Here is the talk by Musimbi Kanyoro, Director of the Population Program at the David and Lucile Packard Foundation, at the NGO Forum on ICPD + 15, held in Berlin September 2-4, 2009. The conference looked at what is still needed to accomplish the Programme of Action adopted at the International Conference on Population and Development, held in Cairo in 1994.
Where is the P in the ICPD?
By Musimbi Kanyoro,
The David and Lucile Packard Foundation
Berlin, September 4, 2009
Many of you will remember the late Allan Rosenfield who fought so consistently and effectively for the rights we all want to see women enjoy. One of his famous articles was called. “Where is the M in MCH?” (i.e. where is the maternal in the Maternal Child Health). During these past three days we have reaffirmed the ICPD agenda and we have a document resulting from our collective passion, but and I want ask that we do more.
Allow me to mimic Dr. Rosenfield by asking “where the P in the ICPD”?
Yes, I know that this is the elephant in the room, but I come from a country with many elephants and so I am not afraid of them. I also draw inspiration from private foundations who take on the responsibility to take risks, accommodate different opinions, support pioneers, innovators, advocates and implementers. Many of our partners in this room know the credibility of foundations for staying the course on issues that have been prominent in this forum, including access to safe and legal abortion.
Since 1964, the David and Lucile Packard Foundation supports organizations working in Population and Reproductive Health and Rights and we know that these areas are in line with the ICPD and the Cairo Plan of Action.
The relationship of population growth to development is complex, but I think it is safe to say that rapid population growth is one factor driving the increasing disparity between the rich north and least developed countries and widening the gap between the poor and rich within countries. In Sub Saharan Africa for example, the percentage of people living in poverty has fallen slightly, but as a result of population growth the absolute number of people living in poverty has risen by many tens of millions. Projections for the population of sub-Saharan Africa have been increased from those published in 1998 by 200 million.
When we leave the P out of the ICPD, we cannot achieve the goals of the ICPD or those of the Millennium Development Goals (MDGs.) The loss of attention to the P in the ICPD since the 1990s has had a particularly alarming impact in countries such as Kenya. In the 1980s considerable effort was put into voluntary family planning and the average family size in Kenya fell from 7.2 to 5.4. As budgets collapsed and attention was taken off family planning, so family size rose, especially amongst the poorest families. In 1990 the projected population of the Kenya for 2050 was 54 million. As a result of the loss of focus on family planning and the increasing number of unintended pregnancies, the population in 2050 is projected to 84 million.
Feeding, educating and employing 84 million will be a huge, perhaps insurmountable challenge for Kenya. In fact, increase in poverty, especially among the urban populations is extremely visible through the mushrooming of slums. No one can doubt the value of empowering women through education but when population grows this fast, countries are simply not able to sustain their development. And when education and health systems are overwhelmed or fail all together, I can assure you that it is girls and women who suffer first and most.
The ICPD, I believe rightly, calls “development a universal and inalienable right” (Chapter 2, Principle 3) Two years ago, the British parliament held hearings on the Impact of the Population growth factor on the MDGs. After listening to experts from around the world, they concluded “the evidence is overwhelming; MDGs are difficult or impossible to achieve with the current levels of population growth in the world’s least developed countries and regions.”
All sensible people were appalled at the coercive family planning which occurred in countries like India in the 1970s. No one wants to experience that obscenity again. But the truly successful family planning in countries such as Iran, Bangladesh, Thailand or Colombia – or I would assert from personal experience in Kenya in the 1980s – have been entirely voluntary. About one third of the decline in maternal mortality in the West is not due to better obstetrics, but to voluntary family planning.
As the ICPD PoA says so eloquently,” The success of population education and family planning programmes in a variety of settings demonstrates that informed individuals everywhere can and will act responsibly in the light of their own needs and those of their families and communities.” (7.12)
Family planning is not a diagnosis but a choice by the woman or man. The Programme of Action calls on “all countries [to] seek to identify and remove all the major remaining barriers to the utilization of family planning services.” (7.19) This goal is still a long way from being fulfilled. There is a great deal of misinformation about the risks of contraception, especially among poor and illiterate women, many of whom believe contraception is more dangerous than childbirth – actually the risks can be literally a thousand fold in the opposite direction.
Ultimately family planning is about individual needs and rights. No women can be free unless she can decide whether and when to have a child. And once family planning is available it brings credible and powerful health benefits to women and families. Family planning opens the door to all the other aspects of reproductive and sexual health.
Misinformation and unnecessary barriers are particularly harmful to the world’s 1.2 billion young people who are in the prime of discovering and understanding the scope of their own sexuality. The Packard Foundation deeply understands the importance of funding youth sexual reproductive health and rights and specifically the empowerment and education of girls. Researchers have shown that secondary school education boosts girl’s agency for making better sexual and reproductive health choices. Investing in these critical areas is the way to go for the achievement of the Cairo agenda and the MDGs.
A way forward must not only ensure universal access to contraceptives (MDG 5b) but also heavily invest in the provision and dissemination of right information and the development new contraceptive technologies for both women and men. It is also vital to position male and female condoms as both contraceptives and a protection from HIV and STIs. Funding of advocacy for change of policies and mobilizing good will and money is vital and urgent.
We all want to see babies delivered by skilled birth attendants but we also know it may take a generation to meet that goal. We can make family planning available practically anywhere. Ethiopia has shown that community health workers with minimal training can deliver injectable contraceptives safely and responsibly. The Packard Foundation has funded community health workers in Ethiopia for nearly a decade and currently funds similar efforts in Pakistan. Programs such as these should be scaled up in as many countries as possible.
We should also recognize that it is impossible to lower maternal mortality without making safe abortion available. Both medical abortion and manual vacuum aspiration are technologies that can be made available in low resource settings largely by empowering local communities to acquire skills to use them responsibly.
In trying to answer my own question, Where is the P in the ICPD, I have found myself turning again and again to the actual ICPD Programme of Action. It seems to have acquired a virtual life, where assertions are made, especially about the population component of Cairo¸ without actually reading the document.
The P is very much part of the ICPD and the future must include
1. Revitalize and reposition family planning
2. Restore and sustain family planning budgets;
3. disseminate accurate and comprehensive information on family planning;
4. set goals to meet the unmet need for family planning as rapidly as possible by implementing universal access to contraceptives (MDG 5b) and
5. empower communities to access and distribute contraceptives
6. build relationships with maternal health advocates and address MDG 5 (a) and (b) as components leading to same goals
7. build bridges between actors in other fields such as HIV/AIDS, education, human rights, development, migrations, etc
8. develop messages which communicate to policy makers and donors the relationship between population dynamics, family planning and maternal health, sexual and reproductive health and be clear about the ask
Not only is it imperative to put the P back in the ICPD, but in doing so we lay the foundation for achieving the central goal of Cairo – to put women and reproductive health at center stage. (7.2)
And so I ask of us,
Let’s put the P back in the ICPD!
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