Miles to go
before we relax

 Thoraya Ahmed Obaid
assesses progress over ten years of action on poverty reduction and development, and sets out priorities for the decade ahead.

As we mark the tenth anniversary of a historic consensus, we should take stock of what it has produced, and reflect on what we must do to fully achieve its aims. Its outcome – the Programme of Action of the 1994 Cairo International Conference on Population and Development – is a blueprint for a balance between population and a nation’s resources. It is meant to tilt the scales in favour of people, the environment and human rights, including those of women.

Regions, nations and communities have concluded that only by addressing population and women’s rights can we achieve humanity’s development goals, specifically those in the Millennium Declaration adopted by the world’s leaders in September 2000. Africa’s development ministers reiterated this in June 2004, declaring gender equality ‘key to breaking the cycle of poverty and improving the quality of life of the people of the continent'. This is my first message for our collective work for the next ten years of the Cairo Programme, to 2015.

I have five more.

If we look around, we see a world out of balance. Twenty per cent of people in wealthy countries consume 80 per cent of the world’s resources. At the same time, over 1 billion people in poor countries live on less than $1 a day. In wealthy countries, maternal death is rare. Yet in poor nations complications of childbirth remain a leading cause of death for women, snatching a woman’s life each minute.

While wealth has increased tremendously during the past quarter century, the proportion of money devoted to international development assistance has declined. This does not bode well for global peace and security. We will have neither unless we eradicate poverty. So we must tilt the scales in favour of social justice and development. We must invest in population, women and reproductive health, including family planning, to make greater inroads into poverty reduction. That is my second message.

Economic growth
There is concrete evidence that investments in population reduce poverty. Slower national population growth supports overall economic growth. Research shows that about a fifth of economic growth between 1960 and 1995 was due to reductions in mortality and another fifth to reductions in fertility. This demographic transition, from large to smaller families and from high to low death rates, is happening in all countries to varying degrees. As women choose smaller families, they acquire more social and economic opportunities. And parents are able to invest more in each child, leading to healthier, better-educated children and more prosperous families.

Because women are having fewer children, population growth is slowing. Today, 77 million people are being added to our planet every year, compared to 81 million a decade ago.

Family planning has also saved the lives of millions of mothers and children. A recent study in Africa showed that it could reduce maternal death by 20 per cent – and that spacing births by three years or more could cut infant death in half.

Overall, the story of population is a success for humanity. It will remain so, if we stay committed to population and reproductive health programmes and provide the necessary resources.

It is heartening that, all over the world, the Cairo blueprint is guiding policy making to secure better health, human rights and gender equality. There is broad consensus in all regions that the Cairo Programme of Action will help the achievement of the Millennium Development Goals. Conversely, we cannot reduce poverty, hunger and disease, especially HIV/AIDS, unless we make greater investments in education and health, including reproductive health. Given the desperate situation in many poor countries, our actions must be swift, effective and scaled up. This is my third message for the next decade.
We cannot reduce poverty, hunger and disease, especially HIV/AIDS, unless we make greater investments in education and health, including reproductive health
Since the 1994 Cairo consensus, the proportion of developing world couples that can choose and use contraception has grown from 55 to 60 per cent. Infant mortality has dropped from 71 to 61 of every 1,000 babies born. Life expectancy in developing countries has risen from 61 years to 63. Fewer women die during childbirth in many countries, but much more still needs to be done to ensure safe motherhood. We must provide three services that save women’s lives: family planning, skilled attendance at birth and emergency obstetric care.

We should offer these services to all as an urgent priority because more than half a million women die each year from complications of pregnancy and childbirth. The absence of services often results in obstetric fistula. This little-known condition, which disappeared from rich countries over a century ago, continues to afflict tens of thousands of poor girls and women in developing countries. It can be prevented and treated: surgery is 90 per cent effective and costs about $300 per patient. With 2 million girls and women awaiting treatment, there is a huge task ahead. Last year UNFPA started the first global campaign to end fistula, providing assistance in many African and Asian countries.

Halting the spread of HIV/AIDS is one of the most vital reasons for increasing investments in family planning. Our first line of defence is prevention, but we must also pay attention to care and treatment. Family planning and maternal health facilities are key entry points for treatment, so the link between reproductive health and HIV infection – mostly a reproductive health problem, after all – must be underlined. As we scale up treatment, we must also boost HIV prevention. This is my fourth message.

Strategic interventions
HIV prevention is a top priority at the United Nations Population Fund. We focus on three strategic interventions: ensuring that information and services reach and involve the young, especially girls; helping pregnant women and their children remain HIV free; and helping to make condoms accessible.

Policy makers must stop underestimating the contributions of reproductive health and family planning to economic and social development. We also must pay greater attention to population and deal with demographic trends. The population of the least developed countries is projected to triple in the next 50 years – a serious matter since these countries already face difficulties in providing basic education, health and housing to their citizens. Over the next half century, the population of developed countries will remain at about 1.2 billion, while the less developed regions will see their numbers rise from 5.2 billion to 7.7 billion.

Meanwhile, population ageing and the emergence of the largest youth generation in history pose great challenges. Greater investments must be made for both. That is my fifth message.

While Europe focuses on population ageing, concern in much of the developing world centres on youth. There are more than 1 billion young people between the ages of 15 and 24. Too many of them are growing up in poverty, in conflict or in environments devoid of opportunity or hope. This must not continue.

This young generation sees a better life, not around the corner but through television screens that whet their appetites. But their expectations are not always matched with opportunities. We must invest heavily in education, health (including reproductive health) and employment to harness their idealism and energy.

As we look to the future, we must remain focused on the Cairo Programme of Action and stay committed to its goals of universal access to education, reproductive health, gender equality, poverty reduction and development. We need to create stronger partnerships – both North-South and South-South – among governments, non-profit organizations, the private sector, parliamentarians and the media, if we are to forge ahead. This is my sixth message at this mid-point of Cairo’s 20-year programme.

Developing nations are close to keeping their side of the bargain to invest $12.4 billion annually on population and reproductive health. But the donor countries meet only half of their Cairo commitment of $6.1 billion, contributing $3.1 billion. The $3 billion gap – worth less than two days of global military spending – is the main reason why we are not making faster progress.

We cannot afford more delay. As United Nations Secretary-General Kofi Annan recently warned Africa’s development ministers, the cost of inaction is too horrendous to contemplate. In maternal health terms alone, it could cause roughly 2.5 million maternal deaths, 7.5 million child deaths and 49 million maternal injuries in the next ten years.

We have miles to go before we can relax

Thoraya Ahmed Obaid is United Nations Under-Secretary-General and Executive Director of UNFPA, the United Nations Population Fund.

PHOTOGRAPH: Stephen Dolmer/UNEP/Topham

This issue:
Contents | Editorial K. Toepfer | Miles to go before we relax | Practical consensus | Power shift | Equally effective | People | Peace of mind, piece of land | The young ones | Fuelling change | At a glance: Women, health and the environment | Aishwarya Rai | Unprecedented opportunity | Books and products | Chemical inheritance | Toxic trespass | First empower | Citizen engagement | Adding feminine perspective | After all ‘nature’ is female... | A unique voice

Complementary issues:
Culture, values and the environment 1996
Poverty, Health and the Environment 2001
World Summit on Sustainable Development 2002
Water, Sanitation, People 2004

AAAS Atlas of Population and Environment:
Population and natural resources
Population, waste and chemicals

Timothy E. Wirth, President of the United Nations Foundation and former U.S. Senator:
ICPD+10 speech September 2004