|Strengthening the Fabric of Society: Population. Capacity Building for Sustainable Development (UNDP - UNFPA, 1996, 53 p.)|
According to the United Nations' latest revision of the World Population Prospects, fertility rates are declining more rapidly than anticipated in most world regions. As a result, the global population is now growing, on average, by 1.5 per cent a year, down from the 2 per cent growth rates of the 1960s and early 1970s. In a number of developing countries, however, growth rates persist at 2.5 or above. And because of the huge population base, we are adding one billion people to the human ark every 12 years until 2011 - the fastest increase in human numbers ever recorded. According to the UN's revised medium range population projections, the earth will have 6 billion people in 1999, 7 billion by 2011, and 8 billion in 2025. The global population is expected to keep on growing until around the end of the next century, when it should stabilize at close to 10.7 billion - about double the current world population. Despite the fact that contraceptive prevalence rates (CPR) are going up in the developing world - reaching 55 per cent in 1994 - there will be a big increase in the number of women of reproductive age over the next 10 years. Excluding China, where existing CPR levels are high (around 80 per cent), this unmet need for family planning amounts to between 15 and 25 per cent of all married couples. In order to help women and men make their own decisions about childbearing, services will have to be improved and the coverage of existing programmes broadened. The UN estimates that, to maintain a trend of declining birth rates, at least an additional 157 million couples must start using reproductive health and family planning services during the next 10 years.
Efforts to tackle population problems date back to the 1920s and 1930s when pioneer organizations like the International Planned Parenthood Federation (IPPF) began launching national networks of family planning clinics. The United Nations initiated research on population issues in 1946 with the formation of the UN Population Division and the Commission on Population, enabling the international donor community and individual countries to examine population issues in a broader social context.
With the founding of UNFPA in 1969, population emerged as a field of public policy in the international community, and multilateral funds were made available to developing countries struggling with population issues. UNFPA's efforts were bolstered at the 1974 World Population Conference in Bucharest. This conference provided the policy framework upon which governments and international agencies could construct national population programmes. The impetus provided by the Bucharest Conference was reinforced at the 1984 International Conference on Population in Mexico City. UNFPA, along with international multilateral and bilateral organizations, non-governmental organizations (NGOs) and others have played catalytic roles in translating population objectives into workable programmes. A large body of demographic knowledge has been produced on the causes and socio-economic and political consequences of mortality, fertility, family planning, internal migration, population distribution and international migration.
Over the past 25 years, many countries have come to recognize that population policies and programmes must be integrated into overall development objectives if they are to be effective and sustainable. Population initiatives, whether in population policy and analysis or in service delivery (eg. provision of reproductive health and family planning services) need to be "institutionalized" and turned into national programmes. Box 1 and 2 list the basic elements present in population policy-making and in reproductive health services. Population programmes should be sensitive to local needs and concerns, with appropriate attention paid to potential political, social and religious obstacles hindering their acceptance.
Today, 129 countries provide direct support for population and family planning activities, with another 17 providing indirect support. Over 90 per cent of the developing world's population lives in countries which have formulated population policies and/or offer some family planning services. Within the last few years, an international consensus has emerged calling for a broadening of family planning services to include a whole range of "reproductive health" initiatives. Now, population programmes are being broadened to include reproductive health services, as defined in Box 2.
The following elements are an integral part of any population policy-making exercise:
· Data Collection. A fundamental activity in the entire process of research and policy analysis. Timely, reliable data from censuses, surveys and vital statistics systems not only facilitate national, regional and global policy-related research but also provide an accurate basis for designing detailed population policies and programmes and for planning at macro-sectoral and sub-national levels.
· Policy Analysis: A continuing activity drawing on research, policy planning, implementation and evaluation to help identify issues that are insufficiently understood or overlooked in policy development and to determine the types of data and analysis needed to improve the knowledge base.
Moving Towards Reproductive Health
Over the past decade, it has become apparent that family planning should be broadened to include an appropriate range of reproductive health care services.
In this context, reproductive health care should include the following elements:
· Family planning information and services;
Blending this combination of services requires decisions on resource allocation, in order to gain the best overall benefit. Complex issues arise in how best to add AIDS services to preexisting family planning and reproductive health services. But progress in this area is underway in a number of countries.
Population programmes now typically emphasize two factors sometimes overlooked by past endeavors: 1) more attention is now being paid to individual needs, especially women; and 2) a broad-based participatory approach to meeting needs is being adopted by a number of countries and international development agencies.
While there clearly is political will and commitment on the part of a large number of developing countries to solve their own population problems, shortfalls in their capacities to deal with the many ramifications of population growth and distribution greatly constrain their ability to make headway.
Access to, and the quality of, reproductive health services varies a great deal within and between countries. In many instances, services fall far short of what is needed. In sub-Saharan Africa, for example, where most countries in the region have launched family planning programmes, the percentage of government-run health facilities that offer family planning services varies from one per cent in Cd'Ivoire to 100 per cent in Mauritius and Seychelles. Such assessments, of course, do not indicate the extent to which the services offered are actually accessible. According to a survey carried out by UNFPA's Africa Division, in only 12 countries - Botswana, Burundi, Comoros, Gambia, Lesotho, Mauritius, Namibia, Rwanda, Seychelles, Swaziland, Zambia and Zimbabwe - did at least half the population have even minimal access to family planning services (defined as living within a set distance from a place where services are at least occasionally offered).
While there is a clear need for governments to strengthen their institutional capacities in the broad areas of population and family planning, they must also concentrate resources in the related areas of health care, education and public information. Integrated, sustainable development requires the capacity to plan for future population needs. But plans must be accompanied by expanded institutional capacity to formulate and implement population plans of action, deliver quality health and family planning services, provide universal access to education for boys and girls, and implement carefully targeted programmes to meet the growing reproductive health needs of overlooked groups, such as adolescents and newlywed couples.