Panel on Population and the Millennium Development Goals

Let me begin by thanking Partners in Population and Development and Jyoti Singh for inviting me to participate in this important, and timely, panel discussion on Population and the Millennium Development Goals (MDGs).

The MDGs have indeed become an important area of focus and engagement for all of us at UNFPA, the United Nations Population Fund. After all, the MDGs are closely linked with the goals and objectives agreed at the 1994 International Conference on Population and Development (ICPD).

UNFPA is committed to working with governments, the United Nations system and other partners to ensure that the MDGs are realized.

Although the important ICPD goal of promoting universal access to reproductive health is not included in the MDGs, we believe that progress towards achieving this goal is absolutely essential for meeting the other MDG targets, and especially for reducing poverty in all its dimensions.

In fact, I will be blunt and say that the Millennium Development Goals, and particularly the first goal of eradicating extreme poverty and hunger, will not be met without addressing the issues of population and reproductive health.

Population and Poverty

All of us in this room know there are clear linkages between poverty and population. Dynamics such as population growth, population structure and distribution, and urbanization and migration all impact on poverty and poverty reduction. Explicitly integrating population into economic and development strategies will both speed up the pace of sustainable development and poverty reduction and contribute to an improved quality of life of the population.

The world is now facing unprecedented demographic changes. The greying of the planet is bringing forth new challenges that must be addressed. The largest youth generation in history can be a dynamic force for progress if their needs for education, health and employment are met. Another challenge is rapid urbanization. Just 30 years ago, the urban population of the developing world was 26 per cent of the total population. Today, 40 per cent of people in less developed regions are urban dwellers.

Today, almost all population growth is taking place in urban areas in the developing world. This rapid urbanization presents an opportunity for social and economic development. But in many large cities, this unplanned growth represents a crisis with regard to living conditions as well as social and health services. Many people who leave the countryside to find better lives in the city meet, instead, a new kind of poverty in growing shantytowns with few amenities.

Today, we see clearly that population, sustained economic growth and sustainable development are so closely interconnected that none of them can be considered in isolation.

Countries that invest in their people’s education and health, including reproductive health, can enjoy a demographic bonus brought on by lower fertility rates and a large working-age population with relatively fewer dependents.

The 1994 Cairo Conference called for greater investment in people and the integration of population and development strategies. It also called for a new action agenda for the empowerment of women to ensure their full participation at all levels of society. The Cairo vision remains just as valid today as it was nine years ago. It is a vision that makes a major contribution to the achievement of the Millennium Development Goals.

 Reproductive Health

Reproductive health is really a critical cross-cutting factor for achieving the MDGs. Ensuring the right to reproductive health is essential for development, for reducing poverty and for achieving the other Millennium Development Goals to improve maternal health, reduce child mortality, empower women, combat HIV/AIDS, and ensure environmental sustainability.

A woman’s ability to control her own fertility is a source of empowerment. But many poor women cannot make basic choices about whether and when to become pregnant. They are stuck in a vicious cycle of poor health, illiteracy, high fertility and poverty. Adolescent girls and women often lack power to make decisions for themselves and also lack access to education and good quality, affordable reproductive health care, including family planning services.

While an estimated 55 per cent of married women in developing countries use family planning, contraceptive use varies widely. In some sub-Saharan African countries, for instance, less than 10 per cent of married women use contraception. Today, there are an estimated 120 million couples that would be using family planning if they had access to it. And it is estimated that the demand for contraception will increase by 40 per cent by the year 2015. So, meeting the unmet need for contraception continues to be a pressing development priority. It is especially pressing when one considers the fact that, if fertility levels remain at today’s levels, world population is projected to double to 12.6 billion by 2050, instead of 8.9 billion, which is the United Nations median projection.

Another area where greater attention and resources is needed is the provision and training of skilled birth attendants. Today, 48 per cent of all births in the developing world take place without a doctor, nurse or midwife. If complications arise, which they will in 15 per cent of all deliveries, there is a need for emergency obstetric services, which remain limited. The consequences of the shortage of these reproductive health services are tragic. Complications of pregnancy and childbirth remain a leading cause of death and disability for women in the developing world.

The lack of reproductive health services actually undermines development and makes the poor remain poor. It does so by weakening, disabling and killing poor women in their prime, disrupting and shortening the lives of their children, and placing heavy financial and social burdens on families. Today, half a million families lose a mother each year, and millions more women suffer injuries and disabilities from pregnancy and childbirth. In addition to the individual suffering and loss for the family, poor maternal health reduces women’s contribution to the market economy and seriously weakens economic growth.

Increased access to voluntary family planning, skilled attendance at birth, and emergency obstetric care are the three interventions needed to reduce maternal mortality as called for in the Millennium Development Goals. These interventions are integral components of comprehensive reproductive health services, which also reduce child mortality rates.

The Millennium Development Goal to reduce the spread of HIV/AIDS also relies on greater access to reproductive health information and services. UNFPA is working to incorporate HIV prevention and voluntary testing and counselling into all reproductive health programmes. Reducing the spread of AIDS also requires greater action for gender equality and women’s empowerment, which are key ICPD goals.

Several challenges lie ahead. The first is the need to look below the averages. Oftentimes, what looks achievable at the national level hides underlying gaps at the subregional, community or income group level. What we have found is that there are serious inequalities in access to health care with huge poor-rich differentials. Within countries and in all regions, the poorest 20 per cent of people have the highest fertility and mortality rates. It is, therefore, important that we target interventions to meet the needs of the poorest and most vulnerable.

Another challenge for monitoring MDG progress involves the question of data. Disaggregated and timely data on access to reproductive health services, maternal health and morbidity, and HIV/AIDS prevalence is essential, yet conspicuously lacking. Without this data, it is difficult for governments to make informed policy and programme decisions, to allocate resources properly and to monitor progress.

However, the largest challenge remains the need for enhanced financial support from donor countries, particularly for poor countries that need desperately to improve reproductive health, and address poverty and population issues. Today, it is in the least developed countries that population is growing most rapidly, and fertility and mortality rates are highest. This is due to a lack of education and health care services, including reproductive health care.

UNFPA is committed to expanding our circle of partners for population and development. Together, we must bring these issues to the forefront of the international development agenda and gain greater support for the ICPD Programme of Action and the key actions agreed at the fifth-year review.

In 2005, Member States will be meeting at the highest level in the United Nations General Assembly to review the first five years of implementation of the Millennium Declaration. It will be crucial for countries, as part of the preparation for that review, to explicitly address issues of population and reproductive health. And UNFPA is working with them to do so.

Before I conclude, I would like to take this opportunity to showcase a new publication prepared by the Technical Support Division of UNFPA entitled, Achieving the Millennium Development Goals: Population and Reproductive Health as Critical Determinants. The report shows the close links between population, reproductive health and poverty, and tracks progress towards achieving the MDGs.

I would also like to point out that The State of World Population 2002 report, which focused on “People, Poverty and Possibilities,” made the case that investments in population and reproductive health help individuals, families and nations to escape poverty. Finally, I would like to mention this small handbook, Population, Reproductive Health and the Millennium Development Goals, which shows, at a glance, how implementing the ICPD Programme of Action assures progress in the achievement of the MDGs.

Together, we must work to ensure that the issues of population, reproductive health and gender are articulated strongly in the MDG process and debates. We must continue to fight the politicization of these vital issues that are essential to sustainable human development. And we must remember that these are issues that are intrinsically linked to the expansion of freedom, choices and opportunity, and the improvement of the quality of life for present and future generations.

Thank you. I look forward to a fruitful discussion.