Demographics and Socio-economic Development

Ladies and Gentlemen,

I am delighted to join you again in Berlin for the 5th International Dialogue on Population and Sustainable Development. I would like to thank the organizers for bringing us together. It is certainly a privilege to share the podium with such distinguished colleagues. (Gill Greer, the new Executive Director of the International Planned Parenthood Federation; Lena Sund of the European Commission; Jacques Baudouy, Director, Health, Nutrition & Population, World Bank; and Professor John Cleland, the renowned demographer from the London School of Hygiene and Tropical Medicine.)

I think all of us in this room understand that demographic dynamics—such as population size and growth, fertility and mortality trends, age structure, population distribution, urbanization and migration—affect in a significant way every aspect of social and economic development.

And the main point that I would like to stress today is that greater investment is needed in population and reproductive health if we are to achieve international development goals.

We will not achieve the Millennium Development Goals (MDGs) to eradicate extreme poverty and hunger, advance gender equality, improve maternal health, reduce child mortality, ensure universal education, combat HIV/AIDS and protect the environment, unless more attention and resources are devoted to population and reproductive health. This is particularly true in the poorest nations, where there are high rates of fertility and mortality, rapid population growth, and high unmet need for family planning.

The achievement of greater socio-economic development in the poorest countries depends to a large extent on success in addressing population and development issues.

Today, poor sexual and reproductive health is a leading cause of death and disability in the developing world. It limits life expectancy, hinders educational attainment, diminishes personal capability and productivity, and thus impacts directly on economic growth and poverty reduction.

Every year, more than half a million women die during childbirth, over 95 per cent in Africa and Asia. Every minute, nearly 10 people are newly infected with HIV and almost 3 million die of AIDS each year.

This is a double tragedy because we know how to prevent these needless deaths. Effective interventions exist.

Yet today, poor people have the least access to education and health care, including reproductive health information and services, as well as family planning. And this keeps them trapped in a vicious cycle of poverty that runs from one generation to the next.

It is this poverty trap that must be broken if we are to achieve the MDGs. And investments in sexual and reproductive health play a significant role.

Benefits of Investing in Reproductive Health and Rights

Good reproductive health enables couples and individuals to lead healthier, more productive lives, and in turn to make greater contributions to their household incomes and to national savings.

The health benefits of these investments are well known, well documented and substantial. It is estimated that ensuring access to voluntary family planning could reduce maternal deaths by 20 to 35 per cent, and child deaths by as much as 20 per cent.

The World Bank estimates that ensuring skilled care in delivery and, particularly, access to emergency obstetric care would reduce maternal deaths by about 74 per cent.

These are significant benefits. But as striking as these numbers are, the personal, social and economic benefits of reproductive health services may be even more important.

A study in Mexico found that for every peso the Mexican social security system spent on family planning services between 1972 and 1984, it saved nine pesos in expenses for treating complications of unsafe abortion and providing maternal and infant care. In Thailand, every dollar invested in family planning programmes saved the Government more than $16. Even more dramatic, an analysis in Egypt found that every dollar invested in family planning saved the Government $31 in spending on education, food, health, housing and water and sewage services.

Studies also show that the benefits go beyond government savings. A study for Latin American countries showed that the relatively modest investments needed to meet women’s needs for family planning in the poorest groups would result in a 1 per cent increase per year in the country’s gross domestic product (GDP).

In addition, reproductive health investments, in particular family planning, can produce what is called a “demographic bonus”.

This is spurred by lower rates of fertility and mortality, and a large healthier working population with relatively fewer dependants to support. If jobs are generated for the working population, this bonus results in higher productivity, savings and economic growth.

In East Asia, where poverty has dropped dramatically, the demographic bonus is estimated to account for about one third of the region’s unprecedented economic growth from 1965 to 1990.

Investing in sexual and reproductive health is also strategic for curbing the HIV/AIDS epidemic. With over 75 per cent of HIV cases due to sexual transmission, delivery and breastfeeding, it makes sense to link HIV/AIDS efforts with sexual and reproductive health, which would benefit women and young people who are being disproportionately affected.

We know what needs to be done. We know what works. What we need is the political will and action to make reproductive health and rights a reality.

And we need added urgency.

Today, there is a great demographic divide between rich and poor nations.

While nations such as Germany are concerned about low birth rates, population ageing and population decline, the population of poor countries continues to grow and remains relatively young. The youngest populations are found in the least developed countries, where prospects for social services and employment remain limited. And it is clear that the opportunities and choices young people have and the decisions they make will shape our common future.

Today, 95 per cent of all population growth takes place in the developing world and population in the poorest nations is expected to double by mid-century.

In countries with rapid population growth, the achievement of goals such as universal education and improved health standards are made more difficult. Every few decades, governments will have to double the number of teachers, equipment and classrooms and a similar strain is placed on health services and housing.

We also see more and more people on the move, migrants leaving their homes in search of better opportunities and lives. Last month, we issued our annual The State of World Population report, which focused on women and migration and we issued our first youth supplement, entitled Moving Young.

Both reports call for greater attention to development, gender and human rights in the policies and debates on migration—and greater investment in population and development to reduce migration pressures.

As I alluded to earlier, this country, Germany, is among 51 nations in the world, including Italy, Japan, the Baltic States and most of the successor States of the former Soviet Union, where population is expected to be lower in 2050 than it is today. Women are having fewer children, which raises concerns among politicians of how to pay for increasing pensions with income from a shrinking workforce and how to ensure economic growth.

There was an interesting article about this in the magazine, The Economist, in April. The headline read: Forget China, India and the Internet, economic growth is driven by women. It said that the increase in female employment in the rich world has been the main driving force of growth in the past couple of decades.

The article said that while some people fear that if more women work, they will have fewer children, the countries where more women do work, such as Sweden and the United States, actually have higher birth rates than Japan and Italy, where more women stay at home. The article concluded that, if female labour force participation rose to American levels in countries such as Germany, Japan and Italy, which are all troubled by the demographics of shrinking populations, it would give a helpful boost to these countries’ growth rates.

The main point is that, if higher female labour force participation is supported by the right policies, it need not reduce fertility.

Europe’s ageing population was also recently addressed in the European Commission’s new Communication on “The demographic future of Europe – from challenge to opportunity”. The Communication highlights five areas for action, including helping people to balance work, family and private life. It also underlines the importance of valuing the contributions of both older and younger employees and to harness the positive impact of migration for the job market.

And I am happy to report that progress is being made. Between 1960 and 2000, the percentage of married women in developing regions using contraception rose from less than 10 per cent to about 60 per cent and the average number of births per woman fell from 6 to about 3.

Yet, while great progress has been made in Asia and Latin America, many of today’s poorest countries, concentrated in sub-Saharan Africa, have a long way to go.

I recently participated in a meeting of Health Ministers of the African Union, in Maputo. All of us in this room should be encouraged that the participants adopted a Plan of Action to dramatically expand comprehensive sexual and reproductive health services in Africa.

The plan recommends a number of measures, including:

• Integrating HIV/AIDS and sexual and reproductive health and rights programmes and services;

• Repositioning family planning as a crucial factor in attaining the health Millennium Development Goals;

• Addressing the sexual and reproductive health needs of adolescents and young people;

• Addressing unsafe abortion;

• Delivering quality and affordable services to improve maternal, newborn and child health; and

• Strengthening reproductive health commodity security with an emphasis on family planning and emergency obstetric care.

The Maputo Action Plan is a big step forward. It has targets, indicators, timelines and estimated costs to guide nations and they move forward.

We are making progress in Africa and I am optimistic, but I am also realistic. Yes, we have a long way to go.

I am pleased to inform you that Member States have recently supported the Secretary-General’s recommendation to establish a new target on universal access to reproductive health by 2015 under MDG 5 (maternal health). We are now developing indicators for it to assist countries in their monitoring of progress made in this area.

In view of that, political will and increased funding for sexual and reproductive health, including family planning, are essential in order to achieve our common goals.

I thank you and look forward to our discussions.