|Beijing Plus Five and Women's Health: Building on ICPD Plus Five|
Beijing Plus Five and Women's Health: Building on ICPD Plus Five
Summary: Review of the Cairo Plus Five agreements and challenges to be addressed in the Beijing Plus Five review, 2 pages.
As we gather in New York in March and June 2000 for "Beijing+5"—the United Nations five-year review of the implementation of the Platform for Action agreed at the Fourth World Conference on Women held in 1995 in Beijing—we should keep foremost in our minds the successful outcome of last year's "ICPD+5" review. The ICPD+5 review assessed the implementation of the Programme of Action of the 1994 Cairo International Conference on Population and Development (ICPD). While the negotiations at ICPD+5 were protracted and often difficult, their result was agreement on a set of forward-looking and concrete targets and benchmarks to accelerate implementation of the ICPD Programme of Action, and to measure progress. Our challenge at Beijing+5 will be to uphold and advance the ICPD+5 commitments, and to agree on similarly concrete targets for all aspects of women's health—as well as for the 11 other areas of concern of the Beijing Platform.
At the September 1994 Cairo Conference, 179 countries and entities had set the goal for "all countries [to] strive to make accessible through the primary health-care system, reproductive health to all individuals of appropriate ages as soon as possible and no later than the year 2015."
The United Nations ICPD+5 review held in New York in June-July 1999 revealed heartening examples of progress at the national level. At the global level, "reproductive health" and "reproductive rights" are now part of the language of diplomacy. Even governments that opposed the ICPD Programme of Action in 1994, turned, at ICPD+5, into staunch defenders of every word contained in it, quoting it chapter and verse throughout the negotiations. Governments clearly recognized that respect for human rights is a prerequisite for health, and conversely, that the right to control every aspect of one's health and sexuality is essential for the enjoyment of other rights.
The ICPD+5 review, however, brought alarming facts back to the world's attention. Worldwide, about 600,000 women still die every year, and some 18 million are left disabled or chronically ill, due to preventable complications of pregnancy and childbirth. The World Health Organization (WHO) estimates that 330 million new sexually transmitted infections occur annually, at least half of these among young people. HIV/AIDS alone accounts for 6 million new infections every year, increasingly affecting women, babies and young people. Sexual violence is endemic and lethal, both within and outside marriage. At least 150 million women who want to limit their childbearing do not yet use contraception. Universal reproductive and sexual health is, it seems, still far from being a reality.
In the ICPD+5 review, more than 180 governments, with strong input from non-governmental organizations (NGOs), agreed on key priority actions for the 15 years remaining in the 20-year agenda set in Cairo. Over the opposition of a handful of delegations, governments set new benchmark indicators and reached major agreements on sexual and reproductive health.
The ICPD+5 document sets the overarching principle that progress towards universal sexual and reproductive health should be measured not by a single indicator—contraceptive use—as in the past, but by monitoring provision of, access to, and use of three fundamental services, namely: the widest achievable range of safe and effective family planning and contraception; essential obstetric care by skilled attendants; and prevention and management of reproductive tract infections, including sexually transmitted diseases (STDs) and HIV/AIDS, especially for young people—including access to male and female condoms and microbicides, if available. Governments agreed that, by 2005, 60 per cent of all primary health care and family planning facilities should be able to offer these services, directly or through referral; aiming for 80 per cent of such facilities by 2010 and 100 per cent by 2015. For each of these services, governments agreed to the following specific goals.
First, governments agreed to mobilize resources to provide the widest possible range of contraceptive methods, including new options and underutilized methods. Governments agreed to close the "gap between contraceptive use and the proportion of individuals expressing a desire to space or limit their families" by at least 50 per cent by 2005, 75 per cent by 2010 and 100 per cent by 2050.
Second, governments reached a set of agreements to address the unacceptably high levels of maternal mortality and morbidity. They specified actions to reduce the 78,000 maternal deaths and millions of injuries and illnesses caused by unsafe abortion every year. The ICPD+5 document states that: "in circumstances where abortion is not against the law, health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible." This was perhaps the most dramatic, and certainly one of the most intensely debated, agreements.
Governments also agreed that in countries where maternal mortality is very high, skilled attendants should assist at least 40 per cent of all births by 2005; at least 50 per cent by 2010; and at least 60 per cent by 2015. Globally, skilled attendants should assist 80 per cent of all births by 2005; 85 per cent by 2010; and 90 per cent by 2015. The Beijing+5 process should make commitments to take concrete, measurable steps towards implementation of the Beijing Platform for Action.
Third, recognizing that the HIV/AIDS pandemic is far more serious than had been understood in Cairo, the ICPD+5 document reiterates the importance of providing access to male condoms, calls for wide provision of female condoms, and urges governments to enact legislation and adopt measures to prevent discrimination against people living with HIV/AIDS and those vulnerable to HIV infection. The document calls on governments, where feasible, to make anti-retroviral drugs available to women during and after pregnancy, and to provide counselling so that mothers living with HIV/AIDS can make free and informed decisions about breastfeeding.
Governments agreed that youth (aged 15-24) are at high risk of HIV infection and specified that, by 2005, at least 90 per cent, and by 2010, at least 95 per cent, of young people should have access to necessary information, education and services to reduce their risk. This includes "access to preventive methods such as female and male condoms, voluntary testing, counselling and follow-up." HIV infection rates in young people were agreed upon as a central benchmark indicator, "with the goal of ensuring that by 2005 prevalence in this age group is reduced globally, and by 25 per cent in the most affected countries, and that by 2010 prevalence in this age group is reduced globally by 25 percent."
In the context of HIV/AIDS, it is worth mentioning that adolescents' right to sexual and reproductive health information and services was hotly debated - as it had been in Cairo. Governments once again resisted calls to subordinate the rights of adolescents to the rights of parents. Rather, the document protects the balance between the two sets of rights achieved in Cairo. Governments also agreed to provide sexuality education at all levels of schooling, and expressly recognized the importance of also addressing adolescents' needs for education, income-generating opportunities and vocational training.
ICPD+5 reached extraordinary agreements that many thought could not be achieved. As in Cairo, non-governmental organizations (NGOs), and in particular women's health advocates, mobilized worldwide to make sure that the ICPD+5 document not only reaffirmed the ICPD Programme of Action, but also specified concrete next steps. A "Women's Coalition for ICPD," 101 NGOs from every region, the majority from developing countries, lobbied for women's and young people's health and rights. In the end, NGO and government proponents of the Programme of Action together won out over ideological opposition and political interests.
In the wake of this success, action is needed on two fronts. At Beijing+5, the important new agreements made at ICPD+5 with respect to sexual and reproductive health must be protected and advanced. In addition, similarly specific commitments to take concrete, measurable steps towards implementation of the Beijing Platform must be made with regard to other aspects of women's health and lives.
To meet these basic health goals, policy makers, health professionals, researchers and advocates, working together with the leadership and staff of the United Nations Population Fund (UNFPA), now need to generate broad political will to move more quickly on ICPD and ICPD+5 implementation. We must all join forces to ensure that budget allocations give priority to developing the effective and accessible health systems required to meet the ICPD and ICPD+5 agreements. We must also respect and promote the human rights of women, and work to eliminate violence, discrimination and other fundamental factors that continue to jeopardize women’s health. We have the plan—let's act on it now.