ENB:06:39
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VIII. HEALTH, MORBIDITY AND MORTALITY
This chapter contains sections on: primary health care and the health-care sector; child survival and health; women's health and safe motherhood; and human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS).
Vice-Chair Nicolaas Biegman opened discussion on the most contentious issue, abortion, as referred to in paragraph 8.25 on Tuesday, 6 September. Delegates were urged to move swiftly on this issue to show the world and the media that this Conference was not about abortion, but about population and development. Nevertheless, during the course of the week, scores of delegations took the floor to comment on this paragraph. Delegates addressed most of their comments to the alternative version of paragraph 8.25, which was originally proposed by the EU at PrepCom III. The following positions emerged during the course of the debate. Norway, the US, South Africa and others said they preferred the original 8.25, but would agree to the alternative 8.25 in order to reach consensus. The EU, Japan, Brazil, India and many others supported the alternative 8.25. The Holy See, Malta, Ecuador and Argentina accepted the alternative 8.25 as a basis for discussion, but indicated reservations on endorsing legal abortion and the terms "safe" versus "unsafe." Honduras, El Salvador, Nicaragua and others suggested removing the qualifiers before the term "abortion" and replacing "legal" with "permitted" or "allowed." Substantive amendments to the alternative 8.25 were suggested by Barbados, supported by the Caribbean States, the US, Kenya and others who said that Governments should not have recourse to punitive measure and access to reliable health care should be provided. Pakistan, supported by Iran, Egypt, Malaysia and Indonesia, stated that in no case should abortion be promoted as a method of family planning. Zimbabwe supported by Cyprus, Zambia, Bangladesh and others, wanted to retain reference to post-abortion counselling, education and family planning.
Late that evening, Biegman circulated a new "compromise" text and the issue was reopened for debate once again Tuesday night and Wednesday morning. The reference to "legal abortion" gave rise to heated exchanges. Malta expressed difficulties, since a State cannot be expected to legalize something it considers illegal. Guatemala said that to have legal abortion was tantamount to having legal robbery or rape. Ecuador could not go along with the new draft and Argentina said that it should reflect the fundamental right to life as a human right. On the other hand, Zambia said that keeping the reference to legal abortion was their "rock bottom" compromise. Cyprus, supported by Canada, said that references to pre-and post-abortion counselling must be taken into account. Norway said that the new draft reflected the consensus.
Since discussion in the Main Committee was getting nowhere, a small working group, chaired by Pakistan, was established to negotiate a compromise. The group included: Iran, Egypt, the US, Norway, Indonesia, the EU, the Russian Federation, Barbados, South Africa, Nicaragua, Trinidad and Tobago, El Salvador, Benin and Malta. The consensus text was distributed in English in the Main Committee on the evening of Thursday, 8 September, and was available in all languages the following morning. Several delegations noted translation problems and it was agreed that these would be addressed in the final version. The Holy See, Argentina, Peru, Malta and the Dominican Republic withheld their assent until the end of discussions on Chapters VII and VIII. The Central American States said that they were working on the Spanish text and would reserve their position, pending the translation. A host of countries, including Barbados (on behalf of the Caribbean States), Germany (on behalf of the EU), the Solomon Islands (on behalf of the Pacific Island States), China, India, the US and Brazil supported the text. Egypt, Bahrain, and Jordan noted that they would be interpret the text in accordance with their national and religious laws.
Paragraph 8.25 now reads: "In no case should abortion be promoted as a method of family planning. All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women's health, to deal with the health impact of unsafe abortionÃÃ*ÄÄ as a major public health concern and to reduce the recourse to abortion through expanded and improved family planning services. Prevention of unwanted pregnancies must always be given the highest priority and all attempts should be made to eliminate the need for abortion. Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling. Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process. In circumstances in which abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family planning services should be offered promptly which will also help to avoid repeat abortions." The footnote reads: "ÃÃ*ÄÄUnsafe abortion is defined as a procedure for terminating an unwanted pregnancy either by persons lacking necessary skills or in an environment lacking the minimal medical standards or both."
Delegates were only then able to address the remaining bracketed text. Quantitative goals in paragraph 8.5 (life expectancy), 8.16 (infant mortality) and 8.21 (maternal mortality and morbidity) were unbracketed. In paragraphs 8.17 and 8.19, the term "safe motherhood" had been bracketed. The Chair proposed adding a footnote containing the WHO definition for safe motherhood: "Safe motherhood aims at attaining optimal maternal and newborn health. It implies reduction of maternal mortality and morbidity and enhancement of the health of newborn infants through equitable access to primary health care, including family planning, prenatal, delivery and postnatal care for the mother and infant, and access to essential obstetric and neonatal care." Delegates agreed and thus the term "safe motherhood" was unbracketed throughout the document. In paragraph 8.35 (prevention of HIV infection), the Holy See reminded delegates that although they agreed to remove the brackets around "condoms," they will not join the consensus on this specific word in this specific paragraph.