Posted by: davidjolson | 09/02/2009

Where Are We with the ICPD?

BERLIN, Germany — In September 1994, some 11,000 delegates from 179 countries gathered in Cairo, Egypt to call for universal access to a package of basic reproductive health services and other specific measures to foster human development, with a particular focus on girls and women, with specific targets set for 2015. They concluded that meeting the needs of women and men was central to reducing poverty, achieving sustainable economic growth and slowing population growth. This meeting, known as the International Conference on Population & Development, has became a marker against which progress in reproductive health has been measured.

Now, exactly 15 years later, NGOs —  including the Global Health Council and many of its members — are gathering in Berlin for “Global Partners in Action: NGO Forum on Sexual and Reproductive Health and Development,” to assess what progress has been only six years before the 2015 goals are to be met and what we still need to do to meet the goals in the next six years.

So where are we, three quarters of the way into the process? Progress has been made, but it is certainly not across the board. “The right to the highest attainable standard of health, particularly sexual and reproductive health, continues to elude millions of people, especially the poor and marginalised,” wrote four organizers of the conference in an article published Aug. 29 in The Lancet.

In 2004, on the tenth anniversary of IPCD, three GHC members (Population Action International, Family Care International and the International Planned Parenthood Federation published a report “IPCD at Ten: Where are we now?” that attempted to measure where exactly each country stood against the targets. No comparable report has been commissioned in 2009, although I picked up a brochure here in  Berlin just published by a group of organizations in Latin America and the Caribbean (Cairo +15: Cuenta Regresiva en la Implementacion del Programma de Accion de la Conferencia Internacional de Poblacion y Desarrollo) that gives some basic data on key indicators.

Here is where the 2004 special report found we were in meeting health needs at that time, with our indication of where we might be in 2009:

Family planning is still up: The 2004 report found that access to contraceptives had improved significantly in the previous 10 years. That trend has continued in the last five years but unmet need is still huge. The Latin America brochure reports good news — that the modern contraceptive prevalence rate in Latin America and the Caribbean has risen an average of 13% from 1995 to 2008 (and the increases occured in every country except Trinidad and Tobago).

Contraceptive supplies are still short: The 2004 report found that millions of people of reproductive age lacked protection from unplanned pregnancies, HIV and other sexually transmitted infections and that many clinics experienced stock-outs of contraceptive supplies. In 2009, over 200 million women lack access to modern contraceptives.

Too many mothers are still dying: Unfortunately, not much has changed since 2004. More than 500,000 women worldwide are still dying from complications of pregnancies or childbirth, including 67,000 from unsafe abortion. The 500,000 figure has not changed significantly in two decades. Millennium Development Goal 5 on maternal mortality is the MDG where the least progress has been made. A glimmer of hope can be found in the Latin American report, which shows that the average rate of maternal mortality in that region has fallen by 3% from 1995 to 2008. However, it is also true that it has risen in almost as many countries as it has fallen in.

HIV/AIDS is a continuing threat: “The HIV/AIDS pandemic has exploded worldwide since 1994,” said the 2004 report. “While some countries have succeeded in limiting its spread, infection rates are rising in others where it had not been prevalent.” In 2009, some 33 million are living with HIV and every minute, four more people are infected. But the pace of infection has slowed, and new drugs have saved countless lives in some places.

In short, some progress has been made but there is a huge amount of work left to be done and 400 delegates have come to Berlin to reinvigorate the process that the Cairo Consensus gave birth to 15 years ago. My colleague Joanne Manrique and I will be in Berlin all this week, monitoring the events and reporting back to you on the salient developments.

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