SPECIAL REPORT: POPULATION REVISITED Cairo's broken promises

Posted: 25 October 2004

The 10th anniversary of the UN Conference on Population and Development, held in Cairo in October 1994, saw much agonising over its impact, and the chances of fulfilling its hard-won Plan of Action by 2015. Here, John Rowley, who edited the first population conference newspaper in Bucharest, in 1974, sums up their findings.

Perhaps the most telling comment on the past 10 years of struggle to implement the Cairo agenda, to secure the reproductive health of women, the survival of their children and their education and rights, comes from Steven Sinding (below), the outspoken American head of the International Planned Parenthood Federation (IPPF).

Steve Sinding
Steve Sinding
"Cairo's promises have not moved from the paper they were written on" he told an audience of some 700 activists from 109 countries who met in London for Countdown 2015, a non-government conference to mark the anniversary. (The United Nations, perhaps understandably, decided not to hold a further 10-year population conference - merely marking the event at a General Assembly meeting in October.)

"In many poor countries family planning is still virtually unknown outside the big cities", said Sinding. "Half a million women still die every year from causes related to pregnancy. One in every 10 pregnancies ends in unsafe abortion, some 19 million a year."

So much for the work of the 11,000 delegates, who met in Cairo after numerous preparatory meetings, to thrash out a new approach to the population problem, moving away from the demographic imperative, to set targets instead to improve women's reproductive health, their education and their rights, as well as reduce infant mortality -and, crucially, pledge the money to do it.

Some advances

But most commentators,including Sinding,agree that there have been some advances for women over the last decade.

Thoraya Obaid, head of UN Population Fund (UNFPA)told me that "laws and policies to promote the Cairo agenda have been put in place in many developing countries, so the groundwork has been laid." She also points to the swell of support from developing countries, with the number of countries funding UNFPA's work growing from 92 to 140 over the past decade.

Three major international NGOs (including IPPF) have also put their name to a report card, which says that there hads been real progress both in improving women's reproductive health, the education of girls and the rights of women.

It says there has been an increase in the share of parliamentary seats held by women, though they hold only 15 per cent of these in the countries surveyed. And there has been a significant increase in gender parity for girls in secondary schools, though some 104-million school-age children are not in school - 60 per cent of them girls.

But the report says that things have stood still or fallen back in the key areas of maternal mortality and HIV/AIDS, while the shortfall in the supply of contraceptives, including condoms, was 'acute and growing'.

Ir reports that 23 countries, including Bangladesh, India, Egypt, Pakistan and Paraguay, have made significant progress overall, while those making little or no progress included some developed nations including Kuwait and the United States as well as poorer countries such as Botswana, Namibia, Senegal and South Africa.

Contraceptive supply crisis

In its separate State of the World Population 2004 report, UNFPA says that "many developing countries have made great strides in putting the conference recommendations into action."

The use of modern contraceptives has risen from 55 per cent of couples in 1994 to 61 per cent. And fertility rates are falling.

At the same time, population is set to grow from 6.4 billion to 8.9 billion by 2050 - with the 50 poorest countries expected to triple in size to 1.7 billion people.And "persistent gaps in serving the poorest populations is impeding progress."

A teacher reads aloud from a textbook to her students. © UNICEF
A teacher reads aloud from a textbook to her students. © UNICEF
A teacher reads aloud from a textbook to schoolgirls.© UNICEF
The report is critical of the progress in women's empowerment. It says that only 28 countries have increased women's political participation, only 42 countries are spending more on schools, and only 16 have increased the number of girls' secondary schools.

It says that some 201 million women, mostly in the poorest countries, have no access to effective contraception, resulting in 142 million pregnancy-related deaths (including 53,000 from unsafe abortions) and 1.4 million infant deaths.

It admits that donor support for contraceptives and other reproductive health supplies has fallen over the past 10 years, from 30 per cent of the money needed in 1992, to just over 20 per cent in 2002. At the same time, contraceptive users are expected to increase by 40 per cent by 2015. Reproductive services for record numbers of young people 'lag far behind the needs'.

Dr Fred Sai, adviser on population, reproductive health and HIV/AIDS to the president of Ghana, told Countdown 2015 that the annual bill to met condom needs for one year was now $75 million. But, the conference was told, such was the scale of the shortfall that a man in Africa has access to only three condoms a year.

Maternal mortality 'crime'

Mother and Child Eritrea. Credit: Jenny Matthews/Network
Mother and Child Eritrea. Credit: Jenny Matthews/Network
Mother and Child Eritrea.© Jenny Matthews/Network
In a statement to the same meeting, Thoraya Obaid, head of the UNFPA, said that while a girl born today faces better prospects than one born ten years ago, with school enrolment increasing, mortality declining and life expectancy rising, "in some areas we are slipping backwards."

Especially critical were maternal health, HIV/AIDS and access to and funding for essential reproductive health supplies.

Commenting on the glaring gap between rich and poor nations in the numbers of women dying from pregnancy and childbirth, she said: "Maternal mortality is more than a shame, it is a crime." While 24 women die for every 100,000 live births from these causes in Europe, the number in sub-Sahara Africa is 920.

"And invariably, it is the poorest and youngest women who fare the worst" she added. With more young women between 15 and 19 years old, dying from pregnancy and childbirth than any other cause, it was essential to increase the access to skilled attendance at birth and to emergency obstetric care.

Stand on abortion

Inevitably, there was bitter criticism of the role of the United States in cutting funding for reproductive health from UNFPA, IPPF and others, on the grounds that they were involved in promoting or supporting abortion activities. According to Steven Sinding of IPPF, the pressure not to provide access to legal abortion was having "a chilling effect" around the world.

"This insidious war on women's health and rights is threatening some of the very real progress that has been made during the last decade", he said. Former US Senator, Timothy E. Wirth, who led the US delegation at Cairo, was even more scathing. The United States government had moved from being a 'beacon of hope' to 'an axis of bigotry' and was "becoming responsible for the deaths of millions of women."

Speakers were also dismissive of the promised increase in US funding for AIDS, tied as it was to the notion of limiting this to programmes which promoted the ABC approach, which puts Abstinence and Being Faithful alongside Condoms.

"Whether at home or abroad, promoting a simplistic one size fits all 'abstinence-only until marriage' policy is at best naive, and at worst dangerous" Marcela Howell, Director of Advocates of Youth told the meeting.

One key outcome of Countdown 2015, was a unanimous call to make safe abortion universally available. This goes beyond the Cairo agreement which talked about men and women's rights to "methods of choice over the regulation of fertility that are not against the law," but stopped short of promoting a general right to safe abortion.

Placard of the Pope
Placard of the Pope
Placard of the Pope at the festival of the Feast of the Assumption, Kalwaria, Poland© BBC
"We hope that this declaration will strengthen global advocacy efforts for the right to abortion" said Sinding, who clearly believes that the United States and the Vatican cannot be more resistant than they already are, and that there is nothing to lose in speaking out. He was supported, among others by Britain's International Development Minister, Hilary Benn, who told the conference "no woman should face death for want of a safe abortion."

Finding the funds

None of which solves the funding crisis, set out by UNFPA and the non government meeting. As both made clear, the shortfall against the promised $23.7 billion (in today's dollars) for the Cairo Plan, by 2005, is massive. Of this, donors should have provided a third - or some $8 billion. In 2003, they actually gave just over $3 billion. Developing countries also fell short, but not so spectacularly.

One complication is the growth of HIV/AIDS which has diverted a good deal of donor attention and funding, though much of that does not address broad reproductive health needs. Indeed Nafis Sadik, the former head of UNFPA and Steve Sinding of IPPF, readily admit that many of those involved in family planning had tended to shy away from HIV/AIDS which they saw as involving problematic minority groups. Now the family planners are having to battle to gain acceptance for the idea that AIDS is having a disproportionate impact on women in many societies and will never be defeated until it is treated as a mainstream reproductive health issue.

Paul Nielsen, the outgoing European Commissioner for Development and Humanitarian Aid summed up the thoughts of many when he told the London conference that "it is sad that we are having to defend ICPD 10 years later, rather than moving ahead." It was also a pity that sexual and reproductive health was still not included in primary health care in some countries. As for AIDS "it must be prevented by good reproductive health services."

There was regret too, that 'reproductive health' was not specifically included in the Millennium Development Goals (MDGs). "Funding for the Cairo Plan of Action is essential if we are to realise the Millennium Goals for 2015," Thoraya Obaid told the meeting.

"Unless international assistance rises to the level agreed to at the Cairo conference" she said, "the numbers of people who need family planning, maternal health care and HIV/AIDS prevention, testing and treatment will continue to grow. Lack of reproductive health care will continue to be the leading cause of death and disability for women in the developing world and the AIDS pandemic will continue to expand and wreak havoc."

Or as Sinding put it: "The ICPD is the only yeast that can make the MDG bread rise." Environmental connections

As for the environmental connections to the continuing growth in human numbers, and our consuming and polluting habits, this gained even less attention in Countdown 2015 than it did at Cairo. UNFPA's report does, however, include a (rather generalised) chapter on this topic.

Interestingly, this makes the point that because the ecological footprint of the United States is three times bigger than that of India (releasing 15.7 million tons of carbon into the atmosphere every year compared to India's 4.0 million tons) its environmental impact is bigger, even though its population is only a fourth as large as India's.

(And, as the latest Population Reference Bureau Data Sheet points out, the United States is the only industrialised nation whose numbers are expected to grow significantly - from 249 million today to 420 million by 2050. So, unless there are rapid changes in consumption habits, its ecological footprint is set to grow accordingly.)

The UNFPA report also makes the point that China's success in slowing its population growth does not mean that its environmental impact will not continue to grow. China's consumption of oil, gas and coal continue to rise. And while it is promoting greater fuel efficiency for its cars "it is not promoting increased use of public transportation, biking and walking, or efficient urban planning so people would not have to drive."

These are messages that could equally well apply to many other developed and developing countries, as the Chinese will no doubt make clear.

Finally, UNFPA points to one other demographic trend - the increase in new households as incomes rise and the average numbers of people under one roof decreases. As each new house impacts on the environment and as energy use per person increases, this can have a significant impact on consumption.

All this points to the need for organisations such as UNFPA to work more closely with conservation and development agencies to explore more rigorously the environment and poverty rationales for population programmes, alongside the powerful gender and health ones. Unfortunately, in the present climate of fear and uncertainty over abortion and family planning fostered by the United States and the Vatican, few environmentalists appear anxious to do so.

John Rowley is Editor-in-Chief of this website.

Footnote: World leaders reaffirmed their support for the action plan of the 1994 International Conference on Population and Development (ICPD) in a statement to coincide with the anniversary of the Cairo Conference.

Signatories include: Bashar Al-Assad, President of Syria; Tony Blair, Prime Minister of the United Kingdom; Jacques Chirac, President of France; Vincente Fox, President of Mexico; Paul Kagame, President of Rwanda; Junichiro Koizumi, Prime Minister of Japan; Aleksander Kwasniewski, President of Poland; Festus Mogae, President of Botswana; Gerhard Schröeder, Chancellor of Germany; Pervez Musharraf, President of Pakistan; Thaksin Shinawatra, Prime Minister of Thailand; Alejandro Toledo, President of Peru; Wen Jiabao, Prime Minister of China; and Khaleda Zia, Prime Minister of Bangladesh.

Other signatories include, Oscar Arias, former President of Costa Rica; Dr. Gro Harlem Brundtland, former Prime Minister of Norway; Jimmy Carter and William Clinton, former Presidents of the United States; as well as Nobel Laureates Nadine Gordimer and Desmond Tutu.

Support also came from lawmakers from around the world who met in Strasbourg in October. Over 130 parliamentarians and ministers from 90 countries endorsed a strong set of commitments to advance the Cairo goals.

These included a commitment to strive to devote at least 10 per cent of national development and development assistance budgets to population and reproductive health programmes and to mobilise an additional $150 million a year for commodities needed by programmes supported by UNFPA and IPPF.

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