Ten years later: the 1994 United Nations International Conference on Population and Development, which took place in Cairo, Egypt, was a watershed event for population control. Since then, some progress has been made, but a lot remains to be done.

Cairo, the capital of Egypt, is a teeming city of 16 million people. It is beset by more than its fair share of problems; as Lonely Planet, the Web-based travel guide, puts it, Cairo "is an all-out assault on the senses. Chaotic, noisy, polluted, totally unpredictable, and seething with people, the sheer intensity of the city will either seduce or appal."

In other words, it is the perfect location for a conference on population and development. Almost 16,000 delegates from 179 nations attended that conference in 1994. They had the goal of coming to grips with the problems caused by rapid population growth; problems that were all too evident on the streets of Cairo.

This was not the first global meeting that tried to tackle the population problem; the World Population Conference in Bucharest, Romania, in 1974, and the International Conference on Population in Mexico City in 1984 were earlier efforts. But, those working to slow the growth of the world's population, say the Cairo conference was a breakthrough.

It changed the focus of reducing the numbers. The emphasis was taken off grand government schemes to focus instead on individual people. Population control could not be dealt with in isolation; now, there was an awareness that population, poverty, patterns of production and consumption, and the environment are closely interconnected. All elements of the problem have to be dealt with at the same time. Actions taken in one area reinforce actions in others. The reverse is also true; failure to act on one problem diminishes the effectiveness of efforts to correct other difficulties.

The Cairo Consensus, which was agreed to at that 1994 meeting, said that population programs ought to be based on the needs of individuals. Providing investment in the social, economic, and health status of individual women and men is the key to reducing population growth. A Program of Action was developed (see sidebar on page 14).

The Program is frequently assessed for its effectiveness. Through meetings and discussions, field workers learn which approaches are successful and which are failures.

Ten years after the Cairo conference report cards on progress were issued by many organizations. Typical is a group called PLANetWIRE: "Countries are making real progress in carrying out a bold global action plan that links poverty alleviation to women's rights and universal access to reproductive health. Ten years into the new era ... the quality and reach of family planning programs have improved, safe motherhood and HIV prevention efforts are being scaled up, and governments embrace the Program of Action as an essential blueprint for realizing development goals."

Many developing countries have written laws and policies to protect women's and girls' rights. Many have begun to build reproductive health services into primary health care.

Use of modern contraception has gone up from 55 percent of couples in 1994 to 61 percent today. Increasingly, those giving birth are being helped by health care professionals and this is bringing down the death rate of women and babies due to childbirth complications. Countries have stepped up efforts to deal with HIV/AIDS through prevention, treatment, care, and support.

It would be nice if that was the end of the report card. But, just as in high school, there's a section for "needs improvement." In fact, it's quite a large section.

The UN's Population Fund says that, ten years after Cairo:

* "More than 350 million couples still lack access to a full range of family planning services;

* "Complications of pregnancy and childbirth remain a leading cause of death and illness among women: 529,000 die each year, mostly from preventable causes;

* "Five million new HIV infections occurred during 2003; women are nearly half of all infected adults, and nearly three-fifths of those are in sub-Saharan Africa; and,

* "While fertility is falling in many regions, world population will increase from 6.4 billion today to 8.9 billion by 2050; the 50 poorest countries will triple in size, to 1.7 billion people."

The challenges faced by developing nations are covered in the State of World Population 2004 report (ISBN: 0897147200) from the United Nations Population Fund (UNFPA). One of these challenges is dealing with the links between poverty and population growth.

Poor women give birth at earlier ages and have more children throughout their lives than wealthier women. An obvious question is: why have more children when you can't properly feed and clothe the ones you already have? Another kid will just drive the family into deeper poverty.

The very poor don't have knowledge about, nor access to, birth control. More than 2.8 billion people in the world still live on less than $2 a day. At the lowest level of poverty, seen in the crowded slums of Third World cities and isolated rural areas, buying condoms or contraceptive pills is simply out of the question.

More than 200 million women, especially in the poorest countries, don't have access to effective contraception; meeting their needs would cost about $4.7 billion annually. Each year, that investment would prevent:

* 23 million unplanned births;

* 22 million induced abortions;

* 142,000 pregnancy-related deaths (including 53,000 from unsafe abortions); and,

* 1.4 million infant deaths.

Fixing this would cost 50 percent of Canada's federal surplus in 2004, or 22 days' worth of spending in 2004 on the Iraq war.

Poverty and poor health are closely linked, and they are tied to gender inequality, and rapid population growth.

So, dealing with this extreme poverty is the first job. But, the United Nations complains that, "Policy makers have been slow to address the inequitable distribution of health information and services that help keep people poor."

Once living standards are raised a number of good things start to happen.

Developing countries that have reduced fertility and mortality by investing in health and education have higher productivity. That means more savings and more productive investment, resulting in faster economic growth.

Wealthier people tend to have fewer children. That helps to stimulate development and reduce poverty, both in individual households and in societies. Smaller families have more money to invest in children's education and health, and this feeds the upward spiral of improving living standards.

At the same time, a central factor in reducing poverty is improving the fives of women. When women gain more control over their lives they have fewer children.

Since 1994, more than half of all countries have adopted national legislation on women's rights, ratified UN conventions, or established national commissions for women.

But, pieces of paper guaranteeing rights are meaningless without enforcement. Men in male-dominated societies are not going to give up their privileges just because someone in a distant capital city signed a document. There has to be a lot of education about the benefits of gender equality and, for those that still don't get it, lawsuits and punishments.

So, progress is uneven. Only 28 countries have increased the participation of women in the political process; some still don't allow women to vote. Fewer than half the world's nations have programs that educate men about the reproductive health of women. Only 42 countries have been able to increase public spending on schools, and only 16 increased the number of girls' secondary schools.

In some countries, women are the possessions of their spouses. In other societies, a woman can gain status and respect only by having a lot of children. Elsewhere, women are denied an education.

There's a long way to go, and the UN has outlined its priorities for the second decade of the Cairo Consensus program. They are:

* Eliminating gender gaps in education;

* Increasing access to sexual and reproductive health information and services;

* Investing in infrastructure to ease women's work burdens;

* Reducing discrimination in employment, property ownership, and inheritance;

* Increasing women's role in government bodies; and,

* Sharply reducing violence against women and girls.

But, in countries that don't even have the resources to provide basic health care, the funding of programs that improve the rights of women is often seen as an unaffordable frill. Despite this, the reproductive and sexual health of women are taking on the status of human rights. Here's how the UN puts it in its State of World Population 2004 report:

"Reproductive rights broadly encompass the right to reproductive and sexual health, throughout the life cycle; reproductive self-determination, including the rights to voluntary choice in marriage, and to have the information and means to determine the number, timing, and spacing of one's children; equality and equity for women and men in all spheres of life; and sexual and reproductive security, including freedom from sexual violence and coercion. These were spelled out in a variety of human rights treaties and conventions and international consensus agreements."

Another issue--and a particularly touchy one--is dealing with the reproductive health needs of the world's 1.3 billion adolescents.

Since 1994, there has been progress in meeting the needs for information and services that will enable young people to prevent unwanted pregnancy and infection. But again, a lot remains to be done.

Young people aged 15 to 24 account for half of all new HIV infections--one every 14 seconds. Worldwide, there is a trend towards later marriage and that means that more adolescents are sexually active before marriage, often without the knowledge or means to protect themselves.

There are many who see a simple solution to this--young, unmarried people should not have sex. As part of that strategy, many countries have banned sex education and made it illegal for young people to buy condoms and other birth control devices. Population experts say this is not the wisest choice in dealing with adolescents with raging hormones.

A better approach is to make sure young people practice safe sex. That means providing accurate information, counselling, and access to birth control in a youth-friendly context. But, this ruffles some feathers. Any method of birth control other than abstinence means contradicting the teaching of some religions. And, pre-marital sexual activity deeply offends the moral values of many groups in many societies.

The United States in particular finds this issue troubling. Under the presidency of Bill Clinton (1993-2001), the U.S. was a major supporter of the Cairo Consensus. That has changed dramatically since George W. Bush came to power in Washington in 2001.

In 2002, 35 Asian and Pacific nations met in Bangkok, Thailand. They agreed to ramp up efforts to provide reproductive health care, combat AIDS, and protect adolescents against unwanted pregnancy and sexually transmitted infections. A group called Engender Health reports that, "All 35 nations present, except the United States, fully reaffirmed their commitment to the Cairo Consensus. The United States called for two procedural votes to remove the terms 'reproductive rights' and 'reproductive health services' from the Plan of Action, claiming that these terms promote sexual activity for unmarried adolescents and abortion."

The same thing happened in 2004 at a meeting of North and South American nations in Santiago, Chile. All 37 countries present (except the United States) agreed to issue a formal declaration in support of the past decade of progress toward achieving the Cairo Consensus.

The Bush administration has a firm "abstinence only" policy and refuses to fund any group that provides information about abortion. The United States, the Vatican (which forbids the use of any artificial birth control), and some conservative Islamic countries have come in for strong criticism. At the September 2004 meeting of the International Conference on Population and Development (ICPD) in London, England, these three were accused of "undermining the Cairo Consensus."

SUGGESTED ACTIVITIES:

1. One of the principles of the Cairo Consensus is that no count should be required to breach its moral or religious culture and traditions in meeting its goals. The administration of U.S. President George W. Bush is strongly opposed to abortion and believes in "the sanctity of life from conception to natural death." Yet, U.S. government officials have been heavily criticized for trying to get their values written into UN population agreements. Discuss.

2. Calculate the ecological footprint of your school and then do the same for a school of the same size in West Africa.

FACT FILE

The lifetime risk of a woman dying in pregnancy or childbirth in West Africa is in 12, In developed regions, the comparable risk is 1 in 4,000.

According to the United Nations, "Gaps in reproductive and sexual health care account for one third of the worldwide illness and premature death among women of reproductive age."

The International Conference on Human Rights in Tehran, Iran, in 1968 was the first international forum to agree that "parents have a basic human right to determine freely and responsibly the number and spacing of their children."

PROGRAM OF ACTION

The Cairo Consensus is a 20-year plan aimed at reducing the rate of population growth to one that can be sustained over the long term. Among its many proposals, the Consensus:

* Establishes the reproductive rights of people as "the basic right of all couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so;"

* Calls for universal access to family planning by the year 2015;

* Recognizes unsafe abortion as a public health crisis that must be addressed. This is a very touchy issue, causing the UN to dance carefully around recommending access to medically supervised abortion: "Prevention of unwanted pregnancies must always be given the highest priority and all attempts should be made to eliminate the need for abortion. Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling;"

* Calls for greater attention to the reproductive health and lives of adolescents;

* Advances "gender equality and equity and the empowerment of women, the elimination of all kinds of violence against women, and ensuring women's ability to control their own fertility."

The Cairo Consensus also sets goals to improve every aspect of individuals' lives. These goals should all be reached at the same time; missing one or more of them will weaken the rest. The goals include recommendations to:

* Reduce maternal mortality;

* Reduce the spread of Sexually Transmitted Infections, including HIV/AIDS;

* Eradicate female genital mutilation:

* Increase male involvement and responsibility;

* Achieve universal primary education by 2015;

* Empower women in terms of their social, political, and economic standing; and,

* Protect the environment.

This all sounds like a good plan. However, these are only recommendations that are not binding on countries in any way.

BIG FOOT

The World Wildlife Fund (WWF) says that humans are consuming natural resources 20 percent faster than Nature can replace them. in its 2004 Living Planet Report the WWF says the size of humanity's ecological footprint has grown by 2.5 times over the last 40 years.

The footprint's a measure of how much land space each person uses in maintaining their lifestyle. According to the WWF, each person's footprint should cover no more than 1.8 hectares. The average person in Asia and Africa has an ecological footprint well under that, but North Americans and Europeans have huge feet. The average Canadian leaves tracks covering 8.5 hectares; three-and-a-half times greater than what is sustainable.

Websites

Action Canada for Population and Development--http:// www.acpd.ca/

Cairo Consensus--http:// www.plannedparenthood.org/ global/021217_cairo_bkgrnd. asp

ICPD Program of Action--http://www.unfpa.org/icpd/ summary.htm

United Nations Population Fund--http:// www.unfpa.org/index.htm

World Wildlife Fund (The Living Planet)--http:// www.wwfus.org/about/ viewpoint/living_planet.cfm