by Thoraya Ahmed Obaid, Executive Director, UNFPA

It is always a pleasure to be in Africa and this occasion is no exception.

It is my honour to deliver the leading lecture on the role of development partners in the implementation of population plans and programmes.

I am happy to report that we have made much progress during the past decade. The tenth anniversary of the historic 1994 Cairo International Conference on Population and Development (ICPD) gave us an opportunity to see what we have accomplished and to better understand where we are and where we need to go.

There is now widespread agreement that the implementation of the ICPD Programme of Action paves the way for the achievement of the Millennium Development Goals.

We will not be able to reduce poverty, improve maternal health, reduce child mortality, reverse the spread of HIV/AIDS, foster women’s empowerment and gender equality and promote sustainable development, unless greater attention and resources are devoted to population and reproductive health.

Today, the greatest population challenges facing Africa as a whole are HIV/AIDS, high infant, child and maternal mortality, and improving the status of women.

Of course, no one knows this better than all of you.

In terms of population policies, one of the most significant developments of the second half of the 1990s was the continued rise in the number of African governments that report policies aimed at reducing rapid population growth.

The United Nations projects that Africa’s population will more than double by mid-century, from 906 million today to 1.9 billion by 2050, with most growth in the cities, and the fastest growth in the poorest countries. This projection assumes that fertility rates will continue to decline. If they remain constant at today’s levels, the United Nations projects Africa’s population will more than triple in the next 45 years to reach 3.1 billion by mid-century.

Population is first and foremost about people and enabling them to improve their quality of life. It is about meeting human needs and respecting human rights. And we know very well that population and development are very closely linked.

As I said in my opening statement last night, we are on a countdown to 2015. This is the target date for the achievement of both the Cairo and Millennium Development Goals, which reinforce each other.

And, as we count down, we need to plan ahead.

The 10-year review of Cairo showed us that African governments have taken a wide range of policy, legal and programme measures to bring the Cairo agreement to life. And UNFPA is proud to have been a partner in this important process. I can assure you that we will continue to stand by you in the decade ahead. There is much progress.

Mauritania enacted a law to suppress human trafficking. Rwanda adopted a new constitution upholding the equal rights of women and men. Today, Rwanda has more women in parliament than any other nation. Mauritius has reinforced laws relating to sexual offences, criminalizing and imposing hard punishments for rape and other crimes. Niger has amended its penal code to address female genital mutilation/cutting, slavery, sexual harassment and rape. Nigeria has enacted a law against human trafficking. Botswana has enacted legislation to enhance the status of women and girls, giving married women an equal say in the disposal of family assests. And Sierra Leone has approved a national youth policy. These are just a few examples of the concrete legislative and policy progress that has been made. There are many more.

The progress made in implementing the Cairo agenda and the Dakar/Ngor Declaration was made clear during a related regional ministerial review conference held in Dakar last June. And it was made clear in the global survey for ICPD at 10 that was undertaken by UNFPA, the United Nations Population Fund, to which most African governments responded.

Population and Development

Significant numbers of countries have made progress in integrating population factors into development plans, in improving the quality and reach of reproductive health programmes, in promoting gender equality and women’s rights, and in strengthening reproductive health policies and programmes to meet the rights of diverse sections of people, including women and adolescents. However, the review found that inadequate resources and persistent gaps in serving the poorest populations are impeding further progress.

There have been notable steps taken in integrating population issues—such as age structures, population distribution and movement, and fertility and mortality into development planning and policymaking, in poverty reduction strategies and in decentralized planning and programming.

Another area where concrete progress has been achieved is in collecting and analysing population data. Nearly all countries reported action to strengthen national capacity in this area - including for national data systems. However, there is a need to strengthen data collection, broken down by sex and age, and to strengthen analysis for the formulation and monitoring of development policies; and for designing programmes targeted at poverty reduction, especially for vulnerable groups.

Gender Equality and Empowerment of Women

In the area of gender equality and the empowerment of women, the UNFPA global survey shows that, while a number of countries have introduced laws and policies, less has been done to translate these into programmes, implementation or monitoring. While many countries have adopted national laws, ratified the United Nations convention to eliminate discrimination against women, and established national commissions for women, far fewer have formulated policies or programmes. And just a very few have developed advocacy programmes for gender equality.

There is an urgent need for advocacy to promote equal opportunity and to decry discrimination and violence against women and girls. In too many countries, the enforcement of laws and the implementation of policies to protect women’s rights remain inadequate. There is clearly a need to do more in this critical area. We will not make greater progress in population and development until women are fully empowered to participate fully and contribute fully to the solutions that are needed.

Reproductive Rights and Reproductive Health

In the area of reproductive health and rights, the UNFPA survey shows that significant progress has been made since 1994. 

• Most countries have taken measures to integrate reproductive health into primary health care services and to increase access to these services.
• The vast majority of countries reported one or more steps to improve the supply and distribution of contraceptives and condoms.
• There have been efforts to start reaching young people and to address sexually transmitted infections and HIV/AIDS.
• Safe motherhood has moved up the policy agenda, with most countries having taken measures to reduce maternal morbidity and mortality.
• There is greater use of evidence to formulate policies and programmes.
• There are increasing attempts to address gender-based violence, and
• Progress has been made in bringing various stakeholders together, such as women’s and youth groups, to help shape reproductive health programmes.

Women and Their Unmet Needs

Despite the progress that has been made, we still have data that make us worry greatly about reaching our targets by 2015. Today, millions of African women want to use contraceptives, but do not have access to such services.

Today, there is no health indicator that shows such a large gap between rich and poor nations as maternal mortality. Poor maternal health remains a leading cause of death and disability for women in Africa. This is despite the fact that we have had success in Egypt, Tunisia and Mozambique. We know what works and what needs to be done, but we need to do it on a large scale. We need to scale up and accelerate action in the countdown to 2015. We need to keep our eyes on the prize: universal access to reproductive health services.

The reality is that, despite international agreements, reproductive health continues to elude millions of people. There are many reasons for this. One is the dismal state of the health system in many African countries.

For hundreds of millions of people, a huge proportion of whom live in sub-Saharan Africa, the health system that could and should make effective interventions available, accessible and used is in crisis, ranging from serious dysfunction to total collapse. Neglect, abuse and marginalization by the health system are part of the very experience of what it means to be poor in many poor countries today.

This situation is compounded by civil unrest and conflict. There is one necessary precondition for development and that is peace. UNFPA is committed to promoting reproductive health, women’s empowerment and their full participation in humanitarian response and post-conflict recovery. Women have a key role to play in peacebuilding and conflict resolution and we must support them in these vital life-affirming efforts. The high rates of sexual violence, used as a tool of war, are alarming, and a cause of tremendous suffering and poor health. UNFPA is working with governments and other partners to improve access by conflict-affected communities to reproductive health care.

Another cause of poor reproductive health is widespread discrimination against women and girls. Access to services depends in part on the ways in which families value and prioritize the health of women and girls, and the willingness of husbands and partners to take responsibility for women’s health and the enjoyment of their human rights.

Reproductive health continues to be out of reach for many of the world’s people because of discriminatory social practices, negative attitudes towards women and girls, and the limited power many women have in the social and economic spheres of their lives, including their sexual and reproductive lives. Today, many women rely on their husbands, mothers-in-law and other relatives to make decisions for them. While some headway has been made on this front, a great deal more needs to be done.

While contraceptive use in developing countries increased 10 per cent in the past 10 years, as many as 46 per cent of women in sub-Saharan Africa have an unmet need for birth spacing and family planning services.

HIV/AIDS

But by far, the greatest challenge facing Africa is HIV/AIDS. Many countries report that HIV/AIDS has become a major impediment to the effective implementation of national development policies and has reversed decades of socio-economic development. Population projections today are lower than even a decade ago because of the impact of HIV/AIDS, particularly in the 38 African countries most affected by the pandemic.

Of particular concern are the dramatic increases in HIV infection among young women, who now make up over three-fourths of the 15-to-24-year-olds in Africa living with HIV/AIDS.

While most African countries have adopted a national AIDS strategy, the UNFPA survey reveals the need to further strengthen the integration of reproductive health and HIV/AIDS services, and to more fully address the specific needs of women and girls. More fully linking sexual and reproductive health and HIV/AIDS policies and programmes will save lives and money and scale up and speed-up an effective response.

As the HIV pandemic is being feminized, it is also hitting hard at young people—a trend that indicates that not enough is being done to ensure that they have the information and services they need. It is painfully clear that the culture of silence surrounding sexuality continues to put young people at enormous risk despite the clear recognition of the need for action.

Young People and Sexual and Reproductive Health

This is a serious issue because, today, half of all people on our planet are under the age of 25. The largest youth generation in history is entering their reproductive years. And the choices and opportunities they have, and the decisions they make, will shape our world for decades to come.

Since 1994, there has been significant progress in understanding the importance of addressing the rights and sexual and reproductive health of adolescents. However, while progress has been made in providing youth-friendly information and services, this progress has been uneven among countries, and in many cases, is reaching only a fraction of the youth.

The Millennium Development Goals

There is also a new focus since Cairo—the Millennium Development Goals (MDGs). These goals to eradicate poverty, hunger and disease and put the world on a more sustainable path were agreed by world leaders at the United Nations five years ago, at the turn of the century. Though the MDGs do not explicitly refer to reproductive health by name, they do list improving maternal health as one of the eight goals. Reducing child mortality, promoting gender equality and empowering women, and combating HIV/AIDS are other MDGs directly related to sexual and reproductive health. And there is wide agreement that the goal of eradicating extreme poverty and hunger is unlikely to be achieved if the issue of reproductive health is neglected.

If we are to achieve the ICPD and MDG goals set for 2015, we need to run, and run fast.

What we have to understand regarding the challenge awaiting us as we walk out of this meeting is that, in order to reach international targets, responses must be scaled up dramatically and urgently.

The Way Forward

Among the key challenges are: 

• Strengthening health systems and increasing the ranks of trained health care providers,
• Improving the quality of care,
• Ensuring a steady supply of contraceptives and condoms and other reproductive health commodities,
• More fully linking reproductive health and HIV/AIDS in areas where they naturally fit with one another, such as services for women and young people,
• More fully involving young people and those living with HIV and AIDS,
• Reaching the poor and marginalized segments of the population, and
• Scaling up interventions to ensure universal access to reproductive health as promised in Cairo at the 1994 International Conference on Population and Development.

Overall, there is a need to translate the existing frameworks, laws, policies and strategies into concrete action. There is a need to build capacity for the enforcement of legislation and the implemention of programmes that will make a real difference in people’s everyday lives.

While the financial difficulties facing the region are to be appreciated, the mobilization of domestic resources would clearly demonstrate the commitment and political resolve to effectively address social issues for the well-being of the African people.

African countries themselves carry primary responsibility for achieving their national development goals. But they cannot do it unless overseas development assistance is increased to 0.7 per cent as agreed in Monterrey—and better quality of aid, fair terms of trade, and deeper debt relief are achieved.

UNFPA will continue to advocate that all countries do their fair share. UNFPA will continue to champion United Nations reforms to improve the quality and effectiveness of development cooperation. We will continue to champion debt relief and fair trade so that resources can be freed for health and education. We are here to lend a helping hand and to support national efforts.

Distinguished Speakers of African Parliaments,

The time has come to rally a response in Africa that is commensurate with the need. The upcoming Group of Eight (G-8) and September MDG summits hold great promise. We must go forward with creativity and passion.

And we must continue to focus on population and reproductive health in the countdown to 2015. The Cairo agenda, with its focus on human rights and gender equality, leads us down the path to achieving the Millennium Development Goals. This is not a bureaucratic business plan, this is a call to action for the benefit of the African people and our planet. By investing in reproductive health and rights and women’s empowerment, we can reduce poverty and maternal and child mortality. We can reverse the spread of HIV/AIDS and we can move closer to equality, justice and sustainable development.

Let us ensure that promises made are promises kept.

Let us strive to devote 10 per cent of national development budgets to population and reproductive health, as parliamentarians have agreed at the international conferences on ICPD in Ottawa, Canada, and Strasbourg, France.

We must use every single opportunity to fight for freedom and justice and to build human capacity. We cannot stand by as millions of Africans die of AIDS. We cannot stand by as families and communities are literally killed by poverty and disease. We cannot turn a blind eye to the young people who seek opportunity and find little or none. As leaders, we bear responsibility.

We must use our power for the benefit of the African people—for the women who are taking care of the children orphaned by AIDS, for the child soldiers who have been scarred by battles and bullets, for the girls who want to go to school and complete their education, for the young people who want to contribute to their countries’ progress, for the women and couples who want to plan their families, for the women and girls who want to live free of violence and discrimination, for the pregnant women who want a safe delivery and healthy baby, for the mothers and fathers who want nothing more than peace and a bright future for their children.

We must act with a unity of purpose guided by a purpose higher than ourselves. As leaders in parliament, you are close to the people. As leaders in parliament, you can and will lead the way. And I can assure you that UNFPA will stand by you every step of the way.

Thank you.