SPEAKERS AT COMMISSION ON POPULATION AND DEVELOPMENT UNDERSCORE NEED TO SCALE UP FUNDING FAMILY PLANNING SERVICES AS SESSION OPENS
SPEAKERS AT COMMISSION ON POPULATION AND DEVELOPMENT UNDERSCORE NEED TO SCALE UP FUNDING FAMILY PLANNING SERVICES AS SESSION OPENS
|Department of Public Information • News and Media Division • New York|
Commission on Population and Development
2nd & 3rd Meetings* (AM & PM)
SPEAKERS AT COMMISSION ON POPULATION AND DEVELOPMENT UNDERSCORE NEED
TO SCALE UP FUNDING FAMILY PLANNING SERVICES AS SESSION OPENS
Falling Donor Aid Compounds Discrimination, Lack of Effective Contraception
The international community must urgently scale up funding to ensure the availability of family planning services, skilled childbirth attendants and emergency obstetric care for women everywhere in order to achieve the ambitious population targets set at the 1994 International Conference on Population and Development, United Nations population experts said today as the Commission on Population and Development opened its forty-second session.
Thoraya Ahmed Obaid, Executive Director of the United Nations Population Fund (UNFPA), said global leaders had promised to empower women and provide universal access to reproductive health by 2015, and they had steadily increased overall funding towards that end, but it was still not enough to meet escalating costs and needs, particularly in developing countries. “If every woman had access to these reproductive health services, a woman would not die during pregnancy and childbirth each and every minute.”
She said donor aid for family planning as a percentage of total population assistance had dropped from $723 million in 1995, or 55 per cent, to $338 million in 2007, or 5 per cent. Some 200 million women in developing countries, particularly Africa, lacked proper access to effective contraception. Discrimination against women and girls was still widespread and the current financial crisis threatened to erase hard-won gains in health and poverty reduction. Moreover, least developed countries were too cash-strapped to pay for national population, gender and reproductive health programmes, notably the 2010 round of censuses. Governments should increase funding for such programmes and all areas of the International Conference’s population package, including data collection and analysis, and its use in development planning and monitoring.
Echoing those concerns, Rachel Mayanja, Assistant Secretary-General and Special Adviser on Gender Equality and the Advancement of Women, read out a statement by Sha Zukang, Under-Secretary-General for Economic and Social Affairs, saying that, without adequate funding, child and maternal mortality would remain high and the crucial health-related Millennium Development Goals would likely not be achieved. The success of many countries in implementing the Cairo agenda was proof that the world knew what to do and that it could achieve its goals. There was no time to lose in ensuring the requisite political will and funding to make that happen.
Stressing that reproductive rights were central to women’s empowerment and advancement, she said fertility rates had dropped in countries that had recognized those rights, changing population dynamics for the better. Lower fertility reduced maternal mortality by between 25 per cent and 40 per cent and could also help reduce child mortality. It produced slower population growth and changes in age distribution that could boost economic growth by reducing the proportion of dependants. Moreover, better health outcomes for women and children led to advances in education, women’s empowerment, gender equality and environmental sustainability. Slowing population growth would buy time and increase the ability of countries to invest in human capital, combat poverty, protect the environment and build infrastructure for a more sustainable development path.
Hania Zlotnik, Director of the Population Division in the Department of Economic and Social Affairs, agreed, saying that the resources saved by slowing the growth in the number of children had been channelled to support economic and human development. But least developed countries, which had high fertility rates and limited access to modern contraception, lacked sufficient resources to feed, educate and provide health care to the rapidly rising numbers of children. Governments must urgently recommit to implement the International Conference’s Programme of Action, and measures to ensure reproductive health must be integral to any strategy to improve global public health. In addition, the Commission must lay the groundwork so that today’s population-related failures were turned into successes by 2015.
Introducing the Secretary-General’s report on the flow of financial resources to assist in implementation of the Programme of Action, Werner Haug, Director of UNFPA’s Technical Division, said donor assistance had risen steadily in the past few years, surpassing the total financial target set by the International Conference, but funding had increased only for HIV/AIDS programmes, while the package’s other components -– such as family planning services, basic reproductive health services, and basic research, data, and population and development policy analysis -– were well below the agreed target.
Philip Guest, Assistant Director of the Department’s Population Division, introduced the Secretary-General’s report on world population monitoring; Jose Miguel Guzman, Chief of the Technical Division of UNFPA’s Population and Development Branch, introduced a report on monitoring of population programmes.
David Canning, Professor at the Harvard School of Public Health, delivered a keynote address on “Population growth and changing age structure: Implications for the achievement of the Millennium Development Goals”, in which he focused on the implications of the demographic dividend on countries around the world.
In other business, the Commission took note of the report of the intersessional meetings of its Bureau, endorsing its conclusions and recommendations.
Earlier in the meeting, Commission Vice-Chairperson Elena Zuniga ( Mexico) recalled that she had been elected on 11 April 2008, alongside Vice-Chairpersons Ivanka Tasheva ( Bulgaria), Raja Nushirwan Zailan Abidin ( Malaysia), Year Ortiz de Urbina ( Spain) and Irene B.M. Tembo ( Zambia).
The Commission then appointed Ms. Tasheva Vice-Chairperson and Rapporteur of the session, and Mr. Nushirwan to chair its informal consultations on draft resolutions.
It also adopted its provisional agenda (document E/CN.9/2009/1) and approved its organization of work (document E/CN.9/2009/L.1/Rev.1).
Addressing the Commission were representatives of the Sudan (on behalf of the “Group of 77” developing countries and China), Czech Republic (on behalf of the European Union), Russian Federation, Bangladesh, Switzerland, Kazakhstan, Iran, Netherlands, Mexico and Indonesia.
Also making statements were representatives of the Economic Commission for Latin America and the Caribbean, the Economic and Social Commission for Asia and the Pacific, and the International Union for the Scientific Study of Population.
The Commission will meet again at 3 p.m. tomorrow, 31 March, to continue its forty-second session.
At the second meeting of the forty-second session of the Commission on Population and Development, participants had before them the report on the Programme of Action of the International Conference on Population and Development (ICPD) (document E/CN.9/2009/3), the report of the Secretary-General on monitoring of population programmes (document E/CN.9/2009/4) and the report on the flow of financial resources for assisting in the implementation of ICPD (document E/CN.9/2009/5).
Background information on the Commission’s session and a summary of the reports can be found in Press Release POP/970 of 26 March.
Today’s keynote address will be delivered by Davind Canning, professor at Harvard University, on “Population growth and changing age structure: Implications for the achievement of the Millennium Development Goals”.
RACHEL MAYANJA, Assistant Secretary-General and Special Adviser on Gender Equality and the Advancement of Women, read out a statement by Sha Zukang, Under-Secretary-General for Economic and Social Affairs, saying that, as the fifteenth anniversary of the International Conference on Population and Development approached, there was an impressive record of achievement, but major gaps remained in implementing its Programme of Action, especially in the least developed countries. That was worrying because achieving the Cairo objectives could contribute towards attaining other development targets, including the Millennium Development Goals.
Noting that reproductive rights were recognized today as central to women’s empowerment and advancement, she said many countries had proved that, by enabling women and their partners, fertility levels dropped, changing population dynamics in a beneficial way. The least progress had been made towards the Millennium Goal of reducing maternal mortality. Lower fertility reduced maternal mortality by between 25 and 40 per cent and could also serve the goal of reducing child mortality. Better health outcomes for women and children meant progress in the health-related Millennium Goals and objectives in the areas of education, women’s empowerment, gender equality and environmental sustainability. Fertility decline produced slower population growth and changes in the age distribution that could boost economic growth by reducing the proportion of dependants.
She said slowing population growth would buy time and increase the ability of countries to invest in human capital, combat poverty, protect the environment and build the infrastructure to pursue a more sustainable development path. By contrast, sustained and rapid population growth generated a drag on the economy, particularly in low-income countries. The strategies to reduce fertility and slow population growth were well known: expand awareness of modern contraceptive methods for women and men; empower women to decide when and how to use those methods; promote male responsibility regarding sexual health and fertility; and satisfy the existing unmet contraception needs. Achieving better child survival through modern contraception intended to increase the intervals between pregnancies could reassure parents that having fewer babies might still produce the number they desired.
Most of the populations that still had very high fertility were also those with moderate or high unmet family planning needs, she said, adding that an estimated 106 million women in developing countries today had an unmet need for contraception. In sub-Saharan Africa, one in every four married women aged 15 to 49 had an unmet need for contraception. Donor funding for family planning had not kept pace with requirements. Without adequate resources, child and maternal mortality would remain high and there would be a serious risk of failure to meet crucial health-related Millennium Goals. The successes achieved by many countries in pursuing the Cairo agenda indicated that what to do and what could be done was known, provided the necessary will and resources existed. “We must ensure that such will and resources materialize even -– and especially –- at this time of global financial and economic crisis. There is no time to loose.”
THORAYA AHMED OBAID, Executive Director, United Nations Population Fund (UNFPA), said that, during the first eight years of the new Millennium, the world had witnessed a dramatic scaling up of investments to improve the education and health of the world’s poor. Those investments had raised school enrolment rates, narrowed the gender gap in education, brought life-saving drugs to people living with HIV/AIDS, expanded HIV prevention, delivered bed nets to prevent malaria and improved child health through immunization. The current financial crisis threatened to wipe out those hard-won gains in improved health and reduced poverty. It required a comprehensive response that would promote early recovery, financial support for the poorest countries and reform of global rules and institutions. It also required stronger regulations and a greening of the economy.
Of existing international agreements for development, the Programme of Action of the International Conference on Population and Development was the most comprehensive, she said. It put people and human rights at the centre and articulated clearly the connections among such interrelated factors as human development, women’s empowerment, health, population dynamics, economic growth, consumption and production patterns, migration, refugees and environmental protection. The Cairo Consensus provided sensible recommendations and hope for the future, while the Programme of Action aimed to put the world in greater balance and improve the lives of current and future generations. Taking the current food, energy and climate crises into account, that agenda was more relevant than ever, but the world was far from achieving it.
The financial crisis threatened to push 200 million people back into poverty and reverse gains made in achieving the Millennium Goals, she said, emphasizing that it was time to redouble efforts to achieve the agenda of the International Conference by investing in the most vulnerable groups, including women, youth and migrants. Greater attention must be paid to population issues and more resources devoted to women’s empowerment and reproductive health, including maternal health care and family planning. “Now is the time to keep the promise to ensure universal access to reproductive health by 2015.” The world could now use population data -– mainly the 2010 census -- to better inform policies and programmes and monitor achievement of the Millennium Development Goals. Several successful projects had been piloted and the world could expand on them to scale up reproductive health services and improve women’s health.
The three critical interventions needed were family planning, skilled attendants at birth and emergency obstetric care, she said, adding: “If every woman had access to these reproductive health services, a woman would not die during pregnancy and childbirth each and every minute.” Far greater investment was needed to tackle widespread discrimination against women and girls. Equal partnerships between the sexes could be promoted on the basis of mutual respect and shared decisions and responsibilities. Public health improved when interventions were integrated through primary health care for reproductive health, HIV/AIDS, tuberculosis and malaria.
While resources for population activities had increased over time, overall funding was not sufficient to meet current needs and escalating costs, she said. In line with the call by the International Conference for a review and update of cost estimates, UNFPA had conducted a revision, taking into account the needs and costs of achieving the International Conference’s recommendations and the Millennium targets. The new cost estimates were contained in the Secretary-General’s report. The funding gap for reproductive health, particularly family planning, must be addressed urgently to ensure progress. Donor assistance for family planning as a percentage of all population assistance had dropped from 55 per cent in 1995, or a total of $723 million, to a mere 5 per cent in 2007, totalling $338 million.
Today there were 200 million women in developing countries, particularly Africa, with unmet needs for effective contraception, she said. “Now is the time to re-energize voluntary family planning. There is no investment in development that costs so little and brings benefits that are so far-reaching and enormous,” she said. She called on all Governments to increase resources for reproductive health, including family planning, and to increase investments in all areas of the International Conference’s population package, including data collection, analysis and its use for development planning and monitoring. Today, many lesser developed countries could not mobilize sufficient resources to fund their own national population, gender and reproductive health programmes. That was clear as countries embarked on the 2010 round of censuses, which was threatened by a lack of financing.
HANIA ZLOTNIK, Director, Population Division, Department of Economic and Social Affairs, stressed the importance of Government family planning commitments and population policies as well as concerted international action over the past 40 years in rapidly reducing fertility in most developing countries, mainly by expanding access to effective contraception methods. The slowing growth of the world population was a major achievement. Time had been on the side of the developing countries that had rapidly expanded the use of family planning. The resources saved by slowing the growth in the number of children in those countries had been channelled to support economic and human development. But least developed countries, which had limited access to modern contraception and high fertility rates, continued to experience fast population growth and generally lacked the resources to feed, educate and provide health care for the rapidly rising numbers of children.
The global population would expand by 1.1 billion in the next 15 years, even if the rate of population growth continued to decline, she said, with most of it in developing countries, and with populations in the least developed countries growing the fastest. The Programme of Action recognized that slowing population growth could buy time to adjust to future population increases. Population polices that ensured reproductive health and access to family planning were essential to combating poverty, underdevelopment, unemployment, disease and hunger. There was a need to more than redouble efforts to expand education, improve health and generate jobs by promoting gender equality and the full participation and partnership of women and men in productive and reproductive health; empowering women by enhancing their decision-making capacity in all spheres of life, particularly in terms of sexuality and reproduction; and ensuring that everyone had access to family planning methods.
It was more important than ever to buy time, as suggested in the Programme of Action, by ensuring that the path to slower population growth was followed, she said. But implementation funds had not kept pace with needs. Governments must urgently recommit to implementing the Programme of Action and take steps to finance implementation. Measures to ensure reproductive health must be integral to any strategy to improve global public health. The Commission must lay the groundwork to ensure that, by 2015, the failures of today were turned into successes.
PHILIP GUEST, Assistant Director, Population Division, introduced the report of the Secretary-General on “World population monitoring, focusing on the contribution of the Programme of Action of ICPD to the internationally agreed development goals, including the Millennium Development Goals” (document E/CN.9/2009/3), saying the world’s population was growing at 1.2 per cent today instead of the 1.7 per cent per year at the time of the Cairo conference. However, many countries had annual growth rates exceeding 3 per cent and populations growing rapidly had young age structures. Rapid declines in fertility produced an age structure that could facilitate economic growth.
While most developing countries today were not on track to meet the fourth Millennium Development Goal, efforts to reduce child mortality must be intensified, he said. Extended access to family planning would allow the spacing of births and thus reduce child mortality. If the average interval between pregnancies could be increased to 36 months, child mortality would decrease by 25 per cent. The risk of HIV/AIDS could also be reduced. However, the reduction of maternal mortality was proving difficult to achieve, particularly in the least developed countries. If unplanned and unwanted pregnancies could be avoided, maternal mortality could be decreased by 25 to 40 per cent. Increased access to family planning was a cost-effective measure to reduce maternal mortality.
He said slowing population growth also had positive implications for sustainability. Because population growth increased demand for water, for instance, moderating that growth would make it easier to conserve water, which was helpful to achieving Millennium Goal 7. There was ample evidence that Government commitment buttressed by adequate funding had made a major difference in the effectiveness of population policy. Given that scarcely six years remained to achieve implementation of the Programme of Action, there was no time to lose in ensuring that countries lagging behind redoubled their efforts to attain the Programme’s goals. The necessary measures were well known and proven. The will and the means to implement them were the main ingredients lacking. “Clearly, the time to act is now.”
Introduction of Report
JOSE MIGUEL GUZMAN, Chief, Population and Development Branch, Technical Division, United Nations Population Fund (UNFPA), introduced the Secretary-General’s report contained in document E/CN.9/2009/4, saying that women and men must be empowered through education, equal opportunities and the means to determine the number and spacing of their children in order to break the poverty cycle that hindered human development. The Fund’s work included efforts to reduce poverty by improving access to reproductive health and family planning, and engaging in policy dialogue to influence the formulation of pro-poor policies, including national development plans and health sector plans.
To achieve Millennium Goal 3, on gender equality, the Fund addressed such issues as women’s right to health and a life free from violence, he said. In that context, it worked with the Division for the Advancement of Women to support 10 United Nations country teams in preventing and responding to violence against women, and supported efforts to accelerate the abandonment of female genital mutilation. To address Goal 5, on maternal health, UNFPA, through programmes in 140 countries, worked with Governments to ensure that sexual and reproductive health -– including family planning -– was an integral part of national health plans and budgets. In addition, the Fund helped countries increase access to such maternal health services as skilled delivery care and emergency obstetric care. In 2003, it had launched the global Campaign to End Fistula, now active in more than 45 countries. To address HIV/AIDS, the Fund led efforts to strengthen HIV/AIDS prevention, reproductive health commodity security, condom programming and prevention of gender-based violence.
Describing UNFPA’s work in the area of Goal 7, environmental sustainability, he said the Fund supported research to improve awareness of the ways in which population dynamics and environmental change affected each other. Its climate change agenda included promoting sustainable cities and identifying the impact of climate change on migration. Generally speaking, UNFPA’s strategies focused on collaboration with a range of partners, strengthening national capacity, investing in human resource development, and facilitating technical support through national, regional and global networks. While much had been achieved in many areas related to the Goals, progress had been uneven, and more remained to be done. The fifteenth anniversary of the International Conference provided an excellent opportunity to redouble efforts.
WERNER HAUG, Director, Technical Division, United Nations Population Fund (UNFPA), introduced the report on the flow of financial resources for assisting in the implementation of the Programme of Action (document E/CN.9/2009/5), saying it analysed international and domestic financial resource flows that were part of the “costed population package”. That included funding for family planning services; basic reproductive health services; sexually transmitted diseases (STDs) and HIV/AIDS activities; and basic research, data, and population and development policy analysis.
He said the Programme of Action estimated that the cost of implementing a “population package” in developing countries and those with economies in transition would be $18.5 billion annually by the year 2005 and $20.5 billion in 2010. Some two thirds of the cost was expected to come from developing countries and one third from the international donor community, he said, noting that donor assistance had been increasing steadily over the past few years and was expected to surpass $8.1 billion in 2007. Although the total financial target of the International Conference had been surpassed, it turned out that funding for HIV/AIDS had increased, but financing for the package’s other components was below the agreed targets.
The resources mobilized were not sufficient to meet the needs in developing countries, he said. The targets had been fixed as of 1993 while today’s population and health situation was different, and the needs greater than anticipated. The report presented revised cost estimates for the four components of the costed package. It was now estimated that total costs for sexual and reproductive health amounted to $23.5 billion in 2009. Revised costs for the HIV/AIDS component were estimated to be $24 billion and those for basic research and policy analysis at $1.6 billion. The impact of the current global financial crisis might also impact the goals. The least developed countries would suffer the most. Commitment to mobilize sufficient funding was now more important than ever. The lack of adequate funding for reproductive health, and for family planning in particular, remained the chief constraint to full implementation of the Programme of Action, undermining efforts to achieve the Millennium Development Goal of universal access to reproductive health, including family planning.
ABDALMAHMOOD ABDALHALEEM MOHAMAD (Sudan), speaking on behalf of the “Group of 77” developing countries and China, said the goals and objectives set out in the Programme of Action were crucial to eradiating poverty and achieving the other Millennium Development Goals. Speedier and deeper debt relief, increased flows of official development assistance and fairer terms of trade were also needed to enable developing countries to boldly fight poverty and alleviate suffering by giving the world’s poorest better access to social services. The mutually reinforcing relationships between international migration and development should be understood within the new context of increased global economic integration, quicker and cheaper transport, and easier and more fluid communications.
Concerned that resources directed towards implementation of the Programme of Action were consistently below their targets, he appealed to donors, United Nations agencies and other international organizations to enhance their financial and technical support to developing countries. A multi-year programme of work with a two-year planning horizon was needed to meet the internationally agreed development goals. Although national and international funding for HIV/AIDS activities had increased significantly over the last few years, the need for full implementation of the Programme of Action had a direct impact on ability to achieve the Millennium Goals linked to health, social and economic outcomes. Thus, those targets aimed at halving the proportion of people living in poverty by 2015, and at significantly improving the lives of at least 100 million sum dwellers by 2020 were even more significant.
HELENA BAMBASOVÁ, Deputy-Minister, Ministry of Foreign Affairs, Czech Republic, speaking on behalf of the European Union, affirmed its strong commitment to the full implementation of the Cairo Programme of Action, pointing out that it was indeed at the Cairo Conference that delegates had first proclaimed the right to attain the highest standard of sexual and reproductive health. The Millennium Development Goals would not be achieved unless those rights were vigorously promoted. In the countdown to 2015, the European Union would accelerate action to guarantee universal access to reproductive health and continue to work closely with UNFPA, Governments and civil society in promoting those rights.
Each year, a lack of investment in sexual and reproductive health led to 80 million unwanted pregnancies and 340 million new sexually transmitted infections, she said. That such numbers had not declined in recent decades could only be seen as a major failure. To make motherhood safe, every woman needed family planning, skilled attendants at birth and emergency obstetric care. Governments must show significant financial commitment in such areas. Furthermore, as the largest generation of adolescents in history was now entering sexual and reproductive life, their access to health information, education and services must be urgently addressed.
For its part, the European Union would do its utmost to increase access to family planning, given the decline in international assistance for it. It welcomed the cost estimates presented to the Commission and the Population Division’s new projections. Formulating the appropriate policy and programme monitoring, performance and reporting depended on the regular availability of quality data, including statistics disaggregated by age, sex and income. Given the current financial crisis, the Cairo agenda’s recommendations pointed the way towards “much needed balance”. Adequate investments in women would reap tremendous rewards.
OLGA RODIONOVA ( Russian Federation), noting that population growth rate and social welfare were interlinked, said that, in the long term, demographic trends should be seen in light of economic growth. In the Russian Federation, the demographic policy up to 2025 was based on two fundamental approaches: the demographic policies tied together the country’s social policies; and the demographic situation shed light on problem areas in social development. The most acute problem was the high mortality rate, in particular among the working people, due to preventable reasons.
In order to change that trend, a national project called “Health” had been started three years ago, she said. It entailed increasing doctors’ pay, supporting medical primary care givers, strengthening health facilities for emergency assistance and building a network of prenatal centres. Vaccination programmes had also been broadened and a programme against cardiovascular diseases and car accidents, primary causes of mortality, had been launched, in addition to cancer-screening programmes and programmes to address tuberculosis, the leading infectious disease. In spite of the financial crisis, the Russian Government had stated that demographic programmes and public health spending would not be reduced.
ISMAT JAHAN ( Bangladesh) said the Programme of Action had several important qualitative and quantitative goals that were mutually supportive of population and development. Its full implementation could significantly contribute to achieving the internationally agreed development goals. Low-income groups generally had much higher fertility rates than high-income groups. High fertility led to persisting poverty from one generation to the next. A decline in the fertility rate could lead to increased national savings and economic growth because it reduced the percentage of dependent children and increased the number of working-age people. That caused a “demographic dividend”.
Noting that the global population growth rate had dropped from 1.54 per cent in 1994 to 1.17 per cent due in part to the drop in the global fertility rate, she said health-care costs had increased significantly since the International Conference and its targets were not sufficient to meet current needs. Bangladesh called for a review and update of resource management to fund population and reproductive health programmes in developing countries. The lack of resources, particularly in least developed countries, was a major impediment.
While developing countries continued to make progress in mobilizing domestic resources, external support was inadequate and donor support was concentrated in a few specific areas, while other areas were neglected, she said. The annual population growth rate of least developed countries was 2.37 per cent and the fertility rate was as high as 4.6 children per woman. High population growth due to sustained high fertility imposed increasing demands on existing resources, and given the current global crisis, least developed countries were least likely to afford large outlays for population activities. The United Nations and other international organizations should enhance their support to help developing countries, particularly least developed countries, implement the Programme of Action.
MARKUS SCHWYN ( Switzerland) said the right of every person to determine the number and spacing of their children, to attain high standards of sexual and reproductive health, and the right of full and equal participation by women were crucial to the attainment of population goals and sustainable development. The Cairo Programme of Action had laid out a path that led to development based on human dignity and the comprehensive personal fulfilment of each human being. The empowerment of women was not only of utmost importance in its own right, but also central to overall progress, poverty reduction and development.
He said it was important to integrate population, sexual and reproductive health and gender issues into national development plans and poverty-reduction strategies. The integration of sexual and reproductive health, including the prevention of and treatment for sexually transmitted diseases, as well as family planning into primary health services were key. Only through the involvement of men and boys in all areas of sexual and reproductive life could an improvement in those areas be possible. Switzerland noted with concern the serious shortcomings regarding the financial resources necessary for implementation of the Programme of Action and called for an increase in bilateral and multilateral assistance as well as domestic budget allocations.
BYRGANYM AITIMOVA ( Kazakhstan) said almost 90 per cent of the world had developed policies to implement the Programme of Action, made the necessary legislative or institutional changes to do so or adopted other national measures to protect reproductive rights. In 2004, Kazakhstan had adopted a reproductive rights law in accordance with its national strategy to reform the health care system. Kazakh officials had set up national machinery for women’s advancement at the highest political level and adopted the second Plan of Action on Gender Equality. However, least developed countries had not achieved their demographic goals for reducing poverty due to high fertility rates, particularly among the very poor. The global food and financial crises had erased the efforts of Governments, civil society and the private sector, despite increased funding for population programmes in recent years.
There was serious concern about the reduction in official development assistance (ODA) as well as a possible decline in interest in population problems, including reproductive health, among private sector partners, she said. Despite overall budget cuts, the Government of Kazakhstan guaranteed social support for the country’s most vulnerable populations, especially women and children, due to their special needs in reproductive health, safe motherhood and gender equality. The Government had expanded benefits packages to pregnant women and those on maternity leave. However, the slow progress in reducing maternal mortality and morbidity was regrettable, and only 30 per cent of people in need, including pregnant women, received antiretroviral therapy despite a decline in the HIV infection rate and growing institutionalization of programmes to prevent and treat HIV/AIDS.
DAVID CANNING, Professor, Harvard School of Public Health, delivered a keynote address on “Population growth and changing age structure: Implications for the achievement of the Millennium Development Goals”, saying that the reduction of world poverty was one of the overriding moral imperatives for the current generation. Twenty years ago, the key theory in demographic trends had been concerned with population numbers and population growth, of which the latter diluted capital, according to the theory. While that theory had seemed obvious, the evidence had turned out to be weak.
There was little evidence that population size affected economic growth. Countries could import and export, but in a global economy, they could deal with large populations by importing the raw materials, he said. At the national level, however, there was evidence that population growth had specific components. Population growth rate was equal to birth rate minus death rate plus net migration rate. The source of growth was important. A low birth rate increased economic growth. A high death rate, which also slowed population growth, lowered economic growth, for instance.
Fertility and mortality rates mattered because of their influence on the age structure, he said. When fertility and mortality rates changed, they caused changes in the age structure which would have economic consequences. In addition, there were also behavioural consequences as longer life spans changed behaviour. Lower fertility also had behavioural effects, which could lead to greater investment in children and the age structure of working people.
He said fertility and mortality rates determined population structures, with those of working age being productive. A large working-age population could be beneficial to the economy, but a large number of children required resources. A large number of older people was different, however, as they could be saving for their retirement. The dependence of elderly people was a function of the social system. The demographic dividend also included the effects of lower fertility and mortality. In 1975, children formed a large part of China’s population as a consequence of lower infant mortality. In 2000, they had aged and East Asia now had a large group of working people. Further into the future, the large cohort of working people would approach retirement age and the number of children behind them would become smaller.
Fertility could decrease too much, as in European countries, he continued. In a “steady” State, there would be fewer workers relative to the aged population. In the developing countries, with their high fertility rates, the effect would be beneficial. In Asia, one third of the growth had been a result of the age structure effect. The “Asian miracle” was one of more workers per capita. Ireland, which had legalized contraception in 1979, had reduced the fertility rate sharply and now had a decline in the youth dependency rate and rapid economic growth.
The estimated effects on the economy could be larger than the accounting effects due to behavioural impacts, he said. The demographic dividend was not automatic, but varied according to Government and economic policy. With good policies, the dividend might be three times larger than the accounting effect. The behavioural effects included increased savings for retirement. There were beneficial effects of early childhood health investments. There were also important fertility mechanisms. When fertility increased, female labour market participation also increased. The reduction in family size could lead to higher investment in education per child.
In conclusion he said that, at the household level, providing family planning services reduced fertility while lower fertility led to increased female labour force participation and income, as well as higher investment in children’s health and education. At the national level, lower fertility increased income per capita and boosted family income. Over the long-run, smaller families could produce a healthier and better educated workforce. Well-informed families, with access to reproductive health and family planning choices, were best placed to make decisions and trade-offs.
During the ensuing question-and-answer period, the representative of Tunisia said demographic dividends were already occurring in her country, which had a large percentage of educated people of working age. Tunisia had ambitious policies to control the birth rate, but there was a high unemployment rate among qualified people. The Government was working to give women and young people better access to jobs.
The representative of Israel asked Mr. Canning to elaborate on how to change family planning strategies to address an ageing population, saying his country had a desire for bigger families and higher fertility, which would require greater economic growth.
Mr. CANNING said the demographic dividend effect was not symmetric. Expanded economic growth was necessary to achieve a large enough stock of capital to support the elderly. Poor countries must find a cliff, so to speak, to become rich. The demographic dividend was like a wave used temporarily to push a country over the cliff. A country that took advantage of that wave could obtain a high level of income fast, but one that did not take the opportunity would see the benefit disappear in 50 years. Because of the demographic dividend, China would see a slowing of its fast-growing economy to the moderate growth experienced in developed countries. Like Israel, European countries and Japan were thinking about a return to larger families since smaller ones had led to very large age dependency rates.
The representative of Cuba asked what would happen in his and other developing countries when the demographic divided ended. Cuba had long invested in human capital and now had three people per family on average. It had lowered its mortality rates and now had an ageing population. Some developed countries had attracted people from developing countries to address work force shortages, but that was not viable in Cuba’s case.
Mr. CANNING said it was always dangerous to predict the future, but lower fertility in developed countries had led to an ageing population, which would happen in China quite soon. Having a lot of elderly people was not the same as having a lot of children. Social security systems were needed to help the elderly. Countries would be well advised to have real resources rather than transfer systems to address ageing.
A representative of the World Youth Alliance said the drop in Europe’s fertility and the subsequent increase in health care prices had made it more expensive to take care of ageing people there. Europe’s active population was funding social services and services for the elderly. Europe had resolved its health-care labour shortage problem by bring in more immigrant health-care workers.
Mr. CANNING said that some European countries and Japan, facing shortages of health-care workers, were indeed bringing them in from Africa and the Philippines. More international collaboration was needed on that in order to prevent a brain drain from the developing to the developed world. Migration flows must be mutually beneficial, but at present, it benefited only the receiving countries and health-care migrants. Perhaps developed countries could pay for those migrants’ training, among other programmes.
Continuation of General Discussion
ESHAGH AL-HABIB ( Iran) emphasized that, notwithstanding the facts regarding population causes of underdevelopment, it was underdevelopment that hindered the attainment of the Cairo goals in developing countries. They faced tremendous economic and financial challenges inherited from the unjust, imbalanced economic, financial and trade systems. Although financial resources for the Cairo International Conference’s Programme of Action had been increasing steady, there was still a big gap between the actual resources and what was needed. Even existing resources had not been allocated to all components of the Programme in a balanced manner. There was also a concern about donors’ funding commitments in light of the current crisis.
He said that, given the diverse challenges facing developing countries, the responses should also vary, based among other things on levels of development. In that regard, capacity-building and development were the core exercise of all relevant stakeholders in realizing the global partnership for development. Although many United Nations operational activities for development were aimed at capacity development, they fell short of expectations. A new approach to technical support was necessary to speed up progress. Iran also wished to emphasize the importance of promoting South-South cooperation in tackling population issues.
MARION VAN SCHAIK ( Netherlands) said the Dutch Government had recently launched a new policy paper on sexual and reproductive health and rights and HIV/AIDS. Titled “Choices and Opportunities”, it was about when to have sex and with whom, as well as the timing, number and spacing of one’s children. But in order to make choices, one needed opportunities, including access to contraceptives and life-saving medicines, a proper education, comprehensive sexual education, protection from sexual violence, exploitation and mutilation, and access to sexual and reproductive health services.
Progress on the fifth Millennium Goal lagged far behind, he said, noting that, between 1990 and 2005, the maternal mortality rate had fallen by only 1 per cent instead of the required 5.5 per cent. Too many women were dying unnecessarily due to inadequate health services. More attention should be paid to addressing the great and rapidly growing gap between demand and supply in family planning. The Millennium Development Goals would not be achieved as long as family planning services were not widely available and unintended pregnancies were not prevented.
Access to sex education and male and female condoms seemed a neglected but very cost-effective approach to advancing the sixth Millennium target, he said, adding that his country’s pragmatic and inclusive approach to HIV/AIDS and sexual and reproductive health and rights had led to the lowest rate of teenage pregnancies and abortions in the world. The Netherlands was one of the largest donors to UNFPA, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
FELIX VELEZ FERNANDEZ VARELA ( Mexico) said his country had been the second in the world to include in its Constitution the right to decide freely on the number and spacing of children. Although the population growth rate had accelerated over the last decades, in absolute terms, they had dropped to 0.8 per cent. Life expectancy had increased by 10 years to 77 years, one factor behind that phenomenon being a drop in infant mortality to 14.7 children per 1,000 live births. Because the population structure had changed, it was important to bring public policies into step with reality. Ageing would accelerate over the next decades, but there was currently a favourable demographic relationship of 53 inactive people for every 100 working people.
He said his country had improved basic services such as education and family planning was included in the health services available. The spacing of children had contributed to a drop in fertility and the use of contraceptives had increased by 50 per cent since 1974. Sexual and reproductive health services had also improved over the years. Mexico’s social policies incorporated a gender-based perspective. Regarding migration, Mexico had been focusing on managing migratory flows with neighbouring countries, and had tried to ensure the human rights of the migrants.
SUGIRI SYARIEF ( Indonesia) said population growth must be well planned to allow any country effectively to formulate a socio-economic development plan to match its capacity and capability. High rates of growth and low quality of population would undermine the country’s quest for social and economic progress. As a result, the balance between the quantity and quality of the population would be so skewed as to leave many needs unmet. Birth control through family planning programmes, particularly in developing countries, was a development necessity. The programmes must be seen in the context of demographic imperatives that emphasized the need for planned population growth and the fulfilment of the reproductive rights of individuals and couples.
He said that, in his country’s development plan for 2005-2025, the desired replacement level of fertility would have been achieved by 2015. However, projected targets had not been achieved as expected, due to some obstacles affecting full implementation of the national family planning programme. The fertility of low socio-economic groups had shown an increase and there had been no marked tendency among young women to postpone marriage between 2002 and 2007. The contraceptive prevalence rate had only increased from 60.3 per cent to 61.4 per cent between 2002 and 2007, and unmet needs had risen from 8.6 per cent to 9.1 per cent. As a result, the Government was currently involved in an attempt to revitalize the family planning programme, and called for international support.
DIRK JASPERS-FAIJER, Director, Population Division, Economic Commission for Latin America and the Caribbean, said the Division would report on implementation of the Programme of Action in the region for the period 2004 to 2009. The report would have a rights-based focus and underline the persistence of unacceptable social and economic inequalities. It would also, among other things, address issues such as ageing, gender equality, migration and urban development, with special attention to the status of groups such as women, youth, elderly and indigenous people. The report would further specify the Division’s support to countries in drafting their national reports. It would underscore the links between compliance with the Programme of Action and achievement of the Millennium Development Goals. The Population Division had organized several seminars in the region and would provide a breakdown of social groups.
KEIKO OSAKI, Chief, Social Policy and Population Section, Social Development Division, Economic and Social Commission for Asia and the Pacific (ESCAP), said the Asia-Pacific region -– home to 62 per cent of the world’s population -– continued to experience significant demographic changes, with the decade up to 2008 having shown a steady drop in annual population growth to 1 per cent. In that period, the total fertility rate had declined from 2.5 children per woman in 1998 to 2.2 children in 2008, a dynamic that impacted prospects for achieving the Millennium Development Goals.
At the same time, the region was an economic powerhouse likely to meet the 2015 target of halving the proportion of people living in income poverty, he said. Indeed, the number of people living in extreme poverty had fallen from 1.9 billion in 1995 to 641 million in 2004, due mainly to a sharp drop in poverty in South-East Asia and China. While nearly all countries had net primary-school enrolment ratios exceeding 90 per cent, there were gender disparities in several countries where data did not exist.
Turning to women’s share of non-agricultural wage employment -– an indicator of their empowerment -– he said they were often employed in labour-intensive, low-value-added manufacturing and service sector jobs. They were also poorly represented in national parliaments. In health and child mortality, the region faced challenges in the approach to 2015, with 250,000 women dying in childbirth or from pregnancy-related complications each year. With the global financial crisis threatening to unravel progress, there was a greater need than ever for strategies proposed in internationally agreed documents.
HELGE BRUNBORG, International Union for the Scientific Study of Population (USSP), said national fertility rates ranged from 1.2 births per woman to well over six births per woman and life expectancy ranged from about 40 to 80 years. Many industrialized countries had fertility well below replacement levels and faced the prospect of long-term decline in population size combined with population ageing. At the other extreme were many poor countries where fertility remained high and populations were set to double or even triple by mid-century. In the middle were a large group of countries, mainly in Asia and Latin America, where fertility had declined appreciably, but population growth, particularly among people in their reproductive and working years, continued.
The session’s main concern was the poorest countries, she said, noting that half of the world’s 76 poorest nations had population growth rates of 2 per cent or higher and fertility rates of about 5 births per woman. Half the people in those populations were under age 15 and 20 per cent of them lacked proper access to contraceptives. Most of those countries were in sub-Saharan Africa. The Secretary-General’s report showed the serious implications of those population features for achieving nearly all the Millennium Goals.
Future prospects for countries with fragile ecosystems were truly alarming, she continued, adding that continued rapid population growth made ending hunger and achieving food security a huge challenge. Efforts to lower fertility in Africa had faltered in the past decade and petered out altogether in some countries. It was time to debate such issues honestly. Reproductive rights and health were fine, but they were no substitute for priority-setting based on a correct understanding of the importance of population trends on development.
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* The 1st Meeting was covered in Press Release POP/965 of 11 April 2008.