed by the Statistical Division,
DESIPA. This publication presents comprehensive data on women's
conditions and contributions worldwide, providing data on economic
life, population and health, family life, education, public life,
and human settlements. First edition published by United Nations
Publications, 1991. Cost: US$19.95. Second edition to include
information on women and men and families; housing, human
settlements and environment; education, science, media and culture;
as well as issues related to women's reproductive health,
discrimination against the girl child, violation of women's civil
and political rights, hunger, malnutrition and poverty will also be
covered. Publication date: July/August 1995, in five official
languages.
9. Changing Perception: Writings on Gender and Development by
Tina Wallace and Candida March (eds). Oxford, Oxfam Press, 1991.
Blending theory and practice, the articles examine the effect of
global issues on women's lives and explores the conceptual basis of
gender-awareness planning and implementation of development
projects. It also includes a number of case studies.
10. Gender Bias: Roadblock to Sustainable Development by Jodi
Jacobson. Washington, D.C., Worldwatch Institute, 1992.
This booklet explores the dimensions, causes and results of gender
bias in development interventions worldwide.
11. Male Bias in the Development Process by Diane Elson (ed).
Manchester and New York, Manchester University Press, 1990.
Examples of ways in which male bias operates in rural and urban
settings, agriculture, industry and services, self-employment and
wage labour are provided throughout this collection of articles.
The authors focus on the structures that perpetuate male bias and
the processes that change, intensify or diminish its impact.
12. Another Point of View: A Manual on Gender Analysis Training
for Grassroots Workers by Rani Parker. Published by UNIFEM. 1993.
Available from: Women, Ink. Price: US$15.95 Using a planning tool,
the Gender Analysis Matrix, this manual offers a step-by-step guide
for conducting a four-day workshop with community members. It
includes a pre-workshop questionnaire, case studies, handouts and
a workshop evaluation questionnaire.
13. A Commitment to the World's Women: Perspectives on Development
for Beijing and Beyond by Noeleen Heyzer, Sushma Kapoor and Joanne
Sandler (eds.) 1995. Published by UNIFEM. Available from: Women,
Ink. Price: $14.95.
This anthology includes articles by more than thirty thinkers,
organizers and leaders. In this book, they re-visit critical
issues and processes that have affected women and their families
and societies, and offer their recommendations and insights.
==================================================================
AGENCY PROFILES
Food and Agriculture Organization of the United Nations (FAO)
The Plan of Action for the Integration of Women in Development
embodies FAO's policies and programmes to improve the lives of
rural women. It is based on the Organization's commitment to the
Nairobi Forward Looking Strategies, which is a pledge by the UN
Member Governments to take concrete steps by the year 2000 to
eliminate all political, economic, social and cultural forms of
sex-based discrimination.
Focusing specifically on agriculture, food and rural
development, including fisheries and forestry, the Plan of Action
outlines three principal areas of activity:
o Gathering statistical data and research studies on all
issues related to women in agricultural development,
ensuring FAO's ability to monitor the status of these
issues in the field;
o Advising policy makers on women in agricultural
development at both the international national levels;
o Assisting in implementing women in agricultural
development projects and programmes, and in mobilizing
the necessary resources.
The Plan recognizes the women already make a crucial
contribution to agricultural production. It is dedicated to
enhancing their participation through projects and programmes that
systematically bring women into the mainstream of development
activities and national life. Within this framework, future
activities will give greater recognition to women's special needs
for income-producing activities and control of income, educational
and training opportunities, and technologies and other means to
ease the burden and increase the productivity of women's work.
FAO takes a two-pronged approach to women in development that
is reiterated in the Plan of Action: first, the implementation of
projects and programmes oriented exclusively to women (women-
specific projects and programmes); and second, the promotion of the
integration of women's issues and of women as participants in all
of FAO's projects and activities (mainstream programmes and
projects).
FAO recognizes the necessity of women-specific projects under
certain circumstances; where "women-only" projects can serve as
demonstrations to encourage national governments to include women
in their mainstream project; where cultural factors prevent women
from working alongside men; or where rural women have been
generally neglected. However, the success of "women-only" projects
is often constrained by small budgets, low government priority, a
lack of skilled project staff and concentration on marginal
enterprises. Therefore, while the Plan incorporates both
approaches, every effort will be given to including both men and
women as full participants in mainstream projects.
In adopting the Plan, FAO's Council requested that Member
Governments make all possible efforts to contribute to its
implementation. It is evident that without the interest and
commitment of governments, the actions envisaged in the Plan cannot
succeed. Comprehensive policy designs, programme and project
planning, implementation and evaluation, as well as legislation
related to women's issues, are requisites at the national level for
the Plan's success. In line with its mandate, FAO stands ready and
eager to assist Member Governments in the realization of greater
participation and greater equality for rural women.
The Plan revolves around four spheres: civil status, economic,
social, and decision-making. They are selected on the basis of
FAO's long experience in working with women in developing countries
and with Member Governments. Each sphere contains its own strategy
for increasing women's status at all levels of society-household,
community, national and international. Within each sphere,
numerous actions are presented that FAO envisages as essential to
the Plan's implementation.
International Labour Organisation (ILO)
Within the context of ILO's mandate for the promotion of
social justice, the promotion of equality between men and women in
employment and the protection of the rights of women workers have
been issues of long-standing concern to the Organization. The
overall strategy of the ILO is to ensure that gender issues and
equality concerns are integrated across the board within its
programme and project objectives and activities, and are reflected
in the various means of action (e.g. standard setting, research,
information dissemination and technical cooperation). This
strategy is based on the recognition that women's equal and full
participation in all aspects of life is essential to the
achievement of all major development objects -- democracy and human
rights, sustainable development, poverty eradication, etc. In this
respect, a gender training programme for ILO staff and constituents
is currently being implemented, jointly funded by the ILO and the
Netherlands Government. The purpose of the programme under the
Office for Women Workers Questions, which is overseeing the
effective follow-up and use of the outputs of the Interdepartmental
Project on Equality of Opportunity for Women in Employment, is to
strengthen the capacity of the ILO and its member States to deal
effectively with equality for women at work.
The programme is focused on training ILO staff in management,
technical and programming positions, as well as representatives of
ILO constituents, with the object of creating a common
understanding and a basis for fruitful dialogue on gender issues
between staff and constituents; and to enlarge the pool of
expertise in counterpart institutions to develop ILO programmes
with a gender-sensitive approach. The priority target groups of
this training programme are the members of ILO's Multidisciplinary
Teams (MDTs) and staff of ILO Area Offices in the field.
These institutional arrangements have given added impetus to
the gender dimension of ILO's Labour and Population Programme,
especially in light of the concerns emphasized in the ICPD
Programme of Action. ILO's Labour and Population Programme has a
component on issues of Gender, Population and Development. The
essential elements of this component include an inter-regional
strategy:
o to enhance the gender sensitivity of population and
development policy-making and programme formulation.
This includes designing frameworks and guidelines to
facilitate and promote participatory gender population
and development analysis at the country level;
o to promote legal reforms, training and application of
International Labour Standards that advance the position
and protection of women workers (including protection of
maternity and promotion of Safe Working Mother
strategies);
o to improve the knowledge base in critical areas where
synthesis of evidence or creation of new information is
required through design and promotion of studies and
state-of-the-art papers;
o to collect, synthesize and disseminate information about
successful initiatives that have empowered women and
enhanced their productive and reproductive choices;
o to enhance the training of trainers opportunities
available to regional and national experts through the
development of special materials, methods and programmes
in close collaboration with specialized technical UN
agencies and the Turin Training Center; and
o to provide technical advice and support to potentially
replicable pilot projects that seek to empower women
workers through expansion of available productive and
reproductive choices, resources and opportunities.
United Nations, Department for Economic and Social Information and
Policy Analysis/ The Population Division
The Population Division of the Department for Economic and
Social Information and Policy Analysis (DESIPA) provides gender-
disaggregated statistics, conducts a variety of analytic studies
that have a gender dimension, monitors population policies and
organizes expert meetings that deal with gender issues. Every two
years the Population Division/DESIPA produces population estimates
and projections, by age and sex, for all countries and areas of the
world. Apart from their direct interest, these statistics serve as
"denominators" for gender-disaggregated estimates and projections
in areas such as school enrolment and employment that are produced
within and outside the United Nations system. The Division also
regularly monitors fertility, contraceptive practice and mortality
levels, by sex, as well as Government policies related to
population concerns.
Since 1990, special studies and expert meetings have dealt
with female migration, education and fertility, abortion policy,
gender differences in age at marriage and living arrangements of
women and children, including women-headed households. The
Division also produces a manual on techniques of population
estimation and analysis, which provide the basis for production of
gender-disaggregated population indicators. These manuals and
reports are widely used in developing-country training programmes
in the areas of population and development. In addition, the
Division serves as global headquarters for the Population
Information Network (POPIN). With both global and regional support
from UNFPA, POPIN is a decentralized information and communication
network for regional, national and non-governmental population
information activities, including gender-and-population issues.
POPIN facilitates Internet access to population information through
the POPIN Gopher (Internet address:gopher.undp.org).
The Population Division serves as the substantive secretariat
for the Commission on Population and Development, which has been
assigned primary responsibility for monitoring the follow-up to the
International Conference on Population and Development (GA
Resolution 49/128).
United Nations Development Programme/Gender in Development
Programme (UNDP/GIDP)
In the ten years since UNDP's Governing Council mandated the
mainstreaming of women-in-development concerns and the subsequent
establishment of the Gender in Development Programme, UNDP has
developed a twin strategy that aims to mainstream gender in all its
programmes and to further the advancement of women as one of its
four major focus areas.
The following three principles guide UNDP's efforts to
mainstream gender: gender equality and equity objectives are built
into Country Cooperation Frameworks and other strategy and policy
documents; the equal participation of men and women is sought in
setting priorities in programme design, development,
implementation, direction and monitoring; and efforts are made to
ensure that programme outcomes benefit men and women equally (where
major inequities exist, equal benefits are considered inadequate
and affirmative action programmes are put in place). Gender
equality and equity at all levels and in all respects within the
organisation itself are also explicit objectives of UNDP's human
resource management policies and staffing.
GIDP works closely with Country Offices to ensure gender
mainstreaming. The assistance that is offered includes:
participation in programme reviews; participation in joint
programming missions; project and programme evaluation; assisting
with the preparation of gender situation analyses; development of
gender strategies or action plans, including follow-up to world
conferences; review of documentation; and gender training.
By fully mainstreaming gender concerns, UNDP also seeks to
assist Country Offices to empower women and contribute to an
enabling environment for their advancement, especially by:
achieving gender equity in decision-making; developing capacity;
recognizing women's power as agents of change; improving women's
access to economic resources and assets; arresting the feminisation
of poverty; advancing women in crisis situations; and creating
legal frameworks that facilitate gender equality and equity.
For UNDP, gender mainstreaming and focusing on the advancement
of women are complementary and mutually reinforcing strategies for
achieving gender equality and equity. Pursuing the advancement of
women requires a gender perspective, while even within a gender-
sensitive framework, provision must be made for a special focus on
the advancement of women to compensate for specific inequities.
United Nations Educational, Scientific and Cultural Organization
(UNESCO)
UNESCO has always endeavoured to promote equality between the
sexes and to improve the status of women within its fields of
competence through education, sciences, culture and communication.
In addition to specific activities, efforts have been made to
incorporate women's issues at all levels of programme design and
implementation. This approach will be followed-up in the
forthcoming Medium-Term Strategy (1996-2001), with particular
emphasis on the participation of women. Taking its cue from the
Platform for Action of the Fourth World Conference on Women, the
Organization's Medium-Term Strategy for women will be three-
pronged.
First, efforts will be made for the main-streaming of a gender
perspective in all policy-planning, programming, implementation and
evaluation activities. This will entail the production of refined
gender-desegregated data and analysis, as well as the revision of
normative instruments to bring them into line with the Convention
on the Elimination of all Forms of Discrimination against Women
(CEDAW) and the development of gender-sensitive indicators to
monitor all UNESCO projects.
Second, UNESCO will encourage the broad and active
participation of women at all levels and fields of activity and pay
particular attention to women's priorities, perspectives and
contribution to the rethinking of the goals and means of
development across cultures and traditions. In this context, the
Organization will ensure greater involvement of women in its
programmes by supporting professional women's groups and
disseminating information about relevant research on women and
gender issues.
Third, UNESCO will endeavour to develop specific programmes,
projects and activities to benefit women, geared towards promoting
equality, endogenous capacity-building, women's full citizenship
and equal participation in policy-making. UNESCO will continue to
support action to combat discrimination against women in order to
make equal rights for men and women a de jure and de facto reality
in its various spheres of competence. It will promote information
on the human rights of women and legal literacy. Greater attention
will be paid to the eradication of sexist stereotypes in education,
particularly in textbooks, and practical measures will be taken, in
cooperation with the relevant professional organizations, to
promote a more diversified and non-stereotyped image of women in
and through the media.
As to specific action, the education of women and girls has
always been a top priority with special emphasis on rural women, on
projects that have a direct bearing on women's access to employment
opportunities, and on lifelong education for women's empowerment.
Particularly in regions where enrolment rates for women are
still low, UNESCO will encourage a review of legislation, policies
and programmes in order to identify the obstacles restricting their
access to education. Emphasis will be on diversifying
opportunities for education and training to benefit women without
schooling; on improving the access of girls and women to technical
and vocational education; and to strengthening women's role in
higher education through the establishment of UNESCO Chairs. The
organization will also support the training and informatics with
particular attention to ways of facilitating their access to posts
of responsibility in the media.
In view of the importance of the role and participation of
women in the management of natural resources and in environmental
concerns, special development projects designed to respond to
certain issues such as water resources management; environment,
population and development interactions; the improvement of
communications, particularly in rural areas; access to new
technologies; training and information, will be implemented.
UNESCO will pursue cross-cultural studies on the formation and
modification of attitudes, and on the consequences of changes in
the perception of women's and men's roles in the family and in
society, highlighting the role of women as agents of social change
and the cultural changes in women's life cycles. Findings that
lead to new concepts will be reflected in teaching and training
programmes and materials.
United Nations Population Fund (UNFPA)
In moving forward from Cairo, UNFPA will play an important
role in monitoring the implementation of the Programme of Action at
the country, regional and global levels. To this end, the Fund has
formulated a mission statement to serve as a framework for its
activities over the coming years; it reaffirms the importance of
providing quality reproductive health and family planning services,
implementing population policies as an integral part of sustainable
development, and undertaking advocacy for population and
development concerns, particularly for the empowerment of women.
The ICPD recognized that there can be no sustainable
development without the full and equal participation of women,
gender equality and equity and the empowerment of women. Gender
concerns will therefore be an integral component of UNFPA
programming and will be factored into all activities undertaken in
the three core areas (reproductive health, including family
planning and sexual health; population and development strategies;
and advocacy) as a "cross-cutting" dimension. Limited support will
also be provided to specific areas such as institution
strengthening, training and research.
The empowerment of women is a fundamental prerequisite to
sound reproductive health and requires that women have increased
access to resources, education and employment, and that their human
rights and fundamental freedoms are promoted and protected so that
they can make choices free from coercion and discrimination.
Family life education and public information for young people that
encourages responsible sexuality, respect for women, and gender
equity are also fundamental to improving the role and status of
women in society.
Women will, therefore, remain the focus of reproductive health
issues, since the burden of ill health associated with reproduction
affects women to a much larger extent than it does men. However,
all programmes and services will also pay special attention to the
role and responsibilities of men in reproductive health.
Thus, within the context of primary health care, UNFPA will
build upon its traditional support through the strengthening or
addition of services that seek to improve reproductive health by
reducing the need for abortion; preventing and treating
reproductive tract infections, including STDs; preventing HIV/AIDS;
preventing and treating infertility; providing routine screening
for other reproductive health conditions; and discouraging harmful
practices, such as female genital mutilation.
The Fund will also support the development of data systems
that generate information that is desegregated by gender as well as
by geographic areas, and undertake research studies focusing on the
acceptability of reproductive health and family planning practices
in various social, economic and cultural settings, and the role and
status of women and reproductive rights.
With regard to advocacy, UNFPA activities will be of two
types. First, UNFPA will address gender equality and equity;
education of women; reproductive rights; protection of the girl
child; and the role of men in matters of sexual and reproductive
health and in the family. Second, the Fund will work as an
advocate for human rights and development issues such as education,
poverty, basic health services, empowerment of women and people's
participation, all emanating from the Programme of Action and
agreements reached at other United Nations fora.
In recognizing that gender issues and concerns have been
expanded beyond women-specific activities to include gender
equality and equity, participation of both men and women in all
aspects of population and development, and including the role of
men in achieving women's empowerment, UNFPA has issued revised
guidelines on Gender, Population and Development, and is organizing
gender training workshop for all its field staff. The overall
objectives of these workshops are to create gender awareness, in
particular the strategic and analytical shift from a narrow women
in development concept to a broader gender focus, and to ensure
that gender issues are mainstreamed in all UNFPA programmes and
projects at the country level.
In addition, UNFPA is collaborating with the Royal Tropical
Institute (KIT) to organize regional pilot workshops in Egypt,
Indonesia, and Zimbabwe, the objectives of which are to: develop
the institutional capacity to provide GPD training as an integral
part of the Fund's regular training programme and as part of the
training and educational structures at local institutions in
selected countries; to build staff capacity to integrate gender
concerns in population and development among UNFPA field staff and
relevant national, government, CST and executing agency staff; and
to design flexible guidelines and a trainers' aid that could be
adapted by UNFPA field offices for future in-country GPD training.
UNFPA field staff will also be encouraged to collaborate
closely with governments and other entities involved in population
and development activities, particularly women's NGOs, to ensure
that gender concerns are taken fully into account in all
programming activities. Efforts will also be made to strengthen
the institutional and technical capacities of women's NGOs at the
local and grassroots levels to better their ability to undertake
gender-specific activities. A revised set of guidelines for UNFPA
collaboration with NGOs has been issued in this regard.
Office of the United Nations High Commissioner for Refugees (UNHCR)
UNHCR's follow-up activities to the International Conference
on Population and Development (ICPD) have centred on addressing
reproductive health (RH) issues in refugee situations. In
addition, an inventory has been made of UNHCR-funded projects to
identify the educational needs of refugee girls.
The traditional approach to reproductive health needs in
refugee situations has been mainly through mother and child
healthcare programmes that focus on reducing infant and child
mortality. While in the past refugee reproductive health needs
were either not fully addressed for socio-cultural reasons or were
overshadowed by competing demands in other life-saving sectors, in
recent years increasing concern over the number of unwanted and/or
unplanned pregnancies has brought to the fore the issue of family
planning and other related activities. Sexually transmitted
diseases (STDs), including HIV/AIDS, and widespread rape in armed
conflict have added new dimensions to the reproductive health needs
of refugees. The ICPD recognized the holistic nature of female
reproductive health needs in its conclusions, which expanded the
definition of RH to include the "..state of complete physical,
mental and social well-being." The conference also addressed the
need for inter-agency cooperation to fill the service and resource
gap and to harmonize technical approaches in implementing RH
programmes in refugee situations.
This new consensus on reproductive health provided UNHCR with
a fresh and expanded opportunity to combine expertise and
coordinate activities with other United Nations agencies and non-
governmental organizations on RH services in refugee settings. A
joint venture was launched initially with UNFPA (following their
policy on RH service coverage in refugee settings) to undertake a
preliminary survey of reproductive health needs and services among
refugee populations. The survey revealed crucial unmet needs in
the are of reproductive health of young adolescents and victims of
violence and trauma. Health service providers in the field further
signalled the need to develop technical guidelines of RH to help
identify target populations and design appropriate measures for
intervention.
As a further follow-up to the recommendation of the ICPD, and
as a result of the survey on RH needs, an inter-agency working
group has been established to prepare the first-draft technical
field guidance manual for standardizing a technical approach to RH
needs. The draft manual will be reviewed at the June 1995
symposium on reproductive health.
While efforts are still underway to develop systematic,
multifaceted and integrated RH programmes in refugee settings,
vertical programmes continue to address specific needs as and when
identified. Specific projects such as the STD/HIV/AIDS pilot
project in Ethiopia, psychiatric and social counselling of victims
of violence in Croatia, and training of traditional birth
attendants in the Sudan continue to meet the manifested needs of
targeted populations.
In addition to the ICPD-related activities mentioned above,
UNHCR has over the past five years developed extensive training
programmes and guidelines for its staff and implementing partners
to assist them in developing programmes that reduce dependency,
enhance the participation of refugee women and ensure their equal
access to the benefits of such programmes. Legal training for
women has been developed to raise their awareness of their human
rights. Human rights training aimed at police, military personnel
and government officials includes components on women's rights.
Proactive efforts have been made to ensure women's participation in
camp organization committees and their access to skills training
and literacy programmes. All of these activities are aimed at
empowering refugee women and enabling them to take an active role
in the rebuilding of their societies after their exile has ended.
United Nations Childrenžs Fund (UNICEF)
The objectives and programme thrusts of UNICEF's actions in
gender and development are defined in its 1985/1987 policy on women
in development and in its recent 1994 policy paper on gender
equality and the empowerment of women and girls. UNICEF's policies
are guided by a growing understanding of the gender-based
discrimination that affects women and girls throughout the life-
cycle, the complementarity of CRC and CEDAW, the needs of the girl
child, and the needs of women in their multiple roles. The
operational approaches to implement its policies and strategies are
mainstreaming gender concerns both as a cross-sectoral dimension
and as an integral aspect in the sectoral programmes; promoting
gender-specific programme activities for girls and women; and
giving special attention to the girl child. UNICEF actions for the
girl child include programmes for the elimination of disparities in
health, nutrition and education for girls, initiatives for the
elimination of the harmful traditional practices of early marriage
and female genital mutilation, and innovative ways to reach
adolescent/young men and women with knowledge about and skills to
delay parenthood and to protect themselves against sexually
transmitted diseases, particularly AIDS.
UNICEF actions are targeted to the elimination of gender
disparities in the achievement of the mid-decade goals and those of
the World Summit for Children, advocacy and specific initiatives
for girls, and integration of gender issues through the application
of the Women's Equality and Empowerment Framework. Programme
activities will also include capacity-building for gender
responsive programme development; involvement of males in sharing
familial responsibilities, particularly parenting; and promoting
gender equity in the family with focus on early socialization and
youth. Other on-going activities for continued action are
collection and analysis of gender and age-disaggregated data and
development of indicators for gender-sensitive policies and
programmes; building capacities through training; advocacy and
women's social mobilization and organized participation at the
community, local and national levels; and alliance building among
government agencies, NGOs women leaders, social activist groups and
others to create a positive environment for the effective
participation of women in the emerging democratization and
decentralization processes in many countries.
United Nations Development Fund for Women (UNIFEM)
UNIFEM, the lead agency for the Inter-Agency Working Group on
Women's Empowerment, which produced these guidelines, is mandated
to use its resources for four priority areas:
o to serve as a catalyst with the goal of ensuring the
appropriate involvement of women in mainstream
development activities;
o to support innovative and experimental activities
benefitting women in line with national and regional
priorities;
o to play an innovative and catalytic role in relation to
the United Nations overall system of development co-
operation; and
o to implement the goals of the United Nations Decade for
Women: Equality, Development and Peace.
Within the framework of its original mandate, UNIFEM is
reshaping its directions and strategies to meet current challenges
and the priorities of women in the 21st century by focusing on
women's political and economic empowerment. To foster women's
economic empowerment, UNIFEM works to put resources directly in the
hands of women in developing countries to support their livelihoods
and to build their capacity to take advantage of new economic
opportunities. Another aspect of work is assisting in the
formulation of gender-sensitive macro-economic policies and
practices in key areas such as trade, structural adjustment and
transitional economies. Of special importance is the examination
of development models, best practices, principal constraints and
lessons learned for widening choices and opportunities for women's
economic participation at all levels.
To foster the political empowerment of women, UNIFEM advocates
for gender equity in decision-making structures from the household
to the international level and the reform of legal and policy
frameworks, codes and instruments that deal with issues such as
property rights and inheritance laws. The Fund supports the
efforts of those working to improve women's status, eliminate
violence against women and promote women's human rights. It also
seeks to strengthen women's organization and other civil society
actors to better their capacity to participate in the decision-
making process.
UNIFEM's comparative advantage lies in its knowledge of and
experience in gender and development, particularly in the following
areas: identifying emerging gender issues, such as trade,
population displacement and structural adjustment; developing
innovative approaches and strategies to address critical issues
affecting women; applying a gender perspective in development
interventions; supporting innovative operational programmes and
projects that benefit women directly; and acting as a catalyst
within the UN system and at the regional and national levels to
bring about women's empowerment. Another area of strength is
UNIFEM's long history of partnership with NGOs; UNIFEM has
extensive experience mobilizing and working with women's
organizations at all levels - grassroots, national, regional, and
global.
UNIFEM also works to ensure that UN Conferences address the
needs of women. UNIFEM works with others to create new political
spaces where women's voices can be heard and consensus can be
forged. It has also sought to empower women by training them to
negotiate in the international arena. UNIFEM works to keep women's
issues high on the agendas of mainstream UN organizations by
playing a mediating role between the international women's movement
and the UN system. UNIFEM also works to synthesize critical issues
and to ensure that the key recommendations of the various UN
Conferences, including the ICPD, are translated into catalytic and
innovative programmes that will empower women in the developing
world.
=================================================================
GUIDELINES ON A COMMON APPROACH TO
NATIONAL CAPACITY BUILDING IN
TRACKING CHILD AND MATERNAL MORTALITY
FOR THE UN RESIDENT
COORDINATOR SYSTEM
INTRODUCTION
1. At the request of the UNDP Administrator, on behalf of the
Secretary General of the UN, a first meeting of the Inter-agency
task force on the implementation of the ICPD programme of action
was convened. This meeting, held on December 13, 1994, at UN
headquar-ters in New York, was attended by representatives of 12 UN
agencies and organizations. It agreed to establish four working
groups on: child and maternal mortality data; basic education and
gender disparities; social policy-related issues; and women's
empowerment.
2. These guidelines are the main outcome of the Working Group on
a Common Approach to National Capacity Building in Tracking Child
and Maternal Mortality which met at UNICEF Headquarters in New York
on May 4, 1995. They are intended to provide a succinct and
readable summary of the relevance of child and maternal mortality
to human development, how the indicators are measured and who in
the UN system can provide what specific kinds of assistance at the
country level to governments, and more broadly civil society, in
their efforts to assess infant, child and maternal mortality as
they act to effect improvements. A list of key references for both
child and maternal mortality is attached.
I. CHILD MORTALITY
Child mortality - an ongoing concern
3. Under-five mortality and its major component, infant
mortality, have been used as measures of childrenžs well-being for
many years. However, it was the International Conference on
Primary Health Care held in Alma Ata in 1978 which first considered
how child mortality could be reduced world-wide by a systematic
development of a primary health care system.
4. The number of under-five deaths are huge, 12 or more million
annually. But this number only tells part of the problem. These
12 million represent over 700 million years of productive life lost
annually. And by far the majority of these lives being lost could
be saved. The following table lists the causes of under-five
deaths for developing countries. It shows that over 70% of these
deaths are caused by diseases for which practical, low cost inter-
ventions exist - involving immunization, ORT use, antibiotics and
the like.
-------------------------------------------------------------------
Table 1: Under-five deaths 1993, developing world
Cause % of total
ARI (mostly pneumonia) 25
Diarrhoea alone 23
Malaria alone 6
ARI-measles 5
Neonatal tetanus 5
Tuberculosis 2
ARI-pertussis 2
Measles alone 2
Diarrhoea - measles 2
Pertussis alone 1
Total 73
Source: WHO, The World health report 1995, Geneva, 1995
5. In this context, it is not surprising that child mortality
measures are of key relevance in assessing progress in overall
national development as well as progress for children. Both U5MR
and IMR measure an end result of the development process rather
than an input such as school enrolment ratio, per capita calorie
availabili-ty, or the numbers of doctors per thousand population -
all of which are a means to an end.
6. Furthermore, child mortality is known to be the result of a
wide variety of inputs: the nutritional health and the health
knowledge of mothers; the level of immunization and ORT use; access
to maternal and child health services (including prenatal care);
income and food availability in the family; the availability of
clean water and safe sanitation; and the overall safety of the
child's environment.
International conferences
7. Specific mention of action to be taken on child mortality can
be found in paragraph 8.16 of the Report of the international
conference on population and development (UN ref. A/CONF.171/13, 18
October 1994). In particular this paragraph includes the
following.
Countries should strive to reduce their infant and under-
five mortality rates by one third, or to 50 and 70 per 1000
live births, respectively, whichever is less, by the year
2000, with appropriate adaptation to the particular situa-
tion of each country. By 2005, countries with inter-mediate
mortality levels should aim to achieve an infant mortality
rate below 50 deaths per 1000 and an under-five mortality rate
below 60 deaths per 1000 births. By 2015, all countries
should aim to achieve an infant mortality rate below 35 per
1000 live births and an under-five mortality rate below 45 per
1000. Countries that achieve these levels earlier should
strive to lower them further.
8. In the context of UN sponsored international conferences,
these same goals for the year 2000 were first mentioned in the
World Summit for Children, which was held in New York in 1990.
Subsequently, the United Nations Conference on Environment and
Development, held in Rio de Janeiro in June 1992 repeated these
goals, as did the World Summit for Social Development in Copenhagen
in March 1995. Thus the target of reducing child mortality has
both broad-based and long-term support.
Definitions
9. The generally accepted definitions for under-five and infant
mortality rates come from demography, are cohort based and can be
stated as follows.
Under-five mortality rate (U5MR): The probability of dying
between birth and the fifth birthday (exact age 5 years),
expressed per 1000 live births.
Infant mortality rate (IMR): The probability of dying between
birth and the first birthday (exact age 1 year), expressed
per 1000 live births.
10. The infant mortality rate is often computed as the ratio of
deaths of children under one year of age occurring during a given
period and births in the same period. The difference between this
and the above stated cohort measure are very small. However, a
similar period based estimate cannot be used for the under-five
mortality rate.
Data sources and estimation methods
11. In the developed countries, measures of child mortality at the
national level have traditionally come from the registration of
births and deaths. If births and deaths are completely recorded,
and the compilation of statistics from the registration system are
timely, then these are the preferred mortality estimates.
12. However, the major problem with vital registration as a data
source is its quality. In many developing countries, birth
registra-tion is incomplete In a still larger number of countries,
the recording of child deaths is incomplete. Registration of
deaths after infancy is, in general, more complete than in infancy,
but the recording of the population by age in childhood is also
subject to error. A further problem with vital registration
systems is the frequent delay in compilation and publication.
13. Experience with programmes to improve vital registration
coverage have been rather discouraging. Work in this area suggests
that complete vital registration evolves over time with general
administrative development and as the importance of records becomes
evident to, and used by, the general population.
14. However, sample registration is proving valuable in some of
the world's largest countries. A successful example is the Indian
sample registration system, introduced in some states in the 1960s,
and currently operating throughout the country. Bangladesh has
developed a similar system which, after some uncertainty, appears
to be stabilizing. China has recently embarked on a related sample
system.
15. In countries where the vital registration system as a basis
for child mortality estimates is of uncertain or unacceptable
quality, as is the case for most developing countries, information
from some type of household survey is required to validate,
calibrate or substitute for vital registration estimates. A
distinction can be drawn between prospective and retrospective
surveys.
16. The essential characteristic of a prospective survey is that
a defined population is followed over time, with the vital events
occurring to the population being recorded. A typical prospective
survey involves the initial recording of populations in a sample of
areas. The population is then resurveyed at regular intervals,
with the reported events checked against changes in household
composition between rounds in order to minimize omission. With
careful fieldwork, prospective surveys can provide relatively
accurate estimates of child mortality. Such surveys, however,
require careful fieldwork over an extended period of time to
estimate trends, and because of sample size limitations, may have
to be extended over several years to provide stable estimates of
child mortality levels. This continuity of effort can be difficult
to achieve in some developing country settings.
17. Retrospective surveys typically obtain information from
mothers on the survival of their children. Such surveys provide
the main source of estimates for most developing countries.
18. Response errors, which arise during data collection, are a
major source of poor quality mortality data from all sources. This
is of particular concern in retrospective surveys where questions
require adequate specification and interviewers must be well
trained and supervised. In addition to such response errors, the
retrospective survey techniques are affected to a greater or lesser
extent by potential selection bias, because in order for a child to
be reported the mother must be a member of the study population at
the time of the survey. Thus, either death or emigration of the
mother can affect the reporting coverage.
19. The most extensively utilized retrospective survey techniques
are: questions to women on aggregate numbers of children born and
dead, often referred to as the 'Brass' questions; and questions to
elicit maternity histories, where each woman is asked for the date
of birth and, if applicable, the age at death of each of her live-
born children. Brass questions have been used in most developing
countries and are the simplest and least costly of the two
techniques to apply. They have worked well in a wide variety of
social contexts and of data collection vehicles, including
censuses.
20. Maternity history data have provided a wealth of information
on child mortality in developing countries. Complete maternity
histories, such as those utilized by the Demographic and Health
Surveys, are more onerous to collect than data from Brass
questions, and hence have been generally limited to national
household surveys where sample sizes are insufficient to provide
detailed sub-national mortality estimates. Maternity history data
have made a particular contribution to the exploration of differen-
tials and associations in child mortality.
21. There are other retrospective survey techniques, such as
asking about recent household deaths by age, or questions on the
survival of a motheržs previous birth. However, for these
techniques either the experiences have been mixed, or they apply
more appropriately to population sub-groups - such as mothers who
give birth in health centres.
22. More information on these and other survey techniques can be
found in Child mortality since the 1960s, and in Approaches to the
measurement of childhood mortality: a comparative review.
Helping countries track child mortality
23. The activities involved in tracking child mortality at the
country level can be usefully divided into three components:
determine what mortality data exist; generate reasonable time
series of mortality estimates; and fill data gaps. These
components are further detailed in the following.
Determine what mortality data exist
24. This task can generally be done by local demographers. A good
example of what should be done to describe these data and to
provide an updateable record is provided in Child mortality since
the 1960s (see references). A typical country profile in this
publication presents the key features: the available data listed
and referenced, and all data graphed. These latter charts (one
each for under-five mortality and infant mortality) provide a very
useful visual assessment of the amount of data, the consistency of
data from different sources, and the trend of mortality over time.
Generate reasonable time series of mortality estimates
25. There are two important aspects to generating time series
estimates (separately) of the under-five and infant mortality rates
for period 1960 to 1995. The first is the ensuing result of a
single set of estimates. The second is the process of obtaining
the time series, which requires assessment of the existing data and
discussion among experts.
26. There are often several different estimates of child mortality
used by different national bodies, be they in the government,
public or private sectors. Different estimates of child mortality
for the same or similar time period are almost always detrimental
to concerted efforts to reduce child mortality, since the lack of
agreement is often associated with a lack of a coordinated effort
on reducing child mortality. Different mortality estimates can
also lead to different, and separate, programme strategies for
mortality reduction. The aim should be to minimize differences
between mortality estimates and to obtain very broad country-wide
support for a single and consistent set of under-five and infant
mortality estimates.
27. Arriving at a single set of under-five or infant mortality
estimates is not an easy task, since there is no unique best method
and the country situations can differ widely. For example, the
data from seven data sets for Bolivia, shown in figure 1, display
a very consistent trend and coherency over the period 1960-92. The
situation in figure 2, for Papua New Guinea, shows the other
extreme. The country has only two data sets, with a very low data
consistency since in the period 1965-67 the 1980 census reports an
under-five mortality rate of just over 100 per 1000 live births,
whereas the 1970 census reports a mortality rate of around 200 for
the same period.
28. In the case of Bolivia, fitting a line representing a single
time series of mortality estimates from 1960 to 1995 appears
feasible, and most reasonable attempts could be expected to fall
within a narrow band (see the annex for further information on line
fitting). Fitting such a line to the data in figure 2 for Papua
New Guinea would give very questionable results since possible
lines would fall within a very wide mortality range, from a line
through the 1970 census data projected to 1995 with the same trend
as that given by the 1970 census, to a line through the 1980 census
data projected both backwards to 1960 and forward to 1995 with the
same trend as the 1980 census.
29. Even in the case of Bolivia - and this is an example of a very
consistent set of data - there would be individual variations if
different experts attempted to produce a mortality time series.
For countries with less consistent data the derivation of a single
time series becomes more variable, and an explicit methodology for
obtaining a consistent and repeatable time series is needed.
30. The work of Hill and Yazbeck in Trends in child mortality
provides a model for generating such a time series at the country
level. This important work is summarized in an annex to these
guidelines. A key consideration in this model is that it be
repeatable and useable by others, particularly at the country
level. Hence countries can understand, adopt and implement this
methodology themselves, leading to a greater awareness and
commitment within each country.
31. The Hill and Yazbeck methodology aids data assessment, since
the choice of regression weights explicitly assigns assessments of
data source quality (see Annex). Assessment approaches which rely
on comparisons between data sources can be found in Child mortality
since the 1960s (pages 12 to 15). At the same time, the quality of
individual sources can and should be explored. Such assessments
are helped if separate quality studies have been implemented as
part of the data collection process. But fairly simple data
analyses, such as the calculation of male/female ratios and their
comparison against known standards, can throw useful light on data
limitations.
Fill data gaps
32. A data žgapž is used here to identify country situations where
there are either no mortality data referenced to a year within the
last five or, where there are such data, they are inconsistent or
refer to a time before a catastrophic occurrence of national impact
- such as civil conflict or major natural disaster.
33. Measured mortality, referenced within the last five years, is
considered the minimum requirement which all countries should be
able to meet. A more frequent measurement of mortality is advan-
tageous in general, preferably annually, but care has to be taken
to balance frequency of mortality measurement with the capacity of
a country. For example, if a country is facing economic hardships
and has a high child mortality level, attempting to measure
mortality every year will absorb significant country resources,
resources which could be better used in reducing child mortality
rather than its frequent measurement. This example fits the
situations in many African countries.
34. Having identified a mortality data gap exists, how it should
be filled depends on the country situation. Countries with gaps to
fill can be divided into two groups: those which have (or had) an
adequate vital registration system, and countries without. An
"adequate" vital registration system is defined here as one which
covers over nearly all births and under five deaths in a country.
The term "nearly all" is used deliberately; it could have been
replaced with 'at least 80% of births and under-five deaths'.
However, a more relevant specification is whether vital regis-
tration can play the major role in tracking child mortality.
Clearly a vital registration system which covers all births and
under five deaths meets this specification. But so also does a
system which covers enough of the births and deaths so that
periodic censuses or large surveys can be used to derive an
adjustment factor. This adjustment is then applied to the annual
vital registration system estimates to arrive at good quality
national child mortality estimates.
a) Countries which have (had) an adequate vital registration
system
35. Countries which had an adequate vital registration but now
have data gaps, are few in number. But this situation can arise
when existing systems have been run down or, as in the case of man-
made or natural catastrophes, when country infrastructures have
been adversely affected. Systems may not have stopped functioning,
but their coverage of births or deaths may have declined, or the
reporting lag between occurrence and reported estimate may have
increased considerably.
36. Filling such data gaps requires a review of the vital
registration system to determine what the problems are, and a
support project initiated to correct them. In some situations,
where there are no mortality data for the last five years, or since
a catastro-phe, a survey may be required to provide more current
data until the vital registration system is functioning adequately
again.
b) Countries without an adequate vital registration system
37. Countries without an adequate vital registration system
comprise the majority of developing countries. An ultimate, long-
term aim is to have complete vital registration for all countries.
However, as noted earlier, experience indicates that complete vital
registration evolves over time, with general administrative deve-
lopment and public use. This is not to say the development of
complete systems should not be supported, but they do not get built
quickly. Projects for vital registration development need to
recognize both the several years for which support will likely be
required, as well as the implementation of household surveys to
provide mortality data in the interim.
38. For those countries where adequate registration systems are
sometime in the future, either retrospective or prospective surveys
need to be used to fill data gaps. In general the technique of
choice is the Brass questions in retrospective surveys, since these
are the easiest and least costly to implement over a wide range of
data collection vehicles. Where correlations of mortality with
other factors are particularly sought, maternity history questions
should be considered.
39. In situations where the primary source of retrospective survey
data, mothers, are likely to introduce a significant selection
bias, prospective surveys can be considered for filling data gaps.
But such situations require careful review, balancing the country
capacity to carry out such a logistically demanding survey against
the degree to which other less costly and simpler techniques may
suffice.
40. Any action on filling data gaps must take into account
feasible data accuracy and the use to which the data are to be put.
In the case of feasible data accuracy, and including both sampling
and non-sampling error components, a useful general rule is that
mortality measurements have an uncertainty of at least plus or
minus 10% of the measurement value. For example, if an under-five
mortality rate of 100 is measured, the actual rate should be
interpreted as being, at best, somewhere in the range 90 to 110,
and is often outside this range. Reducing the uncertainty of
measurement below this 10% level is both difficult and costly.
41. Measurement is of little value if the data are not used.
Hence consideration should be given to how mortality data can be
used to more effect. As noted earlier in these guidelines,
exploring cause of death is useful in helping to better target
programme interven-tions. Additionally, it is beneficial to get
users as well as producers together, not only to discuss existing
data systems and additional data needs, but particularly to clarify
how existing data are presently used, and how new mortality data
will be used. In this the guideline should be that where a cost is
incurred in measuring child mortality, this cost should produce a
greater benefit in mortality reduction, and not solely result in a
measurement report, however imposing and official it may look.
II.MATERNAL MORTALITY
Maternal mortality reduction - an overarching goal
42. Deaths of women due to pregnancy or childbirth is a major
public health problem in developing countries. On average, 500,000
women die from maternity-related causes every year -approximately
one maternal death every minute. 99 percent of these deaths occur
in developing countries with the majority concentrated in Africa
and South Asia. Although there has been a significant decline in
child mortality in recent years, the gap between maternal mortality
ratios in the developing and the developed countries remains wider
than for any other health indicator. While the absolute number of
maternal deaths may seem small in comparison with the number of
infants dying, the risk of death accumulates for women with each
pregnancy. For example, the life-time risk of death from pregnancy
and child birth for a woman in Africa is 1 in 20 while this risk is
1 in 10,000 for a woman in northern Europe. The lack of attention
that has been paid to this problem is a reflection of the lack of
importance given to women's health issues in general.
International conferences
43. The first time that the international health community's
attention was clearly focussed on maternal deaths was in 1987, when
the International Conference on Maternal Mortality was held in
Nairobi, Kenya. This conference reflected a consensus that the
number of maternal deaths in the developing world was too high,
unnecessarily so, and could be prevented or reduced considerably.
A second important moment for the Safe Motherhood Initiative was
the 1990 World Summit for Children. The Summit Declaration and
Plan of Action included the reduction of maternal mortality by half
as one of the seven major goals to be achieved between 1990 and the
year 2000.
44. Most recently, the International Conference on Population and
Development (ICPD) in Cairo, and the World Summit for Social
Development held in Copenhagen in March 1995, reiterated the
maternal mortality reduction goal set forth in Nairobi and the
World Summit for Children, and expanded it to include a further
reduction in maternal mortality of 50% by the year 2015. In
addition, the ICPD Programme of Action recommends that
... Countries with intermediate levels of mortality should aim
to achieve by the year 2005 a maternal mortality rate below
100 per 100,000 live births and by 2015 a maternal mortality
rate below 60 per 100,000 live births. Countries with the
highest levels of mortality should aim to achieve by 2005 a
maternal mortality rate below 125 per 100,000 live births and
by 2015 a maternal mortality rate below 75 per 100,000 live
births. However, all countries should reduce maternal
morbidity and mortality to levels where they no longer
constitute a public health problem. Disparities within
countries and between geographical regions, socio-economic and
ethnic groups should be narrowed...
45. Countries which have formally committed themselves to
achieving the maternal mortality reduction goal are also res-
ponsible for monitoring progress toward that end. To accomplish
this, close collaboration among international and national
agencies, governments and non-governmental organizations is
essential.
Indicators
46. In the context of the World Summit for Children, UNICEF, WHO,
UNESCO and others have worked closely together to agree on a basic
set of indicators to recommend to countries for monitoring progress
toward the goals. In relation to the World Summit for Children and
Health for All maternal mortality reduction goals, the two
monitoring indicators agreed upon by WHO and UNICEF are the
Maternal Mortality Rate (ratio)(MMR): Annual number of maternal
deaths per 100,000 live births and the Annual Number of Maternal
Deaths.
Measurement problems
47. There are several features of maternal mortality, however,
that make it technically difficult to measure. First, as compared
to other commonly measured demographic events (such as births or
under five deaths), it is a relatively rare event. Second,
maternal deaths are often not reported, or when they are, they are
not correctly classified as maternal deaths. As a result, most
official measures of maternal mortality are under-estimates.
48. The relative infrequency of maternal deaths means that large
populations need to be studied which makes such studies very
costly. If the study population or sample is too small, the number
of deaths will not be large enough to yield reliable, stable
estimates. WHO has calculated that to establish a maternal
mortality ratio of 300 (per 100,000 live births), correct to within
20% (95% confidence intervals) would require a sample size of
50,000 births. Of course, many more households would have to be
interviewed to yield 50,000 births.
49. Maternal mortality estimates generally have wide margins of
error. This presents a particular problem in measuring trends over
time because, even if consecutive studies showed a decline over
time, it may not be possible to rule out chance as an explanation
for this finding. Figure 1 illustrates this point using data from
a direct household survey. Scenario B assumes a 50% reduction in
maternal mortality and Scenario C a 25% reduction. In both cases
the 95% confidence limits overlap with the baseline estimate and it
is therefore not possible to measure a statistically significant
difference between the two estimates. In summary, measuring trends
is much more difficult than generally believed, even using the new
sisterhood and network methods.
50. Vital registration is usually relatively complete in most
developed and a few developing countries. However, in most deve-
loping countries, this is not the case. One of the reasons why many
deaths in developing countries are not registered is that they do
not occur in health facilities, where health personnel would be
required to report them. Many deaths occur in the home or on the
way to a hospital and are consequently not recorded.
51. Even in countries with relatively complete vital registration
systems, misreporting of maternal deaths is a serious problem. The
mis-reporting of maternal deaths means that they were reported but
not properly classified as a maternal death. A maternal death is
defined as
the death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the
site of the pregnancy, from any cause related to or aggravated
by the pregnancy or its management, but not from accidental or
incidental causes.
52. Therefore, to properly report a maternal death, it is
necessary to know not only that the woman died but the timing and
the cause of the death as well. Few maternal deaths actually take
place in obstetric wards because when a life-threatening situation
arises, the patient is moved to another department and the cause of
death is not certified by an obstetrician or the death certificate
may not mention the obstetric cause which triggered the series of
complica-tions leading to death. Even in the United States,
studies have shown misreporting of between 25% and 70% of maternal
deaths.
Data sources
53. In addition to vital registration systems, the main sources of
data on maternal mortality are household surveys, reproductive age
mortality surveys (RAMOS), hospital data and community studies.
The RAMOS studies are likely to produce the most reliable estimates
of maternal mortality but are too costly to implement at the
national level on a regular basis. While data from hospitals and
health centres can be informative, they can also be misleading -
this is particularly true when data come primarily from hospitals
which specialize in maternal care, where mortality rates can be
much higher than in the general population. On the other hand,
under reporting and mis-classification can lead to gross under-
estimates of maternity-related mortality, even in countries where
all or most deaths are medically certified. Health systems in a
large number of developing countries do not have adequate popu-
lation coverage. Community studies of maternal mortality are more
common in many developing countries, but these are for very limited
geographical areas, and the quality varies enormously.
54. Household surveys require large sample sizes, even with the
new sisterhood and network methods. While careful field work can
produce good quality estimates, large surveys have often produced
poor results. The sisterhood method has been developed more
recently and minimizes the number of households that need to be
visited in order to obtain information on a large number of women.
The method asks all adult women in a household about the survival
of their sisters: how many sisters they had who survived to
adulthood and how many died of pregnancy-related causes. This
information is then converted into a life-time risk of dying from
maternal causes and maternal mortali-ty. Questions based on the
sisterhood method have been successfully added to many of the
Demographic and Health Surveys. However, the sisterhood method
produces estimates which reflect maternal mortality levels of ten
years or more in the past. Therefore, they cannot be used for
monitoring progress toward the maternal mortality reduction goal
during the current decade. They also do not provide information on
cause of death. Nonetheless, estimates of maternal mortality
derived from the sisterhood technique are valuable, particularly in
places where no reliable community studies are available and/or
where vital registration is inadequate.
55. Maternal mortality epidemiologic surveillance systems may be
appropriate in countries where civil registration is relatively
more complete and where most births take place in health
facilities. The Pan American Health Organization (PAHO) has been
working to develop this methodology further. However, trade-offs
should be considered on the return of investment in this type of
approach since the improvement of civil registration systems is a
long-term undertaking and even in the best systems the measurement
of maternal mortality presents specific problems and this type of
surveillance does not provide information relevant to programme
planners.
56. Because of the measurement problems described above, many of
the national level maternal mortality estimates regularly reported
by international agencies, and used by national governments, are
not accurate reflections of the present situation and are of
limited value in measuring trends over time. This raises a serious
problem for monitoring the maternal mortality reduction goal since
it is set relative to a 1990 baseline. This does not imply that
all attempts to measure maternal mortality should be abandoned.
However, it is important that the limitations of using these
estimates for monitoring progress in maternal mortality reduction
be fully recognized: they are costly to produce, may not be
nationally representative or, in the case of sisterhood estimates,
provide estimates which are not current. Finally, maternal
mortality ratios alone do not provide the information needed for
development of programme interventions or policy formulation.
Model-based estimates
57. An alternative method is to base estimates of maternal
mortality on a mathematical model using widely available predictor
variables. At present, the WHO Maternal Health and Safe Motherhood
Programme and the UNICEF Planning Office are collaboratively
pursuing this option, at least for those countries which are known
to have weak data or no data at all on maternal mortality.
58. Preliminary results are promising, although the predicted MMRs
resulting from a mathematical model may be somewhat imprecise
because of wide margins of error. Given the weakness of the
existing data on maternal mortality, however, the model-based
estimates will likely be an improvement. For countries which lack
accurate national level estimates, the model-based estimates offer
a sound alternative to investment in large-scale surveys. They
provide, at minimum, an indication of the order of magnitude of the
problem which can be used to stimulate action to reduce maternal
mortality.
59. Work on the development of model-based estimates is continuing
and final results are expected to be available by the Fall of 1995.
In addition to UNICEF and WHO, UNDP and The World Bank have
expressed interest in using the model-based estimates for those
countries which have no reliable estimates for maternal mortality.
Process indicators
60. An important alternative to monitoring the impact of
programmes is to monitor the processes which are known to reduce
maternal mortality. There are several distinct advantages to this
approach. First, it avoids the substantial expense involved in
generating maternal mortality rates, which in many cases may not be
accurate, or reflect a situation ten years or more in the past.
Second, process indicators can provide information essential for
guiding policies and programmes.
61. In 1992, UNICEF issued a set of guidelines for monitoring
progress toward maternal mortality reduction which proposed a
series of process indicators [D. Maine, et al., Guidelines for
Monitoring Progress in the Reduction of Maternal Mortality. (A
Workin Prog-ress). UNICEF Statistics and Monitoring Section,
October 1992]. These process indicators are based on the
assumption that the most effective strategy for reducing maternal
mortality is to increase access to prompt, adequate emergency
obstetric care (EOC) and therefore are designed to measure progress
toward improving access to, utilization of and the quality of EOC
services. Using process indicators will help programme planners
identify priority interventions and areas, as well as aspects of
the programme that need strengthening. Thus, monitoring of process
indicators serves a variety of purposes - not just data gathering
for its own sake.
62. Following this pioneering work on indicator development, WHO
convened a technical working group, in 1993, to make recommen-
dations on data collection and analysis for monitoring the
maternal mortality and coverage of care goals. The technical
working group met at a time of growing consensus on the content of
programmes for improving maternal health, growing convergence on
the essential package of indicators for monitoring progress, and
growing need for guidance for the collection and utilization of
these indicators. The main conclusion of the Technical Working
Group meeting was that
... there is a need to recognize that, at the national
and subnational levels, impact indicators are much less likely
to be useful for programme management than process indicators
and are insufficiently accurate for monitoring purposes. From
an international perspective, impact indicators are probably
still needed, principally for advocacy purposes, but the
uncertainty over their usefulness at lower levels and the
difficulties and cost in collecting the necessary information
make it difficult to attach any sense of priority to the two
mortality indicators. Consumer information is needed in order
to enable countries and programme managers to make a decision
on this issue...(p. 26)
63. The outcome of the meeting included a series of recommen-
dations on specific indicators and methodologies [See Indicators to
Monitor Maternal Health Goals. Report of a Technical Working
Group. Geneva, 8-12 November 1993. WHO Division of Family
Health].
64. USAID and The World Bank have also conducted in-depth
reviews of indicators for monitoring and evaluation of repro-
ductive health programmes and there is now a growing consensus on
the use of process indicators for monitoring progress.
65. It should be noted, however, that there is relatively little
experience in the use of these indicators and additional field
testing (of the indicators and data collection protocols) is
required. Further guidance is also needed on the use and
interpretation of all these indicators.
-------------------------------------------------------------------
SELECTED BIBLIOGRAPHY
CHILD MORTALITY
Child Mortality Estimates:
UNICEF, The State of the Worldžs Children 1995, UNICEF, New York.
DIESA, Mortality of children under age 5 - World estimates and
projections 1950-2025, ST/ESA/SER.A/105, United Nations, New York,
1988.
DESIPA, World population prospects - the 1994 revision, United
Nations, New York, 1995 forthcoming.
Estimation Methods:
DIESA, Step-by-step guide to the estimation of child mortality,
ST/ESA/SER.A/107, United Nations, New York, 1990.
DIESA, Manual X. Indirect techniques for demographic estimation,
ST/ESA/SER.A/81, United Nations, New York, 1983.
DHS, Model A questionnaire, DHS-II Basic documentation, Macro
International, Columbia, USA, 1990.
K. Hill, Approaches to the measurement of child mortality: a
comparative review, Population Index, Vol. 57, No. 3.
P. H. David et al, Measuring childhood mortality: A guide for
simple surveys, UNICEF, Amman, Jordan, 1990
Child Mortality Databases:
DESD, Child mortality since the 1960s - A database for developing
countries, ST/ESA/SER.A/128, United Nations, New York, 1992.
K. Hill and A. Yazbeck, Trends in child mortality, 1960-90:
Estimates for 83 developing countries, Background paper number 6,
October 1994.
Source Key for Figures 1 and 2
Figure 1: Bolivia under-5 mortality
EDNi75 - Encuesta demogr fica nacional, 1975, indirect estimates
CENSi76 - Census, 1976, indirect estimates
EDNi80 - Encuesta demogr fica nacional, 1980, indirect estimates
ENPVi88 - Encuesta nacional de poblacion y vivienda, 1988,
indirect estimates
ENDSd89 - Enquesta nacional de demogr fia y salud, 1989, direct
estimates
ENDSi89 - Encuesta nacional de demogr fia y salud, 1989, direct
estimates
DHSi94 - Encuesta nacional de demogr fia y salud, 1994, direct
estimates
Figure 2: Papua New Guinea under-5 mortality
CENSi71 - Census, 1971, indirect estimates
CENSi80 - Census, 1980, indirect estimates
All data from Child mortality since the 1960s - A database for
developing countries, except for DHSi94 data, which come from the
published DHS report on Bolivia.
-------------------------------------------------------------------
SELECTED BIBLIOGRAPHY
MATERNAL MORTALITY
General:
WHO, Maternal Health and Safe Motherhood Programme, Division of
Family Health. Mother-Baby Package: Implementing Safe Motherhood
in Countries. Practical Guide. (WHO/FHE/MSM/94.11), 1994.
Maine, D. Safe Motherhood Programs: Options and Issues. Columbia
University, Center for Population and Family Health, 1990.
Measurement of Maternal Mortality:
Campbell, O. and W. J. Graham. Measuring Maternal Mortality and
Morbidity: Levels and Trends. Maternal and Child Epidemiology
Unit Publication No.2, London: London School of Tropical Medicine
and Hygiene, 1990.
Graham, W. J., "The Sisterhood Method for Estimating the Level of
Maternal Mortality: Seven Years' Experience." The Kangaroo,
December, 1994, p.82-87.
Graham, W. J. and P. Airey. "Measuring Maternal Mortality: Sense
and Sensitivity." Health Policy and Planning 2:323-333, 1987.
Indicators for Monitoring Maternal Mortality Reduction:
Maine, D. et al., Guidelines for Monitoring Progress in the
Reduction of Maternal Mortality. (A Work in Progress). UNICEF
Statistics and Monitoring Section, October 1992. (Update forth-
coming in Fall 1995).
WHO, Maternal Health and Safe Motherhood Programme. Indicators to
Monitor Maternal Health Goals. Report of a Technical Working
Group. Geneva, 8-12 November 1993.
Bulatao, R. A. and L. B. Shrestha. Key Indicators for
Reproductive Health Projects. Draft 5 June, 1995. The World Bank.
Graham, W. J. and V. Filippi. Monitoring Maternal Health Goals:
How Well Do the Indicators Perform? Maternal and Child
Epidemiology Unit Publication No.2, London: London School of
Hygiene and Tropical Medicine, 1990.
International Data Sets on Maternal Mortality Ratios:
WHO, Division of Family Health. Maternal Mortality. A Global
Factbook. Compiled by Carla AbouZahr and Erica Royston, Geneva,
1991, and the WHO Database on Maternal Mortality.
Pan American Health Organization (PAHO). Regional Plan of Action
for the Reduction of Maternal Mortality in the Americas (CE111/11),
27 May 1993.
The State of the World's Children Report, Human Development
Report, World Development Report.
Model-based Estimates of Maternal Mortality:
Stanton, C. And K. Hill. Model-Based Estimates of Maternal
Mortality. Report to UNICEF/WHO. July 28, 1994 Department of
Population Dynamics, John Hopkins University School of Public
Health. [A final report on this work is forthcoming from UNICEF and
WHO].
-------------------------------------------------------------------
BRIEF SUMMARY OF
TRENDS IN CHILD MORTALITY, 1960-90:
ESTIMATES FOR 83 DEVELOPING COUNTRIES
BY K. HILL AND A. YAZBECK
A1. The report describes a methodology for trend fitting, applies
it to the data for 83 countries, presents the results in text and
charts country by country, and draws some general conclusions about
the rates of decline of child mortality since 1960.
Methodology
A2. There are many ways in which a set of estimates can be
obtained from a series of observations, and in which extrapolations
forward or backward to any time point can be made. The simplest
procedure is hand smoothing: drawing a freehand curve through a set
of observations, and extending its general trend onwards to some
time point for which an estimate or projection is required. Such
a procedure is unlikely to be objective - different analysts would
almost inevitably draw different lines, particularly for extrapola-
tions beyond the latest observations.
A3. Regression analysis offers a set of possible approaches:
robust regression, locally-weighted least squares, weighted least
squares, or ordinary least squares. Such regression techniques
offer a greater degree of objectivity than hand smoothing, but
still require the choice of model specification.
A4. The approach adopted in the Hill and Yazbeck report is to fit
a regression line to the relationship between child mortality
indicators and their reference dates using weighted least squares.
The basic model assumes that the rate at which child mortality
changes is linear in time, that is, that child mortality changes at
a constant annual percentage rate over some specific time period.
The simplest model maintains a constant rate of change in child
mortality over the entire period studied. The most complex model
used in the report allows the rate of change of child mortality to
alter every five years. The choice of model depends on the number
of mortality observations by time period.
A5. Weighted least squares is used because a substantial body of
evidence suggests different validity weights for different types of
observations. For example, it is generally thought that the
quality of retrospectively reported information deteriorates with
the length of time since the events reported. All estimates from
vital registration or prospective surveys are given initial weights
of 1.0; in the former case, the weight is justified by the
typically large number of events involved and by the lack of any
substantial lag between event and report; in the latter case, the
high weight is justified by the lack of lag and by the accuracy
enforced by the data collection methodology.
A6. Estimates derived from maternity histories are assigned
weights that vary with the length of time before the survey to
which the estimate refers. Specifically, estimates for the five
years before the survey are given a weight of 1.0, for periods five
to nine years before the survey, 0.8, and periods 10 to 14 years
before the survey, 0.6, and for yet longer periods, 0.4. Weights
for indirect estimates based on the proportions dead of children
ever born vary by age group of mother; estimates based on reports
of young women are given low weight, zero for women aged 15 to 19,
and 0.2 for women aged 20 to 24, because of the selection problems
which affect such estimates - early childbearing is highest among
the poor, who also suffer the highest child mortality rates.
Estimates based on reports of women aged 25 to 29 (0.9) and 30 to
34 (1.0) get the highest weights. Then, as age increases, the
weights decline slowly, on the grounds that information about
events longer ago is more prone to error.
A7. The observation-specific weights described in the foregoing
are essentially based on the authorsž judgement and experience.
However, regression techniques can be used to estimate robust
weights for particular types of observation. These techniques have
been applied by the authors on a subset of 13 countries with a
large number of different types of observation - particularly
indirect estimates based on the Brass questions and direct
estimates based on birth histories. They find broad agreement
between the robust regression weights and those described earlier.
Applying the methodology
A8. For each country, step one of the smoothing and extrapolation
process fits the regression model using appropriate date variables
and the weights described earlier. The infant mortality rate and
the under-five mortality rate are fitted independently. The only
subjective element in the process is in the decision concerning how
many slope variables to include in the model. The observations and
fitted line are displayed graphically. In step two, the step one
results are examined, and data sets that are clearly aberrant are
identified - such as vital registration sequences that fall consis-
tently below all other infant mortality estimates, or indirect
estimates that are clearly inconsistent with the bulk of the other
mortality estimates. In general, the weights for that entire data
set are reduced by a constant factor that is usually zero.
A9. Egypt provides an interesting example of the application of
the methodology. Figure A1 shows the observations and final
regression estimates for infant mortality. The vital registration
and observa-tions from the 1976 and 1986 population censuses are
clearly out of line with all other survey estimates. The step one
regression line (not shown) is pulled down by the registration
data, particularly for the 1960s, giving the almost certainly
erroneous impression of rising infant mortality in the 1960s.
A10. In addition, and generally applied throughout the report, it
is assumed that response errors are more likely to result in under-
estimates of child mortality than in overestimates. Thus when two
data sets indicate very different levels, that set indicating
higher mortality is assumed, other things being equal, to be more
likely to be right. In step two in the case of Egypt, the
registration and census data were all given zero weights.
A11. The intention of the methodology is to provide a transparent
and partially objective way of fitting a smoothed trend to a set of
observations, and of extrapolating the trend to cover the period
from 1960 to the present. However, there are subjective judgements
which still have to be made. Step one depends on the weights
selected for different types of data. At the same time, while
analysts might choose different weights, the weights used in the
report are broadly supported by robust regression results. It is
in the second step that subjective judgements are likely to have a
significant impact - primarily in the decision as to whether, and
if so by how much, to underweight entire data sets.
Country specific results
A12. Each of the 83 countries reported has its own two page section
which is divided into four parts. The first part lists the data
sets used in the analysis, and gives both the initial and final
weights utilized in the model fitting. The second part notes any
unusual characteristics of the application, such as overriding an
apparent trend when extrapolating child mortality on the basis of
known periods of civil disruption. The third part summarizes the
results of the model in the form of estimates of under-five
mortality and infant mortality for the period 1960 to 1992. In
addition to the mortality estimates, the time period coefficients
estimated by the model and the implied annual rates of change for
five year periods are also given. The fourth section presents
graphs showing all available observations of infant and under-five
mortality by source, together with the fitted trend line.
-------------------------------------------------------------------
Source Key for Figure A1
Figure A1: Egypt infant mortality
CENSi76 - Census, 1976, indirect estimates
EFSd80 - Egyptian fertility survey, 1980, direct estimates
EFSi80 - Egyptian fertility survey, 1980, indirect estimates
ECPSi84 - Egypt contraceptive prevalence survey, 1984, indirect
estimates
CENSi86 - Census, 1986, indirect estimates
EDHSd89 - Egypt demographic and health survey, 1988-89, direct
estimates
EDHSi89 - Egypt demographic and health survey, 1988-89, indirect
estimates
EPSd91 - Egypt papchild survey, 1991, direct estimates
EPSi91 - Egypt papchild survey, 1991, indirect estimates Vital
reg.- Vital registration, 1960-87
Estimates - Regression estimates from step two.
-------------------------------------------------------------------
AGENCY PROFILES
The World Bank (IBRD)
In the area of common data systems for monitoring child and
maternal mortality, the World Bank uses the indicators published by
UNICEF and WHO. Both the under-five mortality rate and the
maternal mortality ratio are considered "priority poverty
indicators" that are required by the Bank's Operational Directives
to be included in Bank country economic reports. The Bank has also
started to incorporate surveillance of both outcome and process
indicators for reproductive health into project design and imple-
mentation for several projects currently under preparation. A
paper on indicators for reproductive health projects is currently
in the final stages of preparation. The difficulties in measuring
under-five and maternal mortality described in the report of the
working group are well recognized, and the Bank endorses the
efforts of WHO and UNICEF to improve the data, including the use of
model-based maternal mortality estimates.
United Nations Population Fund (UNFPA)
Since its inception, UNFPA has encouraged and supported
national efforts to formulate and implement population policies,
helping developing countries to establish population planning units
and has funded population analysis and research, as well as data
collection activities. It has also provided support for national
capacity building through training programmes at the national,
regional and global levels. Establishing a common approach to
national capacity building in tracking child and maternal mortality
form an integral part of UNFPA's support to data collection and
analysis activities. UNFPA provides support to numerous population
and housing censuses. This is crucial in sub-Saharan Africa, where
such support has enabled newly independent countries to undertake
their first modern population censuses. Additionally, the Fund
supported demographic surveys, such as the World Fertility Survey
(WFS) programme, and more recently the PAPCHILD surveys undertaken
in the Arab States. UNFPA's future strategy with regards to a
common approach to national capacity building will maintain its
emphasis on strengthening national data systems and analytical
capabilities to provide timely and relevant information for policy
formulation, programme development and monitoring, including
support to intersectoral and inter-disciplinary efforts to
streamline existing national and international approaches to
generate and disseminate data. Special emphasis will be given to
the development of innovative methodologies to generate,
disseminate and use data in population and related areas. UNFPA
will support the development of data systems that generate
information that is disaggregated by gender as well as by
geographic areas. UNFPA has, post ICPD, undertaken a number of
initiatives directed at the improvement of monitoring reproductive
health and family planning activities. The Fund is currently
undertaking a pilot project aimed at establishing the feasibility
of a system for the global monitoring of key indicators of family
planning and reproductive health programmes. UNFPA is also
spearheading an international initiative, with the active
participation of the United Nations and bilateral agencies and
organisations, to help establish comprehensive national and
international data bases on reproductive health and family
planning, inter alia, to facilitate the assessment of needs and the
development of indicators including those measures agreed upon to
track child and maternal mortality.
-------------------------------------------------------------------
United Nations Children's Fund (UNICEF)
In response to the ICPD Programme of Action recommendations,
UNICEF will build on its on-going work, with other United Nations
agencies, in assisting countries to strengthen their capacity to
monitor progress toward the World Summit for Children goals and
thus better address the ICPD goals. Most recently, UNICEF, in
collabora-tion with WHO, UNFPA, UNESCO, the UN Statistical Division
and regional centres of excellence, has been helping countries to
build a statistical base for reporting progress towards specific
goals at mid-decade. A key objective in monitoring has been to
bring together the users and producers of data and to ensure that
policy makers have access to understandable and current information
to make decisions for programme and policy formulation, development
and implementation. This has been a particular concern of UNICEF
in tracking child mortality levels. In tracking maternal mortality
particular emphasis is being placed on process indicators (i.e.,
indicators which monitor the processes which are known to reduce
maternal mortality, including indicators which measure improvements
in access to, utilization of and the quality of Emergency Obstetric
Care services). UNICEF has issued a set of guidelines for
monitoring progress in maternal mortality reduction which include
a detailed description of the measurement issues and proposes a
series of process indicators with a methodology for collecting the
data needed to calculate these indicators. In addition, UNICEF, in
collaboration with WHO, is in the process of developing model-based
estimates of maternal mortality for those countries which have no
data at all or very weak data on maternal mortality.
-------------------------------------------------------------------
World Health Organization (WHO)
WHO maintains global bibliographic and indicator databases on
maternal mortality and associated women's health issues including
coverage of maternity care, unsafe abortion, infertility, anemia in
pregnancy, and fertility. The maternal mortality database
comprises studies bringing together information on a country-by-
country basis of all that is known about maternal mortality - the
dimensions of the problem, causes and avoidable factors and the
populations most at risk. This information provides the
foundations upon which the regional and global estimates of
maternal mortality and morbidity are made. The databases are
available on diskette and have been widely distributed to
countries, WHO Regional Offices, international agencies and
researchers around the world. Tabulations of the indicators are
reissued at regular intervals. WHO also convenes meetings of
experts and produces guidelines on measurements issues, including
methods for assessing maternal mortality at community level,
indicators for monitoring progress towards the attainment of
maternal health goals, and methodologies for measuring maternal
morbidity. Guidelines on verbal autopsy for maternal deaths and
conducting maternal death audits at facility level are currently in
preparation. WHO is working with developing countries to improve
health information systems in general and in particular to increase
national capacity to gather and analyse basic information on
births, deaths and cause of death. WHO's philosophy is that all
data collection should be seen as a means towards an end rather
than an end in itself. It is, therefore, recommended that in the
context of maternal health indicators, countries focus increasingly
on performance-based measures such as maternal audit, surveillance
and other process measures. Such programme indicators should be
useful for policy-making and be generated through data collection
procedures that are useful for programme management at the level at
which the data are collected.
=================================================================
GUIDELINES ON BASIC EDUCATION
WITH SPECIAL ATTENTION TO GENDER DISPARITIES
FOR THE UN RESIDENT COORDINATOR SYSTEM
INTRODUCTION
1. In the last five years, following the World Conference on
Education for All at Jomtien, Thailand, 1990, four United Nations
sponsored world conferences have taken place, each underscoring
basic education as a corner stone for human development. These
conferences in addition to those held at sub-regional and regional
levels have resulted in a multitude of recommendations,
declarations and action plans to achieve education for all. The
time has come for the United Nations system and the specialized
agencies to strengthen inter-agency co-ordination in order to
improve the effectiveness of their contributions towards making
education for all a reality.
2. Basic education is considered to be the essential learning
required by all members of the community to ensure social and
economic progress. The ICPD Programme of Action recognizes basic
education as an urgent priority and draws attention to its links
with demography and social and economic development. It states
that "Everyone has a right to education, which shall be directed to
the full development of human resources, and dignity and potential,
with particular attention to women and the girl child."....
Recognizing that the effectiveness of the implementation of the
Programme of Action depends on an inter-disciplinary approach and
must fit into a national development context, paragraph 10 of the
General Assembly Resolution 49/128, Report on the International
Conference on Population and Development, "calls upon the organs of
the United Nations system and the specialized agencies to undertake
the actions required to give full and effective support to the
implementation of the Programme of Action." In response to the
resolution, the inter-agency Task Force on the Implementation of
the ICPD Programme of Action proposed that its basic education
goals be pursued within the United Nations co-ordination system led
by the Resident Co-ordinator, and within the context of the World
Conference on Education for All (Jomtien), the United Nations
Conference on Environment and Development (Rio), ICPD (Cairo), the
World Summit on Social Development (Copenhagen) and the upcoming
Fourth World Conference on Women (Beijing).
3. The Resident Co-ordinator is expected to establish a modality
for inter-agency co-operation which would serve as a catalyst for
national initiatives in basic education. Such a strategy would
recognize UNESCO as the lead agency and the complementary roles of
other agencies, foremost among them, UNDP, UNFPA, UNICEF, WHO and
the World Bank. The guidelines are not intended to be prescriptive
and will not hinder individual agencies from pursuing their
respective mandates but rather will enhance the complementarity of
their programmmes and allow the UN system to contribute more
appropriately to the achievement of basic education. In essence,
it will facilitate more integrated planning of UN inputs to basic
education within a national development framework and will help
foster a dialogue between the UN system and governments in
achieving the targets for basic education for all.
4. Eliminating disparities between male and female is essential
to achieving basic education for all. There is consensus among
governments and agencies on the importance of educating girls and
women. However, there is still some reserve about committing
resources to make this objective a reality. The Resident Co-
ordinator should be committed to the elimination of disparities
between male and female in basic education. He/she is expected to
keep the education of girls and women high on the national agenda
through support to advocacy, national dialogue and programmes and
projects intended to improve girls' and women's access to good
quality basic education. In addition to disparities between male
and female, there are disparities associated with poverty,
geographical location and ethnicity. It should be recognized that
basic education must aim to eliminate inequalities in the society
and to promote peace and tolerance among all peoples.
5. The interplay between culture and education influences
achievements in basic education, particularly among cultural
minorities and disadvantaged groups. Strategies for basic
education should seek to capture those aspects of the culture which
can be utilized to enhance learning. Support should be given to
programmes which allow for the expression and understanding of
diverse cultures and the acceptance of cultural differences as they
relate to basic education for human development.
The Strategies for Co-ordinating Basic Education
6. Already the Statement on the Role and Functioning of the
Resident Coordinator System provides a framework in which the co-
ordination of substantive areas, such as basic education can be
accommodated. The Resident Co-ordinator needs to harmonize three
inter-related aspects of planning and programming. They concern: a)
governments and national Education For All (EFA) mechanisms, b) the
activities/programmes of the various agencies, and c) the inter-
national and global priorities for basic education.
a) Relationship to government and national EFA mechanisms
7. The primary responsibility for co-ordinating basic education
as well as the inputs from bilateral and multilateral organizations
rests with the government. But, a co-ordinated, inter-agency group
can encourage governments to increase resources to education and to
give priority to programmes directed towards improving educational
opportunities for girls. Special support would be given to
programmes designed to reduce drop-out rates among girls as well as
increase their access to good quality education.
8. The Resident Co-ordinator is expected to plan joint
working/training sessions with national officials and UN agencies
on selected themes/issues related to basic education. This will
allow for the exchange of ideas, the consolidation of objectives,
the rationalization of activities and the identification of
investment priorities. This is particularly critical in the case
of major education reforms, policy discussions or major joint-
agency initiatives in basic education, which may provide a good
opportunity for integration of reproductive health considerations.
The United Nations System can play an important role in raising
education above narrow sectarian interests and in keeping with a
changing socio-economic and cultural environment.
9. The development of practical cost-effective policy and plans
for the achievement of quality education for all must be seen as a
priority activity in which the United Nations System can assist
countries. Whilst the drawing up of such a blue print for
achievement of good quality education for all may be seen as a
largely technocratic process, the wide acceptance of the blue print
as a national programme by a wide spectrum of professional,
business and other interests is absolutely essential.
b) Relationship to the agencies - the Resident Co-ordinator as a
team leader
10. The leadership of the Resident Co-ordinator will be essential
in identifying the inter-related areas for support by the UN
agencies. Given the various disciplines of the United Nations, an
inter-agency approach can create an enabling environment by
promoting inter-agency supported studies, programmes and evaluation
exercises. It will allow for the timely sharing of experiences,
discussions of problems and solutions and the review of progress
made. The Resident Co-ordinator should also facilitate inter-change
of staff expertise between and among programmes and activities.
c) Relationship to basic education - achieving national and
global priorities
11. Keeping in mind that the "primary objective of the operational
activities for development within the United Nations system is to
promote the self-reliance of recipient countries through
multilateral cooperation", co-ordination for promoting basic
education should seek to release "national energies", to sustain
good quality basic education which is accessible to all citizens
and which uses local organizations wherever possible. This goes
beyond identifying national resources. It requires the creative
and imaginative use of such resources to increase the demand and
supply of basic education as well as to promote learning
achievement which will help learners to understand better and cope
with a changing socio-economic environment. It is essential to
personal and national development that the expected outcomes of
basic education be defined within the national context.
12. An underlying objective for basic education improvements is to
bring about change and innovation in the education system.
Traditionally changes in education tend to be evolutionary and
somewhat slow. Under the leadership of the Resident Co-ordinator,
the inter-agency group can be a catalyst for change. Changes for
improvements can be put into three categories, those which will: a)
need few inputs and are not costly. Normally such changes can be
effected through policy and policy dialogue, (for example,
increasing the proportion of female teachers recruited to the
teaching profession requires a policy decision); b) need small
scale funding; c) require large scale financing and for which much
programming and planning must be done. Having identified the
categories of change, the inter-agency group can assist the
government to address them in a timely manner and at a pace which
allows development to be sustained by national resources.
13. Education for all is the business of all. Partnerships should
be encouraged and simultaneously basic education monitoring
mechanisms should be established or strengthened to ensure that
standards are maintained. The contribution of the private sector
and NGOs should be assisted and encouraged. The active
participation of Communities in the provision of their education is
of paramount importance and every effort should be made to
encourage and recognize their role. At the same time efforts need
to be made to bring the quality of education in poor communities on
a par with that of more affluent ones.
14. Expanding access to basic education to unserved and under-
served groups in ways that are more responsive to local needs (e.g.
the establishment of small multigrade schools in remote areas and
the provision of good quality non-formal education for youths)
should be addressed. Alternative delivery systems for the
education of the school age-group should articulate with the
education mainstream. Everyone should have access to good quality
basic education regardless of their social, cultural, geographic
and economic situations.
15. Improving basic education quality has continued to challenge
governments and agencies. Basic education is expected to help
young people to develop decision-making skills needed for them to
function effectively as adults. The implications are that their
education must meet their basic learning needs and the teaching and
learning process should be participatory so that attitude formation
and learning can take place in a meaningful context. The Multi-
channel approach (expanding educational opportunities through a
range of delivery options - distance learning schemes, traditional
media, radio, television, audio tapes, etc.) may be utilized to
enrich educational programmes and reach remote and deprived groups.
Multi-channel approaches are most effective when there is a
supportive environment - one in which the individual is ready to
learn and the channel or channels can be maintained.
16. Basic education strategies must be informed by good quality
data, an important area for institutional strengthening in the
improvement of basic education data management. It is one of the
most complex and challenging problems to be addressed in the
education sector. Efforts should be made to strengthen the
national capacity to improve data sources (starting at the
classroom level) and management information systems. All data
should be disaggregated according to sex (male and female) to allow
for the monitoring of progress on the education of girls and women.
Other examples of key areas for strengthening are research and
evaluation, supervision and management, and the training of all
levels of educational personnel. In all these efforts, attention
should be paid to adequate representation of women personnel as
well as the elimination of traditional gender biases.
17. Information sharing, the transfer and adaptation of successful
experiences within the country would help to promote programmes for
the unserved and under-served groups. It is important that
information be disseminated through various channels including
traditional means and packaged in various forms to allow both
literate and illiterate persons to understand the key messages.
18. Adult literacy, skills training and continuing education
should be given priority. The Resident Co-ordinator can exercise
leadership in supporting the convergence of services, that is, the
"bringing together" of health, education, social welfare and
agricultural services in a comprehensive whole at the community
level. Early childhood care and education should be addressed at
the community level with emphasis on the education of parents or
caregivers to enhance the overall development of young children.
19. Rigorous monitoring, evaluation and reforms needed to create
the required dynamism to achieve education for all targets should
be encouraged. A manageable number of key indicators should be
identified for assessment. Some areas of concern may be evaluated
through sample research. Special attention needs to be given to
progress in reaching excluded groups (among them girls and women),
educational achievement and non-academic areas such as values and
attitudes. It is important to recognize those strategies which
have reached their threshold of usefulness and which must be
changed, sometimes radically, to foster further improvements.
================================================================
SELECTED BIBLIOGRAPHY
World Declaration on Education for All and
Framework for Action to Meet Basic Learning Needs
Adopted by the World Conference on Education for All (WCEFA),
Jomtien, Thailand, 5-9 March 1990.
The main authoritative reference as in the goals and concepts
adopted by the World Conference.
World Conference on Education for All monographs;
I) Education for All: Purpose and Context
II) Education for All: An Expanded Vision
III) Education for All: The Requirements
Final Report: Meeting Basic Learning Needs
Inter-Agency Commission (UNDP, UNESCO, UNICEF, World Bank)
World Conference on Education for All, Jomtien, Thailand, 1990.
The Delhi Declaration on Education for All in the Nine High
Population Countries Adopted at the Education for All Summit, New
Delhi, India, 12-16 December 1993.
UNICEF, UNFPA, UNESCO.
The documents (panel proceedings and final report) present the
declaration and framework for action to achieve primary education
and literacy for all, in the worldžs high-population countries;
Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Nigeria
and Pakistan.
Final Report: Prospects for Providing Universal Access to Primary
Education International Consultative Forum on Education for All,
Paris, 4-6 December 1991.
Final Report: Quality Education for All
International Consultative Forum on Education for All, New Delhi,
8-10 September 1993. The International Consultative Forum is a
global mechanism established by the World Conference to promote and
monitor progress towards Education for All goals.
The Istanbul Declaration and Action Framework
Adopted at the First International Congress on Population,
Education and Development (ICPED), Istanbul, Turkey, 14-17 April
1993. UNFPA, UNESCO. The declaration focuses on the role of
population education in human development with a view to strengthen
the integration of population education into both formal and non-
formal education systems.
Status & Trends: focus on primary schooling
UNESCO for the International Consultative Forum on Education for
All, 1993
Status & Trends: focus on basic education and development
UNESCO for the International Consultative Forum on Education for
All, 1994
Beyond Jomtien, Implementing Primary Education for All
A. Little, W. Hoppers, R. Gardner,
MacMillan Press, London, 1994
A book that offers lessons from six projects designed to promote
education for all, which all anticipated much of the Jomtien vision
and many of its aims (Indonesia, Sri Lanka, Zambia, Guatemala,
Andra Pradesh and Rajasthan in India).
Educating All the Children
C. Colelough with K. Lewin
Oxford University Press, 1992
A study of why a growing number of children remain out of school in
developing countries, how this trend can be reversed and what
resources and policy changes would be required, nationally and
internationally, if schooling for all children were to be achieved
by the year 2000.
Improving Primary Education in Developing Countries
M.E. Lockheed, A. Verspoor and associates
World Bank and Oxford University Press, 1991
A comprehensive review of both the scholarly literature and donorsž
experience, discussing strategies for improving different aspects
of primary education. The book contains a large number of figures
and tables and provides data on 129 countries.
What are we waiting for?
M.B. Anderson
UNICEF, N.Y., 1992
A review of the world situation of basic education, including a
presentation of some innovative educational programmes, which urges
the world to affirm the goals of education for all.
Educating Girls and Women, A Moral imperative
Education Section, Programme Division,
UNICEF, N.Y., 1992
A summary of the magnitude and causes of gender disparities in
education, highlighting some possible strategies. The booklet
suggests that affirmative action is needed to promote girlsž
education and sustainable development.
Basic Education and National Development, Lessons from China and
India M. Ahmed with Cheng Kai Ming, A.K. Jalaluddin and K.
Ramachandran UNICEF, N.Y., 1991
A presentation of policy and strategy lessons for the development
of basic education, based on two reviews of progress in basic
education in China and India, prepared by two teams of researchers
from the respective countries.
Investing in the Future: Setting Educational Priorities in the
Developing World J. Hallak
UNESCO (International Institute for International Planning) and
Pergamon Press, 1990 A book primarily addressed to national policy
makers, describing how educational policies can be formulated, the
priorities for educational development established, and appropriate
strategies designed, based on a through understanding of the
specific local conditions.
=================================================================
AGENCY PROFILES
United Nations Educational, Scientific and Cultural Organization
(UNESCO)
UNESCO is the UN Specialized Agency for Education, Science and
Culture. Education for All (EFA) is the undisputed priority area
within its vast educational programme.
However, UNESCO also works on many aspects and levels of
education, which have a bearing on EFA, e.g. the training of
teachers, educational planning, educational statistics and
indicators, or curriculum development including such specific
aspects as population education, environmental education, education
for peace and international understanding, or education against
AIDS and drug abuse.
UNESCO initiated and co-sponsored (with UNDP, UNICEF, UNFPA,
the World Bank and other agencies) the World Conference on
Education for All (Jomtien 1990) and the Education Summit of Nine
High-Population Countries (Delhi, 1993).
In the EFA, UNESCO pursues a strategy where primary education,
non-formal education programmes and adult literacy are seen as
linked and mutually reinforcing. Programmes which aim at expanding
access for girls and women, but also for disadvantaged groups and
learners with special needs, are complemented by programmes which
seek to improve quality and relevance of basic education, and
enhance learning achievement.
Under its Regular Programme, voted by the General Conference
every two years, UNESCO co-operates with Member States in such
activities as: organization of training programmes tailored to a
countryžs requirements; providing technical advice on specific
educational questions; carrying out action and policy oriented
studies on educational issues; undertaking educational sector work;
facilitating policy dialogue and experience exchange between
countries in the same region or sub-region.
UNESCO also undertakes žextrabudgetary programmesž in EFA,
typically country-specific operational field projects, but also
geared to inter-country co-operation. These tend to be funded by
bilateral donors on a funds-in-trust basis. UNESCO also co-
operates with UNDP, the World Bank and regional development banks
through TSS-1 and TSS-2 arrangements, as well as for the execution
of TA components of educational loan programmes.
In practice, UN Resident Coordinators may call upon UNESCOžs
services either by contacting Headquarters directly, or linking up
with the growing number of UNESCO field offices. UNESCO maintains
at present 52 field offices with either a country-specific, sub-
regional or regional mandate. This field network is being
continuously expanded and strengthened.
Three UNESCO-affiliated International Education Institutes are
also available to work with countries and UN Resident Coordinators:
the International Institute for Educational Planning (IIEP) in
Paris, specialized in training and studies on educational planning:
the UNESCO Institute for Education (UIE) in Hamburg, specialized in
training and studies on literacy and adult education; the
International Bureau of Education (IBE) in Geneva, a worldwide
centre of educational documentation and research.
Addresses
UNESCO Headquarters 7, Place de Fontenoy
Basic Education Division 75352 Paris 07 SP
Fax: 33 1 40 65 94 05
UNESCO Office for Education 12, avenue Roume, B.P. 3311
in Africa - BREDA Dakar, Senegal
Fax: 221 23 83 93
UNESCO Regional Office for Casilla 3187
Education in Latin America Santiago, Chile
and the Caribbean - OREALC Fax: 56 2 209 18 75
UNESCO Regional Office for P.O. Box 2270
Education in the Arab States Wadi Saqra, Amman, Jordan
- UNEDBAS Fax: 962 6 68 21 83
UNESCO's Principal Regional Prankanong, Post Office
Office in Asia & the Pacific P.O. Box 967
- PROAP Bangkok, Thailand
Fax: 66 2 391 08 66
IIEP 7-9 rue Eugne Delacroix
75116 Paris, France
Fax: 33 1 40 72 83 66
IBE 15, route des Morillons
1218 Grand Saconnex,
Switzerland
Fax: 41 22 798 14 86
UIE Feldbrunnenstrasse 58
20148 Hamburg, Germany
Fax: 49 40 41 07 723
United Nations Population Fund (UNFPA)
UNFPA uses a three-pronged approach to create awareness about
population issues (IEC activities):
Public Information/Advocacy
Population Education
Population Communication
Population Education takes place in both formal and non-formal
education and has expanded rapidly since the 60's and its first
tentative introduction into the school systems and curricula. One
of the main contributions of Population Education has been its
emphasis on the teaching of gender issues and the importance of
educating girls, which was also highlighted during the EFA Summit
of the Nine High Population Countries in New Delhi. UNESCO, with
UNFPA funding, is the primary source of international expertise on
Population Education for the formal sector.
In April 1993, the Istanbul Declaration, adopted at the
International Congress on Population, Education and Development,
stated that "Population Education should be part of every schoolžs
curriculum along with reading, writing and arithmetic."
The 1994 International Conference on Population and
Development (ICPD) adopted a Programme of Action whose principles,
goals and recommendations will influence the Fundžs policies and
operational work for the coming years. One of its three goals is
expanding the availability of education especially for girls and it
calls on countries to consolidate the progress made in the 90's
towards providing universal access to primary education as agreed
upon in Jomtien. According to the holistic approach of the
Programme of Action, which makes cooperation within the UN system
and outside it crucial to success, UNFPA will undertake strong
advocacy in support of girlsž and womenžs education and will
continue to be an active partner in the EFA initiative together
with UNESCO, UNDP, UNICEF and others.
Specifically, UNFPA supports:
advocacy for the education of girls and the achievement of
female education goals as specified in the ICPD Programme of
Action, with particular attention to primary and secondary
education of girls. Such advocacy spells out those
interventions known to promote female enrolment and retention
of girls in school, e.g., quality education, female teachers,
flexible schedules, incentive programmes for girls' education,
female extension workers, etc.; activities to improve the
quality and relevance of school curricula through the
introduction of population education including gender equity,
responsible reproductive behaviour and decision-making skills.
International Labour Organisation (ILO)
Enhancement of the institutional strengths of constituents to
promote social justice and protect workersž well-being and family
welfare through basic education activities of several kinds is a
major concern of the International Labour Organisation. In the
ILO, therefore, basic education is viewed as a process of
developing awareness, knowledge, potential, and skills to
contribute in the most efficient manner to the production of goods
and services, and to survive in the workplace. ILO programmes
accordingly aim to build national capacities for organizing,
bargaining and representing the interests of the social partners
and for disseminating information and raising awareness on key
issues which affect worker status and productivity. They include
efforts to promote tripartite participation in policy design and
programme implementation and to support trade union activities
designed to safeguard and ameliorate conditions of vulnerable
groups including women, youth, working children, rural and disabled
workers and workers in the informal sector.
Activities to promote basic education include technical
cooperation projects to develop capacity for designing, planning
and organizing educational programmes; provision of advisory
services in development of curricula; assistance in the preparation
and publication of training materials (manuals, study guides,
various forms of teaching aids, etc.), organization of seminars,
conferences, workshops; and meeting and provision of grants and
fellowships. With regard to basic education on population and
reproductive health issues in work settings, there have been
successful programmes with ILO's constituents - governments,
employers and workers organizations - in more than sixty countries
for over quarter of a century.
World Food Programme (WFP)
Human resources development has always been a priority area of
action for the World Food Programme, which since its creation has
allocated over 50% of its development food assistance to projects
having such objectives. As WFP believes that investment in basic
education is one of the most effective tools for human resource
development, the vast majority of this type of assistance has been
channelled through school feeding programmes. As of December 1994,
WFP was providing support to 44 primary school feeding projects,
with a total commitment of US$535 million. Besides these currently
operational projects, during 1994 new projects were approved which
will provide assistance to over one million additional
schoolchildren.
WFP's assistance to school feeding programmes is tailored to
address specific problems in the educational sector in individual
countries. Aid is most often aimed at encouraging parents to enrol
their children, especially girls, in primary school and to ensure
they complete the full cycle. Once children are enrolled in
school, feeding plays an essential role by relieving short-term
hunger, improving childrenžs ability to concentrate and to benefit
from their education. As school feeding alone cannot ensure gender
equality in education, WFP collaborates with Governments, NGOs and
other agencies in development of complementary activities to
promote basic education for girls. In light of growing evidence of
the importance of early stimulation in preparing children for
primary school, WFP is exploring possibilities for increasing
support to pre-primary education.
WFP support to basic education is targeted to the most
disadvantaged groups in the countries assisted. In some cases, WFP
assistance helps to provide children of extremely poor and
marginalized groups the only opportunity for primary education.
In pursuing the Programme approach and greater inter-agency
collaboration, WFP will continue to seek more innovative ways to
use food aid in support of basic education. It is hoped, for
example, to increase the coverage of literacy and numeracy training
for women in rural development projects, to ensure they are able to
put into practice the marketable skills which they learn through
such projectsž training components.
United Nations Children's Fund (UNICEF)
UNICEF policies, strategies and actions in basic education are
in harmony with the education objectives of the ICPD. UNICEF
strongly and explicitly advocates affirmative action in favour of
girls' education. UNICEF country programmes strive to mainstream
girls in the formal system by making it more responsive to girls'
special needs and concerns. UNICEF also supports nonformal
education programmes of equivalent quality. Training of female
teachers and administrators; gender sensitization of textbooks,
curricula and teacher training materials; mobilizing parents and
communities to get involved in the education of girls; and
sensitization of the civil society about the benefits of girlsž
education are important areas of UNICEF support in basic education.
While most of the activities will be at the national level, the
regional offices provide technical support in training, curriculum
development, collection of gender disaggregated data and monitoring
progress. At the global level, UNICEF has been active in the
development of policies and strategies and advocacy for them as
well as mobilizing resources for girls' education.
================================================================
Reports of the First and Second Meetings of the Inter-Agency
Task Force on the Implementation of the
ICPD Programme of Action
================================================================
Report of the First Meeting of the Inter-Agency
Task Force on the Implementation
of the ICPD Programme of Action
13 December 1994, New York
I. Introduction and Purpose of the Meeting
1. Paragraph 16.29 of the Programme of Action of the
International Conference on Population and Development (ICPD), that
was adopted by consensus in Cairo, Egypt, on 13 September 1994,
invites all specialized agencies and related organizations of the
United Nations system to strengthen and adjust their activities,
programmes and medium-term strategies, as appropriate, to take into
account the follow-up to the Conference. In addition, paragraph 10
of General Assembly resolution 49/128, "Report of the International
Conference on Population and Development", calls upon the organs
and organizations of the United Nations system and the specialized
agencies to undertake the actions required to give full and
effective support to the implementation of the Programme of Action.
2. At the request of the Administrator of the United Nations
Development Programme (UNDP) on behalf of the Secretary-General of
the United Nations, Dr. Nafis Sadik, in her capacity as Secretary-
General of the ICPD, convened and chaired the first meeting of an
Inter- Agency Task Force to develop a coordinated approach for the
implementation of the ICPD Programme of Action.
3. The meeting was convened on 13 December 1994 at the United
Nations Headquarters in New York. Twenty-five participants,
representing twelve UN Agencies and organizations, attended the
meeting. The agenda and the list of participants appear as an
annex.
II. Summary of Opening Remarks
4. Dr. Sadik opened the first meeting of the Inter-Agency Task
Force on the implementation of the ICPD Programme of Action by
stating that she had been requested by the Administrator of UNDP,
on behalf of the Secretary-General of the UN, to convene an Inter-
Agency Task Force aimed at assisting in the development of a
coordinated approach for the implementation of the ICPD Programme
of Action. She referred to the importance the Secretary-General
attaches to a common framework emerging from all the various UN
Conferences, as elaborated in his Agenda for Development. Dr. Sadik
explained the purpose of this meeting, i.e., to agree on a common
framework for follow-up to ICPD and other conferences in the social
sector, past and future, in order to assist countries in the
implementation, and to agree on a common system for monitoring. The
focus of the Inter-Agency Task Force is on country-level
cooperation.
5. According to Dr. Sadik, such a common framework should be
designed so as to reduce the burden on countries with regard to
implementation and be based on the UN Resident Coordinator system.
She stressed the need for coordination among UN agencies and
organizations, particularly at the country level. Paragraph 16.29
of the ICPD Programme of Action and the General Assembly Resolution
on ICPD requested all UN agencies and organizations to cooperate
and coordinate in the follow-up on ICPD and to adjust their
programmes to make them in line with the ICPD Programme of Action.
6. In order to do so, all UN agencies involved in the follow-up
to Cairo should first of all use one set of country data. Where
such data was absent, unreliable or not timely available, UN
agencies should collaborate to establish a system of collecting
data for monitoring and evaluation purposes. Dr. Sadik suggested to
develop a set of guidelines for the UN Resident Coordinator that
would give him/her guidance in coordinating the follow-up at the
country level. She urged all participants not to miss this
opportunity for inter-agency cooperation and to maintain the
momentum of inter-agency collaboration that prevailed throughout
the Cairo process.
7. The Administrator of UNDP, Mr. Speth, reiterated the great
importance the Secretary- General of the UN attaches to the follow-
up on the Cairo Conference. He hoped that this task force would
become a model for future cooperation among UN agencies. There was
a need for the UN to exert leadership in the follow-up to all major
UN conferences. Mr. Speth called upon the agencies to forge a
unified agenda, based on common priorities. The strength of the UN
is its ability to identify problems, to come up with solutions and
to assist countries in the implementation of its proposed actions.
UNDP looked forward to continued cooperation among the agencies in
the follow-up to Cairo.
8. Mr. Desai of UN-PCSD asked what lessons to be learned from
UNCED and observed that it was important to learn from the UNCED
follow-up process and urged participants to focus on what needed to
be done before the next session of ECOSOC, in accordance with draft
resolution L.67 on ICPD. He noted that UNCED proved that the
implementation of the outcomes of UN conferences are limited if
there is no momentum or commitment at the national level. The
question is how to maintain the momentum at the national level. The
same goes for the role of NGOs, how to maintain the role and
commitment of NGOs in the follow-up. UNCED made clear that there
should be a link between the UN policy process and the financing
process, otherwise the implementation will be severely hampered. He
urged the Task Force to discuss how the preparation for ECOSOC
related to the ICPD resolution will be undertaken.
9. Mr. Milleron of UN-DESIPA welcomed the outcome of the ICPD and
assured the participants that his department will continue to play
an active role in technical assistance, given their experience and
network at the national level in the area of data collection and
analysis. In particular, Mr. Milleron also referred to the changing
role of the Population Commission.
10. All organizations participating in the meeting promised
support for the inter-agency follow-up to Cairo and to become an
active participant in the cooperation. Several participants
underscored that it was important that all UN agencies make sure
that the goals of the ICPD would be reinforced in future
conferences, notably the Social Summit and the Women's Conference.
The representative of UN-PCSD informed the group that the goals of
ICPD and other UN Conferences are being incorporated in the draft
Programme of Action of the World Summit on Social Development.
11. Several participants welcomed the holistic, integrated and
forward-looking approach of the ICPD Programme of Action. UNICEF
informed the Task Force that it is preparing a health strategy
paper which will reflect the ICPD Programme of Action and that the
UNICEF Executive Board has asked for a paper on UNICEF's role in
the follow-up to ICPD. Since so much emphasis was put on
monitoring, he suggested all UN agencies should collaborate in
finding ways to generate data in a more speedy manner. He also
referred to the need for UNFPA to revise the Population Assistance
Report in order to reflect financial contributions in accordance
with the Programme of Action. Dr. Sadik supported the first
suggestion, and noted that there is a need to find a balance
between timely data and its reliability. With regard to the second
suggestion, she agreed, in principle, noting that we need to define
what should be classified as "population" activities. She urged
some cautiousness in this regard, noting that not everything should
be categorized as population.
12. Several participants explained the initiatives being
undertaken by their respective organizations to integrate the ICPD
recommendations into their programmes. One participant called upon
the UN agencies to reinforce the role of the CCPOQ in the follow-up
of the ICPD.
13. A number of participants stressed the importance of national
ownership in terms of reporting, noting that coordination at the
national level will depend on the individual country situation. It
will be critical for the UN system to make sure that population
issues are being integrated into the broader national development
plans and the central role for the UNDP Resident Coordinator in
this respect was affirmed by several participants. The importance
of concerted advocacy efforts by the UN system with respect to the
Cairo follow-up was stressed.
III. Summary of the Discussion on the Background Note
Agenda item 2: Technical assistance modalities
14. It was decided that (a) the Task Force should focus on
country-level cooperation; and (b) to add a fourth category for
cooperation, namely situation analysis/diagnostic assessment of
country capacity and the exchange and dissemination of information
both in terms of what UN agencies are doing at the country level
and to exchange country experiences. The latter implies the
exchange of information both within and across countries. South-
South cooperation had, inter alia, proven to be very useful in this
regard. For the moment, the situation analysis and information
dissemination should focus on the social sectors, such as health
and education, and not on issues such as poverty, employment, etc.,
pending the outcome of the World Summit on Social Development.
15. Acknowledging the usefulness of the Background Note, it was
agreed that it should be revised to reflect some of the points
raised at the meeting. In commenting on the Background Note, a
number of participants suggested some changes. WHO would like to
see its role be inserted in the section on female genital
mutilation in the background note. WHO provides both normative and
technical support to countries and other UN agencies. FAO would
like to see its role in issues such as the empowerment of women,
migration, and the environment being reflected in a revised
background note on inter-agency cooperation. Some participants
suggested that more emphasis be put in the Background Note on the
need for developed countries to report on their progress in
implementing the outcomes of UN conferences. In addition, it was
suggested to develop a modality to assess the national capability
to implement the results of UN Conferences.
16. The participants agreed on the need for a unified advocacy
strategy on certain goals/topics, independently from whether these
goals or topics are within the areas of each own programme. It was
deemed essential not to focus narrowly on each agency's or
organization's own agenda, but rather agree on a broader agenda.
This would provide coherence to the UN system in terms of advocacy.
All agreed on the need for a clear framework of advocacy messages.
Agenda item 3: Specific areas of support
17. The need to define a common set of goals emanating from the
Agenda for Development and the various international conferences
was discussed. The title of the first topic population policy
development will be changed in population policy and sustainable
development policies, in order to more reflect the purpose of this
point, namely the integration of population policy development into
the overall development plans. Policy development was understood to
include policy dialogue with governments at macro level and
population policy included a number of issues, not only family
planning. It was agreed that UNFPA, UNDP and the World Bank have
important roles to play in this area, particularly in ensuring that
population issues are addressed when economic policies are
discussed.
18. Regarding basic health improvement, it was noted that there
are areas such as nutrition and food production and women's
empowerment which are part of a broader holistic approach to
health. Based on the suggestion of the chairman, it was agreed to
start the working group on data systems, with the goal to develop
a common data system at country level, based on an agreement on
methodology on data. WHO, UNICEF and UNFPA could focus on this. In
addition, the Resident Coordinator could be requested to start
addressing this issue immediately at country level. Suggestions
were also made to add issues related to adolescent health.
19. With regard to reproductive health care, it was noted that
HIV/AIDS should be listed in this section.
20. Concerning basic education, it was observed that if specific
areas of education are included, the number of actors will increase
tremendously in terms of those who play a role in either advocacy,
technical assistance, or direct funding. It was suggested to focus
on the question of how to eliminate gender disparities. National
statistical systems are critical for work in this area. It was
agreed that, to start with, the working group on this topic should
focus on gender disparities in education, and issues related to
data may be part of the discussion.
21. With regard to the empowerment of women, ILO noted it had a
role here, since issues related to time budgets/time use were
important and there was need for more information on this. UNESCO
observed that there was need to address the specific training needs
of women, and protection of women's legal and other rights. Other
suggestions included to examine employment conditions/practices,
gender specific statistics and data needs. It was agreed to expand
the fifth topic, empowerment of women, to include the following
five issues: Income generation, education and training; the legal,
economic and social rights of women; employment conditions; harmful
practices; and, data collection and analysis.
22. Issues related to difficulties with indicators and measurement
in the area of environment, and the need for a common set of
indicators in this field, were discussed. The roles of UNEP and
HABITAT were referred to. Several participants also noted the
importance of migration issues. Further discussions on the
environment and migration will be postponed pending discussions in
the Social Summit and the preparation of a report to ECOSOC on a UN
conference on migration. The chairperson observed that the
discussion on migration issues in the Task Force might contribute
to the discussion on a UN conference on migration.
23. The chairperson raised the question whether or not a new item
should be included, namely emergency support. In that case the
issue of the countries with economies in transition could be
included in the discussion.
Agenda item 4: Inter-agency coordination
24. It was decided that the Task Force could also address issues
related to collective resource mobilization for the implementation
of the ICPD Programme of Action, taking note, however, that a
separate Task Force on resource mobilization has been established,
and will be chaired by Dr. Sadik in her capacity as Secretary-
General of the ICPD. In the section on inter-agency cooperation in
the background paper, it was agreed to add the issue of collective
resource mobilization.
IV. Decisions
25. In closing the meeting, the Chairman summarized the principal
points of the morning's discussion and enumerated the decisions
taken.
26. Four working groups will be established:
(1) Working group to discuss a common data system at the
national level in the field of health, notably in
the areas of infant, child and maternal mortality;
(2) Working group on basic education, with special
attention to gender disparities;
(3) Working group on policy-related issues, including
the drafting of a common advocacy statement on
social issues;
(4) Working group on women's empowerment.
27. UNFPA, in consultation with its UN partners, will organize
meetings of the working groups as soon as possible. In the
meantime, it was agreed that all of the relevant agencies,
organizations and programmes of the UN system should begin to work
on the issues for ICPD follow-up discussed at the Task Force
meeting, in the context of their respective mandates. The need for
each organization to give attention to follow-up at the field level
was emphasized.
28. The Background Note on Inter-agency Cooperation on the
Implementation of the ICPD Programme of Action will be a revised,
taking into account the comments and suggestions made during the
meeting.
29. It was decided that the UN Division for the Advancement of
Women, Habitat, UNEP and UNIFEM will also be invited to join the
Inter-agency Task Force.
30. The chairman suggested that areas for further research should
be identified and ways explored for collective funding of studies.
In addition, she added that other important concerns, such as human
rights, which, while not specifically addressed in this Task Force,
should certainly play an important role in the work of the Task
Force.
31. All participants agreed that it was important to move quickly
ahead with the discussion on inter-agency cooperation and
collaboration in follow-up to ICPD, both at Headquarters and field
level, in order to utilize the momentum of the Cairo Conference.
==================================================================
ANNEX
LIST OF PARTICIPANTS
United Nations Development Programme (UNDP)
- Mr. James Gustave Speth
Administrator
- Ms. Sarah Timpson
Deputy Assistant Administrator and Director of the
Bureau of Programme Policy and Evaluation
United Nations Children's Fund (UNICEF)
- Mr. Paul Altesman
Director, UN Affairs and Special Assistant to the
Executive Director
- Mr. Kul Gautam
Director, Programme Division
- Dr. France Donnay
Senior Adviser, Women's Health
World Health Organization (WHO)
- Dr. Tomris Trmen
Director, Division of Family Health
United Nations Educational, Scientific and Cultural Organization
(UNESCO)
- Mr. Gustavo Lopez Ospina
Director of the Interdisciplinary and Inter-Agency
Co-operation project:
Environment and Population Education and Information
for Human Development (EPD)
- Ms. Serim Timur
Interdisciplinary and Inter-Agency Co-operation
project: Environment and Population Education and
Information for Human Development (EPD)
International Labour Organisation (ILO)
- Mr. Aziz
Director, a.i.
ILO Liaison Office, New York
- Mr. E.K. Andoh
Coordinator of Population Activities
Development and Technical Cooperation Department,
Geneva
The World Bank (WB)
- Mr. David de Ferranti
Director of the Population, Health and Nutrition
Department
- Mr. Carlston Boucher
Special Representative to the UN
United Nations, Department for Policy Coordination and Sustainable
Development (PCSD)
- Mr. Nitin Desai
Under-Secretary-General for Policy Coordination and
Sustainable Development
- Mr. Jean-Claude Faby
Chief, Office of the Under-Secretary-General for
Policy Coordination and Sustainable Development
United Nations, Department for Economic and Social Information and
Policy Analysis (DESIPA)
- Mr. Jean-Claude Milleron
Under-Secretary-General for Economic and Social
Information and Policy Analysis
- Mr. Joseph Chamie
Director, Population Division
- Mr. Herman Habermann
Director, Statistical Division
Food and Agriculture Organization of the United Nations (FAO)
- Mr. Jacques du Guerny
Population Programme Co-ordinator
United Nations Population Fund (UNFPA)
- Dr. Nafis Sadik
Executive Director
- Mr. Joseph van Arendonk
Deputy Executive Director (Programme)
- Mr. Jyoti Shankar Singh
Director, Technical and Evaluation Division
- Ms. Mari Simonen
Chief, Office of the Executive Director
- Mr. S.L.N. Rao
Chief, Governing Council, UN Liaison and External
Relations Branch, and Deputy Director, Information
and External Relations Division
- Ms. Catherine S. Pierce
Chief, Women, Population and Development Branch,
Technical and Evaluation Division
- Mr. Arthur Erken
Associate Research Adviser, ICPD Secretariat
=================================================================
First Meeting
of the
Inter-Agency Task Force
on
the Implementation
of the
ICPD Programme of Action
Tuesday, 13 December 1994
United Nations Headquarters
Conference Room 9
10:00 - 13:00 hours
Agenda
1. Goals of the ICPD in relation to other UN Conferences.
2. Technical assistance modalities.
3. Specific areas of support.
4. Inter-agency coordination.
==================================================================
Report of the Second Meeting of the ICPD Inter-Agency
Task Force on the Implementation
of the ICPD Programme of Action
25 July 1995
UNFPA Headquarters
New York, NY
1. The Second Meeting of the ICPD Inter-Agency Task Force (IATF)
took place on 25 July 1995, at the United Nations Population Fund
(UNFPA) Headquarters in New York. Dr. Nafis Sadik, Executive
Director, UNFPA and Chairman of the Task Force presided over the
initial sessions and the closing segment of the meeting. Mr. Jyoti
Shankar Singh, Deputy Executive Director (Technical Services),
UNFPA, who had served as Executive Coordinator of the ICPD,
presided over the rest of the meeting.
2. The agenda and list of participants are attached to this
report.
Agenda Items I and II: Welcome and Adoption of the Agenda
3. Dr. Nafis Sadik opened the Second Meeting of the ICPD Inter-
Agency Task Force by welcoming the participants. She noted that
the work of the IATF had evoked positive comments from various
sources, including the recent session of the Economic and Social
Council (ECOSOC) and had generated "great expectations" concerning
the follow-up to the ICPD Programme of Action. She added that the
Secretary-General was also aware of and appreciated the work of the
IATF. The agenda was adopted as presented.
4. Dr. Sadik congratulated the members of the IATF on the
impressive body of work that had been produced since the first IATF
meeting on 13 December 1994, and commended the Task Force for the
speed with which this had been accomplished. While the guidelines
from each group varied, all were user-friendly and instructive.
She noted that the format of the Guidelines on Reproductive Health
clearly illustrated how the Resident Coordinator System could help
to operationalize programmes in the field. She also suggested that
the reproductive health dimension be included in the Guidelines on
Tracking Child and Maternal Mortality.
5. Dr. Sadik reiterated that the main purpose of the guidelines
was to provide advice to the field and, in particular, to the
Resident Coordinator to guide the operationalization of the
Programme of Action and the follow-up to other UN conferences in
the social sector. These were not meant as technical sectoral
guidelines. She observed that the Resident Coordinator should not
be expected to be an expert in the technical areas covered by the
guidelines, however, the five sets of guidelines should provide the
Resident Coordinator with guidance and a sound basis for:
developing dialogue with the Government; assisting the Government
in working in a particular sectoral area; and developing networks
and partnerships that include non-governmental organizations (NGOs)
and other groups. Dr. Sadik added that bilateral agencies were
also keenly interested in sharing the guidelines and in being part
of the process in ways that would facilitate their own work at the
country-level. She emphasized that each set of guidelines should
be accompanied by a short bibliography listing key documents and
relevant audio-visual materials. Additionally, the Resident
Coordinator should be provided with a list of experts who could be
drawn on as needed. Dr. Sadik urged all the lead-agencies to
collect these materials so that they could be sent to the field.
6. Dr. Sadik emphasized the need for improving data collection
and analysis at the country level. She noted that data systems
should help monitor the progress in achieving ICPD goals, as well
as, the impact of programmes and should guide the formulation of
future programmes.
7. Dr. Sadik stated that the Administrative Committee on
Coordination (ACC) had recognized the ICPD IATF with UNFPA as the
lead-agency. The work of the IATF would be reported on to the ACC.
Also under consideration by ECOSOC was a proposal for the
Secretary-General to report on the work of the IATF. Dr. Sadik
invited the participants to discuss, during the course of the
meeting, the appropriate format and time-table for the report. Dr.
Sadik noted that with regard to the IATF report to the Commission
on Population and Development we would need to discuss and define
its focus and content. She added that the theme of the 1996 report
was reproductive health.
8. Noting that she had received requests from several NGOs and
inter-governmental organizations to participate in the IATF, Dr.
Sadik observed that it would be very useful to have this parti-
cipation at the country-level. However, the IATF itself should not
be expanded to a point where it becomes unwieldy.
9. With regard to the future of the IATF and the Working Groups,
Dr. Sadik noted that the Working Groups had been established for
the specific purpose of producing the guidelines and once this had
been accomplished they would not continue. If necessary, ad-hoc
meetings could be convened. Dr. Sadik added that it was important
to keep alive the momentum, interest and attention that had been
generated by the IATF. At the same time, it was necessary to
ensure ways and means for receiving and acting on views and
comments received on the guidelines and the work of the IATF in
general.
10. Dr. Sadik concluded by once again commending the work achieved
by the IATF. She expressed the hope that the discussions would be
constructive and fruitful and that the Task Force would be able to
finalize the guidelines. She thanked the member agencies for their
participation and invited questions and comments.
11. During the ensuing discussion the representative of the
International Monetary Fund (IMF) inquired about the relationship
of the IATF to the Consultative Committee on Programme and
Operational Questions (CCPOQ). Dr. Sadik noted that she had agreed
to provide a report on the IATF to the next meeting of the CCPOQ
for its consideration, however, in the meantime the work of the
IATF should continue and not be delayed in any way. The CCPOQ had
agreed to this. Dr. Sadik added that since most of the IATF
members also belonged to the CCPOQ they should advise their repre-
sentatives of this.
12. The representative of the Economic Commission for Europe
(ECE), on behalf of the five regional economic commissions of the
UN, noted that it would be useful to include the linkages between
the regional framework and country programming.
13. The meeting then turned to the next agenda item, a review of
the activities of the five IATF Working Groups.
Agenda Item III: Review of the Working Group Reports and Guidelines
Working Group on Women's Empowerment (Lead agency: UNIFEM)
14. Ms. Noeleen Heyzer, Director of the United Nations Development
Fund for Women (UNIFEM), gave a short introduction on the work of
the Working Group on Women's Empowerment which had met on 16 May
1995. She noted that ICPD was seen by many women as a key
conference on women's empowerment. She defined women's empowerment
as consisting of five components, namely, women's sense of self-
worth; the right to have choices; the right to have access to
opportunities and resources; the right to have the power to control
their own lives; and the ability to influence the direction of
social change.
15. The draft Guidelines on Women's Empowerment for the Resident
Coordinator System contained strategies to address and opera-
tionalize this concept. Ms. Heyzer stressed the importance of the
guidelines in providing legitimacy at the country level to the need
for empowering women. The guidelines also underscored the need for
multi-donor coordination and the desirability to bring civil
society and governments together in addressing this issue. Most
importantly, the guidelines were aimed at facilitating the creation
of gender-sensitive development policies by encouraging the
Resident Coordinators to play a key role in coordinating multi-
disciplinary national-level data-gathering. Ms. Heyzer also
explained that the guidelines placed much attention to the need for
training in gender analysis and gender-sensitive development
planning.
16. The issue of reproductive health was also addressed in the
Guidelines on Women's Empowerment. The guidelines stress that the
Resident Coordinators' intervention in this area should be guided
by adhering to several key principles: a woman's right and social
responsibility to decide whether, when and how many children to
have; reproductive health issues should be considered an integral
part of everyday life; women have the right to autonomy and
reproductive choice and reproductive rights; and women have the
right to make their own fertility regulating decisions. The goal
of an empowered reproductive health programme should be to increase
womenžs control over their bodies, their sexuality and ultimately
their lives. The guidelines further addressed the issues of culture
and tradition, violence against women, the role of the Convention
on the Elimination of Discrimination Against Women (CEDAW) as a
legal framework for action at the country level, the importance of
women NGOs and the need for strengthening their capacity.
17. Thanking Ms. Heyzer for her presentation, the Chairman opened
the discussion by suggesting to include in these guidelines the
need to identify knowledge and research gaps and to set up a
research agenda in this field at regional and global levels. She
further suggested to avoid instructing Resident Coordinators as to
what they should do. It is up to the United Nations system, not the
guidelines, to instruct the Resident Coordinator on what he/she
should do. It was further pointed out that an annex to the
guidelines, summarizing the activities of different organizations
in this area, should be added.
18. The representative of the ECE suggested that the Resident
Coordinators include all organizations active at the country level
in this field in the process of coordination, such as the
Organization for Economic Cooperation and Development (OECD) and
the European Union (EU). The Resident Coordinators should further
make use of the regional frameworks for follow-up activities to
ICPD. Gender issues should also be an integral part of the Country
Strategy Notes (CSNs). The Chairman noted that the guidelines will
be accompanied by an introductory note on how to use the guide-
lines, including the involvement of non-UN organizations. This note
would draw the attention of the Resident Coordinators to involving
regional organizations.
19. The representative of the United Nations Department for Policy
Coordination and Sustainable Development (DPCSD) informed the
participants of the comments she received from the Division for the
Advancement of Women. These comments would be submitted to UNIFEM.
She noted that the guidelines should place more emphasis on the
need to create economic opportunities for women, as well as the
role of men in womenžs empowerment. The Resident Coordinators
should also be encouraged to communicate the issue of womenžs
empowerment in their contacts with government officials and
representatives of UN agencies and organizations.
20. The representative of the International Labour Organisation
(ILO) emphasized creating economic opportunities for women in terms
of income generation. He further commented on the need for lifelong
training, in addition to lifelong education, to be included in the
paragraph on education. He also promised to submit some factual
comments on the report of the Working Group to the secretariat of
the IATF. One of the representatives of the United Nations
Development Programme (UNDP) shared the view that gender training
was important and that gender issues needed to be included in the
CSNs.
21. The representative of the World Health Organization (WHO)
welcomed the emphasis in the guidelines on gender training. She
felt that the guidelines should not target women exclusively but
should also emphasize the importance of an enabling environment for
empowering women and focus on the roles and responsibilities of
men, particularly young men. The World Bank representative
suggested that some clarification be included in the guidelines on
how to make effective use of the comparative advantages of the
different United Nations agencies and organizations. The repre-
sentative of the United Nations Educational, Scientific and
Cultural Organization (UNESCO) stated that the introductory note to
the guidelines should include reference to the role of culture and
tradition.
22. The Chairman concluded the discussions on the Guidelines on
Women's Empowerment by reiterating the decisions made on the
follow-up procedure, namely that the set of guidelines would be
accompanied by a general introductory note which would explain
their purpose and underscore common dimensions.
Working Group on a Common Data System (Lead agency: UNICEF)
23. Ms. Tessa Wardlaw, Project Officer, Statistics and Monitoring,
Planning Office, United Nations Children's Fund (UNICEF), gave a
brief introduction on the work of the Working Group on a Common
Approach to National Capacity Building in Tracking Child and
Maternal Mortality. She explained that the Working Group parti-
cipants had decided to focus on developing a common approach to
tracking child and maternal mortality. The larger task of deve-
loping a common data system would be taken up by the ACC Sub-
committee on Statistics.
24. The guidelines were divided into two parts: child mortality
and maternal mortality. She explained that the focus on child
mortality was chosen because of the huge numbers (12 million or
more deaths of children under five years of age) and the fact that
under-five mortality measures are a key indicator for human deve-
lopment and well-being. To track child mortality, the guidelines
proposed a three-step approach: (1) determine what country level
child mortality data are available; (2) determine a reasonable set
of child mortality estimates over time; (3) fill data gaps.
25. Maternal mortality, on the other hand, was a rare event. Also,
maternal deaths were often not reported, or when they were, they
were not correctly classified as maternal deaths. As a result, most
maternal mortality measurements were under-estimates. Also, the
progress in achieving the ICPD goals needed to be measured against
the 1990 baseline data, but in many countries there was no baseline
data on maternal mortality. The guidelines draw attention to
measurement problems, so that Resident Coordinators are aware of
the limited value of the existing data. Ms. Wardlaw pointed out
that an important alternative to measure maternal mortality with
conventional methods was to monitor the processes which lead to
reductions in maternal mortality, such as access to emergency
obstetric care. UNICEF and WHO had developed process indicators,
but more field testing was required.
26. The Chairman thanked Ms. Wardlaw for her presentation and
opened the floor for discussion.
27. The Director of the United Nations Statistical Division began
the discussion by reminding the participants that with regard to
the development of a common data system, the ACC Subcommittee on
Statistics could play a coordinating role. Further he offered that
DESIPA would prepare a proposal that would elaborate common
approaches to data collection and presentation including, for
example, development of more explicit guidelines to countries not
only for monitoring mortality but social goal indicators more
generally such as those to be developed on reproductive health. In
the meantime, the guidelines on a Common Approach to National
Capacity Building in Tracking Child and Maternal Mortality should
be issued.
28. The representative of the World Bank expressed the Bank's
support for a common approach. He noted that the Bank had decided
to discontinue its own population projections as of the beginning
of this year and to use the data of the Population Division. With
regard to the guidelines, he suggested that the guidelines should
stress the need for the timely collection and analysis of data and
the explicit identification of their sources. The representative
of the United Nations Food and Agriculture Organization (FAO)
complimented UNICEF for the excellent guidelines. He stated,
however, that the guidelines were too focussed on monitoring and
less so on the importance of data collection for policy purposes.
The UNICEF representative replied that it was definitely the
intention to emphasize the link between data and policy-making.
29. The WHO representative reminded the participants of Dr.
Sadik's statement on the need to set in motion a system to get the
information the UN agencies and organizations need for policy and
programming. She also suggested that this Working Group continue
working on the development of alternative indicators and methodo-
logies, including those on reproductive health. The Chairman then
concluded that the participants were in favour of setting up a
smaller working group with representatives of UNICEF, UNFPA, the UN
Statistical Division, WHO, and other interested organizations. The
UN Statistical Division would take the lead and submit a proposal
on how to proceed.
30. All participants agreed that in the meantime the current
guidelines should be finalized and sent to the Resident Coor-
dinators, while further work is being carried out on a common
approach to data collection and analysis. The representative of
the ECE expressed the hope that problems in measurement would not
lead to discontinuation of ongoing activities in data collection,
particularly at the regional level. The guidelines should
encourage Resident Coordinators to continue current work in this
area.
Working Group on Basic Education (Lead agency: UNESCO)
31. The Chairman invited Mr. Gustavo Lopez Ospina, the
representative of UNESCO, to present the Guidelines on Basic
Education. UNESCO served as the lead-agency for the Working Group
on Basic Education.
32. Mr. Lopez Ospina noted that in formulating the Guidelines on
Basic Education one key contextual element for the Working Group
was the World Conference on Education for All (Jomtien, Thailand,
1990). The Working Group had emphasized the need to incorporate
open learning outside the school setting. It underscored that
opportunities for learning must be offered to those who had never
been to school as well as a second chance to those who had dropped
out. Such an approach would have a special impact on women who
constituted 60 per cent of the world's illiterates. The guidelines
highlight the fundamental elements of Basic Education; present
strategies for programme implementation; suggest the types of
resources available; indicate sources of technical assistance;
emphasize the use of data; and suggest how momentum may be
generated and institutions mobilized. The guidelines also
emphasize the need for good data, an effective strategy and timely
action. The Working Group had stressed that the guidelines for
Resident Coordinators be clear, concise and available in the
appropriate language.
33. The UNESCO representative added that the guidelines currently
provided a brief background on Basic Education and outlined a
strategy for coordination. The guidelines also underscored that
under the leadership of the Resident Coordinator, the inter-agency
group could serve as a strong catalyst for change at the country
level. In addition, they noted the need to eliminate gender
disparities in education; and to encourage partnerships amongst
Government, NGOs, UN agencies and civil society in an effort to
make "education for all the business of all".
34. During the discussion that ensued, the UNIFEM representative
noted that paragraphs 3 and 4 of the Guidelines on Basic Education
were very useful and had been incorporated into the Guidelines on
Women's Empowerment. She suggested that the paragraphs could be
incorporated in the other sets of guidelines as well.
35. UNDP and UNICEF representatives observed that the guidelines
needed to have a greater focus on gender disparities in basic
education and the need to eliminate those disparities since the
elimination of gender disparities was a key objective. Several
other participants concurred with this view. One participant
suggested that the gender dimension should be added to the
principal sections of the guidelines.
36. The Chairman noted that the goal set by ICPD takes the
"Education for All" concept further and emphasizes the need to
dispel gender disparities. He added that the Guidelines on Basic
Education would be amended as suggested and that the two annexes
under preparation would shortly be completed.
37. The representative of the IATF Secretariat informed the
meeting that the Guidelines on Basic Education had been sent for
review to Resident Coordinators in ten countries and replies had
been received from three Resident Coordinators (Ghana, Morocco and
Sudan). These Resident Coordinators noted that the guidelines
served a very useful purpose in providing insights into key issues;
one expressed the need for more details on how to proceed on
specific issues. The Chairman then invited the representative of
WHO to introduce the Guidelines on Reproductive Health.
Working Group on Reproductive Health (Lead agency: WHO)
38. Ms. Carla AbouZahr, the WHO representative, noted that the
Working Group on Reproductive Health held its meeting on 29 June
1995 at WHO Headquarters in Geneva. She observed that the
Guidelines on Reproductive Health were developed on the basis of
the Working Group discussion with a thematic focus on "what is new"
and "what is different" with regard to the concept of reproductive
health. The WHO representative stated that the guidelines were
divided into two parts: (1) Key Facts about Reproductive Health;
and (2) Key Actions for the Resident Coordinator System to Improve
Reproductive Health. Noting that reproductive health is a crucial
part of general health and impacts all stages of life, the WHO
representative underscored that reproductive health does not start
out from a list of diseases, problems or programmes. The aim of
interventions is reproductive health and rights rather than
population policies and fertility control. She highlighted the
involvement of people (including women, adolescents and other
marginalized groups such as refugees and migrants) as being a key
element in defining reproductive health concerns and responses and
stated that this marked a new approach.
39. The guidelines point out that each country must define its own
reproductive health programme in light of its own needs and
priorities in this area. The reproductive health programme should
be the product of and should derive from a local "bottom-up"
process. Reproductive health priorities need to be defined through
a participatory process at the national level. She stressed the
need to clarify that reproductive health is not just a bio-medical
issue but is determined by a whole series of structures and
relationships -- social, economic, legal, civil and sexual.
Clearly, women bear the greatest burden of reproductive ill-health.
Also, young people of both sexes are particularly vulnerable to
reproductive health problems because of a lack of information and
access to services. The WHO representative noted that the
reproductive health concept had major human resource implications.
Also, there is a clear need to define and develop better indicators
for monitoring and evaluation, particularly of quality concerns. It
should also be emphasized that data collection is a means to an end
and not and end in itself. She concluded by mentioning the key
actions for the Resident Coordinator System that were outlined in
Part II of the guidelines.
40. During the discussion that followed, the representative of the
World Bank complimented WHO on its leadership role in producing
clear guidelines in a timely fashion. He suggested the following
revisions: (1) delete the word "must" from the sub-heading of item
5; and (2) rephrase the second sentence in the first paragraph
under item 8, so as to avoid any negative connotation in the use
of the word "experts". The representative added that item 10,
Monitoring and Evaluation is very important and needs to be
developed further. He emphasized the need to develop surveillance
systems that utilize performance-based/operational measures and
move away from population-based measures.
41. Mr. Eduardo Gutierrez, Director, Office of UN System Support
Services, UNDP, stated that he was very pleased to note the kind of
discussion that was taking place as well as the nature and scope of
the guidelines that had been developed. The clear focus on speci-
fics is ultimately what is most useful to the Resident Coordinators
and their teams. He added that it would be helpful to include the
following information in the guidelines: (1) Availability of
Resources -- the UNDP/UNFPA Executive Board at its recent session
had approved the use of 1.7 per cent of overall resources
(approximately US $18 million per year) by the Resident Coordinator
System; (2) Regional dimension -- in an effort to integrate the
follow-up to various UN conferences, several proposals were under
consideration. A major debate on development was scheduled to take
place in the near future and the main actors had indicated a clear
willingness for synthesizing and integrating the outcomes of
various UN conferences. It was also important to bear in mind
Chapter III of the Agenda for Development, as well as, the upcoming
triennial review of operational activities. Clearly, all this
would have implications for the Resident Coordinator System and the
guidelines should signal that changes would take place as a result
of the effort to integrate the follow-up process; and (3) Training
-- it is essential to think of ways and means to include the
guidelines in the training offered to Resident
Coordinators. The UNDP representative concluded by noting that it
would also be useful to select a few Resident Coordinators and have
them review and provide feedback on the guidelines. He observed
that perhaps this could be done in Beijing at the time of the
Women's Conference.
42. The Chairman thanked Mr. Gutierrez for the useful information
he had provided and noted that some of it could be incorporated in
the introductory note to the guidelines.
43. The other UNDP representative noted that it would be useful to
indicate in the guidelines that the reproductive health concept was
new and would evolve and be further elaborated over time. She
added that the Working Group should orchestrate an information
exchange amongst countries on how the ICPD Programme of Action was
being operationalized. She also stressed the need to further
develop Part II of the guidelines and, in this context, underlined
the need for greater emphasis on national capacity building.
44. The representative of FAO observed that item 9 "human re-
sources for reproductive health" should be developed further. In
particular, training needs should be outlined. Also, the issue of
training should be included under the item on Monitoring and Eva-
luation.
45. The representative of the ECE commended the format of the
Guidelines on Reproductive Health and suggested that the same
format be followed in the other sets of guidelines. She added that
the need for regional coordination could be highlighted in part II,
section 6 of the guidelines. The ECE representative agreed with
the suggestions made by the UNDP representative and noted that
perhaps the guidelines should underscore the need for Resident
Coordinators to seek co-financing and cost-sharing for programme
operationalization. She observed that this may be especially
necessary in countries where Governments may not be keen to promote
reproductive health.
46. The WHO representative expressed her appreciation for the
comments made and noted that they would help to strengthen the
guidelines. She welcomed further comments and noted that WHO would
need about three weeks to finalize the Guidelines on Reproductive
Health.
47. The Chairman agreed that this schedule was appropriate and
noted that the annexes to the guidelines should also be completed
in the same time-period. IATF members were asked to submit their
comments to WHO within two weeks. The Chairman then closed the
discussion on the Guidelines on Reproductive Health.
Agenda Item IV: Review of the Common Advocacy Statement on Social
Issues
Working Group on Policy-Related Issues (Lead agency: UNFPA)
48. Mr. Michael Vlassoff, Senior Technical Officer, Technical and
Evaluation Division, UNFPA, introduced the work of the Working
Group on Policy-Related Issues. He explained that the Working
Group had decided to address the "common advocacy" concern by
drawing up a Statement of Commitment that would then be issued by
all agencies and organizations involved in the IATF. The aim of
such a statement would be to ensure that all UN agencies and
organizations use the same language regarding population and
development issues. The "Statement of Commitment on Population and
Development by the United Nations System", drafted by the Working
Group, is divided into three sections: a general introduction
stressing the commitment by the UN agencies and organizations to
implement ICPD; a section on the linkages between population issues
and other development issues; and a concluding section calling for
global partnership in addressing these interrelated issues.
49. During the discussion that followed, different points of views
were expressed as to the "Statement of Commitment". One of the
representatives of UNDP noted that the Programme of Action was in
fact a statement of commitment. The Chairman stated that the idea
behind such a Statement was to ensure that in the follow-up to ICPD
all the UN agencies and organizations would say the same thing.
This Statement just reiterates what is in the Programme of Actions
of the ICPD and the World Summit for Social Development (WSSD); it
is not an operational tool describing the actions to be carried by
various organizations.
50. The UNICEF representative offered some suggestions which she
felt would further strengthen the Statement. She thought that the
Statement did not give adequate attention to the central issues of
the ICPD Programme of Action, such as education, health, including
reproductive health, and womenžs empowerment. If the purpose of
this Statement is to link the ICPD with the WSSD, then this should
be made clear in the introduction. The Statement should be made
more operational, not in the sense of guidelines, but in committing
the UN system to implement ICPD. She also suggested changing the
order of topics in section II, to read: education; health; womenžs
empowerment; environment; food security; employment and sustainable
livelihoods; and poverty eradication. Subsequent speakers,
however, felt that the existing sequence could be retained.
51. The UNICEF representative also suggested some changes in the
opening sentence, to read as follows: "The organizations and
agencies of the United Nations System fully commit themselves to
the implementation of the Programme of Action of the International
Conference on Population and Development (ICPD), in accordance with
their respective mandates, building upon international agreements
related to population and development". In order to resolve the
difficulties the representative of UNICEF had with the reference to
paragraph 8.25 in the last paragraph on page 6 of the Statement,
the Chairman suggested that the complete text of paragraph 8.25 of
the ICPD Programme of Action be included in the Statement.
52. One of the representatives of the United Nations Department of
Economic and Social Information and Policy Analysis (DESIPA) felt
that the tone of the Statement was too pessimistic. He also
suggested to add the word "programme" after "policies" in paragraph
14, line 5. Another representative of DESIPA noted that the issue
of data gathering should be extended to all issues in the Statement
and not just in the section on poverty eradication. The repre-
sentative of the IMF stated that her organization would like to be
associated with the Statement. The IMF would submit some comments
on the text. It was currently looking into ways to integrate the
issues included in the Statement in its own policies.
53. The representative of WHO, like UNICEF, felt that the
Statement did not adequately reflect the main issues of the ICPD.
Also, she would like to see included in the section on health
reference to paragraph 7.3 of Programme of Action on reproductive
rights and in the goals section mentioning of paragraph 8.5 of
Programme of Action, containing the goals in the field of life
expectancy. She further suggested some editorial changes, i.e., to
add the "quality" before "care" in paragraph 18, line 7, and the
word "primary" before "health-care" in paragraph 18, last line.
54. The ECE representative cautioned the participants to be
careful with the use of the word "commitment". She suggested to
change the title to "Statement of Immediate Follow-up". She also
questioned why there was nothing on migration in the Statement.
55. The participants felt that a common statement was useful as an
advocacy tool. The Chairman suggested that UNFPA redraft the
Statement, taking into account the comments received. The final
text could eventually be submitted to the CCPOQ and then ACC for
final consideration, although such a statement could stand on its
own. The issue of reordering would be decided later, based on the
comments received. It was agreed that the tone should be more
positive and that, where necessary, the commitments should be made
more specific.
Agenda Item V: Future Work of the Inter-Agency Task Force
56. It was agreed that four of the working groups had completed
their work, but could be convened on an ad-hoc basis, if deemed
necessary. The IATF participants decided that the tasks dealt with
by the Working Group on a Common Approach to National Capacity
Building in Tracking Child and Maternal Mortality would be
addressed further by a smaller group consisting of UNICEF, UNFPA,
DESIPA, WHO and other interested organizations. DESIPA would
submit a proposal for future work aimed at inter alia elaborating
and refining the current guidelines and perhaps extending them to
social indicators more broadly.
57. At the suggestion of Dr. Sadik, who chaired the closing
session, it was agreed that the Working Group on Reproductive
Health would continue its work, since reproductive rights and
reproductive health were new and evolving issues. This Working
Group would deal, inter alia, with the development of performance
indicators in reproductive health. The Working Group would,
however, not meet for some time, given the range of meetings on
this topic already planned for in the near future. The
organizations will keep WHO informed of developments in this area
and vice versa.
58. In response to the views expressed by the Commission on
Population and Development, at its 28th session, the Inter-Agency
Task Force decided to establish a Working Group on international
migration. Such a working group would deal, in the first instance,
with chapter X "International Migration" of the Programme of
Action. The working group would explore the implications for inter-
agency collaboration in this area. The ILO, together with the
United Nations High Commissioner for Refugees (UNHCR) and the
International Organization for Migration (IOM), and with the
support of the regional economic commissions and DESIPA, would
organize this working group. It was suggested that ILO serve as
the lead agency for this working group. The ILO representative
indicated that he would consult with headquarters and revert to the
IATF Secretariat on this matter.
Agenda Item VI: Other Matters: Action Items
59. A schedule for finalizing the guidelines was drawn up: by 11
August, each of the organizations present would send their comments
on the guidelines to the lead agency; by 18 August the lead agency
would send the completed guidelines to the IATF Secretariat. These
would be compiled and sent out to the Resident Coordinators with an
introductory note which would address the purpose and common dimen-
sions of all the guidelines.
60. The meeting was reminded that each set of guidelines should
include a short bibliography of the key publications in the area
and citations of relevant audio-visual materials. Each agency
should also submit a brief profile of its activities in the
respective fields of women, reproductive health and common data
systems. It was noted that most organizations had already
submitted a brief profile of their activities in the area of basic
education.
61. With regard to the reporting on the IATF to the 29th session
of the Commission of Population and Development (26 February - 1
March 1996), it was decided that the IATF Secretariat would draft
an outline for the approval by the organizations involved in the
IATF on their input for the report. This outline would be sent to
the agencies and organizations by early September.
62. It was agreed to have the third meeting of the IATF prior to
the 29th session of the Commission on Population and Development,
i.e., end of February 1996. With regard to the shipment of
materials to the Resident Coordinators, the UNDP representative
noted that they would pouch those materials when the IATF secre-
tariat made them available to UNDP. In order to assure broad
dissemination of IATF materials, UNICEF suggested that they be put
on a CD-ROM and the UNDP representative noted that the materials
should be added to the UNDP gopher.
63. In closing the meeting, Dr. Sadik thanked the organizations
for their hard work and commitment of the past six months. She was
very pleased with the way the IATF had functioned and expressed the
hope that the spirit of cooperation that had prevailed in the first
half year would continue in the months ahead.
=================================================================
Second Meeting of the ICPD Inter-Agency Task Force
25 July 1995
UNFPA Headquarters
New York, NY
LIST OF PARTICIPANTS
United Nations
Department for Policy Coordination and Sustainable Development
(DPCSD)
Ms. Jeannie Peterson
Senior Adviser on Population
Department for Policy Coordination and Sustainable Development DC2
- 2246
United Nations
New York, NY 10017
Telephone: (212) 963-4177
Fax: (212) 963-4260
United Nations,
Department for Economic and Social Information
and Policy Analysis (DESIPA)
Mr. Hermann Habermann
Director, Statistical Division
Department for Economic and Social Information and Policy Analysis
DC2 - 1420
New York, NY 10017
Telephone: (212) 963-4996
Fax: (212) 963-9851
Mr. Y.C. Yu
Chief, Demographic and Social Statistics Branch
Statistical Division
Department for Economic and Social Information and Policy Analysis
DC2 - 1520
New York, NY 10017
Telephone: (212) 963-4983
Fax: (212) 963-1940
Mr. Larry Heligman
Assistant Director, Population Division
Department for Economic and Social Information and Policy Analysis
DC2 - 1918
New York, NY 10017
Telephone: (212) 963-3208
Fax: (212) 963-2147
Mr. Anthony Turner
(TSS) Technical Support Services Sampling Specialist
Statistical Division
Department for Economic and Social Information and Policy Analysis
DC2 - 1552
New York, NY 10017
Telephone: (212) 963-4877
Fax: (212) 963-1940
Economic Commission for Europe (ECE)
Ms. Dunja Pastizzi-Ferencic
Deputy Executive Secretary
Economic Commission for Europe
Palais des Nations
1211 Geneva 10, Switzerland
Telephone: (011) 41-22-917-2694
Fax: (011) 41-22-917-0036
United Nations Children's Fund (UNICEF)
Ms. Leila Bisharat
Director, Planning Office
United Nations Childrenžs Fund
UNICEF House
H - 1330
New York, NY 10017
Telephone: (212) 303-7996
Fax: (212) 303-7959
Ms. France Donnay
Senior Adviser, Women's Health
United Nations Childrenžs Fund
UNICEF House
H - 1056
New York, NY 10017
Telephone:(212) 326-7313
Fax: (212) 326-7336
Ms. Tessa Wardlaw
Project Officer, Planning Office
United Nations Children's Fund
UNICEF House
H - 1328
New York, NY 10017
Telephone:(212) 326-7183
Fax: (212) 303-7959
Ms. Lesley Miller
Project Officer, Health Promotion
United Nations Children's Fund
UNICEF House
H - 1047-1
New York, NY 10017
Telephone:(212) 326-7609
Fax: (212) 326-7336
United Nations Development Programme (UNDP)
Mr. Anders Wijkman
Assistant Administrator and Director, Bureau for Policy and
Programme Support United Nations Development Programme
DC 1 - 2028
New York, NY 10017
Telephone: (212) 906-5020
Fax: (212) 906-5857
Mr. Eduardo Gutierrez
Director, Office of UN System Support Services
United Nations Development Programme
DC 1 - 1718
New York, NY 10017
Telephone: (212) 906-5500
Fax: (212) 906-3609
Ms. Renata Lok
Senior Adviser
United Nations Development Programme
DC 1 - 2040
New York, NY 10017
Telephone: (212) 906-5038
Fax: (212) 906-5365
United Nations Development Fund for Women (UNIFEM)
Ms. Noeleen Heyzer
Director
United Nations Development Fund for Women
FF - 0616
New York, NY 10017
Telephone: (212) 906-6435
Fax: (212) 906-6705
Ms. Kristin Lewis
Executive Assistant to Director
United Nations Development Fund for Women
FF - 0616
New York, NY 10017
Telephone: (212) 906-6892
Fax: (212) 906-6705
International Labour Organisation (ILO)
Mr. David Freedman
Director, ILO Liaison Office
International Labour Organisation
Liaison Office with the United Nations
220 East 42 Street, Suite 3101
New York, NY 10017-5806
Telephone: (212) 697-0150
Fax: (212) 883-0844
Ms. Miki Takihana
Research Officer
International Labour Organisation
Liaison Office with the United Nations
220 East 42 Street, Suite 3101
New York, NY 10017-5806
Telephone: (212) 697-0150
Fax: (212) 883-0844
Food and Agriculture Organization of the United Nations (FAO)
Mr. Alain Marcoux
Senior Officer, Population Programme Service
Sustainable Development Department
Food and Agriculture Organization of the United Nations
Via delle Terme di Caracalla
00100 Rome, Italy
Telephone: (011) 39-6-5225-3201
Fax: (011) 39-6-5225-5490
United Nations Educational, Scientific and Cultural Organization
(UNESCO)
Mr. Gustavo L¢pez Ospina
Director, Interdisciplinary and Inter-Agency Cooperation Project:
Environment and Population Education and Information for Human
Development (EPD) United Nations Educational, Scientific and
Cultural Organization 7, place de Fontenoy
75700 Paris, France
Telephone: (011) 33-1-45-68-08-68
Fax: (011) 33-1-45-66-96-84
World Health Organization (WHO)
Ms. Carla AbouZahr
Associate Coordinator, Reproductive Health
Division of Family Health
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27, Switzerland
Telephone: (011) 41-22-791-33-67
Fax: (011) 41-22-791-41-89
The World Bank
Mr. Thomas Merrick
Senior Population Adviser, Human Development Department
The World Bank
1818 H Street, NW
Washington, DC 20433
Telephone: (202) 473-6762
Fax: (202) 522-3235
International Monetary Fund (IMF)
Ms. Harriet Shugarman
Special Assistant to the Director
International Monetary Fund
Office at the United Nations
DC 1 - 1140
New York, NY 10017
Telephone: (212) 963-0355
Fax: (212) 319-9040
United Nations Population Fund (UNFPA)
Dr. Nafis Sadik
Executive Director
Mr. Jyoti Shankar Singh
Deputy Executive Director, Technical Services
Ms. Catherine S. Pierce
Manager, UNFPA Task Force on ICPD Implementation
Ms. Mari Simonen
Chief, Office of the Executive Director
Mr. Arthur Erken
Programme Officer, UNFPA Task Force on ICPD Implementation
Mr. Michael Vlassoff
Senior Technical Officer, Technical and Evaluation Division
Ms. Ranjana Dikhit
Technical Adviser (Programme)
Reproductive Health Branch, Technical and Evaluation Division
=================================================================
ICPD INTER-AGENCY TASK FORCE
Second Meeting of the Task Force
Tuesday, 25 July 1995
UNFPA Headquarters
Rafael M. Salas Conference Room
19th Floor
AGENDA
I. Welcome and Chairmanžs overview of the work of the Task Force
II. Adoption of Agenda
III. Review of the reports and guidelines produced by the Working
Groups
IV. Review and adoption of the Common Advocacy Statement on Social
Issues
V. Future Work of the Task Force - items for consideration:
1. Working Groups - should existing ones continue; should
additional groups be set up?
2. Scope of work - response to the view of the twenty-eighth
session of the Commission on Population and Development,
"that the Task Force's work should be expanded to include
migration issues."
3. Inputs for the Report of the Inter-Agency Task Force to
be submitted to the twenty-ninth session of the Commission on
Population and Development.
VI. Other Matters
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