Making Cairo Real
The Programme of Action by itself will not bring about change. It is a tool that people can use to hold their governments and international agencies accountable to the commitments they made in Cairo. While governments, donors, and international agencies have taken a major step forward in redefining the scope of population policy and the specific actions needed to achieve it, considerable work is required to determine how best to implement the plan in specific countries and agencies, and to ensure that action is taken.
BUILDING POLITICAL WILL
The actions undertaken by women throughout the Cairo process to bolster and forge political will and to establish themselves at the policy table are illustrative of the continuing action needed to implement the Programme of Action. For years women have been mobilizing, particularly in the South, to transform population programs and policies. After the United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro in 1992, women and women's organizations were particularly determined to affect population-related polices, which had received scant attention in Agenda 21, the action plan produced by that conference. Women decided that they must be a positive force at the ICPD.In the two years between UNCED and ICPD, women mobilized around the world-at local, national, regional, and international levels-building solidarity, while recognizing and respecting their diversity. At national levels, women formed organizations, convened local and national meetings to articulate their views, lobbied governments, negotiated to be included on delegations, and did staff work for their governments. In many regions of the world, women raised funds for cross-national meetings and strategy sessions (at least four regional meetings took place from 1992-1994), as well as to enable participation in the intergovernmental regional preparatory meetings organized by the United Nations.
In January 1994, 215 women from 79 countries met to prepare for ICPD and to provide a forum for identifying commonalities on reproductive health and justice. This meeting produced the "Rio Statement on Reproductive Health and Justice," which sets population policy and reproductive and sexual health and rights in the broader context of macro-economic policies, sustainable development, and human rights concerns.
In the UN Preparatory Committee meetings and at ICPD itself, hundreds of women from around the world worked together as a Women's Caucus and in small, focused teams to define and lobby for women's concerns in the draft Programme of Action. Women were the most organized and strategically focused NGO group throughout the process.
It was my mother's life and my grandmother's life that brought me to this issue. And the hope that my daughter's life won't find the same needs unmet and uncared for.GITA SEN, PROFESSOR Indian Institute of Management
"Vatican Is Target of Women's Protest"
The Earth Times, 9/9/94
It is also tragic that so many women have had to die from pregnancies before we realized that the traditional mother-and-child health programs, effective in saving the lives of so many children, have done too little to save the lives of women.GRO HARLEM BRUNDTLAND, PRIME MINISTER 0F NORWAY
Opening Statement to the ICPD
DELIVERING REPRODUCTIVE HEALTH
The task of implementing the Cairo agenda is particularly challenging in the arena of reproductive health. As reproductive health and related issues are central to the mission and expertise of IWHC, the following pages focus on how reproductive health can be made a reality.Many population and family planning agencies, governments, and population donors are confused and tentative about how to reconfigure existing health care structures to provide reproductive health care, as defined in the Programme of Action (defined in Paragraph 7.2). This definition encompasses sexual health and views family planning as one component of broader health strategies.
Much of what has been written since the ICPD asserts that we do not know what reproductive health means at the program level, or that we cannot act until we have indicators and measures for assessing program outcomes. Some argue that existing structures for health and family planning simply cannot attempt to incorporate broader reproductive health approaches because they are underfunded, understaffed, and built on fragile and eroding primary health care systems. However, the mandate from Cairo was to change these circumstances. There is already much that we know. The rest we will learn by testing strategies and developing indicators rooted in realities, not theory.
Principles of Reproductive Health
Several principles should guide the process of turning reproductive health rhetoric into reality:
- We must begin with, and have as our ultimate objective, comprehensive, good quality reproductive and sexual health services, that foster women's rights and empowerment, while ensuring that men take responsibility for their own sexual behavior, fertility, and the well being of their partners and children.
- Programs and services should be developed to suit particular circumstances, contrary to current requests for a "model" approach that implies "one size fits all."
- The process must be participatory and emphasize the involvement of women, beginning with the women from virtually every country who were active in the Cairo process.
- We can utilize the resources we already have more efficiently; we do not have to wait for new money, new data, or new staff.
How to Implement a Reproductive Health Approach
Each of the various players will, of course, face some constraints on how much initiative they can take, but all can contribute to imple menting the new ICPD reproductive health approach. For governments, international agencies, and NGOs that have focused primarily on family planning, the first-and most urgent -- obligation is to ensure the quality of those services (i.e., medical technique, contraceptive choice, full and unbiased information about the advantages and disadvantages of all methods of fertility regulation, and respect for clients' health and rights). These agencies could then begin to adopt a "reproductive health approach to family planning" on a priority basis, as follows:
- Reconsider the range of appropriate contraceptive choices, taking into account whether any individual client and/or the majority of clients are likely to be at risk of STD/HIV infection. This would require, for example, analyzing whether IUDs should be offered to certain clients or in specific settings. It would also require serious reassessment of the need for increased investment in condom promotion by all family planning agencies, as either the primary contraceptive method or in combination with another method (whether modem or traditional).
- Greatly increase investments in, and experiments with, programs for men to make condom use a real and attractive choice for couples; increase investment in vasectomy education and services.
- Assess the appropriateness of current policies on contraceptive choices for women in the period immediately after birth.
- Create, through participatory processes, programs to provide information and services for adolescents, taking into account not only sexuality but gender relations.
- Develop counseling that is truly empowering. This counseling would ensure that women understand their fertility regulation choices and can effectively act on their decisions.
Counselling would help women under stand how their bodies function, including the menstrual cycle, pregnancy, and the facts that the sperm determines the gender of the child, and the man can be the source of infertility in the couple. Such understanding would result in many benefits, not least of which is the potential for improved relations and negotiations between partners.
- Give highest priority in the fertility regulation research agenda to development of barrier methods that women control to protect themselves against STD/HIV infection, both with and without contraceptive action. High priority should also be given to creating more contraceptive choices for men.
- Build systematic relationships, including effective referral mechanisms, with maternal health, child health, gynecological, and STD/HIV programs, with the ultimate objective of integration.
Agencies that have been primarily concerned with maternal and child health (MCH) need to prioritize the "M" in MCH, which is still neglected despite the Safe Motherhood Initiative launched by the UN in 1987. These agencies also need to interact more effectively and systematically with family planning programs, STD/HIV programs, and women's health agencies. Likewise, STD/HIV programs can effectively include women in the general population as their clientele by providing referral to, and serving clients from, family planning and MCH programs.
Governments and donors can give higher priority to women's health by reallocating budgets and other resources, as well as redirecting research. Those few countries (e.g., Brazil, Colombia, and Australia) that already have comprehensive women's health policies, but have not implemented them or are pulling back, need to act now.
We already know a great deal about what needs to be done to make reproductive health and better health care for all -- women, children, and men -- a reality. Now, we must generate the will to act. Women and women's groups have central roles to play: as advocates (as in the Cairo process), service providers, researchers, lawyers, policy-makers, and community leaders.
The follow-up is in the hands of the people. We have to be careful we don't let governments off the hook.SANDRA KABIR, FOUNDER - PRESIDENT
Bangladesh Women's Health Coalition
"Population Strategists Must Transfer Talk into Action"
Calgary Herald, 9/16/94
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