UNITED
NATIONS
Distr.
LIMITED
A/CONF.171/PC/L.13
19 April 1994
ORIGINAL: ENGLISH
PREPARATORY COMMITTEE FOR THE
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Third session
4-22 April 1994
Agenda item 6
DRAFT FINAL DOCUMENT OF THE CONFERENCE
HEALTH, MORBIDITY AND MORTALITY
(Chapter VIII of the draft programme of action of the Conference)
Text submitted by the Vice-Chairman, Mr. Nicolaas Biegman
(Netherlands) (Working Group II), on the basis of
negotiations held on document A/CONF.171/PC/5
94-18682 (E) 200494 /...
Chapter VIII
HEALTH, MORBIDITY AND MORTALITY
A. Primary health care and the health-care sector
Basis for action
8.1. One of the main achievements of the twentieth century has
been the unprecedented increase in human longevity. In the past
half century, expectation of life at birth in the world as a
whole has increased by about 20 years, and the risk of dying in
the first year of life has been reduced by nearly two thirds.
Nevertheless, these achievements fall short of the much greater
improvements that had been anticipated in the World Population
Plan of Action and the Declaration of Alma Ata, adopted by the
International Conference on Primary Health Care in 1978. There
remain entire national populations and sizeable population groups
within many countries that are still subject to very high rates
of morbidity and mortality. Differences linked to socio-economic
status or ethnicity are often substantial. In many countries
with economies in transition, the mortality rate has considerably
increased as a result of deaths caused by accidents and violence.
8.2. The increases in life expectancy recorded in most regions
of the world reflect significant gains in public health and in
access to primary health-care services. Notable achievements
include the vaccination of about 80 per cent of the children in
the world and the widespread use of low-cost treatments, such as
oral rehydration therapy, to ensure that more children survive.
Yet these achievements have not been realized in all countries,
and preventable or treatable illnesses are still the leading
killers of young children. Moreover, large segments of many
populations continue to lack access to clean water and sanitation
facilities, are forced to live in congested conditions and lack
adequate nutrition. Large numbers of people remain at continued
risk of infectious and parasitic and water-borne diseases, such
as tuberculosis, malaria and schistosomiasis. In addition, the
health effects of environmental degradation and exposure to
hazardous substances in the workplace are increasingly a cause of
concern in many countries. Similarly, the growing consumption of
tobacco, alcohol and drugs will precipitate a marked increase in
costly chronic diseases among working age and elderly people.
The impact of reductions in expenditures for health and other
social services which have taken place in many countries as a
result of public-sector retrenchment, misallocation of available
health resources, structural adjustment and the transition to
market economies has preempted significant changes in lifestyles,
livelihoods and consumption patterns and is also a factor in
increasing morbidity and mortality. Although economic reforms
are essential to sustained economic growth, it is equally
essential that the design and implementation of structural
adjustment programmes incorporate the social dimension.
Objectives
8.3. The objectives are:
(a) To increase the accessibility, availability,
acceptability and affordability of health care services and
facilities to all people in accordance with national commitments
to provide access to basic health care for all;
(b) To increase the healthy life-span and improve the
quality of life of all people, and to reduce disparities in life
expectancy between and within countries.
Actions
8.4. All countries should make access to basic health care and
health promotion the central strategies for reducing mortality
and morbidity. Sufficient resources should be assigned so that
primary health services attain full coverage of the population.
Governments should strengthen health and nutrition information,
education and communication activities so as to enable people to
increase their control over and improve their health.
Governments should provide the necessary backup facilities to
meet the demand created.
8.5. In keeping with the Declaration of Alma Ata, all countries
should reduce mortality and morbidity and seek to make primary
health care, including reproductive health care, available
universally by the end of the current decade. [Countries should
aim to achieve by 2005 a life expectancy at birth greater than 70
years and by 2015 a life expectancy at birth greater than 75
years. Countries with the highest levels of mortality should aim
to achieve by 2005 a life expectancy at birth greater than 65
years and by 2015 a life expectancy at birth greater than 70
years.] Efforts to ensure a longer and healthier life for all
should emphasize the reduction of morbidity and mortality
differentials between males and females as well as among
geographical regions, social classes and indigenous and ethnic
groups.
8.6. The role of women as primary custodians of family health
should be recognized and supported. Access to basic health care,
expanded health education, the availability of simple cost-
effective remedies, and the reappraisal of primary health-care
services, including [reproductive health care services] to
facilitate proper use of women's time, should be provided.
8.7. Governments should ensure community participation in health
policy planning, especially with respect to the long-term care of
the elderly, those with disabilities and those infected with HIV
and other endemic diseases. Such participation should also be
promoted in child-survival and maternal health programmes,
breast-feeding support programmes, programmes for the early
detection and treatment of cancer of the reproductive system, and
programmes for the prevention of HIV infection and other sexually
transmitted diseases.
8.7 bis. All countries should re-examine training curricula and
the delegation of responsibilities within the health-care
delivery system in order to reduce frequent, unnecessary and
costly reliance on physicians and on secondary- and tertiary-care
facilities, while maintaining effective referral services.
Access to health care services for all people and especially for
the most underserved and vulnerable groups must be ensured.
Governments should seek to make basic health care services more
sustainable financially, while ensuring equitable access, by
integrating [sexual and reproductive] health services, including
maternal and child health and family planning services, and by
making appropriate use of community-based services, social
marketing and cost-recovery schemes with the aim of increasing
the range and quality of services available. The involvement of
users and the community in the financial management of health
care services should be promoted.
8.7 ter. Through technology transfer, developing countries
should be assisted in building their capacity to produce generic
drugs for the domestic market and to ensure the wide availability
and accessibility of such drugs. To meet the substantial
increase in demand for vaccines, antibiotics, and other
commodities over the next decade and beyond, the international
community should strengthen global, regional and local mechanisms
for the production, quality control, and procurement of those
items, where feasible, in developing countries. The
international community should facilitate regional cooperation in
the manufacture, quality control and distribution of vaccines.
8.8. All countries should give priority to measures that improve
the quality of life and health by ensuring a safe and sanitary
living environment for all population groups through measures
aimed at avoiding crowded housing conditions, reducing air
pollution, ensuring access to clean water and sanitation,
improving waste management, and increasing the safety of the
workplace. Special attention should be given to the living
conditions of the poor and disadvantaged in urban and rural
areas. The impact of environmental problems on health,
particularly that of vulnerable groups, should be monitored by
Governments on a regular basis.
8.8 bis. Reform of the health sector and health policy,
including the rational allocation of resources, should be
promoted in order to achieve the stated objectives. All
Governments should examine ways to maximize the cost-
effectiveness of health programmes in order to achieve increased
life expectancy, reduce morbidity and mortality and ensure access
to basic health care services for all people.
B. Child survival and health
Basis for action
8.9. Important progress has been made in reducing infant and
child mortality rates everywhere. Improvements in the survival
of children have been the main component of the overall increase
in average life expectancy in the world over the past century,
first in the developed countries and over the past 50 years in
the developing countries. The number of infant deaths (i.e., of
children under age 1) per 1,000 live births at the world level
declined from 92 in 1970-1975 to about 62 in 1990-1995. For
developed regions, the decline was from 22 to 12 infant deaths
per 1,000 births, and for developing countries from 105 to 69
infant deaths per 1,000 births. Improvements have been slower in
sub-Saharan Africa and in some Asian countries where, during
1990-1995, more than one in every 10 children born alive will die
before their first birthday. The mortality of children under age
5 exhibits significant variations between and within regions and
countries. Indigenous peoples generally have higher infant and
child mortality rates than the national norm. Poverty,
malnutrition, a decline in breast-feeding, inadequacy or lack of
sanitation and of health facilities are all factors associated
with high infant and child mortality. In some countries, civil
unrest and wars have also had major negative impacts on child
survival. Unwanted births, child neglect and abuse are also
factors contributing to the rise in child mortality. In
addition, HIV infection can be transmitted from mother to child
before or during childbirth, and young children whose mothers die
are at a very high risk of dying themselves at a young age.
8.10. The World Summit for Children, held in 1990, adopted a set
of goals for children and development up to the year 2000,
including a reduction in infant and under-5 child mortality rates
by one third, or to 50 and 70 per 1,000 live births,
respectively, whichever is less. These goals are based on the
accomplishments of child survival programmes during the 1980s,
which demonstrate not only that effective low-cost technologies
are available but that they can be delivered efficiently to large
populations. However, the morbidity and mortality reductions
achieved through extraordinary measures in the 1980s are in
danger of being eroded if the broad-based health delivery systems
established during the decade are not institutionalized and
sustained.
8.11. Child survival is closely linked to the timing, spacing
and number of births and to the reproductive health of mothers.
Early, late, numerous and closely spaced pregnancies are major
contributors to high infant and child mortality and morbidity
rates, especially where health-care facilities are scarce. Where
infant mortality remains high, couples often have more children
than they otherwise would to ensure that a desired number
survive.
Objectives
8.12. The objectives are:
(a) To promote child health and survival and to reduce
disparities between and within developed and developing countries
as quickly as possible, with particular attention to eliminating
the pattern of excess and preventable mortality among girl
infants and children;
(b) To improve the health and nutritional status of infants
and children;
(c) To promote breast-feeding as a child-survival strategy.
Actions
8.13. Over the next 20 years, through international cooperation
and national programmes, the gap between average infant and child
mortality rates in the developed and the developing regions of
the world should be substantially narrowed, and disparities
within countries, those between geographical regions, ethnic or
cultural groups, and socio-economic groups should be eliminated.
Countries with indigenous people should achieve infant and under-
5 mortality levels among their indigenous people that are the
same as those of the general population. [Countries should
strive to reduce their infant and under-5 mortality rates by one
third, or to 50 and 70 per 1,000 live births, respectively,
whichever is less, by the year 2000, with appropriate adaptation
to the particular situation of each country. By 2005, countries
with intermediate mortality levels should aim to achieve an
infant mortality rate below 50 deaths per 1,000 and an under-5
mortality rate below 60 deaths per 1,000 births. By 2015 all
countries should aim to achieve an infant mortality rate below 35
per 1,000 live births and an under-5 mortality rate below 45 per
1,000. Countries that achieve these levels earlier should strive
to lower them further.]
8.14. All Governments should assess the underlying causes of
high child mortality and should, within the framework of primary
health care, extend integrated reproductive health care and child
health services, including safe motherhood, child survival
programmes and family planning services, to all the population
and particularly to the most vulnerable and underserved groups.
Such services should include prenatal care and counselling, with
special emphasis on high-risk pregnancies and the prevention of
sexually transmitted diseases and HIV infection; adequate
delivery assistance; and neonatal care, including exclusive
breast-feeding, information on optimal breast-feeding and on
proper weaning practices, and the provision of micronutrient
supplementation, where appropriate. Interventions to reduce the
incidence of low-birth weight and other nutritional deficiencies,
such as anaemia, should include the promotion of maternal
nutrition through information, education and counselling and the
promotion of longer intervals between births. All countries
should give priority to efforts to reduce the major childhood
diseases, particularly infectious and parasitic diseases, and to
prevent malnutrition among children, especially the girl child,
through measures aimed at eradicating poverty and ensuring that
all children live in a sanitary environment and by disseminating
information on hygiene and nutrition. It is also important to
provide parents with information and education about child care,
including the use of mental and physical stimulation.
8.14 bis. In order for infants and children to receive the best
nutrition and for specific protection against a range of
diseases, breast-feeding should be protected, promoted and
supported. By means of legal, economic, practical and emotional
support, mothers should be enabled to breast-feed their infants
exclusively for 4-6 months, without food or drink supplementation
and to continue breast-feeding infants with appropriate and
adequate complementary food up to the age of 2 years or beyond.
To achieve these goals, Governments should promote public
information on the benefits of breast-feeding; health personnel
should receive training on the management of breast-feeding; and
countries should examine ways and means to implement fully the
WHO International Code of Marketing of Breast Milk Substitutes.
C. Women's health and safe motherhood
Basis for action
8.15. Complications related to pregnancy and childbirth are
among the leading causes of mortality for women of reproductive
age in many parts of the developing world. At the global level,
it has been estimated that about half a million women die each
year of pregnancy-related causes, 99 per cent of them in
developing countries. The gap in maternal mortality between
developed and developing regions is wide: in 1988, they ranged
from over 700 per 100,000 live births in the least developed
countries to about 26 per 100,000 live births in the developed
regions. Rates of 1,000 or more maternal deaths per 100,000 live
births have been reported in several rural areas of Africa,
giving women with many pregnancies a high lifetime risk of death
during their reproductive years. According to the World Health
Organization (WHO), the lifetime risk of dying from pregnancy or
childbirth-related causes is 1 in 20 in developing countries,
compared to 1 in 10,000 in some developed countries. The age at
which women begin or stop child-bearing, the interval between
each birth, the total number of lifetime pregnancies and the
socio-cultural and economic circumstances in which women live all
influence maternal morbidity and mortality. At present,
approximately 90 per cent of the countries of the world,
representing 96 per cent of the world's population, have policies
that permit abortion to save the life of a woman. However, a
significant proportion of the abortions carried out are self-
induced or otherwise unsafe, leading to a large fraction of
maternal deaths or to permanent injury to the women involved.
Maternal deaths have very serious consequences within the family,
given the crucial role of the mother for her children's health
and welfare. The death of the mother increases the risk to the
survival of her young children, especially if the family is not
able to provide a substitute for the maternal role. Greater
attention to the reproductive health needs of female adolescents
and young women could prevent the major share of maternal
morbidity and mortality through prevention of unwanted
pregnancies and any subsequent poorly managed abortion. Safe
Motherhood, a notion which does not include the [promotion] of
abortion as a method of family planning, has been accepted in
many countries as a strategy to reduce maternal morbidity and
mortality.
Objective
8.16. The objectives are:
(a) To promote women's health and safe motherhood; to
achieve a rapid and substantial reduction in maternal morbidity
and mortality and reduce the differences observed between
developing and developed countries and within countries. On the
basis of a commitment to women's health and well-being, to reduce
greatly the number of deaths and morbidity from unsafe abortion;
(b) To improve the health and nutritional status of women,
especially of pregnant and nursing women.
Actions
8.17. Countries should strive to effect significant reductions
in maternal mortality by the year 2015; [a reduction in maternal
mortality by one half of the 1990 levels by the year 2000 and a
further one half by 2015. The realization of these goals will
have different implications for countries with different 1990
levels of maternal mortality. Countries with intermediate levels
of mortality should aim to achieve by the year 2005 a maternal
mortality rate below 100 per 100,000 live births and by the year
2015 a maternal mortality rate below 60 per 100,000 live births.
Countries with the highest levels of mortality should aim to
achieve by 2005 a maternal mortality rate below 125 per 100,000
live births and by 2015 a maternal mortality rate below 75 per
100,000 live births.] However, all countries should reduce
maternal morbidity and mortality to levels where they no longer
constitute a public health problem. Disparities in maternal
mortality within countries and between geographical regions,
socio-economic and ethnic groups should be narrowed.
8.18. All countries, with the support of all sections of the
international community, must expand the provision of maternal
health services in the context of primary health care. These
services, based on the concept of informed choice, should include
education on safe motherhood, prenatal care that is focused and
effective, maternal nutrition programmes, adequate delivery
assistance that avoids excessive recourse to caesarean sections
and provides for obstetric emergencies; referral services for
pregnancy, childbirth and abortion complications; post-natal care
and family planning. All births should be assisted by trained
persons, preferably nurses and midwives, but at least by trained
birth attendants. The underlying causes of maternal morbidity
and mortality should be identified, and attention should be given
to the development of strategies to overcome them and for
adequate evaluation and monitoring mechanisms to assess the
progress being made in reducing maternal mortality and morbidity
and to enhance the effectiveness of ongoing programmes.
Programmes and education to engage men's support for maternal
health and safe motherhood should be developed.
8.19. All countries, especially developing countries, with the
support of the international community, should aim at further
reductions in maternal mortality through measures to prevent,
detect and manage high-risk pregnancies and births, particularly
those to adolescents and late-parity women.
8.20. All countries should design and implement special
programmes to address the nutritional needs of women of child-
bearing age, especially those who are pregnant or breast-feeding,
and should give particular attention to the prevention and
management of nutritional anaemia and iodine-deficiency
disorders. Priority should be accorded to improving the
nutritional and health status of young women through education
and training as part of maternal health and safe motherhood
programmes. Adolescent females and males should be provided with
information, education and counselling to help them delay early
marriage and unions, premature sexual activity and first
pregnancy.
8.21. All Governments, intergovernmental organizations and
relevant non-governmental organizations are urged to deal openly
and forthrightly with [unsafe abortion] as a major public health
concern. Particular efforts should be made to obtain objective
and reliable information on the policies on, incidence of and
consequences of abortion in every country. Unwanted pregnancies
should be prevented through sexual health education and through
expanded and improved family planning services, including proper
counselling to reduce the rate of abortion. Governments are
urged to assess the health and social impact of induced abortion,
to address the situations that cause women to have recourse to
abortion and to provide adequate medical care and counselling.
[Governments are urged to evaluate and review laws and policies
on abortion so that they take into account the commitment to
women's health and well-being in accordance with local
situations, rather than relying on criminal codes or punitive
measures. Although the main objective of public policy is to
prevent unwanted pregnancies and reduce the rate of abortion,
women should have ready access to quality health care services
that include reliable information, counselling and medical care
to enable them to terminate pregnancies in those cases where it
is allowed by law, if they so decide, and that provide for the
management of complications and sequelae of unsafe abortion.]
Post-abortion counselling, education and family planning services
should be offered promptly so as to prevent repeat abortions.
8.22. Programmes to reduce maternal morbidity and mortality
should include information and [reproductive health services],
including family planning services. In order to reduce high-risk
pregnancies, maternal health and safe motherhood programmes
should include counselling and family planning information.
8.23. All countries, as a matter of some urgency, need to seek
changes in high-risk sexual behaviour and devise strategies to
ensure that men share responsibility for sexual and reproductive
health, including family planning, and for preventing and
controlling sexually transmitted diseases, HIV infection and
AIDS.
D. Human immunodeficiency virus (HIV) infection and
acquired immune deficiency syndrome (AIDS)
Basis for action
8.24. The AIDS pandemic is a major concern in both developed and
developing countries. WHO estimates that the cumulative number
of AIDS cases in the world amounted to 2.5 million persons by mid
1993 and that over 14 million people had been infected with HIV
since the pandemic began, a number that is projected to rise to
between 30 million and 40 million by the end of the decade, if
effective prevention strategies are not pursued. As of mid 1993,
about four fifths of all persons ever infected with HIV lived in
developing countries where the infection was being transmitted
mainly through heterosexual intercourse and the number of new
cases was rising most rapidly among women. As a consequence, a
growing number of children are becoming orphans, themselves at
high risk of illness and death. In many countries, the pandemic
is now spreading from urban to rural areas and between rural
areas and is affecting economic and agricultural production.
Objective
8.25. The objectives are:
(a) To prevent, reduce the spread of and minimize the
impact of HIV infection. To increase awareness of the disastrous
consequences of HIV infection and AIDS and associated fatal
diseases, at the individual, community and national levels, and
of the ways of preventing it. To address the social, economic,
gender and racial inequities that increase vulnerability to the
disease;
(b) To ensure that HIV-infected individuals have adequate
medical care and are not discriminated against. To provide
counselling and other support for people infected with HIV and to
alleviate the suffering of people living with AIDS and that of
their family members, especially orphans. To ensure that the
individual rights and the confidentiality of persons infected
with HIV are respected. To ensure that sexual and reproductive
health programmes address HIV infection and AIDS;
(c) To intensify research on methods to control the
HIV/AIDS pandemic and to find an effective treatment for the
disease.
Actions
8.26. Governments should assess the demographic and development
impact of HIV infection and AIDS. The AIDS pandemic should be
controlled through a multisectoral approach that pays sufficient
attention to its socio-economic ramifications, including the
heavy burden on health infrastructure and household income, its
negative impact on the labour force and productivity, and the
increasing number of orphaned children. Multisectoral national
plans and strategies to deal with AIDS should be integrated into
population and development strategies. The socio-economic
factors underlying the spread of HIV infection should be
investigated, and programmes to address the problems faced by
those left orphaned by the AIDS pandemic should be developed.
8.27. Programmes to reduce the spread of HIV infection should
give high priority to information, education and communication
campaigns to raise awareness and emphasize behavioural change.
Sex education and information should be provided to both those
infected and those not infected, and especially to adolescents.
Health providers, including family planning providers, need
training in counselling on sexually transmitted diseases and HIV
infection, including the assessment and identification of high-
risk behaviours needing special attention and services; training
in the promotion of safe and responsible sexual behaviour,
including voluntary abstinence and [condom use]; training in the
avoidance of contaminated equipment and blood products; and in
the avoidance of sharing needles among intravenous drug users.
Governments should develop guidelines and counselling services on
AIDS and sexually transmitted diseases within the primary health
care services. Wherever possible, reproductive health
programmes, including family planning programmes, should include
facilities for the diagnosis and treatment of common sexually
transmitted diseases, including reproductive tract infection,
recognizing that many sexually transmitted diseases increase the
risk of HIV transmission. The links between the prevention of
HIV infection and the prevention and treatment of tuberculosis
should be assured.
8.28. Governments should mobilize all segments of society to
control the AIDS pandemic, including non-governmental
organizations, community organizations, religious leaders, the
private sector, the media, schools and health facilities.
Mobilization at the family and community levels should be given
priority. Communities need to develop strategies that respond to
local perceptions of the priority accorded to health issues
associated with the spread of HIV and sexually transmitted
diseases.
8.28 bis. The international community should mobilize the human
and financial resources required to reduce the rate of
transmission of HIV infection. To that end, research on a broad
range of approaches to prevent HIV transmission and to seek a
cure for the disease should be promoted and supported by all
countries. In particular, donor and research communities should
support and strengthen current efforts to find a vaccine and to
develop women-controlled methods, such as spermicides with
microbicidal effects, to prevent HIV infection. Increased
support is also needed for the treatment and care of HIV-infected
persons and AIDS patients. The coordination of activities to
combat the AIDS pandemic must be enhanced. Particular attention
should be given to activities of the United Nations system at the
national level, where measures such as joint programmes can
improve coordination and ensure a more efficient use of scarce
resources. The international community should also mobilize its
efforts in monitoring and evaluating the results of various
efforts to search for new strategies.
8.28 ter. Governments should develop policies and guidelines to
protect the individual rights of and eliminate discrimination
against persons infected with HIV and their families. Services
to detect HIV infection should be strengthened, making sure that
they ensure confidentiality. Special programmes should be
devised to provide care and the necessary emotional support to
men and women affected by AIDS and to counsel their families and
near relations.
8.29. Responsible sexual behaviour, [in particular/including]
voluntary sexual abstinence, for the prevention of HIV infection
should be promoted and included in education and information
programmes. Condoms and drugs for the treatment of sexually
transmitted diseases should be made widely available and
affordable and should be included in all essential drug lists.
Effective action should be taken to further control the quality
of blood products and equipment decontamination.
-----
UNITED
NATIONS
Distr.
LIMITED
A/CONF.171/PC/L.14
20 April 1994
ORIGINAL: ENGLISH
PREPARATORY COMMITTEE FOR THE
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Third session
4-22 April 1994
Agenda item 6
DRAFT FINAL DOCUMENT OF THE CONFERENCE
Interrelationships between population, sustained economic
growth and sustainable development
(Chapter III of the draft programme of action
of the Conference)
Text submitted by the Vice-Chairman (Mr. Lionel Hurst (Antigua
and Barbuda)) (Working Group I) on the basis of negotiations
held on document A/CONF.171/PC/5
94-18844 (E) 210494 /... Chapter III
INTERRELATIONSHIPS BETWEEN POPULATION, SUSTAINED ECONOMIC
GROWTH AND SUSTAINABLE DEVELOPMENT
A. [Integrating population and development strategies]
Basis for action
3.1. The everyday activities of all human beings, communities
and countries are interrelated with population change, patterns
and levels of use of natural resources, the state of the
environment, and the pace and quality of economic and social
development. There is general agreement that persistent
widespread poverty as well as serious social and gender
inequities have significant influences on, and are in turn
influenced by, demographic parameters such as population growth,
structure and distribution. There is also general agreement that
unsustainable consumption and production patterns are
contributing to the unsustainable use of natural resources and
environmental degradation as well as to the reinforcement of
social inequities and of poverty with the above-mentioned
consequences for demographic parameters. The Rio Declaration on
Environment and Development and Agenda 21, adopted by the
international community at the United Nations Conference on
Environment and Development, call for patterns of development
that reflect the new understanding of these and other
intersectoral linkages. Recognizing the longer-term realities
and implications of current actions, the development challenge is
to meet the needs of present generations and improve their
quality of life without compromising the ability of future
generations to meet their own needs.
3.2. Despite recent declines in birth rates in many countries,
further large increases in population size are inevitable. Owing
to the youthful age structure, for numerous countries the coming
decades will bring substantial population increases in absolute
numbers. Population movements within and between countries,
including the very rapid growth of cities and the unbalanced
regional distribution of population, will continue and increase
in the future.
3.3. Sustainable development implies, inter alia, long-term
sustainability in production and consumption relating to all
economic activities including industry, energy, agriculture,
forestry, fisheries, transport, tourism and infrastructure in
order to optimize ecologically sound resource use and minimize
waste. Macroeconomic and sectoral policies have, however, rarely
given due attention to population considerations. Explicitly
integrating population into economic and development strategies
will both speed up the pace of sustainable development and
poverty alleviation and contribute to the achievement of
population objectives and an improved quality of life of the
population.
Objectives
3.4. The objectives are to fully integrate population concerns
into:
(a) Development strategies, planning, decision-making, and
resource allocation at all levels and in all regions with the
goal of meeting the needs, and improving the quality of life, of
present and future generations;
(b) All aspects of development planning in order to promote
social justice and to eradicate poverty through sustained
economic growth in the context of sustainable development.
Actions
3.5. At the international, regional, national and local levels,
population issues should be integrated into the formulation,
implementation, monitoring and evaluation of all policies and
programmes relating to sustainable development. Development
strategies must realistically reflect both the short-, medium-
and long-term implications of, and consequences for, population
dynamics as well as patterns of production and consumption.
3.6. Governments, international agencies, non-governmental
organizations and other concerned parties should undertake timely
and periodic reviews of their development strategies, with the
aim of assessing progress towards integrating population into
development and environment programmes that take into account
patterns of production and consumption and seek to bring about
population trends consistent with the achievement of sustainable
development and the improvement of the quality of life.
3.7. Governments should establish the requisite internal
institutional mechanisms and enabling environment, at all levels
of society, to ensure that population factors are appropriately
addressed within the decision-making and administrative processes
of all relevant government agencies responsible for economic,
environmental and social policies and programmes.
3.8. Political commitment to integrated population and
development strategies should be strengthened by public education
and information programmes and by increased resource allocation
through cooperation among Governments, non-governmental
organizations and the private sector, and by improvement of the
knowledge base through research and national and local capacity-
building.
3.8. bis To achieve sustainable development and a higher quality
of life for all people, Governments should reduce and eliminate
unsustainable patterns of production and consumption and promote
appropriate demographic policies. Developed countries should take
the lead in achieving sustainable consumption patterns and
effective waste management.
B. [Population, sustained economic growth and poverty]
Basis for action
3.8. ter Population policies should take into account, as
appropriate, development strategies agreed upon in multilateral
forums, in particular the International Development Strategy for
the Fourth United Nations Development Decade, the Programme of
Action for the Least Developed Countries for the 1990s, the
outcomes of the eighth session of the United Nations Conference
on Trade and Development, and of the Uruguay round of
multilateral trade negotiations, Agenda 21 and the United Nations
New Agenda for the Development of Africa in the 1990s.
3.9. Gains recorded in recent years in such indicators as life
expectancy and national product, while significant and
encouraging, do not, unfortunately, fully reflect the realities
of life of hundreds of millions of men, women, adolescents and
children. Despite decades of development efforts, both the gap
between rich and poor nations, and the inequalities within
nations, have widened. Serious economic, social, gender and
other inequities persist and hamper efforts to improve the
quality of life for hundreds of millions of people. The number
of people living in poverty stands at approximately 1 billion and
continues to mount.
3.9. bis All countries, more especially developing countries
where almost all of the future growth of the world population
will occur, and countries with economies in transition, face
increasing difficulties in improving the quality of life of their
people in a sustainable manner. Many developing countries and
countries with economies in transition face major development
obstacles, among which are those related to the persistence of
trade imbalances, the slow-down in the world economy, the
persistence of the debt-servicing problem, and the need for
technologies and external assistance. The achievement of
sustainable development and poverty eradication should be
supported by macroeconomic policies designed to provide an
appropriate international economic environment, as well as by
good governance, effective national policies and efficient
national institutions.
3.10. Widespread poverty remains the major challenge to
development efforts. Poverty is often accompanied by
unemployment, malnutrition, illiteracy, low status of women,
exposure to environmental risks and limited access to social and
health services, [including reproductive health services and
family planning]. All these factors contribute to high levels of
fertility, morbidity, and mortality, as well as to low economic
productivity. Poverty is also closely related to inappropriate
spatial distribution of population, to unsustainable use and
inequitable distribution of such natural resources as land and
water, and to serious environmental degradation.
3.10. bis Efforts to slow down population growth, to reduce
poverty, to achieve economic progress, to improve environmental
protection, and to reduce unsustainable consumption and
production patterns are mutually reinforcing. Slower population
growth has in many countries bought more time to adjust to future
population increases. This has increased those countries'
ability to attack poverty, protect and repair the environment,
and build the base for future sustainable development. Even the
difference of a single decade in the transition to stabilization
levels of fertility can have a considerable positive impact on
quality of life.
3.11. Sustained economic growth within the context of
sustainable development is essential to eradicate poverty.
Eradication of poverty will contribute to slowing population
growth and to achieving early population stabilization.
Investments in fields important to the eradication of poverty,
such as basic education, sanitation, drinking water, housing,
adequate food supply and infrastructure for rapidly growing
populations, continue to strain already weak economies and limit
development options. The unusually high number of young people,
a consequence of high fertility rates, requires that productive
jobs be created for a continually growing labour force under
conditions of already widespread unemployment. The numbers of
elderly requiring public support will also increase rapidly in
the future. Sustained economic growth in the context of
sustainable development will be necessary to accommodate these
pressures.
3.12. (merge with 3.9. bis)
Objective
3.13. [The objective is to raise the quality of life for all
people through adequate population and development policies and
programmes aimed at achieving sustained economic growth in the
context of sustainable development and sustainable patterns of
consumption and production, poverty eradication, human resource
development, the right to development and the guarantee of human
rights.] As women are generally the poorest of the poor and at
the same time key actors in the development process, eliminating
social, cultural, political and economic discrimination against
women is a prerequisite of eradicating poverty, promoting
sustained economic growth in the context of sustainable
development, ensuring quality family planning and reproductive
health services, and achieving balance between population and
available resources and sustainable patterns of consumption and
production.
Actions
3.14. (now 3.10. bis)
3.15. Investment in human resource development, in accordance
with national policy, must be given priority in population, and
development strategies and budgets, at all levels, with
programmes specifically directed at increased access to
information, education, skill development, employment
opportunities, both formal and informal, and high-quality
general[, and sexual and reproductive] health services[,
including family planning services], through the promotion of
sustained economic growth in developing countries and countries
with economies in transition.
3.16. (now 3.39)
3.17. Existing inequities and barriers to women in the workforce
should be eliminated and women's participation in all policy-
making and implementation, as well as their access to productive
resources, and ownership of land, and their right to inherit
property should be promoted and strengthened. Governments, non-
governmental organizations and the private sector should invest
in, promote, monitor, and evaluate the education and skill
development of women and girls and the legal and economic rights
of women, and in all aspects of [reproductive and sexual] health,
[including family planning], in order to enable them to
effectively contribute to and benefit from economic growth and
sustainable development.
3.18. High priority should be given by Governments, non-
governmental organizations and the private sector to meeting the
needs, and increasing the opportunities for information,
education, jobs, skill development and [reproductive health
services.], of all underserved members of society.
3.18. bis Measures should be taken to strengthen food, nutrition
and agricultural policies and programmes, and fair trade
relations, with special attention to the creation and
strengthening of food security at all levels.
3.19. Job creation in the industrial, agricultural and service
sectors should be facilitated by Governments and the private
sector through the establishment of more favourable climates for
expanded trade and investment [on an environmentally sound basis.
This will require creating and sustaining democratic
institutions, good governance and transparency, curtailing
corruption, and redirecting domestic budget priorities to the
social sectors and human resource development.] Special efforts
should be made to create productive jobs through policies
promoting efficient, and where required, labour-intensive
industries, and transfer of modern technologies.
3.20. [The international community should continue to promote a
supportive economic environment, particularly for developing
countries and countries with economies in transition in their
attempt to achieve sustained economic growth and eradicate
poverty. Efforts should be particularly addressed to further
liberalizing trade policies, ameliorating the terms of trade of
developing countries, reducing the debt burden, providing
financial assistance, including the promotion of foreign direct
investment as well as new and additional financial resources on
preferential grant and concessional terms, and access to
technologies, and ensuring that structural adjustment programmes
are so designed and implemented as to be responsive to social and
environmental concerns.]
C. Population and environment
Basis for action
3.21. At the United Nations Conference on Environment and
Development, the international community agreed on objectives and
actions aimed at integrating environment and development which
were included in Agenda 21 and other international environmental
agreements. Agenda 21 has been conceived as a response to the
major environment and development challenges, including the
economic and social dimensions of sustainable development, such
as poverty, consumption, demographic dynamics, human health and
human settlement, and to a broad range of environmental and
natural resource concerns. Agenda 21 leaves to the International
Conference on Population and Development further consideration of
the interrelationships between population and the environment.
3.22. Meeting the basic human needs of growing populations is
dependent on a healthy environment. These human dimensions need
to be given attention in developing comprehensive policies for
sustainable development in the context of population growth.
3.23. Demographic factors, combined with poverty and lack of
access to resources in some areas, and excessive consumption and
wasteful production patterns in others, cause or exacerbate
problems of environmental degradation and resource depletion and
thus inhibit sustainable development.
3.24. Pressure on the environment may result from rapid
population growth, distribution and migration, especially in
ecologically vulnerable ecosystems. Urbanization and policies
that do not recognize the need for rural development also create
environmental problems.
3.25. Implementation of effective population policies in the
context of sustainable development[, including reproductive
health and family planning programmes,] require new forms of
participation by various actors at all levels in the policy-
making process.
Objectives
3.26. Consistent with Agenda 21, the objectives are:
(a) To ensure that population, environmental and poverty
eradication factors are integrated in sustainable development
policies, plans and programmes;
(b) To reduce both unsustainable consumption and production
patterns as well as negative impacts of demographic factors on
the environment in order to meet the needs of current generations
without compromising the ability of future generations to meet
their own needs.
Actions
3.27. Governments at the appropriate level, with the support of
the international community and regional and subregional
organizations, should formulate and implement population policies
and programmes to support the objectives and actions agreed upon
in Agenda 21 and other international environmental agreements,
taking into account the common but differentiated
responsibilities reflected in those agreements. Consistent with
the framework and priorities set forth in Agenda 21, the
following actions, inter alia, are recommended to help achieve
population and environment integration:
(a) Integrate demographic factors into environment impact
assessments and other planning and decision-making processes
aimed at achieving sustainable development;
(b) Take measures aimed at the eradication of poverty, with
special attention to income generation and employment strategies
directed at the rural poor and those living within or on the edge
of fragile ecosystems;
(c) Utilize demographic data to promote sustainable
resource management, especially of ecologically fragile systems;
(d) Modify unsustainable consumption and production
patterns through economic, legislative and administrative
measures, as appropriate, aimed at fostering sustainable resource
use and preventing environmental degradation;
(e) Implement policies to address the ecological
implications of inevitable future increases in population numbers
and changes in concentration and distribution, particularly in
ecologically vulnerable areas and urban agglomerations.
3.28. Measures should be taken to enhance the full participation
of all relevant groups, especially women, at all levels of
population and environmental decision-making to achieve
sustainable management of natural resources.
3.29. Research should be undertaken on the linkages among
population, consumption and production, the environment and
natural resources, and human health as a guide to effective
sustainable development policies.
3.30. Governments, non-governmental organizations and the
private sector should promote public awareness and understanding
for the implementation of the above-mentioned actions.
[D. Population, education and sustainable development
Basis for action
3.31. In the last 20 years, the world has experienced a rise in
educational levels. Although the differences in educational
attainment between males and females have shrunk, 75 per cent of
illiterate persons in the world are women. Flaws in basic
education and in the literacy of adults continue to inhibit the
development process in every area. The world community has a
special responsibility to ensure that all children receive an
education of improved quality and that they complete primary
school. Education is an indispensable tool for the improvement
of the quality of life. However, it is more difficult to meet
educational needs when there is rapid population growth.
3.32. Education is a key factor in sustainable development: it
is at the same time a component of well-being and a factor in the
development of well-being through its links with demographic as
well as economic and social factors. Education is also a means to
enable the individual to gain access to knowledge, which is a
precondition for coping, by anyone wishing to do so, with today's
complex world. The reduction of fertility and mortality rates,
the empowerment of women, the improvement in the quality of the
working population and the promotion of genuine political
democracy are largely assisted by progress in education. The
integration of migrants is also facilitated by universal access
to education.
3.33. The relationship between education and demographic and
social changes is one of interdependence. The relationships
among education, marriage age, fertility, mortality, mobility and
activity are complex. The increase in the education of women and
girls contributes to greater empowerment of women, to a
postponement of the age of marriage and to a reduction in the
size of families. When mothers are better educated, their
children's survival rate tends to increase. Broader access to
education is also a factor in internal migration and the make-up
of the working population.
3.34. The education and training of young people prepare them
for professional life. It is on the content and nature of the
training received that the prospects of first-time job seekers
and their mid-career retraining possibilities depend.
Discrepancies between the educational system and the production
system lead to graduate unemployment, a devaluing of
qualifications and, in some cases, an exodus of qualified people.
It is therefore essential to promote a good adaptation of the
education system to the economic and social systems, and vice
versa.
Objectives
3.35. The objectives are:
(a) To achieve universal access to quality education, with
particular priority being given to primary education, to combat
illiteracy and to eliminate gender disparities in educational
access and support;
(b) To improve the content of the curriculum so as to
promote greater awareness on health issues, including
reproductive and sexual health, and gender equity as well as the
interrelationships between population and sustainable
development.
Actions
3.36. (former 3.16) The eradication of illiteracy is one of the
prerequisites of human development. All countries should
consolidate the progress made in the 1990s towards providing
universal access to primary education, as agreed upon at the
World Conference on Education for All, held in Jomtien, Thailand,
in 1990, notably in ensuring universal access to primary
education. All countries should further strive to ensure the
complete access to primary school or an equivalent level of
education by both girls and boys as quickly as possible, and in
any case before the year 2015. Attention should also be given to
the quality and type of education. Countries that will have
achieved the goal of universal primary education [sooner] are
urged to extend education to, and facilitate access to and
completion of education at, secondary school levels.
3.37. Investments in education and job training should be given
high priority in development budgets at all levels.
3.38. (former 4.20) Countries should take affirmative steps to
keep girls in school at least through early adolescence, by
building more community schools, training more female teachers,
and by providing scholarships or, where essential, other monetary
incentives that help compensate parents for the loss of girls'
labour, all with the aim of closing the gender gap in secondary
school education by the year 2015. Countries should also
supplement those efforts by making full use of non-formal and
other appropriate education opportunities.
3.39. (former 11.14) To be most effective, education about
population issues must begin in primary school and continue
through all levels of formal and non-formal education. Where
such programmes already exist, curricula should be reviewed,
updated and broadened with a view to ensuring adequate coverage
of important concerns such as gender sensitivity, reproductive
choices and responsibilities, and sexually transmitted diseases,
including human immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS). To ensure acceptance of population
education programmes by the community, population education
projects should emphasize consultation with parents and community
leaders.]
-----UNITED
NATIONS
Distr.
LIMITED
A/CONF.171/PC/L.15
21 April 1994
ORIGINAL: ENGLISH
PREPARATORY COMMITTEE FOR THE
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Third session
4-22 April 1994
Agenda item 6
DRAFT FINAL DOCUMENT OF THE CONFERENCE
Follow-up to the Conference
(Chapter XVI of the draft programme
of action of the Conference)
Text submitted by the Vice-Chairman, Mr. Lionel Hurst (Antigua
and Barbuda) (Working Group I), on the basis of negotiations
held on document A/CONF.171/PC/5
94-18953 (E) 210494 /...
Chapter XVI
FOLLOW-UP TO THE CONFERENCE
A. National-level activity
Basis for action
16.1. The significance of the International Conference on
Population and Development will depend on the willingness of
Governments, local communities, the non-governmental sector, the
international community and all other concerned organizations and
individuals to turn the recommendations of the Conference into
action. This commitment will be of particular importance at the
national and individual levels. Such a willingness to truly
integrate population concerns into all aspects of economic and
social activity and their interrelationships will greatly assist
in the achievement of an improved quality of life for all
individuals as well as for future generations. All efforts must
be pursued towards sustained economic growth within the context
of sustainable development.
16.2. The extensive and varied preparatory processes at the
international, regional, subregional, national and local levels
have constituted an important contribution to the formulation of
this Programme of Action. Considerable institutional development
has taken place in many countries in order to steer the national
preparatory process; greater awareness of population issues has
been fostered through public information and education campaigns,
and national reports have been prepared for the Conference. The
great majority of countries participating in the Conference
responded to an invitation to prepare comprehensive national
population reports. The complementarity of those reports to
others commissioned by recent international conferences and
initiatives relating to environmental, economic, and social
development is noteworthy and encouraging. The importance of
building on these activities in the follow-up to the Conference
is fully acknowledged.
16.3. The main functions related to Conference follow-up include
policy guidance, including building strong political support at
all levels for population and development; resource mobilization;
coordination and mutual accountability of efforts to implement
the Programme of Action; problem solving and sharing of
experience within and between countries; and monitoring and
reporting of progress in the implementation of the Programme of
Action. Each of these functions requires concerted and
coordinated follow-up at the national and international levels,
and must fully involve all relevant individuals and
organizations, including non-governmental and community-based
organizations.
(a) [Implementation, monitoring and evaluation of the
Programme of Action at all levels requires qualitative and
quantitative indicators consistent with human rights and ethical
principles recognized by the international community and endorsed
in the Programme of Action].
(b) [Implementation, monitoring and evaluation of the
Programme of Action at all levels requires appropriate
indicators].
16.4. The implementation of this Programme of Action at all
levels must be viewed as part of an integrated follow-up effort
to major international conferences, including this Conference,
the World Conference on Health for All, the World Conference on
Education for All, the World Summit for Children, the Conference
on Least Developed Countries, the United Nations Conference on
Environment and Development, the International Conference on
Nutrition, the World Conference on Human Rights, the Global
Conference on the Sustainable Development of Small Island
Developing States, the World Social Summit, the Fourth World
Conference on Women and Habitat II.
16.5. The implementation of the goals, objectives and actions of
this Programme of Action will in many instances require
additional resources.
Objective
16.6. The objective is to encourage and enable countries to
fully and effectively implement the Programme of Action, through
appropriate and relevant policies and programmes at the national
level.
Actions
16.7. Governments should (a) commit themselves at the highest
political level to achieving the goals and objectives contained
in this Programme of Action and (b) take a lead role in
coordinating the implementation, monitoring and evaluation of
follow-up actions.
16.8. Governments, organizations of the United Nations system
and major groups, in particular non-governmental organizations,
should give the widest possible dissemination to this Programme
of Action and should seek public support for the goals,
objectives and actions of this Programme of Action. This may
include follow-up meetings, publications and audio-visual aids
and both print and electronic media.
16.9. All countries should consider their current spending
priorities with a view to making additional contributions for the
implementation of the Programme of Action, taking into account
the provisions of chapters XIII and XIV of the Programme of
Action, and the economic constraints faced by developing
countries.
16.10. All countries should establish appropriate national
follow-up, accountability and monitoring mechanisms, in
partnership with non-governmental organizations, community groups
and representatives of the media and the academic community, as
well as the support of parliamentarians.
16.11. The international community should assist interested
Governments in organizing appropriate national level follow-up,
including national capacity-building for project formulation and
programme management, as well as strengthening of coordination
and evaluation mechanisms to assess the implementation of the
present Programme of Action.
16.12. Governments, with the assistance of the international
community, where necessary, should as soon as possible set up or
enhance national databases to provide baseline data and
information that can be used to measure or assess progress
towards the achievement of the goals and objectives of this
Programme of Action, and other related international documents,
commitments and agreements. For the purpose of assessing
progress, all countries should regularly assess their progress
towards achieving the objectives and goals of this Programme of
Action and other related commitments and agreements and report,
on a periodic basis, in collaboration with non-governmental
organizations and community groups.
16.13. In the preparation of those assessments and reports,
Governments should outline successes achieved, as well as
problems and obstacles encountered. Where possible, such national
reports should be compatible with the national sustainable
development plans that countries will prepare in the context of
the implementation of Agenda 21. Efforts should also be made to
devise an appropriate consolidated reporting system, taking into
account all relevant United Nations conferences having national
reporting requirements in related fields.
B. Subregional and regional activities
Basis for action
16.14. Activities undertaken at both the subregional and the
regional levels have been an important aspect of preparations for
the Conference. The outcome of subregional and regional
preparatory meetings on population and development have clearly
demonstrated the importance of acknowledging, alongside both
international and national actions, the continuing contribution
of subregional and regional action.
Objective
16.15. The objective is to promote implementation of the
Programme of Action at the subregional and regional levels, with
attention to specific subregional and regional strategies and
needs.
Action
16.16. Regional commissions, organizations of the United Nations
system functioning at the regional level, and other relevant
subregional and regional organizations should play an active role
within their mandates regarding the implementation of this
Programme of Action, through subregional and regional initiatives
on population and development. Such action should be coordinated
among the organizations concerned at the subregional and regional
levels, with a view to ensuring efficient and effective action in
addressing specific population and development issues relevant to
the regions concerned, as appropriate.
16.17. At the subregional and regional levels:
(a) Governments in the subregions and regions and relevant
organizations are invited, where appropriate, to reinforce
existing follow-up mechanisms, including meetings for the follow-
up of regional declarations on population and development issues;
(b) Multi-disciplinary expertise should, where necessary,
be utilized to play a key role in the implementation and follow-
up of the Programme of Action;
(c) Cooperation in the critical areas of capacity-building,
the sharing and exchange of information and experiences, know-how
and technical expertise should be strengthened with the
appropriate assistance of the international community, taking
into account the need for a partnership with non-governmental
organizations and other major groups, in the implementation and
follow-up of the Programme of Action at the regional level;
(d) Governments should ensure that training and research in
population and development issues at the tertiary level are
strengthened, and that research findings and implications are
widely disseminated.
C. Activities at the international level
Basis for action
16.18. The implementation of the goals, objectives and actions
of this Programme of Action will require new and additional
financial resources, from the public and private sectors, non-
governmental organizations and the international community.
[Such contributions would place an additional burden on the
already difficult economic situation of developing countries and
their ability to respond to their development needs.] While some
of the resources required could come from the reordering of
priorities, additional resources will be needed. In this
context, developing countries, particularly the least developed
countries, will require additional resources [including on
concessional and grant terms, according to sound and equitable
indicators]. Countries with economies in transition may also
require temporary assistance in the light of the difficult
economic and social problems these countries face at present.
Developed countries, and others in a position to do so, should
consider providing additional resources, as needed, to support
the implementation of the decisions of this Conference through
bilateral and multilateral channels, as well as non-governmental
organizations.
16.19. South-South cooperation at all levels is an important
instrument of development. In this regard such cooperation -
technical cooperation among developing countries (TCDC) - should
play an important part in the implementation of this Programme of
Action.
Objectives
16.20. The objectives are:
(a) To ensure full and consistent support, including
financial and technical assistance by the international
community, including from the United Nations system, for efforts
at all levels directed at the implementation of this Programme of
Action, at all levels;
(b) To ensure a coordinated approach and a clearer division
of labour in population-relevant policy and operational aspects
of development cooperation. This should be supplemented by
enhanced coordination and planning in the mobilization of
resources;
(c) To ensure that population and development issues
receive appropriate focus and integration in the work of the
relevant bodies and entities of the United Nations system.
Actions
16.21. The General Assembly is the highest intergovernmental
mechanism for the formulation and appraisal of policy on matters
relating to the follow-up to this Conference. To ensure
effective follow-up to the Conference, as well as to enhance
intergovernmental decision-making capacity for integration of
population and development issues, the Assembly should organize a
regular review of the implementation of this Programme of Action.
In fulfilling this task, the Assembly should consider the timing,
format and organizational aspects of such a review.
16.22. The General Assembly and the Economic and Social Council
should carry out their respective responsibilities, as entrusted
to them in the Charter of the United Nations, in the formulation
of policies and the provision of guidance to and coordination of
United Nations activities in the field of population and
development.
16.23. The Economic and Social Council, in the context of its
role under the Charter, vis-a-vis the General Assembly and in
accordance with Assembly resolutions 45/264, 46/235 and 48/162,
should assist the General Assembly in promoting an integrated
approach and in providing system-wide coordination and guidance
in the monitoring of the implementation of the Programme of
Action and making recommendations in this regard. Appropriate
steps should be taken to request regular reports from the
specialized agencies regarding their plans and programmes related
to the implementation of this Programme of Action, pursuant to
Article 64 of the Charter.
16.24. The Economic and Social Council is invited to review the
reporting system within the United Nations system regarding
population and development issues, taking into account the
reporting procedures that are required in follow-up to other
international conferences, with a view to establishing, where
possible, a more coherent reporting system.
16.25. Within their respective mandates and in accordance with
General Assembly resolution 48/162, the Assembly, during its
forty-ninth session and the Economic and Social Council, in 1995,
should review the roles, responsibilities, mandates and
comparative advantages of both the relevant intergovernmental
bodies and the organs of the United Nations system addressing
population and development, with a view to:
(a) Ensuring the effective and efficient implementation,
monitoring and evaluation of the United Nations operational
activities that will be undertaken on the basis of this Programme
of Action;
(b) Improving the efficiency and effectiveness of the
current United Nations structures and machinery responsible for
implementing and monitoring population and development
activities, including strategies for addressing coordination and
for intergovernmental review;
(c) Ensuring clear recognition of the interrelationships
between policy guidance, research, standard-setting and
operational activities for population and development, as well as
the division of labour between the bodies concerned.
16.26. As part of this review, the Economic and Social Council
should, in the context of Assembly resolution 48/162, consider
the respective roles of the relevant United Nations organs
dealing with population and development, including the United
Nations Population Fund and the Population Division, regarding
the follow-up to this Programme of Action.
16.27. The General Assembly, at its forty-ninth session, in
accordance with its resolution 48/162, is invited to give further
consideration to the establishment of a separate Executive Board
of the United Nations Population Fund, taking into account the
results of the above-mentioned review and bearing in mind the
administrative, budgetary and programme implications of such a
proposal.
16.28. The Secretary-General of the United Nations is invited to
consult with the various bodies of the United Nations system, as
well as with international financial institutions and various
bilateral aid organizations and agencies, with a view to
promoting an exchange of information among them on the
requirements for international assistance of reviewing on a
regular basis the specific needs of countries in the field of
population and development, including emergency and temporary
needs, and maximizing the availability of resources and their
most effective utilization.
16.29. All specialized agencies and related organizations of the
United Nations system are invited to strengthen and adjust their
activities, programmes and medium-term strategies, as
appropriate, to take into account the follow-up to the
Conference. Relevant governing bodies should review their
policies, programmes, budgets and activities in this regard.
-----
UNITED
NATIONS
Distr.
LIMITED
A/CONF.171/PC/L.16
21 April 1994
ORIGINAL: ENGLISH
PREPARATORY COMMITTEE FOR THE
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Third session
4-22 April 1994
Agenda item 6
DRAFT FINAL DOCUMENT OF THE CONFERENCE
Reproductive rights, sexual and reproductive health
and family planning
(Chapter VII of the draft programme
of action of the Conference)
Text submitted by the Chairman of Working Group II,
Mr. Nicolaas Biegman (Netherlands), on the basis of
negotiations held on document A/CONF.171/PC/5
94-18985 (E) 210494 /...
Chapter VII
REPRODUCTIVE RIGHTS, SEXUAL AND REPRODUCTIVE HEALTH
AND FAMILY PLANNING 1/
A. Reproductive rights and reproductive health
Basis for action
7.1. Reproductive health is a state of complete physical, mental
and social well-being and not merely the absence of disease or
infirmity, in all matters relating to the reproductive system and
to its functions and processes. Reproductive health therefore
implies that people are able to have a satisfying and safe sex
life and that they have the capability to reproduce and the
freedom to decide if, when and how often to do so. Implicit in
this last condition are the right of men and women to be informed
and to have access to safe, effective, affordable and acceptable
methods of [fertility regulation] of their choice, and the right
of access to appropriate health-care services that will enable
women to go safely through pregnancy and childbirth and provide
couples with the best chance of having a healthy infant. In line
with the above definition of reproductive health, reproductive
health care is defined as the constellation of methods,
techniques and services that contribute to reproductive health
and well-being through preventing and solving reproductive health
problems. Sexual health is the integration of somatic,
emotional, intellectual and social aspects of sexual being, in
ways that are positively enriching and that enhance personality,
communication and love, and thus the notion of sexual health
implies a positive approach to human sexuality, and the purpose
of sexual health care should be the enhancement of life and
personal relations, and not merely counselling and care related
to reproduction and sexually transmitted diseases.
7.2. [Sexual and reproductive rights embrace certain human
rights that are already recognized in various international human
rights documents and in other documents reflecting international
consensus.] The cornerstone of sexual and reproductive health
rests on the recognition of the basic right of all [couples and
individuals] to decide freely and responsibly the number, spacing
and timing of their children and to have the information and
means to do so, [and the right to the enjoyment of the highest
attainable standard of sexual and reproductive health]. It also
includes respect for [security of the person and] physical
integrity of the human body as expressed in human rights
documents, [and the right of individuals to make decisions
concerning reproduction free of discrimination, coercion and
violence]. In the exercise of this right, couples and
individuals should take into account the needs of their living
and future children and their responsibilities towards the
community. The promotion of the responsible exercise of these
rights for all people should be the fundamental basis for
government- and community-supported policies and programmes in
the area of sexual and reproductive health, including family
planning. As part of their commitment, full attention should be
given to the promotion of mutually respectful and equitable
gender relations and particularly to meeting the educational and
service needs of adolescents to enable them to deal in a positive
and responsible way with their sexuality. Reproductive and
sexual health eludes many of the world's people because of such
factors as: inadequate levels of knowledge about human sexuality
and inappropriate or poor-quality reproductive health information
and services; the prevalence of high-risk sexual behaviour;
discriminatory social practices; negative attitudes towards women
and girls; the limited power many women and girls have over their
sexual and reproductive lives. Adolescents are particularly
vulnerable because of their lack of information and access to
services in most countries. Older women and men have distinct
[reproductive and sexual health] issues which are often
inadequately addressed.
Objectives
7.3. The objectives are:
(a) To ensure that comprehensive and factual information
and the [full] range of [reproductive and sexual health]-care
services, including family planning, are accessible, affordable,
acceptable and convenient to the users, whether women, men or
adolescents;
(b) To enable and support responsible voluntary decisions
about child-bearing and methods of [fertility regulation] and to
have the information, education and means to do so;
(c) To meet changing reproductive and sexual health needs
over the life cycle and to do so in ways sensitive to the
diversity of circumstances of local communities.
Actions
7.4. All countries should strive to make accessible through the
primary health-care system, reproductive health to all
individuals [of all ages] as soon as possible [and no later than
the year 2015]. [Reproductive health] care in the context of
primary health care should, inter alia, include: family-planning
counselling, information, education, communication and services;
education and services for prenatal care, safe delivery,
[pregnancy termination] and post-natal care, especially breast-
feeding, infant and women's health care; prevention and
appropriate treatment of infertility; prevention of abortion and
the management of the consequences of abortion; treatment of
reproductive tract infections; sexually transmitted diseases and
other [reproductive health] conditions; and information,
education and counselling, as appropriate, on human sexuality,
[sexual and reproductive health] and responsible parenthood.
Referral for family-planning services and further diagnosis and
treatment for complications of pregnancy, delivery, abortion,
infertility, reproductive tract infections, breast cancer and
cancers of the reproductive system, sexually transmitted diseases
and HIV/AIDS should always be available, as required. Active
discouragement of harmful practices such as female genital
mutilation should also be an integral component of reproductive
and sexual health-care programmes.
7.5. [Reproductive and sexual health]-care programmes should be
designed to serve the needs of women and adolescent females and
must involve women in the leadership, planning, decision-making,
management, implementation, organization and evaluation of
services. Governments and other organizations should take
positive steps to include women at all levels of the health-care
system.
7.6. Innovative programmes must be developed to make
information, counselling and services for [sexual and
reproductive health] accessible to adolescents and adult men.
Such programmes must both educate and enable men to share more
equally in family planning, domestic and child-rearing
responsibilities and to accept the major responsibility for the
prevention of sexually transmitted diseases. Programmes must
reach men in their workplaces, at home and where they gather for
recreation. Boys and adolescents, with the support and guidance
of their parents, and in line with the Convention on the Rights
of the Child, should also be reached through schools, youth
organizations and wherever they congregate. Voluntary and
appropriate male methods for contraception, as well as for the
prevention of sexually transmitted diseases and AIDS, should be
promoted and made accessible with adequate information and
counselling.
7.7. Governments should promote much greater community
participation in reproductive and sexual health-care services by
decentralizing the management of public health programmes and by
forming partnerships in cooperation with local non-governmental
organizations and private health-care providers. All types of
non-governmental organizations, including local women's groups,
trade unions, cooperatives, youth programmes and religious
groups, should be encouraged to become involved in the promotion
of better reproductive and sexual health.
7.8. Without jeopardizing international support for programmes
in developing countries, the international community should, upon
request, give consideration to the training, technical
assistance, short-term [contraceptive supply] needs and the needs
of the countries in transition from centrally managed to market
economies, where reproductive and sexual health is poor and in
some cases deteriorating. Those countries, at the same time,
must themselves give higher priority to [reproductive and sexual
health] services, including a comprehensive range of
contraceptive means, and must address their current reliance on
abortion for fertility regulation by meeting the need of women in
those countries for better information and more choices on an
urgent basis.
7.9. Migrants and displaced persons in many parts of the world
have limited access to [reproductive health] care and may face
specific serious threats to their [reproductive and sexual health
and rights]. Services must be sensitive particularly to the
needs of individual women and adolescents and responsive to their
often powerless situation, with particular attention to those who
are victims of sexual violence.
B. Family planning
Basis for action
7.10. The aim of family-planning programmes must be to enable
individuals and couples to decide freely and responsibly the
number and spacing of their children and to have the information
and means to do so and to ensure informed choices and make
available the [full] range of safe and effective [fertility
regulation] methods. The success of population education and
family-planning programmes in a variety of settings demonstrates
that informed individuals everywhere can and will act responsibly
in the light of their own needs and those of their families and
communities. The principle of informed free choice is essential
to the long-term success of family-planning programmes. Any form
of coercion has no part to play. In every society there are many
social and economic incentives and disincentives that affect
individual decisions about child-bearing and family size. Over
the past century, many Governments have experimented with such
schemes, including specific incentives and disincentives, in
order to lower or raise fertility. Most such schemes have had
only marginal impact on fertility and in some cases have been
counterproductive. Governmental goals for family planning should
be defined in terms of unmet needs for information and services.
Demographic goals, while legitimately the subject of government
development strategies, should not be imposed on family-planning
providers in the form of targets or quotas for the recruitment of
clients.
7.11. Over the past three decades, the increasing availability
of safer methods of modern contraception, although still in some
respects inadequate, has permitted greater opportunities for
individual choice and responsible decision-making in matters of
reproduction throughout much of the world. Currently, about 55
per cent of couples in developing regions use some method of
family planning. This figure represents nearly a fivefold
increase since the 1960s. Family-planning programmes have
considerably contributed to the decline in average fertility
rates for developing countries, from about six to seven children
per family in the 1960s to about three to four children at
present. However, the full range of modern family-planning
methods still remains unavailable to at least 350 million couples
world wide, many of whom say they want to space or prevent
another pregnancy. Survey data suggest that approximately 120
million additional women world wide would be currently using a
modern family-planning method if more accurate information and
affordable services were easily available, and if partners,
extended families and the community were more supportive. These
numbers do not include the substantial and growing numbers of
sexually active unmarried individuals wanting and in need of
information and services. During the decade of the 1990s, the
number of couples of reproductive age will grow by about 18
million per annum. To meet their needs and close the existing
large gaps in services, family planning and contraceptive
supplies will need to expand very rapidly over the next several
years. The quality of family-planning programmes is often
directly related to the level and continuity of contraceptive use
and to the growth in demand for services. Family-planning
programmes work best when they are part of or linked to broader
reproductive health programmes that address closely related
health needs and when women are fully involved in the design,
provision, management and evaluation of services.
Objectives
7.12. The objectives are:
(a) To help [couples and individuals] meet their
reproductive goals in a framework that promotes optimum health,
responsibility and family well-being, and respects the dignity of
all persons and their right to choose the number, spacing and
timing of birth of their children;
(b) To prevent unwanted pregnancies and reduce the
incidence of high-risk pregnancies and morbidity and mortality;
(c) To make quality family-planning services affordable,
acceptable and accessible to all who need and want them, [while
maintaining confidentiality];
(d) To improve the quality of family-planning advice,
information, education, communication, counselling and services;
(e) To increase the participation and sharing of
responsibility of men in the actual practice of family planning;
(f) To promote breast-feeding to enhance birth spacing.
Actions
7.13. [(a) Governments and the international community should
use the full means at their disposal to support the principle of
voluntary choice in family planning.]
(b) All countries should, over the next several years,
assess the extent of national unmet need for good-quality family-
planning services and its integration in the [sexual and
reproductive health] context, paying particular attention to the
most vulnerable and underserved groups in the population. All
countries should take steps to meet the family-planning needs of
their populations as soon as possible and should, [in all cases
by the year 2015], seek to provide universal access to the [full]
range of safe and reliable family-planning methods and to related
[legally permissible] [reproductive health] services. The aim
should be to assist [couples and individuals] to achieve their
reproductive goals and give them the full opportunity to exercise
the right to have children by choice.
(c) Governments at all levels are urged to institute
systems of monitoring and evaluation of user-centred services
with a view to detecting, preventing and controlling abuses by
family-planning managers and providers and to ensure a continuing
improvement in the quality of services. To this end, Governments
should secure conformity to human rights, and to ethical and
professional standards in the delivery of family planning and
related [reproductive and sexual health] services aimed at
ensuring responsible, voluntary and informed consent.
(d) Non-governmental organizations should play an active
role in mobilizing community and family support, in increasing
access and acceptability of [family-planning and reproductive
health] services, and cooperate with Governments in the process
of preparation and provision of care, based on informed choice,
and in helping to monitor public- and private-sector programmes,
including their own.
7.14. As part of the effort to meet unmet needs, all countries
should seek to identify and remove all the major remaining
[barriers] to the utilization of family-planning services. Some
of those [barriers] are related to the inadequacy, poor quality
and cost of existing family-planning services. It should be the
goal of public, private and non-governmental family-planning
organizations to remove all programme-related [barriers] to
family-planning use [by the year 2005] through the redesign or
expansion of information and services and other ways to increase
the ability of [couples and individuals] to make free and
informed decisions about spacing [and limiting] births and
protect themselves from sexually transmitted diseases.
7.15. Specifically, Governments should make it easier for
[couples and individuals] to take responsibility for their own
[reproductive and sexual health]. [by removing unnecessary
legal, medical, clinical and regulatory [barriers] to information
and to access to family-planning services and methods.]
7.16. All political and community leaders are urged to play a
strong, sustained and highly visible role in promoting and
legitimizing the provision and use of family-planning and
[reproductive health] services. Governments at all levels are
urged to provide a climate that is favourable to good-quality
public and private family-planning and reproductive and sexual
health information and services through all possible channels.
Finally, leaders and legislators at all levels must translate
their public support for family planning and reproductive health
into adequate allocations of budgetary, human and administrative
resources to help meet the needs of all those who cannot pay the
full cost of services.
7.17. In support of fully responsible, informed, [legally and
permissible] reproductive choices, Governments are encouraged to
focus most of their efforts towards meeting their population and
development objectives through education and voluntary measures
rather than schemes involving incentives and disincentives.
7.18. In the coming years, all family-planning programmes must
make significant efforts to improve quality of care. Among other
measures, programmes should:
(a) Recognize that appropriate methods for [couples and
individuals] vary according to their age, parity, family size
preference and other factors, and ensure that women and men have
information and access to the widest possible range of safe and
effective family-planning methods in order to enable them to
exercise free and informed choice;
(b) Provide accessible, complete and accurate information
about various family-planning methods, including their health
risks and benefits, possible side effects and their effectiveness
in the prevention of the spread of HIV/AIDS and other sexually
transmitted diseases;
(c) Make services safer, affordable, more convenient and
accessible for clients and ensure, through strengthened
logistical systems, a sufficient and continuous supply of
essential high quality [contraceptives]. [Privacy and
confidentiality should be ensured];
(d) Expand and upgrade formal and informal training in
[sexual and reproductive health] care and family planning for all
health-care providers, health educators and managers, including
training in interpersonal communications and counselling;
(e) Ensure appropriate follow-up care, including treatment
for side effects of contraceptive use;
(f) In addition to quantitative measures of performance,
give more emphasis to qualitative ones that take into account the
perspectives of clients and beneficiaries, including effective
management information systems and survey techniques for the
timely evaluation of services;
(g) Family-planning and [reproductive health] programmes
should emphasize breast-feeding education and support services,
which can simultaneously contribute to birth spacing, better
maternal and child health and higher child survival.
[7.18 bis. In keeping with the policies of many nations, as
agreed to in the consensus of the 1984 International Conference
on Population, Governments should "take appropriate steps to help
women avoid abortion, which in no case should be [promoted] as a
method of family planning, and wherever possible, provide for the
humane treatment and counselling of women who have had recourse
to abortion".]
(Paragraph 7.19 may require revision in the light of the outcome
of discussions on chapters XII and XVI)
7.19. In order to meet the substantial increase in demand for
contraceptives over the next decade and beyond, the international
community should move, on an immediate basis, to establish an
efficient coordination system and global, regional and
subregional facilities for the procurement of contraceptive and
other commodities essential to reproductive health programmes of
developing countries and countries with economies in transition.
The international community should also consider measures [such
as transfers of technology to developing countries] enabling them
to produce and distribute high-quality contraceptives and other
commodities essential to reproductive health services, in order
to strengthen the self-reliance of those countries. At the
request of countries concerned, the World Health Organization
should continue to provide advice on the quality, safety and
efficacy of family-planning methods.
7.20. Provision of [reproductive health-] care services should
not be confined to the public sector but should involve the
private sector and non-governmental organizations, in accordance
with the needs and resources of their communities, and include,
where appropriate, effective strategies for cost recovery and
service delivery, including social marketing and community-based
services. Special efforts should be made to improve accessibility
through outreach services.
C. Sexually transmitted diseases and HIV prevention
Basis for action
7.21. The world-wide incidence of sexually transmitted diseases
is high and increasing. The situation has worsened considerably
with the emergence of the HIV epidemic. Although the incidence
of some sexually transmitted diseases has stabilized in parts of
the world, there have been increasing cases in many regions.
7.22. The social and economic disadvantages that women face make
them especially vulnerable to sexually transmitted infections,
including HIV, as illustrated, for example, by their exposure to
the high-risk sexual behaviour of their partners. For women, the
symptoms of infections from sexually transmitted diseases are
often hidden, making them more difficult to diagnose than in men
and the health consequences are often greater, including
increased risk of infertility and ectopic pregnancy. The risk of
transmission from infected men to women is also greater than from
infected women to men, and many women are powerless to take steps
to protect themselves.
Objective
7.23. The objective is to prevent, reduce the incidence of, and
provide treatment for, sexually transmitted diseases, including
HIV/AIDS, and the complications of sexually transmitted diseases
such as infertility, with special attention to girls and women.
Actions
7.24. [Reproductive health] programmes should increase their
efforts to prevent, detect and treat sexually transmitted
diseases and other reproductive tract infections, especially at
the primary health-care level. Special outreach efforts should
be made to those who do not have access to reproductive and
sexual health-care programmes.
7.25. All health-care providers, including all family-planning
providers, should be given specialized training in the prevention
and detection of, and counselling on, sexually transmitted
diseases, especially infections in women and youth, including
HIV/AIDS.
7.26. Information, education and counselling for responsible
sexual behaviour and effective prevention of sexually transmitted
diseases and HIV should become integral components of all
reproductive and sexual health services.
7.26 bis. Promotion and the reliable supply and distribution of
high-quality condoms should become integral components of all
reproductive health-care services. All relevant international
organizations, especially the World Health Organization, should
significantly increase their procurement. Governments and the
international community should provide all means to reduce the
spread and the rate of transmission of HIV/AIDS infection.
D. Human sexuality and gender relations
Basis for action
7.27. Human sexuality and gender relations are closely
interrelated and together affect the ability of men and women to
achieve and maintain sexual health and manage their reproductive
lives. Equal relationships between men and women in matters of
sexual relations and reproduction require mutual respect and
willingness to accept responsibility for the consequences of
sexual behaviour. Responsible sexual behaviour, sensitivity and
equity in gender relations, particularly when instilled during
the formative years, enhance and promote respectful and
harmonious partnerships between men and women.
7.28. Violence against women, particularly domestic violence and
rape, is widespread, and rising numbers of women are at risk from
AIDS and other sexually transmitted diseases 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 have led 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 reproductive
health.
Objectives
7.29. The objectives are:
(a) To promote adequate development of responsible
sexuality permitting relations of equity and mutual respect
between the genders and contributing to improving the quality of
life of individuals;
(b) To ensure that women and men have access to
information, education and services needed to achieve good sexual
health and exercise their reproductive rights and
responsibilities.
Actions
7.30. Support should be given to integral sexual education and
services for children and young people with the support and
guidance of their parents, and in line with the Convention on the
Rights of the Child, that stress male responsibility for their
own sexual health and fertility and that help them exercise those
responsibilities. Educational efforts should begin within the
family unit, in the community and in the schools [at an early
age], but must also reach adults, in particular men, through non-
formal education and a variety of community-based efforts.
7.31. In the light of the urgent need to prevent unwanted
pregnancies, the rapid spread of AIDS and other sexually
transmitted diseases, and the prevalence of sexual abuse and
violence, Governments should base national policies on a better
understanding of the need for responsible human sexuality in the
realities of current sexual behaviour.
7.32. Active and open discussion of the need to protect women,
youth and children from any abuse, including sexual abuse,
exploitation, trafficking and violence must be encouraged and
supported by educational programmes at both national and
community levels. Governments should set 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. Governments should also prohibit the
production and the trade of child pornography.
7.33. Governments and communities should urgently take steps to
stop the practice of female genital mutilation and protect women
and girls from all such similar unnecessary and dangerous
practices. Steps to eliminate the practice should include strong
community outreach programmes involving village and religious
leaders, education and counselling about its impact on girls' and
women's health, and appropriate treatment and rehabilitation for
girls and women who have suffered mutilation. Services should
include counselling for women and men to discourage the practice.
E. Adolescents
Basis for action
7.34. The reproductive health needs of adolescents as a group
have been largely ignored to date by existing reproductive health
services. The response of societies to the reproductive health
needs of adolescents should be based on information that helps
them attain a level of maturity required to make responsible
decisions. In particular, information and services should be
made available to adolescents that can help them understand their
sexuality and protect them from unwanted pregnancies, sexually
transmitted diseases and subsequent risk of infertility. This
should be combined with the education of young men to respect
women's self-determination and to share responsibility with women
in matters of sexuality and reproduction. This effort is
uniquely important for the health of young women and their
children, for women's self-determination and, in many countries,
for efforts to slow the momentum of population growth.
Motherhood at a very young age entails a risk of maternal death
much greater than average, and the children of young mothers have
higher levels of morbidity and mortality. Early child-bearing
continues to be an impediment to improvements in the educational,
economic and social status of women in all parts of the world.
Overall for young women, early marriage and early motherhood can
severely curtail educational and employment opportunities and are
likely to have a long-term, adverse impact on their and their
children's quality of life.
7.35. Poor educational and economic opportunities and sexual
exploitation are important factors in the high levels of
adolescent child-bearing. In both developed and developing
countries, adolescents faced with few apparent life choices have
little incentive to avoiding pregnancy and child-bearing.
7.36. In many societies, adolescents face pressures to engage in
sexual activity. Young women, particularly low-income
adolescents, are especially vulnerable. Sexually active
adolescents of both sexes are increasingly at high risk of
contracting and transmitting sexually transmitted diseases,
including HIV/AIDS, and they are typically poorly informed about
how to protect themselves. Programmes for adolescents have shown
to be most effective when they secure the full involvement of
adolescents in identifying their reproductive and sexual health
needs and in designing programmes that respond to those needs.
Objectives
7.37. The objectives are:
(a) To address adolescent [sexual and reproductive health]
issues, including unwanted pregnancy, [unsafe abortion], sexually
transmitted diseases and HIV/AIDS, through the promotion of
responsible and healthy reproductive and sexual behaviour,
including voluntary abstinence, and the provision of [appropriate
services and] counselling specifically suitable for that age
group;
(b) To substantially reduce all adolescent pregnancies.
Actions
[7.38. Countries should remove legal, regulatory and social
barriers to sexual and reproductive health information and care
for adolescents and must ensure that the programmes and attitudes
of health-care providers do not restrict the access of
adolescents to the services and information they need. In doing
so, services for adolescents must safeguard their rights to
privacy, confidentiality, informed consent and respect.]
7.39. Countries, with the support of the international
community, should protect and promote the rights of adolescents
to [sexual and reproductive health] education, information and
care and greatly reduce the number of adolescent pregnancies.
7.40. Governments, in collaboration with non-governmental
organizations, are urged to meet the special needs of adolescents
and to establish appropriate programmes to respond to those
needs. Such programmes should include support mechanisms for the
education and counselling of adolescents in the areas of gender
relations and equality, violence against adolescents, responsible
sexual behaviour, responsible family-planning practice, family
life, [reproductive and sexual health], sexually transmitted
diseases, HIV infection and AIDS prevention. Programmes for the
prevention and treatment of sexual abuse and incest and other
reproductive health services should be provided. Such programmes
should provide information to adolescents and make a conscious
effort to strengthen positive social and cultural values.
Sexually active adolescents will require special family-planning
information, counselling and services, including contraceptive
services, and those who become pregnant will require special
support from their families and community during pregnancy and
early child care. Adolescents must be fully involved in the
planning, implementation and evaluation of such information and
services with proper regard for parental guidance and
responsibilities.
7.40 bis. Programmes should involve and train all who are in a
position to provide guidance to adolescents concerning
responsible sexual and reproductive behaviour, particularly
parents and families, and also communities, religious
institutions, schools, the mass media and peer groups.
Governments and non-governmental organizations should promote
programmes directed to the education of parents, with the
objective of improving the interaction of parents and children to
enable them to comply better with their educational duties to
support the process of maturation of their children, particularly
in the areas of sexual behaviour and [sexual and reproductive
health.]
Notes
1/ The delegation of Guatemala indicated a general
reservation on the entire chapter.
-----
.
|
|
Disclaimer: The file contained in the
box above or displayed in a separate window from a link in the
box above is NOT owned nor implied to
be owned by BeYoND THe iLLuSioN. Most files at BeYoND THe
iLLuSioN are originally from public Bulletin Board Systems
(BBS) which were popular in the days before the Internet or
from gopher, web, and FTP sites from the early days of the
Internet which no longer exist today. Essentially, all files
were acquired from the public domain in one for or another.
However, there have been occasions when copyright protected
material has appeared on BeYoND THe iLLuSIoN without permission
of the copyright holder. In these instances, we have and will
continue to remove the copyright protected file as soon as it
is brought to our attention. This can now be done using our Report Copyright Material form. Fill
out the form, and the webmaster will be notified of the
situation.
There are also times when files found on BeYoND THe iLLuSioN
have a real home somewhere else on the Internet. In these
instances, we will gladly replace the file with a link to its
true home whenever it is brought to our attention. If you know
of the true home of any of these files, you can use our Report Original URL form to bring it yo our
attention.
|
