International action: Cairo and beyond

Posted: 26 January 2008

In 1994, government delegations from 179 countries and thousands of representatives of civil society met at the International Conference on Population and Development (ICPD) in Cairo, Egypt. Participants came to an unprecedented consensus on a 20-year Programme of Action to stabilise the world's population by investing in people and better meeting their health and development needs. This Programme of Action asserts the interdependence of population and development, and calls for the empowerment of women both as a matter of social justice and as the key to improving the quality of life for all people.

Four essential points emerged from the ICPD process.

• It was agreed first that population and development problems are not simply a relationship between numbers and development needs such as school places, health care and natural resources - but also between numbers and consumption patterns. The Programme of Action recognises that excessive consumption in the wealthier Northern countries and rapid population growth in the poorer South, both contribute to global environmental and development problems.
• Secondly, it acknowledged that tackling poverty must be an essential part of efforts to reduce family size and human numbers. Agreement on these two points helped to defuse some of the North-South conflicts, which were apparent at the two previous world population conferences.
• Thirdly, it accepted that population problems cannot be tackled through a macro numbers approach: solutions must be found at the micro level. So much of what needs to be done turns on a proper understanding of people as individuals and communities, on the status of women, their education and the provision of proper health and particularly appropriate, good quality reproductive health care.
• Fourthly, population and development are issues of concern to many sectors of society. They should therefore be shared among all those concerned, severally and in coalitions.

The Action Programme stated that by meeting people's needs for family planning and other sexual and reproductive health services, population goals will be met by choice and opportunity, not coercion and control. By connecting fertility regulation with other health and development goals, ICPD reinforced a significant change in the focus of population policies. It set specific goals for health and social needs and called for the commitment of funds to meet them.

Key targetsThe 20-year programme approved at Cairo also agreed to:

• Ensure universal access to quality and affordable reproductive health services, including family planning and sexual health. Reproductive health services, including family planning, can save the lives and improve the health of women and children. These services are also a key component of efforts to slow population growth.
• Enable couples to make real choices about family size through social investments.
• Improve rates of child survival. No country in the developing world has experienced a sustained reduction in family size without first reducing infant and child mortality. Couples must feel confident that their children will survive before they are willing to have fewer children.
• Expand educational opportunities, close the "gender gap" in education, and provide universal access to primary education. Educated women tend to want smaller families, and are better at looking after those children they do have. Educated parents rely less on children for income and support, particularly in old age.
• Invest in women's development. When women can exercise their full legal and social rights, they often have both the desire and the ability to choose smaller families. Where women are valued as full human beings, there is less societal preference for sons. Efforts to increase women's self-determination have been shown to improve the health and well being of women and their children, and to slow the pace of population growth.
• Expand opportunities for young women. In the year 2000, some 400 million adolescent girls stand on the brink of adulthood. If many choose to delay childbearing, even for a few years, they will enhance their health, education and employment prospects. In the year 2100, the developing countries' population will be smaller by 1.2 billion if the average age at bearing the first child is delayed by five years.

New rightsA further remarkable development at Cairo was the inclusion of certain definitions in the final document, which condemned any form of coercion and is grounded in the human rights perspective. Thus governments defined 'reproductive rights' as embracing certain human rights, including:

• The right of couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so;
• The right to attain the highest standard of sexual and reproductive health; and
• The right to make decisions free of discrimination, coercion or violence. (ICPD 7.3)

The Conference adopted the WHO definition of 'reproductive health' as a "state of complete physical, mental and social well being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system..." (ICPD 7.2). And delegates committed themselves to promoting the reproductive rights of all individuals and couples, and ensuring universal access to reproductive health care services, including family planning and sexual health, by the year 2015. (ICPD 7.3 and 7.6).

Measuring resultsWhat progress has been made since the Cairo Conference?

By 2000 it was clear that while there was growing evidence that the ICPD agenda is practical and realistic, resources for sexual and reproductive health were falling far short of the targets agreed upon in Cairo. By 2005the shortfall against the promised $23.7 billion (in current dollars) for the Cairo Plan, was massive. Of this, donors should have provided a third - or some $8 billion. In 2003, they actually gave just over $3 billion. Developing countries are also falling short, but not so spectacularly.

Nevertheless, in many regions of the world, ideas and realities are changing in support of sexual and reproductive health, as many of the case examples on this website demonstrate.

• Laws and policies are being reformed and new partnerships formed at international, national, district, and local levels.
• Gender equality and equity are being addressed through both policy and programme initiatives, and there are increasing signs of men's involvement in sexual and reproductive health.
• A wider range of reproductive health needs is being met through an increased focus on service quality, integration, referral, and other service delivery mechanisms, as well as greater acknowledgement of existing public health risks such as gender- based violence and unsafe abortion.
• And the rights and needs of adolescents to and for sexual and reproductive health information and services are beginning to be addressed.

However, there is a long way to go to meet the Cairo targets or the Millennium Development Goals in areas such as maternal mortality. While an annual decline of 5.5 per cent in the number of maternal deaths per 100,000 live births between 1990 and 2015 is required to achieve the MDG goal, figures released in 2007 by WHO, UNICEF, UNFPA and The World Bank show an annual decline of less than 1 per cent. In 2005, 536,000 women died of maternal causes, compared to 576,000 in 1990. Ninety-nine per cent of these deaths occurred in developing countries.