UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)

Annotated Outline of Cairo Population Programme of Action





                                                   14 October 1993


                                                   ORIGINAL: ENGLISH


Forty-eighth session

Agenda item 96 


           Progress report on the preparations for the Conference


         Annotated outline of the final document of the Conference

                       Note by the Secretary-General

    The Secretary-General has the honour to transmit to the General

Assembly, as an annex to the present note, an annotated outline of the

final document of the International Conference on Population and

Development.  The annotated outline has been prepared, in close

collaboration with the Secretary-General of the Conference, in response

to Economic and Social Council resolution 1993/76 requesting that the

annotated outline be included in the progress report referred to in

paragraph 20 of General Assembly resolution 47/176.  The first draft of

the final document based on the present annotated outline will be

discussed by the Preparatory Committee for the Conference at its third

session from 4 to 22 April 1994.

93-51718 (E)   201093                                                   /...





Chapter                                            Paragraphs  Page

                     Part One.  Preamble and principles

  I. PREAMBLE ............................................      1   6

 II. PRINCIPLES ..........................................      2   6

                  Part Two.  Choices and responsibilities



     A.  Population, sustained economic growth and 

         sustainable development ......................... 4 - 6     10

     B.  Population, socio-economic development and poverty 

         alleviation ..................................... 7 - 9     11

     C.  Population and the environment ..................    10 - 12     11

 IV. GENDER EQUALITY AND EMPOWERMENT OF WOMEN ............    13 - 22     12

     A.  Empowerment and the status of women .............    14 - 16     13

     B.  Male responsibilities and participation .........    17 - 19     13

     C.  The girl child ..................................    20 - 22     14


     A.  Diversity of family structures and composition ..    24 - 26     14

     B.  Socio-economic support to the family ............    27 - 29     15

 VI. POPULATION GROWTH AND STRUCTURE .....................    30 - 45     16

     A.  Diversity of fertility, mortality and population

         growth rates ....................................    31 - 33     16

     B.  Children and youth ..............................    34 - 36     16

     C.  Ageing populations ..............................    37 - 39     17

                            CONTENTS (continued)

Chapter                                            Paragraphs  Page

     D.  Disabled persons ................................40 - 42    17

     E.  Indigenous people ...............................    43 - 45     18


     FAMILY PLANNING .....................................    46 - 58     18

     A.  Reproductive health .............................    47 - 49     19

     B.  Family planning .................................    50 - 52     20

     C.  Human sexuality and gender relations ............    53 - 55     20

     D.  Adolescents .....................................    56 - 58     21

VIII.    HEALTH AND MORTALITY ................................59 - 71     22

     A.  Maternal morbidity and mortality ................    60 - 62     22

     B.  Infant and child mortality ......................    63 - 65     23

     C.  Sexually transmitted diseases and acquired

         immune eficiency syndrome .......................    66 - 68     23

     D.  Primary health care and the health-care sector ..    69 - 71     24


     MIGRATION ...........................................    72 - 84     25

     A.  Population distribution, natural resources and

         the environment .................................    73 - 75     25

     B.  Population distribution policies and sustainable 

         development strategies ..........................    76 - 78     26

     C.  Population growth in large urban agglomerations .    79 - 81     26

     D.  Displaced persons ...............................    82 - 84     27

  X. INTERNATIONAL MIGRATION .............................    85 - 97     27

     A.  International migration and development .........    86 - 88     28

     B.  Documented migrants .............................    89 - 91     28

     C.  Undocumented migrants ...........................    92 - 94     29

     D.  Refugees ........................................    95 - 97     29

                            CONTENTS (continued)

Chapter                                            Paragraphs  Page

                    Part Three.  Means of implementation


     A.  Public awareness ................................   99 - 101     32

     B.  Information, education and communication ........  102 - 104     32

XII. CAPACITY-BUILDING ...................................  105 - 114     33

     A.  Management of programmes ........................  106 - 108     33

     B.  Education and training of policy makers, managers

         and other personnel .............................  109 - 111     34

     C.  Institutional development .......................  112 - 114     34

XIII.    TECHNOLOGY, RESEARCH AND DEVELOPMENT ................115 - 124   35

     A.  Basic data collection and analysis ..............  116 - 118     35

     B.  Biomedical research and development .............  119 - 121     36

     C.  Social and economic research and development ....  122 - 124     36

XIV. NATIONAL ACTION .....................................  125 - 131     37

     A.  National policies and plans of action ...........  126 - 128     37

     B.  Resource allocation .............................  129 - 131     38

 XV. INTERNATIONAL COOPERATION ...........................  132 - 138     39

     A.  Modalities ......................................  133 - 135     39

     B.  Resource mobilization:  bilateral and 

         multilateral development assistance .............  136 - 138     40



     AND LOCAL COMMUNITY GROUPS ..........................  139 - 144     40

XVII.    FOLLOW-UP ...........................................145 - 151   42

     A.  Implementation ..................................  146 - 148     42

     B.  Monitoring and review ...........................  149 - 151     43

                                  Part One

                          PREAMBLE AND PRINCIPLES

                                 Chapter I


1.  The preamble will convey the vision and purpose of the International

Conference on Population and Development and define the context of the

proposed action programme.  The preamble will cover the following


    (a) Brief survey of present population dynamics and their

interrelations with current social, economic and political trends,

bringing out the interaction between population, sustained economic

growth and sustainable development. 

    (b) Overview of the experience gained in the field of population

policies and programmes during the past 20 years.  This assessment, based

on the findings of the progress made in achieving the goals and

objectives of the World Population Plan of Action adopted in 1974, will

provide the critical foundation for the development of goals and

strategies for the future.

    (c) Brief presentation of the objectives and general goals contained

in the proposed action programme.

    (d) General introduction to the set of actions necessary to achieve

the proposed population objectives that are consistent with sustained

economic growth and sustainable development.  Particular emphasis will be

given to human rights, as well as to the socio-economic situation of the

developing countries, particularly the least developed countries.

    (e) Indication of the resources and efforts required for the

implementation of the proposed action programme.

    (f) Reference to the most relevant intergovernmental instruments

relating to population, economic and social development and


                                 Chapter II


2.  This section of the proposed action programme will provide the

guiding philosophy in the area of population and development well into

the twenty-first century.  The principles will build as much as possible

on agreed international instruments, including the World Population Plan

of Action, 1/ the recommendations of the International Conference on

Population, held at Mexico City, in 1984, 2/ the Amsterdam Declaration on

a Better Life for Future Generations, 3/ the Rio Declaration on

Environment and Development 4/ and Agenda 21 5/ adopted by the United

Nations Conference on Environment and Development, held at Rio de Janeiro

from 3 to 14 June 1992.  They will also reflect the Nairobi

Forward-looking Strategies for the Advancement of Women 6/ and the

applicable provisions of human rights instruments such as the Universal

Declaration on Human Rights, 7/ the International Covenant on Economic,

Social and Cultural Rights, 8/ the International Convention on the

Elimination of All Forms of Racial Discrimination, 9/ the Convention on

the Elimination of All Forms of Discrimination against Women 10/ and the

Convention on the Rights of the Child. 11/  The guiding principles will

be organized around the following major topics:

    (a) Human rights and population:  recognizing obligations and

responsibilities.  Protection of rights of individuals; elimination of

all forms of discrimination; rights, obligations and responsibilities of

couples and individuals in relation to their sexual and reproductive

life; protection of vulnerable groups; and opposition to all forms of

coercion to have or not to have children.

    (b) The responsibility of society for human development,

reproductive health and family planning:  ensuring choices and


    (c) Sustainable development and population.  Linkages between

population, resource use, consumption, environmental impact and

repercussions on the quality of life for present and future generations.

    (d) Partnership in population:  moving from commitment to action. 

Mutual responsibility and interdependence among individuals, social

groups and nations.

                                  Part Two

                        CHOICES AND RESPONSIBILITIES

                                Chapter III



3.  This chapter will address the inextricable interdependence between

population, resources, the environment and development.  In addition to

reaffirming the relevance of key intergovernmental instruments such as

the Declaration on International Economic Cooperation, in particular the

Revitalization of Economic Growth and Development of the Developing

Countries, the International Development Strategy for the Fourth United

Nations Development Decade and Agenda 21, the Conference is expected to

provide guidance for the formulation of population policies and

programmes that seek to simultaneously achieve sustained economic growth

and sustainable development, taking into account the interlinkages of

population with poverty; production and consumption patterns;

environmental quality; natural resources; and economic, social and gender


                 A.  Population, sustained economic growth and

                     sustainable development

Basis for action

4.  All countries, and especially the developing countries, where almost

all of the future growth of the world population will occur, face

increasing difficulties to improve the quality of life of their people in

a sustainable manner.  Many of those countries experience major

development obstacles, among which are those related to the persistence

of trade imbalances, the slow down in the world economy, the increasing

burden of debt servicing and growing "aid-fatigue" of the international

donor community.  Lack of development or unbalanced development and

poverty are often associated with inappropriate spatial distribution of

the population and undesirable environmental conditions.  The critical

challenge in all countries, whether developed, developing or in

transition, is to improve the quality of life for present generations

without compromising the ability of future generations to meet their own

needs.  It cannot be addressed without recognizing the strong linkages

between population, resources, the environment and development.


5.  To create an international environment favourable to the realization

of the right to development and to establish consistent policy frameworks

that promote balanced and sustainable development, recognizing population

factors as an integral part of any environmentally sustainable policy and


Selected topics for recommendations

6.  Need to foster sustained economic growth in developing countries, by

all appropriate means, including reduction of trade barriers, debt

relief, investment in sustainable job-creating projects and promotion of

relevant technologies.  Formulation of long-term policies and programmes

that simultaneously address population growth, alleviate poverty and

reduce social inequality in both rural and urban settings.  Ensuring that

policies and programmes are responsive to the needs of the poor in all

countries, particularly in health, education, training, and family

planning and maternal and child health programmes. 

                 B.  Population, socio-economic development and

                     poverty alleviation

Basis for action

7.  Widespread poverty is a major challenge to development efforts as

poverty is often accompanied by ignorance, illiteracy, low status of

women and limited access to health and family-planning services, all

these factors tending to result in high levels of fertility, morbidity

and mortality.  Women are often among the poorest of the poor. 

Alleviating the conditions of abject poverty under which close to 1

billion people live today is an integral part of the agenda for

sustainable development.  It is also necessary to prepare for meeting the

basic needs of the population that will inevitably be added in the near

future.  The goals and objectives of the International Development

Strategy for the Fourth United Nations Development Decade aim at

responding to such concerns. 


8.  To break the poverty-population growth cycle through integrated

population and development policies and programmes that recognize the key

role of human resources in national development and give strong emphasis

in national planning and policy-making to the development of human

resources.  To make equity in the allocation of resources and access to

services an important element of national policy, designing policies and

strategies to ensure that the benefits of development are widely shared.

Selected topics for recommendations

9.  Making the alleviation of poverty, the achievement of equitable

social and economic relations, and the provision of basic infrastructure

and social welfare services key components of socio-economic development

and central factors for harmonizing demographic trends with sustainable

development.  Need to give high priority to investments and expenditures

to facilitate access to education, training and credit to all deprived

sectors of society, as well as to economic policies that increase their

opportunity to participate in the formal labour force; particular

attention should be given to the situation of poor women.

                         C.  Population and the environment

Basis for action

10.     Current patterns of population growth and spatial distribution,

associated with present levels and patterns of production and consumption

exert increasing pressures on the carrying capacity of the planet, which

is understood as the number of people that the planet can support at an

acceptable level of quality of life, without irreversibly reducing its

capacity to support people in the future.  This carrying capacity is

being exceeded in many parts of the world.  Some areas are characterized

by deep and widespread poverty, while others are affluent.  Associated

issues are the loss of agricultural land, due either to soil degradation

and erosion or conversion to urban land; the destruction of forests;

water problems such as scarcity, depletion and pollution; loss of

biological diversity; and climatic change.


11. To recognize the critical nature of environmental degradation and

the role of demographic variables.  To adopt environmentally sustainable

development strategies giving due priority to social programmes and

policies, including those on population and education.  To address the

underlying causes of environmental degradation such as poverty and

unsustainable production and consumption patterns.

Selected topics for recommendations

12. Formulation of enforceable measures to promote greater harmony

between population, resources, environment and development, so as to

achieve improved quality of life on a sustainable basis.  Identification

of critically endangered areas subject to acute population pressures and

formulation of actions needed to alleviate pressures on the environment. 

Finding durable solutions to problems related to environmentally

displaced persons.

                                 Chapter IV


13. Gender equality is recognized as a human rights issue by the

numerous international agreements and declarations since the  Universal

Declaration on Human Rights, including the World Population Plan of

Action (1974) and the recommendations for its further implementation

adopted at the International Conference on Population (Mexico City,

1984), the Nairobi Forward-looking Strategies for the Advancement of

Women (1985), the Amsterdam Declaration on a Better Life for Future

Generations (1989), the United Nations Conference on Environment and

Development (1992) and the World Conference on Human Rights (1993). 

Nevertheless, discrimination continues against women and girls.  Hence,

the need to empower women and to improve their status is acknowledged by

most Governments.  In addition, improvement in the status of women is a

key development issue because of women's vital and multiple roles.  It is

widely accepted that improvements in women's advancement, health,

education and employment, are mutually reinforcing and should be pursued

simultaneously in a holistic manner.  Changes in men's and women's

attitudes and behaviour are necessary conditions for achieving full

gender equality.

                  A.  Empowerment and the status of women

Basis for action

14. The improvement of the status of women, particularly with respect to

education, health and economic autonomy, is a highly important end in

itself.  In addition, it affects and is in turn affected by demographic

variables such as fertility and maternal, infant and child mortality. 

Experience shows that population and development programmes are most

effective when measures have been taken to improve the status of women.


15. To achieve full gender equality.  To fully integrate women into

population and development programmes, both as beneficiaries and as

active participants.

Selected topics for recommendations

16. Encouragement of women to participate in the political process,

particularly at the grass-roots level and promotion of women's economic

security, right to inherit or own land and access to credit.  Achieving

balanced representation of both sexes in population and development

programmes, especially at management and policy-making levels, both in

the Government and private sectors.  Combating violence against women and

girls, including sexual violence. 

                B.  Male responsibilities and participation

Basis for action

17. In general, men exercise preponderant power in nearly every sphere

of life, including personal decisions regarding family planning and the

policy and programme decisions taken at all levels of Government.  It is

essential to improve communication between men and women, and the

understanding of their respective and joint responsibilities, so that

women and men are seen as equal partners in public and private life.


18. To promote gender equity by ensuring that men understand and accept

full and equal responsibility in both family and community life, with

regard to all issues of mutual concern to men and women.

Selected topics for recommendations


19. Full and active participation of men in all areas of family and

community responsibilities, so that these responsibilities may be equally

shared by women and men.

                             C.  The girl child

Basis for action

20. Since discrimination on the basis of sex starts at the earliest

stages of life, full equality for the girl child is a necessary condition

for women to fulfil their potential and to contribute effectively to

society.  Investments made in the girl child's health and education are

steps towards raising the age at marriage and reducing early

child-bearing, while also increasing her options later in life.


21. To increase public awareness of the value of the girl child and

eliminate the root causes for son preference.  To strengthen the girl

child's self-image and self-esteem and improve the status of the girl

child, especially in health, nutrition and education. 

Selected topics for recommendations

22. Access by girls and women to education and improvement of the

quality and relevance of their education, including the elimination of

gender stereotyping in school curricula and in the media.  Enforcement of

minimum legal age at marriage, paying attention to the provision of

alternatives to early marriage such as educational and employment


                                 Chapter V


23. The family, in its many forms, is a basic unit of society and it is

the social institution within which most child-bearing and child-rearing

occur.  These two universal roles are complemented by other important

functions such as the mutual support of its members and, in many

countries, the care of the disabled and the elderly.  The large diversity

of family forms and structures reflects how these functions are

accomplished, how societies value and protect their families, and which

patterns of family formation are prevalent in a particular social

context.  Families are important agents of sustainable development at all

levels of society and their contribution to that process is crucial.  The

family also plays an important role in the intergenerational transmission

of social values as a primary agent of socialization and is therefore a

potential agent of social change.

             A.  Diversity of family structures and composition

Basis for action

24. There are numerous concepts of the family around the world; this

diversity corresponds to the wide variety of social, political and

cultural systems.  As part of the process of rapid demographic and

socio-economic change in both developed and developing countries,

patterns of family formation are undergoing considerable change so that

the composition and structure of families are being altered.  In many

societies, a traditional gender-based division of productive and

reproductive functions within the family coexists with new arrangements. 

The recognition of the diversity of family forms is important because in

many cases policies and programmes relative to the family still refer

only to specific sizes and forms of the family that may no longer be

predominant; this issue is particularly important in reference to gender

equality and the rights of children.


25. To adopt policies and laws recognizing and supporting the plurality

of family forms, including due attention to the large number of

households headed by women.

Selected topics for recommendations

26. Provision of means (i.e., social services, kindergartens, part-time

jobs, flexible schedules etc.) to facilitate compatibility between

professional and parental roles.  Elimination of all forms of coercion

and discrimination in policies and practices related to marriage and to


                  B.  Socio-economic support to the family

Basis for action

27. As a basic unit of society, the family is entitled to receive

protection by society and the State.  In many parts of the world the

rapid process of development intensifies the strains on family life. 

There is an increasing number of vulnerable families, including

single-parent families headed by poor women, poor families with disabled

members, families separated by the working conditions of their members,

refugee and displaced families, families affected by human

immunodeficiency virus (HIV) infection and acquired immune deficiency

syndrome (AIDS) or by family disintegration, domestic violence and child

abuse or neglect.


28. To formulate "family-sensitive" policies aimed at providing support

particularly to vulnerable families.  To introduce the concept of "family

impact" into the process of preparation of plans, policies and programmes

of social and economic development.

Selected topics for recommendations

29. Assistance to families which manifest specific problems (i.e.,

domestic violence, drug and alcohol dependency, sexual and child abuse,

neglect etc.), have special responsibilities (i.e., handicapped members,

care of the dependent elderly etc.), or are in a particular vulnerable

position (i.e., circumstances of war, drought, famine, racial and ethnic

violence, economic deprivation etc.).  Establishing guidelines for

monitoring the implementation of family policies and programmes.  

                                 Chapter VI


30. Growth of the world population, in absolute numbers, is likely to

persist at levels near the present all-time high in the coming decades. 

There are also remarkable differences between regions and countries in

terms of population growth and its fertility and mortality components. 

These levels and differentials have implications for the ultimate size

and regional distribution of the world population and for population

structure characteristics, in particular population ageing.  Action is

required to take more fully into account the variety of trends in

population growth and structure in the context of sustained economic

growth and sustainable development.

     A.  Diversity of fertility, mortality and population growth rates

Basis for action

31. Within the context of the ongoing transition from high to low levels

of fertility and mortality, important variations exist both at the

regional level and within regions and countries, reflecting the present

position of countries in their passage through the different stages of

their demographic transition.  The majority of countries are converging

to low rates of population growth but at different speeds of decline,

thus yielding rates of growth that are increasingly diverse.  In

addition, a substantial minority of populations are still at a

pre-transitional stage or at the very beginning of their transition. 


32. To reduce the disparities in regional fertility and mortality levels

and achieve early stabilization of the world population. 

Selected topics for recommendations

33. Action required to accelerate the demographic transition in those

countries that desire such an acceleration.

                           B.  Children and youth

Basis for action

34. Owing to declining mortality levels and the persistence of high

fertility levels, a large number of developing countries continue to have

substantial proportions of children and young people in their

populations.  The ongoing and future demands created by their large young

populations, particularly in terms of health, education and employment,

represent a major challenge.


35. To promote to the fullest extent the well-being of all children and

youth in line with the commitments made in this respect at the World

Summit for Children. 

Selected topics for recommendations

36. Giving priority and higher levels of attention to all dimensions of

human development for children and youth. 

                           C.  Ageing populations

Basis for action

37. There have been notable increases in the proportion and number of

persons at older ages in the population of most countries, a trend

resulting from the decline in fertility levels, reinforced by continued

declines in mortality levels among the elderly.  The situation of

developing countries that have experienced very rapid declines in their

levels of fertility deserves particular attention.  In most societies the

elderly population is composed of considerably more women than men and in

many societies, elderly poor women are especially vulnerable.  The steady

increase of older age groups in national populations has significant

implications for both the developed and the developing countries.  The

economic and social impact of this "ageing of populations" is both an

opportunity and a challenge to all societies.


38. To create conditions that allow the elderly to work and live

independently in their own communities for as long as possible and as


Selected topics for recommendations

39. Need to ensure that long-term socio-economic planning takes into

account the needs of increasingly large proportions of elderly persons in

the population.  Strengthening formal and informal safety nets for the

elderly in all countries.

                            D.  Disabled persons

Basis for action

40. The implementation of the World Programme of Action concerning

Disabled Persons during the United Nations Decade of Disabled Persons

(1983-1992) contributed towards increased awareness and expanded

knowledge of disability issues, increased the role played by persons with

disabilities and by concerned organizations, and the improvement and

expansion of disability legislation. However, there remains a pressing

need for continued action to promote effective measures for the

prevention of disability, for rehabilitation and for the realization of

the goals of full participation and equality for persons with

disabilities.  By resolution 47/88 of 16 December 1992, the United

Nations General Assembly encouraged the consideration by the

International Conference on Population and Development of disability

issues relevant to the subject-matter of the Conference.


41. To ensure the participation of disabled people in all aspects of

social, economic and cultural life to the fullest extent of their


Selected topics for recommendations

42. Recognition of the needs of disabled persons concerning, inter alia,

sexual and reproductive health, including family-planning services and

elimination of the specific forms of discrimination that disabled people

may face with regard to international migration, reproductive rights and

household and family formation.

                           E.  Indigenous people

Basis for action

43. In many regions of the world, indigenous people are experiencing

steady and, in some places, rapid population growth resulting from

improved access, often belated, to health and welfare services.  At

national, regional and international levels, the perspectives of

indigenous people are gaining increasing recognition, most recently at

the United Nations Conference on Environment and Development and the

marking of the United Nations Year of Indigenous People.  This section

will give recognition to the specific perspective of indigenous people on

the interrelations between population, the environment and development. 


44. To ensure that the various perspectives of indigenous people on

population and development are brought before the national and

international communities, taking into account the commitments made

during the United Nations Year of Indigenous People and the ongoing

activities of the proposed International Decade of the World's Indigenous


Selected topics for recommendations

45. Recognizing the distinct perspective of indigenous people on aspects

of population and development and addressing their specific needs.

                                Chapter VII


46. The cornerstone of reproductive rights is the recognition of the

basic right of all couples and individuals to decide freely and

responsibly the number and spacing of their children.  Although

reproductive and sexual health are central to people's lives, many

persons fail to achieve it because the relevant information and means,

including those related to family planning, may not be available to them. 

The disparities are especially marked between those in the developed and

the developing countries.  The result is unnecessarily high levels of

reproductive mortality and morbidity in many developing countries, a

problem that must be addressed by promoting reproductive and sexual

health for all people as the fundamental basis for publicly supported

reproductive health and family-planning programmes.

                          A.  Reproductive health

Basis for action

47. Reproductive health is not merely absence of disease or disorders of

the reproductive process.  It implies that people have the ability and

choice to reproduce, to regulate their fertility and to practise and

enjoy sexual relationships.  Family planning and safe motherhood are

essential components of reproductive health.  The attainment of optimal

reproductive health eludes many persons owing to inadequate knowledge

about human sexuality, inappropriate sexual behaviour, gender bias and

inappropriate, inadequate information and services or owing to

involuntary sterility.  Unsafe abortion is one of the most neglected

underlying causes of reproductive ill health, and constitutes a major

public health issue.  Genital mutilation is also an obstacle to

reproductive health.  Concerning all factors of reproductive ill health,

women, adolescents and disadvantaged population groups are particularly

vulnerable.  Finally, reproductive health cannot be achieved without the

full involvement of both women and men. 


48. To ensure the provision of appropriate information and services that

are free of coercion, voluntary, accessible, affordable, acceptable and

promoting informed choice.  To provide services that respond to the

changing reproductive and sexual health needs of individuals and couples

over the life cycle and reflect the social, cultural, economic and

demographic diversity of the communities they serve.  

Selected topics for recommendations

49. Ensuring that reproductive health services for men and women of all

ages have a client-centred approach, are cost-effective, follow high

standards of quality and include maternity care, family planning,

prevention and treatment of infertility, prevention, diagnosis, treatment

and referral of sexually transmitted diseases, including HIV infection

and AIDS, and education and information on sexuality and responsible

parenthood.  Full involvement of women in the formulation and

implementation of reproductive health programmes.  Review of the legal

and regulatory barriers to reproductive health such as early or enforced

marriages, illegality of abortion, maternity leave regulations and access

to reproductive health services.

                            B.  Family planning

Basis for action

50. Over the past three decades, the emergence of acceptable, safer

methods of modern contraception has permitted greater individual freedom

and control of reproduction.  However, these family-planning methods

remain unavailable to many persons who need them, both women and men. 

Proper widespread use of family-planning services saves the lives and

health of millions of women and children.  Such services are also a

cost-effective intervention, because of their many direct and indirect

benefits for individuals, couples and communities.  The experience of the

past decades points at the importance of promoting informed choice and

availability of a wide range of safe and effective contraceptive methods

and ensuring that women play a central role in the design and

implementation of family-planning services.  Many family-planning

programmes have benefited from partnerships between public,

non-governmental and private sectors.


51. To help couples and individuals to achieve the desired number and

spacing of their children, thereby reducing the incidence and risk of

unwanted pregnancies.  To reduce the incidence of high-risk pregnancies. 

To extend coverage and improve access to family-planning services to all

who need them.  To improve the quality of family-planning services for

women and men.  A quantitative goal concerning the size of the unmet need

for family-planning information and services and the resources required

to meet that need will be proposed for adoption by the Conference.

Selected topics for recommendations

52. Ensuring easily accessible and available high-quality family-

planning counselling and services responsive to individual needs, in

particular through improved human resource planning, selection and

training of staff and community involvement in the delivery of family-

planning services.  Removal of unnecessary and inappropriate legal,

medical and regulatory barriers to access to family planning while

continuing to ensure safety.  Making information, services and supplies

available to unreached populations.  Ensuring sufficient and continuous

supply of contraceptive commodities and strengthening of logistics


                  C.  Human sexuality and gender relations

Basis for action

53. Human sexuality and gender relations are closely interrelated and

together affect the ability of men and women to achieve and maintain

sexual health and control their fertility.  Responsible sexuality and

sensitivity in gender relations, particularly when instilled during the

formative years, enhance and promote respectful and harmonious



54. To ensure that men and women have access to information, education

and services to exercise their reproductive and sexual rights.  To foster

mutually respectful gender relations as an important requisite of sexual

and reproductive health.

Selected topics for recommendations

55. Fostering acceptance among men and women of the importance of equal

rights in sexual relationships through sex education and counselling for

boys and girls in and beyond the formal school system.  Promotion of

responsible and safe sexuality and parenthood.  

                              D.  Adolescents

Basis for action

56. Motherhood at a young age entails a risk of maternal death much

greater than the average, and the children of young mothers also fare

less well.  In many countries, sexually active adolescents of both sexes

are increasingly at high risk of contracting and transmitting sexually

transmitted diseases, including HIV infection, and they are often poorly

informed about how to protect themselves.  In many societies, adolescents

are facing increasing pressures to engage prematurely in sexual activity. 

Young women, particularly poor teenage girls, are especially vulnerable

because of their subordinate social position.  Millions of teenage girls

world wide seek abortions every year, which attests to the critical

importance of the issue of unwanted pregnancy.  Overall, for young women,

early marriage and early motherhood severely curtail educational and

employment opportunities.  Programmes addressing these issues have shown

to be more effective when they secure the full involvement of adolescents

in identifying and searching for solutions to their reproductive and

sexual health needs, including support to those who wish to abstain from

sexual activity. 


57. To address adolescent reproductive health issues, including HIV

infection and AIDS, through the promotion of responsible and healthy

reproductive and sexual behaviour.  To protect the human rights and

well-being of adolescents and to promote their active involvement in the

process of socio-economic development.  

Selected topics for recommendations

58. Recognition of the special needs of adolescents and the programmes

required to meet those needs, including education programmes in the areas

of family planning, family life, reproductive and sexual health, sexually

transmitted diseases, HIV infection and AIDS and reproductive health

services, including family-planning services specially designed to meet

the needs of adolescents.  

                                Chapter VIII

                            HEALTH AND MORTALITY

59. Although mortality has continued to decline at the world level,

there are sizeable population groups within countries and entire national

populations that still experience high morbidity and mortality rates. 

Child survival has increased, but high infant and child mortality rates

still prevail in some population groups and regions.  Women in the

developing world continue to experience high maternal mortality.  Another

cause of great concern is the increasing incidence of HIV infection and

AIDS among children of HIV-infected mothers.  The health of the adult

population in the working ages is being negatively affected by the spread

of HIV infection and certain forms of behaviour, such as the consumption

of tobacco, alcohol or drugs, pointing to the need for changes in

lifestyles.  The growing number of older people is associated with an

increase in the incidence of non-communicable diseases.  Adequate access

to health care is still not available to a large portion of the world


                    A.  Maternal morbidity and mortality

Basis for action

60. Maternal mortality is one of the leading causes of death among women

of child-bearing age in the developing world.  At the global level, about

half a million women continue to die each year from pregnancy-related

causes; 99 per cent of them in developing countries.  Maternal mortality

rates vary widely.  In a majority of developed countries, maternal

mortality rates are below 10 deaths per 100,000 live births.  In

contrast, for the less developed regions, the estimated rate is 420

deaths per 100,000 live births, with Africa having an estimated rate of

630 maternal deaths per 100,000 births.  In developing countries,

mortality resulting from complications of poorly performed abortions

accounts for a significant percentage of maternal deaths.  There is a

particular need to monitor the progress made in reducing maternal

mortality so as to enhance the effectiveness of ongoing and future



61. To achieve a rapid and substantial reduction of maternal morbidity

and mortality in accordance with quantitative goals to be adopted by the

Conference for the period up to 2015.

Selected topics for recommendations

62. Need to increase the provision of maternity services in the context

of primary health care and improve those services by including

safe-motherhood education, nutrition programmes, family planning,

prenatal and postnatal care and delivery assistance by adequately trained

birth attendants.  Need to address the problem of maternal deaths and

complications resulting from unsafe abortion. 

                       B.  Infant and child mortality

Basis for action

63. Important progress has been made in reducing infant and child

mortality rates everywhere, although improvements have been slower in

sub-Saharan Africa.  It is estimated that during the period 1990-1995,

over 100 out of every 1,000 children born alive will die before age 1 in

a number of African and Asian countries, compared with only 12 per 1,000

in more developed countries as a whole.  The mortality of children under

age 5 exhibits a similar pattern.  Poverty, malnutrition, ignorance of

proper sanitation, inadequacy of health facilities, social unrest and

wars are factors associated with high infant and child mortality.  Early,

late, frequent and multiple pregnancies intensify the risks of infant and

child mortality.


64. To improve the health status of infants and children, to reduce the

incidence of low birth weight and to lower infant and child mortality in

line with the commitment of Governments made at the World Summit for

Children.  The document will include quantitative goals for infant

mortality reduction for the period up to 2015.

Selected topics for recommendations

65. Promotion of comprehensive mother-and-child health services,

including prenatal care, child-spacing, breast-feeding, infant and child

health-care services, greater immunization coverage, prevention and

management of childhood diseases and proper nutrition counselling.

                 C.  Sexually transmitted diseases and acquired

                     immune deficiency syndrome

Basis for action

66. The incidence of sexually transmitted diseases continues to be high,

with an estimated annual number of cases surpassing 250 million.  In the

developed world the incidence of many sexually transmitted diseases

caused by bacteria have stabilized but in the developing world that

incidence appears to be increasing.  In addition, over 1 million people a

year are becoming newly infected with HIV, the virus causing AIDS.  The

AIDS pandemic has emerged in both developed and developing countries as a

major public health issue, threatening to undermine major gains in the

reduction of morbidity and mortality.  The World Health Organization

estimates that as of mid-1993 over 2.5 million cumulative AIDS cases have

occurred but more than 14 million people world wide have been infected

since the epidemic began, including more than 1 million children infected

with HIV through their mothers.  The estimated distribution of cumulative

HIV infections in adults as of mid-1993 shows that approximately four

fifths of all cases occurred in the developing countries, where the

infection is increasingly being transmitted through heterosexual



67. To strengthen the contribution that family-planning programmes can

make to the prevention and treatment of sexually transmitted diseases,

with special attention to HIV infection.

Selected topics for recommendations

68. Strengthening programmes that minimize sexually transmitted diseases

and HIV infection through the promotion of safe and responsible sex and

the provision of sexual health education and of preventive, diagnostic

and curative treatment to inhibit the transmission of sexually

transmitted diseases.  

             D.  Primary health care and the health-care sector

Basis for action

69. There have been important advances in improving access to the

essential elements of primary health care and making available basic

curative health services, as reflected in the sustained increases in life

expectancy at birth in most parts of the world.  Notable achievements

include the vaccination of about 80 per cent of the children in the world

and the wide use of low-cost child survival techniques such as oral

rehydration therapy.  Despite such progress, large segments of the

population (mainly the poor) lack access to public services, such as

clean water and sanitation facilities, and are thus at greater risk of

infectious disease.  In many countries and regions, the health effects of

environmental degradation (including workplace environmental conditions)

are increasingly a cause for grave concern.  Various forms of substance

abuse (tobacco, alcohol and drugs), inappropriate diets and lack of

exercise have been found to hamper progress in mortality and morbidity

conditions, particularly among the poor and those unreached by health

education.  There is also concern 

about the reduction of social investment in health that has taken place

in many countries as a result of structural adjustment programmes. 


70. To attain further and more widely shared progress in general

morbidity and mortality reduction, in accordance with intergovernmental

commitments to provide health for all.  Revised quantitative goals for

increased expectation of life will be proposed for adoption by the


Selected topics for recommendations

71. Securing improved access to primary health-care services, with

increased attention to the prevention of ill-health caused by

environmental degradation, and to the promotion of changes in lifestyle

patterns that are conducive to better health.

                                 Chapter IX


72. Migration and urbanization are intrinsic parts of the development

process.  Although rural-rural and urban-urban migration are the dominant

forms of spatial mobility in many countries, attention has mostly been

focused on rural-urban flows because of their contribution to urban

population growth.  The latest United Nations estimates indicate that the

majority of the world population will live in urban areas by 2005.  There

are, however, marked differences in the levels and rates of urbanization

among regions and countries.  The less developed regions are undergoing

rapid urbanization, a process that is projected to continue for decades

to come.  In contrast, the rate of urbanization in the more developed

regions is slow and is expected to remain so.  However, whereas the rural

population of the more developed regions is declining, that of the less

developed regions continues to increase despite rural-urban migration.

     A.  Population distribution, natural resources and the environment

Basis for action

73. The mode of development affects both migration and the resulting

patterns of population distribution.  In rural areas, land degradation

often leads to migration both to urban and to other rural areas.  In

urban areas, environmental strains are also prompting people to move. 

Yet, to the extent that industry, financial services and communication

facilities remain spatially concentrated in urban areas, they will

continue to encourage an unbalanced population distribution.  The pursuit

of sustainable development is likely to foster more manageable population

distribution patterns and eliminate migration prompted by environmental

push factors.  Since the poor are often most vulnerable to the impact of

natural resource depletion and environmental degradation, promoting a

more rational use of natural resources is also consistent with the goal

of poverty alleviation. 


74. To foster a more balanced population distribution by promoting

simultaneously the sustainable development of rural and urban areas, with

particular emphasis on the promotion of social equity.  To reduce the

role of push factors in migration flows.

Selected topics for recommendations

75. Promotion of strategies that simultaneously encourage the growth of

small or medium-sized urban centres and the sustainable development of

rural areas.  Reducing the risks of environmental degradation by

developing appropriate strategies to address the problems emanating from

the expansion of human settlements on areas with fragile ecosystems.

              B.  Population distribution policies and sustainable

                  development strategies

Basis for action

76. Population distribution policies should be part of general

development strategies.  In the early 1990s, approximately half of the

Governments in the world, most of them in developing countries,

considered their patterns of population distribution to be unsatisfactory

and wished to change them.  To be effective, population distribution

policies should be consistent with other government policies, especially

those fostering economic development and the allocation of resources.


77. To formulate effective population distribution policies whose

objectives and goals do not conflict with other government policies.  To

foster administrative efficiency and improve services.

Selected topics for recommendations

78. Paying explicit attention to the spatial impact of macroeconomic and

other policies that have implications for population distribution, in

order to bring them into harmony with relevant national, regional and

local development goals.

            C.  Population growth in large urban agglomerations

Basis for action

79. In many countries, the urban system is characterized by the

overwhelming preponderance of a single major city or agglomeration.  The

tendency towards population concentration, fostered by the concentration

of public and private resources in some cities, has contributed to the

rising number and size of mega-cities.  In 1992, there were 13 cities

with at least 10 million inhabitants and their number is expected to

double by the year 2010.  In that year, most mega-cities will be located

in the developing countries.  The continued concentration of population

in primate cities in general and in mega-cities in particular poses

important economic, social and environmental challenges for Governments,

particularly in view of the unbalanced and unsustainable patterns of

production and consumption and the high degree of social inequality that

generally prevails in such environments.


80. To enhance the management of urban agglomerations, reduce the urban

bias that contributes to the further concentration of population in large

cities, and improve the quality of life of the urban poor.

Selected topics for recommendations

81. Securing the revenue necessary for local authorities to improve

urban infrastructure, safeguard the environment and provide urban

services through measures such as decentralization of expenditure and

tax-raising rights, and adoption of equitable cost-recovery schemes.  

                           D.  Displaced persons

Basis for action

82. During the past decade, awareness about the situation of migrants

who are forced to leave their places of usual residence for a variety of

reasons has been rising.  Because there is no single definition of

internally displaced persons, estimates of their number vary as do the

causes for their migration.  However, it is generally accepted that those

causes range from natural disasters that destroy human settlements to

internal conflicts that force people to flee from one area of the country

to another.  Given the forced nature of their movement, internally

displaced persons often find themselves in particularly vulnerable



83. To offer adequate protection and assistance to persons displaced

within their country.

Selected topics for recommendations

84. Measures that can be taken by the international community to assure

adequate protection and assistance to internally displaced persons,

especially to those who are not able to return to their normal place of

residence in the short term.

                                 Chapter X

                          INTERNATIONAL MIGRATION

85. Voluntary international migration is a rational response of

individuals to the real or perceived economic, social and political

differences between countries.  Most international migration flows are of

a regional nature, with people moving between neighbouring countries or

between countries in the same region.  However, interregional migration,

particularly that directed to developed countries, has been growing. 

During the 1980s, the population gains of developed countries

attributable to net international migration passed from being relatively

low during the early years of the decade to being relatively high towards

the end.  The relaxation of exit regulations in Eastern European

countries contributed to that trend, as did the growing, although still

moderate, outflow of migrants from developing countries.  In Asia, the

temporary migration of workers to the oil-producing countries of Western

Asia remained significant and countries such as Japan and some of the

newly industrializing economies of south-eastern Asia emerged as

receivers of migrant labour.  However, the trend towards increased

international population mobility has not generally been matched by the

willingness of countries of destination to admit more documented

migrants.  Given that the pressures for migration are growing in a number

of developing countries, especially as their labour force continues to

increase, undocumented or irregular migration is expected to rise.  Such

developments, coupled with the steady growth of refugee numbers, imply

that vulnerable migrant groups will increasingly need the aid of the

international community.

                A.  International migration and development

Basis for action

86. International migration both affects and is affected by the

development process.  When that migration is regular, it can be

beneficial for both countries of origin and destination.  A number of

measures can be taken by countries of origin and destination that, by

addressing the causes of migration, can contribute to promote its



87. To maximize the benefits of migration to those concerned and

increase the likelihood that migration has positive consequences for the

development of both sending and receiving communities.

Selected topics for recommendations

88. Assessing the effects of the economic, trade and development

cooperation policies of countries of origin and destination on

international migration. Realizing the full potential of return

migration, both permanent and temporary, as a channel for the transfer of

technology and know-how to the migrants' countries of origin. 

                          B.  Documented migrants

Basis for action

89. Documented migrants are those who satisfy all the legal requirements

to enter, stay and, if applicable, to hold employment in the country of

destination.  Many documented migrants have acquired over time the right

of long-term residence in the countries of destination.  Their

integration into the host society is generally desirable.  Their being

granted all of the rights established by the International Convention on

the Protection of the Rights of All Migrant Workers and Members of Their

Families (1990) would contribute to achieve that aim.


90. To promote the social and economic integration of documented

migrants, especially those who have acquired the right to long-term

residence in the country of destination.  To combat discriminatory

practices against documented migrants, especially female migrants.  To

ensure protection against racism and xenophobia.  To promote the welfare

of documented migrant workers and members of their families.

Selected topics for recommendations

91. Ensuring equality of opportunity for documented migrants in line

with the rights established in the International Convention on the

Protection of the Rights of All Migrant Workers and Members of Their

Families, paying attention to the formulation of appropriate strategies

to combat racism and xenophobia.  Facilitating the naturalization of

documented migrants who already have the right of long-term residence and

of their children, and extend civil and political rights to long-term

foreign residents.  

                         C.  Undocumented migrants

Basis for action

92. It is the sovereign right of every nation State to decide who can

enter and stay in its territory and under what conditions.  Undocumented

or irregular migrants who do not fulfil the requirements established by

the country of destination to enter, stay or exercise an economic

activity are a source of concern.  The control of undocumented migration

is necessary to safeguard the rights of migrants in general and prevent

the exploitation of those in an irregular situation.


93. To control undocumented migration, prevent the exploitation of

undocumented migrants and ensure that their basic human rights are


Selected topics for recommendations

94. Adoption of effective sanctions against those who organize

undocumented migration and those who exploit undocumented migrants, in

particular vulnerable groups such as women and children.

                                D.  Refugees

Basis for action

95. Two thirds of all countries in the world have ratified the 1951

Convention relating to the Status of Refugees and the 1967 Protocol,

which guarantee the right to seek asylum.  However, the growing numbers

of refugees and asylum-seekers are straining the asylum system.  The

number of refugees, which was 8.5 million worldwide in 1985, rose to

nearly 19 million early in 1993 and further increases are expected.  In

addition, the number of persons filing applications for asylum in

developed countries has grown substantially, to average well over half a

million annually during the first years of the 1990s. There is a need to

combat the root causes of refugee movements, with explicit condemnation

of the practice of "ethnic cleansing", and to support the international

protection and assistance of refugees, particularly of refugee women and



96. To reduce refugee flows by combating their root causes, to find

durable solutions for the plight of refugees, to ensure the adequate

protection and assistance of refugee populations and to prevent the

erosion of the right to seek asylum.

Selected topics for recommendations

97. Need to combat the root causes of refugee movements by fostering

conflict resolution, the promotion of peace, the respect of human rights,

the alleviation of poverty, democratization, good governance and the

prevention of environmental degradation.  Need to ensure the adequate

protection and assistance of refugees in first countries of asylum,

keeping in mind the burden-sharing responsibility among the international

community.  Support for the voluntary repatriation of refugees and

provision of reintegration assistance in conjunction with development


                                 Part Three

                          MEANS OF IMPLEMENTATION

                                 Chapter XI


98. The creation and maintenance of awareness about the importance of

population issues is of crucial importance at both the national and the

local levels to promote the aims and activities of population programmes

and at the global level to build world-wide support for population

activities.  Population information, education and communication (IEC)

activities usually have a broad mandate and complex functions, involving

many different audiences, messages and channels of communication.  These

activities will require, inter alia, appropriate use of the most modern

media available, accompanied by state-of-the-art monitoring techniques,

for maximum effectiveness.  Therefore, a coordinated strategic approach

is necessary.

                            A.  Public awareness

Basis for action

99. Public awareness is vital for groups and individuals to act

constructively on population issues.  Awareness is needed at several

levels (professional, political, general public and individual), in both

industrialized and developing countries, taking into account the

differences in their situations.


100.    To create and strengthen population awareness among the various

audiences in need of information, through strategies that provide for

responses to specific needs.

Selected topics for recommendations

101.    Creating and maintaining awareness of population issues in a

large variety of groups, including opinion leaders and policy makers.

                B.  Information, education and communication

Basis for action

102.    Attitudes that form the basis for behaviour and views on

population issues are often formed early; for this reason, an approach

beginning long before adulthood is required and population education in

the school system is one such approach.  Population education may take

place in schools and elsewhere.  It may begin with the home and the

school system and continue with counselling for newlywed couples,

followed by parent education to help them educate their own children, and

continue the cycle with the education of children, young adults and even

grandparents (who may tend to exert pressure on couples to have children

early etc.).


103.    To take action simultaneously and in a coordinated manner on

several fronts to achieve programme goals, through better strategic IEC

planning.  To enable activities to be more client-responsive and

effective through more appropriate research and its application.  To

contribute to increased understanding and to the formation of responsible

population attitudes and behaviour through population education,

beginning at an early age.

Selected topics for recommendations

104.    Adoption of comprehensive planning strategies for IEC

activities, including the development of innovative ways of promoting

IEC, in particular through the use of new technologies.  Making

high-quality population education available to all schoolchildren in the

context of Education for All, paying explicit attention to human rights,

population and environment, gender relationships, responsible

reproductive behaviour, reproductive health and sexuality, and the

consequential choices and responsibilities.

                                Chapter XII


105.    The fundamental purpose of mechanisms for the attainment of

population goals is the generation of the capacity for countries through

their Governments, non-governmental organizations and private and

personal initiatives to undertake programmes of action to further their

own national development, advancing the quality of life and range of

choice of their people.  The development of integrated programmes

addressing population issues, particularly family planning, within the

context of sustainable economic activity, requires the participation of

appropriately trained personnel working within effective institutional

arrangements.  In order to assure the development and widespread

availability of such a capacity, it will be necessary to facilitate the

transfer of technologies and the development of training and

programme-implementation institutions and the dissemination of

information and managerial and administrative skills.  The building of

national capacities and strengthening of local and regional institutions

to meet the challenges of demographic change must be a priority activity. 

                        A.  Management of programmes

Basis for action

106.    National capacity-building in the areas of management skills and

strategic planning is crucial to ensure the appropriate selection and

deployment of trained individuals to maximize institutional

effectiveness.  In times of budgetary constraints for governmental and

non-governmental institutions there is an increased need to ensure that

trained personnel are retained and function effectively in the areas of

their expertise.  The existence of sufficient cadres of trained staff in

population and development will also facilitate the establishment of

institutional linkages within and between countries to allow the

dissemination of information and transfer of operational experience in

the areas of programme development, analysis and evaluation.


107.    To improve the cost-effectiveness and impact of national

population programmes, by training and retaining staff in key areas of

expertise.  To facilitate the flow of information between actors in

national population programmes to enhance the formulation of policy and

monitoring of performance.  To increase accountability for performance in

the implementation of national population programmes. 

Selected topics for recommendations

108.    Strengthening strategic management approaches in public and

private population and development programmes, including the development

of management information systems.

                  B.  Education and training of policy makers, 

                      managers and other personnel

Basis for action

109.    The recent trend towards decentralization of authority in many

national population and development programmes, particularly in

government programmes, significantly increases the requirement for

training staff to meet new responsibilities at all administrative levels. 

This increased demand for trained personnel is added to the requirement

for continued strengthening of national institutions.  The

decentralization trend modifies the skill-mix required in central

institutions more towards policy analysis, evaluation and strategic

planning in collaboration with a diverse variety of institutions.  New

modalities for programme implementation and development require the

assessment of the adequacy of past human resource development and

institution-building strategies and their modification to changing



110.    To ensure the availability of an appropriately trained supply of

personnel for the formulation, implementation and monitoring of

population programmes.

Selected topics for recommendations

111.    Promoting coordinated educational and training activities and

advisory services related to population programmes.

                       C.  Institutional development

Basis for action

112.    In many countries and in some regions, the formulation of

population and development policies, programmes and plans of action, and

their implementation and monitoring remains constrained by insufficient

local capacity.  The quality of technical inputs to programme formulation

is, in some cases, another important bottleneck.  Widespread

dissemination of the lessons learned in programme implementation will be

required to make the development and transfer of tested procedures and

approaches more efficient.  


113.    To increase national capacities for population and development

programme and project formulation.  To reduce attrition of trained staff. 

To facilitate the timely dissemination and use of information and policy

analyses produced at national institutions. 

Selected topics for recommendations

114.    Ensuring sustained commitment by both donor and national

authorities to all aspects of institution-building and maintenance,

thereby increasing the share of technical activities in population being

directly undertaken by national personnel.

                                Chapter XIII


115.    The need to base population and development policies and

programmes on sound knowledge is increasingly recognized.  The research

needs involve a broad spectrum of disciplines, to measure and analyse

population trends, to develop safer and more effective programme inputs

and to improve the delivery of services in accordance with the conditions

prevailing in various socio-economic and cultural settings.

                   A.  Basic data collection and analysis

Basis for action

116.    Important improvements have been made over the past 20 years in

the collection and analysis of demographic data, as well as in population

policy databases, which have become more comprehensive and systematic. 

Nevertheless, much crucially important work remains to be done.  Indeed,

in many developing countries, basic demographic data and analyses based

on current direct observation are still lacking.  Data on migration are

generally felt to be scarce and incomplete.  In all cases, there is need

to continuously update, consolidate and improve data collection and

analysis to keep pace with rapid and often unprecedented population

trends currently taking place in many regions and in numerous newly

independent countries.  There is also need for greater insight into those

areas and subpopulations that have been neglected in the past or where

change is lagging, to help in devising appropriate action to speed the

process of demographic transition. 


117.    To enhance the balance, coverage and relevance of programmes of

data collection and analysis, to improve the basis for analysis,

interpretation and presentation of population and relevant phenomena.

Selected topics for recommendations

118.    Improving the quality of basic data on vital processes and

national subpopulations, taking gender into account, and making those

data accessible and available on a timely basis.

                  B.  Biomedical research and development

Basis for action

119.    As a result of continuing biomedical and related research, more

and more people at present have access to modern methods of fertility

regulation.  In many parts of the world, this has led to improved

reproductive health and reduced fertility.  However, a substantial degree

of effort across a wide range of activities will be required to ensure

that all people have the opportunity to achieve and maintain sound

reproductive health and to exercise their basic right to safe and

voluntary fertility regulation.  Higher levels of biomedical research and

development are essential elements in achieving these goals. 


120.    To expand reproductive choice by developing new and improved

methods of fertility regulation which are safe, effective and respond to

the needs and concerns of users.  To continue to ensure the long-term

safety of existing and new methods of fertility regulation.

Selected topics for recommendations

121.    Promoting research on all methods of fertility regulation,

including women-controlled barrier methods and male methods, according to

internationally accepted ethical principles and technical standards and

incorporating women's perspectives into all stages of the research

process and seeking the involvement of private industry and

drug-regulatory agencies as partners in biomedical research.  Promoting

research on unsafe abortion and other aspects of reproductive health,

including those related to the needs of adolescents.

              C.  Social and economic research and development

Basis for action

122.    Greater understanding of social and behavioural processes is

essential in order to achieve many of the goals of population and

development programmes; such programmes should be based on accurate and

culturally relevant knowledge of the people whom they seek to serve. 

There is need to promote research essential to the design and monitoring

of population policies and programmes, in order to ensure, inter alia,

that they respond to the needs of the society at large, as well as to the

needs of women and of vulnerable, marginalized and underserved people. 

Such research should address issues such as quality of care, cost and

accessibility of services.


123.    To advance the understanding of demographic processes and their

interrelations with the environment and social and economic development. 

To establish balanced programmes of research that are policy-relevant and

action-oriented.  To foster the dissemination and use of research

results, particularly to policy makers and programme officers.

Selected topics for recommendations

124.    Promotion of research on the broad field of interrelations

between population, environment and development.  Ensuring that the

population programme and policy research agenda has a balance of

theoretical, operational and methodological work.

                                Chapter XIV

                              NATIONAL ACTION

125.    National action undertaken by countries to address their own

population problems, in a broadened context of balanced social and

economic development, encompasses the coordinated work of national

Governments, regional or local authorities, organizations, institutions,

associations, unions or communities.  National action requires sound

policies to ensure that the benefits of development are shared by the

entire population.  National, state and local community-level resource

mobilization in each country according to their capacities is another

priority area for action if countries are to meet the current and future

demand of their people for family-planning services and other population

programme needs.

                 A.  National policies and plans of action

Basis for action

126.    National Governments are primarily responsible for designing,

implementing and evaluating national population policies and programmes. 

In many countries, clarifying the mode of interaction between the entity

of the central government responsible for coordinating population

policies and programmes, the sectoral ministries and other concerned

parties is still a problem to be overcome.  However, over-reliance on the

government sector can become a bottleneck.  The experience of the past

decades suggests that the mobilization of sustained political commitment,

not only at the highest level but also down to local leaders of the

public, private and non-governmental sectors at the grass-roots level,

has been an important factor behind the success of strong national

population programmes.  There has also been growing recognition of the

fact that population policies stand a lesser chance of success in the

long run if their beneficiaries are not fully involved in their design

and subsequent implementation.


127.    To address population problems through effective and concerted

action within the framework of a national population policy and to

achieve grass-roots involvement in formulating and implementing plans of

action in the field of population.

Selected topics for recommendations

128.    Increasing the political commitment of Governments to formulate,

implement and evaluate their national population programmes and

strengthening their capacity to enlist the cooperation of the private

sector, non-governmental organizations, academia, the mass media and

other influential groups and to foster the grass-roots participation of

programme beneficiaries. 

                          B.  Resource allocation

Basis for action

129.    The allocation of resources at the national level generally

falls into several broad categories:  population data collection and

analysis; policy-relevant research; awareness-creation and advocacy;

capacity-building activities; policy formulation and implementation;

family-planning services; IEC activities and special programmes for youth

and women; and population and development.  National resource

mobilization is a priority area for action, in the light of the

substantial increase in demand for reproductive health and family-

planning services that will take place in the coming decades.  Efforts to

generate domestic resources to support service-delivery programmes and

associated information, education and communication activities will need

to be intensified, although many of the countries where the demand will

be growing most rapidly are currently witnessing recessionary trends in

their domestic economies. 


130.    To achieve an adequate level of national resource allocation

devoted to programmes aimed at resolving population problems, based on a

clear understanding of the costs involved in meeting the unsatisfied

demand for family-planning services and for other social-sector services,

such as primary education and primary health care, which also affect

population dynamics.

Selected topics for recommendations

131.    Intensifying efforts to generate domestic resources to support

all categories of population programme activities, with increased

attention to selective use of user fees, social marketing, cost-sharing

and other forms of cost-recovery.

                                 Chapter XV

                         INTERNATIONAL COOPERATION

132.    International cooperation in the area of population comprises,

in addition to technical and financial assistance by bilateral and

multilateral agencies to population activities in developing countries,

other forms of cooperation regarding issues such as international

migration and the AIDS pandemic.  Attention needs to be directed as well

to the comparative advantages (and disadvantages) of various modalities

for the provision of international assistance.  International technical

and financial assistance has played an important role in facilitating the

efforts of national Governments to devise and implement population

policies and programmes but has not kept pace with growing resource

requirements as more and more developing countries have formulated and

begun to implement national population policies and programmes.  National

population and development programmes need to receive stable, consistent

and appropriate levels of international support, taking into account the

balance and relationship between international assistance directed to

population-related activities and international cooperation connected to

broader areas of socio-economic development.  

                               A.  Modalities

Basis for action

133.    The coordination of international inputs to population and

development is primarily the responsibility of Governments.  However,

reducing duplication of efforts, identifying and expanding successful

programmes and ensuring maximal effectiveness is also a task that profits

considerably from the cooperation of all donors and active participants,

including the specialized agencies and organizations and bodies of the

United Nations system.  


134.    To assure the effective and coordinated use of various

mechanisms of assistance for the formulation, implementation and

monitoring of national population programmes.  To ensure the full

mobilization of national (governmental and non-governmental organizations

and the private sector) participants in the national population programme

for effective action in their areas of particular competence, expertise

and comparative advantage.  To monitor performance of the various

components of the national population programme to assure that

appropriate technical and material contributions are made by

organizations according to their capacities.

Selected topics for recommendations

135.    Coordination of international organizations and donor nations to

encourage use of multilateral and multi-bilateral mechanisms, including

technical back-stopping, to guarantee consistency and continuity of

support to programmes, based on the analysis of the impact and

cost-effectiveness of such mechanisms and in line with comprehensive

national development strategies. 

             B.  Resource mobilization:  Bilateral and multilateral

                 development assistance

Basis for action

136.    Little progress has been made over the past 5-10 years towards

reaching the earlier goals articulated in the donor community for support

for population activities as proportions of their overseas development

assistance or as proportions of their gross national product.  The

current average is 1.3 per cent, compared to 2 per cent in the early

1970s.  Nevertheless, there remains a strong consensus on the need to

mobilize significant additional financial resources both from the

international community and within countries for the implementation of

national population programmes in support of sustainable development

policies.  Additional resources are required, inter alia, to satisfy the

existing unmet need for family-planning services, respond to future

increases in demand, keep pace with the increased population sizes that

must be served, and improve the quality of care of programmes.  Although

intensified additional efforts to mobilize domestic resources are needed

and projected, additional financial resources from the international

community will be required especially to assist the least developed

countries and countries implementing structural adjustment programmes,

including so-called countries in transition.  


137.    To satisfy the growing resource requirements of population


Selected topics for recommendations

138.    Mechanisms for the international community to establish

guidelines/ recommendations for assistance levels as proportions of gross

domestic product and overseas development assistance, on the basis of

updated estimates for resource requirements consistent with the scale of

efforts needed to achieve the quantitative goals adopted by the

Conference and taking into consideration the constraints created by

economic reform and structural adjustment programmes.

                                Chapter XVI



                         AND LOCAL COMMUNITY GROUPS

139.    There is an increasing recognition of the need for a partnership

on population and development issues between Governments and

non-governmental groups, which are composed of non-governmental

organizations, the private sector and local community organizations.  In

some areas of population and development activities, non-governmental

groups may have comparative advantages in relation to governmental

agencies, either because their experience of advocacy and programme

implementation (especially at the local level) predate that of

Governments, or because they represent and interact with constituencies

that are poorly served and hard to reach through governmental channels. 

Non-governmental groups operate locally, nationally and, in some cases,

internationally, often having networks and affiliates facilitating

cooperation at all levels and enhancing partnership among themselves and

with Governments.  Where they are working on population and development

activities as partners with Governments, the quality of services has

often improved markedly.  

Basis for action

140.    Non-governmental organizations have been actively involved in

the provision of services for population and development programmes and

projects and support activities such as data collection and analysis. 

They have been working as partners with Governments in delivering

services and helping implement population and development programmes; in

many cases this partnership has been instrumental in ensuring that

national policy goals were achieved.  They also have acted as catalysts

for change, often serving as a voice for previously unrecognized

concerns, reaching underserved populations, setting quality standards

responsive to the beneficiaries' needs and developing innovative


141.    In many countries, the private sector has the financial capacity

and the technology to produce and deliver commodities and services in the

population field, and Governments usually rely to some extent on the

private sector for the procurement of such programme inputs.  This has

produced a valuable partnership, which the private sector is keen to

expand.  By acknowledging the valuable contribution of the private

sector, and by seeking more areas for cost-effective and mutually

beneficial cooperation, Governments may expect to enhance the efficiency

of population and development activities.  

142.    Local community organizations vary from country to country.  In

some countries, Governments helped establish them and in others they have

been created by the communities themselves.  They range from the family

and kinship to political, social, economical, religious and educational

institutions and organizations.  They are generally well-established and

continue from one generation to the next, providing a social framework

for their communities.  They are generally seen as meeting the needs of

families and individuals and their role as providers of services is

widely and favourably acknowledged.  Numerous development processes can

be encouraged by fostering the partnership between Governments and local

community organizations.  Some who already provide a number of social

services could readily be encouraged to also participate in population



143.    To enhance the partnership between Governments, non-governmental

organizations, the private sector and local communities in order to

attain a more effective working relationship and to identify new areas

for cooperative activity, including, as appropriate, the efficient

production of population programme commodities and the fair-cost delivery

of services.

Selected topics for recommendations

144.    Creating suitable mechanisms and frameworks to enhance the role

of non-governmental organizations in the field of population.  Promoting

the effective use of the experience and resources of the private sector

to achieve population and development goals.  Ensuring the participation

of local communities in the formulation and implementation of population

policies and programmes.

                                Chapter XVII


145.    In order to ensure that commitments made at the Conference are

implemented with tangible results, it will be necessary to make

arrangements appropriate for the effective implementation of the

recommendations of the Conference.  At the level of the United Nations

system, this should involve increased integration of population concerns

into social and economic development efforts, including policy

development.  Arrangements will need to be outlined to ensure ongoing

monitoring, review and appraisal of the outcome of the Conference. 

Attention will also need to be given to effective follow-up at the

operational level, particularly in regard to funding, technical

assistance and coordination.

                             A.  Implementation

Basis for action

146.    The World Population Plan of Action, adopted in 1974, contained

a number of recommendations related to institutional arrangements for its

proper implementation, further elaborated by the recommendations of the

International Conference on Population, held at Mexico City in 1984. 

Similarly, there will be a need for the Cairo Conference to consider how

best to organize the involvement of the international community of

Governments, non-governmental organizations, the United Nations system

and regional intergovernmental bodies to assist Governments in the

implementation of the new action programme adopted by the Conference,

also in view of the outcomes of other major United Nations conferences of

the decade, particularly the United Nations Conference on Environment and

Development, the World Conference on Human Rights, the World Social

Summit and the Fourth World Conference on Women.


147.    To ensure the effective implementation of the new action


Selected topics for recommendations

148.    Ensuring the integration of population concerns in governmental,

non-governmental and international development efforts through

appropriate arrangements.

                         B.  Monitoring and review

Basis for action

149.    The World Population Plan of Action called for continuous

monitoring and periodic review and appraisal of its implementation. 

Accordingly, three quinquennial review and appraisal exercises have been

carried out to assess the progress in the implementation of the Plan and

a fourth one will take place at the Cairo Conference.  The Conference may

find it necessary to establish appropriate mechanisms for the monitoring

and review of its action programme.


150.    To assess the progress in the implementation of the action

programme adopted by the International Conference on Population and

Development and take necessary measures to guide further action.

Selected topics for recommendations

151.    Establishing accurate and timely mechanisms for assessing the

progress made in achieving the goals and objectives of the action

programme adopted by the International Conference on Population and



    1/  Report of the United Nations World Population Conference,

Bucharest, 19-30 August 1974 (United Nations publication, Sales No.

E.75.XIII.3), chap. I.

    2/  Report of the International Conference on Population, Mexico

City, 6-14 August 1984 (United Nations publication, Sales No. E.84.XIII.8

and corrigenda), chap. I, sect. B.

    3/  Report of the International Forum on Population in the

Twenty-first Century, Amsterdam, the Netherlands, 6-9 November 1989 (New

York, United Nations Population Fund, 1990), annex.

    4/  Report of the United Nations Conference on Environment and

Development, Rio de Janeiro, 3-14 June 1992, vol. I, Resolutions Adopted

by the Conference (United Nations publication, Sales No. E.93.I.8),

resolution 1, annex I.

    5/  Ibid., resolution 1, annex II.

    6/  Report of the World Conference to Review and Appraise the

Achievements of the United Nations Decade for Women:  Equality,

Development and Peace, Nairobi, 15-26 July 1985 (United Nations

publication, Sales No. E.85.IV.10), chap. I, sect. A.

    7/  General Assembly resolution 217 A (III).

    8/  General Assembly resolution 2200 A (XXI), annex.

    9/  General Assembly resolution 2106 A (XX).

    10/ General Assembly resolution 34/180, annex.

    11/ General Assembly resolution 44/25, annex.


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