United Nations A/69/62, 12 February 2014
In English: http://www.unfpa.org/sites/default/files/pub-pdf/ICPD_beyond2014_EN.pdf
In French, Chinese, Russian, Spanish and Arabic: http://www.unfpa.org/publications/framework-actions-follow-programme-action-international-conference-population-and
Executive summary
The present report has been prepared pursuant to General Assembly resolution 65/234, in which the Assembly, responding to new challenges and to the changing development environment, and reinforcing the integration of the population and development agenda in global processes related to development, called for an operational review of the implementation of the Programme of Action on the basis of the highest-quality data and analysis of the state of population and development, taking into account the need for a systematic, comprehensive and integrated approach to population and development issues.
The Programme of Action of the International Conference on Population and Development, adopted in 1994, represented a remarkable consensus among 179 Governments that individual human rights and dignity, including the equal rights of women and girls and universal access to sexual and reproductive health and rights, are a necessary precondition for sustainable development, and set forth objectives and actions to accelerate such development by 2015. Achievements over the ensuing 20 years have been remarkable, including gains in women’s equality, population health and life expectancy, educational attainment and human rights protection systems, with an estimated 1 billion people moving out of extreme poverty. Fears of population growth, which were already abating in 1994, have continued to ease, and the expansion of human capability and opportunity, especially for women, which has led to economic development, has been accompanied by a continued decline in the population growth rate from 1.52 per cent per year from 1990 to 1995 to 1.15 from 2010 to 2015. Today, national demographic trajectories are more diverse than in 1994, as wealthy countries of Europe, Asia and the Americas face rapid population ageing while Africa and some countries in Asia prepare for the largest cohort of young people the world has ever seen, and the 49 poorest countries, particularly in sub-Saharan Africa, continue to face premature mortality and high fertility.
Our greatest shared challenge is that our very accomplishments, reflected in ever-greater human consumption and extraction of the Earth’s resources, are increasingly inequitably distributed, threatening inclusive development, the environment and our common future.
The evidence of 2014 overwhelmingly supports the consensus of the International Conference that respect, protection, promotion and fulfilment of human rights are necessary preconditions for improving the dignity and well-being of women and adolescent girls and for empowering them to exercise their reproductive rights, and that sexual and reproductive health and rights and understanding the implications of population dynamics are foundational to sustainable development. Safeguarding the rights of young people and investing in their quality education, decent employment opportunities, effective livelihood skills and access to sexual and reproductive health and comprehensive sexuality education strengthen young people’s individual resilience and create the conditions under which they can achieve their full potential.
The path to sustainability, outlined in the present framework, will demand better leadership and greater innovation to address critical needs: to extend human rights and protect all persons from discrimination and violence, in order that all persons have the opportunity to contribute to and benefit from development; invest in the capabilities and creativity of the world’s young people to assure future growth and innovation; strengthen health systems to provide universal access to sexual and reproductive health to enable all women to thrive and all children to grow in a nurturing environment; build sustainable cities that enrich urban and rural lives alike; and transform the global economy to one that will sustain the future of the planet and ensure a common future of dignity and well-being for all people.
The report provides an analysis and recommends key areas for future action for a new framework for population and development beyond 2014, in five proposed thematic pillars: dignity and human rights; health; place and mobility; governance and accountability; sustainability.
The following extract outlines the key areas for future action in health.
Health
Accelerate progress towards universal access to quality sexual and reproductive health services and fulfilment of sexual and reproductive rights
An alarmingly high proportion of people, particularly the poor, continue to live without access to sexual and reproductive health services. Economic growth, by itself, is insufficient to ensure universal, equitable coverage, and therefore countries must dedicate resources to ensure that all persons have access to affordable, quality care. Current discussions give considerable weight to “universal health coverage” as a means to assure that all persons have access to health care without financial hardship.
The highest priority should be to strengthen primary health-care systems to make integrated, comprehensive, quality sexual and reproductive health services, with adequate referrals, accessible to where people, especially rural, remote and resource-limited populations, including the urban poor, live. These efforts should ensure the availability of the widest range of technologies and commodities, as well as the strengthening of health management information systems.
Special attention should be directed towards ensuring that human resources are available and accessible to provide comprehensive, quality sexual and reproductive health services, including by investing in the capacity of health workers, particularly mid-level cadres such as midwives, addressing maldistribution and strengthening health training institutions.
Improved availability and accessibility must be coupled with improved quality of sexual and reproductive health services to support each person in a holistic and integrated way, protect the human rights of all persons, and ensure the privacy and confidentiality of services and information regarding patient rights.
Protect and fulfil the rights of adolescents and youth to accurate information, comprehensive sexuality education and health services for their sexual and reproductive well-being and lifelong health
Rates of sexually transmitted infection and HIV infection and AIDS-related mortality, abortion-related deaths and maternal deaths among young people reveal the urgent need to address the inadequate access to information and services currently experienced by the largest generation of adolescents and youth in history.
Greater investment must be made in information and services so they are accessible and acceptable to adolescents and youth. Programme monitoring and evaluation should explicitly assess the extent to which adolescents are being reached, and which interventions bring the greatest long-term health and well-being for young people.
The sexual and reproductive health of adolescent girls requires ending gender inequality in education, adopting and enforcing a legal minimum age of marriage of 18 years, eradicating female genital mutilation/cutting and other harmful practices, and eliminating all forms of discrimination and violence against girls. Such protections of adolescents and youth are essential in order to create a society in which they can build their capabilities, expand their education and enter freely into marriage and childbearing.
To realize sexual and reproductive health and rights, adolescents and youth, both in and out of school, should receive comprehensive sexuality education that emphasizes gender equality and human rights, including attention to gender norms, power and the social values of equality, non-discrimination and non-violent conflict resolution. Such programmes can also empower young people to adopt healthy behaviours, with lifelong benefits for themselves and for society at large.
All programmes serving adolescents and youth, in and out of school, must provide referral to reliable, quality sexual and reproductive health counselling and services, as well as other health services including mental health. Legal, regulatory and policy barriers limiting young people’s access to sexual and reproductive health services should be removed.
Strengthen specific sexual and reproductive health services
Contraception
The availability and accessibility of the widest possible range of contraceptive methods, including emergency contraception, with adequate counselling and technical information, to meet individuals’ and couples’ contraceptive needs and preferences across the life course, are essential for reproductive health and reproductive rights. Yet some countries provide only a few methods, or do not make options or information widely available that would enable individuals to exercise free and informed choice, especially where health systems are weak, for example in rural areas. Decisions about what contraceptive mix to provide must be calibrated to the capacity of health service providers, while also building the health system and the capacity of health workers to provide a range of methods to meet the needs and preferences for everyone across the life course.
Abortion
With increasing access to safe abortion and post-abortion care, abortion rates as well as rates of abortion-related deaths have decreased globally, with significant regional variation. However, progress is inadequate as death rates resulting from unsafe abortion remain unacceptably high in Africa and South Asia, with more than half of these deaths occurring among young women under 25 years. Concrete measures are urgently needed to:
| (a) | Reduce unplanned pregnancies by increasing access to contraception and fulfilling the rights of women and girls to remain free from forced or coerced sex and other forms of gender-based violence; | ||||
| (b) | Ensure access to quality post-abortion care for all persons suffering from complications of unsafe abortion; | ||||
| (c) | Take action as indicated in the WHO publication Safe Abortion: Technical and Policy Guidance for Health Systems, to remove legal barriers to services; | ||||
| (d) | Ensure that all women have ready access to safe, good-quality abortion services. | ||||
Maternity care
Ninety per cent of maternal deaths are preventable, and the elimination of all preventable deaths requires a well-functioning and integrated primary health-care system that is close to where women live; effective referral mechanisms to respond to complications of pregnancy and delivery; and the availability and accessibility of functioning basic and comprehensive emergency obstetric care. To achieve universal availability and accessibility of quality maternity care requires strengthening the health system, particularly in sub-Saharan Africa and South Asia.
For each woman who dies of a pregnancy-related complication, an estimated 20 women suffer serious and often lifelong morbidities such as obstetric fistula, uterine prolapse, incontinence or severe anaemia. Maternal morbidity and case fatality rates should be increasingly utilized as indicators of the quality of sexual and reproductive health services and the progressive realization of women’s right to health.
Sexually transmitted infections, including HIV
Evidence suggests a 40% increase in the annual incident cases of sexually transmitted infections since the International Conference on Population and Development, yet data reflect widespread weakness in surveillance. Despite the facts that sexually transmitted infections have serious consequences for women’s health and fertility, contribute to miscarriage and low birth weight and can cause congenital disorders, these infections remain among the most poorly monitored, diagnosed or treated sexual and reproductive health conditions worldwide. Enhanced global commitment towards strengthening sexually transmitted infection surveillance and increasing access to effective prevention, diagnosis and treatment of sexually transmitted infections for all persons, particularly young people, is sorely needed.
Continued investment is also required to achieve universal access to HIV prevention, treatment and care, and to accelerate full integration of HIV and other sexual and reproductive health services in a manner that will holistically strengthen health systems. Further, it is necessary to scrutinize and address the structural conditions that may be contributing to the persistence of new HIV infections in Southern Africa.
Non-communicable diseases, including reproductive cancers
The prevalence, and attendant mortality and morbidity resulting from reproductive cancers further highlight the inadequacy and inequalities in access to sexual and reproductive health information, education and services globally.
More than half a million women each year develop cervical cancer, which is responsible for the death of over half that number of women, predominantly in developing countries, and which is preventable through screening and the human papilloma virus vaccine. Despite lower incidence of breast cancer in developing countries, mortality rates are higher owing to a lack of access to screening and treatment.
In all regions of the world except Africa, where there is a double burden, deaths from non-communicable diseases exceed those caused by maternal, perinatal, communicable and nutritional disorders combined, and related mortality is occurring at earlier ages in developing countries. Cardiovascular diseases, cancers, diabetes, depression and chronic respiratory diseases are responsible for the majority of non-communicable illnesses and deaths. This changing burden of disease reflects significant changes in tobacco use, harmful use of alcohol, insufficient physical activity and unhealthy diet/obesity.
It is critical to address the rising burden of reproductive cancers, including breast, cervical and prostate cancers, by investing in prevention strategies including the human papilloma virus vaccine and routine screening, early treatment at the primary care level and reliable referrals to higher levels of care.
It is also necessary to reduce risk factors for non-communicable diseases through the promotion of healthy behaviours and lifestyle choices, particularly among children, adolescents and youth.