icpd beyond 2014 [framework of actions for the follow up to the programme of action of the...
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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]
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Thematic Pillars for Population & Development Post-2014
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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.
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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
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Dignity
• Wealth • Education• Employment• Discrimination
• Women• Youth• Older Persons• Disabled Persons• Indigenous Persons• …. all persons....
DIGNITY & HUMAN RIGHTS
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Global Wealth Pyramid (Credit Suisse 2012)
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Unequal gains in income, 1988-2008
Impact on development?
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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%).
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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
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“Men make better political leaders than women”
Proportion who disagree - 1995-2005
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% 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)
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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
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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.
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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
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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
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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 %)
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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
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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
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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
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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
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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
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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
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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.
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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
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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 (%
)
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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
(%
)
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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
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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
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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 (%
)
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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
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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
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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;
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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)
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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.
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Professionalization of delivery care, 2000-2015
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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
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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
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Dignity
• Spatial & Social Inequalities • Changing Household
Structures • Internal Migration &
Urbanization• International
Migration• Insecurity of Place
SECURITY OF PLACE & MOBILITY
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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
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Proportion of all hh’s that are one-person hh’s, 1990-2010
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Total Population by City Size, 1970,1990,2011,2025
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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
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Dignity
• Accountability• Elaboration of
Institutions• Participation• Knowledge Systems• Partnerships,
Collaboration & Coherence
GOVERNANCE & ACCOUNTABILITY
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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)
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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
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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
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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
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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
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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