Commission on Population Development 2009
The International Planned Parenthood Federation (IPPF) welcomes the priority theme of the 42nd session of the Commission on Population and Development (CPD), ‘The contribution of the Programme of Action of the International Conference on Population and Development to the internationally agreed development goals, including the Millennium Development Goals’.
The Millennium Development Goals (MDG) framework is a valuable development agenda. It does, however, have limitations. For instance, the MDG development paradigm does not recognize or call for action on some key aspects of development, such as specific goals and targets related to young people, violence and conflict, nor is there a comprehensive approach to sexual and reproductive health and rights, as envisaged by the ICPD.
The ICPD Programme of Action (PoA), Millennium Declaration and the MDGs, approach development as a complex process which necessitates simultaneous advances on a range of interlinked issues: education; gender equality; health; environmental sustainability; and partnerships. Like the ICPD PoA, the MDGs rely on quantifiable targets and indicators, including the recently added MDG target 5b on universal access to reproductive health – a direct contribution of the ICPD PoA.
However, the ICPD PoA, impacts either directly or indirectly on all of the MDGs. Therefore, in order to achieve the MDGs, those aspects of the ICPD PoA not specifically included within the MDGs require addressing, including the importance of partnership with civil society and the implementation of a rights-based approach to development. The recognition of sustainable development by governments is essential, as is the requirement for the adoption of strategies to address crises and emergency situations including the provision of sexual and reproductive health and rights information and services, in order to protect the most vulnerable.
The ICPD PoA has successfully influenced population, health and human rights policies. Much has been accomplished in some countries, but health, and women’s health in particular, has not been prioritized despite the right to health being recognized as a human right. The lack of priority to health, particularly sexual and reproductive health including maternal health is not only a social injustice, but a basic denial of human rights.
Extreme poverty will not be significantly reduced (MDG 1) unless comprehensive sexual and reproductive health policies and programmes that reach the poorest people and realise the vision of ICPD are successfully implemented. In ‘Investing in Development’ (2005), the UN Millennium Project demonstrated that access to sexual and reproductive health information and services is essential for achieving the MDGs. Gender equality cannot be achieved without guaranteeing women and girls’ empowerment and sexual and reproductive health and rights. As former UN Secretary-General Kofi Annan noted, the MDGs will not be achieved unless issues of population, reproductive health and women’s rights are addressed. More recently current Secretary General Ban Ki-moon called on Governments to honour commitments made at the ICPD and stressed the importance of family planning and the ICPD framework for achieving the MDGs. In this way, the achievement of the MDGs is directly dependent on the fulfilment of human rights, including sexual and reproductive rights, and widespread access to sexual and reproductive health services.
“Health is also central to the MDGs as it is central to poverty reduction and development. Good health is not just an outcome of poverty reduction and development: it is a way of achieving them”. Four MDGs are directly related to health, whilst three are also related: Goal 1 (to eradicate extreme poverty and hunger); Goal 7, in terms of access to food and water, vectors of disease and numerous other ways, and Goal 8 (to develop a global partnership for development). Both remaining goals (achieving universal primary education and empowering women - Goals 2 and 3) directly impact on health, and vice versa.
Two hundred million women currently lack access to contraceptives; only 58 per cent of women in developing countries deliver with the assistance of a midwife or doctor and only 3 per cent of HIV positive pregnant women are offered drugs to prevent transmission from mother to child. The provision of family planning services to HIV positive women is crucial. In addition, an estimated 122.7 million married women have an unmet need for contraception. It is well documented that educated girls and women provide better care and nutrition for themselves and their children.”
Voluntary family planning programmes are widely recognized as one of the most cost-effective health interventions. At least 200 million women want to space or limit their pregnancies, but are unable to because they lack access to safe and effective family planning methods. In addition, access to emergency obstetric care remains low, while birth rates among adolescent girls and young women, who are most vulnerable to complications in childbirth, remain high.
The 2008 MDG Review High Level Event noted advances on some MDGs but showed that MDG 5 (Improve Maternal Health) demonstrated least progress to date. At present, the world’s maternal mortality ratio is declining at too slow a rate to reach MDG 5 by 2015. To reach this goal an annual decline of 5.5 per cent between 1990 and 2015 is required. However, the actual rate of decline stands at below one per cent. In 2005, an estimated 536,000 women died of maternal health related causes, compared to 576,000 in 1990, though other credible estimates place this figure at 872,000. Uncertainty about the true scale of maternal mortality, particularly in sub-Saharan Africa and Asia is due to a lack of data from countries with some of the worst death tolls, a tendency to under-report maternal deaths, particularly if related to illegal unsafe abortions, and the use of national averages.
The interventions needed to improve maternal health – especially family planning, emergency obstetric care and the presence of a skilled birth attendant – are widely recognized and cost effective. Access to family planning reduces unwanted pregnancies, unsafe abortion and maternal mortality and morbidity. Access to voluntary family planning alone could reduce maternal deaths by 20-35 per cent, while ensuring skilled attendance at delivery, backed up by emergency obstetric care, would reduce maternal deaths by approximately 75 per cent. However, donor support for family planning has decreased dramatically. Funding explicitly for family planning as a percentage of population funding has declined from 55 per cent in 1995, to 5 per cent in 2006. Poor access to these interventions within a high quality comprehensive health service package is a significant barrier to improving maternal health. If member states significantly increased their investment in health systems, and dedicated the resources required to provide universal access to voluntary family planning, skilled birth attendants and emergency obstetric care and services to prevent and treat sexually transmitted infections, including HIV, the health of women, families and communities would inevitably improve which would in turn contribute significantly to the achievement of the MDGs.
The ability of women to freely decide the number and spacing of their children is central to MDG 3 — gender equality and the empowerment of women. As has been noted, “Women aren’t seeking more children, but more for their children” Family planning and reproductive health and rights lead to empowerment and increased opportunities for women to participate in economic, social and decision-making fora. As a result of later first pregnancy, fewer pregnancies and birth spacing, women are likely to have healthier pregnancies and babies; children are more likely to survive and less likely to be malnourished. The elimination of child marriage helps reduce risks associated with early childbearing including fistula and uterine prolapse. Alternatives to child marriage can be created by providing and promoting economic opportunities for women. Eliminating traditional practices and gender-based violence, including female genital mutilation, will help to achieve MDG 3 of the ICPD PoA. Men and boys play a key role in realizing this goal as envisaged in the ICPD, as does women’s economic empowerment.
The strong commitment of the ICPD to adolescents and young people is implicit, but not explicit within the MDGs, yet young people make up half the world’s population and deserve a better, brighter future. Complications from pregnancy and childbirth are the leading cause of death among young women aged 15 to 19 in developing countries. It should be noted that half of all new HIV infections are among young people; demonstrating a failure to implement the ICPD. “Young people (15-24 years) remain at the centre of the AIDS pandemic in terms of transmission, vulnerability and impact, with an estimated 4-5,000 people in this age group acquiring HIV every day”. The transmission of HIV is fuelled by gender inequality which places adolescent girls and women at grave risk, including within marriage and is exacerbated by high rates of forced and early marriage in many countries. Universal access to reproductive health, including information, education and services, is crucial to reduce the spread of HIV and AIDS and sexually transmitted infections. Linkages between reproductive health and rights programmes, especially family planning and sexual health and HIV and AIDS programmes are especially critical to achieving MDGs 4, 5 and 6.
Addressing the reproductive health and rights of young people is critical to achieving the MDGs. Investing in education, including comprehensive sexuality education, plays a major role in addressing these concerns along with targeted investment in the provision of and access to reproductive health supplies, services and information. However, “Effective HIV/AIDS prevention requires States to refrain from censoring, withholding or intentionally misrepresenting health-related information, including sexual education”. A comprehensive rights-based approach to HIV/AIDS will also reduce stigma and discrimination against marginalized and vulnerable groups.
Recognizing that poverty cannot be eliminated without comprehensive sexual and reproductive health and rights, IPPF believes that Member States must:
· Recognize that both the ICPD PoA and the MDGs will end in 2015 and will urgently require increased political will and resources if they are to be achieved.
· Develop for 2015, a coherent, visionary, rights-based development framework that incorporates the most crucial aspects of the MDGs and the ICPD, in order to achieve sustainable social and economic development.
· Recognize the linkages between the ICPD PoA and the MDGs and reaffirm and implement the political and financial commitments for the implementation of the ICPD PoA and its role in achieving the MDGs.
· Prioritise implementation and monitoring of the “universal access to reproductive health” target (MDG 5b), including family planning; pre- and antenatal care; skilled attendance at birth; and emergency obstetric care.
· Prioritize resources to meet the sexual and reproductive health and broader development needs of adolescents and young people across the MDGs, including through the provision of comprehensive sexuality education and youth-friendly services.
· Ensure access to comprehensive safe abortion care and services in order to decrease maternal mortality and morbidity and where necessary remove existing legal, financial and other barriers.
· Recognize the importance of economic and social stability, especially in fragile states, for lifting individuals, families and communities, especially the chronically poor, out of poverty.
· Governments must provide sexual and reproductive health services for women and young people (including internally displaced persons and refugees) during crises and the rebuilding of societies;
· Develop and provide sex-disaggregated data and appropriate indicators to monitor progress for achieving the MDGs.
· Address health inequities and poverty reduction in Middle Income countries;
· Enable civil society to participate in the development, implementation and evaluation of policies and programmes to achieve the ICPD and the MDGs so contributing towards good governance and accountability.
· Address women’s human rights including economic and legal rights through the creation of a policy environment that provides equal employment opportunities, salaries, and access to credit, inheritance and property rights.
· Eliminate violence against women including sexual violence and child marriage to help reduce maternal mortality and morbidity and the transmission of STIs including HIV, and ensure human rights for girls and women.
· Ensure adequate financial resources are available to achieve the MDGs. Wealthy nations must fulfil their 0.7 per cent of their Gross National Product (GNP) to Official Development Assistance (ODA) commitment before 2015. Meeting the MDGs costs approximately half of 1 per cent of wealthy nations’ GNP.