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lead.jpg (22302 bytes)    Volume 4 
   Number 1
   1 February 1999 


by Susan Davis

These days, the only people who still talk about "population controllers" are the anti-abortion fundamentalist minority. It seems that most everyone else who cares about the future of our planet and survival of our species has abandoned the language and trappings of "population control" in favor of women’s empowerment, choice and female education. How did this sea change happen? What does it mean? Will it last?

The debates in Cairo at the International Conference on Population and Development in 1994 focused more on feminism than on population control. Indeed, there is not even one reference to ‘population control’ in the 100+ page document. While the largely feminist tone may be "language co-optation," there is a neo-Malthusian current that occasionally surfaces. A key question is to what extent does the "common ground" alliance between feminists and ‘population controllers’ remain intact?

Neo-Malthusians seeking to reduce population growth have demonstrated their willingness to call for the education of girls and women. They have backed up that call with resources and increased support. Given the dramatic changes in the global economy, the crucial question now is how this new awareness will influence the debate on new financial architecture. For example, will they call for "land reform, the redistribution of economic and political power, and the repudiation of international debt" as radical feminists challenged them to do a decade ago?

Advocates for women’s rights reluctantly accepted the expressions of concern in the Cairo document about population growth. Feminist wariness originates from viewing the history of population control as one based on "eugenic, racist, sexist and exploitative actions against certain races and classes of people." It also arises from antipathy towards instrumentalist approaches. Feminists advocate education for girls as a matter of social justice, not simply as an efficient means to fertility control. As advocates of gender equality adopt the language of the market and argue that "investing in women" is economically efficient, there is inevitably some tension among human rights advocates. The difficulty surfaces because of trade-offs and resource allocations among competing priorities.

Five years after that landmark event in Cairo, the international conference on population and development, the global community of the world’s governments, legislators, funders, service providers and advocates are gathering again to take stock, assess and re-calibrate the long-term plan adopted amidst the pyramids. The review process will be predictably political and cumbersome; its dividends will provoke further questions. Nevertheless, organizers of the Cairo + 5 process ostensibly learned many lessons from the disappointing Rio + 5 process in 1997. And, undeniably, Cairo + 5 directions affect us all. The following is a quick overview of what to expect from this process and how NGOs participating in it have framed the agenda for advocacy and negotiations.

Cairo + 5 Issue Clusters

Resources and advocacy
: The availability of resources and strong advocacy, not only to mobilize these resources but also to bring about change, are critical components for the implementation of the ICPD Programme of Action. This issue area will focus for example on the mobilization of funding—what NGOs have learned about resource effectiveness; how NGOs can be involved in lobbying for more resources for the Cairo agenda in the next five years; what advocacy strategies have been most effective in reaching policy makers; and how to increase contributions by countries commensurate with the relative size of their economies.

ICPD ethos in practice—implementing policies and services: Discussions around the ICPD ethos in practice will consider issues such as the paradigm shift from family planning to sexual and reproductive health and access to quality sexual and reproductive health information and services for all sectors of society, particularly young people and other vulnerable and disadvantaged groups.

Rights—rhetoric to reality: As the Cairo Conference stressed the importance of reproductive rights, which were reinforced and strengthened at the Beijing Fourth World Conference on Women, this issue area will take up such issues as what sexual and reproductive rights mean in different societies; to what extent they are recognized and operationalized with respect to both policies and services; and how governments, service providers and others are accountable in this area.

Partnerships: To achieve the goals of the ICPD Programme of Action partnerships will need to be developed and/or strengthened between NGOs and other key actors such as governments, intergovernmental agencies, the private sector and other parts of civil society. These might include partnerships between government and NGOs in providing appropriate and accessible services for young people or between NGOs and religious and community leaders in order to work to reduce the prevalence of harmful practices such as female genital mutilation (FGM).

Links between reproductive health, population, environment and development: Since Cairo, the main emphasis on the implementation of its outcomes has been on reproductive health. This area will include issues such as the extent to which reproductive health has addressed the concerns surrounding environment and sustainable development and how stronger linkages can be developed, both in policies and in programmes.

Gender and Youth are cross-cutting issues: Is implementation gender-based or youth-based; what indicators are being used; and to what extent are women and young people involved in the decision-making process from planning to monitoring and evaluation.

The Cairo + 5 Process

Similar to other UN processes, the five-year review of ICPD is comprised of a series of expert group meetings, technical consultations, regional meetings, preparatory committee meetings and culminating in a special session of the General Assembly June 30-July 2, 1999 in New York. In 1998, UNFPA organized three technical consultations, three expert group meetings and participated in one special consultation. In addition, every UN regional organization carried out its review session. With support from the Dutch government, UNFPA is organizing a special global meeting in The Hague February 8-12. In advance of this government gathering, NGOs, youth and parliamentarians are holding their own forums. The March meeting of the Commission for Population and Development will become the prepcom for the Cairo + 5 special session.

Overall, the UNFPA staff have been open and inclusive during the planning and preparations for Cairo + 5. A broad-based constituency has been actively involved throughout and information has been widely accessible through the Internet. Civil society organizations have worked well together to pool their resources, maintain their common ground alliance and maximize results.

Assessment of Progress and Areas for Further Negotiation

Money Matters
: The ICPD Programme of Action made headlines because it included a US$17 billion annual price tag by the year 2000 to make quality reproductive health services available to all in need of them. The international community’s deal was that two-thirds would be financed by developing countries and donor countries would pick up the remaining one-third.

Not surprisingly, both donor and developing countries remain far from achieving the year 2000 ICPD funding goals according to reports by UNFPA and major NGOs such as Population Action International. Total spending on reproductive health in developing countries was about $10 billion in 1996. Overall, eight donor nations paid for 90% of all external contributions (Denmark, Germany, Japan, Netherlands, Norway, Sweden, the United Kingdom and the United States), but donors contributed only one-fifth of the costs of the global effort in 1996, rather than the one-third agreed on in Cairo. According to PAI, this represented at most 35 percent of the year 2000 contribution required from donor nations. In contrast, developing countries provided roughly 70 percent of their US$11.3 billion target for the year 2000. However, a few large Asian countries (Bangladesh, China, India and Indonesia) account for the bulk of domestic reproductive health spending.

PAI also notes that "Financial contributions from many governments remain negligible, including donor countries such as France and Italy and many developing countries in Africa and Latin America. Private household expenditures on reproductive health also vary greatly from country to country; overall, they represent an underutilized source of additional financing for reproductive health care."

The bottom line is that money is a metaphor for power in the market economy and money matters. Indeed, some cynical observers suggest that the entire Cairo + 5 process is a fundraising exercise by UNFPA and its NGO partners. Others point to the significant changes in the global economy and the radically altered development context. As the world begins discussing a new financial architecture for our global home, advocates at Cairo + 5 may wisely ask, who’s building the floor? And will there be a ceiling? It is likely that the Financing for Development negotiations will become increasingly important in resolving these questions. There will be considerable attention on resources, but don’t expect much of a breakthrough during Cairo + 5.

Shifts in practice:

Governments agreed, albeit with some reservations, that "Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health. States should take all appropriate measures to ensure, on a basis of equality of men and women, universal access to health-care services, including those related to reproductive health care, which includes family planning and sexual health. Reproductive health-care programs should provide the widest range of services without any form of coercion. All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so."

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.

Righting wrongs

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.

Links among reproduction, population, environment and development

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 20th 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.

Susan Davis is currently a consulting member of the transition team for the new Director General of the ILO. In March she assumes responsibilities as Associate Chair of Get America Working! and is a founding prinicipal of Social Entrepreneur Associates. Previously she was the Executive Director of the Women’s Environment and Development Organization (WEDO) for five years. She had prior experience with the Ford Foundation in Bangladesh, Women’s World Banking and the Port Authority of NY and NJ and was educated at Harvard, Oxford and Georgetown universities.