Keynote Speaker, Delegates Urge Greater Investment in Family Planning Services as Commission on Population and Development Continues General Debate
Keynote Speaker, Delegates Urge Greater Investment in Family Planning Services as Commission on Population and Development Continues General Debate
|Department of Public Information • News and Media Division • New York|
Commission on Population and Development
4th & 5th Meetings (AM & PM)
Keynote Speaker, Delegates Urge Greater Investment in Family Planning Services
as Commission on Population and Development Continues General Debate
Robust investments in family planning services could pay immense dividends in the battle to achieve development targets, delegates and experts said today as the Commission on Population and Development continued the 2011 general debate of its forty-fourth session.
“Family planning is to maternal survival what vaccination is to child survival,” affirmed keynote speaker Amy Tsui, quoting a comment by a World Bank official. “The low cost of investing in contraception and the high return on investment makes contraceptive security a feasible outcome for all nations,” added Ms. Tsui, a professor at the Johns Hopkins Bloomberg School of Public Health and director of the Bill and Melinda Gates Institute of Population and Reproductive Health, stressing that many Governments could “afford to step up to the plate”.
Ms. Tsui’s keynote address explored worldwide trends in the use of contraceptives and other family planning methods. It charted the impact of unintended childbearing — particularly in high-fertility countries — including higher levels of maternal mortality, lower levels of secondary education and a diminished ability to invest in human capital.
Following her presentation, many speakers echoed the call to invest in making adequate family planning services more widely available. The representative of Bangladesh said that, while his country suffered from “huge unmet needs” in the area of family planning, the recent decline in its overall fertility was a positive trend. Moreover, he noted that population control would be needed to realize development progress in the world’s least developed countries, including his own. “If we cannot check the population growth rate in the LDCs … most of our development efforts are likely to fail,” he warned.
“The nexus between poverty and reproductive health can be characterized as a vicious cycle,” said the representative of the Philippines, adding that high fertility and lack of access to reproductive health services had exacerbated the poverty prevailing in his country. Nigeria’s representative, meanwhile, cautioning that his country’s high fertility rate would likely push the national population to 164.8 million this year, stressed that Nigeria was working hard to reduce fertility rates and expedite development. Only 10 per cent of married women used modern methods of contraception, he said, a situation that resulted both from cultural beliefs and large unmet needs for family planning services. Moreover, almost half of all Nigerian women were married by the age of 18 and began bearing children early in life, he added.
Delegates from several countries with low fertility rates, or with high rates of successful family planning, also shared their experiences, with Denmark’s representative calling on all Member States to promote women’s health in their national agendas. “It is the right thing to do and it pays off,” he added. Detailing some of his country’s efforts to support women’s health in the developing world, he called for “determined political leadership” on the part of Governments, saying it was unacceptable that in 2011 far too many women around the world had no right to make decisions about their own bodies, and that so many women and girls were denied full, equal participation in social development.
Norway’s representative agreed, noting that family planning was freely available and widely used in her country, and that its rates of maternal mortality were so low that they could hardly be reduced. Norway had benefited from “courageous politicians” who had insisted on the moral imperative of working towards the best outcomes, even if that meant taking up sensitive issues. At the same time, those positive indicators did not necessarily mean that fertility must remain low, she cautioned. Norway, in fact, enjoyed one of the highest fertility rates in Europe, thanks to significant amounts of Government-mandated parental leave and other “family-friendly” policies.
Other delegations disagreed more strongly with the assertion that high fertility was a negative condition. “The increasingly discredited concept of population control must be discarded,” said the Permanent Observer for the Holy See, adding that Governments must not forget that people were an asset, not a liability. He went on to state that the relevant report of the Secretary-General improperly suggested that reproduction rates in developing countries were a primary concern demanding urgent attention. It also promoted the “tragic theory” that fewer poor children would reduce the need to provide education, fewer poor women giving birth would mean less maternal mortality, and fewer people to feed would result in less malnutrition and greater resources for development. Such a distorted world view saw the poor as a problem to be commoditized and managed rather than unique individuals with innate dignity and worth, he said.
Also speaking today were the representatives of Mexico, Botswana, Cuba, Portugal, Pakistan, Netherlands, Guatemala, Israel, Uganda, Argentina, Gambia, India, South Africa, Jamaica, Belarus, Sweden, Viet Nam, Colombia and Belgium.
Taking part in a question-and-answer session with the keynote speaker were the representatives of Malaysia, Iran, Norway, Indonesia, Denmark, Kenya, United States, Netherlands and the Gambia.
A representative of the World Health Organization also delivered a statement.
Others speaking today were representatives of the following non-governmental organizations: Asian-Pacific Resource and Research Centre for Women; Family Care International; Ipas; Equidad de Genero: Ciudadania, Trabajo y Familia; International Planned Parenthood Foundation; World Population Foundation; International Planned Parenthood Federation Africa Region; Latin American and Caribbean Women’s Health Network; Advocates for Youth; Population Action International; New Zealand Family Planning Association(on behalf of a network of civil society organizations working in the Asia-Pacific region); Catolicas por el Derecho a Decidir; Global Youth Action Network; International Planned Parenthood Federation Western Hemisphere Region; European Parliamentary Forum on Population and Development; and International Planned Parenthood Federation European Region.
The Commission will reconvene at 10 a.m. tomorrow, 13 April, to continue its general debate.
The Commission on Population and Development met this morning to continue its general debate on national experiences in population matters: fertility, reproductive health and development.
FELIX VELEZ, Secretary-General, National Population Commission of Mexico, said fertility in his country was highest among rural indigenous women and poor urban women. According to the 2010 census, the fertility rate for mothers with greater access to education was 1.1 children per women, while that for uneducated mothers stood at 3.5. While the 2009 national population survey had revealed that all Mexican women had knowledge of contraception, 60 per cent of them had not used it in their first sexual relationship, thereby increasing the risk of unwanted pregnancy. Emphasizing that contraceptives were universally available and free, he said the country’s average age was between 26 and 29 years, although the population of people over 65 was growing by 3.5 per cent annually. The demographic boom would continue until 2030, the year in which the proportion of seniors would surpass that of young people. Discussions on fertility must go hand in hand with the debate on economic development, he said, emphasizing the importance of improving the quality of human capital in terms of health, nutrition, education and access to sexual and reproductive health in order to sustain the workforce and thereby promote development.
TOMAS OSIAS ( Philippines) said his country had only reduced its birth rate to 162 deaths per 100,000 live births, compared with its original goal of 52 deaths per 100,000 live births. High fertility and lack of access to reproductive health services had exacerbated the prevailing poverty and negatively affected development in general. “The nexus between poverty and reproductive health can be characterized as a vicious cycle,” he said. Since poor Filipinos had little access to information and services that should be provided by the State, many women continued to experience unwanted and unplanned pregnancies. Another emerging risk was the rising incidence of sexually transmitted diseases, including HIV/AIDS. Moreover, the Philippines had yet to establish a comprehensive national policy on reproductive health and population, though the majority of its people had spoken in favour of one. In 2007, the Government had launched the Maternal, Newborn, Child Health and Nutrition Programme. It had also created the Conditional Cash Transfer Programme to address socio-economic factors affecting fertility and reproductive health. “The country is at a defining moment as it tries to legislate a national population policy,” he said, adding that it needed all the support it could solicit from the international donor community.
CARSTEN STAUR ( Denmark) said his country was at the forefront of promoting sexually responsible human development in partner countries, including reduced maternal mortality. It supported the health sectors of five African countries, as well as a range of key international organizations involved in national-level advocacy, capacity-building and reproductive health services. Denmark’s support to Marie Stopes International would provide 1 million safe abortions and distribute more than 160 million condoms; it would continue supporting and promoting women’s health and rights, he said, adding: “It is the right thing to do and it pays off.” It was unacceptable that in 2011, far too many women around the world had no right to make decisions about their own bodies and that so many women and girls were denied full, equal participation in developing their societies. Determined political leadership would ensure access to free, skilled maternal health services and effective health systems, he said, stressing also that neglected areas such as sexual and reproductive health and rights should be addressed through access to safe, legal abortion and expanded access to family planning.
ABDUL MOMEN (Bangladesh), associating himself with the Group of Least Developed Countries, recalled that the Secretary-General’s report mentioned his country several times, including as an intermediate-fertility country, where the mean age at first birth was still low at 17.7 years. Noting that fertility had declined markedly, from 4 children per woman in 1995 to 2.4 in 2009, he said that where child marriage had once been pervasive, a substantial increase in girls’ education had reduced the rate of that practice. Maternal mortality had also fallen, though there was still a long way to go in that regard. As for family planning, there were “huge” unmet needs, he said, adding that Bangladesh looked forward to the outcome of the upcoming Fourth United Nations Conference on Least Developed Countries, which would address the situation of millions of poor people and call for the donor community to renew its commitments to ameliorate their plight. “If we cannot check the population growth rate in the LDCs and adequately face the bad consequences of change, most of our development efforts are likely to fail and are doomed to collapse,” he concluded.
CHARLES T. NTWAAGAE (Botswana), noting steep variations in the fertility rates of countries with similar developmental challenges, said other factors — including the liberalization of policies, which gave rise to options such as abortion, and the prevalence of marriage and divorce — must be at play. The correlation between high fertility rates and negative development indicators was “alarming”. Like most developing countries, Botswana was experiencing a transition in its demographic outlook, with a considerable decline in overall population growth due to higher literacy rates among women and increased contraception. It had been able to roll out extensive health infrastructure, ensuring that 84 per cent of the population lived within five kilometres of the nearest health facility. About 95 per cent of pregnant women now received some type of ante-natal care from a skilled health professional, he said, adding that anti-HIV programmes had yielded some promising results, particularly in minimizing mother-to-child transmission of the AIDS-causing virus.
JAIRO RODRÍGUEZ HERNÁNDEZ ( Cuba) said country’s sexual and reproductive health services had been enhanced nationwide, and were now free of charge and universally available. All population-related initiatives aimed to promote comprehensive education and health care, as well as minimum, stable social security and welfare for all. Cuba had shown “unquestionable achievements” in promoting gender equality, including by integrating women into all aspects of social and political life, and in carrying out a broad campaign to eradicate sexist stereotypes. Although the Government had also launched a massive effort to curb the spread of HIV and educated the population about the disease, its efforts had not escaped the unjust economic blockade, he said, recalling that, at the beginning of the year, the Government of the United States had seized some $4 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria that had been earmarked for three cooperation projects in Cuba. Washington’s hostile and illegal action had “seriously hindered” the multilateral international cooperation offered by the United Nations, he noted. Worse, it impacted funds directed towards combating the spread of pandemics in Cuba.
JOÃO MARIA CABRAL ( Portugal) said his country’s population was ageing due to a decline in fertility (1.3 children per woman in 2009) combined with reduced mortality rates and higher life expectancy. Legislation and other measures adopted in 2007 to ensure universal access to reproductive and sexual health, had boosted access to both infertility treatment and contraception, he said, describing further initiatives in support of reproductive health and family well-being, as well as programmes targeting marginalized groups and adolescents. Diagnoses of AIDS had increased in 2009, but the pace was slowing due to the distribution of condoms and other materials. Portugal’s commitment to the empowerment of women carried through to its development assistance to Guinea-Bissau and other countries, he said.
TANIMOWO DOTUN ODUNEYE, Federal Commissioner, Population Commission of Nigeria, said his country’s fertility rate remained high at 5.7 per cent, which, if sustained, would push the national population to 164.8 million in 2011, a 75 per cent increase from 1991. The high fertility rate was due largely to early marriage, as almost half of all Nigerian women were married by age 18. Unintended, unwanted pregnancies were common, resulting from unsafe abortions that put women at risk of death and fistula. That was due in part to resistance to family planning due to cultural beliefs and misconceptions, coupled with large unmet needs for modern contraception, he said, noting that only 10 per cent of married women used modern family planning, significantly below the Government target of 22 per cent. To reduce fertility rates and expedite development, the Government had revised the national population policy in 2004, implemented strategies for national adolescent health and gender equality, increased its commitment to girls’ education, provided free maternal health services, boosted funding for HIV/AIDS programmes and family planning services, and trained 30,000 health-care providers to perform life-saving post-abortion services, among other steps.
SOHAIL AHMAD, Secretary, Planning and Development Division of Pakistan, said his Government was in the process of finalizing its latest national population policy, which sought to strike a balance between population and resources. Its goals had been set out in line with three of the main objectives of the Programme of Action of the International Conference on Population and Development, including expanded access to education, particularly for girls; reduced mortality rates; and greater access to quality reproductive health-care services and family planning. The policy laid out a broad framework for achieving economic development and enhancing the quality of life by focusing on family planning, especially for those living in rural areas, he said. The Government would concentrate on raising awareness, strengthening advocacy, building alliances and renewing commitment at the national level. The Government had also adopted various measures to help empower women and enhance their integration into all levels of society, he said, adding that, in the longer-term, it planned to support gender-sensitive budgeting to address gender inequality on multiple levels.
ELLY LEEMHUIS-DE REGT ( Netherlands) said her country’s national policy on fertility, reproductive health and development and its role as an international donor was clearly stated in the Secretary-General’s report. That policy illustrated the cost-effectiveness of investing in women, young people and vulnerable groups. She said comprehensive sex education, access to family planning, including condoms and contraceptives, continued care, including the legal right to safe abortion, and harm-reduction programmes had helped people decide freely and responsibly the number, spacing and timing of their children. Thanks to those national policies, the Netherlands enjoyed low rates of teen pregnancy, HIV infection and abortion. As an international donor, the Government had made sexual and reproductive health and rights a top policy priority, adding that pragmatism had produced good results in family planning, education and support to youth. Hailing recent initiatives by organizations around the world to share best reproductive-health practices, she said the Africa Progress Panel policy brief on maternal health was an important publication about best practices on that continent, as well as concrete key approaches.
VERONICA SAJBIN ( Guatemala) said her country had frequently found it difficult to pass national laws in areas relating to reproductive health. In particular, endeavouring to reduce the inequalities faced by rural and indigenous women, who were frequently less educated than other women, had proven difficult. While a national law on reproductive services had been passed in 2002, and a strategy to allow comprehensive access to family planning means adopted in 2009, legislation on those matters remained challenging. Similarly, access to sexual and reproductive education, and to family planning means, were now widely available, but they had been challenging to establish. Among other goals, the Government was now pursuing policies for the prevention of sexually transmitted diseases and HIV/AIDS, while seeking to raise the age of first pregnancy, she said.
SERGIO DELLA-PERGOLA, Professor and Shlomo Argov Chair on Israel-Diaspora Relations, Hebrew University of Jerusalem, Israel, said that despite widespread and fully accessible family planning, his country had the highest fertility rate of the world’s 50 most developed countries, at 2.96 per cent in 2009. It also had the world’s sixth lowest maternal mortality rate and the nineteenth lowest infant mortality rate. National law fully supported women’s right to make fertility choices, he said, noting that medically assisted fertility was comparatively high. Fertility rates were highest among religious Israelis, but secular married adults desired 2.7 children on average. Recent fertility-rate stability was due to the rise in the percentage of well-educated working women, he said. Fertility was not so much related to religion or the State, but to the well-being of the nuclear family, the couple and “the self”. He stressed the importance of expanding public and private funding for reproductive health and development, with an emphasis on a broad range of services and facilities to improve early-childhood education, housing and other conditions for working women rather than on payment transfers.
WILBERFORCE KISAMBA-MUGERWA, Chairman, National Planning Authority of Uganda, said his country’s population, with a fertility rate of 6.7, was projected to more than double from the current 33 million (around half below the age of 18) to 80 million by 2030. Maternal mortality was falling gradually, having stood at 435 per 100,000 live births in 2006. The national development plan for 2010 to 2015 incorporated a multi-sectoral approach to population and development, encompassing: reproductive health; human-resource development; improved nutrition; poverty alleviation; women’s empowerment and equality; protection of women from violence and harmful traditional practices, and universal primary education; and greater access to contraceptives and family planning services through various national health initiatives and public-private partnerships.
Ms. AUSTEG ( Norway) said her country’s maternal mortality and related indicators were so low they could hardly be reduced. Historically, Norway had benefited from a strong push for midwifery and maternal care in hospitals, among other policies. Courageous politicians had insisted on the moral imperative of working towards the best outcomes, even if that meant taking up sensitive issues, she said. She said Norway’s total fertility was among the highest in Europe, a result of family-friendly policies including 56 weeks of parental leave with pay, full kindergarten coverage for children up to one year of age, and much additional parental leave each year. Even male Cabinet Ministers took parental leave. Because of those and other factors, the Norwegian population was expected to age considerably more slowly than those of other European countries. Additionally, family planning and abortion services were easily accessible and widely available, while contraceptives were largely available free of charge. Teenage pregnancy had declined to a low 9 per 1,000, and while the child-bearing age had risen, it was now stabilizing in the early 30s. Responsible reactions by non-governmental organizations had helped to keep sexually transmitted infections relatively low and reduced rates of discrimination, she said in conclusion.
FRANCIS ASSISI CHULLIKATT, Permanent Observer, Holy See, said the Secretary-General’s report improperly suggested that reproduction rates in developing countries were a primary concern demanding urgent attention. It also promoted the “tragic theory” that fewer poor children in the world would lead to a reduced need to provide education, fewer poor women giving birth would mean less maternal mortality, and fewer people to feed would result in less malnutrition and greater resources for development. “To combat legitimate problems, the increasingly discredited concept of population control must be discarded,” he emphasized, adding that such a distorted world view saw the poor as a problem to be commoditized and managed rather than unique individuals with innate dignity and worth who needed the international community’s commitment to help them realize their full potential. Noting that population growth was below replacement level in some countries, he said lower fertility rates had given rise to ageing populations unable to sustain economic development or provide the necessary resources to support themselves. Governments must not forget that people were an asset, not a liability, he stressed.
AMY TSUI, Professor, Johns Hopkins Bloomberg School of Public Health and Director, Bill and Melinda Gates Institute of Population and Reproductive Health, delivered the keynote address. Describing family planning as one of the 10 best public health achievements of the twentieth century and today, she said more people around the world now practised contraception than not. In developing countries, particularly, the number of couples practising contraception had risen tenfold over the last 50 years, from an estimated 70 million in 1960-1965 to about 700 million today. An estimated 73 per cent of the means used by married women were “modern methods”, such as tubal ligation, intrauterine devices and the birth control pill. In Indonesia’s case, the introduction of newer methods had often resulted in an increase in the overall use of contraception among the female population, which underscored the importance of providing a variety of methods. “Introducing new methods enables choice, and this increases use,” she added.
Despite those gains, however, challenges continued to hinder the realization of universal access to contraception, she said, pointing out that major economic inequalities in access to contraceptive and other reproductive health services remained in all world regions. Between the highest and lowest income groups, there were disparities in contraceptive use, teen pregnancy rates, unmet needs and unwanted child-bearing. Poverty deprived women of access to essential health-care services, especially in settings where gender discrimination was prevalent, and the resulting poor health outcomes, in turn, adversely affected opportunities for women and their families to escape poverty. Vulnerable groups, such as adolescent girls, were the most disadvantaged and least empowered to make decisions about their own bodies, she said. While family planning programmes in sub-Saharan Africa particularly had shown varying degrees of success in reaching all social segments, inequalities persisted in all countries, according to one recent study, she said.
She went on to note that the world population aged 15-24 continued to increase, becoming increasingly clustered in the Asia-Pacific and African regions, while a trend of increasing sexual activity among young, unmarried youth had been noted. The consequences of unintended child-bearing included higher overall fertility rates and negative impacts on the age structure of a population, she said. Additionally, investment in human capital was clearly associated with fertility levels, with high-fertility countries proving the most challenged in terms of investment in human capital. The share of secondary school-aged girls enrolled in classes tended to be higher in countries with lower fertility rates, while higher fertility was associated with an elevated risk of maternal death, she said. Meanwhile women aged 15-39 had the highest HIV prevalence and was also the age group most likely to have unmet contraception needs.
In response to some of those challenges, efforts to integrate family planning, maternal, newborn and child health-care were improving, with resulting cost-efficient synergies in resource allocations, she said. Experts had estimated in 2010 that meeting the unmet contraceptive needs of some 215 million women would cost an additional $3.6 billion — or $4.50 per capita — on top of existing family planning spending. Another $24.6 billion could fill the existing gaps in maternal and newborn health care, she said. Two important paths of action were needed to secure overall success in family planning, she said. First, the continued spread of knowledge among youth and those with unmet needs was required, and secondly, national commitment and resource mobilization were needed to make them self-reliant in contraceptive financing. “The low cost of investing in contraception and the high return on investment makes contraceptive security a feasible outcome for all nations,” she stressed, adding: “Governments can afford to step up to the plate.” She concluded by quoting a 2009 comment by World Bank official Khama Rogo: “Family planning is to maternal survival what a vaccination is to child survival,” and urged delegations to consider their reproductive health investments in that light.
During the ensuing discussion, delegates asked Ms. Tsui to comment on the influence of religion on the use of contraception, the increasing fertility rate among wealthy members of religious groups, the link between explosive youth population growth and the unmet need for or access to contraceptives, the potential for widespread use of female condoms, and the supply of contraceptives to meet the demand for family planning in developing countries.
The representative of Iran, citing Ms. Tsui’s comments about the drop in his country’s fertility rate, said its population policies over the last 20 years had been based on a development approach, respect for religious values and cultural sensitivities, and strengthening of the family. In no way had they been coercive. The representative of Malaysia asked about falling fertility rates in her own country.
Ms. TSUI, responding, pointed to high contraceptive use among Catholics, ranging from 60 to 70 per cent in the United States, Brazil and Mexico, as well as among people of other religious persuasions in Indonesia and Iran. “Historically, I would say that religion is not a barrier to (contraceptive) practice,” she said.
While her message was not that contraception should lower fertility, that was the case, she said, adding that there was no reason to require wealthy families to have fewer children. The point was that all human beings deserved protection and an enabling environment in order to grow. In fact, as families became wealthier, they often opted to have larger families since they could afford them.
Regarding youth, she said they often chose not to use contraceptives, despite their knowledge of and access to it. That resulted in unintended pregnancies and consequently unsafe abortions, which put them at risk of infertility.
As for constraints on the supply of contraceptives in low-income countries, she noted efforts to improve the procurement of condoms, particularly in countries with high HIV prevalence rates. The use of Depo-Provera, a hormonal contraceptive, was rising rapidly in sub-Saharan Africa, as well as in Thailand and Indonesia, due in part to the lack of other contraceptive methods like intrauterine devices. But since Depo-Provera carried a slight risk of bone loss for young women, she called for greater use and availability of other contraception methods, pointing to the rising popularity of the female condom, especially in South Africa, but cautioning that its current high cost limited widespread use.
In response to the Iranian delegate, she hailed his country’s successful family planning programme, agreeing that it respected local cultural values and was in no way coercive. “I don’t believe that contraception as a health and development intervention is to be driven by population control issues,” she added. Regarding the rapid decline in Malaysia’s fertility rate, she said it was likely to be a consequence of late marriage and abstinence, emphasizing that she had no prescription for what to do when fertility rates fell too low.
Also speaking during the discussion were representatives of Norway, Indonesia, Iran, Denmark, Kenya, Malaysia, United States, Netherlands and Gambia.
JORGE ARGÜELLO ( Argentina) said the theme of population must address the question of ageing and the requisite development of an institutional network, on the national and international levels, to protect society’s most vulnerable people. Going on to describe sexual and reproductive rights as unequivocally human rights, he said his country promoted their strengthening, in accordance with global treaties, and urged countries in which abortion was legal to promote ways to overcome the barriers preventing women’s access to such services. He also stressed the need to reduce the number of unwanted pregnancies and deaths from unsafe abortions, to promote responsible maternity and protect vulnerable groups, particularly youth, including through access to reproductive health and sex education programmes. He underlined United Nations Population Fund’s (UNFPA) important role in promoting human rights in Latin America, where it helped regional Governments adopt policies to implement relevant United Nations recommendations.
LAMIN NYABALLY ( Gambia) said his country’s population growth rate had declined from 4.2 per cent in 1993 to 2.8 per cent in 2003. The Government believed strongly in universal access to reproductive health, and provided services including those to fight HIV/AIDS. It also believed that couples and individuals had a right freely to decide the number, spacing and timing of their children, and had shown high political will in that respect. The “the icing on the cake” was its provision of free maternal care to all Gambians, he said. The Government also recognized that gender equity and the empowerment of women was critical to ensuring universal access to reproductive health and rights. Nonetheless, a number of challenges remained, including socio-cultural beliefs and practices, resource inadequacies and the high percentage of youth among the population. Unless the international community fulfilled its funding obligations, developing countries would find it difficult to realize the goals of the Programme of Action, he concluded.
MANJEEV SINGH PURI ( India) said that since 2005, as part of its national rural health mission, his country had launched a comprehensive maternal health-care strategy encompassing pre- and post-natal care, family planning and counselling services, emergency obstetric and newborn care, skilled care during pregnancy, and safe abortion services. Its rural child health strategies included breastfeeding for children up to six months old and were coordinated with strategies for controlling HIV/AIDS. India had worked to strengthen its health infrastructure by providing funds for human resources, drugs and equipment so as to ensure reproductive and child-health services in rural areas. Those and other strategies that were part of the national rural health mission had benefited more than 10 million women and had successfully reduced maternal and infant mortality, he said. India’s health budget for the 2011-2012 period was $5.9 million, 20 per cent higher than for the previous period, with a substantial percentage of the increase aimed at women’s and children’s health, he added.
ZANE DANGOR ( South Africa) said his country’s total fertility rate had declined from 2.9 in 1998 to 2.38 in 2010. Although it had made tremendous progress in providing basic services to the poor and vulnerable, gender disparities and location — especially in rural areas — limited access to some reproductive health services. Pregnancy and childbirth therefore continued to involve significant risks for women, he said, citing other and major concerns such as the persistently high rate of maternal mortality, violence against women, and high-risk, unplanned pregnancies. Additionally, South Africa had a high rate of pregnancy-termination, especially among younger women, which might reflect persistent unmet family planning needs. The 2009 review of South Africa’s implementation of the Programme of Action had yielded several recommendations, including on the need for more research on teenage fertility and contraceptive use; for efforts to remove barriers hampering young people’s access to contraceptives or other reproductive health services; for addressing unmet needs in the area of family planning; and for promoting responsible, healthy reproductive lifestyles among high-risk groups and youth.
EASTON WILLIAMS ( Jamaica) said his country’s policy and legislative reforms had led to notable progress in the areas of women’s and children’s rights, poverty eradication and reproductive health. However, Jamaica would not be able to achieve all the Programme of Action’s goals in terms of maternal and child health, gender equality, adolescent reproductive health, non-communicable diseases, HIV/AIDS and social protection. With support from UNFPA, the United States Agency for International Development and other development partner, Jamaica had made a major effort to address youth reproductive health and fertility issues, in line with the Programme of Action, he said, adding that his country strongly emphasized the reproductive health concerns of disabled people. The national fertility rate had fallen from 3 children per woman in 1994 to 2.4, a decline caused by increased use of contraceptives, educational empowerment and greater participation by women in the labour force. However, maternal mortality stood at 95 deaths per 100,000 live births, he said, noting that the rate was below the desired Millennium target despite efforts to integrate maternal and child heath and family planning and set up “baby- and mother-friendly” clinics, as well as free health care in public hospitals, among other initiatives.
ZOYA KOLONTAI ( Belarus) said that, with the adoption of its national plan to implement the Programme of Action, her country had made several important strides. Though it had not been able to increase its birth rate to pre-Second World War levels, the country had nonetheless been able to raise aggregate birth-rate levels and to improve child and maternal health, she said. With UNFPA, Belarus was conducting work on a national reproductive health strategy. Reforms were under way in the area of pre-natal care, and, with the support of UNFPA and the United Nations Children’s Fund (UNICEF), the Government had created 16 reproductive health centres to provide psychological and other health services to adolescents. Belarus was also working to support families and orphans, and its support for families was expected to increase four-fold this year. Legislation had strengthened care for children under the age of three, and now both parents were able to stay home to care for them. Recalling that the Chernobyl nuclear disaster had cost her country suffering on the order of $230 billion, she said women and children had been particularly affected. Belarus valued the active support of international agencies, regional partners and others in dealing with the consequences, she said.
MÅRTEN GRUNDITZ ( Sweden) said individual rights and choices must remain the focus of efforts to promote sexual and reproductive health, as well as sustainable population growth. Everyone must be able to choose when, how and under what circumstances to have children. They must have access to a full range of sexual and reproductive health services, including contraceptives to delay or limit birth. Despite some progress, there was still a large unmet need for contraceptives, particularly among the young, he noted, stressing that they must have access to sex education in school and out. They must also have the right to reproductive health services that respected their integrity and right to confidentiality. Governments must take legal measures to eliminate child and early marriages, he emphasized, adding that action was also needed to eliminate preventable maternal mortality and address the root causes of sexual and reproductive ill health, unintended pregnancies and unsafe abortion. Linking initiatives on sexual and reproductive rights to HIV/AIDS was vital for a successful response to the pandemic, he concluded.
TRAN VAN CHIEN ( Viet Nam) said that, after nearly 50 years of implementing policies in support of family planning, and more than 10 years of implementing the Programme of Action, his country’s population had declined and its quality of life had risen. While high population density remained a challenge, fertility decline targets had been achieved earlier than planned, dropping from to 2.03 in 2009. Viet Nam was experiencing modernization, democratization, sustainable development and higher school enrolment levels, he said, adding that other development targets had been achieved earlier than planned, including declines in maternal mortality and infant mortality. Communication and education on reproductive issues were more widespread and integrated into curricula for youth and adolescents. Moreover, access to family planning had been enhanced in several key population groups, and overall development had exerted a “comprehensive and positive” impact on society, he said.
FERNANDO ALZATE (Colombia), stressing the link between access to reproductive health services, particularly the need for family planning, and improving maternal health, said his country was working to strengthen social protection systems so as to improve maternal health and development prospects, and to break the cycle of poverty. There must be a focus on vulnerable sectors of the population such as the disabled and those who had suffered violence. Underscoring the importance of reproductive health education and promoting reproductive health policy, he said Colombia’s 2010-2014 national development plan focused on national reproductive health, which recognized the need to promote gender equality in access to services. The Government was taking the necessary steps to promote family planning and HIV/AIDS prevention, he said, adding that it was working with UNFPA to realize the health-related Millennium Development Goals. Its efforts had led to a reduction in the fertility rate from 2.5 children per woman in 2005 to 2.1 children in 2010, while the adolescent pregnancy rate had fallen by 19.5 per cent in recent years, he noted. The prevalence of modern contraception methods had also risen considerably over the last 10 to 15 years.
THOMAS LAMBERT ( Belgium) said his country was among those with low fertility and high life expectancy, and was therefore concerned about population ageing. Given its rather low birth rate, Belgium was also working to develop positive policies in the areas of family services and parental aid. While education on reproductive health rights was “absolutely essential”, it was unfortunate that around the world, information on access to reproductive health was far from perfect. It was therefore imperative to place reproductive health issues at the core of health systems. Belgium supported the work of several key international agencies, including UNICEF, in the areas of improving child health and related reproductive health goals. It further supported the Secretary-General’s recommendation to integrate demographic information into planning for development goals.
Ms. SAY, World Health Organization (WHO), said improved sexual and reproductive health was a key pillar of overall health, adding that poor access contributed to poverty. WHO’s global reproductive health strategy was based on the Programme of Action, and called on Governments to strengthen the capacity of health systems while supporting actions to that end. Despite progress in family planning, maternal health, and reducing sexually transmitted diseases, much more must be done to address increasing health-related inequalities between and within regions, she emphasized.
A representative of the non-governmental organization Asian-Pacific Resource and Research Centre for Women (ARROW) said the region faced age-old challenges in maternal mortality and morbidity, as well as in the provision of access to family planning. Although total fertility rates had declined in the region, many of those living in hard-to-reach areas and urban slums, as well as other marginalized people, were not being reached. Low condom use reflected gender imbalances, and unintended adolescent pregnancy rates were high. Despite being home to 60 per cent of the world’s “deprived people”, donors seemed reluctant to invest in the region, and global economic crisis was expected to leave its 892 million people in extreme poverty by 2015, negatively impacting women’s access to sexual and reproductive health. She said new and emerging challenges — including climate change, natural emergencies and conflict — were also having a negative impact on women, who needed universal access to comprehensive, gender-sensitive health care and reproductive rights as a matter of priority. The international community should also fulfil all its “vital commitments” in those areas, she added.
A representative of Family Care International said that over the past two decades — covering the 1994 Cairo Programme of Action, the 2000 Millennium Development Declaration, the 2005 recognition of the critical need for universal access to reproductive health in solving maternal mortality and fostering sustainable development, and the Global Strategy for Women’s and Children’s Health — the world had promised to right the wrong of thousands of women dying annually from preventable and treatable complications of pregnancy and childbirth, as well as the vast gender inequalities persisting in many countries and societies. Now was the time, she emphasized, to fulfil those oft-repeated promises through universal access to high-quality reproductive health services; ante-natal care, skilled birth attendants; emergency obstetric services and post-natal care; contraception; safe abortion; diagnosis and treatment of sexually transmitted diseases; and sex education. It meant meeting the unmet family planning needs of more than 200 million women and empowering them to control their own fertility.
A representative of Ipas, an international organization dedicated to reducing the number of deaths and injuries due to unsafe abortion, affirmed the links between women’s control over their own fertility and sustained economic growth and development. While the last decade had seen significant progress in addressing unwanted pregnancy and unsafe abortion, such abortions remained a major contributor to maternal mortality and morbidity and was still a “pervasive and neglected” reproductive health problem. Unsafe abortion accounted for some 47,000 deaths each year, almost half of them among women under the age of 25, she said. Since early abortion by trained providers was among the safest of medical procedures, the loss of those lives was a “flagrant tragedy”, she said, adding that, since unsafe abortion was one of the easiest causes of maternal mortality to address, the issue must be “brought out of the shadows and addressed forthrightly”.
A representative of Equidad de Genero: Ciudadania, Trabajo y Familia said full enjoyment of reproductive rights remained a goal rather than a reality. Efforts were still needed to meet the health and reproductive rights goals set forth in the Programme of Action and its indefinite extension should not reduce the urgent need to fulfil commitments already made. Without adequate implementation of policies to promote sexual and reproductive health, poverty and social ills increased, as did unwanted pregnancies and sexually transmitted diseases. Civil society and Governments must collaborate better in advancing reproductive health rights goals, she said, expressing concern about the increasing number of unsafe abortions, particularly in developing countries.
A representative of the International Planned Parenthood Foundation (IPPF) underlined the importance not only of extending the period of time for implementation of the Programme of Action, but also of heightening the priority placed on the related policies, funding and programmes that were still so urgently needed. All people, including the youth, had the right to the highest health standards, including sexual and reproductive health, as well as the right to control their fertility — to choose the number and spacing of their children. Girls and young women today bore a disproportionate burden of sexual and reproductive ill-health, she said. Few development interventions had such cost-effective, far-reaching, and profound impacts as empowering women, particularly young ones, to take decisions regarding all aspects of their lives, including their sexuality and fertility. It was vital to provide young people with comprehensive education on gender equality, sexuality and sexual and reproductive health, both in and out of school, and to secure their access to related information, counselling and services, she said, adding that family planning, a key component of reproductive health, prevented at least one in three maternal deaths, while helping Governments and communities realize sustainable social, environmental and economic development.
A representative of the World Population Foundation discussed his foundation’s experiences in implementing sexual and reproductive health education programmes in Indonesia, Pakistan and Viet Nam, stressing the importance of involving youth meaningfully in policies concerning them. Women’s and girls’ rights must be at the centre of national and global responses to end gender inequality, reduce maternal mortality and ensure universal access to reproductive health. Noting that about one quarter of all marriages involved underage women, which had led to 2.9 million unsafe abortions a year in Indonesia and 1 million a year in Pakistan, he stressed the need for family planning, as well as sexual and reproductive health and development for youth, not just adult married couples. He said his organization did not promote sexual activity among young people, but it provided them with the necessary information and skills to enable them to make healthy choices.
A representative of International Planned Parenthood Federation Africa Region (IPPFAR) said having a child at a very young age denied a woman access to equal opportunities. “Do we think that our women and girls are just factories without maintenance, or do we want to give them equal rights?” he asked. HIV/AIDS, fistula, and the need for abortion disproportionately impacted young women, he pointed out, emphasizing the urgent need for sexual education in schools. Describing sexuality as natural behaviour, he cautioned that, without informed education, its risks were high. The inalienable rights of women to live free of fear and enjoy human dignity should not seem unachievable, he stressed.
A representative of Latin American and Caribbean Women’s Health Network said that today more than ever it was necessary to revitalize the spirit and proposals of the Programme of Action so as to guarantee that all women enjoyed the right to life and health, the freedom to make choices without being subjected to coercion or violence, and the right to have their choices respected. Noting with concern that the targets of the International Conference on Population and Development may not be met, she said there was an urgent need for States to show, without delay, true political will by investing in the health and well-being of girls rather than in weapons. She welcomed creation of UN Women and hoped that its actions would help effectively to address the urgent priorities of the women’s and feminist movements of Latin American and the Caribbean.
A representative of Advocates for Youth said that, given that 2011 was the International Year of Youth, the rights of young people should be an international priority. “Youth demand change,” she emphasized, noting that young people were disproportionately affected by poverty and violence. Gender inequality and discrimination deprived young women of their sexual and reproductive rights, as well as related services. Governments were failing the young women they had committed to supporting by continuing instead to deny them access to sexual education, services and supportive policies, she said. Realizing the sexual and reproductive rights of young people was essential to development, and Governments must ensure the rights of young women through comprehensive health packages covering contraception and sexual education, she said.
A representative of Population Action International said that, despite the importance of sexual and reproductive health and rights, an estimated 215 million women who wished to avoid pregnancy were not using modern contraceptives. To achieve universal access to reproductive health and fully realize reproductive rights in resource-poor settings, donors and Governments must increase funding and take a more integrated, inclusive approach to addressing the needs of marginalized groups, including women, youth and people living with HIV. The lack of adequate funding was a significant constraint to full implementation of the Programme of Action, she said, adding that priority must be given to evidence-based policies and programmes that integrated sexual and reproductive health, HIV and maternal health services.
A representative of the New Zealand Family Planning Association, speaking on behalf of a network of civil society organizations working in the Asia-Pacific region, said five women died in the region every day due to pregnancy, childbirth and related health problems. Much of the region’s population was under 24 years of age, and the teenage fertility rate was consistently high, which had a negative impact on maternal mortality since young women were less able physically to give birth safely. Additionally, sociocultural norms in the region often did not allow women to seek information and reproductive health services. The region had high unmet family planning needs and high levels of sexually transmitted infections, as well as high rates of gender-based and sexual violence. Meeting unmet family planning needs had even been shown to reduce carbon emissions significantly, an important issue facing the Pacific region, she said.
A representative of Catolicas por el Derecho a Decidir called on all Governments to implement sexual and reproductive rights, noting that in India 49 per cent of girls were married off before they turned 18 and 45 per cent of all new HIV infections afflicted people under 25 years of age. Young women’s rights must be put first, she emphasized, pointing out that 75 per cent of new sexually transmitted infections in Indonesia were among young people who lacked access to safe contraception. About 60 per cent of Egyptians used contraception, but family planning messages in that country were not reaching women, she said. Moreover, 83 per cent of Egyptian women reported sexual harassment daily. Polish women were still denied their right to choose, and Poland’s ban on abortion had a negative effect mainly on poor women who lacked the means to travel abroad for care. In Mexico, violations of reproductive rights such as mandatory sterilizations were a reality, she noted, adding that in Kenya, women carrying condoms were accused of practising prostitution.
A representative of Global Youth Action Network said at least 1.8 billion youths were between the ages of 10 and 24 — the largest population of young people in history. Comprehensive sexual education empowered young people with the knowledge, skills, and tools necessary to determine and enjoy their sexuality, and the right to that education was in fact a human right that was currently denied them, she said, demanding that Member States ensure that sexual education was integrated into educational policies for all young people and eliminate legal, regulatory and social barriers in that respect.
A representative of the International Planned Parenthood Federation Western Hemisphere Region said 1.3 billion youth lacked access to sexual and reproductive health and rights, while more than 500,000 young people were newly infected with sexually transmitted diseases annually. It was vitally important to provide young people with access to sexual and reproductive health services, she said, underlining that comprehensive sex education was a right. Access to information and services bolstered development and furthered decision-making capabilities, she said, calling for specialized personnel to teach comprehensive sex education in schools. Sexual and reproductive rights were human rights and they should be integrated into all national development plans, she said, emphasizing that Governments must recognize them as such as a matter of priority.
A representative of the European Parliamentary Forum on Population and Development said many European countries faced decreasing fertility and ageing populations, which called for specific measures such as support to enable young families and young women to combine work and family. The woman herself — not politicians, Governments, region or churches — had the right to decide how many children she would have and when she would have them. Although the right to sexual and reproductive health had been proclaimed, it was far from universally respected, she noted, stressing that sexual and reproductive health was not only important from a human rights perspective, but even more so from a public health perspective. Parliamentarians had an important role to play in holding Governments accountable for their political and financial promises, she added.
A representative of the International Planned Parenthood Federation European Region noted that Albania had taken significant measures to strengthen its legal and institutional framework on gender equality and fight domestic violence. Still, women continued to face discrimination in employment, education and property rights. She recalled that in 2008 Albania had joined the 2005-2015 Decade of Roma Inclusion, adopting a national action plan focused on education, employment and social protection, among other measures for Roma women. Some 59 per cent of Albanian women of reproductive age used traditional contraceptive methods while 11 per cent used modern methods, she said, adding that the country had a low fertility rate, at 1.6 children per woman. The fact that women were highly reliable on traditional methods showed that they wished to control their fertility. She said her organization had worked with the Albanian Government to develop a national reproductive health strategy approved in 2009, but it was still waiting for an appropriate budget allocation and proper implementation.
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