Part 1 of 2
III. RECOMMENDATIONS FOR ACTION
13. Many of the following recommendations are addressed to Governments. This is not meant to preclude the efforts or initiative of international organizations, non-governmental organizations, private institutions or organizations, or families and individuals where their efforts can make an effective contribution to overall population or development goals on the basis of strict respect for sovereignty and national legislation in force.
A. SOCIO-ECONOMIC DEVELOPMENT, THE ENVIRONMENT AND POPULATION
14. The World Population Plan of Action recognizes explicitly the importance of the interrelationships between population and socio- economic development and affirms, inter alia, that "the basis for an effective solution of population problems is, above all, socio-economic transformation" (paragraph 1) and that "population policies are constituent elements of socio-economic development policies, never substitutes for them" (paragraph 14 (d)). Consequently, the Plan of Action includes a number of recommendations dealing with socio-economic policies, the contents of which fully deserve reaffirmation and further development. The following recommendations reflect the view that if national and international policies are not adopted and implemented to increase the overall resources and the share of the world's resources going to the very poor, it will be extremely difficult for many countries to achieve the levels of fertility and mortality that they desire. The recommendations reflect the importance to be attached to an integrated approach towards population and development, both in national policies and at the international level. The recommendations also reflect the view that, although the actions of the developing countries are of primary importance, the attainment of the goals and objectives stipulated in the International Development Strategy for the Third United Nations Development Decade will require appropriate policies by the developed countries and by the international community which support the efforts of the developing countries to achieve those objectives.
Considering that social and economic development is a central factor in the solution of population and interrelated problems and that population factors are very important in development plans and strategies and have a major impact on the attainment of development objectives, national development policies, plans and programmes, as well as international development strategies, should be formulated on the basis of an integrated approach that takes into account the interrelationships between population, resources, environment and development. In this context, national and international efforts should give priority to action programmes integrating population and development.
National and international efforts should give high priority to the following development goals included in the International Development Strategy for the Third United Nations Development Decade: the eradication of mass hunger and the achievement of adequate health and nutrition levels, the eradication of mass illiteracy, the improvement of the status of women, the elimination of mass unemployment and underemployment and the elimination of inequality in international economic relations. To achieve these goals, it is further recommended that Governments should take population trends fully into account when formulating their development plans and programmes.
In order to promote the broadly based socio-economic development that is essential to achieving an adequate quality of life as well as national population objectives and to respond effectively to the requirements posed by demographic trends, all countries are urged to co-operate in efforts to achieve the above objectives and to accelerate development, particularly in developing countries, inter alia, through policies to lower barriers to trade, to increase multilateral and bilateral development assistance, to improve the quality and effectiveness of this assistance, to increase real income earnings from the export of commodities, to solve the problems arising from the debt burden in a significant number of developing countries, to increase the volume and improve the terms of international lending, and to encourage various sources of investment and, wherever appropriate, entrepreneurial initiatives. To respond to the needs of populations for employment, food self-sufficiency, and improvements in the quality of life and to increase self-reliance, productive investment should be increased, appropriate industries should be encouraged and substantial investments should be fostered in rural and agricultural development.
In countries in which there are imbalances between trends in population growth and resources and environmental requirements, Governments are urged, in the context of overall development policies, to adopt and implement specific policies, including population policies, that will contribute to redressing such imbalances and promote improved methods of identifying, extracting, renewing, utilizing and conserving natural resources. Efforts should be made to accelerate the transition from traditional to new and renewable sources of energy while at the same time maintaining the integrity of the environment. Governments should also implement appropriate policy measures to avoid the further destruction of the ecological equilibria and take measures to restore them.
B. THE ROLE AND THE STATUS OF WOMEN
15. The World Population Plan of Action (paragraphs 15 (e), 32 (b), 42 and 43) as well as other important international instruments - in particular the 1975 Mexico City Plan of Action, the 1980 Copenhagen Programme of Action for the United Nations Decade for Women and the Convention on the Elimination of All Forms of Discrimination against Women (General Assembly resolution 34/180, annex) - stress the urgency of achieving the full integration of women in society on an equal basis with men and of abolishing any form of discrimination against women. Comprehensive strategies to address these concerns will be formulated at the 1985 Nairobi Conference which is being convened to review and appraise the achievements of the United Nations Decade for Women.
16. In view of the slow progress made since 1974 in the achievement of equality for women, the broadening of the role and the improvement of the status of women remain important goals that should be pursued as ends in themselves. The achievement of genuine equality with respect to opportunities, responsibilities and rights would guarantee that women could participate fully with men in all aspects of decision-making regarding population and development issues that affect their families, communities and countries.
17. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights; likewise, the assurance of socio-economic opportunities on an equal basis with men and the provision of the necessary services and facilities enable women to take greater responsibility for their reproductive lives. The following recommendations take into account the need for actions to ensure that women can effectively exercise rights equal to those of men in all spheres of economic, social, cultural and political life, and in particular those rights which pertain most directly to population concerns.
Governments are strongly urged to integrate women fully into all phases of the development process, including planning, policy and decision-making. Governments should pursue more aggressively action programmes aimed at improving and protecting the legal rights and status of women through efforts to identify and to remove institutional and cultural barriers to women's education, training, employment and access to health care. In addition, Governments should provide remedial measures, including mass education programmes, to assist women in attaining equality with men in the social, political and economic life of their countries. The promotion of community support and the collaboration, at the request of Governments, of non-governmental organizations, particularly women's organizations, in expediting these efforts should be given paramount importance.
Governments should ensure that women are free to participate in the labour force and are neither restricted from, nor forced to participate in, the labour force for reasons of demographic policy or cultural tradition. Further, the biological role of women in the reproductive process should in no way be used as a reason for limiting women's right to work. Governments should take the initiative in removing any existing barriers to the realization of that right and should create opportunities and conditions such that activities outside the home can be combined with child-rearing and household activities.
Governments should provide women, through education, training and employment, with opportunities for personal fulfillment in familial and non-familial roles, as well as for full participation in economic, social and cultural life, while continuing to give due support to their important social role as mothers. To this end, in those countries where child-bearing occurs when the mother is too young, Government policies should encourage delay in the commencement of child-bearing.
Governments concerned should make efforts to raise the age of entry into marriage in countries in which this age at marriage is still quite low.
Governments should promote and encourage, through information, education and communication, as well as through employment legislation and institutional support, where appropriate, the active involvement of men in all areas of family responsibility, including family planning, child-rearing and housework so that family responsibilities can be fully shared by both partners.
All Governments which have not already done so are strongly urged to sign and ratify or accede to the Convention on the Elimination of All Forms of Discrimination against Women.
C. DEVELOPMENT OF POPULATION POLICIES
18. The World Population Plan of Action urges that population policies should not be considered substitutes for socio-economic development policies but rather should be integral components of those policies (paragraph 2). In formulating population policies, Governments may aim to affect one or more of the following population trends and characteristics, among others, population growth, morbidity and mortality, reproduction, population distribution, internal and international migration and population structure. The Plan also recognizes the sovereignty of nations in the formulation, adoption and implementation of their population policies (paragraph 14), consistent with basic human rights and responsibilities of individuals, couples and families (paragraph 17).
Governments are urged to adopt population policies and social and economic development policies that are mutually reinforcing. Such policies should be formulated with particular attention to the individual, the family and community levels, as well as to other factors at the micro-level and macro-level. Special emphasis needs to be given to linkages between population trends, labour supply and demand, the problems of unemployment and the creation of productive employment. Governments are urged to share their experience in integrating population policies into other social and economic development policies.
Governments are encouraged to provide adequate resources and, where appropriate, to adopt innovative measures for the implementation of population policy. To be effective and successful, population programmes and development activities should be responsive to local values and needs, and those directly affected should be involved in the decision-making process at all levels. Moreover, in these activities, the full participation of the community and concerned non-governmental organizations, in particular women's organizations, should be encouraged.
D. POPULATION GOALS AND POLICIES
1. Population growth
19. United Nations population projections, as assessed in 1982, indicate that, between 1984 and the end of the present century, the growth rate of the world population will decline more slowly than during the past 10 years. This is partly due to the fact that, as a consequence of high fertility levels in the past, the number of women of child-bearing age (15-49) will continue to grow rapidly. Although, according to the medium variant projections, the total fertility rate during this period is expected to decline from 3.6 to 3.0 children per woman, the annual rate of growth is projected to reach only 1.5 per cent. For the world as a whole, the present annual increment of 78 million is projected to increase to 89 million by 1995-2000. Thus, in the 16 years from 1984 to 2000, the world population is expected to increase by 1.3 billion, from 4.8 billion in 1984 to 6.1 billion in 2000.
20. These global perspectives conceal significant demographic differences existing at the regional as well as the country levels. According to the United Nations estimates, the current total fertility rates range from 6.4 children per woman for Africa, 4.7 for South Asia, 4.1 for Latin America, 2.3 for East Asia, to 1.9 for Europe and North America. During the remainder of the present century these differences are not expected to narrow significantly. Moreover, these projections assume a continuation of present efforts and policies without which uninterrupted declines in both fertility and population growth cannot be achieved. The World Population Plan of Action invites countries to consider adopting population policies, within the framework of socio-economic development, which are consistent with basic human rights and national goals and values (paragraph 17). It is in the light of that provision and the above-mentioned trends that the following recommendation is made.
Countries which consider that their population growth rates hinder the attainment of national goals are invited to consider pursuing relevant demographic policies, within the framework of socio-economic development. Such policies should respect human rights, the religious beliefs, philosophical convictions, cultural values and fundamental rights of each individual and couple, to determine the size of its own family.
2. Morbidity and mortality
(a) Goals and general guidance for health policies
21. The World Population Plan of Action set targets for those countries with the highest mortality levels for 1985 and noted the progress necessary for each region to attain an average life expectancy of 62 years by 1985 and 74 years by 2000 (paragraphs 22 and 23). Recommendation 14 below updates the targets for countries with higher mortality levels and challenges countries with intermediate or lower mortality levels to continue and strengthen their efforts for the improvement of health and the reduction of mortality in the context of overall population and development planning. The targets are feasible, provided a commitment is made and resources are well allocated. Their achievement requires that communities become increasingly involved in efforts to promote their health and welfare, that all agencies and institutions of government be involved in this endeavour, and that each programme be evaluated. The achievement of these targets will also require that countries will not be subject to aggression (paragraph 24 (f)). The attainment of reduced levels of morbidity and mortality is in accordance with the Declaration of Alma Ata, endorsed by the General Assembly in its resolution 34/58 of 29 November 1979.
All Governments, regardless of the mortality levels of their population, are strongly urged to strive to reduce morbidity and mortality levels and socio-economic and geographical differentials in their countries and to improve health among all population groups, especially among those groups where the morbidity and mortality levels are the highest. Countries with higher mortality levels should aim for a life expectancy at birth of at least 60 years and an infant mortality rate of less than 50 per 1,000 live births by the year 2000. Countries with intermediate mortality levels should aim to achieve a life expectancy at birth of at least 70 years and an infant mortality rate of less than 35 per 1,000 live births by the year 2000. The countries with lower mortality should continue their efforts to improve the health of all population groups and to reduce mortality even further, in keeping with their social and economic capacities. Levels, trends and differentials in mortality should be monitored in order to evaluate the success of programmes in achieving these goals.
Governmental, intergovernmental, parliamentary and non-governmental organizations should involve the community in all possible ways in the planning, implementation and evaluation of health improvement programmes.
The promotion and preservation of health should be the explicit concern of all levels and branches of government. It is strongly urged, therefore, that governmental action in the area of mortality and health should go beyond the health sector and involve all relevant sectors of national and community development. All development programmes should be monitored and analysed by the Government concerned in order to assess and to improve their impact on health.
(b) Infant, child and maternal morbidity and mortality
22. The World Population Plan of Action (paragraphs 24 and 32 (a)) gives special attention to measures aimed at reducing foetal, infant and early childhood mortality, and related maternal morbidity and mortality. The following recommendations give more precise guidelines for the implementation of the Plan, in accordance with the objective of the Global Strategy for Health for All by the Year 2000, which was adopted by the World Health Assembly and endorsed by the General Assembly in its resolution 36/43 of 19 November 1981.
Governments are urged to take immediate steps to identify the underlying causes of morbidity and mortality among infants and young children and develop special programmes to attack these conditions. Strategies to be considered include emphasis on mother and child health services within primary health care, the introduction and support of a package of specific intervention measures, and massive community-wide education and mobilization to support them. Special efforts should be made to reach under-served and deprived populations in rural areas and urban slums. The international community should take concerted action to support national efforts to this end.
All efforts should be made to reduce maternal morbidity and mortality. Governments are urged:
(a) To reduce maternal mortality by at least 50 per cent by the year 2000, where such mortality is very high (higher than 100 maternal deaths per 100,000 births);
(b) To provide prenuptial medical examinations;
(c) To provide prenatal and perinatal care, with special attention to high-risk pregnancies, and ensure safe delivery by trained attendants, including traditional birth attendants, as culturally acceptable;
(d) To give special emphasis in nutritional programmes to the needs of pregnant women and nursing mothers;
(e) To take appropriate steps to help women avoid abortion, which in no case should be promoted as a method of family planning, and whenever possible, provide for the humane treatment and counselling of women who have had recourse to abortion;
(f) To support family planning as a health measure in maternal and child health programmes as a way of reducing births that occur too early or too late in the mother's life, of increasing the interval between births and of diminishing higher birth orders, and by giving special consideration to the needs of those in the post-partum and/or breast-feeding period;
(g) To encourage community education to change prevailing attitudes which countenance pregnancy and childbearing at young ages, recognizing that pregnancy occurring in adolescent girls, whether married or unmarried, has adverse effects on the morbidity and mortality of both mother and child.
Governments are urged, as a special measure, to take immediate and effective action, within the context of primary health care, to expand the use of techniques such as child growth monitoring, oral rehydration therapy, immunization and appropriate birth spacing, which have the potential to achieve a virtual revolution in child survival. All available communication channels should be used to promote these techniques. The important role of the family, especially of mothers, in the area of primary health care should be recognized.
Governments are urged to promote and support breast-feeding. Information should be widely disseminated on the nutritional, immunological and psychological benefits of breast-feeding, as well as its influence on child spacing. Nursing mothers, especially those in the labour force, should be provided with appropriate maternal benefits, including day-care facilities, access to proper food supplements for themselves, and complementary weaning and foods for their infants, in order to ensure adequate nutrition throughout infancy and early childhood. Governments which have accepted it should be urged to take the necessary steps to implement the International Code of Marketing of Breast-Milk Substitutes, as adopted by the 34th World Health Assembly (resolution WHA 34.22).
Governments are strongly urged to take all necessary measures, including, whenever they consider it useful, utilizing the services of non-governmental organizations, to raise the level of education attained by women as an end in itself and because of its close link to child survival and spacing. In countries where there are still many illiterate women, a supplementary effort should be made to extend mass education programmes.
(c) Adult morbidity and mortality
23. The levels of adult morbidity and mortality and their major causes are still of concern for many Governments in both developing and developed countries. The World Population Plan of Action recognizes the importance of improving health conditions for the working-age population and stresses the need for the eradication of infectious and parasitic diseases (paragraphs 24 (d) and (e)). In countries where infectious and parasitic diseases have reached low levels of incidence, chronic and non-infectious conditions still require urgent attention. As personal health practices and behaviour affect health, dissemination of the relevant information is important so that people can act on the basis of full information
Governments of countries where mortality is still high are urged, with adequate international support, to implement intensive programmes to control infectious and parasitic diseases, provide as far as possible sufficient potable water and adequate sanitation facilities, and implement other elements of primary health care for both adults and children.
Governments, assisted by intergovernmental and non-governmental organizations, are urged to provide individuals and families with all relevant information on the ways in which personal behaviour or practices affect health, and to ensure that the necessary resources are available for them to act on the basis of this information. In this context, Governments are urged to initiate or strengthen preventive action programmes to reduce the consumption of tobacco, alcohol, drugs and other products potentially dangerous to health.
Governments are urged to take necessary preventive or corrective measures to eliminate the negative consequences for health that characterize many occupations.
3. Reproduction and the family
24. The World Population Plan of Action recognizes the family, in its many forms, as the basic unit of society and recommends that it should be given legal protection and that measures should be taken to protect both the rights of spouses and the rights of children in the case of the termination or dissolution of marriage and the right of individuals to enter marriage only with their free and full consent (paragraph 39). It also recommends that all children, regardless of the circumstances of their parentage, should enjoy equal legal and social status and the full support of both parents (paragraph 40). The family is the main institution through which social, economic and cultural change affects fertility. While the family has undergone and continues to undergo fundamental changes in its structure and function, the family continues to be recognized as the proper setting for mutual love, support and companionship of spouses, as the primary determinant of the survival of children born into it, as the first agent of the socialization of future generations, and in many societies as the only supporting institution for the aged. The family is also an important agent of social, political and cultural change. Therefore, in the design and implementation of fertility policies, Governments must respect individual rights while at the same time giving full recognition to the important role of the family.
25. The World Population Plan of Action recognizes, as one of its principles, the basic human right of all couples and individuals to decide freely and responsibly the number and spacing of their children (paragraph 14 (f)). For this right to be realized, couples and individuals must have access to the necessary education, information and means to regulate their fertility, regardless of the overall demographic goals of the Government (paragraphs 28 and 29 (a)). While this right is widely accepted, many couples and individuals are unable to exercise it effectively, either because they lack access to information, education and/or services or because, although some services are available, yet an appropriate range of methods and follow-up services are not. Indeed, data from the World Fertility Survey for developing countries indicate that, on average, over one fourth of births in the year prior to the Survey had not been desired. In addition, the decline in the prevalence of certain traditional practices, such as prolonged breast-feeding and post-partum abstinence, has increased the relative importance of non-traditional family planning as a tool for the proper spacing of births.
26. While the Plan also stresses the responsibility of individuals and couples in exercising their right to choose, the experience of the past 10 years suggests that Governments can do more to assist people in making their reproductive decisions in a responsible way (paragraph 14 (f)). Any recognition of rights also implies responsibilities; in this case, it implies that couples and individuals should exercise this right, taking into consideration their own situation, as well as the implications of their decisions for the balanced development of their children and of the community and society in which they live. The following recommendations reaffirm the provisions of the World Population Plan of Action and suggest specific measures for the attainment of the objectives of the Plan in these areas.
Governments should, as a matter of urgency, make universally available information, education and the means to assist couples and individuals to achieve their desired number of children. Family planning information, education and means should include all medically approved and appropriate methods of family planning, including natural family planning, to ensure a voluntary and free choice in accordance with changing individual and cultural values. Particular attention should be given to those segments of the population which are most vulnerable and difficult to reach.
Governments are urged to promote the best conditions for family formation and family life, ensuring, inter alia, that children enjoy the most favourable environment for their physical, psychological and social development.
Governments and intergovernmental and non-governmental organizations are urged to allocate, in accordance with national policies and priorities, the necessary resources to family planning services, where these services are inadequate and are not meeting the needs of a rapidly growing population of reproductive age.
Governments are urged to improve the quality and enhance the effectiveness of family planning services and of the monitoring of those services, including appropriate follow-up. Coverage should be extended as rapidly as possible to all couples and individuals of both sexes, particularly in rural areas. Family planning services should be made available through appropriate and practicable channels, including integrated health-care programmes (especially maternal and child health and primary health care), community-based distribution, subsidized commercial retail sales, and, in particular, local distribution through retail outlets where health infrastructure and health referral services exist. Also, Governments should bear in mind the innovative role which non-governmental organizations, in particular women's organizations, can play in improving the availability and effectiveness of family planning services. All countries should ensure that fertility control methods conform to adequate standards of quality, efficacy and safety.
Governments are urged to ensure that adolescents, both boys and girls, receive adequate education, including family-life and sex education, with due consideration given to the role, rights and obligations of parents and changing individual and cultural values. Suitable family planning information and services should be made available to adolescents within the changing socio-cultural framework of each country.
Governments are urged to ensure that all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so; couples and individuals in the exercise of this right should take into account the needs of their living and future children and their responsibilities towards the community.
Legislation and policies concerning the family and programmes of incentives and disincentives should be neither coercive nor discriminatory and should be consistent with internationally recognized human rights as well as with changing individual and cultural values.
Governments which have adopted or intend to adopt national fertility goals should translate these goals into specific policies and operational steps that are clearly understood by the citizens.
Governments that have adopted or intend to adopt fertility policies are urged to set their own quantitative targets in this area. Countries implementing family planning programmes should establish programme targets at the operational level, respecting the basic right of couples and individuals to decide freely and responsibly the number and spacing of their children, taking into account the needs of their living and future children and their responsibilities, assumed freely and without coercion, towards the community.
Family policies adopted or encouraged by Government should be sensitive to the need for:
(a) Financial and/or other support to parents, including single parents, in the period preceding or following the birth of a child, as well as the period during which parents assume the major responsibility for the care and education of children;
(b) A strengthening of child welfare services and child-care provisions;
(c) Maternity and paternity leave for a sufficient length of time to enable either parent to care for the child, with adequate remunerative compensation and without detriment to subsequent career prospects and basic communal facilities that will enable working parents to provide care for children and aged members of their families; and
(d) Assistance to young couples and parents, including single parents, in acquiring suitable housing.