ARE THERE TOO MANY PEOPLE ON THE PLANET?: AN OVERVIEW OF CAIRO + 5
by Susan Davis

NGOs such as IPPF, FCI, IWHC, CEDPA and many others have led the way in shifting practices and improving services. After Cairo, few deny that the cost of denying sexual and reproductive rights is unacceptably high. UNFPA estimates that it has the following effects:

• 585,000 women - one every minute - die each year from causes related to pregnancy.

• About 200,000 maternal deaths each year result from lack or failure of contraceptive services. 120-150 million women who want to limit or space their pregnancies are still without the means to do so effectively. At least 75 million pregnancies each year (out of a total of 175 million) are unwanted; they result in 45 million abortions and over 30 million live births. 70,000 women die each year as a result of unsafe abortion: an unknown number suffer from infection and other health consequences.

• One million people die each year from reproductive tract infections, including sexually transmitted diseases (STDs) other than HIV/AIDS. There are an estimated 333 million new cases of STDs per year. Six out of ten women in many countries have a sexually transmitted disease. All face a higher risk of infertility, cervical cancer, or other serious health problems. 3.1 million people in 1996 were infected by the human immunodeficiency virus (HIV) which leads to AIDS. 120 million women have suffered female genital mutilation; another 2 million are at risk each year. The international community and governments have condemned the practice, yet it remains widespread in 28 countries.

The Vatican and its supporters disagree on the above assessment. They argue that the cost to the unborn is paramount and use figures such as worldwide, abortions range from 150 million to 500 million a year, or 300 to 1,000 per minute. They juxtapose these large numbers against only 120 million births a year. They also reject the number of maternal deaths, 585,000 estimated to occur a year as a result of unsafe abortions and proper reproductive health care.

Indeed, abortion is the Achilles’ heel of the Cairo strategy. It is the basis of the current politics of paranoia that is threatening multilateralism as evidenced by the ability of this narrow minority to hold hostage US foreign policy and contributions to the UN and related agencies. The manifestations of paranoid politics are the repeated attempts to read everything as "code words" for abortion or homosexuality. Even recent negotiations in Rome on the International Criminal Court fell prey to such games around the term "forced pregnancy" which was being used to describe the repeated rapes of women with the intent to impregnate them. The anti-abortionists rejected this term on the grounds that it was a ‘code word’ and back door for abortion on demand. No one expects this faction to go away, hence the debate will continue. Fortunately, as reproductive and sexual health services improve, UNPFA is finding evidence that the number of abortions decline. Other pragmatists are betting on technological developments that make ‘the morning after’ pill widely available and render the debate moot.

Governments tried to negotiate an agreement on the most sensitive and personal issues. ICPD is about love and sex, marriage and fidelity, birth and death. It intersects with culture and tradition, religion and politics, economics and ecology. The reproduction of our species has also reproduced inequalities that became unacceptable.

Indeed, the Vatican and a few others worry about women’s right to say "yes" to sex and childbearing outside of marriage but in fact, Cairo is more about the right to say "no" to sex and childbearing at any age and under any conditions or marital status. The negotiations by governments took into account gender differentiated power. Just as rape is about power, not sex, so too is the negotiation with a partner engage in sex, to use contraception and to get married. While abstinence and fidelity may be a better means of protection than condoms against HIV/AIDS and other sexually transmitted diseases, the current realities of gender roles make such a stance naïve and impractical. In Africa, it is life threatening: ravaged by AIDS, life expectancy has dropped to 47 years from 54 years.

Cairo established that "reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents. In the exercise of this right, they should take into account the needs of their living and future children and their responsibilities towards the community. The promotion of the responsible exercise of these rights for all people should be the fundamental basis for government- and community-supported policies and programmes in the area of reproductive health, including family planning. As part of their commitment, full attention should be given to the promotion of mutually respectful and equitable gender relations and particularly to meeting the education and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality." Other ICPD Principles include the right to education and to gender equity.

A year after Cairo, governments agreed in the Beijing Platform for Action that the human rights of women "include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free from coercion, discrimination and violence."

Power struggles and control issues are fundamental to these debates. They go to the core of the role of the state, the church and the family. Expect more emotional negotiations in this area particularly in the area of adolescents and gender.

For example, there is still a strong current that pits the state against "parents’ rights." Anti-abortion activists tend to misconstrue the ICPD references to adolescents as a nefarious plot to encourage sexual freedom of 10 year olds, citing WHO’s definition of adolescents. In most countries, girls who are educated, especially who attend secondary school, are more likely to delay marriage and childbearing. Girls with less education are more likely to become mothers as adolescents. In fact, some 15 million girls, aged 15 to 19 years, give birth every year. Another 5 million have abortions. In Asia, adolescent mothers tend to be married. The same is true for Sub-Saharan African countries. In industrialized countries, girls tend to marry later but initiate sexual activity in their middle to late teens. While there is a decline in teen pregnancy, the US still has the highest rate of teenage pregnancy among Western nations: 4 out of 10 girls will become pregnant at least once before they turn 20, 80% of them while unmarried.

In most countries, girls who are educated, especially who attend secondary school, are more likely to delay marriage and childbearing. Girls with less education are more likely to become mothers as adolescents. Indeed, there is ample evidence of steady progress in educating girls and reducing the gender gap in education. However a recent PAI study found that 51 countries still have significant gender disparities in education. There were 75 million fewer girls than boys in school.

However, achieving gender equality, equity, and the empowerment of women goes far beyond eliminating gender gaps in education. There has been significant attention to awareness raising and improved strategies to eliminate violence against women which includes a range of specialized forms such a trafficking in women and girls, female genital mutilation, child abuse, child marriage, rape and battering.

Another area for highly emotional negotiations will most likely be in the assessment of male involvement and appropriate programs and services. Despite much language in the ICPD Programme of Action regarding gender equity and equality, the difference between the terms ‘women’s rights’ and ‘male involvement’ are poorly understood. Increasing calls for "male involvement" has often been interpreted as increased attention to male access to reproductive health care services on the grounds of men having "equal rights" to services. This trend is at odds with the language adopted in Cairo that clearly states as the basis for action in the area of male responsibility and participation.

This issue is particularly significant as resources for sexual and reproductive health are relatively scarce, and more funding for "male involvement" is likely to come from budgets which would otherwise have been available to improve women’s sexual and reproductive health despite higher reproductive morbidity and mortality of women.

Government officials, UNFPA and NGOs widely believe that forming and sustaining partnerships has been a crucial element in making the concepts and proposed actions of the ICPD both operational and development-oriented. Indeed, the HERA network suggests that research evidence supports this conclusion.

Partnerships seem to work well when basic principles like equality and democracy are respected. Certainly partners who share common goals, receive mutual benefits and who share certain ideological beliefs seem to sustain alliances over time. Others have successfully used coalition building and networking, core strategies of the women’s movement, during the Cairo process as well.

In November 1997, the Vatican reportedly called for more NGOs that were ‘pro-life’ and ‘pro-family’ to become accredited with the UN. A new Catholic Family and Human Rights Institute was set up across the street from the UN to mimic activities of their feminist opponents. Their weekly fax regular covers population issues and keeps close tabs on UNFPA and their ‘enemies,’ i.e. feminists who are pro-choice and homosexuals who somehow threaten the traditional family by their very existence.

During the five years since Cairo, there have been many changes in our worlds, some of which impact on all of us and some of which are very area or country-specific. Many organizations have found, for instance, that changes in government often require a change in strategies or plans and partnerships, and therefore certain flexibility in implementation. In a number of countries, there is a need to strengthen government-NGO partnerships. Some governments still attempt to control and limit the activities of NGOs under the professed goal of improving coordination within the NGO community. In addition, a number of governments still view NGOs as unwelcome competitors for donor funds.

Expect to hear a lot more debate about accountability, transparency, and capacity building. All of these words mask underlying tensions in unequal partnership arrangements.

At Cairo + 5, the global progress on slowing down the overall population growth rate may lead to the unraveling of the carefully-constructed political consensus. Since 1996, there has been a reduction of a half billion and since 1994, almost one billion as the population growth rates declined from 1.37% to 1.33% and projected to be .45% in 2050. The population estimates have declined from 7.6 billion to 11.1 billion in 2050 to 7.3 billion to 10.7 billion. Two years ago, there were 51 countries with below replacement level fertility rates; today there are 61 countries. The point is that unless we radically depart from the path we are now on, most experts conclude that we will never double our global population again.

The expert demographers are all talking about the "gray dawn" i.e. the aging of the population. These demographics have enormous implications for work and social security. It is likely to generate dramatic shifts in our political and cultural landscapes.

Fertility control and reproduction of life is moving ever more quickly along new frontiers of science that are likely to spark intense new policy debates. In an age of cloning, where the global economy will be shaped by biotechnology and biomaterials, much the same way the last part of the 20^th Century was shaped by the revolution in computer and information technologies. As evidenced by the tremendous public discussion around genetic engineering, these new debates on ethics, rights and wrongs will be particularly challenging for policy-makers concerned with population and development policies including reproductive and sexual health.

Food security will become more in political and policy circles. Will the public let ADM become the ‘supermarket to the world’ or will their be limits to the centralization of agriculture?

We have 15 years ahead of us to complete the goals and actions agreed upon at Cairo in 1994. The ICPD+5 evaluation is an opportunity to take stock of our collective progress and reassess the appropriateness of our goals. At minimum, this process can highlight ways to enhance what’s working and to promote new partnerships.

Perhaps the old debate on whether we have too many people on the planet is slowly being transformed. Viewed from above, Earth is one. Nation-state boundaries do not exist to complicate this question. With the transition to a global economy and the globalization of capital, the pressure on other factors of production increases. Are we creating a global labor market? International migration policies remain political lightening rods and too hot to touch at present. But the pressure on policy-makers to create a social floor for the global economy will increase. Thus, the key question is not are there too many people but how many enlightened people do we have on the planet? The answer at this time is, clearly, not enough.