BERLIN, Germany – Four hundred delegates from 130 countries released a final version of the “Berlin Call to Action” this morning after two days of discussion at the NGO Forum on Sexual and Reproductive Health and Development that is following up on the historic International Conference on Population & Development held in Cairo, Egypt 15 years ago.
After long and sometimes heated discussions, the delegates “demand” that donors and governments accelerate implementation of the ICPD Programme of Action “as fundamental to achieving equality and equity, human rights and social and economic development.” They urged the following actions to be taken immediately (the Call to Action language is in bold; my comments are italicized):
- Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. This reflects the delegates’ desire to go beyond the realm of public health and position sexual and reproductive rights as fundamental human rights.
- Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. The new idea here is to acknowledge the fact that the current aid architecture emphasizes health system strengthening and the delegates belief that associating SRH with health systems can help our cause.
- Ensure the sexual and reproductive rights of adolescents and young people. Approximately 25% of all of the delegates were under the age of 30 and the focus on youth was a recurring theme of the conference. Jill Greer, chair of the Steering Group, said that it was vital that the movement develop new leaders for the future.
- Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. The message here is that governments have to bring civil society organizations to the table as meaningful partners.
- Ensure that donor contributions and national budgets and policies meet the needs of people for sexual and reproductive health and rights. This financial aspect was enhanced considerably from the earlier draft and reflects the delegates’ recognition that their lofty visions will not be realized without the financial resources to carry them out.
In presenting the text to the delegates this morning, Sivananthi Thanenthiran, a co-chair of the Steering Group, recognized that the most intractable hurdle to overcome in finalizing the text was the split between those who preferred ICDP language, and those who preferred the language of the Millennium Development Goals, which was the focus of my blog yesterday (see below). “We have positioned ourselves in the middle,” said Ms. Thanenthiran. “We want to move beyond Cairo and leverage the MDGs.”
Another key issue was toning down the rhetoric because of the fundamentalism of many countries where the legitimacy of governments is based on religion. To overcome this, the Drafting Committee tried to find language that would not offend.
Finally, the drafters made a conscious decision not to mention every marginalized group that would benefit from this program of action. Ms. Thanenthiran said the Drafting Committee did this both to keep the document as short as possible and not to offend any group that might me left out inadvertently. This obviously caused distress from some who wanted their particular group singled out for attention.
BERLIN, Germany – Spirited discussion around the “Berlin Call to Action” now being drafted at this NGO Forum on Sexual and Reproductive Health and Development is heating up. It seems that the debate on the extent to which Millennium Development Goal (MDG) advocacy language should be incorporated into the ICPD sexual and reproductive health framework that has been seen at the Council’s Maternal Health Roundtable has also come to Berlin. To wit, some sexual and reproductive rights groups feel that MDG 5 has consumed the ICPD agenda through MDG5b, which they believe does not clearly articulate the goals of the reproductive and sexual health community. Others say that we must face the fact that international donors and the U.S. government have started to use the MDG language in their own communication and costing of global health priorities, and that this language provides a template to help policymakers in making and advocating for global health policy change.
To change the advocacy hymn book at this point could undue years of hard work in terms of getting international and U.S. policy makers to understand the importance of funding global health issues, they say, and that it would be a mistake to remove this language from the Berlin Call to Action. The Latin America delegation is one of the prime drivers of the anti-MDG sentiment and is in no mood to compromise. Its members believe that the MDG language has prevented the advancement of the ICPD agenda and they feel the U.S. and European constituencies do not understand the realities on the ground. They say the MDG language does not represent the concrete results that they need to offer greater access to reproductive health (contraception, safe and legal abortion, etc.) and prioritization of sexual and reproductive health as a critical component of economic and social justice and development.
This debate has already been going on in the Maternal Health Roundtable at GHC. However, the discussion the last two days here in Berlin is heated with no compromise in sight. The deadline for written comments to the first draft took place at 9:00 this morning and a second draft is scheduled to come out on Friday. Stay tuned.
BERLIN, Germany – At the first plenary session this morning, here at the NGO Forum on Sexual and Reproductive Health and Development observing the 15th anniversary of the International Conference on Population and Development, a speaker who participated in ICPD in Cairo in 1992 recalled how the stars had aligned that year and for the two following years to produce something important in sexual and reproductive health and rights amid a sea of “bad years.” She cited three developments that led to this historic alignment:
- The existence of a charismatic and committed leader, Undersecretary of State Tim Wirth, who was unrelenting in pushing forward the agenda of the ICPD;
- A supportive American administration – Bill Clinton had just been elected president less than two years before – and Democratic Congress; and
- An increasingly sophisticated non-governmental organization movement which played a leading role in making ICPD a reality.
She said this alignment started falling apart in late 1994 when conservative Republicans took control of congress and the Clinton Administration lost its early momentum. When I talked to this same woman later in the day, she said she sees a similar aligning of the stars happening now – a progressive and supportive American administration and Congress and an NGO movement that, if anything, is more sophisticated than it was in 1994. The only thing missing, she said, is a charismatic and committed leader like Tim Wirth. Later in the evening, I talked to another person who had been in Cairo in 1992 as a senior U.S. government official. He agreed with this scenario but thinks it is still possible for such a leader to emerge in our times. Specifically, he mentioned Secretary of State Hilary Clinton as such a leader.
BERLIN, Germany — In September 1994, some 11,000 delegates from 179 countries gathered in Cairo, Egypt to call for universal access to a package of basic reproductive health services and other specific measures to foster human development, with a particular focus on girls and women, with specific targets set for 2015. They concluded that meeting the needs of women and men was central to reducing poverty, achieving sustainable economic growth and slowing population growth.
This meeting, known as the International Conference on Population & Development, has became a marker against which progress in reproductive health has been measured. Now, exactly 15 years later, NGOs — including the Global Health Council and many of its members — are gathering in Berlin for “Global Partners in Action: NGO Forum on Sexual and Reproductive Health and Development,” to assess what progress has been only six years before the 2015 goals are to be met and what we still need to do to meet the goals in the next six years.
So where are we, three quarters of the way into the process? Progress has been made, but it is certainly not across the board. “The right to the highest attainable standard of health, particularly sexual and reproductive health, continues to elude millions of people, especially the poor and marginalised,” wrote four organizers of the conference in an article published Aug. 29 in The Lancet. In 2004, on the tenth anniversary of IPCD, three GHC members (Population Action International, Family Care International and the International Planned Parenthood Federation published a report “IPCD at Ten: Where are we now?” that attempted to measure where exactly each country stood against the targets. No comparable report has been commissioned in 2009, although I picked up a brochure here in Berlin just published by a group of organizations in Latin America and the Caribbean (Cairo +15: Cuenta Regresiva en la Implementacion del Programma de Accion de la Conferencia Internacional de Poblacion y Desarrollo) that gives some basic data on key indicators. Here is where the 2004 special report found we were in meeting health needs at that time, with our indication of where we might be in 2009:
- Family planning is still up: The 2004 report found that access to contraceptives had improved significantly in the previous 10 years. That trend has continued in the last five years but unmet need is still huge. The Latin America brochure reports good news — that the modern contraceptive prevalence rate in Latin America and the Caribbean has risen an average of 13% from 1995 to 2008 (and the increases occured in every country except Trinidad and Tobago).
- Contraceptive supplies are still short: The 2004 report found that millions of people of reproductive age lacked protection from unplanned pregnancies, HIV and other sexually transmitted infections and that many clinics experienced stock-outs of contraceptive supplies. In 2009, over 200 million women lack access to modern contraceptives.
- Too many mothers are still dying: Unfortunately, not much has changed since 2004. More than 500,000 women worldwide are still dying from complications of pregnancies or childbirth, including 67,000 from unsafe abortion. The 500,000 figure has not changed significantly in two decades. Millennium Development Goal 5 on maternal mortality is the MDG where the least progress has been made. A glimmer of hope can be found in the Latin American report, which shows that the average rate of maternal mortality in that region has fallen by 3% from 1995 to 2008. However, it is also true that it has risen in almost as many countries as it has fallen in.
- HIV/AIDS is a continuing threat: “The HIV/AIDS pandemic has exploded worldwide since 1994,” said the 2004 report. “While some countries have succeeded in limiting its spread, infection rates are rising in others where it had not been prevalent.” In 2009, some 33 million are living with HIV and every minute, four more people are infected. But the pace of infection has slowed, and new drugs have saved countless lives in some places. In short, some progress has been made but there is a huge amount of work left to be done and 400 delegates have come to Berlin to reinvigorate the process that the Cairo Consensus gave birth to 15 years ago. My colleague Joanne Manrique and I will be in Berlin all this week, monitoring the events and reporting back to you on the salient developments.