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Summary: By Adrienne Germain (Our Planet Magazine, October 2004). Explains why empowering women is the key to solving a range of global health, development, and environmental challenges, reviews commitments made on improving women's health and advancing women's rights at the International Conference on Population and Development (ICPD, Cairo, 1994) and summarizes achievements made in the last decade.

First Empower

Adrienne Germain, President, International Women’s Health Coalition, says that securing women’s rights is the key to ensuring their health and to protecting the environment.

Are women part of the problem or part of the solution? Ten years ago at the International Conference on Population and Development in Cairo, 179 countries agreed that—when it comes to families and health, education and development, population and the environment, in every country, whether rich or poor—women's health and rights are key to the solution.

Participants recognized that the world's most pressing challenges—poverty, ill health, ignorance, environmental destruction—could be solved only by addressing the needs and rights of every girl and woman, especially the disenfranchised, at the most personal level. They confirmed each individual's right to health, education and, yes, the ability to control her sexual and reproductive decisions.

These were not utopian notions, motivated by idealism, although idealism abounded. The underlying premise was that, by investing in each woman's education and health—step by step, woman by woman—her empowerment would enable her to make choices that would profoundly benefit her family, her community and her world. Her decisions and those of millions of others like her around the globe would lead to slower population growth, increased prosperity and less pressure on the environment.

Investing in women
In Cairo, countries rejected demographic targets as a strategy to slow population growth and aid economic development. They agreed that the best way to build families, communities and nations was by investing in women, including comprehensive reproductive health care, girls' education and environmental conservation. Participants from both rich and poor countries recognized the high cost of continuing to deny women's most basic human rights: a self-perpetuating cycle of poverty and the concomitant degradation of individuals, societies and the environment around them.

By empowering girls, the rest would follow.

Demographic dividend
The achievements of the latter half of the 20th century crucially informed the underpinnings of the consensus. Many economists credit the success of nations like Japan and the Asian Tigers to their declining birth rates, which created a so-called demographic dividend, allowing parents and societies to invest more in fewer children.

In Europe, the Americas, Africa and Asia, a similar pattern holds true: if a girl receives an education, she marries later and has fewer and healthier children. If she attends school even for four years, her child is twice as likely to survive as the child of an uneducated woman. On a national level, later childbirth and a reduction in child mortality often result in a decline in fertility rates, which translates to more resources for the next generation.

The conference at Cairo was a watershed event, recognizing the centrality of women and how—if this neglected half of the world's population were healthier and better educated, and their human rights were protected - they would make pivotal contributions to solving the world's ills. So, ten years later, what of the commitments made there?

Evidence continues to mount that such investments work, as countries have begun to put the precepts agreed at Cairo into practice. Between 1998 and 2001 Brazil reduced maternal deaths from 34.4 to 28.6 per 100,000 hospital admissions, through the efforts of the government and non-profit organizations. In Bangladesh, thanks to a coordinated government and civil society initiative, the percentage of women receiving antenatal care went from 26 to 47 per cent, female life expectancy increased from 58 to 60 years, and maternal mortality fell from 410 per 100,000 live births to 320, between 1998 and 2002.

Sadly, many examples over the past decades also illustrate how high population growth rates can erode quality of life and the environment, and hinder developmental progress.

While population growth has stabilized in the industrialized world, growth rates in parts of the developing world remain high. The average number of births for an African woman, for example, is 6, compared to the current global average of 2.7. Nearly half of the countries in Africa have population growth rates of around 3 per cent, and the continent's share of the world population is expected to almost double from 13 to 24 per cent by mid-century. At the same time more than 300 million Africans subsist on less than $1 a day. Per capita food production is declining, and the public health crisis, spurred by HIV/AIDS, is mounting. The demands of the increasing number of people on land, forests and water resources contribute to deforestation, land erosion, desertification and falling water tables. By some estimates, half of sub-Saharan Africa is suffering from degradation of arable land, undermining the livelihoods of a largely agricultural people.

Step by step
Similarly India's population is expected to increase 52 per cent to 1.6 billion by mid-century, when it will overtake China as the world's most populous nation. Meanwhile, in Rajasthan, high fertility rates and a devastating drought are forcing men to migrate to find work and women to bear 80 per cent of the agricultural burden while trying to secure adequate food, water and fuel for their children amid the scarcity. Migration has introduced the spectre of HIV/AIDS.

Yet despite these challenges, the news is far from all bad. For one thing, we know what to do, step by step, one woman, one girl, at a time: adhere to the actions agreed at Cairo. A decline in fertility rates translates to more resources for the next generation. Backing for the Cairo consensus continues to be strong. At regional meetings in the last two years in Asia, Latin America and Africa, countries have overwhelmingly reaffirmed their commitment to its plan of action, despite opposition by the US Administration and a handful of ultra-conservative voices.

This May the 57th World Health Assembly in Geneva adopted the World Health Organization (WHO)'s first strategy on reproductive health, based on the Cairo agreements. It recognized that reproductive and sexual ill health accounts for 20 per cent of the global burden of ill health for women, and 14 per cent for men. The new strategy lists five priorities: improving antenatal, delivery, postpartum and newborn care; providing high-quality services for family planning; eliminating unsafe abortion; combating reproductive tract and sexually transmitted infections, including HIV; and promoting sexual health.

The WHO strategy also highlights the concern of the world community about insufficient progress made in improving reproductive and sexual health in the past decade and commits the agency to helping mobilize more concerted political will and critically needed investment. Industrialized countries, in particular, have fallen far short of their commitments to family planning and reproductive health programmes. Industrialized countries that were expected to contribute one third of the total annually, or $6.1 billion by 2005, contributed only $3.1 billion last year.

Breaking the cycle
This lack of will is particularly worrisome for the poorest nations, their citizens and the environment that they live in. The world is now home to the largest ever generation of young people—some 1.2 billion aged between 10 and 19—the vast majority of whom live in the developing world. The subcontinent and Africa, for example, are overwhelmingly young. In India 34 per cent of the population is 15 or younger. At least 45 per cent of the population in most African countries is under 15. If these young people do not receive adequate reproductive and sexual health care services and information, if girls do not have access to school or income-earning options, the cycle of high fertility and ill health, poverty and environmental pressures will continue.

Population issues encompass the world's largest problems, but their solutions involve the most personal decisions, beliefs and behaviour. Ten years ago we recognized that each woman and each girl is important in her own right and, given the opportunity, holds the key to better health and a better life for herself, her family and her world. We will overcome the challenges of poverty, ill health and environmental pressures only by committing resources—and not just making agreements—that put the needs, desires and rights of individual women and girls at the centre of global health and developmental policies.

Adrienne Germain is President of the International Women's Health Coalition.

Originally published in the Women, Health, and Environment issue of Our Planet, the United Nations Environment Programme's flagship magazine for environmentally sustainable development. Reprinted with permission. For more information, visit www.ourplanet.com.

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