ICPD and the Millennium Development Goals – Recommendations Halfway through the ICPD Programme of Action

Meeting: International Conference on Population and Development: Status, Challenges and Recommendations for the Strengthening of the ICPD Goals

Speaker: Steven W. Sinding, Director General IPPF

Location: Egts Pakhus, Copenhagen

Many thanks to the organisers for inviting me to speak in Copenhagen today. I’m delighted to be in Denmark, where there has been such excellent support and leadership on the Millennium Development Goals as well as on the field of Sexual and Reproductive Health (SRH).
I’ve been asked to discuss ICPD and the Millennium Development Goals, and in particular to look at where things stand halfway through the ICPD Programme of Action. I will focus in particular on the changes that need to be made, and why they are so urgent at this crucial midpoint in the Cairo Programme of Action.

The UN’s eight Millennium Development Goals (MDGs) from 2000/2001 are ambitious plans with an over-arching aim of reducing poverty internationally. It is hoped that fulfilling these goals will improve the lives and health of people throughout the world by 2015. The MDGs represent a bold vision and an extremely ambitious agenda.

Preliminary reviews of progress in achieving the MDGs, in anticipation of the MDG summit review this coming September, suggest that the international community and many individual countries are making unsatisfactory progress and are in danger of falling well short of achievement of the goals by 2015.

One important reason for this is the failure to include sexual and reproductive health as a core component of the MDGs when they were decided upon at the original Millennium Summit in 2000.

A substantial proportion of people who work in SRH believe that the core goal adopted by the 1994 International Conference on Population and Development (ICPD) – universal access to reproductive health information and services – is not only fully compatible with the MDGs, it should have been included as one of them.

This is because universal access to RH information and services is fundamental to the achievement of virtually all the individual MDGs – and certainly to attainment of the overarching goal of halving poverty by 2015!

It appears that the ICPD recommendations were purposely excluded from the MDGs in 2000 as a matter of political expediency.

The ICPD was the only one of the major UN conferences of the 1990s whose core goal was omitted from the MDGs.

This omission was both unjust and unwise: unjust because it is resulting in the denial of the fundamental right to reproductive freedom and reproductive health, especially to women; and unwise because it places in jeopardy the entire MDG agenda.

For some months IPPF called for the reinstatement of the Cairo universal access goal by way of a 9th MDG – the missing MDG.

We have now been persuaded by our friends and allies in the movement that a 9th MDG is too radical a goal – unachieveable, we are told, because too many governments oppose any reopening of the eight existing MDGs.

We have accepted this political reality and are, instead, now calling for the recasting of one of the original MDGs and adopting new targets and indicators to monitor progress in achieving a couple of others.

Millennium Development Goals and Reproductive Health

The MDGs commit the international community to an expanded vision of development, one that vigorously promotes human development as the key to sustaining social and economic progress in all countries. There is an over-arching aim of poverty reduction encompassed by all the goals.

The MDGs have come to define global development priorities and they are widely accepted as a framework for measuring development progress.

Poverty Reduction Strategy Papers and other instruments of development cooperation have adopted the MDGs as the key agenda items for development dialogue and country strategies. To be an MDG is to be “on the agenda.”

However, increasing political and social conservatism at the UN, particularly concerning the roles and choices of women and young people, has meant that the Cairo goal was dropped. ⁽¹⁾

This change is due in large part to a change in administrations in the United States and to growing conservatism in a few other countries, and also to an aggressively accelerated anti-ICPD campaign by a number of conservative religious institutions, including first and foremost the Vatican. ⁽²⁾

Three of the MDGs address health: maternal health, HIV/AIDS, and infant mortality. A fourth addresses gender equality.

In principle, these goals overlap entirely with, and indeed, were included in, the Cairo agenda. So the result at the Millennium Summit should have been increased commitment – political and financial – to reproductive health services. But this has not been the case.

As I said, to be excluded from the MDGs is to be relegated to a lower status in development priorities – by developing countries, donor countries, and international institutions. Many developing countries, as well as multilateral and bilateral development agencies, have adopted the MDGs as the template for development strategy development and development cooperation. Poverty Reduction Strategies and sector plans are based fundamentally on achievement of the MDGs.

The absence of the Cairo goal means that sexual and reproductive health are frequently omitted from such strategies, even within the health sector itself.

The omission of Cairo even has resulted in a deep and growing gulf between HIV/AIDS and SRH programmes and institutions – a tragic development in light of the crucial links between sexual and reproductive health services and HIV prevention.

In short, the politics of the MDG process has severely compromised earlier commitments to sexual and reproductive health and rights – commitments that were strong and clear at the conclusion of the Cairo and Beijing conferences and the feasibility of achieving the MDGs themselves.

One consequence of the Cairo goal being absent from the MDGs is that, although in 1994 donor nations agreed to provide US$6.1 billion per year by 2005 for reproductive health programmes, they are currently fulfilling only 40 per cent of their ICPD commitments, placing the reproductive health field in an ever more marginal position. ⁽³⁾

This is partly because since 2000 the donor community has focused its aid on other priorities, tracking with the MDGs.

Another unhappy outcome circumstance, reinforcing the funding shortfall, is the current US Administration’s antipathy toward reproductive health programs and its determination to withhold funds from some of the largest and most effective institutions in the field, particularly United Nations Family Planning Association and IPPF.

Sexual and reproductive health and HIV/AIDS are closely linked

Unfortunately, as I’ve just mentioned, since Cairo the fields of HIV/AIDS and reproductive health have grown further and further apart.

The establishment of a Global Fund for AIDS, TB and Malaria as separate and distinct from sexual and reproductive health has deepened the gulf, as has the WHO decision to move responsibility for HIV/AIDS from the sexual and reproductive health section to the unit dealing with infectious and communicable diseases.

With 70 per cent or more of new HIV infections being sexually transmitted, this separation of HIV/AIDS prevention efforts from its natural ally, family planning and reproductive health, is self-defeating.

Instead of operating in a coordinated and mutually reinforcing way, reproductive health and HIV/AIDS programs find themselves increasingly in competition for funds, with the HIV/AIDS side decisively and increasingly in the lead. ⁽⁴⁾

I have no doubt that political pressure from the United States, if it did not cause this false separation, is surely reinforcing it today.

As evidence, let me just cite the fact that IPPF’s members in several countries have been denied US HIV/AIDS funds – under the so-called PEPFAR initiative – on the grounds that IPPF is ineligible for US funding under the Global Gag Rule – this despite the fact that the US Congress explicitly refused to extend the Global Gag Rule to HIV/AIDS funding.

Furthermore, the increasing emphasis on AIDS treatment, as opposed to prevention, has correspondingly deepened the isolation of the sexual and reproductive health community and has ensured that HIV prevention gets ever less attention.

Sexual and reproductive health and poverty reduction

Universal access to contraception, Sexually Transmitted Infection (STI) prevention and treatment services, and safe deliveries are key to improving sexual and reproductive health.

Alongside this, the prevention of unintended childbearing and the enhancement of women’s reproductive freedom can be seen to be fundamental to both improving the economic prospects of individual families and to reducing the incidence of poverty in every country.

Providing freedom for all to use sexual and reproductive health services must be actively promoted. Where reproductive rights are realised, fertility declines, population growth diminishes, and individual and societal prosperity are enhanced.

Unrestricted access to, and use of, sexual and reproductive health information and services have been shown to substantially reduce poverty in many countries. ⁽⁵⁾

For example:

• If women and men, but especially women, are able to exercise full control over the timing and spacing of pregnancies, they will have fewer children.
• Parents with fewer children have a significantly better chance of escaping poverty than parents with large numbers of children.
• Smaller families and longer birth intervals allow families to invest more in their children’s nutrition, health and education.
• Reproductive freedom also allows women to use their education and skills, and take on paid work.

Almost everywhere in the developing world, actual fertility still exceeds desired fertility. There is a considerable unmet need for family planning, a need that is worsening because of contraceptive supply shortages.

At least 120 million women in the developing world would like to postpone childbearing or limit the size of their family, but are currently unable to do so.

Furthermore, some 3.5 million women and men die every year from reproductive-health related causes – including AIDS, complications of pregnancy, childbirth and unsafe abortion – a massive cost on both the individual scale, and for nations.

Many more people are suffering from chronic illnesses, reducing their capacity to work and to earn. Honouring the Cairo goal would give women the means and the right to have children by choice and to protect their reproductive health, perhaps one of the most powerful ways to further gender equality and to improve health and general living conditions globally.

Recommendations for reaching both ICPD and MDG goals

There have been many efforts since the Millennium Summit in 2000 to connect sexual and reproductive health to the eight existing MDGs, and these have been helpful in keeping the subject on the global development agenda.

The new Millennium Project report, 'Investing in Development: a Practical Plan to Achieve the Millennium Development Goals', notes the strong links between SRH and the MDGs and calls for the addition of specific SRH targets and indicators.

September’s MDG Summit meeting will be one of the last opportunities to firmly and directly include mention of sexual and reproductive health and rights on the MDG agenda.

The recommendations of the Millennium Project report, and the recommendations of several of the Millennium Project task forces that contributed to that report, should be strongly endorsed. Adoption of these targets and indicators by the Summit is essential to the overall achievement of the MDGs.

However, it still doesn’t go far enough. Extra steps need to be taken to ensure that sexual and reproductive health returns to the forefront of global anti-poverty efforts.

The ICPD goal of universal access to sexual and reproductive health information and services is the vital missing piece of the MDGs and now is the right time to call for the modification of the existing maternal health MDG to explicitly incorporate reproductive health.

In addition, workers in the field of sexual and reproductive health should support the adoption of a ‘universal access’ indicator that can be used to hold governments accountable for progress on sexual and reproductive health and rights.

Along with other experts in the SRH field, IPPF proposes the following changes to the MDGs: 

1. To modify the language of MDG 5 (“Improve Maternal Health”) to explicitly include reference to Reproductive Health (“Improve Maternal and Reproductive Health”).
2. To modify the targets under MDG 6 (“Combat HIV/AIDS, malaria and other diseases”) to include reference to sexual health. 
3. We endorse the recommendations of the Child and Maternal Health Task Force, the Education and Gender Task Force, and the HIV/AIDS Task Force to include the following indicators:

• the contraceptive prevalence rate,
• prevalence among 15-24 year-old women
• the proportion of births attended by skilled birth attendants
• the proportion of demand for family planning satisfied
• the adolescent fertility rate, and
• the availability of emergency obstetric care.

Finally, we strongly support the recommendation of the Gender Task Force, calling for strategic priorities to include a “guarantee [of] sexual and reproductive health and rights [for all].”

Working with governments, parliamentarians, UN agencies, and NGO partners, IPPF intends to ensure that at the MDG Summit the progressive language of 'Investing in Development' is adopted, and that attempts to remove the strong references to sexual and reproductive health are defeated.

The omission of the Cairo goal from the MDGs is unacceptable and costly, and we must all persist in calling for universal access to reproductive health services to be integrated at all levels of the MDG process.

In particular, G-77 countries must become more vocal in asserting the need for SRH and its pivotal role in reducing poverty. Given IPPF's presence in over 180 countries, we are supremely well placed to build that capacity and we intend to do so.

In closing, let me say that I welcome the opportunity this conference presents for finding the best ways to put ICPD back firmly where it belongs on the international development agenda.

I urge the Danish Government and the strong NGO community here to actively participate in a global campaign between now and the MDG review summit in September to ensure that the sexual and reproductive health, particularly of women, are not yet again sacrificed on the altar of political expedience. We must all join in the fight for sexual and reproductive rights and health.

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1. Barbara Crossette, “Hurting the World’s Poor in Morality’s Name,” World Policy Journal, Volume XXI, No 4, Winter 2004/05.
2. Ibid.
3. Sally Ethelston, et al., Progress and Promises: Trends in International Assistance for Reproductive Health and Population, Washington, D.C.: Population Action International, 2004.
4. Steven W. Sinding, keynote speech before 2004 International Parliamentarians’ Conference on the Implementation of the ICPD Programme of Action, Strasbourg, France. 18 October 2004
5. Nancy Birdsall and Steven W. Sinding, “How and Why Population Matters: New Findings, New Issues,” in Nancy Birdsall, Allen C. Kelley, and Steven W. Sinding, Population Matters: Demographic Change, Economic Growth, and Poverty in the Developing World, Oxford: Oxford University Press, 2001.