Women, empowerment and health
INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT
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
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
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
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
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
"[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/