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'The State of the World Population 2004' report examines population, reproductive health and the global effort to end poverty ten years after the International Conference on Population and Development in Cairo
 Ten years after 179 countries adopted this landmark agreement at the International Conference on Population and Development (ICPD) in Cairo, and nearly halfway to its 2015 completion target, nations are reviewing and reaffirming their support for a global action plan linking population to economic growth, reproductive health and women’s rights, HIV/AIDS and environmental decay. But inadequate resources and gender bias and gaps in serving the poor are undermining further progress as challenges mount, according to the United Nations Population Fund’s (UNFPA’s) 'State of the World Population 2004' report. The report, ‘The Cairo Consensus at Ten: Population, Reproductive Health and Global Effort to End Poverty’, reviews countries’ achievements and constraints in implementing a programme of action. It examines actions addressing links between population and poverty, environmental protection, migration and urbanisation, discrimination against women and children, and key reproductive health issues including access to contraception, maternal health, HIV/AIDS and the needs of adolescents and people in emergency situations. The starting point of the ICPD was the premise that population size, growth and distribution were closely linked to development and that action in one area reinforces action in another. The Cairo conference gave priority to investing in people and broadening their opportunities. Seen in this context, important gains have been made. More people have access to family planning. The use of modern contraceptives has risen from 55% of couples in 1994 to 61% today. Between 2000 and 2015, contraceptive users in developing countries are expected to increase by 40%. New laws prohibit discrimination and violence against women. Sensitive but urgent concerns like adolescents’ need for reproductive health information and services are now being addressed in many countries. HIV prevention efforts have been scaled up and governments embrace the ICPD programme of action as an essential blueprint for realising development goals. Ten years after Cairo the scenario remains alarming - More than 350 million couples still lack access to a full range of family planning services. Complications during pregnancy and childbirth remain a leading cause of death and illness among women: 529,000 die each year, mostly from preventable causes.
- Five million new HIV infections occurred during 2003; women constitute nearly half of all infected adults and nearly three-fifths of those are in sub-Saharan Africa.
- While fertility is falling in many regions, the world’s population will increase from 6.4 billion today to 8.9 billion by 2050; the 50 poorest countries will triple in size to 1.7 billion people.
Population and poverty Some 2.8 billion people -- two in five -- still struggle to survive on less than $ 2 a day. Poverty perpetuates and is exacerbated by poor health, gender inequality and rapid population growth. Richer population groups have far greater access than poorer groups to delivery by skilled attendants, contraceptives and other reproductive health services. Poor women give birth at an earlier age and have more children throughout their lives than wealthier women. Reduced fertility and mortality (healthier people with less children) help higher productivity and greater savings and encourage family investments in health, nutrition and education. Declining fertility also reduces the proportion of dependent children on working-age populations, opening a one-time window of opportunity (before the dependent older population becomes a burden) in which countries can make investments to spur economic growth and reduce poverty. Footprints on the planet Unsustainable consumption and production patterns coupled with rapid population growth are taking their toll on the environment. More people are using more resources with more intensity, and leaving a bigger ‘footprint’ on the earth than ever before. A rapidly growing global consumer class is using resources at an unprecedented rate with an impact far greater than is commensurate with their numbers. Farmers, ranchers, loggers and developers have cleared about half the world’s original forests. Three-quarters of the world’s fish stocks are at or beyond sustainable limits. Half a billion people live in countries defined as ‘water stressed’ or ‘water scarce’; by 2025, that figure is expected to be between 2.4 billion and 3.4 billion people. Fast-growing poor populations have no option but to exploit their local environment to meet their subsistence needs for food and fuel. Gender plays a strong role in how resources are used and developed, and greater equality in this between men and women is imperative. Migration and urbanisation Due to continued rural to urban migration, the number of people living in cities is growing twice as fast as total population growth. A majority of the world’s people will be living in cities by 2007; by 2030 all regions will have urban majorities. Both mega-cities of 10 million people or more (20 in all, 15 in developing countries) and small and medium cities are growing, severely testing the limits of local infrastructure and services. This migration is in response to inequitable distribution of resources, services and opportunities. There were 175 million international migrants in the world in 2000 -- 1 in every 35 -- up from 79 million in 1960. A growing number of women are seeking employment abroad. Today three-fourths of countries are taking action, more in relation to existing poverty, to stop migration; in 1994 only one-fifth had done so. Women’s empowerment Gender equality lies at the heart of the ICPD vision, strongly linked to reproductive health and rights. Since 1994, more than half of all countries have adopted national legislation on women’s rights, including ratifying UN conventions and establishing national conventions. But the progress has been uneven. Although many countries have introduced laws on gender violence these are often not enforced. Only 28 countries have increased women’s political participation. Efforts promoting women’s advancement are susceptible to budget cuts. Only 42 countries were able to increase public spending on schools and 16 had increased the number of secondary schools for girls. Priorities for improving the status of women include improvements in the areas of education, information, removing discrimination in employment, ensuring property ownership and inheritance, participation in governance and reduction in violence against women. Reproductive health and family planning Gaps in reproductive and sexual healthcare account for one-fifth of the worldwide burden of illness and premature death, and one-third of illness and death among women of reproductive age. The broad reproductive health concept of the ICPD continues to gain support although the situation remains grim. Some 201 million women in the poorest countries still have an unmet need for effective contraception. Meeting their demand would cost $ 3.9 billion a year and prevent 23 million unplanned births, 22 million induced abortions, 142,000 pregnancy-related deaths (including 53,000 from unsafe abortions) and 1.4 million infant deaths. However, much important progress has been made in this area. Maternal health Obstetric complications are a leading cause of death among women of reproductive age in developing countries. Though one of the most urgent and intractable (treatable but hard to detect in time) health problems, this issue has not been given deserving priority. The global number of deaths has not changed significantly since 1994. Moreover, poverty dramatically increases a woman’s chances of dying. The lifetime risk of a woman dying during pregnancy or childbirth is 1 in 12. In developed nations, the comparable risk is 1 in 4,000. Reducing maternal death requires skilled attendance at delivery, emergency care and transport facilities. Skilled personnel assist half of all deliveries in developing countries; 35% in South Asia and 41% in sub-Saharan Africa. However, since the ICPD, countries are increasing people’s access to family planning services to reduce unintended pregnancies and unsafe abortions -- another major cause of maternal death. Preventing HIV/AIDS In just over two decades, the AIDS pandemic has claimed 20 million lives and infected 38 million people. Fewer than 20% of people at high risk have access to proven prevention interventions. The consequences of AIDS are far-reaching. In some areas of sub-Saharan Africa, 25% of the workforce is HIV-positive. Studies show that if 15% of a country’s population is HIV-positive its GDP will decline by 1% a year. Reproductive and sexual health information avenues provide a critical point in preventing HIV transmission. Educating people about the virus, detecting and managing sexually transmitted illnesses (STIs), promoting the use of condoms, helping prevent mother-to-child transmission and counselling infected people are important interventions. Serving adolescents and young people Since 1994, and especially in the past few years, significant attention has been paid to sensitive issues related to adolescents. HIV, unwanted pregnancies, early marriage, high dropout rates for girls and counselling about sexuality and reproductive health remain areas that call for urgent intervention. Helping communities in crisis Since the ICPD, attention to the reproductive health of women made vulnerable by war and disaster has increased greatly. A quarter of the tens of millions of refugees in the world are women of reproductive age. Death during childbirth in disaster-stricken countries, rape and gender-based violence occur more frequently during wars. STIs, HIV/AIDS, unsafe sex and abortion increase during periods of disaster. Humanitarian groups, including the UNFPA, respond with basic materials, counselling and treatment where they can. Priorities for action Successful action towards implementing the Cairo agenda and combating poverty depends on adequate funding and effective partnerships. Developing country domestic expenditures on the ICPD package in 2003 were around $ 11.7 billion. A large portion of this is from developed countries. The poorest countries depend heavily on donor funding. However, while donors agreed to provide $ 6.1 billion a year by 2005, in 2002 contributions were $ 3.1 billion -- only half their commitment. Policy priorities for action over the next 10 years include better integration of populations into national planning; better delivery of health services; investing in rural development; reform laws and policies to end discrimination against women; and making civil society participation an integral part of institutional activities. -- Summarised by Manipadma Jena (Manipadma Jena is an independent journalist based in Bhubaneswar, Orissa) InfoChange News & Features, September 2004
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