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Focus on Population And Development
The U.S. and the UN Conference On Population and
World leaders will gather in Cairo, Egypt, in September
1994 to address crucial problems facing humanity at the
third decennial UN conference on population.  The
International Conference on Population and Development
(ICPD) presents a critical opportunity to address
problems that cause immeasurable human suffering in all
parts of the world.
Delegates to the ICPD will agree on a Program of Action
that will help guide the population programs of the
United Nations and national governments into the next
century.  The Program of Action is not a binding treaty,
but it will serve as a benchmark and standard to which
governments and agencies should strive.
The U.S. Government is taking a leadership role in
preparations for Cairo--and in articulating a new
approach to population policy.  The new approach enjoys
the support of a majority of the world's nations, both in
the industrialized North and the developing South.
Grounded in a commitment to health, development, and
empowerment, the new approach strengthens families and
communities, promotes economic and social development,
and affirms, in the words of the UN Charter, "the dignity
and the worth of the human person."
An Emerging Consensus
The new international consensus on population policy is a
recent development, but it has been decades in the
making.  Since they were implemented on a broad scale in
the 1960s, population and family planning programs have
enabled millions of men and women to plan the size and
spacing of their families.  In large part, these services
have improved the lives of millions of people, but they
have periodically drawn criticism for narrowly focusing
on lowering birthrates and insufficiently addressing
human rights, women's health, and cultural differences.
Previous UN conferences on population were marked by
heated debates on how to address population growth and,
indeed, whether population growth is a problem at all.
At the World Population Conference in Bucharest in 1974,
the U.S. and other industrialized countries advocated
programs to slow growth rates, while the developing
countries countered that "development is the best
contraceptive."  By 1984, when the UN held its second
conference on population in Mexico City, many positions
were reversed.  The developing countries acknowledged the
need for the population programs, but the U.S. delegation
pronounced population a "neutral factor" and scaled back
family planning efforts worldwide.  During the 1992 earth
summit in  Rio de Janeiro, delegates vigorously debated
the role of population in sustainable development.
In welcome contrast, preparations for the Cairo
conference have been characterized by an extraordinary
degree of international agreement.  The new consensus
reflects, in part, the degree to which population
professionals have responded to concerns voiced by
women's groups and the citizens of developing
countries.  It also is a product of improved
understanding of the complex context in which decisions
about childbearing are made.  There is now broad
agreement that development and family planning can work
separately to slow population growth but that they work
most effectively when pursued together.  There also is
increasing recognition that population growth is part
of a constellation of factors that can cause
environmental degradation.  And it is widely
acknowledged that family planning should be provided as
part of broader primary and reproductive health
initiatives, that population policy encompass economic
opportunity for women, and  that legal and social
barriers to gender equality be eliminated.
The preparatory process for the Cairo conference also
has benefited from a high level of citizen
participation.  More than 1,200 representatives of
citizens' groups attended the last preparatory meeting
in New York. They have played an important role in
drafting conference documents.  Many were women who
came from diverse backgrounds and all regions of the
world.  The U.S. delegation included 10 citizen
representatives, including women's health experts,
environmentalists, and population experts.
The Administration actively pursued the input of
citizens and organizations in the development of its
new policies.  State Department representatives
participated in town meetings from coast to coast
and conducted meetings encouraging participation in
document drafting.  Continuous outreach for input
has been at the crux of U.S. preparations.  The
increased international involvement of citizen
groups signals an important shift--from top-down
imposition of "population control" measures to
community-based programs that are crafted to respond
to the needs of individuals and families.
North-South Agreement
At previous UN population conferences, the fault lines
of debate tended to separate industrialized and
developing countries.  The Cairo process, in contrast,
has prompted far more cooperation between North and
South.  This may imply a greater understanding that
political boundaries are porous; that modern-day
plagues of environmental devastation and disease do not
respect national borders, and increasing globalization
has drawn more tightly the bonds that connect us.  The
problems facing the human community--although they
differ greatly in magnitude--are the same the world
over.  We all aspire to have strong families, secure
livelihoods, high-quality health care, and a healthy
environment.  We share a concern about the world that
our children will inherit and struggle to maintain our
moral compass in a world that is rapidly changing.
These shared concerns are each, in some way, enmeshed
with the issue of population growth.  The size and rate
of growth of the human population certainly affects the
quality of public health, opportunities for employment,
and the ability of families and societies to provide
for their members.  But there are other, equally
important factors:  the way resources are used and
distributed and the economic, political, and social
factors that moderate access to opportunity.
Participants in the Cairo conference will address
population growth not simply as a problem of numbers
but as one of many factors that shape the human
prospect.  Our guiding vision is of stabilized
population growth and sustainable development, which
meets the needs of current generations without
compromising the ability of future generations to meet
their needs.  Successfully realized, this goal will
assure broad- based economic growth; protect the
environment; and enhance human rights, health, and
The theme of the Cairo conference, "Choices and
Responsibilities," encapsulates the new approach to
population issues.  This emphasis reinforces the U.S.
conviction that the decision to bear a child is a
profoundly personal one and that men and women have the
right to decide freely the number and spacing of their
children.  With choice, however, comes responsibility.
The Cairo conference underscores the responsibilities
of parents to their children, of men and women to each
other, of governments to their citizens, of caregivers
to their clients, and of current to future generations.
A Program of Action
Following is a broad outline of the issues to be
discussed in Cairo, with a brief summary of how each
issue is addressed in the conference's Program of
Action.  The Program of Action is a draft in progress;
final language will be approved by consensus in Cairo.
The U.S. Government supports the emerging common ground
embodied in the Cairo Program of Action; therefore, the
following also may be read as a statement of U.S.
population policy.  U.S. domestic policies in this area
are identical to those it supports internationally.
The U.S. does not employ a "double standard" in which
it advocates programs and policies in other countries
that it would not sanction at home.
The Family.  Families are the basic unit of society.
They are the nurturers, caregivers, role models, and
teachers who instill shared societal values.  Around
the world, they also are challenged as never before.
The number of single-parent homes has soared to as many
as one in three worldwide.  Families are sundered for
many reasons--divorce, death, war, or migration in
search of economic opportunity.  But the result is
often the same:  Most single-parent families are headed
by women, many are desperately poor, and children are
denied the benefits of an intact family.
The Cairo Program of Action seeks to preserve the integrity
of families and help those that face special challenges,
such as single-parent families and extended families caring
for the elderly.  Improved health care and greater economic
security, which are discussed in more detail, are
recommended to bolster the capacity of family members to
sustain and care for each other.  The Program of Action
asks governments to ensure that men shoulder their full
share of responsibility as parents, for example, through
childrearing and the enforcement of child support laws.
Governments also are urged to help increase the earning
power of poor women, especially those with children,
through training and self-help programs.  The Program of
Action also calls for measures that enable parents to
combine family responsibilities and labor force
participation.  An example of such policies is the Family
and Medical Leave Act, signed into law by President Clinton
in 1993, which  guarantees that no worker will have to
choose between keeping his or her job and caring for a new
child or sick family member.
Elderly men and women are valued members of the family.
In the developed countries, falling birth rates and
medical advances have created a sharp increase in the
number of elderly men and women:  By the year 2025,
people over 60 years of age are expected to comprise
nearly one-fourth of the population.  Sadly, the erosion
of extended family networks has left many older men and
women without adequate care and support.  The Cairo
Program of Action seeks to repair frayed support networks
by promoting the strengthening of social security systems
and enhancing the ability of families to care for elderly
Sustainable Development.  Despite the great technological
advances of the last halfcentury, a global chasm of
inequity still separates rich and poor.  While a billion
of the world's people live in relative affluence, an-
other billion exist on the knife-edge of survival.  One
person in five does not have enough to eat.  Despite
decades of development efforts, the gap between rich and
poor nation--and inequalities within nations--remains
In much of the developing world, poverty is both a cause
and effect of population growth.  Mortality rates have
fallen steeply due to public health advances, but
fertility remains high, in part, because poor families
rely on children for social and economic security.  A
destructive synergism takes hold:  Rapid population growth
perpetuates poverty by straining the ability of families
and societies to support their members, and economic
uncertainty, in turn, fosters rapid population growth.
Among the greatest challenges we face as a global
community is that of assuring secure livelihoods for the
world's people.  This problem is especially acute in the
developing countries, where the UN estimates that a half-
billion people currently are unemployed or underemployed.
To accommodate their growing populations, those countries
must create some 30 million new jobs each year just to
maintain current employment levels.  Few consider it
likely that the strained governments of the developing
world can generate increases of that magnitude.
At the UN Conference on Environment and Development
(UNCED) in Rio in 1992, world governments agreed to
"Agenda 21"--a worldwide blueprint for sustainable
development. The ICPD Program of Action reinforces many
of the UNCED objectives, without rewriting Agenda 21.
The Program of Action recommends steps to both stabilize
population growth and foster broad-based economic
development.  It asks the international community to
rethink trade policies to maximize job creation in the
industrial, agricultural, and service sectors; to seek
methods of reducing the debt burden on developing
countries; and to promote development strategies that
enhance the personal and economic potential of the
world's poorest citizens through health care, education,
and training.  For their part, developing country
governments are urged to create and sustain democratic
institutions, curtail corruption, and redirect domestic
budget priorities to human resource development.
Gender Equity.  Another inequitable divide separates
boys and girls, men and women.  In many parts of the
world, girls are fed less, given less medical care,
withdrawn from school earlier, and forced into hard
labor sooner than boys.  Women, who perform an
estimated 60% of the world's work, own only 1% of the
world's land and earn just 10% of the world's income.
This inequity exacts another toll in women's lives,
health, and potential and is closely associated with
high fertility.  Where they are denied education,
secure livelihoods, and the full legal and social
rights of citizenship, women depend on children as
their only means of attaining status and security.
Efforts to increase women's selfdetermination have been
shown to improve the health and well- being of women
and their children and to slow the pace of population
growth.  For example, women with even a primary school
education have fewer, healthier, and better-educated
children and are far less likely to die in childbirth
than their uneducated peers.
Improving the status of women is a core objective of
the Cairo conference.  The Program of Action urges
governments to close the gender gap in education and
political life and to eliminate all forms of
institutionalized discrimination against women, for
example, in hiring practices, access to credit, and
property-ownership laws.  It condemns the preferential
treatment of boy children and encourages affirm- ative
measures to improve the health, nutritional status, and
self-esteem of girls.
Health.  In the past 50 years, global life expectancy has
increased by nearly 20 years, and the risk of dying in the
first year of life has fallen by almost two-thirds.  While
these gains are significant and encouraging, they mask
persistent disparities between rich and poor.  Poor people
worldwide--particularly women and children--sicken and die
by the thousands from health problems that are readily
preventable and curable.
Every year, 500,000 women die of pregnancyrelated causes.
The vast majority of those deaths take place in the
developing world.  An African woman, for example, is 200
times more likely than a European woman to die in
childbirth.  The infant mortality rate in the developing
countries is six times higher, and the child mortality
rate is  seven times higher, than in developed countries.
Disparities exist within countries as well.  In the U.S.,
infant mortality among whites is at 8 per 1,000 births,
while African-American infant mortality is at 18 per
1,000--a rate higher than that in Cuba or Poland.
Maternal and child mortality is closely associated
with insufficient family planning services and
reproductive health care.  At least 100 million women
in the developing world--one in six married women
outside China--wish to avoid or postpone pregnancy
but lack access to modern contraception.  And even
where family planning and reproductive health
services are available in developing countries, the
quality of care is often poor.  When couples lack the
ability to plan and space their pregnancies, high
fertility takes a great toll on women's lives and
health.  The leading causes of maternal deaths are
postpartum hemorrhage, which is most common among
poor women who have had several closely spaced
pregnancies, and unsafe abortion.  Between 50 and 60
million abortions are performed each year, nearly
half of which are illegal and often unsafe.
High fertility takes a toll in children's lives as well.
A child born less than two years after a previous birth
is more likely to die before his or her fifth birthday.
Child mortality and high fertility form another
destructive synergism:  Where infant and child mortality
rates are high, parents tend to have more children in the
hope that some will survive, yet high fertility results
in an even greater number of infant and child deaths in
the absence of necessary health services.
The ominous advance of AIDS and other sexually
transmitted diseases (STDs) poses another threat to
global health.  The World Health Organization
estimates that, in 1994 alone, approximately two
million people will become infected with HIV, the
virus that causes AIDS.  Women are the fastest-
growing population of persons living with AIDS and
HIV infection.  In some U.S. cities, AIDS already has
become the leading cause of death among vulnerable
groups of women, especially those between the ages of
15 and 45.
The Cairo Program of Action recommends several measures
to halt these pandemics of disease and death.  It calls
for extending integrated primary, maternal, and child
health services to all, and ensuring universal access
to prenatal care, immunization coverage, and programs
to combat malnutrition.  Such programs are urged to pay
particular attention to the most vulnerable and
underserved groups in the population and to remove
barriers to access.  The Program of Action asks
governments to develop multisectoral strategies to
combat AIDS and other STDs, particularly through early
diagnosis and treatment and public education campaigns
stressing the importance of safe and responsible sexual
Improved family planning and reproductive health
services are a cornerstone of the Program of Action's
recommendations to improve health.  The Program of
Action asks governments to assess the extent of unmet
need for family planning services and to provide
universal access to the full range of safe
contraception and reproductive health services.  It
rejects the use of incentives, such as cash gifts to
those who agree to use contraception, as well as
disincentives, such as policies that punish families
for having more than a certain number of children.
The Program of Action does not promote abortion, but it
does recognize the need to address unsafe abortions as
a critical public health concern.  This issue has
generated some controversy in the preparations for
Cairo, because although abortion is permitted under
some circumstances in 173 of 190 countries, national
laws on abortion vary.  The Program of Action will be
implemented by each country in accordance with national
law and international human rights standards.
Agreement exists on reducing the need for abortion
through the provision of safe and effective family
planning services.  Although the specific language for
this section is still being negotiated, governments are
considering reviewing their laws pertaining to
abortion, with the aim of including as a basis a
commitment to women's health and well-being.  The
international community is still working on language to
ensure that women have access to quality health care
services, including reliable information, counseling,
and medical care to enable them to terminate their
pregnancies in those cases allowed by law, as well as
access to services to provide for the management of
complications of unsafe abortions.
Adolescents.  Adolescent sexual activity and fertility
pose a special set of problems and challenges.
Adolescents often are directly or indirectly coerced
into early sexual activity, either through forced
marriage or the seemingly inexorable forces of peer
pressure.  Although men and women are marrying later in
many parts of the world, adolescent marriages are still
common in some areas.  In Mali, for example, the
average age for marriage is 16.  And in the U.S., one
in five 15-year-old girls has had sex at least once;
the comparable figure for boys is two in five.  Many
adolescents lack the emotional and cognitive maturity
to enter into responsible sexual relationships.
Whether it takes place within or outside marriage,
early sexual activity risks the lives and well-being of
young women and their children.  Adolescent mothers are
twice as likely to die in childbirth as mothers aged
20-24, and their babies are more than twice as likely
to die in their first year of life.  Moreover,
adolescent motherhood-particularly among the unmarried-
-can sharply limit a young woman's education and
earning potential, as well as her children's horizons.
And sexually active adolescents risk exposure to deadly
STDs, including increased incidence of AIDS among
teenagers.  Among unmarried teens, STDs and unplanned
pregnancies may reflect their lack of access to family
planning and reproductive health services, which are
often limited to married couples.
These problems are expected to grow along with the
burgeoning world population of adolescents which, by the
year 2000, is expected to number 1 billion.  Accordingly,
the Program of Action offers several strategies to
address sexual activity and fertility.  It asks
governments to enforce laws governing the minimum age of
consent and age at marriage.  The Program of Action also
recommends programs to curtail adolescent pregnancy by
encouraging young teens to delay the initiation of sexual
activity.  In addition to emphasizing the importance of
interpersonal relationships and responsibilities of
sexuality, the Program of Action advocates measures to
ensure that adolescent girls have alternatives to early
childbearing, such as educational and employment
opportunities.  Governments are asked to ensure that
those teens who are sexually active have access to
appropriate counseling, family planning, and reproductive
health services.  The Program of Action recognizes that
parents have a central role in teaching their adolescent
children about moral and responsible behavior and
recommends programs that support and strengthen that
The Environment.  Our planet's thin layer of life is
threatened as never before.  Ozone depletion, climate
change, and species loss are all red alerts that we
have strained the regenerative capacity of ecological
systems.  These problems have deeply disturbing
implications for future generations.  As the U.S.
National Academy of Sciences and the Royal Society of
London warned in 1992, "If current predictions of
population growth prove accurate and patterns of human
activity on the planet remain unchanged, science and
technology may not be able to prevent either
irreversible degradation of the environment or
continued poverty for much of the world."
Population growth per se is not a direct cause of
environmental problems; the effect of any given
population on the environment can be magnified or
mitigated by patterns of resource consumption and
technology.  The industrialized world has the most
environmentally damaging habits and technology, and,
therefore, contributes the lion's share to trends
attributed to global environmental degradation.
Estimates show that, with only 22% of the world's
population, the developed countries use two-thirds of all
resources consumed and generate 75% of all pollutants and
wastes.  Many analysts believe that the earth cannot
support all of its current--much less future--inhabitants
at contemporary Northern levels of consumption.  A
central challenge for the international community is,
therefore, to craft a paradigm of development that meets
human needs at lower environmental cost.
The Program of Action emphasizes the role of
unsustainable resource use as a cause of environmental
problems and urges the development and sharing of
environmentally sustainable technologies and practices.
It also calls for the integration of population dynamics
into planning for sustainable development and asks
governments to integrate women into matters of natural
resource protection and management.
Urbanization-Migration.  Whether from country to city or
from one country to another, many people have
traditionally moved in search of improved opportunities--
a better job; better surroundings; a better quality of
life.  In recent decades, millions have sought better
lives by moving to urban areas, and cities have
mushroomed.  The number of cities with populations of
more than 1 million rose from 111 in 1960 to 288 in 1990,
more than two-thirds of which are in the developing
world.  Building capacity to provide housing, employment,
and sanitation for growing urban populations is a major
challenge for many countries.  To meet that challenge,
the Program of Action promotes urban development that is
both participatory and environmentally sustainable.  It
also urges governments to provide services for migrants
from rural areas, in order to improve their health and
earning potential.
Other migrants seek better lives across national
boundaries.  International migration encompasses two
distinct phenomena:  the voluntary movements of people
which are beneficial to both migrants and host countries,
such as family reunification and legal labor migration;
and what has been called "irregular" migration--those
flows which are involuntary (refugees) or illegal
(undocumented labor migration).  While reliable global
statistics are hard to come by, it is safe to say that
international migration is increasing.  Refugee flows,
which take place mostly within and between developing
countries, also have escalated in size and volatility in
recent years.  Data linking population growth to migration
outflows are inconclusive because it is difficult to
isolate the role of population growth from other variables
influencing migration.  But it is clear that the combined
effects of rapid population growth, poverty, resource
depletion, and human rights violations can fuel political
unrest and drive population growth movements, particularly
irregular migration, which can destabilize both sending
and receiving countries.
The Cairo Program of Action reflects a growing awareness
that more must be done to address the root causes of
irregular migration.  Stepped-up border control measures,
while necessary, will not be sufficient to cope with
illegal immigration; nations need to address the panoply
of social and environmental problems that impel people to
leave their homes.  Governments are asked to take measures
to improve the quality of life in migrant-sending
countries by, for example, fostering employment, opening
markets, promoting good governance, and preventing land
degradation.  The Program of Action also urges governments
to adopt effective sanctions against those who profit from
smuggling aliens and to safeguard the human rights of
undocumented migrants.  The international community is
asked to continue to protect refugees and asylees, to seek
to reduce the pressures that fuel refugee movements, and
to support international refugee assistance.
Investments.  The Cairo Program of Action represents more
than agreement in principle.  Both developed and
developing countries have renewed their commitment to
provide resources for family planning, health, and human
development programs.  In the U.S., the President's
budget request for family planning and reproductive
health programs for fiscal year 1995 is $585 million, an
$83million increase over the previous year.  Additional
resources also are needed for child health, education,
and development programs.  Japan has agreed to spend $3
billion over seven years on a broad package that includes
family planning, reproductive health, AIDS prevention,
maternal and child health, and basic education--a tenfold
increase over current spending.  Germany has indicated
that it will significantly increase its current
contribution, after doubling its investment over the past
four years, and the European Union announced recently
that its contributions will increase tenfold to $350 mil-
lion by the year 2000.  Australia and the United Kingdom
also are reported to be planning significant increases.
Developing countries, which provide at least two-thirds
of the financing for population programs, will foster
local partnerships with nongovernmental organizations to
make optimal use of those resources.
The International Conference on Population and
Development is a crucial milestone on our long journey
toward population stabilization and sustainable
development.  The challenges before the global community
are great, but we are compelled to act by moral
imperatives to alleviate human suffering and to safeguard
our collective future.
There are plenty of sound reasons for hope.  For all the
difficulties we face, we can still say that in the last
50 years we have made more progress in alleviating human
misery than in the previous two millennia.  Life
expectancy in the developing countries grew by one-third,
death rates for infants and children were cut in half,
and real incomes more than doubled.  If we could do all
that while burdened with the political and economic costs
of the Cold War, how much greater should be the goals we
set ourselves now?
The Cairo conference offers an unparalleled opportunity
to define and meet those goals.  The emerging
international consensus on population issues provides a
firm basis for action, and the Clinton Administration is
poised to take a leadership role in Cairo and beyond.
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