United Nations Population Fund
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KAMPALA, Uganda, 25 June (UNFPA) -- Experts on reproductive rights and health from around the world agreed today on actions needed to speed progress towards the goals set by the International Conference on Population and Development (ICPD) held in Cairo in 1994.
The Expert Round-table Meeting on Ensuring Reproductive Rights and Implementing Sexual and Reproductive Health Programmes, Including Women's Empowerment, Male Involvement and Human Rights concluded after adopting a set of recommendations on carrying out the ICPD Programme of Action.
Launched on 22 June, by the Executive Director of the United Nations Population Fund (UNFPA), Dr. Nafis Sadik, the four-day conference brought together about 50 experts and observers to assess achievements and constraints and propose key future actions. The UNFPA-organized event at Kampala's International Conference Centre is part of ICPD+5, a year-long evaluation of progress in the five years since Cairo.
Participants included government and non-governmental health professionals and women's rights advocates from some 30 countries, and representatives of the United Nations Population Division, UNICEF, WHO and the World Bank. It featured presentations on a wide range of topics,among them: developing a sexual and reproductive health policy; implementing and monitoring feasible standards of care; broadening the constellation of services within existing health systems; reducing maternal mortality; female genital mutilation; violence against women: the role of the health and education sectors; key issues in improving access to sexual and reproductive health services; reproductive health as a human right; and legislating reproductive rights.
The recommendations adopted were proposed by four working groups formed around the round table's four agenda themes: policies for sexual and reproductive health; designing quality sexual and reproductive health services; accessibility; and creating the necessary conditions for implementing sexual and reproductive health and rights.
The experts agreed that implementation efforts should be based on human rights principles and objectives that underpin the ICPD Programme of Action, including gender equality and women's empowerment; universal access to the means to ensure reproductive and sexual health and to exercise reproductive choice; and that there should be no discrimination or coercion in reproductive and sexual health programmes.
Proposing key future actions on policies for sexual and reproductive health, for instance, the experts recommended that governments give priority to ensuring such health for all at the highest achievable standard of care. They specifically suggested executive-level decisions to reorientate health systems to ensure that policies, strategic plans and all aspects of implementation are rights-based, cover the life cycle and serve everyone. This requires changing the attitudes of policy makers, health care providers and consumers to make health systems open to inputs from civil society.
Governments, they proposed, should enact laws to meet Cairo commitments and finance groups that are translating the Programme of Action into legal terms and advocating its implementation. They should provide more money to carry out the Programme. Civil society organizations should also provide more resources to build alliances, to undertake advocacy and raise awareness as well as to create a favourable environment for implementing the Programme of Action.
To create conditions necessary for realizing sexual and reproductive rights, the experts recommended, among other things, increasing the involvement of non-governmental organizations (NGOs) in States parties' implementation of human rights treaties. Human rights commissions should be set up, they added, in all countries to address the rights discussed at the round table.
At the same time, they recommended policies to advance the rights of women and girls, and that restrictive, discriminatory and punitive laws be repealed.
Participants agreed there has been progress towards the comprehensive approach to sexual and reproductive health services called for by the ICPD Programme of Action. Family planning programmes in several countries have been broadened to offer a wider choice of contraceptive methods, and some now include post-abortion care and treatment of abortion complications. Some services for men have been set up. There is growing political support for integrated reproductive health services, and community involvement has increased.
Health providers are often overworked, underpaid, however; many need better counselling skills and training, they noted. Some programmes are mismanaged or inadequately monitored. Minimum care standards are not well-defined. A lack of funds has slowed improvements in care and the expansion of services to those not previously cared for, including adolescents. Restrictive or ambiguous laws impede provision of some services.
Non-governmental organizations (NGOs) need to be supported to play a greater role in service delivery. Innovative programmes need to be funded and scaled up. Decentralization of national health systems must not lead to neglect of reproductive health priorities. And they agreed that international donors should fund the shift from family planning programmes to broader reproductive health care.
Among actions proposed to promote gender equality, the round table recommended that practical steps be taken to end legal, economic and social discrimination against women; and to make men recognize women's critical need for access to reproductive health care.
The round table identified various constraints impeding ICPD implementation. These included: the increase in poverty and inequality worldwide; underfunded social sectors; the privatization of health services; persistence of gender inequality; fundamentalist ideological opposition to aspects of the Programme of Action; and government restrictions on civil society bodies' participation in policy development and implementation.
Important successes achieved in the areas of sexual and reproductive health and rights were also highlighted by the experts. For example:
South Africa's new population and health policies; bans on female genital mutilation (FGM) in Egypt, Burkina Faso and Senegal, and
Uganda's culturally sensitive approach to eradicating it; and the enactment in many countries of laws against domestic violence.
In remarks to close the round table, the Director of Uganda's Population Secretariat, Jotham Musinguzi, said his country has tried innovatively to implement the Programme of Action, with the help of UNFPA, and will continue to strive to "promote reproductive rights, provide reproductive health programmes, empower women, involve men and protect human rights".
"Even though Uganda has done its best, its best may not be good enough," he continued. "Therefore, we will follow the outcome of the round table closely in order to find lessons to learn and apply in this country."
James Kuriah, the UNFPA Representative in Uganda, expressed hope that the meeting will promote networking and further exchange of experiences in ICPD implementation.
The Director of the Technical and Policy Division, Mohammed Nizamuddin, congratulated the experts for producing recommendations that will have far-reaching effects.
"This meeting has not witnessed the kind of polarization that has become the feature of many similar events across the world," he said. He said he had hoped for more concrete recommendations on how to attract greater resources to implement the Programme of Action.
The round table is the second in a series of international events that are part of the ICPD+5 process which consists of activities connected with a five-year review of progress made in implementing the ICPD Programme of Action and to make recommendations for the future.
As part of the ICPD+5 process, UNFPA is sponsoring a series of events including technical meetings and round-table discussions on selected subjects as well as an International Forum on ICPD implementation to be held in February 1999 in the Netherlands. The first round table, on adolescent reproductive and sexual health needs and in reducing levels of teenage pregnancy, was held on 14-17 April in New York.
The ICPD+5 process will conclude with a special session of the United Nations General Assembly on 30 June-2 July, 1999, to appraise the implementation of the Programme of Action.
The report of the round table on reproductive rights and sexual and reproductive health programmes will be consolidated, along with those from other round tables and technical meetings, into a report for review by the International Forum and as background document for the United Nations Secretary-General's report to the Assembly's special session.