Steven W. Sinding, Why the Cairo Programme of Action Is So Important
Statement by Steven W. Sinding, Director-General, International Planned Parenthood Federation at the International Parliamentarians' Conference on the Implementation of the ICPD, Ottawa, Canada
21 November 2002
I would like first to thank the organisers for inviting the International Planned Parenthood Federation (IPPF), one of the world's largest NGOs and the largest in the fields of population and sexual and reproductive health and rights. I have been asked to speak to you on the implementation of the ICPD Programme of Action.
There are some similarities between parliamentarians and civil society organisations. While you are the formal representatives of the people in your countries, we regard ourselves as their informal representatives. As such, we are your allies, especially as we can sometimes deal with the more sensitive issues of the ICPD Programme of Action. In a sense, an alliance between the formal and informal peoples' representatives is of crucial importance in moving the Cairo agenda forward.
As I am new to the position of Director General of IPPF and addressing you in such a capacity for the first time, I seek your indulgence in telling you a little bit about IPPF. We are a Federation of 150 national member associations working in 180 countries through the contributions of some 120 million volunteers. We provide reproductive health information and services to 24 million people. While some of our smallest associations have one clinic in the capital city, our largest (the China Family Planning Association) has one million branches. In terms of activities, while some associations limit their work to advocacy, some, like Profamilia in Colombia, represent the major source of reproductive health services and supplies in the country.
IPPF was established in Bombay, India, on November 29, 1952 - 50 years ago next Friday - by women from eight countries who were both brave and angry; angry because they saw the misery of women who were denied access to free choice regarding their fertility and denied a political voice through their exclusion from the democratic process in many countries. They were also brave because they challenged the restrictive contraceptive laws that were prevalent in many developed countries and their colonies and because they set up an international network of Planned Parenthood Associations which, 50 years later, covers the entire world.
Throughout its 50 years, IPPF has been a pioneer. In 1952, we insisted that family planning be seen as a human right, a principle that was adopted by the UN General Assembly in 1966 and confirmed at the Tehran Conference on Human Rights in 1968. With the exception of only a very few countries, it was the IPPF members that began to legitimise the concept of family planning, often in the face of official hostility and social conservatism. These member associations were instrumental in demonstrating the safety and acceptability of modern contraceptives, in sensitising men to their responsibilities, and in advocating the introduction of population and sex education in the school curriculum.
In the late 1960s, IPPF realised that because there were few clinical facilities in rural areas, it was necessary to ''invent'' an approach to provide services where no medical facilities or physicians existed. Consequently, in the early 1970s IPPF developed the concept of community-based distribution, which was introduced first in Thailand. The close relationship between IPPF member associations and the local communities enabled our members to incorporate community participation into family planning programmes and later to introduce cost-sharing approaches in order to achieve a degree of self-sufficiency.
Throughout the first four decades of IPPF's life, the Federation recognized the relationship between population growth and development, but we have always insisted that family planning programs should be based on the concepts of voluntary acceptance and human rights. We believed that informed choice, not demographic targets, was the key to successful implementation of family planning programmes. This human rights dimension, on the one hand, and our belief in a holistic approach to deal with women's health and empowerment, on the other, led IPPF to adopt in October 1992 our Vision 2000, a program strategy that consolidated these beliefs. The adoption by 179 governments of the ICPD Programme of Action in Cairo two years later came as a confirmation of IPPF's own strategic vision. Following ICPD, IPPF began to see that the implementation of its strategic goals and objectives would be particularly valuable if we were to concentrate on those sensitive and complex aspects of the Programme of Action that governments were not well-equipped to address or where they were reluctant to take action.
Towards Cairo + 10: Achievements and constraints The Cairo Conference of September 1994 represented a landmark in the areas of sexual and reproductive health and rights. As we meet here today, eight years after Cairo, it is worthwhile to briefly survey what has been accomplished, the constraints to full implementation of the Programme of Action, and the areas of unfinished business. As many of the ICPD achievements will be presented by Thoraya Obaid, UNFPA's Executive Director, I will focus on a select few.
Many governments began right after Cairo to take steps away from demographic targets and family planning quotas, and towards enabling individuals and couples to decide freely about their reproductive choices. An early example in this direction was the decision of the Indian government in 1996 to adopt a national "target-free approach." In Vietnam, the parliament debated the negative impact of the two-child policy and decided to adopt new policies more consistent with the Cairo Programme of Action. And China is gradually softening the one-child policy in various ways.
The gender equality language of ICPD influenced many governments to introduce programmes, and to change laws, to empower women and to influence men to participate more fully in programmes of sexual and reproductive health. While progress has been made, especially in the area of young women's access to education and skills, there remain many obstacles related to traditional views about the role of women in society.
In addition, some social and religious movements aspire to roll back the progress made by women during the last 50 years, and especially during the last decade. Women everywhere are fighting to maintain and strengthen the equal rights to which they should always have been entitled.
Many governments have extended reproductive health services to rural areas and slums in the ever-growing cities and towns in developing countries. Nevertheless, 360 million women have no access to reliable contraceptives and 600,000 women die every year as a result of complications arising from pregnancy. While today nearly 60% of women in reproductive age are using contraception, the majority of the other 40% percent of women have little or no access to reproductive health services.
Tragically, if women do not have access to reliable contraception, when unwanted pregnancy occurs, many women resort to unsafe abortion, often leading to death or permanent physical or emotional damage. Around the world, close to 46 million abortions occur every year, some of them under legal conditions, the others under both illegal and unsafe conditions. The vast majority in the developing world are unsafe. The World Health Organisation estimates that 78,000 women die every year as a result of these unsafe interruptions of pregnancy. Unfortunately, despite this massacre - 227 women every day - most governments are turning their heads the other way.
But pretending unsafe abortion and the resulting mortality do not exist will not make them go away. We need to detoxify the issue of abortion, face this human tragedy head on, and deal with it. Who better to do that than policymakers like yourselves? You can initiate careful reviews of the actual situation in your countries and then stimulate rational debate about how to deal with unwanted pregnancies and unsafe abortion. There are many policy approaches available to you. One of those is decriminalization. The Parliament of Nepal did just that in September of this year, opening the way to saving lives.
The ICPD Programme of Action was right in identifying young people as a major population group in need of support with regard to sexual and reproductive health education, information and services. The largest cohort of young people in human history is now reaching reproductive age - 1.2 billion in this decade, nearly 20 percent of humanity. There have never before been so many young people in need of our attention and there never will be again! This is the largest cohort in human history.
And these young people are, whether we like it or not, becoming more sexually active at younger ages than ever before. Like abortion, we can ignore this issue and hope that it goes way, or we can confront it in an open, enlightened, and compassionate way. The truth is that, no matter how you look at it - demographically, socially, or in terms of health - whether and how we deal with the reproductive and sexual health needs of this largest generation ever will have an enormous impact on the future.
Young women are the most likely to have unwanted pregnancies and to resort to unsafe abortions. They are also the most likely to die if they try to give birth. Young men and women are the most susceptible to sexually transmitted diseases, including HIV/AIDS. And, because the cohort is so large, whether and when they bear children will have huge consequences for future population size. Much of the progress made in the last 50 years of international cooperation in the field of population could be undone if we fail to deal effectively with this largest generation ever.
In the face of this growing challenge, you can consider several alternatives, the first being the one presently being pushed by the United States: abstinence. But all of us know that the call for abstinence has not saved, and will not save, hundreds of thousands of young people from having unwanted pregnancies or contracting HIV or other sexually transmitted infections. The more common contemporary alternative may be called the ostrich solution: see nothing, hear nothing and do nothing until the HIV/AIDS epidemic, an unwanted pregnancy or an unsafe abortion hits home - the family home, that is.
It is time for legislators to face the reality of that young people have serious sexual and reproductive health problems. The costs of inaction - in health, social, economic, demographic, and even political, terms - could be enormous.
At Cairo, the world was becoming aware of just how devastating the AIDS pandemic was and how much worse it could get. The community of nations recommended wide ranging approaches to prevent the growing catastrophe. Unfortunately, the misguided morality of those who opposed and still oppose the wide distribution of condoms and the dissemination of knowledge about sexuality and sexual health has helped the epidemic to grow by leaps and bounds, ravaging parts of sub-Saharan Africa, and moving rapidly to Asia, including the two most populous countries in the world, China and India.
More than 20 million people have died of AIDS; more than 40 million people are living with HIV; and close to 10 people, many of them newborns, are infected every second of the day. By the time we go to bed tonight, 14,000 people will have been newly infected. When we meet in two years' time, ten years after Cairo, 10 million will have been infected. In addition, in Asia alone, the number of AIDS orphans is close to 860,000. We cannot permit this tragedy to continue.
HIV/AIDS and two other infectious diseases, malaria and tuberculosis, received the attention of the G8 at the Okinawa Summit and UN Secretary-General Kofi Annan. He set up the Global Fund to combat these three diseases and that is certainly a step in the right direction. But how about the funding situation of the other components of the ICPD programme of Action and especially universal access to reproductive and sexual health services by the year 2015? Unfortunately, the picture is not rosy.
Many of us can recall the UN General Assembly Resolution on Official Development Assistance adopted in 1970 which encouraged developed country governments to devote 0.7% of Gross National Product to development assistance. Unfortunately 32 years after the resolution was adopted only five countries have managed to achieve the 0.7% goal. These countries are Denmark (1.01%), Norway 0.83%), the Netherlands, Luxembourg (0.82) and Sweden (0.76). I take this opportunity to salute the members of parliament of these countries present here for the commitment to development they express through this aid. Unfortunately, I cannot say the same about the government of my own country which today provides a meagre 0.11%.
Unfortunately, within overall development cooperation funding, population assistance is the poor relation. Despite our efforts to see four percent of ODA devoted to this sector, the current share in developed countries is 2.6%. Only six countries have reached the four percent. Interestingly, the U.S. is one of these, thanks mainly to Congress and a few committed leaders there, including Carolyn Maloney and Joe Crowley who are here with us today. Thank you for your efforts.
Many donors are tempted to decrease their funding for reproductive health because they say their priority now is the alleviation of poverty, as called for by the Millennium Development Goals (MDGs). And to be sure, eliminating poverty is and must remain the principal goal of development aid. But poverty is not only the lack of money. Poverty is deprivation in other important areas of life: education, health, culture. Poverty is a hydra-headed monster and it must be attacked multiple weapons. The experience of East and Southeast Asia over the past 30 years shows just how critical good reproductive health services are to the elimination and alleviation of poverty. Tom Merrick's presentation later in this conference demonstrates just how important strong reproductive health programs are to the fight against poverty and I hope you will all listen carefully to what Tom has to say. Economic development is much more difficult to achieve in the absence of a sound and humane population policy, and individual poverty is impossible to achieve if people are unable to realize that most fundamental freedom - the freedom to have children by choice: the number they want when they want them. Let me say it clearly: The struggle to ensure universal access to reproductive health services by 2015 is an integral part of the struggle to achieve the Millennium Development Goals and to alleviate poverty.
This conference is held at a crucial moment in the life of the population and reproductive health movement. Eight years ago those who were in Cairo made tremendous efforts to reach an international consensus around the Cairo Programme of Action. Nearly 180 governments, including the United States, gave their blessing to this consensus.
As an American, it pains me greatly to say that the United States, as it did once before, has reversed course and decided to mount a systematic and sustained attack on precisely those rights and services it so strongly championed at Cairo. In January 2001 the US administration de-funded IPPF, because IPPF defends the right of women to have the choice of terminating a pregnancy. From there, they moved to de-fund UNFPA, this time with the untruth that UNFPA's funds are used to support coercive abortion and sterilisation services in China, an allegation that was discredited by a UK parliamentary delegation and a U.S. State Department delegation which visited China this year.
But, the attack does not stop there. During the World Summit for Children this past May, the US delegation strenuously objected to the use of agreed Cairo language - the terms "reproductive health services" and "reproductive rights," because they said these terms connote abortion. Furthermore, the US lobbied hard for, among other things, the inclusion of abstinence-only programs for youth, a softening of the consensus language on abortion to which everyone had agreed, even the Vatican, and deletion of all references to sex education.
Now, just this month, the US tried to further weaken the language agreed to in Cairo by announcing at the preparatory meeting for the 5th Asia-Pacific Population Conference in Bangkok its determination to withdraw its support for the Cairo Programme of Action - a decision it called "non-negotiable." At our 50th anniversary symposium in New Delhi last week, IPPF issued a declaration, signed by nearly 50 leaders in the field of sexual and reproductive health and rights. It reads in part: "We the undersigned…denounce unanimously all efforts to weaken or subvert the ICPD Programme of Action; condemn, in particular, recent and ongoing efforts to undermine or roll back the ICPD agreements and commitments; and pledge to advocate globally to safeguard and promote the ICPD Programme of Action in our common efforts to uphold reproductive health and rights everywhere."
Where will the attacks stop? I call upon parliamentarians from all countries to safeguard the hard-won gains of Cairo. The ICPD Programme of Action is not, as the United States would like us to believe, a radical agenda. It is the carefully negotiated consensus of 179 member States, all trying their best to safeguard their cultural and religious traditions and all recognizing the importance of ensuring that women and men can safely, freely and effectively determine the number and spacing of their children and protect their reproductive health.
The Cairo Consensus is a major contribution to human dignity and human development. As such, it is our collective duty to safeguard it.
Thank you very much for your kind attention.