Good morning.

It is a pleasure, once again, to be in London to share with you The State of World Population 2004 report of UNFPA. This year’s report is entitled, The Cairo Consensus at Ten: Population, Reproductive Health and the Global Effort to End Poverty.

Ten years ago, the leaders of about 179 countries at the International Conference on Population and Development in Cairo, the ICPD, adopted a landmark agreement to advance human well-being by linking the alleviation of poverty to the empowerment of women and universal access to reproductive health.

The Cairo Conference marked a shift in population policy away from a focus on managing human numbers and towards a concern for the rights of people and the choices they have in their lives. Investing in people is the key to sustained economic growth and sustainable development, as well as to population levels that are in balance with the environment and available resources.

In 2004, halfway through the ICPD’s 20-year Programme of Action, it is time to take stock. Many of you will recall that less than two weeks ago, a global round table took place here in London, gathering some 700 participants from all over the world to commemorate this extraordinary consensus as well as to point to ways to move it forward in the next 10 years.

This year’s State of World Population is part of this collective effort to examine the progress countries have made in implementing the Cairo agenda, the obstacles they have encountered and the needs that remain unmet.

We are moving forward and we have much to celebrate. A global survey of 169 countries by UNFPA last year shows how countries have made the ICPD Programme of Action part of their national development policies and strategies. In regional review meetings, they have reconfirmed their commitment to it despite pressure not do so. They say, ”Nobody can tell us to change it.”

The gains cited in this report are impressive:

--Since 1994, 99 per cent of the 151 developing countries surveyed have adopted measures to protect the rights of girls and women, including passing national legislation and laws on women’s rights.

--A total of 131 countries have changed national policies, laws or institutions to recognize reproductive rights. Many countries have begun to integrate reproductive health services into primary health care, improve facilities and training and expand family planning method choices.

--The use of contraception has increased from 55 per cent of couples in 1994 to 61 per cent today.

--Three quarters of countries have adopted national strategies on HIV/AIDS.

--Topics that were previously often ignored in policy discussions—such as gender-based violence, unsafe abortion and post-abortion care, harmful traditional practices, the reproductive health and rights of adolescents and support for women’s reproductive health among populations affected by armed conflict or natural disaster—are being addressed.

--We have learned that we must listen to, and partner with, the groups we want to reach: The approaches to implement the ICPD programme of Action always have to reflect national and local conditions and sensibilities, and be rooted in the communities we serve; youth leaders know best how to reach their own generation and people living with HIV and AIDS are key partners in the global effort to achieve reproductive health and rights for all.

But now that the groundwork has been laid, and laws and policies put into place, we must reinforce action to achieve greater results. As the report explains, progress has been uneven. So much more needs to be done and the challenges we face are daunting:

--Glaring gaps between rich and poor in access to health services persist throughout the world. Some 200 million poor women in developing countries continue to have an unmet need for effective contraception.

--In 2003, some 3 million people died of AIDS; and an estimated 5 million people, half of them female, were newly infected with HIV. Half of all new cases were among young people between 15 and 24. Yet, only one person in five at high risk of infection has access to proven prevention interventions. Discrimination and sexual violence increase the risk for millions of women and teenage girls.

--Population growth is exacerbating poverty and contributing to increased stress on the global environment. World population will rise from 6.4 billion today to 8.9 billion by 2050; although families are getting smaller in many regions, the 50 poorest countries will triple in size, to 1.7 billion people.

--Because it is poor women who are suffering and dying, maternal mortality is a crisis that does not get the attention it deserves. No other health indicator shows such a glaring gap between rich and poor nations. We have heard it again and again, but it needs to be repeated: Every minute, one woman dies from pregnancy-related complications - 529,000 women every year - leaving a devastating void in their families and communities. In Africa, 1 woman in 16 will die of those causes, compared to 1 in 2,800 in developed countries. We know how to reduce deaths: expand access to skilled attendance at delivery, emergency obstetric care, and referral and transport services so that women can receive medical care quickly.

Making the world safe for mothers, means making the world safe for all women and girls. It means improving the status of women and securing broader opportunities and choices, and full participation in society for the female half of the human race.

The report recounts an example of the big difference one local programme can make. To get from the village of Goudiry in Senegal to the regional hospital 70 kilometres away, women in labour had to travel along a rough dirt road, often in donkey carts. Women with pregnancy complications couldn’t get help in time, and many died. In 2001, with UNFPA support, Goudiry’s tiny clinic was expanded into a model obstetric care centre. It has already saved more than 100 women. But to save the lives of millions of women, Goudiry’s clinic needs to be replicated thousands of times in thousands of places.

This brings me to the most disappointing conclusion of our report. Lack of resources is impeding further progress, and even as the needs continue to mount, the response of the international community has been—to put it plainly—woefully inadequate.

More than 80 per cent of developing countries say that available resources do not meet their reproductive health needs, yet donor countries have given only about half the amount that they agreed would be needed to implement the Programme of Action—$3.1 billion a year rather than the $6.1 billion a year pledged by 2005.

Though more prosperous developing countries are paying their own way—devoting an estimated $11.7 billion a year to the plan—the poorest nations depend mainly on donor funding for their family planning, reproductive health, HIV/AIDS and research and policy needs.

Donors’ share of funding for contraceptives and condoms for HIV prevention has declined over the past 10 years. Yet, demand is expected to increase by 40 per cent by 2015. Without supplies, individuals cannot exercise their reproductive rights, to the detriment of their health and well-being. In sub-Saharan Africa, the average number of condoms for each man is three per year. The number speaks for itself.

Many developing countries are in crucial need of funding, exchange of information and technology to increase the human, financial and technical capacity of their national health services and scale up successful programmes. They need trained staff and the ability to ensure that people are available where the needs are greatest. All of these issues must be addressed systematically so that resources can be most effectively deployed, with good management and good results.

Unless international assistance rises to the levels agreed to at the Cairo Conference, the numbers of people who need family planning, maternal health care and HIV/AIDS prevention, testing and treatment will continue to grow. Lack of reproductive health care will continue to be the leading cause of death for women in the developing world and the AIDS pandemic will continue to expand and wreak havoc.

The United Nations recent commitment to the Millennium Development Goals—to reduce extreme poverty and hunger, maternal and child mortality and the spread of AIDS, among others—offers a new opportunity to put the full implementation of the ICPD Programme of Action on the front burner of international priorities. Indeed, the ICPD target of universal access to reproductive health care by 2015 is an essential condition for meeting the Millennium Goals. But to achieve this, as our report says, “commitments to development assistance must move from declarations of good intentions to active partnerships and investments.”

We must continue to build stronger and more strategic partnerships, and to fight for effective laws and policies, and to demand that financial commitments are honoured so that the ICPD Programme of Action can be a reality for everyone.

So, this year's report is, above all, a call to mobilize the political will and resources needed to make the Cairo vision a reality. It is a call for governments to invest in the education, health and human rights of women and young people to ensure a more equitable and sustainable world.

Thank you.