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BMJ. British Medical Journal. 2005 Jul 2; 331:46-47.I want to congratulate you, Prime Minister Blair, on the hard work that you and your team have put into the Commission for Africa’s report. It is an honest document, probing gently but fearlessly into the reasons why so many endeavours in this great continent have failed. You emphasise the responsibility of African leaders to drive development from within Africa but at the same time make clear the responsibility of the richer countries to commit to serious partnership in the process, with the aim being Africa’s development rather than their own. I am sure you don’t need reminding that these principles will be difficult to put into practice, but I am hopeful that the report will be a template for action. When I heard about the commission last year I tried to contact you, requesting that at least one of the commissioners be involved in health care. Maybe you were overwhelmed by advice, as my letters went unanswered. However, your report has touched on matters of health, with sections on HIV and AIDS, tuberculosis, and malaria. These diseases are of enormous importance and are already being tackled by many groups in Africa. I am not involved in HIV treatment myself, but many of my patients are infected by the virus and my wife is working in a palliative care project for dying children, most of whom have HIV or AIDS, so I know first hand of the misery and hopelessness in so many lives. (excerpt)
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):100-102.For a long time, the sexual and reproductive health needs of men— beyond their roles as women’s partners— received little attention from the global reproductive health community. In fact, some people feared that involving men in women’s reproductive health would undermine attempts to empower women. This changed only with the onset of the AIDS epidemic in the 1980s. Early attempts to understand and contain the disease made it clear that public health experts required better knowledge of men’s (and women’s) sexual behaviour. But men’s health care needs and the significance of men’s roles go far beyond HIV/AIDS. Men play a key role in the occurrence and prevention of unplanned pregnancies and sexually transmitted infections (STIs) other than HIV/AIDS, as well as in healthy marital relationships and child rearing. In 1994, the ICPD recognised the importance of “male responsibilities and participation” in sexual and reproductive health. The conference’s 20- year Programme of Action called for leaders to “promote the full involvement of men in family life and the full integration of women in community life”, ensuring that men and women are equal partners in both spheres. In particular, it said, “efforts should be made to emphasise men’s shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning; prenatal, maternal and child health; prevention of sexually transmitted diseases, including HIV; [and] prevention of unwanted and high-risk pregnancies”. (excerpt)
Making it real. Universal access to reproductive health care is difficult to measure and even more difficult to achieve.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):92-95.The International Conference on Population and Development was, fundamentally, about making sure that everyone could get the reproductive health services they wanted or needed—“universal access”. This goal seems straightforward, if by no means easy to achieve—especially for the poor and those in isolated rural areas. But ensuring access is not only about mobilising the political will and financial resources to make services available. It is also about making sure people know what and where the services are; that they can physically get to them; and that they can afford to pay for them. Finally, it is about ensuring that people want to use the services—because their families and communities support their choices, and because they feel welcome and accepted at service sites. (excerpt)
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):88-91.In the effort to make the Cairo consensus a reality, no issue has been more controversial than abortion. Most of the industrialised world and the larger developing countries passed liberal abortion laws by the mid-1970s, around the time when women’s rights and autonomy began to be widely recognised. But abortion remains illegal in most African and Latin American countries and some parts of Asia, except in cases of rape or incest or when a woman’s life is in jeopardy. Even then, it is often difficult for women to find safe and legal services. New actors in the world of political and social conservatism have recently joined forces with the institutional Catholic Church, bolstering its opposition to all forms of reproductive health. The result has been a shrewd takeover of the terms of debate on abortion and a severe public backlash against it. The threat, however, is not just to the legal right to abortion: every kind of reproductive health service and family planning method is now under siege. In the early 1990s there was growing international consensus that safe and legal abortion was a public health imperative, a human right and a compassionate response to unintended and unsustainable pregnancies. Now, however, we have doubt, hesitation and in some cases, a full-scale retreat. Public courage is at a low ebb and will not resurge without a strong push. (excerpt)
The difficult years. The Programme of Action hits adolescence, along with the generation that needs it the most.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):70-77.This year, the ICPD Programme of Action turns ten years old, and enters a critical juncture: adolescence. The 1.2 billion adolescents living in the world now are making important choices that will affect their health, futures and personal development—choices about sex, school, family and work. The decisions of their governments about whether or not to implement the ICPD framework will influence just how healthy those choices might be. For young people, the ICPD Programme of Action is a document of hope. It affirms that respecting and promoting their human rights and protecting their reproductive and sexual health is essential for ensuring the health and development of communities and nations, and it lays out comprehensive guidelines to achieve this. Governments have come a long way since 1994 in implementing the ICPD Programme of Action, but more effort is needed to improve young people’s sexual and reproductive health and protect young people’s sexual and reproductive rights. (excerpt)
Women, gender and HIV / AIDS. Women bear the heaviest HIV / AIDS burden, but they can’t prevent its spread by themselves.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):65-68.Women, especially young women, are increasingly the face of the HIV/AIDS epidemic. About half of all adults infected with HIV worldwide are women, although this proportion varies by region. In sub-Saharan Africa, 75 percent of those infected are young women and girls, and the proportion of pregnant young women in capital cities who are HIV positive—an indicator of how the epidemic is spreading— remains high in five of the most populous countries in sub-Saharan Africa. Recent data from South Africa, one of the countries hardest hit by HIV/AIDS, showed that 10.2 percent of all 15- to 24-year-olds were infected in 2003, and three of every four HIV-infected young people were female. In the United States, AIDS is now the leading cause of death among African-American women age 25-34. Even in Thailand and Cambodia, relative HIV-prevention success stories, the epidemic increasingly affects women: The rate of new infection is now higher among women than men, and many of those women are the wives of HIV-positive men. (excerpt)
Can this marriage work? Linking the response to AIDS with sexual and reproductive health and rights.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):58-63.For people involved in family planning, ICPD was a landmark event. Yet it is striking how few experts, activists and stakeholders involved in other SRHR issues, particularly HIV/AIDS, were centrally involved in Cairo. Cairo had no visible involvement of people living with HIV, and no HIV/AIDS-dedicated non-governmental organisation was amongst the many formal observing agencies. Even five years later, at the ICPD+5 meeting in New York where progress was reviewed and further targets established, only one HIV/AIDS NGO was formally present. In the years immediately following Cairo, many AIDS activists felt excluded and ignored by the SRHR community. This perception was worsened by a sense that the SRHR community was trying to “take over” AIDS, while simultaneously not taking AIDS seriously. One prominent SRHR expert repeatedly stated that “there should be no such thing as an HIV/AIDS programme”; he insisted these should be replaced with holistic sexual health strategies. The World Health Organization’s Global Programme on AIDS was abolished and replaced with what was initially a much smaller and more modestly-funded inter-agency body, UNAIDS. And by 1997 the majority of OECD donors had abolished their stand-alone global HIV/AIDS departments or budget lines and “integrated” these efforts within new or restructured SRHR funding. (excerpt)
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):52-53.It is hard to believe that ten years have passed since 179 countries came together in Cairo for the International Conference on Population and Development (ICPD). A decade after the adoption of the historic Programme of Action, it’s worth reflecting upon the progress the international community has made, and looking ahead to the challenges before us. When it was originally adopted, the Programme of Action was designed to highlight the links between population and development by focusing on meeting the needs of individuals, rather than broad demographic targets—a habit not easily broken by governments accustomed to dealing with issues on a macroscopic level. The Programme of Action called upon the international community to think more strategically about how it could provide development assistance. (excerpt)
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):51.Ten years ago, my country joined with 178 other nations in the historic International Conference on Population and Development (ICPD). Together, we promised to make the world a better place by improving reproductive health and ensuring that women were at the centre of development efforts. We set ourselves a deadline of 2015 for achieving our goal and each country pledged to commit human and financial resources, confident that these investments would yield significant gains in terms of poverty alleviated and lives saved. In Africa, at the ten-year mark, we have some things to celebrate and much work to do. In some countries, including my own, we have made progress in making certain elements of reproductive and sexual health care more accessible. However, if we are to achieve the ICPD goal of making these services universally available by 2015, we must accelerate our efforts dramatically. And we must ensure that everyone— including young people—has access to the full range of sexual and reproductive health services: not just a few methods of family planning, but sexuality education to help them make healthy, informed decisions; prenatal, delivery, and postnatal care to ensure that women go safely through pregnancy and childbirth and that they and their infants thrive; and information about and effective means to prevent sexually transmissible infections. (excerpt)
Protecting choice means making choices. Legislators worldwide must choose to preserve the Cairo consensus.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):48-50.At the ten year mark of the ICPD Programme of Action, never HAS a woman’s right to decide freely the number and spacing of her children been so widely recognised and exercised—yet paradoxically challenged. These challenges are both old and new, and they call upon us as European parliamentarians to make a number of fundamental policy, diplomatic and budgetary choices. In 1994, the adoption of the ICPD Programme of Action by 179 countries marked a major shift towards placing the individual at the centre of development and abandoning demographic targets. The Millennium Development Goals further enshrined women’s right to make their own decisions as a global development objective. Despite this explicit political will and the great strides forward of the past decade, trends have emerged that force us to reassess our long-held strategies. The first is the HIV/AIDS pandemic. In 2004, the worst-case scenarios of the early 1990s are becoming reality. The developed world watches as entire generations suffer in less developed countries from a disease that is both preventable and treatable—one that has been controlled in donor countries. Yet rather than coming together to fight a common enemy, the HIV/AIDS community and sexual and reproductive health and rights (SRHR) advocates have seemed to drift apart. (excerpt)
Beyond the averages. Meeting the ICPD and Millennium Development Goals for reproductive health might still fail to help the poor.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):35-37.Reproductive health services are centrally important for women, especially for poor women. While we know that these services often fail to reach the women most in need, the data sometimes imply that all is going well. This is because averaging data over large populations—regions, countries, or even sub-national populations, in some cases—masks often dramatic differences between sub-groups of those populations. Take, for example, the information in table 1. It shows the situation in six countries, measuring the use of two common reproductive health services according to wealth. In most of the countries shown, as in most of the 50 or so others with data available, the wealthiest 20 percent of women are at least twice as likely— sometimes more than ten times as likely—to use modern contraception or to give birth with a qualified medical attendant as the poorest 20 percent of women. The limited information we have indicates that the picture is similar if we look at population groups broken down by other characteristics, such as race, education or language. (excerpt)
American Journal of Public Health. 2005 Jul; 95(7):1091-1092.In recent years the World Bank has become “the world’s largest external funder of health.” According to Ruger, this situation reflects the Bank’s increased sensitivity to poverty and its growing sophistication— beginning under the leadership of US Secretary of Defense turned World Bank President (1968–1981) Robert McNamara—about development theory and practice. Such an uncritical portrayal befits the World Bank’s own Web site (a major source for Ruger’s article), but Journal readers should expect more. Missing from this officialist version are discussions of the Bank’s undemocratic governance and decision-making structures; the untoward human effects of longstanding World Bank pro-privatization policies and practices, most notably structural adjustment programs (which have denuded the social welfare infrastructure of developing countries in areas such as housing, education, health services, subsidies, and family transfers); and the impact on health of the Bank’s newfound focus on the health sector. (excerpt)
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):8-11.Participants negotiated a global Programme of Action that set priorities and time-bound goals to guide national level policymaking for the next 20 years. Specifically, the Programme of Action addresses a broad range of topics related to population and development, including sexual and reproductive health, education, human rights, the environment, internal and international migration, and the prevention and control of HIV/AIDS. This grand ambition and the size of the gathering made ICPD a landmark event. But it was a departure in other ways as well. Previous population conferences had recognised the rights of couples and individuals to decide the number and spacing of their children and to have the information and services necessary to make those decisions. However, these gatherings focused on the need to control fertility levels to achieve quantitative population and demographic targets. Family planning programs were seen as the means to achieve these targets, usually in the context of population policies that sometimes included incentives, disincentives and quotas that were intended to either increase or reduce birth rates. (excerpt)
Can we get there from here? Ten years of work raise the question of whether the ICPD goals are plausible or only a pipe dream [editorial]
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):4-7.A decade ago the world witnessed the end of apartheid and celebrated Nelson Mandela’s triumphant ascent to South Africa’s presidency. We also watched in horror as the Rwandan genocide unfolded, and breathed a collective sigh of relief as the peace plan for Bosnia-Herzegovina was signed. In that same year, 1994, thousands of senior policy makers and activists gathered in Cairo for what turned out to be a watershed moment—the International Conference on Population and Development. In a dramatic shift, ICPD put the concepts of rights and choice at the centre of population policy, signalling the end of the population control era. Instead of pursuing demographic targets via population policies based on family planning programmes, the goals now were to achieve broad improvements in reproductive health, to meet young people’s reproductive health needs, and to empower women. The world of sexual and reproductive health today is dramatically different from that of 1994. It is the right time not only to take stock of progress made, but also to assess the challenges we still face and the actions we need to take now as a community. It is appropriate that we celebrate the successes achieved since Cairo and acknowledge the disappointments. We must learn from both. (excerpt)
Washington, D.C., International Center for Research on Women [ICRW], 1998. 16 p. (ICRW Working Paper No. 6)How is it that 556 million women and girls throughout the world are illiterate, and this is not viewed as a violation of their right to education? When 600,000 women die annually as a result of complications of pregnancy, and an additional 18 million women suffer from pregnancy-related morbidities that go untreated, how is this not seen as a failure of governments to meet their obligations to promote, protect, and fulfill women's rights to the most basic attainable standard of health? How can the feminization of poverty be viewed as anything less than a violation of women's rights to an adequate standard of living, equal access to employment, credit, property, and training? These alarming statistics constitute the foundation of the literature on women in development (WID), and are generally referred to as "the state of the world's women." The time has come to call these realities what they truly are: human rights violations. It is fitting that the 50th Anniversary of the Universal Declaration of Human Rights--adopted unanimously by the UN General Assembly in 1948--comes at a time when a new discourse on human rights and development is emerging. This new thinking is especially important to the field of women in development, as it holds the potential of launching a revitalized effort toward ensuring gender equity and equality for the next century. This trend, however, has only recently begun to gain a sense of currency among WID researchers and practitioners. Until recently, the promotion and protection of human rights and the realization of sustainable development have been viewed as separate domains. Notably, development measures are rarely viewed as contributing to the realization of specific human rights--for example, the right to food--when that is precisely what such measures have done. (excerpt)
Forced Migration Review. 2005 May; (23):48-49.The conceptual apparatus in forced migration and population resettlement research is being continuously enriched. One important – but still relatively unknown – development was introduced recently into the resettlement policies of the World Bank, African Development Bank and Asian Development Bank. This new thinking is set out in the revised (January 2002) World Bank Operational Policy (OP) 4.12 on resettlement. This significantly defines the ‘restricting of access’ to indigenous and other people in parks and protected areas as ‘involuntary displacement’ even when physical displacement and relocation are not required. The justifying rationale is that restrictions impose impoverishment risks and these risks lead to severe deprivations. Significantly, this new definition has come from major international agencies themselves involved in instituting ‘restricted access’ regimes. As the definition has been adopted, the world’s major development agencies have moved towards policy consensus that restricted access is a form of displacement. (excerpt)
Population 2005. 2002 Sep-Oct; 4(3):1, 6-7.As we approach the 10th anniversary of the International Conference on Population and Development (ICPD), it is fair to ask as to how far we have come toward realizing the goals and objectives adopted at the conference. With a consensus among the participating 179 countries, the conference adopted an ambitious 20-year Program of Action (1995-2015). The program emphasized the integral linkages between population and development, focused on the importance and urgency of meeting the needs of individual men and women in the areas of family planning and reproductive rights, and urged empowerment of women as a highly important end in itself and as a key to improving the quality of life for everyone. (excerpt)
Population 2005. 2002 Sep-Oct; 4(3):2-3.Global events organized under the auspices of the United Nations have achieved, to different degrees, more visibility for particular issues or institutions. Beyond the visibility, success may also be measured by the direct impact of a global event on more effective actions for development. It is generally believed that success, in these terms, depends on three political conditions and two technical conditions. These are presented here as a checklist for success and subsequently applied in an overall assessment of major U.N. events held during the 1990s. On this basis, proposals are made regarding the 10th anniversary of the 1994 Conference on Population and Development, better known as the Cairo Conference. (excerpt)
Population 2005. 2002 Nov; 4(4):2, 4.Is sustainable development possible without a population focus? This question has been discussed recently at several meetings, primarily in the context of the outcome of the Johannesburg Summit on Sustainable Development. I recall the discussion on this topic during the preparatory process for the United Nations Conference on Environment and Development (UNCED) held in Rio de Janeiro, Brazil in 1992. There was a certain amount of hesitancy among the delegates participating in the UNCED process about discussing the relationship of population with the concept of sustainability. First, because population was considered a ‘controversial’ topic and many of the delegates did not want one more controversial topic added to the agenda. Second, as the International Conference on Population and Development (ICPD) was already scheduled to take place in 1994, many of them also felt that this should be left to ICPD to sort out. (excerpt)
Population 2005. 2002 Nov; 4(4):3.Advocates of population stabilization came away frustrated from the recent World Summit on Sustainable Development (WSSD) in Johannesburg – the most important global environment and development meeting since the 1992 Earth Summit in Rio de Janeiro. Oddly, there was no place on the official agenda for discussion of the relationship between population growth and sustainable development, though there can be no doubt in anyone’s mind that the two are inexorably linked. After all, we live in a world where: More than a billion people in developing countries lack access to clean water; Some 90-95 percent of sewage and 70 percent of industrial waste in developing countries are dumped untreated into surface waters, contaminating the supply for drinking. At current rates of deforestation, the last significant concentrations of tropical forests, containing half of the world’s biodiversity, could be harvested by the middle of this century; In the poorest countries, 160,000 people migrate each and every day from rural areas to towns and cities, escalating environmental health challenges arising from both traffic congestion and too many people crammed too closely together in inner city slums or shantytowns lacking basic sanitation and health services. (excerpt)
Population 2005. 2004 Dec; 6(4):16.UNFPA’s resources were boosted in the closing weeks of 2004 and prospects for 2005 appear brighter than anticipated. That is the upbeat assessment by UNFPA Executive Director Thoraya Ahmed Obaid. The view is to some extent rooted in cross-currency exchange rates but is also based on the latest announcements received from a number of donor countries. At most recent count, core resources for 2004 stood at $325 million with another $80-$100 million in non-core funds. In 2005, the core contributions may reach $ 340 million, while some of the new non-core commitments will be directed to the promotion of reproductive health commodity security (RHCS) in developing countries. RHCS is an initiative pursued by UNFPA, a leading player in the effort, in collaboration with other partner organizations. Its aim is to help developing countries institutionalize the capacity to predict and then to meet requirements for supply of stocks of essential drugs and contraceptives. Of greater urgency, however, is the Fund’s concern about filling existing gaps in supplies of these commodities in the least developed countries. (excerpt)
Population 2005. 2002 Mar-Apr; 4(1):2.More than 70 nongovernmental organizations have endorsed a declaration in support of a global event on population and development in 2005, which was prepared by the executive board of Population 2005 in February 2002. The statement was presented to the United Nations Commission on Population and Development at its 35th session in New York in April. The declaration reads as follows: In its Program of Action, the International Conference on Population and Development (ICPD) held in Cairo in 1994 set three sets of specific goals for: 1) provision of family planning and other reproductive health services 2) reduction of infant, child and maternal mortality, and 3) universal access to primary education, with particular attention to the girl child. (excerpt)
Population 2005. 2004 Dec; 6(4):9-12.The International Conference on Population and Development, held in Cairo, Egypt (ICPD) from 5 to 13 September 1994, was an epoch-making event. The 179 countries participating in the Conference established, by consensus, several far-reaching goals and objectives within a 20 year framework that provide the basis for urgently needed action by national governments, NGOs and the international community in the areas of reproductive health, population and development: Accessibility to reproductive health services to all individuals of appropriate ages through the primary health care system as soon as possible and no later than the year 2000. Meeting the family planning needs of all countries' populations as soon as possible and no later than the year 2015 so as to provide universal access to a full range of safe and reliable family planning methods and lawful reproductive health services to individuals and couples who need them. Reduction of infant mortality to 50 per 1,000 live births by the year 2000, to below that level by 2005, and to below 35 per 1,000 live births by 2015. (excerpt)
Population 2005. 2004 Dec; 6(4):1-2, 4,12.At a UN General Assembly commemorative meeting in October, marking the 10th anniversary of the Cairo Conference on Population and Development (ICPD), senior health and population officials from around the world joined with members of the diplomatic corps to review progress and note the remaining obstacles to the achievement of goals set in 1994 under a 20-year Program of Action. Among the nearly 70 speakers addressing the Assembly was Deputy Secretary-General Louise Frechette, who observed that 30 years ago in Bucharest, the World Population Conference had overcome political differences to adopt a comprehensive plan of action. That plan had given the world its first template for integrating population concerns into economic and social development, and established the basic principles guiding population programs today. Ten years ago in Cairo, the effort to address the intertwined challenges of population and development took another major step forward, as the Program of Action adopted there situated population issues more firmly in the broader quest for development and poverty reduction. Today, countries throughout the world continued to use the Cairo Program in forging the strategies and policies with which they hoped to address population issues and achieve the Millennium Development Goals. They were making substantial progress, building on the achievements of the earlier decades. (excerpt)
Population 2005. 2004 Dec; 6(4):3.Cairo was a turning point in development thinking. Cairo put the focus where it should be—on improving the quality of life of all people. It put the focus on protecting human rights and the natural resources on which all life depends, and bringing our world into greater balance. It recognized that what happens in one part of the world affects what occurs in another, and migration, urbanization, and poverty and sustainable development are interconnected. With emphasis on gender equality and reproductive health and rights, the ICPD Program of Action was ahead of its time. It was and is, and we have some serious catching up to do. All over the world, people are demanding information and services to prevent HIV/AIDS and unwanted pregnancy. Increasing numbers of women are speaking out against the violence they face, and a growing number of men are standing by their side, demanding that justice be served. (excerpt)