New ways needed to address population problem

By Tom Merrick

JAKARTA: Experts and policymakers from around the globe gathered in The Hague, the Netherlands, last week to review progress on population since the landmark meeting in Cairo in September 1994.

The Cairo conference marked a turning point in the way population and development issues are understood. Population growth was, for many years, depicted in doomsday terms, as a Malthusian bomb about to overwhelm us. Debate on population often confronted deep religious and political sensitivities which defied resolution.

After Cairo, a new consensus emerged. It moved from alarm about exploding growth and fretting about meeting demographic targets to endorsing a new focus for population work -- one centered on people, particularly the poor, and on addressing their rights and needs throughout their lives.

Five years after Cairo, we have witnessed significant progress. Investment in education, health and family planning have made it possible for couples who want smaller families to find safe, effective means of achieving that goal. Women and children have a better chance of surviving pregnancy and childbirth and living healthier, more productive lives.

Improvements in the status of women, dissemination of new ideas through the mass media and organized efforts to increase access to modern methods of contraception have reduced birth rates in East Asia and Latin America to half their 1960 levels. Several countries in Eastern Europe and Central Asia have low or even negative population growth. Over the past generation, life expectancy in developing countries has risen from 55 years to 64 years, and infant mortality has been halved.

The World Bank -- the single largest external source of financing for health and education in the developing world -- has been part of this story. The change in mind-set which happened in Cairo five years ago is now reflected in the policies of the bank, its borrowing countries and its partners. We have learned, for example, that by investing modest amounts in micro-credit programs which provide grants to women entrepreneurs, we can create higher incomes and better jobs for women, in turn enabling them to make more informed decisions about childbirth and family size.

Despite this progress, many challenges remain, and new ones have surfaced. Rapid population growth is still a stubborn problem in sub-Saharan Africa, and in several countries in Asia and the Middle East. These countries will account for most of the additional two billion to three billion people still to be born before global population stabilizes sometime late in the next century.

The poor in all regions are still denied access to good reproductive health services and counseling. This means unwanted pregnancies, malnutrition and high child and maternal death rates. In developing countries, poor maternal health and birth- related problems are the leading causes of death and disability for women. Tragically, one in every 48 women in the developing world dies from pregnancy-related causes each year. In developed countries, only one in 4,000 dies from such causes.

Young women hold the promise of a better future. If we educate them, they will tend to have fewer children, each of whom will lead longer, healthier lives. But many girls drop out of school because of poverty, discrimination and early pregnancy. In most developing countries, fewer girls than boys attend school; enrollment of girls aged six years to 11 years is only three- fourths that of boys. That proportion declines with each succeeding educational level.

Sexually transmitted diseases, including HIV/AIDS, spread quickly and attack the young. In Africa and Asia, the HIV/AIDS epidemic is decimating the ranks of young adults and reversing earlier gains in life expectancy. With its victims drawn from people in the prime of life -- those aged 20 years to 40 years -- HIV/AIDS leaves not only thousands of orphans, but also undermines economies by destroying their vital forces. And, in a globalized world, disease travels across geographic boundaries and oceans.

The World Bank's new strategy on population and reproductive health reflects these lessons. For example, the bank-supported Malawi Social Action Fund helps upgrade schools, health clinics, community water wells, urban and rural markets, and granaries in that central African country. These investments address the needs of Malawian women, as defined when the project was designed.

The bank will continue to work with its partners -- borrower governments, civil society and other international agencies -- to implement the new global vision outlined in Cairo. This means supporting family planning, ensuring child survival, seeking better health for mothers, educating young girls and empowering women to take charge of their lives.

The writer is a senior adviser on population, reproductive health and family planning issues at the World Bank.