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DRAFT PROGRAMME OF ACTION OF THE INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT

Chapter I

Preamble.........................................1.1 - 1.21

PREAMBLE

1.1. The 1994 International Conference on Population and Development occurs at a defining moment in the history of international cooperation. With reductions in international and regional tensions, and with the growing recognition of global economic and environmental interdependence, the opportunity to adopt suitable socio economic policies to promote sustained economic growth and sustainable development and to mobilize human and financial resources for global problem solving has never been greater. Never before has the world community had so many resources, so much knowledge and such powerful technologies at its disposal with which it could foster socially equitable and environmentally sustainable world development.

1.2. This is also a time of great and urgent challenges. The decisions that the international community takes over the next several years, whether leading to action or inaction, will have profound implications for the quality of life for all people, including generations not yet born, and perhaps for the planet itself. Around the world many of the basic resources on which future generations will depend for their survival and well being are being depleted and environmental pollution is intensifying, driven by the unprecedented growth in human numbers, widespread and persistent poverty, social and economic inequality, and wasteful consumption. New ecological problems, such as global climate change, largely driven by unsustainable patterns of production and consumption, are adding to the threats to a future. At the same time, there is emerging global consensus on the need for increased international cooperation in regard to population, sustainable development and the environment. Much has been achieved in this

respect, but more needs to be done.

1.3. The growth of the world population is at an all time high in absolute numbers, with current increments exceeding 90 million persons annually. According to United Nations projections, annual population increments are likely to remain above 90 million until the year 2015. While it took 123 years for world population to increase from 1 billion to 2 billion, succeeding increments of 1 billion took 33 years, 14 years and 13 years. The transition from the fifth to the sixth billion, currently under way, is expected to take only 11 years and to be completed by 1998.

1.4. During the remaining six years of this critical decade, the world's nations by their actions or inactions will choose from among a range of alternative demographic futures. The most likely of those alternatives are foreseen in the low, medium and high variants of the United Nations population projections. Looking ahead 20 years, these alternate projections range from a low of 7.27 billion people in 2015 to a high of 7.92 billion. The difference of 660 million people in the short span of 20 years is nearly equivalent to the current population of the African continent. Further into the future, the projections diverge even more significantly. By the year 2050, the United Nations low projection shows a world population of 7.8 billion people, and the high projection a population of 12.5 billion people. Implementation of the goals and objectives contained in the present 20 year Programme of Action, which address many of the fundamental population, health, education and development challenges facing the entire

human community, would result in world population growth during this period and beyond at levels close to the United Nations low variant.

1.5. The International Conference on Population and Development is not an isolated event. Its Programme of Action builds on the considerable international consensus that has developed since the World Population Conference at Bucharest in 1974 2/ and the International Conference on Population at Mexico City in 1984, 3/ to consider the broad issues of population, sustained economic growth and sustainable development, and advances in the educational and economic status of women. The 1994 Conference was explicitly given a broader mandate than previous population conferences, reflecting the growing awareness of the interlinkages among population issues, sustained economic growth and sustainable development.

1.6. The International Conference on Population and Development follows and builds on other important recent international activities, including:

(a) The World Summit for Children, held in New York in 1990; 4/

(b) The United Nations Conference on Environment and Development, held at Rio de Janeiro in 1992; 5/

(c) The World Conference on Human Rights, held at Vienna in 1993; 6/

(d) The International Year of the World's Indigenous People, 1993, 7/ which would lead to the International Decade of the World's Indigenous People; 8/

(e) The International Year of the Family, 1994. 9/

1.7. The Conference will make significant contributions to three major conferences in 1995 and 1996, namely, the World Summit for Social Development, 10/ the Fourth World Conference on Women, 11/ and the Second United Nations Conference on Human Settlements (Habitat II), as well as to the celebration of the fiftieth anniversary of the United Nations. These events are expected to highlight further the call of the 1994 Conference for greater investments in people, and for a new action agenda to make women full partners with men in the social, economic and political lives of their communities.

1.8. Over the past 20 years, many parts of the world have undergone remarkable demographic, social, economic and political change. Many countries have made substantial progress in expanding access to reproductive health care and lowering birth rates, as well as in lowering death rates and raising education and income levels, including the educational and economic status of women. The dramatic success of some countries provides a basis for optimism about what all countries can accomplish over the next 20 years. The world as a whole has changed in ways that create important new opportunities for addressing population and development issues. Among the most significant are the major shifts in attitude among the world's people and their leaders in regard to reproductive health, family planning and population growth. A particularly encouraging trend has been the strengthening of political commitment to population policies and family planning programmes by many Governments.

1.9. Significant changes in attitudes, leading to much greater demands for family planning information and services, have occurred at the grass roots level among individual women and men. Over the past several decades contraceptive use in developing countries has increased fivefold, reflecting the growing strength of organized family planning programmes in a large majority of developing countries and relatively rapid reduction in family size norms. These international trends, while highly encouraging, conceal great demographic diversity among countries and regions. In Western Europe, North America and much of East Asia, access to family planning is almost universal, contraceptive use is between 65 and 80 per cent and average family size is near or below replacement level fertility of two children per couple. By contrast, in most sub Saharan African and some Pacific Island countries, a few of which have made rapid progress recently, family planning services are not yet widely available, contraceptive use is b

elow 15 per cent and women bear an average of six or more children. At the global level, an estimated 350 million couples do not have access to a full range of modern family planning information and services. At the same time, an estimated 120 million women would be practising a modern family planning method if it were available, affordable and acceptable by the husband, family and community. One indication of the large unmet demand for more and better family planning services is the estimated 50 million abortions that occur every year, many of them unsafe.

1.10. Remarkable, albeit uneven, progress has been made over the past 20 years in reducing levels of morbidity and mortality, especially high death rates among young children. Infant mortality for the world as a whole has dropped by one third, from 92 to 62 deaths per 1,000 births. But much remains to be done both in further reducing infant and child morbidity and mortality levels and in narrowing the large gap between developing and developed countries (infant mortality is currently 69 and 12 deaths per 1,000 births in developing and developed countries, respectively).

1.11. An even greater gap in death rates exists between regions of the world with respect to levels of maternal mortality. Maternal death rates are 15 to 50 times greater in the developing world than in most developed countries. Average maternal mortality in developing regions is about 420 deaths per 100,000 live births on average, compared to just 30 deaths per 100,000 live births in developed regions. At least half a million women die each year as a consequence of pregnancy and childbirth, with 99 per cent of those deaths occurring in developing countries. Almost all of those deaths are preventable. In some countries, as many as half of maternal deaths may result from unsafe abortions; many others result from the absence of the most basic antenatal, maternity and post natal care.

1.12. Over the past 20 years, average life expectancy has increased by three and a half years in the developed regions, from 71 to 74.6 years, and by eight years in the developing countries, from 54.5 to 62.4 years. These gains are a major accomplishment. But further gains may be jeopardized in many parts of the world by prolonged economic recession, poorly designed structural readjustment programmes that have reduced already low levels of public health expenditure, and recent dislocations in the health infrastructures of most countries with economies in transition. In many parts of the growing environmental health problems, the increasing prevalence of substance abuse and the acquired immunodeficiency syndrome (AIDS) pandemic are all contributing to high levels of morbidity and mortality.

1.13. Levels of education have risen considerably during the past two decades and, in many parts of the world, the gap in educational attainment between males and females has narrowed. None the less, the estimated number of illiterate persons in the world, two thirds of them women, is almost 960 million. Some 130 million children, including over 90 million girls, are denied access to primary schooling. The large remaining shortfalls in basic education and adult literacy, particularly among girls and women, continue to be major obstacles in many countries to progress in every sphere of their development, including changes in patterns of human reproduction.

1.14. Significant changes have occurred in the roles and status of women in many countries. In addition to gains in education, women have been entering the labour force in record numbers, many of them in non traditional economic roles. In many countries, women's monetary incomes are an important source of support for families. All of these trends are contributing to the rising demand for family planning services. But not all recent trends have been positive for women and their families. In some communities the failure of men to meet their family responsibilities means that women are left as the principal or only source of support for themselves and their children. Everywhere these households are the poorest of the poor, in part because women have less access than men to training, credit, property, natural resources and better paid jobs.

1.15. The two decades ahead are destined to produce a further shift of rural populations to urban areas as well as continued high levels of migration between countries. These migrations are an important part of the economic transformations occurring around the world. But they also present serious new challenges. By the year 2015, nearly 56 per cent of the global population is expected to live in urban areas, compared to under 45 per cent in 1994. The most rapid rates of urbanization will occur in the developing countries. The urban population of the developing regions was just 26 per cent in 1975, but is projected to rise to 50 per cent by 2015. This change will place enormous strain on existing social services and infrastructure, much of which will not be able to expand at the same rate as that of urbanization.

1.16. Particular challenges are presented by those countries that are undergoing changes in population composition, resulting in the ageing of the population. This includes both countries with very low fertility rates and countries with high fertility rates. Included in the latter category are those developing countries that are undergoing very rapid demographic transition and, as a result, will need to accommodate in the near future large numbers of elderly persons, often with limited national resources to draw upon. These changes have major implications for every area of social and economic activity.

1.17. The problems and challenges outlined above indicate that intensified efforts are needed in the coming 5, 10 and 20 years, in a range of population and develop.nent activities, bearing in mind the crucial contribution that early stabilization of the world population would make towards the achievement of sustainable development. The present Programme of Action addresses all those issues, and more, in a comprehensive and integrated framework designed to improve the quality of life of the current world population and its future generations. The recommendations for action made here are formulated in a spirit of consensus and international cooperation, recognizing that the formulation and implementation of population policies is the responsibility of each country and should take into account the economic, social, environmental, cultural and political diversity of conditions in each country, as well as the shared responsibilities of all the world's people for a common future.

1.18. The present Programme of Action commits the international community to quantitative goals in three areas that are mutually supporting and of critical importance to the achievement of other important population and development objectives. These areas are: education, especially for girls; infant, child and maternal mortality reduction; and the provision of universal access to family planning and reproductive health services.

1.19. Many of the quantitative and qualitative goals of the present Programme of Action clearly require additional resources, some of which could become available from a reordering of priorities at the individual, national and international levels. However, none of the actions required nor all of them combined are expensive in the context of either current global development or military expenditures. A few would require little or no additional financial resources, in that they involve changes in lifestyles, social norms or government policies that can be largely brought about and sustained through greater citizen action and enlightened political leadership. But to meet the resource needs of those actions that do require increased expenditures over the next two decades, additional commitments will be required on the part of both developing and developed countries. This will be particularly difficult in the case of some developing countries and some countries with economies in transition that are experienc

ing extreme resource constraints.

1.20. The present Programme of Action recognizes that over the next 20 years Governments cannot and should not expect to meet the goals and objectives of the International Conference on Population and Development single handedly. All groups in society have the right, and indeed the responsibility, to play an active part in efforts to reach those goals. The increased level of interest manifested by non governmental organizations, first in the context of the United Nations Conference on Environment and Development and the World Conference on Human Rights, and now in these deliberations, reflects an important and in many places rapid change in the relationship between Governments and a variety of non governmental institutions. In nearly all countries new partnerships are emerging between Government, business, non governmental organizations and community groups, which will have a direct and positive bearing on the implementation of the present Programme of Action.

1.21. The International Conference on Population and Development represents the last opportunity in the twentieth century for the international community to collectively address the critical challenges and interrelationships between population and development. The legacy of this Conference will be measured by the strength of the specific commitments made here, as part of a new global compact among all the world's countries and peoples, based on a sense of shared responsibility for each other and for our planetary home.

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