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She
THE STATE OF
family
WORLD
Planiy
POPULATION
1997
UNFPA
United Nations
Population Fund
THE RIGHT TO CHOOSE:
Dr. Nafis Sadik
Reproductive Rights and
Executive Director
Reproductive Health
IMPORTANT
FACT CHARTS
All these materials may be reproduced freely.
The United Nations Population Fund (UNFPA) would
Graphs and visualizations of the report's key facts and themes
very much like to receive clippings of the published
PHOTOGRAPHS
materials taken from, or based on this press file.
Please use the envelope provided.
By Still Pictures and UNICEF
Mail to:
REPORT
UNFPA
Full text of The State of World Population 1997
220 East 42nd Street
New York, NY 10017
PRESS SUMMARY
U.S.A.
Résumé of the report's contents and recommendations
NEWS FEATURES
The Press Summary as well as other articles and material
in this file are not to be considered as official United Nations
documents and do not necessarily reflect the opinions of the
United Nations or any of its member states.
Printed on recycled paper
Designed and produced by Prographics, Inc., U.S.A.
ADVANCE
PRESS COPY
NOT FOR
PUBLICATION BEFORE
28 MAY 1997 12:00 GMT
UNFPA
United Nations
Population Fund
Dr. Nafis Sadik
Executive Director
Population Action
April 11, 1997
International
William H. Draper, In
National and
Honorary Chair
Mrs. Hillary Rodham Clinton
1965-1974
The White House
Officers
National Chair
Washington, D.C. 20500
Robin Chandler Duke
National Co-Chairs
Victoria P. Sant
Dear Mrs. Clinton:
Joseph D. Tydings
Robert B. Wallace
President
Over many years, I have worked with the United Nations
Hugo Hoogenboom
Population Fund on population and family planning matters.
Vice Presidents
Victoria Markell
Patricia L. McGrath
Their State of World Population Report is a vital document for
Treasurer
women around the world. Enormous strides have been made to
William C. Edwards
Secretary
advance the education, health, and well-being of women and families.
Phyllis Tilson Piotrow
Directors
Vincent Anku
Your association with this report will vitally enhance its impact on
Vicki-Ann E. Assevero
the world community. All of us who care about the advancement of
Pouru P. Bhiwandi
Norman E. Borlaug
women are supporting Dr. Sadik and her report.
Sharon L. Camp
Marion M. Dawson Carr
William Clark, Ir.
I sincerely hope we can count on you to be with us on May 28.
A.W. Clausen
Philander P. Claxton, Jr.
Barber B. Conable
1. Edward Day
Sincerely yours,
William H. Draper, III
Henry H. Fowler
Bill Green
Marshall Green
Robin
Kaval Gulhati
Julia 1. Henderson
Robin Chandler Duke
Lawrence R. Kegan
C. Payne Lucas
National Co-Chair
Edwin M. Martin
Robert S. McNamara
Wendy B. Morgan
Russell W. Peterson
Yolonda Richardson
Thomas H. Roberts, Ir.
Allan Rosenfield
Isabel V. Sawhill
Constance Spahn
Scott M. Spangler
Elmer Boyd Staats
Timothy L. Towell
Joseph C. Wheeler
Howard H. Williams, III
William D. Zabel
1120 19th Street, NW, Suite 550 Washington, DC 20036 Tel: (202) 659-1833 Fax: (202) 293-1795
Printed on TRIC led paper
UNFPA
United Nations
The Executive Director
Population Fund
9 April 1997
Dear Mrs. Clinton,
It is my honor to invite you to join me in Washington on the morning of 28 May to launch
UNFPA's 1997 State of World Population Report. If you agree we could adjust to your
schedule that day and find an appropriate venue. The Report is UNFPA's major yearly
publication and UNFPA's most quoted and reported publication in the population field. We have
produced the Report since 1978. Each year it concentrates on a specific topic of importance to
the field, and includes global population indicators including statistics related to the goals adopted
at the International Conference on Population and Development (ICPD) Programme of Action,
such as female education and maternal mortality. Also included in the report is an annex detailing
programme country progress on operationalizing the ICPD Programme of Action.
This year's report spotlights reproductive rights, a topic that you champion and to which
UNFPA is committed. It will discuss the gap between the reproductive rights agreed upon in Cairo
and the reality of reproductive rights we find around the world today.
We launch the report simultaneously in about 100 capital cities around the world. Your
participation would assure massive coverage in the United States, it would serve to highlight the
U.S. government's support for reproductive rights and population programming and it would
serve to encourage both donor and programme countries to increase their own efforts to support
ICPD goals.
Three years after Cairo we see tremendous efforts being made in every corner of the globe
to increase and improve family planning services, to provide maternal health care and assisted
deliveries, to prevent STDs including HIV/AIDS, to eradicate female genital mutilation and to
promote gender equality and women's empowerment. Our biggest problem today is not national
commitment but funding, both from donors and in programme countries for their own
programmes.
Your presence would guarantee visibility for reproductive rights and population. It would
also have a tremendous global impact on the cause we share.
Mrs. Hillary Rodham Clinton
The White House
Washington, DC
220 EAST 42ND STREET
NEW YORK. N.Y. 10017
The Executive Director
Mrs. Hillary Rodham Clinton
9 April 1997
Page 2
I have enclosed the press kit and a copy of the 1997 report for your review.
Thank you so much for considering my request.
With best wishes I am,
Yours sincerely,
work
Nafis Sadik, M.D.
Under-Secretary-General
UNFPA
United Nations
Population Fund
220 EAST 42ND STREET
NEW YORK, N.Y. 10017
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C.
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
THE STATE OF
WORLD
POPULATION
aerd
THE
RIGHT TO
CHOOSE:
Reproductive
Rights and
Reproductive
Health
1997
ADVANCE PRESS COPY
UNFPA
NOT FOR PUBLICATION BEFORE
United Nations
Population Fund
28 MAY 1997 - 1200 GMT
Dr. Nafis Sadik
OFF
Executive Director
UNFPA/Mikumo
Dr. Nafis Sadik
EXECUTIVE DIRECTOR OF THE
UNITED NATIONS POPULATION FUND
28 May 1997
Dear Editor,
I am pleased to present The State of World Population 1997 report from the United Nations
Population Fund.
This year's report is on reproductive health and reproductive rights, a topic that touches the lives
of everyone on the planet. At issue are the rights of all people to enjoy the best possible sexual and
reproductive health, and to be free to make their own decisions about sexuality, marriage and
childbearing. Although the international community recognizes these to be basic human rights,
they are still denied to millions of people-especially to women, the vast majority in developing
countries.
As the report emphasizes, making quality reproductive health care and information more access-
ible would spare millions of women each year from death and suffering due to complications of
pregnancy and sexually transmitted diseases. Enabling women to determine whether and when to
have children is also essential if they are to participate fully and equally in shaping the futures of
their families, communities and nations.
THE STATE OF WORLD POPULATION 1997
A key aim of this report, therefore, is to increase global awareness that reproductive rights are an
integral part of human rights, and that laws and policies must be strengthened and better enforced
so all people can enjoy sexual and reproductive health and free choice. We also aim to build
support for increased funding-from both domestic resources and international assistance-for
services that will allow everyone to exercise their reproductive rights.
I hope the report's examination of these issues will be of interest to you and your readers.
We would appreciate receiving copies of any articles, editorials or broadcasts based on the report.
Thank you.
Stirling D. Scruggs
Director, Information and External Relations Division
Printed on recycled paper.
UNFPA
United Nations
Population Fund
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
PRESS SUMMARY
NOT FOR RELEASE BEFORE 28 MAY 1997
Denial of Reproductive Rights Kills or Harms Millions of Women
and Impedes Progress Towards Equality and Development
UNITED NATIONS, New York - Gaps and failures in reproductive health care, combined with
widespread discrimination and violence against women, amount to a massive violation of human
rights. Denial of sexual and reproductive rights-including free choice with regard to pregnancy
and childbearing-causes millions of deaths every year, and much more illness and disability. Most
of those affected are women, the vast majority in developing countries.
T
hese human rights violations, and efforts to
world currently spends each week on armaments.
end them, are the focus of The State of
But while many governments have increased their
World Population 1997 report by the United
allocations for population programmes since
Nations Population Fund (UNFPA), to be released
1994, annual global expenditures are still well
on 28 May. The report, titled "The Right to
below half the $17 billion mark.
Choose: Reproductive Rights and Reproductive
Building on human rights treaties, the ICPD
Health", summarizes the international under-
recognized a core set of sexual and reproductive
standings that define sexual and reproductive
rights: the right to reproductive and sexual health,
rights, presents evidence on progress and prob-
throughout the life cycle; reproductive self-deter-
lems in attaining and protecting those rights, and
mination, including the rights to voluntary choice
examines the effects of denying them to millions
in marriage, and to have the information and
of women and men.
means to determine the number, timing and spac-
To enable individuals to exercise their sexual
ing of one's children; equality and equity for men
and reproductive rights, the report stresses the
and women in all spheres of life; and sexual and
need for gender equality and increased investment
reproductive security, including freedom from sex-
THE STATE OF WORLD POPULATION 1997
in education and primary health care. Specific
ual violence and coercion.
recommendations focus on improving the avail-
The State of World Population 1997 docu-
ability and quality of information and services
ments the effects of denying these sexual and
that meet a broad range of sexual and reproduc-
reproductive rights:
tive health needs.
At the International Conference on Population
585,000 women-one every minute-die each
and Development (ICPD) in 1994, 180 nations
year from pregnancy-related causes, nearly all
agreed that quality reproductive health informa-
in developing countries. Many times this num-
tion and services should be available to everyone
ber are disabled as the result of childbirth.
by the year 2015. The UNFPA report reviews the
Much of this death and suffering could be
considerable progress countries have made in
averted with relatively low-cost improvements
implementing the conference recommendations,
in health care systems.
and presents statistical indicators describing the
current situation.
About 200,000 maternal deaths per year result
from the lack or failure of contraceptive services.
"The international community has
agreed repeatedly that reproductive
120-150 million women who want to limit or
health is a right for both women and
space their pregnancies are still without the
men," said Dr. Nafis Sadik, Executive
means to do so effectively. Altogether 350 mil-
Director of UNFPA. "The challenge
lion couples lack information about and access
now is to make this right a reality for
to a range of contraceptive services.
every individual."
At least 75 million pregnancies each year (out
The ICPD estimated that providing better
of about 175 million) are unwanted; they result
reproductive health care worldwide will cost $17
in 45 million abortions, 20 million of which are
billion annually by the year 2000-less than the
unsafe.
Printed on recycled paper.
UNFPA
United Nations
Population Fund
NEWS FEATURE
Reproductive Rights — Why Do They Matter?
M
odern contraception has revolutionized family life. Until the pill came into widespread
use in the 1960s, sex was a lottery: there were no really safe contraceptives. Today, nearly
60 per cent of the world's couples use modern family planning, and "reproductive
health", which includes the right to decide the size and spacing of the family, is recognized as a
human right.
The place of reproductive and sexual rights in the human rights framework is described in
The State of World Population 1997 report by the United Nations Population Fund (UNFPA),
published on 28 May. The report, The Right to Choose: Reproductive Rights and Reproductive Health,
shows how internationally-agreed human rights can make a difference in people's lives by giving them
the power of choice. For women reproductive rights are especially important-guaranteeing the
ability to make choices about childbearing empowers women to make choices in other areas of life.
A central theme of the report is that reproductive choice, gender equality and sustainable devel-
opment are closely connected, a linkage the international community has recognized repeatedly at
the 1990s series of conferences on social development issues.
Says Dr. Nafis Sadik, Executive Director of UNFPA, "The consensus means what it says: that
reproductive health is a right for both women and men; that every individual has the right to decide
the size and spacing of the family, and to have the means and information to do so; that there must
be no coercion, either to have or not to have children; and that these rights are part of the inter-
national structure of human rights, which has as its foundation the concept that all men and
women are equal."
At the International Conference on Population and Development, held in Cairo in 1994, and
the Fourth World Conference on Women, held in Beijing in 1995, the world's nations spelled out
in detail the components of reproductive rights and their implications. These rights include volun-
THE STATE OF WORLD POPULATION 1997
tary choice in marriage, sexual relations and childbearing, and the right to enjoy the highest attain-
able standards of sexual and reproductive health.
The State of World Population report shows how these understandings flow from the United
Nations Charter, the Universal Declaration on Human Rights, and international human rights
treaties which are binding on states that have ratified them-the International Covenant on Civil
and Political Rights, the International Covenant on Economic, Social and Cultural Rights, the Con-
vention on the Elimination of All Forms of Discrimination Against Women and the Convention on
the Rights of the Child.
In particular, these treaties obligate governments to protect individuals against violations of
their reproductive rights, and to ensure that everyone has access to safe and affordable services
addressing a broad range of sexual and reproductive health concerns (including family planning,
safe motherhood and prevention of sexually transmitted diseases, among others). The United
Nations system for monitoring treaty compliance therefore offers important support for efforts to
protect and promote reproductive rights.
The conference agreements themselves express a global consensus and are invaluable advocacy
tools which can influence the formulation of national laws, policies and standards. The report cites
numerous examples of how countries are putting the Cairo and Beijing agreements into operation.
For example, the South African Constitution, adopted last year, explicitly prohibits discrimina-
tion on grounds of gender, sex, pregnancy, marital status or sexual orientation. It also recognizes
that everyone has the right "to bodily and psychological integrity, which includes the right
to
Printed on recycled paper
UNFPA
United Nations
Population Fund
make decisions concerning reproduction", and "to have access to
health care services, including
reproductive health care".
The Ugandan Constitution was recently revised to recognize the priority of human rights for
women over traditional and local laws. Chile is considering a constitutional reform to establish legal
equality between women and men.
The government of Sri Lanka recently approved a Women's Charter which acknowledges women's
right to control their reproductive lives. In Colombia, a new social security law recognizes women's
rights to sexual and reproductive health.
Brazil, Colombia, Jamaica, Haiti and Peru are among the many countries that have recently estab-
lished or strengthened institutions to protect the rights of women. Laws protecting women against
sexual and domestic violence have been approved in Bolivia, Costa Rica, Ecuador and Panama.
Strengthening and enforcing these safeguards will be vital for global development.
The UNFPA report lists a basic set of internationally-accepted reproductive rights, which are
implied by the rights recognized in international human rights instruments:
The right to survival/right to life implies that women's status and health services should be
improved to reduce the 585,000 maternal deaths that occur each year from pregnancy-related causes.
This involves, for example, reducing early marriage and higher-risk pregnancies; expanding access to
pregnancy care, trained birth attendants and emergency obstetric services; providing quality family
planning services and information; and reducing reliance on unsafe abortion.
The right to liberty and security of the person implies the right to enjoy and control one's sexual
and reproductive life, and the right to informed consent in medical interventions. Several countries'
constitutional courts have held that compulsory sterilization and abortion violate this right. The prac-
tice of female genital mutilation violates the security of the person.
The right to the highest attainable standard of health implies a right to have access to the high-
est-possible quality care related to sexual and reproductive health, protection from harmful practices,
and a right to counselling and impartial information to allow informed decisions.
The right to family planning has been acknowledged, clarified and expanded in human rights
instruments and international declarations since 1968. The Cairo Programme of Action, reaffirming
earlier agreements, states, "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."
The right to marry and found a family implies a government obligation to offer services for the
prevention and treatment of sexually transmitted diseases, since these are a leading cause of infertility.
The right to a private and family life includes the right to make autonomous and confidential
choices in regard to whether and when to have children.
The right to the benefits of scientific progress implies a right to have access to available repro-
ductive health care technology, including safe and acceptable contraceptive methods.
The rights to receive and impart information and to freedom of thought are applicable in
demonstrating that everyone (including adolescents and the unmarried) have a right to information
and counselling about family planning methods and service availability.
Fulfilment of the right to education is one of the most important means of empowering women
with the knowledge, skills and self-confidence necessary to participate fully in the development
process. Promoting the education of women and girls contributes to postponement of the age of
marriage, and to a reduction in the size of families.
The right to non-discrimination on the basis of sex is violated by laws and practices that prevent
women but not men from taking reproductive health decisions without their spouses' consent; by
policies limiting girls' rights to stay in school when they are pregnant; by family practices favouring
sons over daughters with regard to nutrition, health care and education; and by prenatal sex selection
and female infanticide.
The right to non-discrimination on the basis of age implies that young people have the same
rights to confidentiality with regard to reproductive health care as adults.
For more information: United Nations Population Fund, Information and External Relations
Division, 220 E. 42nd Street, New York, NY 10017, U.S.A. Tel. 212-297-5020; fax: 212-557-6416.
E-mail: [email protected]. Website: www.unfpa.org.
NEWS FEATURE
Reproductive Health Programmes
Emphasize Quality of Care
'W
hen you gave birth at the hospital, the doctor would give you a contraceptive injection
without even asking you whether you wanted it or how many more kids you wanted to
have," a South African woman recalls. That was under the apartheid regime; today,
South Africa is moving to ensure that family planning programmes respond to the needs and
desires of clients, not to government dictates.
South Africa is one among many countries acting on the recommendations of the 1994 Inter-
national Conference on Population and Development, which called for universal access to a com-
prehensive set of reproductive health services, including family planning, by 2015. The emphasis
should be on the quality of care offered to clients and on delivering the best possible service.
Although nearly 60 per cent of couples are using modern contraception, up from 10-15 per cent
thirty years ago, the right to reproductive health acclaimed at the 1994 Cairo conference is still far
from a reality in many countries, according to The State of World Population 1997 report by the
United Nations Population Fund (UNFPA). The report is published on 28 May.
Among the most important reforms is to offer a range of reproductive health services along
with family planning under one roof. In South Africa, says Dr. Helen Rees of the Reproductive
Health Research Unit of Baragonath Hospital in Soweto, "We are trying to improve and integrate
reproductive health services into family planning or primary care services, and then to develop
rational guidelines for management that can be applied on a very large scale."
A key objective of integrated reproductive health care is to ensure that women know their
options and can exercise them. The report stresses that the quality of services may determine
whether women and men can exercise their right to voluntary choice in matters of reproduction
THE STATE OF WORLD POPULATION 1997
and sexuality. Clients are more satisfied and more likely to continue using services that ask and act
on their preferences. Dissatisfied clients who have no alternative to poor-quality public services
may simply stop using them.
One key to identifying the reproductive health needs of any individual or couple is privacy, to
ensure confidential exchange of information. Clients need to feel free to discuss their reproductive
intentions, state of health, cultural understandings and social circumstances.
Clients should have access to a range of safe and effective contraceptive methods so they can
choose the method most suitable for them, the report stresses. Prospective contraceptive users need
information about how methods work, how effective they are and which to avoid. For example,
women who are breastfeeding should not take oral contraceptives. Intra-uterine devices (IUDs)
should not be recommended to patients with reproductive tract infections, for instance.
Staff training in new methods and counselling techniques, along with improved supervision, is
therefore a critical step in improving service quality and maintaining continuity, according to
the report.
A new programme in the Indian state of Rajasthan offers clients a mix of family planning
methods-the pill, IUD, condom and sterilization-and child survival services. Nurse midwives
and female health assistants explain the advantages and disadvantages of each contraceptive
method. There is no compulsion, no targets, and no motivation fee. The IUD, the most popular
contraceptive method, is offered only after verifying that the woman is free of reproductive tract
infections. Others can receive the device once their infections are treated. The result has been a vast
increase in the IUD retention rate.
Printed on recycled paper.
UNFPA
United Nations
Population Fund
Sometimes, the report points out, providers steer clients to certain methods based on their age,
marital status or ethnicity, without regard to medical considerations or the clients' wishes. Clients are
rarely asked about their sexual practices or those of their partners. Providers' attitudes or legal
barriers may even prevent would-be clients-such as unmarried women and adolescents (married and
unmarried)-from using reproductive health services at all.
At a clinic in Zimbabwe, "all the clients, no matter how old or young" are welcome, says Dorothy
Chikwanda, the junior clinic manager. She says that the key to service quality is to offer those inter-
ested a range of options: "First we have to give the client the choice, then we have to explain her
choice to her."
The physical state of a facility also affects the quality of care-and sometimes the health of clients.
Common problems include inadequate supply of clean water and electricity, insufficient or under-
trained staff, unavailability of blood supplies, shortages of essential drugs including antibiotics, and
missing supplies and equipment.
Since the Cairo conference, many developing countries have taken steps to improve the quality of
reproductive health and family planning services. These include training health care providers in inter-
personal communications, strengthening the health infrastructure, and developing new medical
protocols. In South Africa, the Women's Health Project in Johannesburg has conducted workshops to
help health care providers improve their interaction with clients. In Iran, 18,000 Women Health
Volunteers provide reproductive health and family planning information and services in urban slums.
Kenya has integrated family planning with other reproductive health services to avoid duplication,
and make services more convenient, accessible and cost-effective. Chile, Thailand and the Philippines
are also moving to integrate reproductive health services and make them more accessible. Ghana and
Mali have revised reproductive health standards to improve services in poor communities.
India's Family Welfare Programme has increased funding for reproductive health and expanded
the range of services. To ensure respect for individual clients, it has set up new rules for family
planning programmes that use client-centred performance goals in place of method-specific contra-
ceptive targets. Bolivia now gives women free access to prenatal care, delivery and post-natal care,
family planning, and pap smears. Family planning services in Brazil now offer a full range of contra-
ceptive methods.
The expansion of family planning services has been a special priority in Eastern Europe and the
former Soviet Union. Russian medical authorities acknowledge that improved availability of family
planning has helped reduce the abortion rate. Family planning activities have also been strengthened
in Kazakstan, Tajikistan, Ukraine and Poland.
UNFPA has been working closely with other UN agencies to develop a reliable set of indicators to
help design integrated reproductive health programmes and monitor their progress. Conventional
statistics on service utilization and contraceptive practice will be augmented with new measures of
unmet demand, access, service coverage and quality of care.
In the Gaza Strip, a Women's Health Centre was recently established in the Al-Bureij Refugee Camp
with UNFPA support. The centre combines previously unavailable reproductive health services-
including pre- and post-natal care, safe delivery and family planning-with social assistance, legal
counselling, psychiatric support, and community education and physical fitness programmes.
Says Sabah Ammer, a regular visitor, "The doctor spends a lot of time talking over our problems
with us. If one method of family planning does not work for us, she will recommend another type,
teach us how to use it, and keep working with us until something works."
For more information: United Nations Population Fund, Information and External Relations
Division, 220 E. 42nd Street, New York, NY 10017, U.S.A. Tel. 212-297-5020; fax: 212-557-6416.
E-mail: [email protected]. Website: www.unfpa.org.
NEWS FEATURE
Learning the Safe Way: Teens Want
Sex Education, Not Rumours
A
dolescents, especially girls, often pay a heavy toll when they start having sex without
knowing how to deal with it in a positive way," says Nadia Blaja, 16, of Moldova.
Blaja is among the growing number of teenagers worldwide who want answers to their ques-
tions about sexuality and the changes in their bodies, so that they can make responsible decisions.
The State of World Population 1997 report from the United Nations Population Fund (UNFPA),
published on 28 May, notes that ignorance about sexuality and contraception increases teenagers'
exposure to the health risks of early pregnancy and sexually transmitted diseases (STDs). But, as
the report notes, parents are often uncomfortable talking to their children about sexual matters, so
teens instead get information-much of it incorrect-from their peers.
Adolescents' right to information and services to protect against unwanted pregnancy and STDs
is a major focus of the UNFPA report, titled The Right to Choose: Reproductive Rights and
Reproductive Health.
Surveys show that teenage sexual activity is increasing in many countries, and that in some,
adolescents are starting sexual activity earlier and having more partners and more casual relation-
ships. But many sexually active teens know little about reproduction or contraception.
Youth organizer Annie Nkumba of Malawi has heard the kinds of misinformation that young
people often spread. "They sometimes tell each other that if you have sexual intercourse maybe
while standing in a river, or if after having sexual intercourse you take a number of capsules or
aspirins or chloroquines, you won't be pregnant," she says.
The report notes that teenage mothers are at least twice as likely to die during childbirth as
THE STATE OF WORLD POPULATION 1997
women in their 20s, and their children have higher levels of illness and death. Early marriage and
childbearing also impede young women's educational and employment opportunities.
Young women are particularly vulnerable to STDs. Half the new cases of HIV infection occur
in youths aged 15-24. But adolescents are often too ashamed or too poor to seek help from health
services; and when they do, they may be denied information or care, either for policy reasons or
because providers are embarrassed.
Many first sexual experiences are with older partners, often the result of force, coercion or
financial inducements that girls from poor families may find difficult to resist. Says Pamela McNeil,
director of the Jamaica Women's Centre, "If a very bright girl wants to continue her education and
a man in the neighbourhood happens to offer her money for a textbook or bus fare, she will accept
it because this is what she wants. But she then feels that she's indebted to him, so when the sex
proposal comes up, she accepts it."
Mónica Antoinette Gutiérrez Gómez, 16, of Peru says that when young people have to ask their
friends about sexual issues, "instead of solving the problem, they create more confusion." Nicolette
Fergusen of Jamaica, who got pregnant at age 15, agrees. She believes family life education should
be mandatory: "It should be a broad topic in school because that's where teenagers get their infor-
mation from, from school and from parties."
Kevin Barnaby, of the Youth for Education on Sexuality (YES) Project in Jamaica, says some
parents oppose family life education because they feel their children are being exposed to
information about sexuality too early. "The fact is that teenagers are being exposed to things like
HIV, other STDs and teenage pregnancy, and they need to know how to handle their sexuality at
a certain stage in life," he stresses.
Printed on recycled paper.
UNFPA
United Nations
Population Fund
Advocates of family life and sex education are confronted with the persistent myth that this
instruction leads to promiscuity. "The misconception is that sex education teaches people how to have
sex, whereas it actually teaches young people about the development of their body, reproductive
health, sexually transmitted diseases and contraceptives," Blaja notes.
"The term 'sex' conjures up in people's minds the sex act, that is, intercourse, and even educators
may believe that sex education will promote sexual activity," says Allan K. Kondo, UNFPA Popula-
tion Adviser to the Pacific Island countries, "but actually, worldwide research has shown that school
sex education does not increase sexual activity but reduces teen pregnancy and STDs."
Over the past three decades, UNFPA has funded the development and inclusion of family life
education in school curricula and programmes to reach out-of-school youth in 79 countries.
The report finds that family life education leads to responsible sexual behaviour, including higher
levels of abstinence, later start of sexual activity, higher use of contraception and fewer sexual
partners. These effects are greatest where children and parents discuss sex and reproduction frankly.
Zhou Quan, 18, of China, recommends giving young people access to sex education "to take away
the cloak of mystery and make sex a science, a kind of knowledge, not a taboo, mystery or something
shameful." Mushira Saad Al-Din Mahmud Zaidan, 19, of Egypt, agrees: "In order to confront life
positively, young people must be given all the facts about reproductive health and relations between
the sexes."
Since 1994, many governments and non-governmental organizations (NGOs) have taken
initiatives to meet adolescents' reproductive and sexual health needs. In Chile, a UNFPA-supported
programme run by the NGO Education for Improving the Quality of Life organizes group discussions
where young people are encouraged to discuss their feelings and sexuality. They also receive vital
information about reproduction and STD prevention.
At the Black Rock Polyclinic in Barbados, Nurse Mary Proud has seen the positive changes that
sex education can bring. "Before the young people came here they were very ignorant about what
happens to their bodies during adolescence, and many of them had fears of how they were going to
cope with these changes." Programmes at the clinic, she says, "help them to see that adolescence is a
positive stage where they can enjoy life, and help them to be able to make decisions and choices that
develop positive self-images."
For more information: United Nations Population Fund, Information and External Relations
Division, 220 E. 42nd Street, New York, NY 10017, U.S.A. Tel. 212-297-5020; fax: 212-557-6416.
E-mail: [email protected]. Website: www.unfpa.org.
NEWS FEATURE
Men Take Responsibility for Reproductive Health
and Family Planning
'W
omen point their fingers at men and say, 'We are willing to use family planning, but
these people prevent us from doing so." Emmanual Sabakati has heard this lament
often while counselling couples on family planning. Sabakati is project director of the
"Man to Man" programme in Malawi, designed to address the critical role of men in family
planning.
But studies show that men are concerned for women's reproductive health, and are willing to
participate in making decisions, according to The State of World Population 1997 report by the
United Nations Population Fund (UNFPA). The problem may be communication: husband and
wife may want the same thing, but they don't tell each other. The result can be a bigger family than
either really wanted. The report is published on 28 May.
Husband and wife communication about reproductive health, including family planning, has
been improving over the past few decades, the report notes. However, a large minority of men still
consider sexual and reproductive health to be exclusively women's concerns-so they don't discuss it.
Worse, men often impede women's efforts at family planning, as the women in Sabakati's clin-
ic charge. Dr. Everald Hosein coordinates the University of the West Indies Caribbean Population
and Family Health Programming in Port of Spain, Trinidad and Tobago. He says that almost every
method of contraception a woman might choose can be opposed by her partner for one reason or
another. For example, some men complain that condoms and intra-uterine devices interfere with
their sexual pleasure. One woman told Hosein, "My man doesn't want me to use the pill; he says
it will make me fat."
The report finds that men are frequently insensitive to women's reproductive and sexual health
THE STATE OF WORLD POPULATION 1997
needs. In many cultures misunderstandings and myths about female sexuality and reproductive
systems persist-though there are indications that male attitudes towards a range of taboos
(including concerns about menstruation and "cleanliness") are changing.
Boys and men should be taught about responsible sexuality and parenthood, the report recom-
mends. They need to understand the risks women face from pregnancy and childbirth, and from
multiple partners, harmful traditional practices, and sexual initiation too early in life. Women's
reproductive and sexual health requires the mutual concern and investment of both partners.
Man to Man was founded in response to these needs. Says Sabakati, "It is important to target
males because they are the heads of families, and therefore they should know about family plan-
ning." Participants are taught about various methods of contraception, particularly those men can
use. "When men are motivated to seek methods suitable for them, they choose between vasectomy
or condoms," notes Sabakati. All choices are strictly voluntary. "If they choose condoms, we supply
them. If they choose vasectomy, we assist them in arranging it." Those who undergo vasectomy are
usually in their late thirties or early forties.
When he was a Boy Scout in Zimbabwe, Joseph Mabuto received family life education. The
experience "gave a new dimension to my life," he said. Now a scout leader, Mabuto advises
teenage scouts about family and reproductive matters. "My scouts are always coming to me to ask
about sexuality, maturity, peer pressure and the like," he says.
Zimbabwe's Chief Scout Commissioner, Ignatius Kajenga, points out that the whole society
benefits from providing family life education to boys. "The boys disseminate the information to
their family and friends. We teach them about sexuality, sexual health, sexually transmitted
diseases including AIDS, and family planning." Most courses are conducted in local languages.
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Population Fund
"Decision-making is an important aspect of the education," Kajenga says. "Eventually it is incum-
bent upon the boys themselves to make up their mind on what types of families they are going to
have." He adds that the boys are glad to receive information on sexuality and reproduction, as such
subjects are generally taboo with parents.
Legal barriers also underscore the important role men play in family planning, according to the
report. Fourteen countries require a woman to get her husband's consent before she can receive any
contraceptive services. This has the effect of denying services to unmarried women, including adoles-
cents and the divorced or widowed, as well as to women who wish to delay or limit births but who
cannot persuade their husbands. An additional 60 countries require spousal authorization for
permanent methods. Spousal consent restrictions often apply only to women, the report notes.
But the report finds signs of improvement, especially at the grassroots. In the Philippines, a new
centre for men is experimenting with innovative ways to involve men in reproductive health
programmes. In Indonesia, the government plans to expand its counselling programme to include
training materials on male participation in family planning and reproductive health. In Ghana,
seminars and plays have been organized for both male and female audiences to generate discussions
on partners' joint responsibility in the use of family planning, parenting and family life.
The Noor Al Hussein Foundation in Jordan has launched a two-year nationwide motivational
campaign with "Family health is a joint responsibility of both spouses" as its slogan. The campaign,
begun in April 1996, includes a wide range of activities: puppet shows, seminars, a mobile science
exhibition, counselling and interactive educational theatre. Special activities are intended to sensitize
men about their responsibilities in family planning and reproductive health.
Efforts to reach men are eliciting a response. "When I read in the paper about the vasectomy, I
was very much interested because I wanted to give relief to my wife," said Aaron Kumwenda, a client
at the Man to Man project in Malawi. "Having borne four children, she was tired, I thought. As the
head of the family, I had to do it."
Anderson Mazengera, who underwent the same procedure after deciding with his wife that they
had reached their desired family size, notes that male responsibility does not end with vasectomy:
"Now what we have to do is develop our family."
For more information: United Nations Population Fund, Information and External Relations
Division, 220 E. 42nd Street, New York, NY 10017, U.S.A. Tel. 212-297-5020; fax: 212-557-6416.
E-mail: [email protected]. Website: www.unfpa.org.
FACT CHART
Causes of Maternal Death, 1990
Indirect Causes
19%
Haemorrhage
25%
Other Direct Causes
8%
Sepsis
15%
Unsafe Abortion
13%
Obstructed Labour
Hypertensive Disorders of
7%
Pregnancy and Eclampsia
13%
Source: World Health Organization, Maternal Health and Safe Motherhood Programme (Geneva),
unpublished estimates.
Access to Contraception, 1994
THE STATE OF WORLD POPULATION 1997
PERCENTAGE OF THE POPULATION WITH EASY ACCESS TO CONTRACEPTIVE METHODS
STERILIZATION
IUD
PILL
CONDOM
NUMBER OF
REGION
FEMALE
MALE
COUNTRIES
Less developed
93
regions*
61
47
61
64
66
Africa
35
17
9
33
54
51
Northern Africa
11
5
47
80
45
Other Africa
18
10
28
46
53
Asia
33
69
57
68
64
69
Eastern Asia
88
71
89
72
71
South-central Asia
34
34
59
61
61
South-eastern Asia
66
55
51
55
71
Western Asia
28
8
59
74
63
Latin America and
the Caribbean
24
64
35
52
78
65
Source: United Nations, World Population Monitoring, 1996 (draft).
*Including one country in Oceania.
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United Nations
Population Fund
FACT CHART
Maternal Mortality Ratios, 1990
NUMBER OF MATERNAL DEATHS PER 100,000 LIVE BIRTHS, BY REGION/SUBREGION
0-100
100-400
400-800
800-1200
THE STATE OF WORLD POPULATION 1997
Europe
36
WORLD 429
Eastern Europe
61
More developed regions* 27
Northern Europe
11
Less developed regions** 479
Southern Europe
15
Africa
878
Western Europe
17
Eastern Africa
1,061
Latin America and the
Middle Africa
944
Caribbean
194
Northern Africa
343
Caribbean
408
Southern Africa
437
Central America
137
Western Africa
1,023
South America
197
Asia
383
Northern America
11
Eastern Asia
91
Oceania
382
South-central Asia
562
Australia-New Zealand
12
South-eastern Asia
443
Melanesia/Micronesia/
Western Asia
320
Polynesia
1,123
Source: World Health Organization, Maternal Mortality Ratios and Rates. A Tabulation of Available
Information, 4th ed. (Geneva, forthcoming).
*
More developed regions comprise all regions in Europe, Northern America and Australia, New Zealand
and Japan.
** Less developed regions comprise all regions of Africa, Asia (excluding Japan), Latin America and the
Caribbean and regions of Melanesia, Micronesia and Polynesia.
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New Cases of Curable Sexually Transmitted Diseases
Among Adults, 1995
FACT CHART
REGION
NUMBER OF CASES IN MILLIONS
AFRICA
Northern Africa/Western Africa
10
Sub-Saharan Africa
65
ASIA
Eastern Asia/the Pacific
23
Southern/South-eastern Asia
150
Australasia
1
EUROPE
Eastern Europe and Central Asia
18
Western Europe
16
Latin America and the Caribbean
36
Northern America
14
0
25
50
75
100
125
150
Population Fund
United Nations
UNFPA
Source: World Health Organization, An Overview of Selected Curable Sexually Transmitted Diseases (Geneva, 1995).
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THE STATE OF WORLD POPULATION 1997
Estimated Annual Deaths from Unsafe Abortion
FACT CHART
World
Total
Former USSR
500
70,000
NORTHERN
EUROPE
AMERICA
100
(negligible)
ASIA
More Developed
40,000
Regions
AFRICA
23,000
600
LATIN AMERICA and
the CARIBBEAN
6,000
Less Developed
OCEANIA
Regions
500
69,000
Population Fund
United Nations
UNFPA
Source: World Health Organization, Maternal Health and Safe Motherhood Programme (Geneva), unpublished estimates.
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THE STATE OF WORLD POPULATION 1997
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"Reproductive Rights-Why Do They Matter?"
THE STATE OF WORLD POPULATION 1997
UNICEF 1717/ / Marcus Halevi
Everyone has a basic right to be free from sexual violence and coercion. But this right is denied to countless women and
girls-including the millions driven into the global sex market each year by poverty and growing demand. Above, street scene
in Thailand.
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"Reproductive Health Programmes
Emphasize Quality of Care"
THE STATE OF WORLD POPULATION 1997
Mark Edwards/Still Pictures
Ensuring that women know their options and can exercise them has become the principal goal of many reproductive health
programmes. Above, women in Addis Ababa, Ethiopia, listen to a talk about family planning.
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"Learning the Safe Way"
THE STATE OF WORLD POPULATION 1997
What Albs Does AIDS OF OOK Like? with
of
disexte
Jorgen Schytte/Still Pictures
Ugandan schoolchildren learn about AIDS prevention. Family life and sex education for adolescents results in more
responsible sexual behaviour.
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FOR USE WITH THE NEWS FEATURE
"Men Take Responsibility for Reproductive Health"
THE STATE OF WORLD POPULATION 1997
UNICEF/93-1969/Giacomo Pirozzi
Father and daughter in Niger. Men around the world need to take more responsibility for parenting, and for their partners'
sexual and reproductive health.
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