Commission on Population and Development Hears Divergent Views as Issue of Abortion Takes Centre Stage in Continuing General Debate

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New York, NY (MMD Newswire) April 14, 2011 - - With more than 50,000 women dying annually from unsafe abortions, especially in Africa and South-Central Asia, Governments everywhere must make greater efforts to ensure that the old-age and widespread practice of abortion was safe, legal and available to all women and girls, today's keynote speaker told the Commission on Population and Development as it continued its general debate.

"When political leaders and policymakers fail to implement known, affordable solutions to an entirely preventable problem, one can only conclude that they do not sufficiently value the women and girls whose lives are at stake," said Eunice Brookman-Amissah, Vice-President for Africa of Ipas, a global non-governmental organization dedicated to ending preventable deaths and disabilities resulting from unsafe abortion.

According to the World Health Organization (WHO), more than 21 million women underwent unsafe abortions every year, often ingesting poison or inserting sharp objects into themselves, said Ms. Brookman-Amissah, a former Minister for Health of Ghana. Hundreds of millions more women would do the same at some point during their lifetime, particularly in Africa and Latin America, where the practice was largely banned or highly restricted, causing a heavy burden on health systems and impeding realization of Millennium Development Goal 5, on improving maternal health.

She said she was encouraged, however, that since the 1994 International Conference on Population and Development, Governments were paying more attention to the problem. Most African Governments had ratified the African Union's protocol on women's rights, which granted access to safe abortion for health and other reasons, while several countries had eased legal restrictions on abortion or increased access within current laws. Since 2003, when WHO had provided advice to Governments on how to make abortion safe, deaths from unsafe abortions had dropped 16 per cent, she noted.

Describing access to reproductive health services as a fundamental need for all people, she called upon Governments to improve national reproductive health policy and commit financial resources to meet reproductive health goals as part of their in national development plans. "I ask that you rise above political expediency and ideology and base your decisions on respect for basic human rights, and that you focus on how we can work together to scale up the evidence-based approaches and life-saving strategies that we know will solve the most urgent reproductive health challenges we face." The first priority must be to create effective interventions in poor countries for family planning, safe abortion care and maternal, newborn and child health.

While numerous participants addressing the session voiced similar concerns, some speakers strongly disagreed with their stance on abortion. Swaziland's representative opposed the view of abortion and sexual education as human rights and criticized organizations that exerted pressure on Governments to legalize abortion, saying it undermined State sovereignty and the cultural and moral beliefs of local communities. Sex education undermined the right of parents to control the themes to which their children were exposed, he added.

A representative of the Centro de Investigación Social, Formación y Estudios de la Mujer said abortion imposed a high price on States, which had to deal with the "double cost" of contraceptives and abortions, as well as that of treatment for abortion-related complications. She expressed regret that speakers had not discussed the progressive replacement of surgical abortion by chemical abortion, its radical effects on women, or the negative consequences of induced abortion -- including the increased risk of breast cancer, psychological problems and post-abortion syndrome, among others.

Also today, the Commission held its general debate on further implementing the 1994 Cairo Programme of Action.

Nafis Sadik, Special Envoy of the Secretary-General for HIV/AIDS in Asia and the Pacific, said the international community had failed to make good on its financial commitments to ensure that the stated goal of the International Conference to create global demographic stability was met. Funds for family planning had fallen significantly, and reproductive health had not been incorporated into the Millennium Development Goals, she noted. As a result, many women had died or suffered needlessly, and an even greater number remained unable to exercise their human rights or contribute fully to development.

Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA), said the decision to extend the Cairo Programme of Action to 2014 reaffirmed the centrality of population to sustainable development, as well as the unfinished nature of that "visionary road map". The international community must focus on human rights and women's rights -- including the right to sexual and reproductive health -- as well as principles of equity and social justice in order to guide collective efforts for sustainable development, he emphasized.

Sha Zukang, Under-Secretary-General for Economic and Social Affairs and Secretary-General of the 2012 United Nations Conference on Sustainable Development, also made a statement on that topic.

Also speaking today were the Dominican Republic's Vice-Minister for Women, and the Acting Executive Director of Ghana's National Population Council.

Representatives of the Czech Republic, Myanmar, Zambia, Hungary (on behalf of the European Union), United States, Indonesia, Netherlands, China, Norway and Egypt also made statements.

Additional statements were delivered by representatives of the World Bank, International Labour Organization (ILO) and the International Organization for Migration (IOM).

Representatives of the following non-governmental organizations also addressed the Commission: Partners in Population and Development; Action Canada for Population Development; German Foundation for World Population; World Youth Alliance; Global Helping to Advance Women and Children; NGO-Endeavour Forum Inc.; Catholic Women's League of Australia; International Federation of University Women; International AIDS Women's Caucus; Mosaic Training Service and Healing Centre for Women; and the World Mission Foundation.

During the discussion following the keynote address, the Commission heard from representatives of South Africa, Norway, Saint Lucia and Niger. A representative of the Foundation for Studies and Research on Women also spoke.

The Commission will reconvene at 10 a.m. tomorrow, 14 April, to continue its session.

Background

The Commission on Population and Development met this morning to continue its general debate on national experiences in population matters: fertility, reproductive health and development.

Statements

SONIA DIAZ (Dominican Republic), Vice Minister for Women, said her country's significant achievements in terms of the Programme of Action of the International Conference on Population and Development included a reduction in fertility and increased access to contraceptive methods for about 70 per cent of both married and unmarried women. However, challenges remained, she said, emphasizing the need to redouble efforts to change the indicators on maternal mortality, unwanted pregnancies -- among adolescents in particular -- reduce HIV/AIDS prevalence rates, eliminate stigma and discrimination, and end femicides and other violence against women and girls. Eradicating poverty remained the biggest challenge due to its high incidence in socio-economic demographic indicators, which limited the full exercise of people's rights and human development. She said her country had put the National Development Strategy 2010-2030 in place with the aim of reducing poverty and increasing equality, among other goals.

DAVID ČERVENKA (Czech Republic), recalling that several speakers had highlighted the link between high fertility rates and high poverty levels, said that some countries, including his own, had to deal with challenges relating to ageing populations. In that vein, the draft resolution under consideration by the Commission should accurately reflect the diverse population situations worldwide. Life expectancy in the Czech Republic had risen and fertility had declined to the lowest level ever recorded, he said. The Government had made gains in enhancing sexual and reproductive health rights and continued to support national implementation of the Programme of Action, which, together with the Beijing Programme of Action, formed the "cornerstone" of global population policies. With its newly transformed Development Ministry in the lead, the Czech Republic looked forward to scaling up their implementation, as well as that of the Millennium Development Goals, both nationally and internationally.

MARIAN KPAKPAH, Acting Executive Director, National Population Council of Ghana, said that despite an encouraging general improvement over the years, various socio-cultural practices and beliefs tended to support and sustain high fertility rates in her country. Ghana's total fertility rate had declined from 5.5 children per woman in 1993 to 4.0 in 2008; two years ahead of the target year. However, maternity mortality remained such a challenge that it had been deemed necessary to declare it a national disaster in 2008, she said. A consultative meeting had identified the need for priority interventions in terms of increased family planning coverage; basic and emergency obstetric and newborn care; prevention and management of unsafe abortion; and adolescent health and development. A 2007 study had also identified abortion as the second highest contributor to maternal death at 15 per cent, behind haemorrhage at 24 per cent, she said, adding that 16 per cent of adolescent pregnancies had resulted in abortions. To address those challenges, the country's Reproductive Health Policy and Standards had been reviewed to include the provision of abortion care services to the extent permitted by the law. She said that, given continued political will, adequate funding and an integrated package of services, Ghana would record better progress in its reproductive health indicators.

NYI NYI (Myanmar) said his country's population and socio-economic aims included striving to achieve higher levels of development and reducing poverty. It approached those issues not only from a population perspective, but also from the perspective of concern for women's health. Fertility rates had decline due largely to higher levels of education and employment, as well as increased contraceptive use, among other factors. A woman's mean age at first marriage had risen to 21 by 2006, and the number of adolescent marriages had fallen, he said. However, further mechanisms were needed to provide unmarried people with education on sexual and reproductive health, as well as family planning. Additionally, Myanmar was not close to realizing the Millennium Goal on reducing maternal mortality, while the relatively high maternal death rate remained a challenge, he said, stressing that the country would continue its efforts to reduce it while pursuing other reproductive health goals related on all levels.

HARRY JOOSEERY, Executive Director, Partners in Population and Development, said that ensuring universal access to reproductive health-care services and meeting family planning needs could speed up improvements in maternal and child health while benefiting development, especially in high fertility countries. Current funding levels, particularly for family planning, were way below the level needed to achieve the Programme of Action. He recalled that during a recent international conference on promoting family planning and maternal health for poverty alleviation, organized by his organization and the Government of Indonesia, health, population and social development ministers from 29 countries had adopted the Yogyakarta Declaration, which contained recommendations for expediting implementation of the Programme of Action. They also committed to the integration of family planning and maternal health into national poverty alleviation plans, he said, urging the Governments of developing countries to make "suitable" policy decisions in addressing address climate change in the broader context of population dynamics and sustainable development.

DOMINIQUE BICHARA, Special Representative of the World Bank to the United Nations, said recent analyses of population and economic growth focused on the impact of changes in age structures. The Bretton Wood's institution's Reproductive Health Action Plan, approved in May 2010, detailed its engagement on reproductive health issues in 57 priority countries, mostly in the poorest countries of Africa and South Asia. The Bank was also committed to scaling up its work on gender mainstreaming and to helping countries achieve gender-related Millennium Development Goals, he said. The World Bank's 2012 World Development Report would contain substantial information on women's health and related issues, and could contribute to global knowledge and policy dialogue, he said.

KEVIN CASSIDY, International Labour Organization (ILO) said the second edition of the global ILO report Maternity at work: A review of national legislation, based on the agency's newly updated Database of Conditions of Work and Employment Laws, outlined the status and progress of maternity-protection laws around the world and showed a gradual improvement over the last 15 years, with 30 per cent of Member States fully meeting the requirements of the ILO's 2000 Maternity Protection Convention (No. 183) on duration, level and source of financing for maternity leave. "However, actual coverage of the law remains a concern and additional efforts are needed to extend maternity protection coverage to all working women, including informal, domestic and agriculture workers," he said. Turning to national experiences, he said ILO and employers' organizations were working with garment factory owners in Cambodia to strengthen awareness and implementation of maternity protection, as well as health and breast-feeding measures through factory-based training and on-site nursing facilities, information materials and a nationally televised soap opera series on workers' rights and responsibilities. The agency was also providing technical assistance to Jordan and working closely with its Government, employers and workers to introduce a fair, affordable cash-benefits scheme into the national social security system to benefit women during maternity leave.

ZWELETHU MNISI (Swaziland) said that in his country, which had an estimated 1.2 million people, population growth rate had declined significantly over the past 10 years, due potentially to the HIV/AIDS-related mortality rate and to a countrywide decrease in fertility. The goal of Swaziland's family planning programme, in place since 1973, was to integrate reproductive health information with maternal and child health services, he said. It had met with considerable success in raising awareness of family planning, but greater efforts needed. Moreover, the country lacked the resources to achieve those aims, and needed international support, including through official development assistance (ODA). Noting with concern that several pro-abortion organizations had submitted statements under the current agenda item, he emphasized for the record that his delegation did not view access to abortion as a human right and did not support efforts by organizations that "put pressure on Governments to legalize abortion", as such efforts undermined State sovereignty, as well as the cultural and moral beliefs of local communities. Additionally, Swaziland did not support sexual education as a human right, since it undermined the right of parents to control the themes to which their children were exposed.

MUYAMBO SIPANGULE (Zambia) said his country's population was young due to the high fertility rate, which had stood at 6.2 per cent in 2007. That had increased pressure on the Government for social services, such as schools, health centres and employment opportunities for youth. It had also created a high child-dependency ratio that had placed a heavy burden on the working population. Meanwhile, the expanding population had put pressure on the already overburdened education, health and food security systems, he said. The Government, with the support of the United Nations and other partners, had been working hard to address those challenges, he said, noting that modern family planning use among married women of reproductive age had gradually increased from 8.9 per cent in 1992 to 26.5 per cent in 2007. However, more support was needed to increase it further, particularly in rural areas in order to reduce the high unmet need for contraceptives. He said the Government had created the Reproductive Health Commodity Security Committee to ensure the steady supply of adequate reproductive health commodities over the past two years, as well as Safe Motherhood Action Groups to provide information about family planning and health facilities to pregnant women. A Government analysis of reproductive health services for adolescents and young people had identified high rates of teen pregnancy, as well as inadequate access to reproductive health services and information, he said, adding that a strategy was being developed to address those gaps.

A representative of Action Canada for Population Development said the world was radically different from that in which the parents of today's youth generation had grown up. It contained new challenges, including HIV/AIDS, as well as the continuing threats of child marriage, unplanned pregnancies and others. Young people should be meaningfully involved in formulating policies and decisions affecting them, she said, adding that, to that end, young people were now lobbying for that right through regional and international advocate groups. As a diverse group, youth called for policies that would take a variety of their needs and perspectives into account, she said, emphasizing that national, State and local communities must invest in young people, and underscoring the essential importance of a renewed commitment to sexual and reproductive health -- with young people at its centre.

A representative of the German Foundation for World Population reiterated the recommendations made at the 2009 Non-Governmental Organization Forum on Sexual and Reproductive Health and Development, which called on decision-makers to join non-governmental organizations in creating and implementing concrete, practical and fully-funded actions to ensure sexual and reproductive health and rights. She said the "Berlin Call to Action" also urged Governments, policymakers and other leaders to commit to invest in comprehensive sexual and reproductive health information, supplies and services; ensure sexual and reproductive health rights for adolescents and young people; establish formal mechanisms for meaningful civil society participation in programmes, policy and budget decisions, as well as monitoring and evaluation; and ensure the allocation of sufficient resources and budgets to meet people's needs in terms of sexual and reproductive rights. She emphasized the need to empower young people to make informed decisions about their lives in an environment free of barriers to the full range of sexual and reproductive health information and services.

A representative of the World Youth Alliance said all development and population policies should place people at their centre, respect human dignity and encourage the spiritual, emotional and mental growth of individuals. A people-centred approach recognized the intrinsic value of human life, which was not dependent on context or other external factors. In many countries -- especially developed countries -- the difficulty of reconciling work and family life affected and often prevented individuals from achieving their desired family size, she said, urging their Governments to support families since it was through investing in human beings that development was achieved. She went on to stress that all too often education was sacrificed for a country's need to reduce fertility rates, while not enough efforts were made to empower individuals fully. Additionally, reproductive health programmes should serve the needs of all women, including adolescents, and educational programmes should help couples determine and achieve their own goals with respect to family size by increasing their knowledge. Human development emerged from the family -- the basic social unit -- and it was there that children first learned to understand human dignity, she emphasized.

A representative of Global Helping to Advance Women and Children, speaking also on behalf of the Family Rights Caucus, played a video clip featuring three Mozambican siblings, in which the oldest said he spoke on behalf of the 14 million AIDS-orphaned children in sub-Saharan Africa.

Expressing worry that many developing countries were trying to tell African youth that they had a "right" to "sexuality" education, he said that encouraging young people to have sex in countries ravaged by HIV and AIDS sounded like a death sentence, and had been for three of his family members. His sister then called upon Member States, United Nations agencies, non-governmental organizations and other entities to stop promoting abortion, sexual rights and "comprehensive education on human sexuality" rather than basic sex education.

A representative of the NGO-Endeavour Forum Inc. said the recent efforts of population control organizations had gone well because their "propaganda campaigns and fear-mongering" under the guise of family planning had resulted in widespread permanent sterilizations, birth-control chemicals and devices, as well as "rampant, coerced and induced" abortions. As a result, fertility rates were dropping in developed countries, leaving them to scramble merely to replace their populations and maintain their cultures. It was multi-million-dollar drug-manufacturing companies that actually profited from such practices, she said. Organizations were now targeting Africa, where abortion was still illegal in most countries, using maternal mortality as an excuse to push its legalization. The United Nations had an obligation under the Universal Declaration of Human Rights and the Declaration on the Rights of the Child to defend and protect innocent persons from violence, she said, emphasizing that there was no such thing as a "safe" abortion.

A representative of the Catholic Women's League of Australia spoke about the "Billings Ovulation Method", one of the Government family planning programmes available in many countries, such as India and China. It had empowered millions of women and parents around the world to take charge of their fertility without cost to Government or families. It also enhanced and safeguarded maternal health, she said, adding that it helped couples labelled "low fertility" to conceive 80 per cent of the time. In 1978, the World Health Organization (WHO) had found the method to be 98.5 per cent effective when used to prevent pregnancy in the five nations in which trials had been conducted, she said, stressing that it was just as effective as contraceptive devices and medical contraception methods, but without their costly side effects. It was "puzzling" that the United Nations Population Division had not included the method within its 2011 population statistics, particularly since it was modern, natural, culturally acceptable, as well as environmentally friendly, safe and cost-free, she said, urging Governments to fund and promote the spread of the Billings Ovulation Method. She also encouraged them to send health professionals to bi-annual workshops held in Australia.

A representative of the Centro de Investigaci ón Social, Formaci ón y Estudios de la Mujer said that her country, Chile, had recently been awarded the international "Protect Life Award" for having South America's lowest maternal mortality rate. She noted that international and non-governmental organizations attending the current session had been advocating a reduced world population growth rate while many countries were struggling just to achieve population replacement. Moreover, nothing had been noted about the progressive replacement of surgical abortion by chemical abortion, its radical effects on women, or the negative consequences of induced abortion -- including increased risk of breast cancer, psychological problems, post-abortion syndrome, and others. She added that abortion also imposed a high price on States, which had to deal with the "double cost" of contraceptives and abortions, as well as the treatment needed as a result of abortion.

Keynote Address

EUNICE BROOKMAN AMISSAH, Vice-President for Africa of Ipas, a global non-governmental organization dedicated to ending preventable deaths and disabilities from unsafe abortion, and a former Minister for Health of Ghana, said access to reproductive health services was a basic, fundamental need for all people, especially women. They must be able to make their own choices and plan for their lives as well as those of their families. "I ask that you rise above political expediency and ideology and base your decisions on respect for basic human rights, and that you focus on how we work together to scale up the evidence-based approaches and life-saving strategies that we know will solve the most urgent reproductive health challenges we face," she said.

Pointing to progress since the 1994 International Conference on Population and Development, she said the use of effective, modern contraceptive methods had increased in every region. They were now used by more than half of the women who were either married or in unions. The HIV/AIDS pandemic appeared to be levelling off, with transmission rates falling substantially in several countries over the past decade and more people gaining access to antiretroviral treatment. Overall, maternal deaths had declined by a third since 1990, from an estimated 545,000 to 358,000 in 2008, she said, adding that deaths resulting from unsafe abortions had fallen by 16 per cent since 2003, according to WHO.

The number of maternal deaths from unsafe abortions had not been reduced because fewer women were having abortions, but because of safer abortion procedures and services overall, she continued. Still, abortion-related death rates in Africa and South Asia were exceedingly high when compared with the near-zero rates in developed countries. With some notable exceptions, sub-Saharan Africa had shown little progress in providing access to reproductive health, which had placed young people at great risk from unprotected sex, lack of information and unsafe abortion, she said. That "gross injustice" was unacceptable when so much could be accomplished with relatively modest investment, she stressed. "We need to be more creative in engaging young people to be part of the solution rather than just viewing them as a problem or as hapless victims."

Despite progress in reducing maternal deaths, the average annual decline since 2008 was just 2.3 per cent globally and 1.7 per cent in Africa, she continued. A 5.5 per cent annual decline was needed to realize Millennium Development Goal 5. Moreover, the global community's focus on maternal mortality had obscured the debilitating effects of material disabilities and morbidities, such as obstetric fistula, which affected an estimated 262,000 women in sub-Saharan Africa. Complications from unsafe abortion caused nearly 50,000 deaths annually, with more than 90 per cent occurring in Africa and South-Central Asia, she noted.

She went on to emphasize that the first priority must be to establish in poor countries a package of evidence-based cost-effective interventions for family planning, safe abortion care, as well as maternal, newborn and child health measures, such as those recently outlined in a WHO report. That document was a helpful companion document to the Secretary-General's Global Strategy for Women's and Children's Health, launched last September. There was a need to improve basic health infrastructure, strengthen the health-care workforce, notably midwives, and integrate reproductive health services rather than separating family planning from other areas.

It was also essential to address the socio-cultural context in which health care was delivered, she said, noting that social disapproval fostered discrimination and created barriers to health care and information. It was important to better understand the role of stigma in reproductive health and how to overcome it. Education, collaboration with men's organizations and community engagement were crucial for progress. Another priority was improving national reproductive health policy by basing it on sound evidence and human rights, and without allowing any single political, religious or cultural viewpoint to dominate or set policy. Policymakers must commit human and financial resources to meet reproductive health goals, she stressed, adding that they would be more likely to mobilize them if evidence-based reproductive health priorities were explicitly built into national development plans and strategies.

Noting that abortion had existed since ancient times, she said that, according to WHO, more than 21 million women had unsafe abortions annually, often by ingesting poison or inserting sharp objects. Hundreds of millions of women of reproductive age today would seek unsafe abortions, due in part to the persistence of restrictive laws, especially in Africa and Latin America. However, criminalizing the practice did not prevent women from having abortions, but merely drove it underground and made it unsafe, she said. Evidence from countries as varied as the United States, Romania and South Africa indicated that fewer restrictions on the availability of safe abortion led to a dramatic reduction in deaths and illnesses.

"When political leaders and policymakers fail to implement known, affordable solutions to an entirely preventable problem, one can only conclude that they do not sufficiently value the women and girls whose lives are at stake," she said, warning that the absence of decisive action to address unsafe abortion would result in a quarter of a million preventable deaths, millions of injuries and a heavy burden on health systems. In Africa, most Governments had ratified the African Union's women's rights protocol authorizing access to safe abortion for health or other reasons. Several African Health Ministers were working to implement the Maputo Plan of Action, which included safe abortion objectives. Also, several countries were making their laws less restrictive or had taken steps to increase access to safe abortion under current laws.

Discussion

The representative of South Africa said it was clear that reducing the number of unsafe abortions was really a "developing-country issue" and a sub-Saharan African one in particular. He asked about the medical community's views on working in a restrictive legal environment.

A representative of the Foundation for Studies and Research on Women asked what difficulties and challenges still existed in the African, Latin American and Caribbean and Asian regions for adolescents seeking abortion without adult support. She noted that the major problem in those regions was non-compliance with abortion laws and that many women were still dying as a result.

The representative of Norway asked how best to frame the issue of abortion in various cultural and religious contexts, and whether there were any "success stories" in that regard

Dr. BROOKMAN-AMISSAH, responding to the question about the medical fraternity's response to restrictions on abortion in Africa, said the general sense among doctors was one of "confusion". The necessary regulations and guidelines were not in place, and without such guidance, doctors did not know what to do. They were often unable to provide abortion services, including, occasionally, when a woman's life was at stake. There should be better guidelines so that doctors willing to provide abortion services would be able to do so in a safe environment, she stressed, adding that doctors also needed to be linked up with those needing abortions and that those services should be integrated into national health-care systems.

Another representative asked how it was possible to work for the prevention of women's deaths without considering the deaths of unborn children.

The representative of Saint Lucia asked whether any information was available on the short-term health of women who had abortions, including the emotional side effects.

The representative of Niger pointed out that the Maputo Protocol allowed abortion when a woman's health was threatened.

Dr. BROOKMAN-AMISSAH, responding to the question about the rights of unborn children, said the issue "got to the crux of international debates on abortion". The Declaration on the Rights of the Child was widely understood to protect children starting "from birth". She said that, while both sides of the argument were entitled to their beliefs, as a doctor and policymaker, she had seen many women dying and felt they should be helped.

Regarding the emotional side effects of abortion, she said women were "very much relieved" when they were able to have an abortion about which they had thought seriously, noting that there was little emotional upset in such cases. Rather, guilt was often a result of stigma, condemnation and societal taboos, not the actual practice.

Finally, she agreed with the Niger delegate's interpretation of the Maputo Protocol, but stressed that the instrument had not yet been implemented in many countries.

The Commission then began its general debate on the further implementation of the Programme of Action of the International Conference on Population and Development.

Opening Remarks

NAFIS SADIK, Special Envoy of the Secretary-General for HIV/AIDS in Asia and the Pacific, said the achievement of the International Conference had been to resolve an apparent conflict between demographic outcomes on the one hand and human rights on the other. The consensus had been to achieve global demographic stability as quickly as possible while still recognizing that human rights were central to demographic outcomes.

"The individual, un-coerced decisions of women and men must determine fertility and family size," she said, adding that high-fertility countries in particular had much to gain from enabling choice. The Programme of Action had adopted explicit goals for 2014 and had reached consensus on costs, which had been divided between countries in need of assistance and the international community. Yet following the International Conference, resources for reproductive health had failed to grow along the agreed lines, she said. Funding for family planning had fallen significantly, while reproductive health had failed to make its way into the Millennium Development Goals.

Momentum had been lost and, as a result, many women had died or suffered needlessly, she said. More women had been prevented from exercising their human rights and making their full contribution to development. While a "fatalistic approach to women's lives and health" had been a challenge for many years, the International Conference had taken a huge step forward in understanding and action in those areas. She disagreed with the "strange" but common argument that cultural values would be threatened if women were able to make their own decisions, stressing that true cultural values respected and valued women equally with men and accepted changes in the wider world, adapting their practices accordingly. "The consequences of failing to act on sexual and reproductive health reach far beyond women's individual and family lives," she said, pointing out that the global population would reach 7 billion before 2012, and was projected to reach 9 billion by 2045.

There had been a consensus at the International Conference to aim for rapid population stabilization, and on the human right to sexual and reproductive health as a contribution to that end, she said. The poorest billion people on earth often found themselves on the cutting edge of change as change cut them first and cut them hardest. "They survive only through their ability to respond in creative and ingenious ways," she said. Action on the scale required implied a broad cultural change -- one already in progress and that was evident in the overall declines in the fertility rates of developing countries. In some high-fertility developing countries, however, women remained without access to the full range of reproductive health information and services, she said, emphasizing that equality was political, as well as social and economic. In North Africa and West Asia, women were demanding their right to a full and equal voice in the reforms that would emerge from the current turmoil.

SHA ZUKANG, Under-Secretary-General for Economic and Social Affairs and Secretary-General of the 2012 United Nations Conference on Sustainable Development, shared his perspectives on the critical role of population in sustainable development. The recent financial and economic crisis and the greater frequency of extreme weather conditions due to climate change had led to a re-evaluation of development priorities and the requirements for long-term sustainability. Most experts assumed that population growth would continue to decline until it reached zero in 2050.

He went on to note that United Nations projections were based on the assumption that fertility would continue declining wherever it remained above 2 children per woman until it reached 1.85, a value well below replacement levels. Therefore, population stabilization would only be feasible in the current century if every nation's fertility rate fell below the replacement level. Since fertility decline had been slow in several least developed countries and fertility may stagnate in other countries, it was not certain that all countries would reach sufficiently low fertility levels by 2050, he cautioned. If it were to stop declining at 2.25 children per woman instead of dropping below 2 children per woman, the world population could soar well above 10 billion by 2050 and continue rising over the rest of the century, he said. Ensuring that 9 billion people had enough food and energy by that year already appeared to be a major challenge that would become even greater if the global population surpassed 10 billion.

Historical evidence suggested that socio-economic progress and fertility went hand in hand, he said, noting that fertility rates were generally higher among the poor and in poor countries. High rates of infant mortality, the absence of social protections, the lack of access to reproductive health and several other socio-economic factors contributed to higher fertility rates among the poor. "Thus, the discussion on fertility and population growth cannot be carried out in isolation. It is an issue at the root of sustainable development," he emphasized. Accelerated implementation of the Programme of Action must be integral to overall poverty-reduction and sustainable development efforts, he said. Hailing the extension of the Programme of Action beyond 2014, he underlined, however, that it must be accompanied by a firm commitment to ensure that sustainable development goals and objectives were met soon.

BABATUNDE OSOTIMEHIM, Executive Director of the United Nations Population Fund (UNFPA), said the decision to extend the Programme of Action beyond 2014 reaffirmed the centrality of population to sustainable development, as well as the unfinished nature of that "visionary roadmap". The international community must focus on human rights and women's rights -- including the right to sexual and reproductive health -- as well as principles of equity and social justice so as to guide its collective efforts for sustainable development, he said.

Noting that modern human activity was affecting every part of the planet, including its climate, he said those in developing nations with limited resources were the most likely to suffer the effects of climate change. Rising populations, coupled with environmental stress and unsustainable production and consumption patterns, were testing the limits of food and water security, while the world faced other challenges, including an energy crisis. "Whether we can live together, in health and dignity on a healthy planet will depend on the choices we make now," he emphasized.

In that regard, the development consequences of high fertility -- including unemployment, poverty, slow economic growth, natural-resource depletion, and the potential for civil strife, among others -- was "hardly a recipe for sustainable development", he said. For those reasons, in the days and months leading up to 2014 and the twentieth anniversary review of the International Conference, UNFPA would do its utmost to ensure that population, reproductive health and gender equality were prioritized at next month's United Nations Conference on the Least Developed Countries, the upcoming High-level Meeting on HIV and AIDS and International Youth Conference, and Rio 2012.

Statements

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