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@M"$%Y*+x-'23F59;=Az,o_4_Note (S)Codes for manual notes Single Col.t 3     {g! ! @M"$%Y*+x-'23F59;=AX{  t 3    {g! ! @M"$%Y*+x-'23F59;=AX{(WV $   ^d B8_ L Mandateblock of asteriscsA&T)dEA  v&v  >{g!:L ! @M"$%Y*+x-'23F59;=AX{   {g!:L ! @M"$%Y*+x-'23F59;=AX{# e37=CIQYag1.a.i.(1)(a)(i)1)a)(O[$0 : 2 e  a  .3  0:#:#  _"UKUS.,    ,.777 3      FR#iddd{g!: ! @M"$%Y*+x-'23F59;=AX{    @ 3  e7e    _"UKUS.,    ,.777 3      FR#iddd{g!: ! @M"$%Y*+x-'23F59;=AX{  @ 3  e7e  z^:_Par.Col (S)Parallel column for single text 3      ( ##((n$ (  1  ) (xj$0  0` (#(#0 ` (#` (#2 e(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2 e(  a  )3  0h(#(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2 e(   )3  0h(#h(#(t$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2 e  0  )3  0(#(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2 e  a  )3  0p(#(#fY8_Tab SingleTabs for single columng!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  !UKUS.,    ..JlQJl 3        & 2S7 dd7V#iddd{g!: ! @M"$%Y*+x-'23F59;=AX{  Z9C U },PTRX3'"Letter (Portrait)3'3'"Letter (Portrait)3'T    XXg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=AQQQQ 33        & 2TRX3'SS7 dd7VV  T/3T/8T/? ro  QQQQ  3  & 2   t[FA&T)  dp{E A?&T' ! dE! ?~ : !: ! @M"$%Y*+x-'23F59;=A~  GWGCz|  `@ H@E    0 : 0 :#:#dQQQ#Sid    UnitedNationsd Q#idS    uu<# # #!  * Q*  *#bPid  E! *  *Q *#idbP    /CN.9/1999/PC/2!  * Q*  *#bPid  ! *  *Q *#idbP    ݈  "(ha ##(0  Qr ^#_Lid  EconomicandSocialCouncil  0 *  rQ *^#id_L        Distr.:General7January1999Original:English    k(ha ll(QQQQ#idid 3          & 2 "&FRSSX f   o 3  S    QQXEXQ#Vid      CommissiononPopulationandDevelopmentactingasthepreparatorycommitteeforthespecialsessionoftheGeneralAssemblyforthereviewandappraisaloftheimplementationoftheProgrammeofActionoftheInternationalConferenceonPopulationandDevelopmentSk !XEXXXEQXXE#idV           24!31March1999Item3oftheprovisionalagenda*y! O#  *              QQQQ#idid   PreparationforthespecialsessionoftheGeneralAssembly       QQQQ#idid 3    o> 33  \C AW<6789:  #C  QQQQ#idid 33          ~g!: ! @M"$%Y*+x-'23F59;=A: ~& 2*SS  hD     QQQ#Sid  3    0 : 0::Reviewandappraisaloftheprogressmadeinachievingthe  goalsandobjectivesoftheProgrammeofActionoftheInternationalConferenceonPopulationandDevelopmenthD  #idS 3Q         S    QQXEXQ#Vid  3    0 : 0::ReportoftheSecretaryGeneralS |XEXXXEQXXE#idV 3          9  ab ^} :^U^-^"c#$^(;*+^/1r2^67J9!: ! @M"$%Y*+x-'23F59;=AQQQQ#idid 33    ;Qm{;  XEXQԀSummary#QXXE# BP$ 8   b TheProgrammeofActionoftheInternationalConferenceonPopulationandDevelopmentrecommendsthatinordertoensureeffectivefollowuptotheConference,aswellastoenhanceintergovernmentaldecisionmakingcapacityfortheintegrationofpopulationanddevelopmentissues,theGeneralAssemblyorganizearegularreviewoftheimplementationoftheProgrammeofAction.  8   b Initsresolution49/128,theGeneralAssemblychargedtheCommissiononPopulationandDevelopmenttobethebodyresponsibleformonitoring,reviewingandassessingtheimplementationoftheProgrammeofAction,andrequestedtheEconomicandSocialCounciltoreviewthereportingproceduresregardingpopulationanddevelopmentissues,includingaquinquennialreviewandappraisaloftheprogressmadeinachievingthegoalsandobjectivesoftheProgrammeofAction.Initsresolution1995/55,theCouncilrequestedthatthereportoftheSecretaryGeneralprovidingsuchareviewandappraisalbepreparedquinquenniallyfortheCommissiononPopulationandDevelopment.Initsresolution52/188(asreaffirmedinitsresolution53/183),theGeneralAssemblydecidedtoconveneaspecial9lde#R)`)4  #t[FU    g!: ! @M"$%Y*+x-'23F59;=Ab ^} :^U^-^"c#$^(;*+^/1r2^67_QQQQ#idid 33    <l))))!!<  y  ab ^} :^U^-^"c#$^(;*+^/1r2^67J9!: ! @M"$%Y*+x-'23F59;=AQQQQ#idid 33    AQ&&& A  8  sessionfrom30Juneto2July1999inordertoreviewandappraisetheimplementationoftheProgrammeofAction.Thepresentreport,alongwiththereportoftheinternationalforum(E/CN.9/1999/PC/3),providesinputtothereportoftheSecretaryGeneralforthespecialsessioncontainingdraftmeasuresforthefurtherimplementationoftheProgrammeofAction(E/CN.9/1999/PC/4).  8   b Inaccordancewiththeabovementionedresolutions,thepresentreportpresentsasummaryoftheresultsofthefirstquinquennialreviewandappraisaloftheprogressmadeinachievingthegoalsandobjectivesoftheProgrammeofAction.Thereportprovidesanoverallassessmentoftheissuesconcerningpopulationtrends,populationgrowth,structureanddistribution,reproductiverightsandreproductivehealth,healthandmortality,internationalmigrationanddevelopment,andpopulationprogrammesandresources.Thepreliminary,uneditedversionofthefullreportisavailableasaworkingpaperindocumentESA/P/WP.148.  8   b ThereportwaspreparedbythePopulationDivisionoftheDepartmentofEconomicandSocialAffairsoftheUnitedNationsSecretariat;theUnitedNationsPopulationFundprovidedtheinformationforsectionVI(Populationprogrammesandresources).  y`&<>` &`))!)!<  g!: ! @M"$%Y*+x-'23F59;=Ab ^} :^U^-^"c#$^(;*+^/1r2^67_QQQQ#idid 33      -pC AW<6789:   AW<6789:C7Jldd7  #idid 33          & 2SS5P5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  6g!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  3    QQQContentsQQ P .@##.2Jn::: J 22=p!Paragraphs n ""H#Page n QQQ  :::  Introduction((@(.Z Z  v n n Dp!1!6 v ##K#3 v  :I.0  Populationlevelsandtrends#((@(.-((#    Cp!7!10  ##K#4   :II.0  Populationgrowth,structureanddistribution#((@(.&&>((# $ Bp!11!21 $ ##K#6 $ __ :III.0  Reproductiverightsandreproductivehealth#((@(.<((# P Bp!22!32 P ##K#9 P XX :IV.0  Healthandmortality#((@(. %((# &| Bp!33!41 &| D#D#J#11 &|  :V.0  Internationalmigrationanddevelopment#((@(.8((# R Bp!42!50 R D#D#J#13 R XX :VI.0  Populationprogrammesandresources#((@(.MM4((# ~ Bp!51!59 ~ D#D#J#15 ~  :VII.0  Concludingobservations#((@(.(((#   Bp!60!63   D#D#J#17   mm :Tables !,  !,  !,  $}      QQQQ7x@ ((7g!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A   :1.0  Countrieswithnegativeannualratesofnaturalincrease,1995!2000#!!H!.eeT!!# #X ##K#5 #X  :2.0  Governmentsviewsonpopulationgrowthrate,1998#!!H!.kkC!!# .$ ##K#6 .$  :3.0  Governmentsviewsonspatialdistribution,1998#!!H!.XXA!!# Z% ##K#8 Z% ww :Figure &   &  :::  Worldpopulationsize:pastestimatesandmedium,highandlowfertilityvariants,1950!2050!!H!.Y!Y!m '" ##K#4 '" ::: (4#  (4# (x!!(Ҝ   *`$  },PTRX3'"Letter (Portrait)X3'"Letter (Portrait)3'"Letter (Portrait)3'"Letter (Portrait)T    XXg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=AQQQQ 3        & 2TRX3'SS7 dd7^^VV  T-i -pC AW<6789:   AW<6789:C7Jldd7  #idid 33          & 2SS55QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  hD     QQQ#Sid  3    0 : 0::IntroductionhD ~I 4J#idS 3Q         0 : 0::1. AsrequestedbytheCommissiononPopulationandDevelopmentatitsthirty-first t session,thereviewandappraisalconcentratesonchaptersoftheProgrammeofActionwhichweredesignatedasthethemesfordiscussionanddebateatitstwentyninththroughthirtysecondsessions,namely,reproductiverightsandreproductivehealth;internationalmigrationanddevelopment;healthandmortality;andpopulationgrowth,structureanddistribution.Nevertheless,astheCommissionhadrequested,theWorldPopulationMonitoringreportspreparedforanddebatedatthosesessionsoftheCommissionincorporatedelementsfromallthechaptersoftheProgrammeofAction.AsrequestedbytheCommission,thereviewandappraisalalsofocusesonpopulationprogrammesandresources.  0 : 0::2. TheInternationalConferenceonPopulationandDevelopment(ICPD)wasamilestone   intheinternationalcommunitysthinkingaboutpopulationanddevelopmentissues.Thefive-yearperiodbetweenICPDanditsfirstquinquennialreviewandappraisalisclearlytooshortfortheConferencesthinkingandfornewlyinstitutedpolicychangesornewlyformulatedprogrammestohaveplayedoutinvisibledemographicoutcomes.Moreover,becausethefactorsthataffecttrendsandpatternsoffertility,mortalityandmigrationaresocomplex,itisnotpossibletoseparateouttheroleoftheProgrammeofActioninaffectingdemographicchangefromthatofotherfactorswhichwerealreadyinplacepriortotheincorporationoftherecommendationsoftheProgrammeofActionintonationalpoliciesandprogrammes.  0 : 0::3. Thepresentreportdocumentsmajorchangesinpoliciesandprogrammeapproaches  whichemphasizethelinkagesbetweenpopulationanddevelopmentandintegratepopulationconcernsthroughouteconomicandsocialsectors.Thosepolicyandprogrammaticchanges,asillustratedbelow,canbeexpectedtoplaythemselvesoutinthecomingyears,tohastenthedemographictransitionandtofostersustainedeconomicgrowthandsustainabledevelopment.  0 : 0::4. Athemerunningthroughthepresentreportisthelackofaccurate,timelyand   internationallycomparabledatatoprovidethebasisforareliablemonitoringoftheimplementationofthegoalsandobjectivesoftheProgrammeofAction.TheProgrammeofActionemphasizedthatvalid,reliable,timely,culturallyrelevantandinternationallycomparabledataformthebasisforpolicyandprogrammedevelopment,implementation,monitoringandevaluation.TheProgrammeofActionfurthernotedthatmanygapsremainwithregardtothequalityandcoverageofthebaselineinformation,includingvitaldataonbirthsanddeaths,aswellasthecontinuityofdatasetsovertime.FiveyearsaftertheConference,therehasbeenlittleimprovementintheavailability,qualityandcomparabilityofthedatanecessaryformonitoringandappraising.Thisisparticularlypertinentformanycountriesinsub-SaharanAfrica,whichremainfarfrommeetingtheobjectivesandgoalsoftheProgrammeofAction,andforsomeofthecountriesofAsiaandEuropewitheconomiesintransition,wheretrendspointtoworseningconditionsfortheirpopulations.Financialandotherconstraintshavealreadyledtothecancellationorpostponementofsomecensuses,whichprovidethebasicdatafornationalplanningactivitiesandmonitoringofprogress.  0 : 0::5. Notyetevidentinthereviewandappraisalistheextenttowhichthecurrentcrisis |)#1 infinancialmarketsisaffectingtheimplementationoftheProgrammeofActioninthecrisis-hitcountries.Thecrisis,whichhasledtomassiveandsuddenoutflowsofcapitalfromthosecountriesanddeclinesincapitalflowstothem,hasledtoeconomicrecessionandnegativeeffectsonfundingofsocialprogrammes.AstheGeneralAssemblynotedinits ,&5 resolution53/172,amostimportantquestionthatneedstobeaddressedbytheinternationalcommunityintheprocessofglobalizationistheneedtomobilizeresourcesforsuchgoalsaspovertyreduction,humanresourcesdevelopment,andhealthandeducation.  0 : 0::6. Adequatefinancialresourcesatthenationalandinternationallevelsarenecessary P toachievethegoalsandobjectivesoftheProgrammeofAction.However,thenationalexperienceshighlightedinthepresentreportshowthatresourcesontheirowndonotnecessarilyleadtosustainedprogress.AstheProgrammeofActionstates,ininstanceswheretheleadershipisstronglycommitted,countrieshavebeenabletomobilizesustainedcommitmentatalllevelstomakepopulationanddevelopmentprogrammesandprojectssuccessful.Inotherwords,itisthepoliticaldimension"thatis,Governmentleadership,prioritiesandcommitment"thatisthedeterminingfactorinthesuccessorfailureofpolicyadoptionandprogrammeimplementation.  hD     QQQ#Sid  3     :I.0  PopulationlevelsandtrendshD `H >a#idS 3Q          0 : 0::7. TheICPDProgrammeofActiondefinedpopulationgrowthasanimportantvariable   fordevelopment.Inparticular,theProgrammeofActionstatesthatinordertoachievetheultimategoalofanimprovedqualityoflifeforcurrentandfuturegenerationsitisimportanttofacilitatethedemographictransitiontowardsapatternoflowbirthanddeathrates,andhenceslowerpopulationgrowthrates.Whilecurrentandfuturedemographicdynamicsimplythatpopulationstabilizationisalong-termgoal,relativelysmallchangesinpopulationgrowthtodaycanhaveadramaticimpactonlongtermpopulationsize(seefigure).  e    QQQQ#idid  3    0 : 0::Worldpopulationsize:pastestimatesandmedium,highandlowfertility - variants,1950!2050o   eaeH fQQQQ#idid 3         oftor 3  0 : 0::$N*Ԝ^  ^Q(Billions)#Q ^^ [h#ԛN М) $l  3~ !: ! @M"$%Y*+x-'23F59;=A~QQQ   0  0000Source:UnitedNations,WorldPopulationProspects:The1998Revision(UnitedNationspublications,0@ @  @ ) $ $N*$**$0  00000forthcoming).  М̛ -pC AW<6789:   AW<6789:C  7Jldd7  #idid 33          & 2SS5+&5Q~g!: ! @M"$%Y*+x-'23F59;=A~  0 : 0::8. Themid-yearworldpopulationin1998isestimatedtobe5.9billion,50.4percent +&# maleand49.6percentfemale.Eachyear,78millionpersonsarecurrentlyaddedtothe r,&$ world,whichisanannualaveragegrowthrateof1.3percent.Fouroutoffivepeopleintheworldliveinthelessdevelopedregions(4.7billion),whileoneoutoffive(1.2billion)liveinthemoredevelopedregions.Thecontributionofthemoreandlessdevelopedregionstothegrowthoftheworldspopulationdifferswidely:75millionofthetotalannualpopulationincrease(about96percent)originatesinthelessdevelopedregionsoftheworld,whilethemoredevelopedregionscontributeabout3million.  0 : 0::9. Since1974,whentheWorldPopulationProgrammeofActionwasadoptedatthe   WorldPopulationConferenceatBucharest,dramaticdemographicchangeshaveoccurred.Duringthepastquartercentury,theaveragenumberofchildrenperwomanhasdecreasedfrom4.5to2.7,andlifeexpectancyatbirthhasincreasedby6.8yearsto63.3yearsformalesandby8.2yearsto67.6yearsforfemales.Theworldpopulationgrowthratehasgraduallydeclined,fromabout2percent,ahistorichigh,to1.3percenttoday.Absoluteincrementstoworldpopulation,however,haveshowedalaggedtrend:theycontinuedtoincreaseforaboutanother20years,from76millionannuallyduring1970!1975to86millionannuallyduring1985!1990,andbegantodeclinethereafter.Asaresult,inaperiodofaquartercenturytheworldspopulationgrewfrom4billionto6billion.Thatincreaseof2billionpeopleinsuchashortperiodoftimeisunprecedentedinhumanhistory.  0 : 0::10. Annualratesofnaturalincreasedifferwidelyamongcountries.Forexample,forthe   period1995-2000,thereare42countries(orareas)withannualratesofnaturalincreaseof2.5percentorhigher,allofthemdevelopingcountriesandthemajorityinAfrica.Incontrast,thereare18countries,allinEurope,withnegativeratesofnaturalincrease,rangingfrom-0.52percentforLatviato-0.01percentforPortugal.MostofthecountrieswithnegativeratesofnaturalincreaseareEasternEuropeancountrieswitheconomiesintransition(seetable1).  0 : 0::0 0!  o 3  Table1 ! !  e    QQQQ#idid      0 : 0::0 0!  Countriesawithnegativeannualratesofnaturalincrease,! !  0 : 0::0 0!  1995!2000oxcces 3  excces yQQQQ#idid 3o! !              QQQQ#ldid { !: ! @M"$%Y*+x-'23F59;=A{  *}~&n" ddd Xdd Xdd X},k !! ,[!!#+  9&j( U  CC9Country G&j6%B!&j GAnnualrateofnaturalincrease [Q0B"3 CC  &j `[ C9% c# C [Q0 c$3 `  !![Latvia C9%% CЄ0.52 VL0&3 !!   !!VBulgaria C9%B' CЄ0.47 QG+B(3 !!  !!QEstonia C9%* ) CЄ0.47 QG+* *3 !!  !!QUkraine C9%!h+ CЄ0.43 QG+!h,3 !!  !!QRussianFederation C9%!P- CЄ0.42 QG+!P.3 !!  !!QHungary C9%"8/ CЄ0.38 QG+"803 !!  !!QМBelarus C9%# 1 CЄ0.34 QG+# 23 !!  !!QRomania C9%$3 CЄ0.23 QG+$43 !!  !!QCzechRepublic C9%%5 CЄ0.22 QG+%63 !!  !!QLithuania C9%& 7 CЄ0.16 QG+& 83 !!  !!QGermany C9%j'!9 CЄ0.16 QG+j'!:3 !!  !!QItaly C9%R("; CЄ0.14 QG+R("<3 !!  !!QМSlovenia C9%:)#= CЄ0.10 QG+:)#>3 !!  !!QМCroatia C9%"*x$? CМ0.09 QG+"*x$@3 !!  !!QSweden C9% +`%A CЄ0.09 QG+ +`%B3 !!  !!QGreece C9%+H&C CЄ0.03QG++H&D3 !!  !!QSpain C9%! CЄ0.02 QG+!3 !!  !!QPortugal C9% & CМ0.01;1/ 3 !!  & ;~j": ! `M"$%Y*+x-'23F59;=A~0 V Source:UnitedNations,WorldPopulationProspects:The1998Revision. vV V  0 V 0 V V (UnitedNationspublication,forthcoming).    g!: ! `M"$%Y*+x-'23F59;=A": ! `M"$%Y*+x-'23F59;=A0 V a0 V V Forcountrieswithpopulationsof150,000inhabitantsormorein1995.{Uk QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! `M"$%Y*+x-'23F59;=Az        #idld  -pC AW<6789:   AW<6789:C  7Jldd7  #idid 3          & 2SS5 h5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  -pC AW<6789:   AW<6789:C 7Jldd7  #idid 33          & 2SS56 ~5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  hD     QQQ#Sid  3    JJ :II.0  Populationgrowth,structureanddistributionhD k !#idS 3Q           -pC AW<6789:   AW<6789:C7Jldd7  #idid 33          & 2SS55QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  0 : 0::11. TheProgrammeofActionarticulatesacomprehensiveapproachtoissuesofpopulation  anddevelopment,identifyingarangeofdemographicandsocialgoalstobeachievedovera20-yearperiod.WhiletheProgrammeofActionprovidesnoquantifiablegoalsforpopulationgrowth,structureanddistribution,itdoesreflecttheviewthatanearlystabilizationofworldpopulationwouldmakeanimportantcontributiontorealizingtheoverarchingobjectiveofsustainabledevelopment.  0 : 0::12. Despitesignificantdeclinesinratesofpopulationgrowth,rapidpopulationgrowth   remainsaconcernforamajorityofGovernmentsindevelopingcountries(seetable2).Thedeclineingrowthratesischieflyattributabletotheincreaseduseofeffectivemethodsoffamilyplanning,whichhasenabledcouplesandindividualstohavebettercontroloverthetimingandthenumberofbirths.Whilenotableprogresshasbeenmadeinextendingfamilyplanningandotherreproductivehealthservices,therevolutioninreproductivechoiceisunfinishedandinsomecountrieshasbarelybegun.Unwantedandmistimedbirthsarestillcommon.Desiredfamilysizeisdeclininginalldevelopingregions,fuellingthedemandforreproductivehealthservices.Continuedandenhancedeffortstomeetthatgrowingdemandwilldirectlybenefitcouplesandindividuals,andwillalsohelptobuytimefortheachievementofbroaderdevelopmentgoals.  o 3  0 :   Table2 :: e    QQQQ#idid      0 : 0::Governmentsviewsonpopulationgrowthrate,1998o 3  eF QQQQ#idid 3 #         0 : 0::(^  ^QPercentageofcountries#Q ^^ #)$     QQQQ#ldid { !: ! @M"$%Y*+x-'23F59;=A{  *l|&nd" dk !! [!!#~&l,!! ,H!! ,!! ,!! ,!! ,Q!!#+  9&j(  b& CC9 G&j6%] '&j GToohigh G&j6%] (3&j GSatisfactory G&j6%] )3&j GToolow G&j6%] *3&j GTotal G&j6%] +3&j GNumberofcountries [Q0] ,3 CC  &j `[ C9%(!p- C C9%(!p.3 C C9%(!p/3 C C9%(!p03 C C9%(!p13 C VL0(!p23 `  !!VWorld C9%!3 C41 C9%!43 C44 C9%!53 C14 C9%!63 C100 C9%!73 C180 QG+!83 !!  !!QMoredevelopedregions C9%"9 C2 C9%":3 C69 C9%";3 C29 C9%"<3 C100 C9%"=3 C45 QG+">3 !!  !!QLessdevelopedregions C9%y#?& C54 C9%y#@3& C36 C9%y#A3& C10 C9%y#B3& C100 C9%y#C3& C135;1/y#D3 !!  & ;  3! !QQQ   Source:PopulationPolicyDataBankmaintainedbythePopulationDivision,Departmentof %IE 0  EconomicandSocialAffairsoftheUnitedNationsSecretariat.B3 3Q~g!: ! @M"$%Y*+x-'23F59;=A~%F     #idld  -pC AW<6789:   AW<6789:C7Jldd7  #idid 3          & 2SS5M&5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  &  0 : 0::13. Atpresent,morethantwothirdsofGovernmentsindevelopedcountriesconsidertheir c' I ratesofpopulationgrowthtobesatisfactory,butagrowingminorityarevoicingconcernoverlowratesofpopulationgrowthandtheirconsequencesforsocio-economicdevelopment.Insomecases,theconcernislesswithpopulationgrowthpersethanwiththe'c'edegreeandpaceofpopulationageing.ForGovernmentsconcernedbylowpopulationgrowth,therearenowelltestedpolicyrecipestofollow.Thecomingyearsmaytherefore seeincreaseddiscussionofpolicyalternatives,andGovernmentsmaybenefitbycomparing ,[%O ideasandexperiences,andbycontinuedeffortstoimproveunderstandingoftheforcesunderlyingtheirchangingdemographiccircumstances.   0 : 0::14. TheobjectivesoftheProgrammeofActioninregardtopopulationagestructureare  directedatmajorgroupsatoppositeendsoftheagespectrum,namely,children,youthandadolescents,andolderpersons.Althougharisingtrendinschoolenrolmentatalleducationallevelsanddeclinesinilliteracyhavebeennoted,32countriesstillhaveenrolmentratiosoflessthan50per100school-agechildrenforprimaryandsecondaryschoolcombined.Inmanycountries,educationcontinuestobecharacterizedbyhighdrop-outrates,veryhighpupil-teacherratiosandinadequatelyequippedschoolfacilities.Inmostcountries,boyshavehigherenrolmentratesthangirls,andthedifferencesaresubstantialinmanycountries,particularlywherelevelsofenrolmentarelowoverall.Inhalfofthedevelopingcountries,theenrolmentratioforboysexceedsthatforgirlsbyfivepercentagepointsormore.However,inLatinAmericaandtheCaribbean,thegendergapinschoolenrolmentisnarrowerthanintheotherlessdevelopedregions.Inasubstantialfractionofthecountriesofthatregion,enrolmentratiosforfemalesarehigherthanformales.  0 : 0::15. Asregardsthepopulationofolderpersons,developedcountriesgenerallyhaveinplace T  arangeofpoliciesandprogrammestomeettheneedsofolderpersons,whiledevelopingcountriesarelessfaralong.Onechallengeforbothdevelopedanddevelopingcountriesishowbesttoallocatelimitedresourcesamongpublicsectors.Accordingly,planningmayhavetoreflectgreatersensitivitytoexpecteddemographicchanges.Fordevelopingcountries,thereisaneedtomovetowardsbroad-basedformalsystemsofincomemaintenanceforolderpersons,withoutacceleratingthedeclineininformalsystems.Toachievethosedualobjectives,informalsupportsystemswillhavetobebolsteredbyofferingassistancetofamilycaregivers.Actionswillalsoberequiredonthemedicalfront.Becausemedicalcareinmanydevelopingcountrieshasnotbeengearedtotheneedsofolderpersons,somereorientationofthemedicalsystemwillbenecessary,aswellastheestablishmentand/orstrengtheningofgeriatrictrainingformedicalpersonnel.Fordevelopedcountries,giventhepersistenceofbelow-replacementfertilityandfuturecontractionsintheworkingagepopulation,theadvisabilityofmeasureswhichencourageearlyretirementisquestionable.Amoreappropriatepolicyinthosecircumstancesmightbetoraisemandatoryretirementagesandeliminateincentivestoearlyretirement.AnumberofGovernmentshaverecentlytakensuchsteps.  0 : 0::16. Oneofthemajortrendsinthelatterhalfofthetwentiethcenturyistheunparalleled # growthofurbanagglomerations.By2006,thenumberofurbandwellerswillexceedruraldwellersforthefirsttimeinhistory.Problemsassociatedwithinappropriatepopulationdistributionplaguemanycountries,particularlyindevelopingregions,andposeseriousobstaclestosustainabledevelopment.Onlyaboutonefourthofcountriesaresatisfiedwiththeirpatternsofspatialdistribution(seetable3).TheProgrammeofActionrecommendsthatGovernmentsincreasethecapacityandcompetenceofcityandmunicipalauthoritiestomanageurbandevelopment.Inthisregard,theymaywishtoconsiderdecentralizingtheiradministrativesystems.Thisalsoinvolvesassigningresponsibilityforexpendituresandtherighttoraiserevenuetoregionaldistrictsandlocalauthorities.Suchmeasurescanincreasetheabilityoflocalauthoritiestosafeguardtheenvironment,respondtotheneedofallcitizensforpersonalsafetyandservices,andcopewithhealthandsocialproblems,includingproblemsofsubstanceabuseandcriminality.Governments,aswellasnon-governmentalorganizations,cancontributetothewelfareoftheurbanpoorbyhelpingtodeveloptheirincome-earningability.TheHabitatAgendaandIstanbulDeclaration,adoptedbytheUnitedNationsConferenceonHumanSettlements(HabitatII)in1996, containadditionalcommitmentsandstrategiesforachievingadequateshelterforalland ,j&3 makinghumansettlementssafer,healthierandmoreliveable,equitable,sustainableandproductive.   0 : 0::17. Governmentswishingtocreatealternativestoout-migrationfromruralareasshould  improveruraleducation,healthandothersocialservices,andprovidesafewater.Equitableruraldevelopmentcanbefurtherpromotedthroughlegalandothermechanisms,asappropriate,thatadvancelandreform,recognizeandprotectproperty,wateranduserrights,andenhanceaccesstoresourcesforwomenandthepoor.Thereisalsoaneedforeffectivesystemsofregionalplanninganddecision-making,ensuringthewideparticipationofallpopulationgroups.TheProgrammeofActionalsourgescountriestorecognizethatthelandsofindigenouspeopleandtheircommunitiesshouldbeprotectedfromactivitiesthatareenvironmentallyunsoundoractivitiesthattheindigenouspeopleconcernedconsidertobesociallyandculturallyinappropriate;thereisacontinuingneedforeffectivestepstoensuresuchprotection.  o 3  0 :   Table3 :: e    QQQQ#idid      0 : 0::Governmentsviewsonspatialdistribution,1998o 3  e QQQQ#idid 3          0 : 0::^  ^Q(Percentageofcountries)  #Q ^^ i#    QQQQ#ldid { !: ! @M"$%Y*+x-'23F59;=A{  *z&ndd!! H!! !! !! !! Q!!#|&,U!! ,-!! ,K!! ,;!! ,g!! ,a!!#+  9&j( o CC9 G&j6%\&j GМSatisfactory G&j6%:3&j GМMinorchangedesired G&j6%:3&j GМMajorchangedesired G&j6%:3&j GМTotal G&j6%:3&j GМNumberofcountries [Q0:3 CC  &j `[ C9%  C C9%!3 C C9%"3 C C9%#3 C C9%$3 C VL0%3 `  !!VWorld C9%0& C27 C9%0'3 C29 C9%0(3 C44 C9%0)3 C100 C9%0*3 C179 QG+0+3 !!  !!QMoredevelopedregions C9%n, C48 C9%n-3 C32 C9%n.3 C20 C9%n/3 C100 C9%n03 C44 QG+n13 !!  !!QLessdevelopedregions C9%V2& C21 C9%V33& C28 C9%V43& C51 C9%V53& C100 C9%V63& C135;1/V73 !!  & ;  3! !QQQ   Source:PopulationPolicyDataBankmaintainedbythePopulationDivision,Departmentof 8 0  EconomicandSocialAffairsoftheUnitedNationsSecretariat.3 3Q~g!: ! @M"$%Y*+x-'23F59;=A~.9     #idld  -pC AW<6789:   AW<6789:C7Jldd7  #idid 3          & 2SS5*5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  0 : 0::18. TheProgrammeofActionaimstofullyintegratepopulationconcernsinto @< development,environmentalandpoverty-reductionstrategiesandresourceallocationatalllevels,withtheobjectivesofmeetingtheneedsandimprovingthequalityoflifeofcurrentandfuturegenerations,promotingsocialjusticeanderadicatingpoverty.Withrespecttothewiderangeofenvironmental,social,healthandeconomicobjectivessetoutintheProgrammeofActionandatotherglobalconferences,progresshasbeenmixed.Overallprogresshasbeenmade,thoughinvaryingdegrees,towardsreducingpovertyrates(thoughnotasyettheabsolutenumberofthepoor),increasingfoodsuppliesandimprovinghealthandeducation.TheProgrammefortheFurtherImplementationofAgenda21,adoptedbytheGeneralAssemblyatitsnineteenthspecialsession,in1997,particularlynotedrecentdeclinesintheglobalrateofpopulationgrowthasamongthepositivetrendssinceAgenda21wasadoptedbytheUnitedNationsConferenceonEnvironmentandDevelopmentin1992.  0 : 0::19. Eventhoughpovertyrateshavedeclineddramaticallyinmanycountriesinrecent `& J years,progresshasbeenuneven:morethan1.3billionpeoplearestillclassifiedaspoor,andtheeconomicdownturnthatbeganwiththeAsianfinancialcrisisin1997hasreversedsomeofthegains.Itiswidelybelievedthatthemostimportantfactoraccountingforpovertyisthemacroeconomicenvironment,especiallyfactorsthatgovernthegrowthofemployment.Withsomenotableexceptions,includingtheeconomiesintransition,countriesinthe1990sgenerallyachievedrobusteconomicgrowth.However,therecentfinancialcrisisshowsthatsustainedprogresscannotbetakenforgranted,andthatintodayseconomytheramificationsofanationalorregionalfinancialcrisiscanquicklyspreadthroughouttheglobe.,&R Ї0 : 0::20. Whilepopulationfactorscannotaccountforshort-termeconomicfluctuations,there  hasbeenpersistentinterestinpopulationspossibleeconomiceffectsinthelongerrun.Thepredominantviewinrecentyears,asreflectedintheProgrammeofAction,isthatslowerratesofpopulationgrowthcanbuymoretimetoadjustandcanincreasecountriesabilitytoattackpoverty,protectandrepairtheenvironment,andbuildthebaseforfuturesustainabledevelopment.  0 : 0::21. Thegrowthanddistributionofthepopulationhasdirectimpactsonenvironmental   use,butthenatureofthoseimpactsislargelygovernedbyinstitutionalrealities"propertyrights,landdistribution,taxesandsubsidiesonvarioustypesofproductionandconsumptionetc.Giventhenatureofenvironmentalresources,governmentpoliciesarecriticaltopopulation-environmentalinteractions.Whilenon-governmentalorganizationsandtheprivatesectorcanandshouldplayanimportantrole,governmentcommitment,supportandleadershipatthelocal,regionalandnationallevelsremainscriticalforhaltingandreversingdamagetotheenvironment,andfortheprovisionofprimaryandsecondaryeducation,primaryhealthcareandotherbasicsocialservices,especiallyasregardsaccessforthepoor.  hD     QQQ#Sid  3     :III.0  ReproductiverightsandreproductivehealthhD E: #idS 3Q2         0 : 0::22. TheProgrammeofActionemphasizesthatallcountriesshouldstrivetomake  reproductivehealthaccessibletoallindividualsofappropriateagesassoonaspossible,throughtheprimaryhealth-caresystem.However,theProgrammeofActionandtheconceptsitdescribeshavenotbeendisseminatedaswidelyandpubliclyaswasenvisionedandhopedforafterICPD.Consequently,someaspectsofthereproductivehealthandrightsagendahavereceivedlimitedsupport.WheregeneralsupportfortheProgrammeofActionexists,fullsupportisstilllackingforlegislationtoensurereproductiverightsandreproductivehealth,andgenderequityandequality.Moreover,policydevelopmentandimplementationarelimitedbyinadequateunderstandingofthestructuralandstrategicimplicationsofashiftfromverticalmaternalandchildhealthandfamilyplanningstructurestoarights-basedreproductivehealthstrategy.  0 : 0::23. Twokeystrategicstepstobetakeninmovingtowardsareproductivehealthapproach # areintegratingexistingservicesandbroadeningofavailableservices.Anotherkeyissuehasbeenqualityofcare,withincreasingemphasisbeinggiventosuchissuesasclientchoiceofmethods;informationforandcounsellingofusers;technicalcompetenceofproviders;interpersonalrelationsbetweenprovidersandclients;mechanismsforfollow-upandcontinuityofcare;andanappropriateconstellationofservices.  0 : 0::24. Intheprocessofhealthsectorreform,additionalemphasisisneededtoensuresexual #* andreproductivehealthforallatthehighestachievablestandardofcareandtomobilizethenecessaryresources.Governmentswillneedtocontinuetopromotereorientationofthehealthsystemtoensurethatpolicies,strategicplansandallaspectsofimplementationarerights-based,coverthelifecycleandserveall.Thisrequireschangingtheattitudesofpolicymakers,healthcareproviders,andusers/clientssothatthepublichealthsystemisopentoinputsfromcivilsocietyregardingthecontentanddeliveryofpublichealthservicesandinformation.  0 : 0::25. Theaveragelevelofcontraceptiveuseisestimatedat70percentinthemore *n$3 developedregionsandat55perentinthelessdevelopedregions;contraceptiveprevalencehasincreasedsubstantiallyoverthepast10years,byatleast10percentagepoints,inalargenumberofdevelopingcountries.Between1988and1998,prevalencerosefrom27to39 p,&6 percentinKenya,from32to49percentinBangladesh,andfrom36to46percentinthePhilippines.EveninsomeoftheleastdevelopedAfricancountries,thelevelofusehasrecentlyincreasedmarkedly.Forexample,since1988-1991,contraceptiveprevalencehasincreasedfrom12to24percentinTogo,from5to15percentinUganda,andfrom4to8percentintheNiger.    0 : 0::26. However,despitethesustainedriseincontraceptiveuse,effectivecontroloverfertility  6 haseludedasizeablenumberofcouples.Thegapbetweenstateddesirestopreventordelayabirthandtheactualuseofcontraceptiontoachievethosegoalsisconsiderableinmanycountries,andthefullrangeofmodernfamilyplanningmethodsstillremainsunavailabletolargenumbersofcouplesworldwide.Forcountriessurveyedinthelate1980sandearlyϜ1990s,aboutoneinfourcoupleswanttoavoidpregnancybutarenotusingcontraception.Mostofthemwouldbeusingamodernfamilyplanningmethodifmoreaccurateinformationandaffordableserviceswereeasilyavailable,andifpartners,extendedfamiliesandthecommunityweremoresupportive.  0 : 0::27. Theemphasisonhealthissuesinconnectionwithfamilyplanninghasbeengrowing, 6  andwhileconcernsabouthealtheffectsofmodernmethodsarewidespreadnotallfearsarewellfounded.Thereisaneedtoknowmoreaboutthenatureandseverityoftheeffectswomenfear,andtoaskquestionsaboutperceivedrisksinsimilardetailtowomenusingandnotusingamodernmethod.Thedrawbacksofexistingcontraceptivemethodspointtoaneedfornewandimprovedmethods.Afullrangeofmodernmethodstailoredtotheconvenienceofuseandindividualcontroloverbeginningandstoppinguse,inadditiontosafetyandefficacyatpreventingpregnancy,shouldbemadeavailable.  0 : 0::28. TheProgrammeofActionhasplacedfamilyplanningwithintherealmofreproductive  healthandreproductiverights.Thus,policiesthatviewfamilyplanningsolelyasameansforthereductionoffertilityneedtobereorientedformeetingtheobjectivessetoutintheProgrammeofActionanditsimplementation.Tothatend,guidanceisneedednotonlyintheformulationofappropriatepoliciesbutalsoinclearlydefiningtheplaceoffamilyplanningprogrammeswithinthewiderframeworkofreproductivehealthandreproductiverights.Further,measuresfortheevaluationofprogrammesbeyondtheirimpactontheleveloffertilityneedtobeelaborated.  0 : 0::29. Inmanycountries,womendonothavethepowertoinsistonsafeandresponsiblesex R" practices,andhavelimitedaccesstoinformationandservicesforpreventionandtreatment.Manywomenandadolescentstendtoavoidclinicsforsexuallytransmitteddiseases(STDs)outoffearofbeingstigmatized.Moreover,despitethefactthatthehighestratesofSTDsareamongthoseaged15!29andthatadolescentshaveincreasedbiologicalsusceptibilitytocertainsexuallytransmitteddiseases,theaccessofadolescentstotreatmentfacilitiesisrestrictedinmanycountries.  0 : 0::30. PreventionofSTDsandtheirdetectionandtreatmentisanimportanthuman $n* Мimmunodeficiencyvirus(HIV)preventionstrategy,aswellasapublichealthpriorityinitsownright.IntermsofHIVprevention,priorityneedstobegiventoSTDpreventionandtreatmentforpeoplewithhigh-risksexualbehaviour,whoalsoingeneralhavethehighestSTDinfectionrates.DespitemuchscepticismatthebeginningoftheacquiredϜimmunodeficiencysyndrome(AIDS)epidemic,itisclearthatwidespreadchangesinsexualbehaviourandcondomusearepossible.Socialmarketingofcondoms,inassociationwithinterventionsthathavebeendesignedtopromotesafesex,hasresultedinanincreaseincondomuse.  0 : 0::31. Adolescentreproductivebehaviourhasbecomeanemergingworldwideconcerndue n+%4 toaloweringoftheageatmenarcheandincreasingnumbersinitiatingsexualactivityat 6,&5 ayoungage.Mostcountriesdonothavecoherentpoliciesfortheprotectionandmaintenanceofreproductivehealthinadolescents,inpartbecauseofthesensitivityofthesubject.Thediversityoflawsandpoliciesrelatedtoadolescentsexualbehaviourissogreatthatitisdifficulttogeneralizeaboutthematter.Moreandmorecountrieshavebeendevelopingacomprehensiveapproachtoadolescentreproductivehealthduetoagrowingrecognitionthatsexualandreproductivehealthconcernsarecloselyrelated:adolescentsinneedofoneservicearelikelytoneedothersaswell.Thereisalsoatrendtowardstheintegrationofactivitiesdesignedforinformation,education,communicationandotherformsofhealthpromotionforadolescentreproductivehealthwithlocalreproductivehealthservicesforadolescents.  0 : 0::32. Adolescentsexualandreproductivehealthissuesoftengeneratedeepcontroversy    Мbecauseofthesensitivityofthetopic,andbecauseissuesdiscussedunderthatrubricaresometimesseenasinfringingontherights,responsibilitiesandauthorityofadultstowardstheiradolescentchildren.Thereisalsosometimesmistrustandfearaboutsexualandreproductivehealtheducationforadolescents.Thepurposesofsexualandreproductivehealtheducationshouldbemadeclearinordertoemphasizethatitsprimaryobjectiveistohelpadolescentstounderstandthesexualchangestheyareexperiencingaspositiveandnaturalaspectsoftheirdevelopment,andisnotdesignedtoencouragebehaviourcontrarytotheirvalues.Therisksofnoteducatingyoungpeopleaboutreproductivehealthneedstobeexaminedanddiscussed,alongwiththeknowledgethathonestdiscussionandopenquestionsinanenvironmentoftrustwillcontributetopromotinghealthandwell-being.Itisimportantthatparentsandthoseworkingintheconcernedprofessionswhodealwithyoungpeoplebefullyinformedaboutadolescentsexualmaturationanddevelopment,andbeabletodiscusssensitiveaspectsofsexualityandreproduction.Thatcanbeachievedthrougheducationandtrainingappropriatetoeachgroup.   -pC AW<6789:   AW<6789:C7Jldd7  #idid 33          & 2SS5C5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  ݜ̛̜ -pC AW<6789:   AW<6789:C7Jldd7  #idid 33          & 2SS5:5QQQQg!: ! @M"$%Y*+x-'23F59;=A!: ! @M"$%Y*+x-'23F59;=A  hD     QQQ#Sid  3     :IV.0  HealthandmortalityhD  #idS 3Q:         0 : 0::33. Whilegloballifeexpectancyisincreasing,progressisbynomeansuniform.Itis   estimatedthatby2005,101of184countrieswillhavemetthegoalssetoutbytheProgrammeofAction,withaveragelifeexpectanciesof70yearsormore.Another25highmortalitycountrieswillmeetthelifeexpectancygoalof65years.Fifty-eightcountrieswillnotreachtheProgrammestargetgoalby2005,mostoftheminsub-SaharanAfrica.Inregionswheremortalityhasbeendeclining,newchallengesthreatentooffsetimprovements.SomeofthecountriesofEasternEuropehavebeenexperiencingastagnationofmortalityimprovementandevendeclinesinnationallifeexpectancies.Mortalityinthosecountrieshasbeenparticularlyhighamongadultmalesduetonon-communicablediseases,accidents,injuriesandviolentdeaths.  0 : 0::34. Inadditiontolongstandinginfectiousdiseases,re-emergingdiseases,suchasmalaria, $"+ tuberculosisandcholera,aswellasthemorerecentemergenceofHIV,threatentounderminegainsinlifeexpectancy.Furthermore,lackofbasicsanitation,watersupplyandfoodsafetycontinuetocontributegreatlytodiarrhoealdiseasemortalityandmorbidity.Thenumberofpeoplewithoutsanitationin1994totalled2.9billionfordevelopingcountries;thatfigureisprojectedtoincreaseto3.3billionbytheyear2000.  0 : 0::35. Anemphasisonprimaryhealthcarehascontributedtosignificantgainsinhealth ) $2 status.However,formanylow-incomecountries,thecostofprovidingthemostbasicpublichealthandclinicalservicesexceedscurrentgovernmentspending.Furthermore,thedistributionofresourcesstillfavoursthecapitalcities,leavingoutlyingareaswith ",x&5 inadequatesupport.Reformofthehealthsector,includingefficientdrugdistributionandthepromotionoflocalcapacitytoproducegenericessentialdrugs,remainsakeyareaforimprovement.Increasednationalcapacitytoenhanceprimaryhealthcareandmaternalandchildhealthdeliverynetworksareofutmostpriority,andthefocusshouldbeonexpandingcoverageinordertobringthepoorestandmostremotecommunitiesandfamilieswithinreachofhealthcareservices.  0 : 0::36. Asregardschildsurvival,progresshasbeenmadeinthecontrolofpreventable   diseases,specificallythepromotionofsuchservicesasimmunizationcoverage,controlofdiarrhoealdiseasesandiodinedeficiencydisorders,theeradicationofpolioandguineawormdisease,andthepromotionofbreastfeeding.Whileachievementshavebeenmade,anumberofchallengesremain.About10millionchildrenundertheageoffivecontinuetodieeachyearindevelopingcountries,nearlyallfromcausesforwhichinexpensivetreatmentssuchasimmunizationandantibiotics,areavailable.Atthecurrentpaceofdeclineinunder-fivemortality,asmanyas64countries"45inAfrica,15inAsia,3inLatinAmericaandtheCaribbeanand1inOceania"willnotmeetthegoalof70deathsper1,000birthssetfortheyear2000.Those64countriescontainnearlyhalfoftheworldschildrenaged0!4years.ToachievethegoalsoftheProgrammeofAction,aswellasthoseoftheWorldSummitforChildren,newdirectionsmayneedtobepursued,suchasfine-tuningnationalprogrammes,reformulatinggoalsandstrategies,accordingspecialattentiontocapacity-building,prioritizinggoalsatnational,subnationalandcommunitylevels,andadaptingtolocalsituationstoaddress,forinstance,thepresenceofseriousepidemicdiseases,suchasHIV/AIDS,malaria,tuberculosisorotheracutediseases.  0 : 0::37. Duringpregnancy,anywomancandevelopseriouslife-threateningcomplications v thatrequiremedicalattention.Itisessentialthatpregnantwomenhaveaccesstohighqualityobstetriccareaswellasantenatalcare.Studiesshowthatmoreandmorepregnantwomenareseekingantenatalcare.In1985,aboutonethirdofbirthswereattendedbyatrainedattendantinAfrica;in1996,attendancehadincreasedtoatleast42percent.Attendanceatbirthincreasedfrom49to53percentinAsia,andfrom64to75percentinLatinAmericaandtheCaribbean.  0 : 0::38. Oneofthemostalarmingdevelopmentsinthefieldofhealthandmortalityisthe <  HIV/AIDSepidemic.Bytheendof1998,about33millionpeoplewereinfectedwithHIVand13.9millionpeoplearoundtheworldhadalreadylosttheirlivestothedisease.Some2.5millionpeoplediedofAIDSin1998,ofwhom0.5millionwerechildren.TheepidemicisparticularlydevastatinginAfrica.In29hard-hitAfricancountries,lifeexpectancyatbirthiscurrentlyestimatedat47years,sevenyearslessthanwhatcouldhavebeenexpectedintheabsenceofAIDS.ThedemographicimpactofAIDSisevenmoredramaticwhenonefocusesonthehardesthitcountries.TheaveragelifeexpectancyatbirthintheninecountrieswithanadultHIVprevalenceof10percentormoreis10yearslessthanitwouldhavebeenintheabsenceofAIDS.  0 : 0::39. ManyofthecountriesseverelyaffectedbytheHIV/AIDSepidemichavebynow Z%+ developedresponsesthathavebecome,overtime,increasinglyacceptedbyindividualsandcommunities,andhavebeenexpandedtobringinmoreresourcesandactivepartnersfromdifferentsectorsofsocietyandoftheeconomy.Experiencefromthepasttwodecadesshowsthattherearesomeresponsesthatworktocontainthespreadofthediseaseandlightentheburdenonindividuals,familiesandcommunities.However,solutionsthathaveworkedwellinoneplaceorforonegroupmaynotnecessarilyworkforanother.Thus,thestrategicplanningprocessshouldaimtomobilizethestrengthsofallsocialandeconomicgroupsandbesufficientlyflexibletocopewiththechangingnatureoftheepidemic.    %,{&4 0 : 0::40. EffortstomodifybehaviourarecentraltopreventionprogrammesbecauseHIVis   transmittedmainlythroughsexualcontactorbyinjectingdrugs.Preventionprogrammes,suchasmediacampaigns,peereducation,accesstoinexpensivecondomsandcleaninjectionequipment,aswellasincreasedknowledgeofHIVandhowtoprotectonesselffrominfection,haveallbeenshowntoworkinmanyplacesbyreducingrisk-takingbehaviour.Programmesthatworkbestconcernthemselveswiththetotalityofapersonshealth.  0 : 0::41. WhileHIVinfectionisnotcurableatpresent,itisnowclearthatitscoursecanbe   delayedsignificantlywithanti-retroviraltherapy.Moreover,therearearangeoftreatmentsavailabletopreventandtreatopportunisticinfectionsandmalignanciesthataffectpeoplewhoseimmunesystemhavebeenweakened.Therearealsoprophylacticanti-retroviraltherapiesthatcanreducethelikelihoodofHIVinfectionafterexposuretothevirus.Theprobleminmanycountries,however,isoneofaccessibility,giventhelackofavailabilityand/oraffordabilityofmanytreatments.  hD     QQQ#Sid  3    XX :V.0  InternationalmigrationanddevelopmenthD @? ?#idS 3Q          0 : 0::42. AkeyobjectiveoftheProgrammeofActionistoaddresstherootcausesofmigration. N  Undeniably,economicdisparitiesbetweencountriesareattherootofmostinternationalmigrationmovements.Theirreductionwouldcontributetodampeningthepotentialforinternationalmigration.Yetthereisnosignthatsuchreductionisoccurring.Infact,thereisagrowingpolarizationintermsofincome:betweenthelate1960sandtoday,theratiooftheincomeoftherichestfifthoftheworldtothepoorestfifthhasmorethandoubled,from30:1to78:1.Anotherkeyfactorleadingtointernationalmigrationisthedegreeofsocialandpoliticalstabilityofacountry.AlthoughbyoneestimatethenumberofStateswithdemocraticallyelectedcivilianGovernmentshasdoubledsince1984,manyofthosecountriesareexperiencingvaryingdegreesofsocialandpoliticalinstability.Inseveralregions,GovernmentshavelosttheabilitytoundertakethebasicfunctionsoftheState,includingmaintaininglawandorder.Insituationsofdecliningprosperity,peoplehavetendedtoseeksecurityincommunalalliances,aprocessthathasreinforcedthepotentialforsocialandpoliticalconflict.Asaconsequence,thereareabout35civilwarsandalargernumberoflower-intensityconflictsragingaroundtheworld.Thepartiestothoseconflictshaveoftenviolatedinternationalhumanitarianlawbyadoptingtacticswhichrelyonthebrutaltreatmentofcivilianpopulations. Ethnic-cleansingisoneofthosetactics.Boththenumbersofpeoplethathavebeenforcedtoleavetheirplaceofnormalresidenceandthegeographicalextentoftheareasaffectedhaveincreasedinrecentyears.Althoughitisacknowledgedthatthepreventionofconflict,particularlythatoccurringwithincountries,andtheresolutionofconflictsaftertheyoccurarekeyelementsofanystrategytoaddressthecausesofforcedmigration,Statesovereigntylimitsthetypesofactionsthattheinternationalcommunitycantakeandraisesquestionsaboutthelegitimacyofexternalintervention.Furthermore,evenwheninterventiontakesplace,itmaynotbesufficienttoensurealastingpeace.  0 : 0::43. WhentherelationshipbetweentheStateanditscitizenshasbrokendown, $'z!. humanitarianactioncancompensatefortheabsenceofnationalprotectionbyinstitutingsomedegreeofsecurity.However,humanitarianactioncanplayonlyaverylimitedroleinsafeguardingsecurityinsituationsofactiveconflict.Furthermore,theinternationalcommunitysrecentemphasison incountryprotectionhasbeenparallelledbyadiminishedwillingnesstograntasylum.Therecentdeclineintheworldsrefugeepopulation(from16millioninJanuary1994to12millioninJanuary1997)andthesimultaneousincreaseinthenumberofinternallydisplacedpersons(thoseofconcerntotheOfficeof ,&5 theUnitedNationsHighCommissionerforRefugees(UNHCR)haverisenfrom7millionin1994to10millionin1997)aremanifestationsofthosedisturbingtrends.Evidently,problemsstemmingfromforceddisplacementcannotberesolvedbyeffortstoobstructthedeparturefromorcompeltheprematurerepatriationofpeopletocountrieswheretheStateisunableorunwillingtoprotectitscitizens.Thedevelopmentsoutlinedabovepointtotheenormouschallengesfacedwhentryingtoaddresstherootcausesofinternationalmigrationingeneralandofpopulationdisplacementinparticular.TheProgrammeofActionrecognizesthatwhentherootcausesofmigrationcannotbereducedorcontrolled,someinternationalmigrationwillhavetobeaccommodated,evenbycountriesreluctanttoadmitinternationalmigrants.  0 : 0::44. TheProgrammeofActionattachesgreatimportancetotheprotectionofthehuman    rightsofmigrants,whetherdocumentedornot.RatificationoftheUnitedNationsConventionontheRightsofAllMigrantWorkersandMembersofTheirFamiliesisanimportantstepinthatdirection.AsofJune1998,theConventionhadbeenratifiedoraccededtobyninecountries.Topromoteratification,theInternationalMigrantsRightsWatchCommitteehasconvenedasteeringcommitteethatisconductinganinformationcampaignamongGovernments.Inaddition,in1997theCommissiononHumanRightsappointedanintergovernmentalworkinggrouptoidentifybarrierstotheeffectiveprotectionofthehumanrightsofmigrants.TheProgrammeofActionalsostressestheneedforprotectionagainstracism,ethnocentrismandxenophobia.AnexampleofevolvingactioninthisregardisprovidedbytheEuropeanUnions1997TreatyofAmsterdam,whichstatesthat theCouncilofEuropemaytakeappropriateactiontocombatdiscriminationbasedonsex,racialandethnicorigin,religionorbelief,disability,ageorsexualorientation(article6a).Althoughthearticlemakesnomentionofnationalorigin,itneverthelessprovidesabasisforactionbytheEuropeanUniononissuesrelativetoracismordiscriminationonthebasisofreligion,bothofwhicharerelevantinthetreatmentofinternationalmigrants.  0 : 0::45. Therehasbeenlittleprogressinensuringthatdocumentedmigrantsenjoyequality ^ oftreatmentwithcitizensintermsofconditionsofwork.Inmostcountries,migrantworkersadmittedonatemporarybasisaregenerallyconstrainedtoremaininaparticularjoboroccupation.Changingemployerrequirespriorauthorization.Thoseconditionsofworkfortemporarymigrantworkersdonotonlyimplydiscriminationbutoftenleadtoexploitativeconditionsofwork,especiallyinthecaseoffemalemigrantsengagedindomesticservices.RealizingthattemporarymigrationforemploymentandtrainingpurposeshasbeenrisinginEuropeancountries,theCouncilofEuropehasissuedguidelinesforthelegalprotectionofshort-termmigrantworkers.InAsia,receivingcountrieshavegenerallymaintainedrestrictiveconditionsforthelegalemploymentofforeigners,whereascountriesoforiginhavebeenconcernedwiththeprotectionoftheirworkersabroad.ThePhilippines,inparticular,hastakenastrongstancetowardstheprotectionofFilipinomigrantworkers.  0 : 0::46. Thepreventionofundocumentedmigrationisoneofthemajorprioritiesforcountries  %b* allovertheworld.Variousmeasureshavebeenadoptedtodeterundocumentedmigration,andtherehavebeenseveralconcertedeffortstoexchangeinformationamongtheimmigrationauthoritiesofdifferentcountries.Traffickinginmigrantshasbecomeamajorconcerninallregions,butmanycountriesstilllacklegislationmakingtraffickinginmigrantsacriminaloffence.Becausetraffickinginmigrantsinvolvestransnationaloperationsthatareoftencarriedoutbyorganizedcrimesyndicates,strategiestocombatitrequirethecooperationofauthoritiesinthevariouscountriesinvolved.Regionalconsultativeprocesses,suchasthosereceivingthelogisticalsupportoftheInternationalOrganizationforMigration(IOM),havealreadyresultedinclosercooperationbetweenreceivingcountriesandcountriesoforiginortransit.Attheinternationallevel,in1998the ,2'4 CommissiononCrimePreventionandCriminalJusticecalledfortheelaborationofaninternationalinstrumentagainstillegaltraffickinginmigrantsanddraftproposalsonaconventionagainstthesmugglingofillegalmigrants,andaprotocolaimingatcombatingthetraffickingandtransportofmigrantsbyseawerepresentedtotheCommission.  0 : 0::47. Internationalcooperationhasbeenconsideredessentialinaddressingtheproblems  n facedbyrefugees,asylum-seekersanddisplacedpersons.A1996regionalconferencetoaddresstheproblemsofrefugees,displacedpersons,otherformsofinvoluntarydisplacementandreturneesincountriesoftheCommonwealthofIndependentStates(CIS)andrelevantneighbouringStatesprovidesanexampleofsuchcooperation.Nationalactionplanshavebeendevelopedonthebasisoftheprogrammeofactionadoptedbytheconference,andarebeingimplementedwithfundsraisedbyUNHCRandIOM.  0 : 0::48. InEurope,thenumberofpersonsfilingapplicationsforasylumhasdeclinedasmore 4  stringentrulesdeterminingwhocanapplyforasylumhavebeenadopted.Nevertheless,thenumberofpersonswhoseasylumapplicationsaredeniedcontinuestobehigh,andhostcountriesarefacedwiththeproblemofensuringthatthosepersonsreturntotheircountriesoforigin.Tomakereturnpossible,hostcountrieshavebeennegotiatingreadmissionagreementswiththemaincountriesoforiginofasylum-seekers,aswellaswithcountriesthatserveaspointsoftransittothosepersons.  0 : 0::49. Theendofthecoldwarhasmadepossibleverysizeablerepatriationsofrefugees.  However,theGovernmentsofcountriesdevastatedbywarcannotensureanadequatereintegrationofreturningrefugeesandotherdisplacedpersons.Tofacilitatereintegration,UNHCRhasprovidedassistancetoentirecommunitiesinwaysthatdiscouragedependencyandcontributetothedevelopmentoflocalself-sufficiency.Inimplementingthatapproach,specialattentionhasbeengiventotheneedsoffemaleheadsofhouseholdandthedisabled.Unfortunately,theresourcesneededtoprovideassistancetorepatriatingreturneesandtothemillionsofrefugeesthatstillremaininexileindevelopingcountrieshavebeendeclining,ashasthewillingnessofcountriesofasylumtoprovideahavenforpeoplefleeingconflictintheirhomecountries.  0 : 0::50. TheICPDProgrammeofActionreflectskeyconcernsoftheinternationalcommunity   regardingtheneedtoaddresstherootcausesofinternationalmigrationandtopromotethecontributionsofmigrationtodevelopment.Thedevelopmentssinceitsadoptioncorroboratetheimportanceoffocusingonthoseissuesbutatthesametimeindicatetheextremecomplexityoftheproblemsinvolved.AstheProgrammeofActionsuggests,themanageabilityofinternationalmigrationhingesonmakingtheoptiontoremaininonescountryaviableoneforallpeople.Unfortunately,toomanypeoplearestillnotinapositiontochoosethatoptiontoday.  hD     QQQ#Sid  3     :VI.0  PopulationprogrammesandresourceshD [licle m#idS 3Qf$+         0 : 0::51. SinceICPD,manycountrieshaverevisedtheirpopulationpoliciesandprogrammes 0& . inlinewiththerecommendationsofitsProgrammeofAction.SomeGovernmentshavebegunpolicydialogueatthehighestlevels.Othershaveestablishedministriesorcommitteestoaddresspopulationconcernsandintegratepopulationindevelopmentpolicies.AnumberofGovernmentshavebeguntointegrateanddecentralizereproductivehealthandfamilyplanningservices,providingopportunitiesformoreefficientmanagementandcoordinationofactivitiesthroughcollaborationwithpartnersinthepublic,privateandnon-governmentalsectors.Inaddition,duringthelastfiveyearsthenumberandstrengthofnon-governmentalorganizationscommittedtopopulationconcernshavegrownsignificantly.Many p,&6 GovernmentsarealsoincorporatinggenderconcernsintotheirdevelopmentpoliciesandintegratingSTDsandHIV/AIDSintoreproductivehealthprogrammes.Increasingnumbersofcountriesareformulatingpoliciesandinitiatingprogrammesthataddressthereproductivehealthconcernsofadolescents,andsomehavemademaleinvolvementinreproductivehealthapolicyconcern.  0 : 0::52. Governments,non-governmentalorganizations,theprivatesectorandlocal  6 communities,assisteduponrequestbytheinternationalcommunity,willneedtocontinuetomobilizeandeffectivelyutilizeresourcesforpopulationanddevelopmentprogrammes.Prioritiesshouldbere-examinedandconsiderationgiventodevotinganincreasedproportionofpublic-sectorexpendituresaswellasanincreasedproportionofofficialdevelopmentassistancetopopulationandrelatedsectors.Recipientcountrieswillfurthertheirprogrammesbyensuringthatinternationalassistanceforpopulationanddevelopmentprogrammesisusedefficientlytomeetnationalpopulationanddevelopmentobjectives,andshouldmakeeveryefforttoincreasedomesticresourcesforpopulationandrelatedprogrammes.  0 : 0::53. TheflowoffinancialresourcesforpopulationactivitiesincreasedjustpriortoICPD, T  aswellasintheperiodimmediatelyaftertheConference.SeveralmembersoftheinternationaldonorcommunitydemonstratedtheircommitmenttoachievingthegoalsandobjectivesoftheProgrammeofActionbyincreasinglevelsoffunding.However,themomentumgeneratedbyICPDappearstohavediminished.Althoughanumberofdonorscontinuedtoincreasetheirfundinglevelsin1996,overallinternationalassistancehasremainedunchangedsinceanumberofdonorseitherreducedtheircontributionsorremainedatthesameleveloffundingasthepreviousyear.  0 : 0::54. Anumberofnewmodalitieshaveemergedinanefforttoincreaseeffectivenessof  financialassistancetothesocialsector.Sector-wideapproachesofferamodalityforprovidingassistancetoasector(forexample,healthoreducation)basedonanagreementonapproachesandaprogrammeofaction,andsharedfunding.The20/20Initiative,whichhasbeenendorsedbyrecentUnitedNationsglobalconferences,enhancesthefocusontheprovisionofbasicsocialservicesbycallingondonorcountriestoallocateatleast20percentofofficialdevelopmentassistanceandondevelopingcountriestoallocateatleast20percentofpublicexpenditureforbasicsocialservices.Emergingnewchannelsofassistanceincludeprivatefoundationswhichhaveshownincreasedcommitmenttopopulationassistance.  0 : 0::55. Intensifiedeffortsbytheinternationalcommunitywillbeneededtoenhancenational 8$ capacity-buildingforpopulationanddevelopmentandtransferofappropriatetechnologyandknow-howtodevelopingcountriesandcountrieswitheconomiesintransition.Amongthoseeffortsarecertainlytheagreedtargetof0.7percentofthegrossnationalproductforoverallofficialdevelopmentassistanceandthegoalofdevotingatleast4percentofoveralldevelopmentassistancetopopulationfunding.  0 : 0::56. Governmentsshouldconsiderdiversifyingthesourcesofcontributionswhilestriving $6+ toavoidareductioninresourcesforotherdevelopmentareas.Innovativefinancing,includingnewwaysofgeneratingpublicandprivatefinancingresources,shouldbeexplored,andnewmodalities,suchasincreasedinvolvementoftheprivatesectorandtheselectiveuseofuserfees,shouldbeexamined.DonorGovernmentsandagenciesmaywishtocoordinatefinancingpoliciesandplanningproceduresinordertoimprovetheimpact,complementarityandcost-effectivenessofcontributionstopopulationprogrammes,avoidduplicationofservicesandensurethatbasicneedsaremet.  0 : 0::57. Fornon-governmentalorganizationsandothermembersofcivilsociety,ICPDwas n+%4 aturningpoint.Althoughmanyorganizationswerealreadyinvolvedinpopulationand 6,&5 developmentactivitiesbeforeICPD,itclearlylegitimizedthemasfullpartnersintheimplementationoftheProgrammeofAction.Atthecountrylevel,manycivilsocietyorganizationsnowenjoyeasieraccesstoanddirectcontactswithministriesanddepartmentsofnationalGovernments.Non-governmentalorganizationsareincreasinglybeingaskedtocontributetotheformulationand/orimplementationofprogrammesandprojectsthattheyexecuteontheirownorinpartnershipwithGovernmentinstitutions.  0 : 0::58. NotallGovernmentshaveestablishedpartnershipswithnon-governmental   organizations,norareallexistingpartnershipseffectiveandharmonious.Amongthemorefrequentconstraintsencounteredaretheabsenceofanenablingenvironmentformutuallybeneficialpartnershipsandthelackoffinancialsustainability.Buildinghuman,institutionalandfinancialresourcesisessential,asarecooperationandmutualtrust.  0 : 0::59. Governmentsandinternationalorganizationsshouldcontinueintheireffortsto 4  integratenon-governmentalorganizationsinthedecision-makingprocessandfacilitatetheircontributiontopopulationanddevelopmentissues.Governments,non-governmentalorganizationsandinternationalorganizationscouldalsointensifytheircooperationwiththeprivatesectorinmatterspertainingtopopulationanddevelopmentinordertostrengthenthecontributionofthatsectorintheimplementationofpopulationanddevelopmentprogrammes.ImplementationoftheProgrammeofActionwillbegreatlyfacilitatedbyGovernmentsandcivilsocietyorganizationsimprovingandstrengtheningtheirrespectivehumanresourcemanagementandtechnicalcapabilities,institutionalcapacitiesandfinancialsustainability.  hD     QQQ#Sid  3     :VII.0  ConcludingobservationshD icle ԋ#idS 3Qh         0 : 0::60. TheICPDProgrammeofActioncoversanexpansivefieldoftopics,issuesand 2 concerns,andaddressestheentirespectrumofcountries,institutions,groupsandindividuals.Butonlyfiveyearshaveelapsedsinceitsadoption,sothatthenotablechangesingovernmentpoliciesandestablishmentofnewprogrammesalongthelinesoftheProgrammeofActionhavenotyethadtimetofullybearfruit.  0 : 0::61. Itisclearthatforsomeissuesandforsomecountries,regionsandgroups,progress h# hasbeenachieved.MortalityinmostcountrieshascontinuedtofallsinceICPD.Reproductivehealthprogrammeshavebeenestablishedinmanycountriesandrisingcontraceptiveuseamongcouplesindicatesgreateraccessibilitytofamilyplanningandgreaterabilityofcouplestohavethenumberandspacingofchildrentheydesire.Manycountries,bothsendingandreceiving,havetakenimportantsteps,particularlyattheregionallevel,tomanageinternationalmigrationflowsthroughbi-nationalandmultinationalagreements.Inaddition,manycivilsocietyorganizationsarecontributingtotheformulationandimplementationofpolicies,programmesandprojectsontheirownorinpartnershipswithgovernmentalandintergovernmentalinstitutions.  0 : 0::62. Nonetheless,forsomeissuesandforsomecountries,regionsandgroups,progress 0& . hasbeenlimited,andinsomecasessetbackshaveevenoccurred.TheHIV/AIDSpandemichasledtorisesinmortalityinmanycountries,particularlyinsub-SaharanAfrica.PoliticalshocksandadjustmentsfromthetransitiontomarketeconomiesforanumberofcountriesinAsiaandEuropehavebeenaccompaniedbystagnationsandrisesinmortality,particularlyamongadultmen.YettobeseenistheextenttowhichthefinancialcrisesthatareaffectingsocialwelfareincountriesofEastAsiaandelsewherewilllimittheirprogressinimplementingtheProgrammeofAction.    3,&6 0 : 0::63. Progresshasbeenachievedbutitisuneven,andagreatdealremainstobedone.   Resourcesarenecessary,butnationalevidenceshowsthatgovernmentleadership,prioritiesandcommitmentarethecriticalvariablesforsuccessfulimplementationoftheProgrammeofAction.Withsufficientresourcesandcommittedgovernmentaction,thereviewandappraisaltobeundertakenintheyear2004willnodoubtdocumentenormousprogressinachievingthegoalsandobjectivesoftheICPDProgrammeofAction.  A&T) dEL Aߛ