A New UN Goal

In fact, the adoption of the Programme of Action (POA) of ICPD was the culmination of years of debate that achieved a compromise and transformed the international discourse on population and development from one that was merely technical to a clearly political discourse, which has far-reaching ramifications.

Undoubtedly, SRH hits some hot-button issues. The contentious topic of abortion mobilises debate and resistance. Gender relations and adolescents’ needs for information and services add further controversy. Besides, there is the core concept of reducing the unmet need for family planning to zero.

The UN, in putting together a development framework for the 21st century to provide coherence to conference priorities, does not want debate.

Yet, the UN Millennium Project attributes to population a significant causal role in development in a number of important areas. Rapid population growth continues to be recognised as creating a demographic poverty trap in the poorest countries. And SRH and rights are recognised as central pillars of gender equality. SRH is even recognised as essential to progress against illness and mortality among mothers, infants, and populations at risk of acquiring HIV/AIDS. Population dynamics are recognised as a background driver to climate change.

In most of South Asia, reproductive health is still not a priority, and in countries like India, Nepal, Bangladesh, Pakistan and Sri Lanka, the Maternal Mortality Rate (death per 100,000 live births) continues to be high: 830 in Nepal, 600 in Bangladesh, 440 in India, 200 in Pakistan, 60 Sri Lanka. In these countries – with the exception of Sri Lanka – most deliveries take place without assistance by skilled attendants.

The forthcoming summit in New York offers a new opportunity to see how SRH and rights can be kept at the centre of the policymaking process.

Two key elements are explicitly included in the MDGs: improving maternal health, and combating the spread of HIV/AIDS. These goals and their associated targets and indicators are vitally important in themselves, but are also powerful signifiers of a wider range of issues, such as gender-based discrimination and violence.

Since 2002, 10 task forces (more than 250 experts) have been working under the aegis of the Millennium Project, suggesting several additional targets and indicators. One of the recommendations is: “Focus on women’s and girl’s health (including reproductive health) and education outcomes, access to economic and political opportunities, right to control assets and freedom from violence.” Another group recommends: “Universal access to reproductive health services by 2015 through the primary health system, ensuring the same rate of progress or faster amongst the poor and other marginalised groups.”

Almost everywhere in the developing world, actual fertility still exceeds desired fertility. There is ample research-based evidence to show that where reproductive rights are realised, fertility declines, population growth diminishes, and individual and societal prosperity are enhanced. Improved access to and use of SRH information and services have been shown to reduce poverty substantially in many countries.

In fact, SRH is both a consequence and a cause of poverty and hunger. If women and men — but especially women — are able to exercise full control over the timing and spacing of their pregnancies, they will have fewer children. Parents with fewer children have a significantly better chance of escaping poverty and investing more in their children’s nutrition, health, and education. Reproductive freedom also allows women to use their education and skills and to take on paid work.

Furthermore, some 3.5 million women and men die every year from causes related to SRH -including AIDS and complications of pregnancy, childbirth, and unsafe abortion – a massive cost individually and nationally.

Indeed, policy makers can also tackle the vexing question of access to abortion. Instead of trying to bring the subject directly into the MDG discourse, much can be gained by imitating the cleverly crafted language of the Cairo POA about the ‘sovereignty’ of countries and their right to implement policies that are ‘‘consistent with national laws and development policies’’. India’s is a case in point, where abortion is legal yet there remains an urgent need to enhance access to safe abortion services to prevent high rates of maternal mortality and morbidity.

In order to achieve success, the Millennium Project must bring the SRH community on board. After decades of hard work, those in the SRH field have built large networks of public and private service providers, particularly in resource-poor settings. The field abounds in civil society networks at the grassroots level promoting behavioural change and mobilising communities.

The SRH field offers several important lessons for the effort to implement the MDGs. One, solutions from the North should not be imposed on the South. Two, the voices of women should be heard and respected. And three, a human rights perspective should inform all policies and programmes. Not heeding these lessons will prove very costly. Developing countries cannot afford this!

The writer is Regional Director of the Population Council, South and East Asia, and an international expert on reproductive health issues