PROGRESS AND DIFFICULTIES IN IMPLEMENTING THE PROGRAMME OF ACTION OF THE INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT IN THE REGION

Notes (Chapter II)

5. Brazil, Jamaica, Nicaragua, Panama, Peru and Trinidad and Tobago are some of the countries that made progress in the institutional area. In 1995, Brazil set up a National Commission for Population and Development, consisting of representatives from ten ministries and experts from academic bodies and civil society organizations, including several women’s organizations, participating in a personal capacity. In Jamaica, after population policy was brought into line with the guidelines produced by the International Conference on Population and Development, it was decided that the Intersectoral Coordinating Committee for Population Policy should be replaced with a Population and Development Commission of a technical nature, which will deal with the broad area of sustainable development. In 1997, Nicaragua set up a National Population Commission attached to the Social Cabinet, the main function of which is to coordinate the implementation of the population policy ratified in 1998. In Panama, the Social Cabinet set up a Technical Committee for Population (COTEPO) as an advisory body; the Committee serves as a forum for discussion, formulation, monitoring and assessment of public population and development policies. In Peru a Ministry for the Advancement of Women and Human Development (PROMUDEH) was created, with responsibility for formulating and implementing the National Population Plan 1998-2002; a national commission with eight representatives at vice-ministerial level was set up to coordinate the Plan, and a tripartite board was established between the Government, non-governmental organizations, academic bodies and international organizations to monitor implementation of the Programme of Action. In 1996 Trinidad and Tobago adopted a National Population Policy. Other countries have chosen to consolidate the bodies that existed before the International Conference on Population and Development, rather than establish new institutions. Perhaps the most noteworthy case is Mexico, whose National Population Council designed a National Population Programme for the period 1995-2000, which is being implemented with the participation of State Population Councils (COESPOs), under the authority of the governors of the federal states. In Bolivia, population issues were incorporated as a cross-disciplinary theme in the four "pillars" (opportunity, equity, institutional framework and dignity) of the General Economic and Social Development Plan for 1997-2002.

6. Particular mention should be made here of the case of Peru, which explicitly considered lack of access by the poor to reproductive health services as an important dimension of social inequity. A number of other countries —such as El Salvador, Jamaica, Nicaragua and Panama— included population components in their social development policies. Even some of the countries that do not have explicit population policies, such as Bolivia, have policies and programmes that are consistent with the guiding principles of the International Conference on Population and Development.

7. A multitude of initiatives in this field have taken advantage of the availability of census databases in the REDATAM format. In Chile, for example, census micro-databases have been made available to all the municipalities in the country. The Municipality of San Pedro Sula, in Honduras, has set up a local information system with an extensive database, which is also used by the private sector, making it self-financing. With the support of UNFPA, the experience gained in San Pedro Sula is also being made use of in other countries in the subregion such as Guatemala, Nicaragua and Panama. In Brazil, the North-Eastern Development Authority has promoted the use of sociodemographic information in the planning departments of the country’s poorest municipalities.

8. For example, in 1996 Peru set up the Ministry for the Advancement of Women and Human Development (PROMUDEH), and in 1997 Panama set up the Ministry for Youth, Women, Children and the Family.

9. These institutional arrangements were put into practice in a number of Central American countries and Ecuador. In Costa Rica, in addition to the National Institute for Women, ministerial and sectoral women’s offices were set up under different government departments.

10. In Bolivia, for example, Supreme Decree 24648 was promulgated recently (October 1997), establishing equality of opportunities for men and women. In Venezuela a National Plan for Women was formulated for the five-year period 1998-2003, with contributions from various ministries and non-governmental organizations.

11. Some examples of such participation mechanisms are: the Intersectoral Committee of Women in Health of the National Health Council in Brazil, set up in 1997, and the Inter-agency Group for Reproductive Health in Mexico, in which government bodies and non-governmental organizations participate. Other countries are currently designing similar mechanisms; in Peru, the National Programme for Reproductive Health and Family Planning makes provision for local monitoring by women’s non-governmental organizations. Nonetheless, this new openness has come up against obstacles. One of them is resistance to the idea of changing the vertical method traditionally used to plan and administer services, which generally excludes institutions from civil society. Another obstacle is the reluctance of women’s non-governmental organizations to work together with agencies of Governments with which they disagree; conversely, some Governments have been unwilling to involve non-governmental organizations.

12. Many Caribbean countries have adopted new measures to encourage more responsible sexual and reproductive conduct on the part of men, using programmes of information and education and child support laws to encourage them to play a more active role in the family. With the same ends in view, the Family Planning Association of Barbados organized a public meeting called Men talking to Men; in Jamaica a programme called Fathers Incorporated was set up; and in Peru counselling programmes were created to promote more active participation by men in family planning.

13. For example, the National Programme for Responsible Motherhood and Fatherhood in Cuba provides for women and their partners to be educated jointly in different aspects of reproductive health; Paraguay has a Programme of Reproductive Health and Family Planning for members of the armed forces and the national police force. Mention should also be made of the Male Support Programmes organized by the Ministry of Culture and Gender Affairs of Trinidad and Tobago with the involvement of non-governmental organizations, which include information, education, counselling and services.

14. An assessment of the experiences of these men’s groups, with the aim of using them in the design of policies and programmes, was carried out in 1998 at the Regional Conference on Gender Equity in Latin America and the Caribbean, which considered the challenges arising from the male sense of identity, and at the symposium on the theme, "Male participation in sexual and reproductive health care: new paradigms", which adopted a declaration by men against violence against women.

15. One example is that of the 1998 constitutional reforms in Ecuador, which placed reproductive and sexual rights among civic, economic, social and cultural rights; the sections of the constitution relating to the family also mention reproductive and sexual health.

16. For example, the University of the West Indies and the Family Planning Association of Trinidad and Tobago have organized a programme of education for family life, which is given at the School of Education.

17. Participants in these programmes include plantation, sugar mill, hotel and tourism workers in the Dominican Republic and employees of maquila plants in El Salvador and Nicaragua and of industrial firms in Haiti and the north-eastern states of Brazil. Work has also been done with young people taking part in occupational training programmes; thus, in rural areas of Paraguay 6,000 young instructors have been trained in sex education and gender equity. In Venezuela, education in sexual and reproductive health and in gender equity has been incorporated into a programme of training for productive employment run by the Ministry of Youth.

18. Particular reference should be made to community education bearing on the sexual and reproductive health of adolescents and adults, which aims to develop the ability of individuals to make decisions about their emotional lives, sexuality and reproductive health, with activities that simultaneously involve schools, the community, health care services and the media. This involves schools holding sessions of conversation about emotion and sexuality, which foster dialogue between students, teachers and parents on issues of sexuality and reproductive health, supported by professionals in health care, sex education, psychology and ethical guidance.

19. Courses on safe motherhood, contraceptive techniques and the diagnosis and treatment of sexually transmitted diseases have been held in a number of the countries of the region.

20. This is the case with the Muchachas y Muchachos programme of the Bertha Calderón Hospital in Managua, Nicaragua; the centres for integrated care for adolescent development at the Percy Boland Maternity Institute in Santa Cruz and at the Jaime Mendoza Hospital in Sucre (both in Bolivia); the Centre for Integrated Sexual and Reproductive Health Care of APLAFA in Caracas, Venezuela, and the Integrated Youth Services (SIJUs) in Riobamba and Esmeraldas, Ecuador. In Costa Rica, El Salvador, Mexico, Panama and the Dominican Republic, national programmes of reproductive and sexual health care for adolescents have been introduced. Peru has a health programme for school students and adolescents which includes reproductive and sexual health services.

21. In October 1998 a Caribbean Youth Summit was held in Barbados under the auspices of the UNFPA office for the Caribbean. This helped to raise awareness about the health and rights of young people as regards sexuality and reproduction, and it produced a Regional Plan of Action. Likewise, the Jamaican Ministry of Health has designed a Plan of Action for Adolescent Health (1996-2000) and the Government of Saint Lucia is preparing a programme for the prevention of teenage pregnancy. In Colombia, Costa Rica and El Salvador, special rules for adolescent health care have been established.

22. The gap is particularly wide in the case of modern methods, with prevalence rates varying from 13% in Haiti (1994-1995) to 18% in Bolivia (1994) and 70% in Brasil (1996).

23. For example, the Safe Motherhood Committee of Bolivia, with the support of UNFPA, is developing a strategy to reduce maternal mortality rapidly, emphasizing improvements in the quality of emergency obstetric care; together with the introduction of maternity insurance, instituted in 1996 to provide free care (financed jointly by the national health system and the municipalities) to pregnant women and children under five years of age, this strategy includes training programmes for medical and paramedical staff, systems for monitoring causes of death and awareness campaigns for leaders and communities. In Peru, the National Population Plan 1998-2002 includes strengthening of the Emergency Plan for the Reduction of Maternal Mortality. Similarly, the Ministry of Health of Ecuador implemented a National Programme for the Reduction of Maternal Mortality; and in the Dominican Republic, the General Directorate for the Advancement of Women —with support from the State health sector and various non-governmental organizations— has formulated a National Mobilization Plan for the Reduction of Maternal and Child Mortality.

24. For example, more than a third of new cases of AIDS recorded in the English-speaking Caribbean countries were women, mostly aged 15 to 19 (UNAIDS/AIDSCAP, 1996). In Brazil, the ratio of men to women fell from 1 to 16 in 1986 to 1 to 3 (1 to 2 in some areas) in 1998 (UNAIDS/WHO, 1998a); according to UNAIDS estimates —based on the use of models applied to a total of 120,000 AIDS cases (men and women) recorded up to 1997—, some 125,000 adult women are thought to be living with HIV in Brazil (UNAIDS/PAHO/WHO, 1998). A clear example of the impact of HIV/AIDS on morbidity and mortality in Brazil’s major cities is São Paulo, where it has become the chief cause of death among women of childbearing age (UNAIDS/AIDSCAP, 1996). Although the prevalence of infection among pregnant women remains relatively low in Latin America, in Honduras it has already reached 1%, and it is over 3% in Porto Alegre, Brazil; the rates are considerably higher in the Caribbean, particularly in Haiti, where a 1993 study found that more than 8% of pregnant women were infected with HIV (UNAIDS/AIDSCAP, 1998).

25. According to data from demographic and health surveys carried out in seven countries around 1995, nearly all women of child bearing age in cities had heard about AIDS; by contrast, a substantial proportion (between one third and two thirds) of rural women in Bolivia, Guatemala and Peru stated that they knew nothing about AIDS.

26. Many studies show that young people adopt safer sexual behaviour when they have access to information, knowledge and methods and that, if they are given such opportunities, they show a greater propensity to protect themselves than older adults. In Chile, a study conducted in 1996 showed that condom use was more frequent among young people between 15 and 18 than among their elders; similar results have been observed in Brazil and Mexico (UNAIDS/WHO, 1998b).

27. One example is the National Programme to combat AIDS (LUSIDA) of the Ministry of Health and Social Action of Argentina. In 1998, under the auspices of UNAIDS and with participation by public institutions, non-governmental organizations and international agencies, LUSIDA organized a workshop on prevention of vertical transmission of HIV in the Mercosur member and associate member countries (UNAIDS, 1998).

28. Unfortunately, a lack of surveys dealing with sexual and reproductive behaviour and reproductive health in the countries that have progressed further in the demographic transition (such as Uruguay, Argentina and Chile) makes it difficult to know what the situation is in this regard and to determine to what extent more favourable conditions have been created for poorer segments of the population to exercise these rights.

29. Qualitative shortcomings in services tend to be accentuated in areas where there is a concentration of indigenous people, owing to the insensitivity of health services in general, and reproductive health care and family planning programmes in particular and to the cultural diversity of the communities being served. This is why underutilization of services is recorded in many cases.

30. Mexico has set up consultative councils for its national population programme; Belize has done the same in its Population Policy Subcommittee; in Jamaica non-governmental organizations and private-sector entities participate in the Coordinating Committee for Population Policy, the IEC (information, education and communication) Committee, the Working Group on International Migration; Colombia has a Technical Advisory Committee for Population and the Environment, which includes universities and non-governmental organizations; in Nicaragua, civil society was given a greater role in the defining stage of the national population policy and throughout the actual formulation of a Plan of Action for that policy; the Government of Venezuela has forged links with the Network of Non-Governmental Organizations for Population and Development, whose objective is to monitor compliance with the agreements arising out of the International Conference on Population and Development; in 1997 the Ministry of Health of Panama began a project for mobilization and coordination of actions by government and civil society in sexual and reproductive health, whose objective is to prepare the National Plan of Action in this field.

31. Ecuador has begun a long-term strategic planning process ("Ecuador 2025") with the involvement of civil society; the National Commission for Social Development in the Bahamas, which was set up in 1994, has invited non-governmental organizations to participate as partners in development planning; non-governmental organizations, particularly women’s NGOs, participate in the Standing Committee for Population Issues established by the Netherlands Antilles in 1994; representatives of the Government, labour unions and civil society sit on the tripartite committee that monitors national policies in Grenada; in 1998 Trinidad and Tobago set up the Civic Council for Social Development as a counterpart to the Interministerial Council for Social Development; the Dominican Republic set up provincial development councils in 1996, organized coordination sessions in 1997 (these culminated in a National Forum on Public Social Policies) and in 1998 staged a national dialogue between the Government, different sectors of civil society –including women’s organizations– and the political parties; in Bolivia a similar exercise was carried out in 1997, focusing on the concepts of opportunity, equity, institutional structure and dignity, in which women’s non-governmental organizations were actively involved.

32. One such example is the Forum for Women and Development of Panama, which prepared a National Plan for Women and presented it during the national coordination exercise entitled "Bambito III", which involved the Government and civil society, it was agreed that the Plan should be adopted as public policy as part of the Commitment to Development Pact.

33. The Women’s Forum in Nicaragua, with representation from the economic, political and social sectors of the country, organized the First Symposium on Women and Politics, which culminated in a Minimum National Agenda —to promote equal opportunities for men and women— and in the formation of the National Women’s Coalition; the National Women’s Task Force of Belize prepared that country’s Gender Development Plan; in Venezuela, the Population and Development Network and the National Women’s Coordination Office drew up a Plan of Action for the Empowerment of Women and Development 1988-2000; a group of non-governmental organizations in Costa Rica ("Women’s Political Agenda"), in which women from government institutions and civil society participate, deals with the issues addressed in the Programme of Action of the International Conference on Population and Development; the Women’s Political Coordination Office in Ecuador has set up a bipartite commission to set a joint agenda with the Government, and the Health and Gender Coordination Office carries out activities directly related to the Programme of Action.

34. In Haiti a group of 23 women’s non-governmental organizations is working with parliamentarians to revise laws that discriminate against women; in the Dominican Republic a Committee of Honorary Women Advisers to the Senate was created. In Mexico, the feminist group DIVERSA and eight political parties have agreed on a legislative agenda for women’s rights.

35. The Latin American and Caribbean Women’s Health Network (RSMLAC) is one of the most dynamic organizations in this field and, with the support of UNFPA and the cooperation of 13 women’s organizations, including two national networks, has monitored the implementation in Brazil, Chile, Colombia, Nicaragua and Peru of agreements concluded at the International Conference on Population and Development.

36. Around 1995, the non-governmental sector met more than 50% of the demand for family planning in seven countries (Haiti, Guatemala, Paraguay, Colombia, Ecuador, the Dominican Republic and Brazil); by contrast, they played a secondary role in countries with major government-run reproductive health and family planning programmes (Mexico, Peru) or wide public health care coverage with reproductive health and family planning components (Costa Rica). The general tendency is towards stabilization or reduction of the role of non-governmental organizations and the private sector; the most substantial reduction has been seen in Bolivia, a fact that reflects the more active role of the public sector in a country where the use of modern contraceptive methods still had a very low prevalence rate (18%) in 1994.

37. In Mexico the public sector provides training for service providers in non-governmental organizations and supports social marketing programmes for contraceptives; in Trinidad and Tobago there is a programme called "Adopting a Community", which fosters collaboration between the non-governmental organizations, the private sector and the Government in health services, including reproductive health care; the Personal Choice Programme in Jamaica uses private service providers to increase the range of family planning options; in Ecuador and the Dominican Republic non-governmental organizations, the private sector and the community are involved in plans to reduce maternal and infant mortality; in the Dominican Republic, the private sector also participates in the formulation and implementation of the IEC national strategy and the Comprehensive Sex and Family Education Programme.

38. From 1987 to 1996, despite year-on-year fluctuations, non-governmental organizations tended to have the largest role in channelling funds for population activities; bilateral cooperation took over second place from multilateral cooperation. Figures for foreign financial assistance to the countries of Latin America and the Caribbean in 1996 show that non-governmental organizations channelled half of all foreign financial assistance, bilateral agencies just over a third, and multilateral organizations only 16%.

39. In addition to non-reimbursable financial assistance in the area of population, the countries of the region obtained resources through soft loans; although the amounts involved are substantial, these loans cannot be considered in this analysis owing to the lack of up-to-date information on the amounts involved and the fact that periods of several years are involved.

40. The countries in the region that received the largest amounts of such international assistance during the biennium 1995-1996 were Peru (US$ 44 million), Mexico (US$ 42 million), Haiti (US$ 40 million), Brazil (US$ 35 million) and Bolivia (US$ 31 million); taken together, they received half of all the international financial assistance to the region for population activities. In per capita terms, the countries that benefited most were Nicaragua (US$ 5.40), Haiti (US$ 5.35), Bolivia (US$ 3.88), Jamaica (US$ 3.28) and Honduras (US$ 2.96). These countries, with the exception of Jamaica, had the region’s lowest levels of per capita income in 1995; hence, the distribution of international aid resources was in accordance with the spirit of equity called for in the Programme of Action (UNFPA, 1996).

41. Except for intra-uterine devices (IUDs), the contributions by the agencies during the three-year period 1994-1996 were below estimated needs; the condoms supplied met 48% of estimated needs, injectables 21% and pills barely 10% (UNFPA, 1997).

42. As for international non-governmental organizations, the regional office of IPPF provided financing in 1996 for technical assistance —mostly to its member bodies— of an amount equivalent to US$ 2.6 million (IPPF, 1996).

43. The amounts allotted to population and health programmes represented 29.4% of the total USAID budget for Latin America and the Caribbean in 1997, falling to 24.8% and 21.3% respectively in fiscal 1998 and 1999. Furthermore, with the passage of time these resources have been increasingly concentrated in three countries (Haiti, Peru and Bolivia), which are slated to receive half of the resources budgeted for 1999.

44. Nonetheless, faced with this critical financial situation, the region has made great efforts to apply a resource mobilization strategy focused on institution-building and the execution of reproductive and sexual health programmes (IPPF, 1998a).

45. The most novel institutional mechanism would appear to be the Summits Monitoring Office set up by the Government of the Dominican Republic. In Bolivia, the Subcommittee for Population Research, Assessment and Policy (SIEPP) and the Ministry of Sustainable Development and Planning have held workshops for assessment and programming of activities related to the recommendations produced by the International Conference on Population and Development and the Fourth World Conference on Women. Other mechanisms that are not expressly designed for monitoring agreements entered into at international conferences but that provide scope for doing so are the Social Indicators Committee in Belize and the Technical Secretariat of the Social Front in Ecuador.

46. A number of countries carry out regular surveys on demography and health and on living conditions, which could prove to be instruments of great value for monitoring International Conference on Population and Development targets.

Latin American and Caribbean Demographic Center (CELADE / ECLAC)
Casilla 179-D, Santiago Chile
Fax: (56-2) 208 0196  Tel: (56-2) 210 2002
email: djaspers@eclac.cl
Page last revised 9 February, 1998