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Women, empowerment and health

 

INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT
Cairo, Egypt
5-13 September 1994


ICPD INFORMATION KIT -- STORY 5

WOMEN, EMPOWERMENT AND HEALTH

The empowerment and autonomy of women, and improvements in their political, social, economic and health status, are recognized by the International Conference on Population and Development (ICPD) as highly important ends in themselves. In addition, they are seen as essential for the achievement of sustainable development.

The central role women play in regard to population and development has been strongly emphasized in all preparations for ICPD. Empowerment of women was discussed during five regional population meetings, three sessions of the ICPD Preparatory Committee, and a number of expert group meetings and round tables.

The need for gender equality, equity and empowerment of women is emphasized throughout the Programme of Action of the Conference. Chapter 4 of the Programme, entitled, Gender Equality, Equity and the Empowerment of Women, includes subchapters on: the empowerment and status of women; the girl child; and male responsibilities and participation. The chapter calls upon countries to act to empower women and to take steps to eliminate inequalities between men and women as soon as possible.

Recognizing that discrimination on the basis of gender starts at the earliest stages in life, the document asserts that greater equality for girls in regard to health, nutrition and education is the first step in ensuring that women realize their full potential and become equal partners in development. The Programme encourages leaders to speak out forcefully against gender discrimination, and undertake efforts to promote equitable treatment of girls and boys with respect to nutrition, health care, inheritance rights, education, and social, economic and political activity.

The Programme of Action underscores the need to promote gender equality in the family and in the community, noting in particular that men should take responsibility for their fertility and parental duties. It calls for special efforts to involve men in safe and responsible parenthood and family planning.

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. One of the goals specified in the Programme of Action is for all countries to ensure that all girls and boys have access to primary school or equivalent level of education, as quickly as possible and in any case before 2015.

Countries that achieve universal primary education sooner are urged to extend access to and facilitate completion of secondary and higher levels of education and training. In seeking to attain these goals, the Programme states that particular attention should be given to eliminating disparities in educational access and support that are detrimental to girls.

REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTH: To realize their full potential, women must be guaranteed the exercise of their reproductive rights and must be able to manage their reproductive roles, the ICPD draft Programme states. Chapter 7, Reproductive Rights and Reproductive Health, focuses on: reproductive rights and reproductive health; family planning; sexually transmitted diseases and prevention of human immunodeficiency virus (HIV) infection; human sexuality and gender relations; and adolescents.

The Programme defines reproductive health as: "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes."

Reproductive health implies that people are able to have a satisfying and safe sex life and that they will have the capability to reproduce and the freedom to decide if, when and how often to do so. Women and men must be provided with the necessary information and services to exercise this right, according to draft Programme.

Sexual health is defined in the draft Programme as: "the integration of somatic, emotional, intellectual and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication and love."

According to the document, the cornerstone of reproductive health is recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, and to have the information and means to do so.

Promotion of the responsible exercise of these rights by all people should be the basis of government policies and programmes in the area of reproductive health, including family planning, the Programme asserts. It urges all countries to strive to make accessible through the primary health-care system reproductive health care to all individuals as soon as possible.

Reproductive health care, the document states, should include: information and services for family planning, prenatal care, delivery and post-natal care; prevention of abortion and management of complications of abortions; health care for women and infants; and prevention and treatment of infertility and sexually transmitted diseases; among others.

The Programme stresses that women should be involved in all levels of health care programmes, and involved in the planning, implementation and evaluation of reproductive health care programmes. The document emphasizes that the principle of informed free choice is essential to the long-term success of family planning programmes; no form of coercion has any part to play.

Currently about 55 per cent of couples in developing countries use some method of family planning. This figure represents a tenfold increase in absolute terms (to 460 million couples) and a fivefold increase in percentage terms since the 1960s. Family planning programmes have contributed considerably to the decline in fertility rates in developing countries from about six to seven children per family in the 1960s to three to four children at present.

However, the number of couples of reproductive age will grow by at least 18 million each year during the rest of this decade. The full range of modern family planning methods presently remains unavailable to at least 350 million couples world-wide, many of whom say they want to space or prevent another pregnancy. Survey data suggest that approximately 120 million additional women world-wide would currently be using a modern family planning method if more accurate information and services were accessible to them.

These figures would be even higher if sexually active unmarried individuals were also included. The reproductive health needs of adolescents have been largely ignored by existing services. The Programme calls upon Governments to remove legal, regulatory and social barriers to sexual and reproductive health information and services for adolescents.

Another crucial issue addressed in Chapter 7 is human sexuality and gender relations, two closely related issues which together affect the ability of men and women to achieve and maintain sexual health and manage their reproductive lives. Violence against women is widespread, and rising numbers of women are at risk from acquired immune deficiency syndrome (AIDS) and other sexually transmitted diseases as a result of the high-risk sexual behaviour of their partners. In a number of countries, harmful practices like female genital mutilation pose a major lifelong risk to women's health.

The world-wide incidence of sexually transmitted diseases is high and increasing. The situation has worsened considerably with the emergence of the HIV pandemic. draft Programme calls for prevention and reduction of the incidence of sexually transmitted diseases, including HIV/AIDS. At the same time, it states, treatment should be provided for the complications of sexually transmitted diseases such as infertility, with special attention to girls and women.

HEALTH, MORBIDITY AND MORTALITY: Chapter 8 of the draft Programme of Action, "Health, Morbidity and Mortality", deals with: primary health care and the health-care sector; child survival and health; women's health and [safe motherhood]; and HIV infection and AIDS.

In the past half century, life expectancy in the world as a whole has increased by about 20 years, and the risk of dying in the first year of life has been reduced by nearly two thirds. Nevertheless, the draft Programme points out, considerable
improvements are still needed; the document calls upon countries to ensure that health care services and facilities are accessible, available, acceptable and affordable to all people.

The Programme presents a comprehensive set of mortality-reduction goals, calling particular attention to the need to reduce infant and child mortality and maternal mortality. It states that one of the aims of Governments should be to eliminate excess mortality of girls, wherever such a pattern exists. It underscores the need to achieve a rapid and substantial reduction of maternal morbidity and mortality. The realization of these goals will have different implications for countries with different levels of mortality. However, all countries are called upon to reduce maternal morbidity and mortality levels to where they no longer constitute a public health problem.

The age at which women begin or stop child-bearing, the intervals between births, the total number of pregnancies and the sociocultural and economic circumstances in which women live all influence maternal morbidity and mortality.

Addressing the threat to women's health due to self-induced or otherwise unsafe abortion is another feature of Chapter 8. There was considerable debate on this issue during PrepCom III. This debate continued at the Conference. The draft text contained two alternative paragraphs on abortion under section 8.25. Both are bracketed and will be the subject of further negotiation in the Main Committee of the Conference. They were:

     "8.25. [All Governments, intergovernmental organizations and relevant non-governmental organizations are urged to deal openly and forthrightly with [unsafe abortion] as a major public health concern. Particular efforts should be made to obtain objective and reliable information on the policies on, incidence of and consequences of abortion in every country. Unwanted pregnancies should be prevented through sexual health education and through expanded and improved family-planning services, including proper counselling to reduce the rate of abortion. Governments are urged to assess the health and social impact of induced abortion, to address the situations that cause women to have recourse to abortion and to provide adequate medical care and counselling. [Governments are urged to evaluate and review laws and policies on abortion so that they take into account the commitment to women's health and well-being in accordance with local situations, rather than relying on criminal codes or punitive measures. Although the
main objective of public policy is to prevent unwanted pregnancies and reduce the rate of abortion, women should have ready access to quality health-care services that include reliable information, counselling and medical care to enable them to terminate pregnancies in those cases where it is allowed by law, if they so decide, and that provide for the management of complications and sequelae of unsafe abortion. Post-abortion counselling, education and family-planning services should be offered promptly so as to prevent repeat abortions].

     "[ALTERNATIVE 8.25. All Governments and intergovernmental and non-governmental organizations are urged to deal openly and forthrightly with unsafe abortion as a major public health concern. Governments are urged to assess the health impact of unsafe abortion and to reduce the need for abortion through expanded and improved family-planning services. Prevention of unwanted
pregnancies must always be given the highest priority and all attempts should be made to eliminate the need for abortion. In no case should abortion be promoted as a method of family planning. In circumstances where abortion is legal, women who wish to terminate their pregnancies should have ready access to reliable information and compassionate counselling and such abortion should be safe. In all cases, women should have access to services for the management of complications arising from unsafe abortions. Any measures to provide for safe and legal abortion within the health system can only be determined at the national level through policy changes and legislative processes which reflect the diversity of views on the issue of abortion.]"

The paragraph adopted by the conference reads:

"8.25. In no case should abortion be promoted as a method of family planning. All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women's health, to deal with the health impact of unsafe abortion as a major public health concern and to reduce the recourse to abortion through expanded and improved family-planning services. Prevention of unwanted pregnancies must always be given the highest priority and every attempt should be made to eliminate the need for abortion. Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling. Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process. In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family-planning services should be offered promptly, which will also help to avoid repeat abortions."

AIDS is another major threat to health, in both developed and developing countries. The World Health Organization estimates that the cumulative number of AIDS cases in the world by mid-1993 amounted to 2.5 million persons, and that over 14 million people had been infected with HIV since the pandemic began. The Programme calls upon Governments to assess the demographic and development impact of HIV/AIDS and to address the pandemic through policies in a range of social sectors.

* taken and adapted from the UN Population Information Network (POPIN) at http://www.undp.org/popin/
and http://www.undp.org/popin/icpd/infokit/
http://www.undp.org/popin/icpd/infokit/infokit.eng/5women.html

 

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