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B. Explanatory
memorandum by Mrs McCafferty, rapporteur
(open)
4.7. Cancer of the reproductive
system
Figure
3: Unmet need
Report | Doc. 11992 | 05 August 2009
Fifteen years since the International Conference on Population and Development Programme of Action
(Former) Social, Health and Family Affairs Committee
Summary
2009 is the fifteenth anniversary of the International Conference on Population and Development Programme of Action; women, children and their families cannot wait any longer for the promises made fifteen years ago by leaders of 179 nations.
The rapporteur thinks that funding for this programme must increase, sexual and reproductive rights must be upheld, and policies should respond to needs and not be coercive. Health systems must be strengthened, in order to improve lives and achieve the promises of the Millennium Development Goals, in particular, Goal5 to improve maternal health.
A range of family planning, including emergency contraceptives, safe abortion, skilled birth attendants and obstetric emergency care, must be accessible, affordable, appropriate and acceptable to all, irrespective of age, community or country.
A. Draft recommendation
(open)1. At the 1994 International Conference on Population
and Development (ICPD) in Cairo, 179 countries agreed that population
and development are inextricably linked and that empowering women
and meeting individuals' and couples’ needs on education and health,
including reproductive health, were necessary for both individual
advancement and international development. The conference adopted
a Twenty-year Programme of Action, which focused on individuals'
needs and rights rather than on achieving demographic targets.
2. Advancing gender equality, eliminating violence against women
and ensuring women's ability to control their own fertility were
acknowledged as cornerstones of population and development policies.
The ICPD goals centred on providing universal education; reducing
infant, child and maternal mortality; through universal access by
2015 to reproductive health care, which includes family planning,
assisted childbirth and prevention of sexually transmitted infections
(STIs) including HIV/AIDS.
3. The Parliamentary Assembly notes that while some progress
has been made, achievements on education enrolment, gender equity
and equality, infant child and maternal mortality and morbidity
and the provision of universal access to sexual and reproductive
health services, including family planning and safe abortion services,
remain mixed. 113 countries have not reached the goals on gender
equity and equality in primary and secondary education. An estimated
137 million women in 2007 had an unmet need for family planning
and more than 500 000 women die every year from pregnancy-related
causes, 99% of them in developing countries.
4. Furthermore, violence against women, particularly domestic
violence and rape, is widespread, and rising numbers of women are
at risk from AIDS and other STIs as a result of high-risk sexual
behaviour on the part of their partners. In a number of countries,
harmful practices meant to control women's sexuality lead to great suffering.
Among them is the practice of female genital mutilation, which is
a violation of basic rights and a major lifelong risk to women's
health.
5. The Assembly draws attention to the fact that Europe is the
world’s largest donor of official development assistance (ODA).
European states’ ODA accounts for almost 70% of the total global
population assistance. It is of concern that global ODA declined
in 2007 for the second consecutive year.
6. The Assembly further notes with concern that even within Council
of Europe member states, a large proportion of individuals and couples,
particularly in central and eastern European countries do not have access
to comprehensive sexual and reproductive health information, education
and services. Member states need to prepare and/or review and update
national as well as international population and development policies and
strategies to ensure universal access to comprehensive sexual and
reproductive health services with particular attention to ensuring
access to affordable, acceptable and appropriate family planning
methods, skilled birth attendants and obstetric emergency care to
prevent unwanted pregnancies, abortions, STIs and maternal ill health
and death.
7. The Assembly urges Council of Europe member states to compare
progress made on sexual and reproductive health and rights policies
and funding in the run-up to the fifteen anniversary of the ICPD Programme
of Action and agree on priority actions to ensure its full implementation
by 2015.
8. The Assembly calls on the Committee of Ministers to:
8.1. review, update and compare Council
of Europe members states’ national and international population
and sexual and reproductive health and rights policies and strategies;
8.2. review and compare funding to ensure the full implementation
of the ICPD Programme of Action by 2015;
9. In particular, the Assembly asks the Committee of Ministers
to address specifically the challenges of:
9.1. maternal mortality and morbidity, with a particular emphasis
on reducing unsafe abortions, by:
9.1.1. ensuring
universal access to comprehensive sexual and reproductive health
and rights information, education and services, with an emphasis
on the provision of a variety of modern methods of family planning
services and counselling, skilled birth attendants at birth and
access to obstetric emergency care;
9.1.2. ensuring that the specific needs of vulnerable populations,
including migrants, minorities and rural populations are met, with
attention to the provision of free sexual and reproductive health
and rights services;
9.2. age-appropriate, gender-sensitive sexuality and relationship
information and education in schools, by:
9.2.1. ensuring that all school children receive such an information
and education to prevent sexual coercion, STIs, unplanned pregnancies
and subsequent abortions;
9.3. demographics, including migration, by:
9.3.1. improving access to reproductive
health supplies, with a particular emphasis on the provision of
a variety of family planning methods to suit different populations;
9.3.2. improving maternity pay and leave, access to childcare,
flexible working hours for parents returning to work as relevant
to countries' development;
9.3.3. improving access to infertility treatment as relevant
to countries’ population and development;
9.4. HIV/AIDS and STI pandemic, by:
9.4.1. developing and improving policies on STIs including HIV/AIDS.
Policies need to include comprehensive prevention strategies with
universal sexuality and relationship information and education,
national information campaigns, access to affordable reproductive
health supplies and non-judgmental voluntary counselling and testing
and treatment and care for infected individuals;
9.4.2. improving screening for reproductive tract cancers to
minimise suffering, with particular reference to preventing cervical
cancers, through appropriate access to Human Papilloma Virus (HPV)
vaccines;
9.5. gender equality and relations, by:
9.5.1. ensuring that policies are in place for women and men
to access information, education and services needed to achieve
good sexual health and equality and exercise their reproductive rights
and responsibilities;
9.5.2. ensuring active and open discussions on the need to protect
women, young people and children from any abuse, including sexual
abuse, exploitation, trafficking and violence including female genital
mutilation, supported by educational programmes at both national
and community levels. Victims must report violations and governments
should establish the necessary conditions and procedures to encourage
victims to report violations of their rights. Laws addressing those concerns
should be enacted where they do not exist, made explicit, strengthened
and enforced, and appropriate rehabilitation services provided;
9.6. funding the ICPD Programme of Action, by:
- In European donor countries:
9.6.1. ensuring that donor governments
fulfil their commitment to allocate 0.7% of Gross National Income
for ODA, despite the global economic crisis;
9.6.2. ensuring that donor governments allocate 10% of ODA to
population/sexual and reproductive health and rights reflecting
the Parliamentary Statements of Commitments in Ottawa in 2002, Strasbourg
in 2004 and Bangkok in 2006;
9.6.3. ensuring that ODA is long-term and predictable to better
support health planning and health systems strengthening with attention
to country plans;
- In recipient countries:
9.6.1. ensuring that recipient countries’
health budget reaches the agreed commitment, such as 15% of annual
national budget as agreed by African leaders at the Abuja Summit
in 2001;
9.6.2. ensuring that two thirds of recipient countries’ population/sexual
and reproductive budget comes from the national budget and one third
from the international donor community in aggregate, adapted to
national needs and capacities;
9.6.3. putting in place a system of “checks and balances” as
ODA recipient governments are increasingly empowered by new ODA
decision-making modalities. Civil society and parliaments must take
their rightful place in decision-making;
9.6.4. encouraging countries to include in country health plans
the new Goal 5 of the Millenium Development Goals: “Achieving universal
access to reproductive health by 2015”;
9.6.5. encouraging country ownership with the involvement of
government officials, parliamentarians, civil society, the private
sector and donors.
10. Based on the progress in the above fields, the Parliamentary
Assembly encourages the Committee of Ministers to:
10.1. start developing a European
convention on sexual and reproductive health;
10.2. review progress on the full implementation of the ICPD
Programme of Action and agree on priority action to achieve universal
access to sexual and reproductive health and rights by 2015.
B. Explanatory
memorandum by Mrs McCafferty, rapporteur 
(open)1. Introduction
1. The International Conference on Population and Development
(ICPD) Programme of Action was signed in Cairo in 1994 by leaders
from 179 nations. Consensus was reached to improve the quality of
life and well-being of human beings and to promote human development
by recognising the interrelationships between population and development
policies aiming to achieve poverty eradication, sustainable economic
growth, education, especially for girls, gender equity and equality,
infant, child and maternal mortality reduction, the provision of
universal access to reproductive health services, including family
planning and sexual health, sustainable patterns of consumption
and production, food security, human resources development and the guarantee
of all human rights, including the right to development as a universal
and inalienable right and an integral part of fundamental human
rights.
2. In the ICPD Programme of Action, countries agreed on a range
of demographic and social objectives as well as qualitative and
quantitative goals to be achieved over a twenty-year period. It
reflects the contribution that early stabilisation of the world
population would make towards the achievement of sustainable development.
2. Council of Europe Parliamentary Assembly involvement in the International Conference on Population and Development (ICPD)
3. The Council of Europe Parliamentary Assembly has
continuously been involved in monitoring the implementation of the
ICPD Programme of Action.
4. The rapporteur refers to Assembly's Recommendations 1683 (2004) on sexual and reproductive health and rights in Europe, 1784 (2007) on HIV/AIDS in Europe, 1515 (2001) on demographic change and sustainable development, 1564 (2002) on the state of the world population, Resolution 1399 (2004) on population trends in Europe and their sensitivity
to policy measures (Doc.
10923) and the report on demographic challenges for social
cohesion (3 May 2006).
5. In October 2004, the Assembly hosted the Second International
Parliamentarians’ Conference on the Implementation of the ICPD Programme
of Action (IPCI/ICPD), which was held in Strasbourg.
6. At this conference 130 parliamentarians and ministers from
over 90 countries endorsed a commitment, including calls to:
- strive to devote at least 10% of national development budgets and development assistance to population and reproductive health programmes;
- mobilise an additional USD 150 million a year for reproductive health commodities;
- strengthen safe motherhood services and mount public campaigns supporting women;
- promote adolescent reproductive health and enforce laws on age of marriage;
- work to eliminate discrimination against girls;
- remedy the lack of qualified medical personnel in many countries.
3. Background to the International Conference on Population and Development (ICPD)
7. At the 1994 International Conference on Population
and Development in Cairo, 179 governments adopted a twenty-year
action plan. At the 2005 World Summit, leaders agreed to integrate
the goal of access to reproductive health into national strategies
to attain the Millennium Development Goals (MDGs) to end poverty,
reduce maternal death, promote gender equality and combat HIV/AIDS.
In October 2006, the United Nations General Assembly endorsed the
addition of universal access to reproductive health as a monitoring target
for measuring progress towards MDG 5: 5B - improve maternal health.
8. The ICPD Programme of Action called for universal access to
reproductive health services and a sharp reduction in maternal deaths
by 2015. It stated that if needs for family planning and reproductive
health care are met, along with other basic health and education
services, then population stabilisation will occur naturally, not
as a matter of coercion or control. It emphasized the centrality
of reproductive health - which it defined as "complete physical,
mental and social well-being" in all areas related to reproductive
systems.
9. The programme made commitments to meet those needs, so that
individuals would have genuine choices about the timing and number
of their children. The plan also acknowledged the central role of
women and young people in the development process.
10. The rapporteur underlines, that the ICPD Programme of Action
is firmly grounded in the affirmation of the human rights of all
people and the need to empower women, whose rights have so often
been denied, and to involve men.
11. The rapporteur notes with concern that the progress in meeting
the Cairo goals has been mixed and in many parts of the world stalled
or reversed.
- Globally, each year, 210 million women suffer from life-threatening complications of pregnancy, over half a million of women die from pregnancy-related causes, three million infants die in the first week of life, at least 120 million couples have unmet need for contraception, 80 million women have unwanted or unintended pregnancies and 340 million new cases of curable sexually transmitted infections (excluding HIV and other incurable viral infections) occur.
- In the Council of Europe member states, the rapporteur welcomes the overall low levels of maternal mortality, but notes with concern the often high rates of unwanted pregnancies and subsequent abortions, as well as high teenage pregnancy rates in some countries.
- The rapporteur notes the low fertility rates in many member states, which individual countries may wish to address via improved policies on maternity leave, childcare and flexible working hours.
- The rapporteur remains concerned about the lack of comprehensive sexuality and relationship education in schools for young people and the unmet need for family planning. The Assembly further notes with great concern the increase in STIs including HIV/Aids
4. ICPD agenda and progress in the Council of Europe member states
12. The ICPD Programme of Action states: “The implementation
of the recommendations contained in the Programme of Action is the
sovereign right of each country consistent with national laws and
development priorities, with full respect for the various religious
and ethical values and cultural backgrounds of its people, and in
conformity with universally recognized international human rights.”
13. The rapporteur notes that the countries within Europe are
making ongoing improvements in some aspects of reproductive health.
Europe has one of the lowest maternal mortality rates in the world.
Countries in the region have the highest use of modern contraceptives,
with western and northern Europe having almost universal access
and use of modern contraceptives. In the former Soviet Union countries,
the efforts of international donors and governmental agencies have
resulted in improved access to family planning information and commodities. The
Assembly notes with concern, however, that despite efforts, many individuals
and couples in the European region, particularly in the countries
of central and eastern Europe, do not have access to quality contraceptive
services and supplies and many women still resort to abortion to control
fertility.
In the former Soviet Union countries,
the efforts of international donors and governmental agencies have
resulted in improved access to family planning information and commodities. The
Assembly notes with concern, however, that despite efforts, many individuals
and couples in the European region, particularly in the countries
of central and eastern Europe, do not have access to quality contraceptive
services and supplies and many women still resort to abortion to control
fertility. 14. Member states need to improve education and information on
reproductive health, as well as access to all family planning methods
to reduce the number of unwanted pregnancies, abortions and STIs
including HIV infections. A comprehensive approach to full continuum
of reproductive, maternal and newborn care would also ensure coverage
of deliveries by skilled birth attendants with access to emergency
obstetric care to address complications and appropriate post-partum
services.
15. Many countries in Europe have developed and approved national
sexual and reproductive health strategies, policies and/or programmatic
documents, but many have not and some need updating. Many member
states who are now overseas development donors need to develop international
sexual and reproductive health and rights strategies and policies.
Challenges
16. While some progress has been made, in certain areas
of sexual and reproductive health and rights progress is mixed and
unacceptable. There is a clear need for political leadership to
take urgent and concerted action or many millions of people will
not realise their basic sexual and reproductive health and rights
both within Europe and internationally.
17. Progress has been made in enrolling more children into school,
in the developing world. Enrolment in primary education increased
from 80% in 1991 to 88% in 2005.
18. Child mortality has declined globally, however over half a
million women still die each year from treatable and preventable
complications of pregnancy and childbirth. The chances that a woman
will die from these causes in sub-Saharan Africa are one in sixteen,
over the course of her lifetime, compared to one in 3 800 in the
developed world.
19. The number of people dying from AIDS worldwide increased to
2.9 million in 2006, and prevention measures, are failing to keep
pace with the growth of the epidemic. In 2005, more than 15 million
children had lost one or both parents to Aids.
20. The provision of universal access to reproductive health,
the new MDG target 5B, must be incorporated into national development
plans, backed by adequate predictable financing.
4.1. Maternal mortality and morbidity and unsafe abortion
21. The rapporteur notes with concern that 99% of all
maternal deaths occur in developing countries, where 85% of the
population lives. More than half of these deaths occur in sub-Saharan
Africa and one third in South Asia. The maternal mortality ratio
in developing countries is 450 per 100 000 live births versus 9
per 100 000 live births in developed countries. Maternal mortality
ratios are greater than 1000 per 100 000 live births in fourteen
countries, those countries being Afghanistan, Angola, Burundi, Cameroon,
Chad, the Democratic Republic of the Congo, Guinea-Bissau, Liberia,
Malawi, Niger, Nigeria, Rwanda, Sierra Leone and Somalia .
.22. Attendance at delivery by a skilled birth attendant who is
trained to monitor and detect problems early and treat or refer
to emergency obstetric care is essential to reduce maternal mortality
and morbidity. The regions with the lowest numbers of skilled birth
attendants at birth are South Asia and sub-Saharan Africa, which
correlates to the high number of maternal deaths. The leading causes
of maternal death in developing countries are haemorrhage, prolonged
obstructed labour, infections, pre-eclampsia and unsafe abortions. Malnutrition
and anaemia are major indirect contributors to maternal deaths.
Gender equality and women empowerment is paramount to improving
maternal health.
23. Maternal mortality in eastern Europe is estimated to be twice
as high as that in western Europe and complications from abortions,
especially those performed in unsafe conditions, are among the leading
causes of maternal death. The reasons behind these high numbers
are a lack of access to information, education and services and
restrictive abortion laws. In the Republic of Moldova in 2003, 50%
of maternal deaths were caused by unsafe abortions and between1990-2002,
30% of all maternal deaths were related to unsafe abortions. In Ukraine
in 1998, 35% of maternal deaths were due to unsafe abortions, in
2002 this reduced to 23% and in 2003 there were no registered maternal
deaths due to unsafe abortions. In the whole European region, the estimated
number of unsafe abortions varies from 500 000 to 800 000 annually. The
rapporteur stresses that according to the ICPD Programme of Action
(paragraph 8.25) “in circumstances where abortion is not against the
law, such abortion should be safe”, whereas legality remains to
be determined by the member states.
The
rapporteur stresses that according to the ICPD Programme of Action
(paragraph 8.25) “in circumstances where abortion is not against the
law, such abortion should be safe”, whereas legality remains to
be determined by the member states. 4.2. Reproductive Health Supplies and Access to modern Contraceptives
24. Global contraceptive prevalence increased slowly
from 55% in 1990 to 64% in 2005, but remains low in sub-Saharan
Africa, at 21%. Preventing unplanned pregnancies could avert one
quarter of maternal deaths. An estimated 137 million women have
an unmet need for family planning. An additional 64 million women
are using traditional methods of contraception with high failure
rates.
25. The rapporteur notes with concern that in many countries including
in the eastern and central European region, high costs and poor
quality services, restrict access to care. Free or subsidised services
including contraceptives and improved quality of care would improve
contraceptive uptake and subsequent health outcomes. Unmet need
for family planning in Armenia is 15%, in Ukraine
18% and in Georgia 24%.
in Ukraine
18% and in Georgia 24%. 26. Four contraception methods (female sterilisation, oral contraceptive,
injectables and intrauterine device) account for 75% of total contraceptive
use among married women globally. The
rapporteur notes that as reproductive health needs of women vary
greatly, the provision of a range of different methods of family planning
can improve contraceptive uptake, satisfaction and continuation.
The
rapporteur notes that as reproductive health needs of women vary
greatly, the provision of a range of different methods of family planning
can improve contraceptive uptake, satisfaction and continuation.4.3. Effects of urbanisation
27. The rapporteur stresses the effect of the recent
economic transition and the trend to urbanisation in some Council
of Europe member states, which results in a rapid decrease of urbanised
young families and a considerable increase of single parent families.
The members states have to ensure that they meet the need for quality
sexual and reproductive health services, which is rapidly increasing
alongside the increased need for family services in the modern metropolitan
areas.
4.4. The need for sexuality and relationship education
28. The rapporteur notes the fact that a large cohort
of young people has now entered their reproductive years and specific
measures must be taken to ensure confidential, youth-friendly sexual
and reproductive health and rights services.
29. Young people are often concerned about confidentiality and
lack the knowledge and skills to negotiate safe sex and are vulnerable
to engage in risky sexual behaviour.
30. There is strong international evidence that school-based sexuality
and relationship education is effective in reducing high-risk sexual
behaviour and has a positive effect on knowledge and awareness of
risk, values and attitudes. The
rapporteur is concerned that in many Council of Europe member states,
the issue of including sexuality and relationship education into
the school curriculum has not been recognised as a nationally important
issue or priority, when it should be seen as an important component
in broader initiatives to improve the health and well-being of young
people.
The
rapporteur is concerned that in many Council of Europe member states,
the issue of including sexuality and relationship education into
the school curriculum has not been recognised as a nationally important
issue or priority, when it should be seen as an important component
in broader initiatives to improve the health and well-being of young
people.4.5. Demographics, including migration
31. The pace of growth of the world’s population has
increased markedly through the last century. While the pace is slowing
this century, we can anticipate a further 50% increase in the world’s
population by 2050.
32. Population momentum, unwanted pregnancies and high fertility
desires are the drivers of population growth, and they vary dramatically
in different world regions.
33. Many experts agree that world population growth poses a serious
threat to human health, socio-economic development, and the environment.
34. Everything else being equal, high levels of fertility and
population growth make it far more difficult for families and societies
to overcome poverty than would otherwise be the case.
35. Satisfying the unmet need for contraceptive services alone
in developing countries would avert 52 million unintended pregnancies
annually, which, in turn, would avert the loss of more than 1.5
million children’s lives and prevent over 500 000 children from
losing their mothers.
36. By keeping young adults healthy and productive, by allowing
parents to have smaller families and thus devote greater time and
financial resources to each child, and by reducing public expenditures
on education, health care and other social services, sexual and
reproductive health services contribute to economic growth and equity.
37. Progress through the demographic transition also helps reduce
the risk of civil conflict and thus contributes to a more peaceful
and secure world.
38. A lack of access to sexual and reproductive health information
and services and subsequent population growth, particularly in the
poorest countries, continue to pose significant challenges to development
and the attainment of the Millenium Development Goals (MDG).
39. The rapporteur notes the very low birth rates throughout Europe.
A majority of countries have total fertility rates (TFR) below 1.5
children per women with a number of these countries the rate being
below 1.3. Recent research suggests
that the era of the very lowest fertility seems to have ended, but
continued monitoring is needed to determine its validity and future
progress.
Recent research suggests
that the era of the very lowest fertility seems to have ended, but
continued monitoring is needed to determine its validity and future
progress. 40. The rapporteur urges the Council of Europe member states to
formulate national policies which include family benefits, such
as maternity pay, parental leave and high-quality universal childcare.
41. 10-12% of Europeans experience infertility in part due to
undiagnosed STIs and in part due to an increase in women postponing
motherhood to later years. Fertility decline with age and the risk
of miscarriage also increases with age. The rapporteur welcomes
infertility treatment offered in many European countries. In the
Nordic countries, 6-7% of
children are born as a result of infertility treatment. Member states
are urged to invest in infertility research and equal access to
the treatment.
of
children are born as a result of infertility treatment. Member states
are urged to invest in infertility research and equal access to
the treatment. 42. International and national migration is increasing, which
is a challenge to health care planners.
43. The rapporteur expresses her concern that to date, national
and local health authorities of the Council of Europe member states
have given little attention to the health of migrants. Reproductive
health challenges include a lack of awareness of family planning
and reproductive health services available in host countries, together
with cultural barriers to family planning. Immigrant women are often
seen late in pregnancy and at late onset of disease. In the Netherlands,
high abortion rates are found among people of non-Dutch origin.
In Germany, young people from migrant families have little sex
and relationship education at home.
In the Netherlands,
high abortion rates are found among people of non-Dutch origin.
In Germany, young people from migrant families have little sex
and relationship education at home. 4.6. HIV/AIDS and STI
44. Globally, 4.3 million people were newly infected
with HIV in 2006, with Eastern Asia and the Commonwealth of Independent
States showing the fastest rates of infection. In South and South-East
Asia, people are most often infected through unprotected sex with
sex workers. The use of non-sterile injecting drug equipment remains
the main mode of HIV transmission in CIS countries (former Soviet
Republic). As of December 2006, an estimated 2 million people were
receiving antiretroviral therapy in developing countries. This represents
28% of the estimated 7.1 million people in need. Though sub-Saharan
Africa is home to the vast majority of people worldwide living with
HIV (63%), only about one in four of the estimated 4.8 million people
there who could benefit from antiretroviral therapy are receiving
it.
45. The rapporteur is concerned about the sharp increase in STIs
including HIV in some member states. Of particular concern are STIs
in some countries of eastern Europe and the Commonwealth of Independent States.
Most (90%) of the newly reported HIV diagnoses occurred in two countries,
the Russian Federation and Ukraine. While the incidence of reported
syphilis is below two per 100 000 and gonorrhoea is below twenty
per 100 000 in Western Europe, epidemic levels have been reached
in Eastern Europe.
4.7. Cancer of the reproductive
system
46. Reproductive health cancers are of concern and often
a neglected area in health care planning. Preventing reproductive
health cancers via universal screening programmes must be a priority.
47. The rapporteur is particularly concerned about the rise of
reproductive cancers in many European countries.
- The incidence of breast cancer is rising among women in many European countries, affecting up to one in sixteen women.
- Approximately 50 000 women in Europe are diagnosed with cervical cancer and almost 25 000 die each year.
48. Evidence shows that well-organised screening and cytology
can reduce mortality and morbidity when treatment services are available.
The new Human Papilloma Virus vaccine is also of great importance
to reducing cervical cancers.
Europe’s international responsibility – policy and funding to ensure the full implementation of the ICPD Programme of Action
4.8. Gender equality and equity and education
49. Net enrolment ratio in primary education in the developing
countries increased to 88% in the school year 2004/2005, up from
80% in 1990/1991. Although sub-Saharan Africa has made significant
progress over the last few years, it still trails behind other regions,
with 30% of its children of primary school age out of school. Girls
are still excluded from education more often than boys, a pattern
that is particularly evident in West and South Asia.
4.9. Funding the ICPD Programme of Action
50. In 1994, at the ICPD, 179 nations committed themselves
to the goal of universal access to reproductive health by the year
2015 at an estimated cost of US$ 20.5 billion. At the 2005 World
Summit, world leaders committed themselves to MDG target 5B of achieving
“Universal access to reproductive health by 2015”. Funding to achieving
above goal was revised in 2009 at the UN Commission on Population
and Development. Investment of US$ 64.7 billion is needed in 2010
for sexual and reproductive health and rights and population programmes
to reduce poverty, promote development and curtail maternal death.
In 2013 US$ 68.6 billion is needed and in 2015 US$ 69.8 billion
is needed. One third of these sums are expected as international assistance,
while the remaining two thirds would be domestic investments by
developing nations. The US$ 64.7 billion figure for 2010 is broken
into work categories adopted in Cairo. The total 2010 costs for
sexual and reproductive health and rights, which include family
planning and maternal health, are estimated at US$ 27.4 billion ;
US$ 32.5 billion for HIV/AIDS ; and US$ 4.8 for basic research,
data collection and policy analysis.
51. The rapporteur underlines, that Europe is the world’s largest
donor of ODA. The aid programmes of the European States account
for almost 70% of ODA.
52. The rapporteur welcomes the fact that European support to
sexual and reproductive health and rights-related organisations
in 2006 increased to US$ 1.75 billion, i.e. a 27% increase over
2005. The sexual and reproductive health and rights-related organisations
which benefited the most were UNFPA, UNAIDS, GFATM, UNIFEM and IPM
also benefited from the increase in multi-lateral spending. Funding
to the world’s largest sexual and reproductive health and rights
NGO, IPPF, remains steady.
53. The United Kingdom, the Netherlands, European Commission,
Sweden, Norway and France remained the largest bilateral donors
to population assistance, allocating over US$ 150 million in 2005.
54. In spite of these efforts, the rapporteur notes its concern
that :
:
- according to the 2008 OECD report, ODA declined for the second consecutive year down to 15% for Development Assistance Committee (DAC) Members and 9% for the EU DAC Members in 2007 compared to 2006.
- while population assistance of OECD member states dramatically increased from 1995-2005, most of this went to HIV/AIDS (72% of 2005 total). Funds for family planning represent the second smallest percentage of the total (7% of 2004 total) and have decreased in recent years. Funds for basic reproductive health has remained relatively stable (17% of 2004 total), while funding for population research has decreased to its lowest level (4% of 2004 total);
- many European donors are disbursing their funds via “budget support”. Whilst this is welcome if country plans include sexual and reproductive health and rights, it is of concern if they are excluded. Budget support ensures that the funds are aligned with the developing countries’ plans and priorities, but the European Court of Auditors (ECA)
- climate change, the energy crisis, the food crisis and the financial/economic crisis are placing developing countries at serious risk, as their economies’ growth depends upon increased export revenues, foreign direct investments and remittances from abroad.
- international and national data collection on sexual and reproductive health and rights input, outcome and impact indicators is important for monitoring and evaluating programme work.
55. Finally, the rapporteur recommends that the Parliamentary
Assembly, through its Social, Health and Family Affairs Committee,
contribute to the International Parliamentary Conference on the
Implementation of the ICPD Programme of Action to be held in October
2009 and help establish all-party parliamentary groups on population
and development in national parliaments.
***
Reporting committee: Social, Health and Family Affairs Committee
Reference to committee: Doc. 11750, Reference No. 3509 of 26 January 2009
Draft recommendation adopted by the committee on 11 June 2009
Members of the committee: Ms Christine McCafferty (Chairperson), Mr Denis Jacquat (1st Vice-Chairperson), Ms Darinka Stantcheva (2nd Vice-Chairperson), Ms Liliane Maury Pasquier (3rd Vice-Chairperson), Mr Frank Aaen, Ms María del Rosario Fátima Aburto Baselga, Mr Francis Agius, Mr Konstantinos Aivaliotis, Mr Farkhad Akhmedov, Mr Vicenç Alay Ferrer, Mr Milos Aligrudić, Ms Magdalina Anikashvili, Ms Sirpa Asko-Seljavaara, Mr Jorodd Asphjell, Mr Lokman Ayva, Mr Mario Barbi, Mr Andris Berzinš, Mr Roland Blum, Ms Olena Bondarenko, Ms Monika Brüning (alternate: Mr Hubert Deittert), Ms Boženna Bukiewicz, Ms Karmela Caparin, Mr Igor Chernyshenko, Mr Agustín Conde Bajén, Mr Imre Czinege, Mr Karl Donabauer, Ms Emilia Fernández Soriano, Ms Daniela Filipiová, Mr Ilja Filipović, Mr André Flahaut, Mr Paul Flynn (alternate: Baroness Anita Gale), Mrs Doris Frommelt, Mr Marco Gatti, Mr Ljubo Germič, Ms Sophia Giannaka, Mr Marcel Glesener, Mr Luc Goutry, Mrs Claude Greff, Mr Michael Hancock, Mrs Olha Herasym’yuk, Mr Ali Huseynov, Mr Fazail Ibrahimli, Mrs Evguenia Jivkova, Mrs Marietta Karamanli, Mr Włodzimierz Karpiński, Mr András Kelemen, Mr Peter Kelly, Baroness Knight of Collingtree (alternate: Mr Tim Boswell), Mr Haluk Koç, Mr Oleg Lebedev, Mr Paul Lempens, Mr Andrija Mandić, Mr Bernard Marquet, Mr Félix Müri, Ms Christine Muttonen, Ms Carina Ohlsson, Mr Peter Omtzigt, Ms Lajla Pernaska, Mr Zoran Petreski, Ms Marietta de Pourbaix-Lundin, Mr Cezar Florin Preda (alternate: Mr Josif Veniamin Blaga), Ms Vjerica Radeta, Mr Walter Riester, Mr Nicolae Robu, Mr Ricardo Rodrigues, Ms Maria de Belém Roseira, Ms Marlene Rupprecht, Mr Indrek Saar, Mr Maurizio Saia, Mr Fidias Sarikas, Mr Ellert Schram, Ms Anna Sobecka, Ms Michaela Šojdrová, Ms Arũné Stirblyté, Mr Oreste Tofani, Mr Mihai Tudose, Mr Oleg Tulea, Mr Alexander Ulrich, Mr Mustafa Ünal, Mr Milan Urbáni, Mr Luca Volontè, Mr Victor Yanukovych (Mr Ivan Popescu), Mr Valdimir Zkidkikh, Ms Naira Zohrabyan
N.B.: The names of the members who took part in the meeting are printed in bold
Secretariat of the committee: Mr Mezei, Ms Lambrecht, Ms Arzilli
Appendix – Figures
(open)Figure 1: Worldwide Maternal Mortality Ratio 2006
Source: The World Bank, World Development Indicators, 2008
Figure 2: Average number of children for richest and poorest quintiles
Source: African Population and Health Research Centre, written evidence to APPG on PD&RH, 2007
Figure
3: Unmet need for
Family Planning
Married Women of childbearing age (%)
Source: Demographic Health Survey, Measure DHS STATcompiler, 2008
Figure 4: Provisional net ODA/GNI ratios for DAC donors 2007
Source: UK Department for International Development’s (DfID) Annual Statistics on International Development, 2008
Figures 5 and 6: Country spending on sexual and reproductive health and rights/population activities
Source: UNFPA, “Financial Resource Flows for Population Activities in 2005