August 24, 2004

Recalling Cairo Ten Years Later

INTER PRESS SERVICE NEWS AGENCY

More than 700 professionals in the health field from 107 countries will gather in London next week to push forward a delivery of reproductive health services that has been slowing down if not stalling.

LONDON, August 24, 2004
by Sanjay Suri

More than 700 professionals in the health field from 107 countries will gather in London next week to push forward a delivery of reproductive health services that has been slowing down if not stalling.

The conference 'Countdown 2015' called by leading non-governmental organisations in the field is expected to produce strategies to produce badly needed services by 2015.

Agreements reached at the International Conference on Population and Development in Cairo in 1994 are part of the Millennium Development Goals (MDGs) which cover reproductive health issues.

The Cairo conference was seen by professionals in the field as a landmark event. It highlighted the link between poverty and population, and it spoke of reproductive health as not just a means to control population but as a rights issue. The very idea of 'reproductive health' was born at the Cairo conference.

Reproductive health came to mean mostly family planning, sex education, safe motherhood and protection against sexually transmitted infections including HIV/AIDS.

A programme of action produced at Cairo said "all countries should reduce mortality and seek to make primary health care, including reproductive health care, available universally by the end of the current decade."

The end of the nineties brought nothing of the kind. It marked in fact the beginning of a cut in funds and commitment.

The Cairo conference had anticipated a budget for services in the field beyond that decade. It was agreed that 17 billion dollars would be needed in 2000, rising to 18.5 billion dollars in 2005. But 2000 onwards, budgets have begun to fall. The London conference Aug. 31 to Sep. 2 is expected to produce detailed figures of the decline.

"We have all fallen well behind the commitments made at Cairo," Marie Stopes International's external relations director Patricia Hindmarsh told IPS. "The northern governments have fallen well behind, the southern ones have done a little better."

The Marie Stopes International global partnership provides sexual and reproductive health information and services to 4.2 million people worldwide in 37 countries across Africa, Asia, Australia, Europe, Latin America and the Middle East.

Commitments have fallen behind "due to a lack of political will to accomplish this task," Hindmarsh said. "There isn't sufficient commitment. People got very excited at Cairo, it was a ground-breaking conference. The U.S. was very much in the lead in establishing a programme of action. Southern governments also showed interest. But as time has worn on, political commitment seems to have weakened."

This is due partly to the extent of the HIV/AIDS crisis, she said. "That should be a part of reproductive health, but it has become the only focus. There is a reasonable commitment to doing something about HIV/AIDS, but not enough for the rest of reproductive health. Maternal mortality remains atrociously high. So does infant mortality."

A big blow has been that the U.S. government that had been expected to be a major donor has ceased to take leadership, she said. "One of the first decisions of the Bush administration was to reinstate the Mexico city ruling under which the U.S. will not fund any agency in the south that provides information on abortion. Never mind abortion services, but just be talking about it."

This has had a ripple effect, Hindmarsh said. "It has undermined reproductive health work, not just abortions. For this U.S. government abstinence seems the only agenda. Abstinence would be a good way of dealing with the problem—if it were feasible."

The developing world where the services are most urgently needed is suffering acutely as a result of the U.S. position, experts in the field say. "Because the Bush administration is not able to really prevent reproductive health measures in the U.S.—because the Constitution will not allow it—they export anti-reproductive health ideology to the developing world," Frances Kissling, president of the Washington-based Catholics for a Free Choice told IPS.

"They can't make abortion illegal in the United States, so they refuse to spend U.S. money on other agencies that provide abortion," she said. "Third World women pay the price for U.S. public policy."

NGOs will seek through the London conference to push governments to renew their commitments to the Cairo goals. "This will be an important event, because much of the delivery of reproductive health services is accomplished through NGOs," Kissling said. "Civil society organisations should always be ahead of the government. Governments are usually stuck in status quo, and civil society must push the governments to be more progressive."

Hindmarsh says NGOs are natural leaders in this field. "Governments find it difficult to provide services in this field because it's about people's sex lives," she said. "In many developing countries such as male-dominated Pakistan governments feel measures in this field will make them unpopular. Reproductive health places power in women's hands, and the husbands get upset."

The task ahead for NGOs will not be easy, Hindmarsh says, because while northern governments have reduced their commitments, "the political will on part of southern governments for our work is not great. Quite a few are positive, like India which has taken considerable steps. And there are other countries in Africa that have been positive. But sub-Saharan Africa has been a major problem. And the Pakistan government does not seem to like NGOs."

NGOs are still in the lead in providing services to people in the south and lobbying northern governments, she said. "Without that lobbying, the Cairo declaration would have been off the agenda by now. It is NGOs who are holding governments to account, telling them this is what you said before, now stick with it."

All rights reserved, IPS Inter Press Service (2004).
Total or partial publication, retransmission or sale forbidden.