ICPD Beyond 2014

[Framework of Actions for the follow up to the Programme of Action of the International

Conference on Population and Development Beyond 2014

[Operational Review of progress in the Programme of Action

from the 1994 International Conference on Population and Development]

Thematic Pillars for Population & Development Post-2014

Cross-Cutting: Equality & Human Rights

Affirmation of the entitlements of all persons to the rights & freedoms set forth in the Universal Declaration of Human Rights, without distinction of any kind.

Recognition that the relationship of population to development is so intertwined with issues of poverty, patterns of production and consumption, and inequality, that none can be fruitfully addressed in isolation.

Methods & Sources• 3 thematic meetings: youth, human rights,

women’s health• Regional UN meetings• Review and analysis of national data (DHS,

MICS, WHO, UNAIDS, UNICEF, etc.)• Global Survey of 174 governments:

– Commitments last 5 years– Priorities next 5 years

Dignity

• Wealth • Education• Employment• Discrimination

• Women• Youth• Older Persons• Disabled Persons• Indigenous Persons• …. all persons....

DIGNITY & HUMAN RIGHTS

Global Wealth Pyramid (Credit Suisse 2012)

Unequal gains in income, 1988-2008

Impact on development?

Women’s Empowerment & Gender Equality

• Women’s labour force participation – Gender gap narrowed slightly since 1994– Women paid less, over-represented in vulnerable, informal

employment, – Under-represented positions of power and decision-making,

and with a disproportionate share unpaid care responsibilities• GBV & harmful practices:

– 1 in 3 women experience physical/sexual abuse– 1 in 4 men in a 10,000 person multi-country study in Asia &

Pacific admitted to perpetrating rape;– Despite growing legislation against harmful practices, early and

child marriage and FGM/C remain prevalent

Government priorities for gender equality and women’s empowerment: economic empowerment and employment (67%), political empowerment and participation (56%) and the elimination of all forms of violence (53%).

Support for gender equality by region

2004-2009

0

10

20

30

40

50

60

70

80

90

100

University education

Business executives

Political leaders

Right to a job

Per cent

Africa Asia Eastern Europe

LAC West Europe & other developed countries

“Men make better political leaders than women”

Proportion who disagree - 1995-2005

% of Governments Addressing Equality in Work & Family Life ? (Global Survey 2012)

85% Commitments or laws against workplace discrimination of women

64% Policy commitments to work/family balance

90% Maternity leave 54% Paternity leave 41% Breastfeeding in the public workplace

~ All 5 policies & provisions? 18.7% (26/113)

The rising proportion of older persons (60+ years), 1950-2050 19

50

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

0%

5%

10%

15%

20%

25%

30%

35%

40%

Africa

Americas

Asia

Europe

Oceania

World

Older Persons• Proportion of older persons is 11% globally, 20% in Europe,

rising in all countries• By 2050, 20% of the global population will be over 60• Needed pensions, health care, housing, social protection

Older People & Work• More than 40% of 65+ in Africa are economically active, nearly

25% in Asia, Latin America, the Caribbean• Women’s labour force participation after age 65 has risen; • Global illiteracy rate is 26% among persons aged 65+ (25% in

Latin America, 68% in Africa) – higher among women;• Lifelong learning, retraining, and flexible employment are

critical.

The demographic importance of young people 10-24 yrs, 1950-2050

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

0%

5%

10%

15%

20%

25%

30%

35%

Africa

Americas

Asia

Europe

Oceania

World

Adolescents & YouthEducation• Gains in primary, secondary school attainment, primary

school enrollment rates approaching 90%• Largest gains in primary school completion among girls• High variation in access and quality – urban/rural, wealth• Secondary education far from universal

Employment• Of estimated 197 million unemployed, nearly 40% are 15-24 • Young people disproportionately in low paid, intermittent,

insecure work• 600 million productive jobs needed over the next decade

Adolescents & YouthChild/Early marriage• Legal age of marriage 18 in 158 countries • Yet 34% of women 20-24 in developing regions are married or in

union by age 18; 12% by age 15

Adolescent Pregnancy• Early marriage is very linked to early fertility: 1 in 5 girls in

developing countries become pregnant before age 18, and 90% of births under age 18 occur in the context of early marriage

• Higher levels of education are associated with lower ABR

Government priorities for young people: economic empowerment and employment (70 %), social inclusion and education (56 %)

Stark Health & Wealth Inequalities for Indigenous Peoples

Life expectancy of indigenous vs. non-indigenous children:• 20 years in Nepal or Australia• 13 years in Guatemala• 11 years in New Zealand

Among 28 million indigenous people in Latin America almost no change in poverty (~80%) from early 1990’s to early 2000’s, and poverty among indigenous…

– 8x non-indigenous in Paraguay– 6x … Panama– 3x …Mexico

Unequal Burden of Disability

• 5% age 0-14 are live with a disability • 15-20% over age 15 live with disability• Rising dramatically with age – and increasing

due to population aging, rise in years lived with ncd’s

• Women more than men• Higher in lower income countries

Non-Discrimination Applies to All Persons

• Ethnic and Racial Minorities• Persons of Diverse Sexual Orientation and

Gender Identity• Persons Living with HIV and AIDS• Migrants• Sex Workers• ……….many others

Social Cost of Discrimination

Even without physical violence, stigma and stereotype threat leads to loss of human health & productivity:• negative birth outcomes• higher depression and anxiety• lower performance on aptitude tests & productivity

World Values Survey data highlights national differences in discriminatory attitudes:• where greater intolerance, directed towards

multiple population groups

Key Messages: Dignity & Human Rights

1. Wealth and income inequalities are increasing 2. Empowerment of women and gender equality

remain unfulfilled3. Lifelong learning, and building human

capabilities, warrants substantial investment – especially for young people

4. Public attitudes towards gender equality and stigma vary greatly between countries – warrant tracking

Dignity• Spatial & • Social Inequalities

• Sexual & Reproductive Health • Maternal Health – 47%• Rising Use of Contraception• Changes in Abortion• Aggregate gains mask serious

inequalities• Challenge of STIs• Young people?• CSE – gender “skills”

HEALTH

Changes in Global Health 1990-20101. Life expectancy increased from 64.8 years in 1990-95

to 70 years by 2010-2015 (5.2 years)2. Under-5 mortality rate dropped from 90 deaths per

1,000 live births in 1990 to 48 in 20123. Dramatic shifts in global health burden towards

NCDs and injuries4. But - persistence of communicable, maternal,

nutritional and neonatal disorders in sub-Saharan Africa, South Asia• In 1990 and 2010, SRH-related illness was 14% of global

burden of disease – but changing composition.

Skilled Birth Attendance increased ~ 15% worldwide, 1990-2010 (DHS, MICS)

1990 20100

20

40

60

80

100

World

Northern Africa

sub-Saharan Africa

Latin America/Caribbean

Eastern Asia

Southern Asia

South Eastern AsiaWestern Asia

Source: UN Millennium Development Goals 2012 Report Statistical Annex

Percentage of women who had a skilled attendant (doctor, nurse or mid-wife) at birth, 1990 and 2010

Good progress: Absolute & Relative Gains in Skilled Attendance

Source: MDG5b+ Database and additional analysis, UNFPA

02

04

06

08

01

00

02

04

06

08

01

00

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

1990 1995 2000 2005 2010

Country example Country example Country example

Country example

Richest 20%

Fourth 20%

Middle 20%

Second 20%

Poorest 20%

Ski

lled

atte

ndan

ce a

t birt

h (%

)

Stagnancy / increasing inequalities in Skilled Attendance

Source: MDG5b+ Database and additional analysis, UNFPA

02

04

06

08

01

00

02

04

06

08

01

00

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

1990 1995 2000 2005 2010

Country example Country example Country example

Country example

Richest 20%

Fourth 20%

Middle 20%

Second 20%

Poorest 20%

Ski

lled a

ttend

an

ce a

t birth

(%

)

Contraceptive Prevalence Rate (CPR) increased ~ 10% world-wide, 1990-2010

1994 20140

20

40

60

80

Africa

AsiaEurope

Latin America/Caribbean

North America

OceaniaWorld

Source: UN Department of Economic and Social Affairs, World Contraceptive Use 2012

Percentage of married (or in union) women 15 – 49 years who are using modern method of contraceptive, 1994 and 2014

Good progress: Absolute & Relative Gains in CPR

Source: MDG5b+ Database and additional analysis, UNFPA

02

04

06

08

01

00

02

04

06

08

01

00

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

1990 1995 2000 2005 2010

Country example Country example Country example

Country example

Richest 20%

Fourth 20%

Middle 20%

Second 20%

Poorest 20%

Ski

lled

atte

ndan

ce a

t birt

h (%

)0

20

40

60

80

10

00

20

40

60

80

10

0

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

1990 1995 2000 2005 2010

Country example Country example Country example

Country example

Richest 20%

Fourth 20%

Middle 20%

Second 20%

Poorest 20%

Con

trac

eptiv

e pr

eval

ence

rat

e, m

oder

n m

etho

d (%

)

Good progress: Absolute & Relative Gains in CPR

Stagnancy / increasing inequalities in CPR

Source: MDG5b+ Database and additional analysis, UNFPA

02

04

06

08

01

00

02

04

06

08

01

00

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

1990 1995 2000 2005 2010

Country example Country example Country example

Country example

Richest 20%

Fourth 20%

Middle 20%

Second 20%

Poorest 20%

Ski

lled

atte

ndan

ce a

t birt

h (%

)

02

04

06

08

01

00

02

04

06

08

01

00

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

1990 1995 2000 2005 2010

Country example Country example Country example

Country example

Richest 20%

Fourth 20%

Middle 20%

Second 20%

Poorest 20%

Ski

lled

atte

ndan

ce a

t birt

h (%

)

Trends in Abortion• Number of abortions declined from 45.6

million in 1995 to 43.8 million in 2008, of which 22 million are unsafe

• 8.7 million unsafe abortions among women age 15-24, 3.2 million at 15-19 yrs

• Global rate of abortion declined from 35 per 1000 women (age 15-44 yrs) in 1995, to 29 in 2008; highest rates in East Europe (43); lowest in West Europe (12)

• 86% took place in the developing world

Deaths due to Unsafe Abortion

• Risk of death due to abortion is decreasing globally:– better technologies,– more legal access– more use of WHO guidelines for safe abortion

and post-abortion care

• Yet death rates from unsafe abortion in Africa and Asia remain shockingly high at 460 and 160 deaths per 100,000 unsafe abortions

Sexually Transmitted Infections have risen - weak surveillance

• WHO reports 40% rise in STI incidence (trichomoniasis, gonorrhea) over the past 20 years – (esp Latin America, SSA)

• Monitoring is extremely weak outside the wealthiest countries;

• Highest rates among the urban young 15-35;

HIV is far from eradicated

• 33% global decline new HIV infections;

• Preventive behavior decline;

• Delayed infection in south Africa;

• 34% eligible patients get ART;

• HIV is rising in Eastern Europe, Central Asia;

(World Bank 2011)

Persistent Inequalities in access to Quality SRH care

• Aggregate gains in SRH care not universal• SSA and South Asia weakest health systems,

wealth/spatial inequalities also high;• Most evident for urgent care (SKATT) – than

for CPR• Health workers, information systems critical• PMTCT in 18 countries – only 9% of infants

born to HIV+ mothers located at 1st immuniz.

Professionalization of delivery care, 2000-2015

Poor monitoring of young people’s access to SRH & CSE

• Limited SRH service data available for youth yet….– Women < 25 yrs account for ~50% of deaths from

abortion– Persons 15-24 yrs account for 41% of new HIV

infections worldwide

• Few CSE evaluations, but best show those addressing gender and power markedly more effective – expansion, standardization, monitoring

Key Messages: Health

1. There are persistent inequalities in access to fundamental SRH services

2. Health systems need innovative strengthening, linking rural and urban, & assuring continuity of care for SRH

3. Improve access to SRH & CSE for young people, including age 10-14

4. Strengthen STI diagnostics, treatment, surveillance5. Fully integrate HIV and SRH services6. Start building systems for reproductive cancers,

NCD, elder care

Dignity

• Spatial & Social Inequalities • Changing Household

Structures • Internal Migration &

Urbanization• International

Migration• Insecurity of Place

SECURITY OF PLACE & MOBILITY

Changes in living arrangements, households

• Single-person households are rising in all regions outside of Africa

• Persons never married has risen across a majority of countries of Europe, Oceania and the Americas

• Proportion of persons divorced or separated has increased

• Single parent households are rising – not in all regions – and these households are primarily headed by women

Proportion of all hh’s that are one-person hh’s, 1990-2010

Total Population by City Size, 1970,1990,2011,2025

Key Messages: Security of Place, Mobility

1. Household structures and living arrangements are increasingly diverse

2. The world must plan and build sustainable cities, and strengthen rural-urban linkages

3. International migrants need greater security, and governments must increase cooperation

4. Those with insecurity of place (Homelessness, Displacement, Statelessness) are poorly counted

Dignity

• Accountability• Elaboration of

Institutions• Participation• Knowledge Systems• Partnerships,

Collaboration & Coherence

GOVERNANCE & ACCOUNTABILITY

Global Survey: % of Governments committed to participation of key groups in decision-making

76% Adolescents and youth73% Women61% Persons with disabilities47% Older persons

~ All 4 key population groups? 21.7% (30/138)

Strengthen the Knowledge Sector

• Knowledge sectors remain weak – often detached from government

• Monitoring population dynamics is essential to enhance dignity, health and human rights – and promote development

• Global SRH data have improved, but health data still weak for MDG monitoring – STI’s, morbidity especially

• Gender statistics increasing; gaps in GBV, values• Very weak data on migration, either internal or

international – and on those with insecurity of place – e.g. the homeless

Data for Population & Development

• Only 109 of 193 member states have complete coverage of birth registration; only 99 have complete coverage of death registration.

• Only about 1/3 of births in LDCs are registered, despite a 30% gain since 2000; difficulty registering births without a male relative

• Progress: In the 2010 census round 7 Member States had no census plans, compared to 25 in 2000

• Census dissemination remains weak - with important implications for public policy, and use of population dynamics in development planning

• Inadequate number of trained census experts and demographers in developing countries

Collaboration, Partnerships & Resource Flows

• Since 1994: number, diversity of donors increased • The architecture for development cooperation shaped by

the urgent response to HIV/AIDS• Funding for 4 costed ICPD components (FP; RH,

STI&HIV/AIDS; and research, data, policy), increased in absolute dollars – with dominant share to HIV/AIDS– HIV/AIDS received 66% of total assistance (2011) – RH received 22%

• Global targets and accountability matter: focus on MDGs

Key Messages: Governance & Accountability

1. Participation should be more systematic, more inclusive

2. Population dynamics are critical to development planning

3. Knowledge sectors need strengthening4. Nature & range of partnerships has increased,

need equality and coherence5. Need for accountability systems

Dignity

1. Dignity, Human Rights, Non-Discrimination for All2. Lifelong investment in health & education,

particularly for young people3. Universal access to SRHR 4. Security of Place, Safe Mobility5. Sustainable, inclusive cities linked to rural areas6. A fundamental change in patterns of

consumption7. Stronger global leadership and accountability

Paths to SUSTAINABILITY