Declines in fertility levels evident in Africa, notes UN Population Fund.

The Africa regional meeting, held in Harare, Zimbabwe, from 10 to 14 November 1997, brought together all the United Nations Population Fund (UNFPA) Africa representatives, deputy representatives, Country Support Team directors and advisors, selected national programme officers and directors of UNFPA-supported regional training institutions and participants from Headquarters.

The meeting took place three years after the International Conference on Population and Development (ICPD), which was held in Cairo, Egypt in 1994, and two years after a similar Africa regional meeting, held in Accra in August 1995, to define strategies to implement the Programme of Action, adopted by 179 countries and elaborated at the ICPD, taking into account the specifics and context of the Africa region. The 1994 landmark Conference and the Programme of Action underscored the integral and mutually reinforcing linkages between population and development and the urgency of meeting the needs of individual women and men. It also promoted a human rights framework and emphasized the centrality of the human person as the subject of development, marking a distinct shift from a focus on demographic targets to a focus on people-centered development.

Two years after Accra, there was a need to take stock and assess achievements, constraints and lessons learned from the implementation of the ICPD goals in the Africa region in order to reinforce or reorient the programme strategies, where necessary, and to chart a course for the twenty-first century.

The Harare meeting, therefore, reviewed recent developments in the United Nation, including the UN reform and its impact on UNFPA's work, its new programme guidelines in the framework of further decentralization to the country offices, the UNFPA experience with national execution and its role in emergency situations. The meeting also reviewed the role of UNFPA in capacity building at the country level, in encouraging South-to-South cooperation, as well as in advocacy for such issues as reproductive rights, including violence against women and children, and the promotion of gender equality and women's empowerment. The status of implementation of the three main areas of UNFPA's work - reproductive health, population and development strategies, and advocacy - after the ICPD were reviewed in detail. The results will be fed into the ICPD + 5 review process. It was observed that much had been achieved and encouraging signs of declines in fertility levels are evident. Countries are adopting the reproductive health approach, female genital mutilation is being addressed as a reproductive-health and rights issue, and population policies are being revised to take account of the ICPD goals.

Thirty-two new country programmes, formulated in 1996 and 1997 after an extensive population assessment, integrate the overall strategic orientations of the Cairo Programme of Action. The resulting country programmes have a sharper focus on peculiar population issues of priority to the concerned countries. Examples of these include the REACH and PEARL projects in Uganda, which focus on reducing female genital mutilation and sexually transmitted diseases, including HIWAIDS, among youth and adolescents, respectively. Another example is the multi-media network for population programmes in Senegal, which creates awareness and conducive environment to advocate for population programmes. Also in Senegal, UNFPA brought together 800 Oulemas and Imams for a few days to examine the teaching of the Koran on the issues of child spacing, family-life education and sexual health. The clarification encourages the population for greater utilization of reproductive health services.

New and evolving issues have been selectively articulated in the programmes of the countries concerned. These include adolescent reproductive health, reproductive rights, HIV/AIDS and male involvement and participation in reproductive health, including family planning and sexual health.

It was noted that the emerging partnerships between Governments, United Nations agencies, non-governmental organizations, bilateral donors, the private sector, community-based organizations and dvil society confirm that population issues are increasingly becoming a common agenda for all.

The meeting underlined that mobilizing the resources required to address these issues is a major challenge. Compounding the problem of the overall decline in donor support is the fact that most African countries are grappling with structural adjustment programmes and are finding it increasingly difficult to allocate sufficient funds for population and related programmes. Furthermore, civil strife and political upheavals have led to large numbers of refugees whose needs must be met. Thus, it is encouraging that UNFPA's allocations for the subSaharan Africa region have substantially increased in the last several years. Total allocations increased from $60 million in 1995 to $80 million in 1997.

All partners and stakeholders will need to continue working together to ensure the attainment of the ICPD goals in Africa in the next century.

Programme of Action

There is a high level of unmet need for family planning in Africa resulting in unwanted pregnancies and abortions which occur under unsafe conditions. This problem is particularly serious among adolescents. Maternal mortality ratios are still unacceptably high. The task of bringing African countries to the threshold levels of the ICPD goals is enormous since the following challenges will need to be urgently addressed:

* Large segments of the population still have limited access to basic health services.

* The number of trained personnel remains limited.

* Physical infrastructure for primary health care/reproductive health is deteriorating and basic equipment and essential drugs are lacking.

* There are insufficient financial resources to maintain and operate existing health facilities.

* Demand for services in reproductive health, including adolescent reproductive health, are growing while resources decrease.

* The spread of sexually transmitted diseases and HIV/AIDS is still not satisfactorily checked.

* The technical and counselling skills of service providers are still weak or lacking.

* More work is required to effectively implement strategies for operationalising the gender concept.