World Population Day 2019 - The Road from Cairo and the Journey Ahead
By Jay Gribble, HP+
Can it really be almost 25 years since the International Conference on Population and Development (ICPD) took place? World Population Day 2019 provides an opportunity to pause and reflect on what has happened over the past quarter century—the advances that have taken place and the unfulfilled aspirations yet to be achieved. The famous Cairo conference in 1994 created a new paradigm for the way we think about family planning and reproductive health. As a result of ICPD, “population programs” no longer focus on the macro-level indicators that harken to messages of population control, fertility goals, and a paternalistic way of providing family planning and reproductive health services. Today, we prioritize family planning programs that are women-centered and rights-based and that address empowerment, informed choice, and service integration. Yet, there is still a lot to do in related areas such as gender, local participation, and local ownership.
Family planning is no longer only about birth control; it has become a comprehensive way of thinking about the care of women and girls. Integrating family planning into other health services, such as immunization, care for HIV, and even antenatal care reflect a way of thinking about women’s health over the life course, while also respecting the time and resources that women invest in order to attend health services. As a result of ICPD, models for outreach are greatly improved, whether through mobile services, community health providers, or other approaches that focus on specific underserved populations, such as youth. It’s no longer the “doctor knows best” model of the past. The process through which women and men are engaged in program decision making has also evolved with communities, civil society, and individuals giving voice to how services are designed and how policies are developed. Advances in accountability have changed the way that family planning is envisioned and implemented. There are still many ways that family planning service delivery can be improved with higher quality, greater participation, and more emphasis on what clients—and non-clients—want and need. Thanks to ICPD, we continue to see progress in how services are designed and implemented.
ICPD elevated gender as a key issue. We’ve seen a change in the attitudes of providers toward clients, as well as a shift in the ways that people think about family planning. By focusing on the individual, ICPD helped reframe family planning as a tool for women to make decisions about the timing and spacing of pregnancies—allowing more women to take charge of more aspects of their lives, including working outside the home, having the number of children they want, and creating a better future for themselves and their daughters. ICPD motivated the family planning community to take a stand on harmful practices against girls—FGM, child marriage, limited educational opportunities. The role that men play in family planning—as supportive partners, as users, and as change agents—was also advanced by ICPD. These efforts have helped shift family planning from a “woman’s issue” to something that is important for individual empowerment, healthier women and children, and economic development. Until women’s status and gender norms move more toward greater equality, individuals, households, communities, and nations will fail to achieve their full potential. We have certainly seen improvements in gender status, with more opportunities for women and girls today than in 1994, but we still have a long way to go.
New issues have emerged that are influencing the global family planning movement. Sustainability is at the forefront. It’s an umbrella topic that includes the role of the private sector and responds to reductions in donor funding and economic growth at the country level that is increasing gross domestic product per capita. To help accelerate financial sustainability, advocates continue to make the case for increased funding for family planning at the national and subnational levels through generating evidence that supports the health, economic, and empowerment benefits of investing in family planning. Models developed by colleagues on the USAID-funded Health Policy Plus and previous projects that quantify the impact of family planning on achieving the Sustainable Development Goals (FP-SDG), the health and economic benefits of investing in family planning (ImpactNow), the health and social benefits of investing in youth (Youth Count model will be released later this year) are all making a positive impact by generating evidence of the value of family planning’s many benefits. We all need to continue to make the case for investing in family planning and focusing on sustainable approaches to meeting the health needs of women and girls.
ICPD provided a foundation for many of the advances we have seen in recent years, including the FP2020 movement, the efforts underway to develop and implement family planning programs based on a human rights framework, and the ongoing efforts to better respond to the reproductive health needs not only of women and girls, but of men and boys, too. Much progress has been made, and much more needs to be made. While I’ve no idea where things will stand in 2044 when we turn to ICPD+50, I am optimistic that the progress we have seen in recent years will only continue to accelerate in the next decades. I have no doubt that our field will continue to make great advances over the next quarter century, and we will have much more to celebrate then.