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UNITED NATIONS
                                                             
Distr.
GENERAL
                                                                  
                                                    A/CONF.171/4
                                                    27 July 1994
                                                             
ORIGINAL:  ENGLISH
Item 8 of the provisional agenda*


        EXPERIENCES CONCERNING POPULATION AND DEVELOPMENT
                    STRATEGIES AND PROGRAMMES

       Fourth review and appraisal of the World Population Plan
                           of Action**

                 Report of the Secretary-General


                             SUMMARY

     The present report presents the results of the fourth
quinquennial review and appraisal of progress made towards
achieving the goals and objectives of the World Population Plan of
Action.  The findings of the review and appraisal of the Plan of
Action have been used by the Economic and Social Council to make
the necessary modifications in the goals and recommendations of the
Plan of Action.  The present report focuses on 30 selected
population issues.  The report provides an overall assessment of
the level of implementation of the World Population Plan of Action
and appropriate background information on population trends and
policies that would help facilitate the deliberations at the
Conference.  The report also provides important input in the
preparation of the draft Programme of Action of the Conference.   
    
-------------------
     *    A/CONF.171/PC/1.
    **    Based on A/CONF.171/PC/3.

=================================================================
                                     
                            CONTENTS

                                                                  
                                                 Paragraphs  Page

INTRODUCTION ................................     1 - 6       6

  I.  PRINCIPLES AND OBJECTIVES OF THE WORLD POPULATION
      PLAN OF ACTION ........................     7 - 9       7

      Issue No. 1.   Individual rights and responsibilities
      versus societal goals and objectives ..     8 - 9       8

 II.  SOCIO-ECONOMIC DEVELOPMENT, THE ENVIRONMENT 
      AND POPULATION ........................    10 - 46      9

      Issue No. 2.   Attainment of the development 
      goals of the International Development 
      Strategy for the Fourth United  Nations
      Development Decade ....................    11 - 29      9

      Issue No. 3.   Population, the environment 
      and development .......................    30 - 46     15

III.  GENDER EQUALITY AND EMPOWERMENT OF WOMEN    47 - 66     21

      Issue No. 4.   Achieving gender equality    48 - 55     21

      Issue No. 5.   Women's education and its 
      demographic impact .....................    56 - 66     24

IV.   THE FAMILY:  ITS ROLES, COMPOSITION AND 
      STRUCTURE ..............................    67 - 82     27

      Issue No. 6.   Diversity of family structures 
      and composition ........................    68 - 77     27

      Issue No. 7.   Socio-economic support to 
      the family .............................    78 - 82     30

V.  POPULATION GROWTH AND STRUCTURE ..........    83 - 109    32

      Issue No. 8.   Diversity of rates of population
      growth .................................    88 - 97     37

      Issue No. 9.   Changes in the population 
      structure ..............................    98 - 109    40

VI.  REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH AND 
     FAMILY PLANNING .........................   110 - 142    44

      Issue No. 10.  Diversity of reproduction 
      patterns and policies ..................   111 - 126    44

      Issue No. 11.  Availability and access to 
      family planning ........................   127 - 137    53

      Issue No. 12.  Adolescents .............   138 - 142    59

VII.  HEALTH AND MORTALITY ...................   143 - 187    61

      Issue No. 13.  Goals and targets in morbidity 
      and mortality ..........................   144 - 160    61

      Issue No. 14.  Maternal mortality ......   161 - 175    66

      Issue No. 15.  Acquired immunodeficiency 
      syndrome (AIDS) ........................   176 - 187    70

VIII. POPULATION DISTRIBUTION, URBANIZATION AND 
      INTERNAL MIGRATION .....................   188 - 204    73

      Issue No. 16.  Population growth in large urban
      agglomerations .........................   193 - 204    74

IX.  INTERNATIONAL MIGRATION .................   205 - 235    79

      Issue No. 17.  Documented migrants .....   209 - 214    81

      Issue No. 18.  Undocumented migrants ...   215 - 219    83

      Issue No. 19.  Refugees ................   220 - 235    84

X.  POPULATION INFORMATION, EDUCATION AND 
    COMMUNICATION ............................   236 - 270    89

      Issue No. 20.  Technical population 
      information ............................   240 - 245    89

      Issue No. 21.  Creation of awareness ...   246 - 270    91

XI.  TECHNOLOGY, RESEARCH AND DEVELOPMENT ....   271 - 299    97

      Issue No. 22.  Balanced programme of data 
      collection .............................   272 - 282    97

      Issue No. 23.  Substantive and operational 
      research ...............................   283 - 299   100

XII.  NATIONAL ACTION ........................   300 - 348   104

      Issue No. 24.  Integrated approaches for 
      population policies ....................   301 - 315   104

      Issue No. 25.  Management of programmes    316 - 331   108

      Issue No. 26.  Achieving self-reliance .   332 - 348   111

XIII. INTERNATIONAL COOPERATION ..............   349 - 374   116

      Issue No. 27.  Priority areas for international
      cooperation ............................   350 - 363   117

      Issue No. 28.  Strengthening the population programme
      of the United Nations system ...........   364 - 374   124

XIV.  PARTNERSHIP WITH NON-GOVERNMENTAL SECTORS  375 - 383   127

      Issue No. 29.  Strengthening the partnership 
      with non-governmental sectors ..........   377 - 383   128

XV.  MONITORING, REVIEW AND APPRAISAL ........   384 - 394   130

      Issue No. 30.  Monitoring, review and 
      appraisal ..............................   384 - 394   130

                             Tables

1.   Major demographic indicators by major area, 
     1950-2015 ................................               33

2.   Governments' perception of rates of population 
     growth, 1976-1993 ........................               36

3.   Governments' policies aimed at influencing rates 
     of population growth, 1976-1993.............             37

4.   Estimates and projections of proportions of the 
     population under age 15 and age 65 years or over, 
     by major area, 1950-2015 ....................            42

5.   Age-specific fertility rates for major areas and 
     regions of the world, 1990-1995 ..............           48

6.   Governments' views on fertility levels, 1976-1993        50

7.   Aim of Governments' policies to influence fertility 
     levels, 1976-1993 ............................           50

8.   Grounds for permitting abortion, 1993 ..............    53

9.   Average prevalence of specific contraceptive methods, 
     by region, 1990 .....................................   55

10.  Governments' policies concerning access to 
     contraceptive methods, 1974-1993 .....................   56

11.  Availability of contraceptive services in developing         
     countries, by region, 1982 and 1989 ..................   58
                                                              
12.  Mortality indicators, 1950-2015 ......................   62

13.  Population size of urban agglomerations with 10 million 
     or more in 2010, for the years 1970, 1990 and 2010, 
     and their average annual rate of growth, 1970-1990 and       
     1990-2010 ............................................   76

14.  Governments' perceptions and policies concerning level 
     of immigration and emigration, 1976-1993 .............   80

15.  Expenditures for population assistance by channel of         
     distribution, 1982-1991 ..............................  119

16.  Total donor expenditures by programme area, 1982-1990   121

17.  UNFPA expenditures by programme area, 1975-1991 ......  122
==================================================================

                                   INTRODUCTION


1.   The World Population Plan of Action, 1/ which was adopted by
the United Nations World Population Conference, held at Bucharest
in 1974, stipulates (para. 108) that a comprehensive and thorough
review and appraisal of progress made towards achieving the goals
and recommendations of the Plan of Action should be undertaken
every five years by the United Nations system.  The findings of
such reviews and appraisals have been considered by the Economic
and Social Council in order to make the appropriate modifications
to the goals and recommendations of the Plan of Action.  Three
assessments previous to the present review and appraisal were
undertaken, in 1979, 1984 and 1989. 2/  As a result of those
assessments, a total of 117 additional recommendations for the
further implementation of the Plan of Action were adopted by the
Economic and Social Council.  The findings of the second assessment
were discussed at the International Conference on Population, which
was held at Mexico City in 1984, and provided the rationale for a
set of 88 recommendations for the further implementation of the
Plan of Action, which hereinafter will be referred to as the Mexico
City recommendations. 3/ 

2.   Normally, the present report would have covered the findings
of the fourth review and appraisal only for the period 1989-1994. 
However, considering that a new programme of action might be
adopted at the International Conference on Population and
Development in 1994, it has been deemed more appropriate that this
report also cover the period following the adoption of the Plan of
Action in 1974.  The appropriate background information on trends
and policies provided by this report, as well as the illustration
of the major advances and successes in applying the provisions of
the Plan of Action, the lessons learned and issues that have
emerged, could help facilitate the deliberations of the
International Conference on Population and Development.

3.   On the basis of the experience gained from the previous
assessments, it was considered useful to focus the report on a
selected number of relevant population issues.  At its twenty-fifth
session, the Population Commission suggested that the fourth review
and appraisal should concentrate on a selected number of issues, as
had been done for the third assessment. 4/  As a result of various
consultations, including a discussion with the members of the
inter-agency task force established for the Conference by the
Administrative Committee on Coordination (ACC), 30 issues were
selected for the fourth review and appraisal. 5/ 

4.   The present report covers the major topics of the Plan of
Action, but follows the structure of the draft Programme of Action
of the Conference.  The structure of the two documents might be
better understood if the proposed actions are grouped in three
major sets as follows:

     (a)  The areas that are the subject-matter of the Plan of
Action, namely, socio-economic development and population; women;
the family; and the major demographic factors, namely, population
growth and demographic structures, human reproduction, mortality,
population distribution, and internal and international migration;

     (b)  The planned activities that will affect the subject areas
presented in the first set:  data collection and analysis,
research, provision of services, managerial operations of
programmes, creation of awareness and information, education and
communication activities, and evaluation of actions;

     (c)  The different actors that are responsible for the
activities in each area:  Governments; the international community;
non-governmental organizations; the private sector; scholars; and
the media, among others.  For each of the topics included in the
present report, there is a brief summary of overall trends and
tendencies, a description of the most salient issues related to the
topic indicating its relevance, actions contemplated by the Plan of
Action (if any), measures adopted by Governments and by the
international community, and an assessment of the implementation of
the Plan of Action.

5.   For the preparation of this report, a large number of sources
were used.  Among the most important were the preparatory
activities for the 1994 Conference (namely, the documentation for
the six expert group meetings and the five regional population
conferences, and the deliberations of the Preparatory Committee for
the Conference), as well as products of various activities in the
work programme of relevant units of the United Nations system, such
as the results of the 1991 biennial report 6/ and the 1993 biennial
report 7/ on the monitoring of population trends and policies; the
report of the Secretary- General on monitoring of multilateral
population assistance (E/CN.9/1994/6); the reports of the
Secretary-General on the activities of the United Nations system in
the field of population (E/CN.9/1994/5) and on the work of
intergovernmental and non-governmental organizations in the
implementation of the World Population Plan of Action
(E/CN.9/1994/7), and information from the Population Policy Data
Bank maintained by the Population Division of the Department for
Economic and Social Information and Policy Analysis of the United
Nations Secretariat (hereinafter referred to as the Population
Policy Data Bank), which also includes the findings of the seven
Population Inquiries among Governments.

6.   The present assessment, like the three previous reviews, has
been carried out by the relevant units of the United Nations
system.  Owing to stringent budgetary constraints, it was conducted
with the utmost economy of resources, by making extensive use of
existing facilities and coordinating mechanisms, as recommended by
the Population Commission.  The report has been prepared by the
Population Division of the Department for Economic and Social
Information and Policy Analysis of the United Nations Secretariat,
with valuable contributions from other divisions of the same
Department, the regional commissions, the United Nations Population
Fund (UNFPA), the specialized agencies and other bodies and
programmes of the United Nations system, as well as several
non-governmental organizations.


               I.  PRINCIPLES AND OBJECTIVES OF THE WORLD
POPULATION
                   PLAN OF ACTION

7.   The World Population Plan of Action contains a set of
principles and objectives (paras. 14 and 15).  The two paragraphs
setting forth those principles and objectives indicate the
rationale for action in the field of population, the guiding
criteria and the expected results to be achieved.  This part of the
Plan of Action may be perceived as constituting its structural
segment, while the set of recommendations refers to the instruments
to be used in order to achieve its objectives.  The prior three
assessments of the Plan of Action have shown that the validity of
the principles and objectives are universally recognized by
national Governments, the international community and
non-governmental organizations.  The Economic and Social Council,
in its resolution on the convening of an International Conference
on Population in 1984, decided that the 1984 Conference should work
within the framework of the existing World Population Plan of
Action, the principles and objectives of which continued to be
fully valid. 8/


               Issue No. 1.  Individual rights and responsibilities
                       versus societal goals and objectives

8.   During the deliberations at the first and second sessions of
the Preparatory Committee for the International Conference on
Population and Development, as well as at various sessions of the
Economic and Social Council, there were several suggestions that
the relationships between individual rights and societal goals be
discussed, inasmuch as some specific situations might create
ambiguities in the way human rights were recognized and respected. 
Although the Plan of Action affirms (para. 14) that the formulation
and implementation of population policies is the sovereign right of
each nation, it is none the less also based on the principle (para.
14 (f)) that all couples and individuals have the basic right to
decide freely and responsibly the number and spacing of their
children and to have the information, education and means to do so.

Individual rights and societal goals may be at odds in some
specific circumstances, particularly in periods of rapid social
change.  In this respect, human reproduction and other demographic
phenomena are not so very different from other elements of the
reality of social life, where in many instances individuals,
whatever their rights, face strong appeals to conform to societal
goals.  The Plan of Action, however, clearly recommends (para. 29
(a)) that all countries should respect and ensure, regardless of
their overall demographic goals, the right of persons to determine,
in a free, informed and responsible manner, the number and spacing
of their children.  The Plan of Action also acknowledges (para. 34)
that family size may also be affected by incentives and
disincentive schemes, but it emphasizes that if such schemes are
adopted or modified it is essential that they should not violate
human rights.  The Plan of Action rejects any form of coercion.

9.   The principle that couples and individuals have the basic
right to decide freely and responsibly the number and spacing of
their children (para. 14 (f) of the Plan of Action) also stipulates
that the responsibility of couples and individuals in the exercise
of this right takes into account the needs of their living and
future children, and their responsibilities towards the community. 
Such consideration of the needs and rights of future generations is
precisely at the core of the concept of sustainable development. 
It is also consistent with the widely recognized notion that every
right that has received wide currency in recent years also entails
obligations, and that those responsibilities refer to duties not
only  vis--vis other human beings, but also vis--vis future
generations.  In the Mexico City recommendations it was affirmed
(recommendation 24, para. 26) that the experience since the
adoption of the Plan of Action had suggested that Governments could
do more to assist people in making their reproductive decisions in
a responsible way; this statement is still applicable, and is
relevant to the trends observed in the present decade. 

          II.  SOCIO-ECONOMIC DEVELOPMENT, THE ENVIRONMENT AND
POPULATION

10.  The explicit aim of the World Population Plan of Action is to
help coordinate population trends and the trends of economic and
social development (para. 1).  Population policies and programmes
are conceived by the Plan of Action as constituent elements of
socio-economic development policies (para. 14 (d)) whose aim is to
affect, inter alia, population growth, morbidity and mortality,
reproduction and family formation, population distribution and
internal migration, international migration and, consequently,
demographic structures (para. 15 (c)).  The following two issues
have been selected to illustrate the level of implementation of the
Plan of Action and refer to the role played by the socio-economic
transformation proposed by the Plan of Action and the
interrelationships among population, the environment and the
process of development.


             Issue No. 2.  Attainment of the development goals of
the
             International Development Strategy for the Fourth
United
                           Nations Development Decade 9/

11.  The Plan of Action affirms, as one of its principles, that
population and development are interrelated (para 14 (c)).  To meet
the challenges of development, in the Plan of Action (paras. 68-70)
and the Mexico City recommendations (para. 14 and particularly
recommendations 1-3), adopted at the International Conference on
Population in 1984, Governments are urged to adopt an integrated
approach towards population and development, both in national
policies and at the international level.  Such recommendations also
reflect the view that, although the actions of developing countries
are of primary importance, the attainment of development goals will
require appropriate policies and support by the developed countries
and the international community.

12.  The Plan of Action emphasizes that the basis for an effective
solution of population problems is, above all, socio-economic
transformation (para. 1).  Consequently, the Plan of Action makes
a number of recommendations dealing with socio-economic policies,
and mentions specifically some issues, for example, development
assistance, economic growth, food and agriculture, education,
health and employment, with the understanding that such
socio-economic transformation will modify demographic variables by
creating new conditions.  The wide range of issues mentioned by the
Plan of Action correspond, mutatis mutandis, to the themes included
in the last three international development strategies adopted by
the General Assembly. 9/  The major findings of this review and
appraisal confirm, in general, the results of the previous
assessments, which have concluded that the impact of economic
growth on the levels of fertility and mortality is likely to be
less direct than on other dimensions of development.  In other
words, there is increasing evidence that the resolution of
demographic issues is to be found in the synergistic combination of
various strategic dimensions that call for simultaneous action on
various fronts:  income distribution; improvement in the status of
women; gender equality; basic education; primary health care
(including family planning); and employment opportunities. 10/ 

Sustained economic growth

13.  Sustained economic growth remains a desperately important
imperative throughout the developing world.  Without the benefits
of such growth, developing countries will not be able to improve
the standards of living of their people and a durable resolution to
demographic issues will be seriously hampered.  In the Declaration
on International Economic Cooperation, in particular the
Revitalization of Economic Growth and Development of the Developing
Countries, the States Members of the United Nations strongly
affirmed the need to revitalize growth and development in the
developing countries and to address together the problems of abject
poverty and hunger. 11/  Similar ideas appear in the Declaration on
the Right to Development. 12/  During the past decades, the
developing world has made enormous economic progress.  This can be
seen most clearly in the rising trend for incomes and consumption: 
between 1965 and 1985, consumption per capita in the developing
world went up by almost 70 per cent.  Broader measures of
well-being confirm this picture:  life expectancy, infant and child
mortality, and educational attainment have all improved markedly. 
Nevertheless, while overall trends clearly show that during the
past two decades significant economic and social progress was
achieved in the developing world, markedly diverging regional and
national trends have been observed.  It is clear that in some cases
efforts were quite successful, while others involved a sequence of
difficulties.  The very diverse trends in the growth of output per
person highlight this fact.

14.  Slow growth of per capita output in Africa, at an average
annual rate of 0.4 per cent in the first decade after the adoption
of the Plan of Action, gave way to an outright decline of 0.6 per
cent per annum after 1984.  In the smaller and generally poorer
countries of sub-Saharan Africa (that is, those excluding Nigeria),
the situation was more extreme; an average annual decline of 1.0
per cent in the first 10 years became an average decline of 1.8 per
cent per annum after 1984.  In Latin America, the 1980s are
commonly referred to as the lost decade.  Indeed, after per capita
output rose 0.7 per cent per annum on average in the 10 years up to
1984, it has been virtually stagnating since, with a growth per
capita of only 0.2 per cent per annum.  Unlike the African
situation, however, there are now signs that growth in Latin
America is on the verge of significant improvement, as economic
recovery seems to have begun recently to take hold in some
countries and foreign and domestic investors have brought
considerable sums of foreign exchange back into the region.  In
other words, Latin America seems to be at a turning-point.  In the
Asian and Pacific region, in contrast, per capita output rose by a
robust 2.6 per cent annually in the 10 years after the United
Nations World Population Conference in Bucharest, and it has been
rising by an even stronger 3.1 per cent per annum in the more
recent period.  Since the developing countries of Asia and the
Pacific constitute over 70 per cent of the population living in the
less developed regions, this trend is particularly heartening -
even more so because the more rapidly growing countries include
some of the poorest of the world.  In the West Asian subregion,
however, output per capita has been falling 3.1 per cent per annum
since 1984.  If many of the citizens of this region have been
fortunate to be living over vast pools of petroleum resources, they
have also been afflicted by almost a decade of warfare, which took
its economic as well as human toll.  The region is not unique in
this regard.  The recent devastation in the former Yugoslavia has
virtually wiped out all the growth in average output per capita in
the Mediterranean region since 1974.

15.  Given the important economic achievements realized by the
developing countries as a group, it is all the more appalling that
almost one third of the total population, or 1.3 billion people, in
the developing world are still living in poverty.  Progress in
raising average incomes, however welcome, must not distract
attention from this massive and continuing burden of poverty, which
is spread unevenly:  among the regions of the developing world,
among countries within those regions, and among localities within
those countries.  In those countries that have exhibited a marked
economic progress since the 1960s, poverty has declined and even
the incomes of those remaining in poverty have increased.  However,
the conditions of the poor were exacerbated in countries that
experienced poor economic performance.  Nearly half of the world's
poor live in South Asia, a region that accounts for 30 per cent of
world population.  Sub-Saharan Africa accounts for a smaller but
still highly disproportionate share of global poverty.  Poverty is
usually coexistent with illiteracy, unemployment, malnutrition,
poor health, low status of women and deteriorating environmental
conditions.  Such situations are also often accompanied by high
levels of fertility, morbidity and mortality.  In these particular
cases, extensive poverty aggravates the negative impacts of
population pressure on land use and, in turn, constitutes a major
obstacle to obtaining fertility and mortality declines in rural
areas.  

16.  During the 1980s, many developing countries had to cope with
economic crises and embarked on macroeconomic reforms, including
stabilization policies aimed at reducing inflation and external
deficits, and structural adjustment programmes addressing internal
and external imbalances in resource allocation in specific sectors
such as trade, finance and industry.  Such policies intended to
eliminate rigidities in the countries concerned and to foster a
macroeconomic environment conducive to sustained economic growth. 
Although in the longer term economic restructuring associated with
adjustment is likely to bring about an improvement in the standard
of living of the entire population, in the short term those
economic policies have tended to increase the number of the poor
and have put many of the poor at risk.  The comparison of
experiences of developing countries suggests that poverty reduction
can be achieved by first pursuing a strategy that promotes the
productive use of the poor's most abundant asset, namely labour, in
both industry and agriculture.  Experience also shows that equally
critical is the provision of basic social services to the poor. 
Primary health care, family planning, nutrition and primary
education are especially important.

17.  Several lessons are embedded in the above considerations.  The
first is a reminder that peace and a functioning civil society are
prerequisites of sustained economic growth and sustainable
development.  A second lesson is that rigid economic structures and
excessive dependence on a limited range of commodity exports and on
a thin layer of "human capital" have been extremely costly.  High
levels of domestic savings, access to modern technologies, low
levels of inflation and particularly heavy investments in education
have been associated with the successful case-stories.  Indeed,
international cooperation during this period has increasingly
focused on facilitating and hastening structural adjustment and on
building capacities to identify and capture opportunities. 
Finally, it should be repeated that poverty is increasingly
recognized to be closely associated with both undesirable
demographic trends and environmental degradation and that, together
with social and economic inequality, it is exacerbating the
problems derived from rapid population growth.  There is little
doubt that economic growth is necessary to combat poverty and to
provide the means to satisfy basic needs; but economic growth
should be reconcilable with sustainable development.  Such
development may be achieved if appropriate technologies are
developed and made available to developing countries on
preferential and concessional terms, and suitable strategies and
policies are adopted to stimulate conservation of non-renewable
natural resources and avert environmental degradation.

Food and agriculture

18.  The Plan of Action recognizes the important role that food and
agriculture play in improving the standards of living of people and
recommends that Governments give high priority to improving methods
of food production, the investigation and development of new
sources of food and more effective utilization of existing sources
(para. 70) in response to the needs of the rapidly growing world
population.  Trends in per capita food production and food supplies
have, to a large extent, paralleled trends in per capita output. 
Such a situation is not very different from the one assessed a
decade ago when the second review and appraisal of the World
Population Plan of Action found that globally the growth of food
production had more than kept pace with the rate of population
increases and was projected to do so in the future. 13/   Similar
findings were noted in the third review and appraisal of the World
Population Plan of Action. 14/  Equally remarkable is the fact that
during the past three decades the number of countries that have
been able to meet their daily per capita requirements has gone from
less than 25 to more than 50.  Nevertheless, enormous disparities
account for the fact that about 800 million people still do not get
sufficient food. 15/

19.  During the 1980s, per capita food production continued to grow
at the global level.  At the world level, the average food
production per capita increased 1.1 per cent per annum on average
and such growth took place mostly in the developing countries,
reflecting above all high growth rates in Asia (China and India
increased their production by 27 per cent during the periods
1979-1981 and 1988-1990).  Sub-Saharan Africa continued on its
long-term path to decline (minus 0.5 per cent per annum).  Per
capita food supplies continued to increase at the global level, but
there was no progress in sub-Saharan Africa (with per capita food
supplies stagnant at grossly inadequate levels) and Latin America. 
The overall incidence of undernutrition declined significantly in
relative terms but only slightly in absolute terms in the
developing countries.  However, the incidence of undernutrition
increased in both absolute and relative terms in sub-Saharan Africa
and in absolute terms in Latin America.  The cereals deficit of the
developing countries continued to increase but at a much slower
rate than in the 1970s.  Much of the increase originated in the
growth of cereal imports into the regions of northern Africa and
Western Asia.

20.  At the global level, the Food and Agriculture Organization of
the United Nations (FAO) estimates that the daily calorie supply
per capita increased from 2,383 in 1965 and 2,580 around the period
1979-1981 to 2,700 in the period 1988-1990.  Important improvements
have been achieved in Asia, but not in Latin America, which
remained stagnant at a daily calorie supply per capita of 2,690
during the past decade, and sub-Saharan Africa, where there was a
decline (from 2,120 to 2,100).

Education

21.  The Plan of Action recalls the important place of education in
achieving social and economic development (para. 69).  Notable
improvements have been registered in this area; during the past two
decades, primary school enrolment has increased from less than 70
to more than 80 per cent, while secondary school enrolment has
almost doubled (from 25 to 40 per cent).  Such achievements have
been realized particularly during the past decade and in those
countries that have guaranteed the right to education for all.  The
countries that have invested more in education are also those that
have generally manifested a better performance in terms of economic
growth, reduction of poverty and overall improvement in the
standard of living of their populations.  Approximately 1 billion
school-age children are currently enrolled.  However, sub-Saharan
Africa, and Western and Southern Asia still lack sufficient school
space to enrol all children in first-level education.  For
sub-Saharan Africa, as was not the case for the other developing
regions, coverage of the primary school-age population declined
appreciably, from 79 to 67 per cent.  In 1990 there were an
estimated 130 million out-of-school youth in the age group 6-11 in
the developing countries, and 277 million in the age group 12-17. 
Millions more satisfy the attendance requirements but fail to
complete basic education programmes, and thus do not acquire
essential knowledge and skills.

22.  Even though the total number of illiterate adults in the world
- 948 million in 1990 - is still important, significant progress
towards adult literacy has been achieved.  The adult literacy rates
in all regions of the world are rising and the global rate is
expected to go above 75 per cent before the end of the century.  In
sub-Saharan Africa and Southern Asia the rate is expected to be
lower, and a figure of 49 per cent is projected for the group of
least developed countries.

23.  In a majority of developing countries, girls are still
underrepresented in enrolment at every level of formal education. 
Moreover, the opportunities for girls to advance beyond the first
level of formal education to the second and third levels are still
significantly fewer than for boys.  The United Nations Educational,
Scientific and Cultural Organization (UNESCO) estimates that
currently one out of three adult females in the world is
illiterate, compared with only one out of five adult males.  While
there has been substantial progress in reducing male/female
disparities in illiteracy, the gender differences remain pronounced
in certain regions, notably Southern and Western Asia, and
sub-Saharan Africa.

Health

24.  Although specific aspects related to the health sector are
covered in chapter VII below, it is important to mention that in
general there has been notable progress in improving the health
conditions of populations.  However, there is still a wide gap
between the health coverage of urban areas and that of rural ones. 
The health-care systems in the majority of the developing countries
have not been able to attend properly to the needs of rural areas
and have demonstrated increasing difficulties in coping with the
rapidly increasing demand of fast-growing populations in the urban
and suburban areas.  As a result, increasing numbers of people are
not receiving appropriate or comprehensive health care.  Even more
alarming is the gap between population growth and the amount of
health sector investments, which are even shrinking in many
countries.  According to the World Health Organization (WHO), this
deterioration has been a result of the low priority given to the
health sector by many Governments, as well as of the effect on the
social sector of the debt crisis and the effect of poorly designed
structural adjustment policies.  Furthermore, the quality of the
services has become increasingly difficult to maintain or improve,
as the physical infrastructure is decaying.

25.  World food production outweighs consumption, as has been
mentioned above.  Nevertheless, the lack of access to food has
affected a large number of people.  Among the victims are more than
2 billion people who suffer from micronutrient deficiencies which
can lead to blindness, mental retardation and death, as well as
more than 150 million people in Asia and about 30 million people in
Africa (including a large proportion in the two regions of children
under five years of age suffering from protein-energy
malnutrition).

Employment

26.  The Plan of Action recognizes that a major challenge faced by
developing countries is the creation of sufficient employment
opportunities in the modern sector of their economies to absorb
their rapidly growing labour force.  As the six-billionth
inhabitant is currently expected to be born in the year 1998, one
year sooner than was projected in the late 1980s, population growth
and concomitant growth in the labour force are making the
employment issue a great challenge, especially for developing
countries in which unemployment, underemployment and poverty are
associated with low levels of investment, and where the economic
climate is most likely to remain unfavourable.

27.  According to the International Labour Organization (ILO), the
major economic factors and policies that have aggravated the
employment problem are (a) the disproportionate emphasis given by
countries to growth-oriented development strategies at the expense
of other major development goals; (b) the selection of ill-suited
production techniques that are capital-intensive in the industrial
as well as in the agriculture sectors; (c) the lack of an adequate
balance between national production destined for export and that
destined for domestic consumption; (d) labour-market segmentation,
giving preference to capital-intensive production methods rather
than to the informal sector; and (e) the insufficient monitoring of
structural adjustment programmes and other policies implemented to
deregulate the economy and to reduce the size of the public sector.

28.  Strategies for responding adequately to the above problems
have been fostered by the international community and are based on
the recognition of the existing links among population growth,
employment, income distribution and poverty.  Such strategies aim
at promoting employment in all sectors, facilitating the access to
productive inputs and improved technologies, and
establishing/strengthening education and training systems
responding to specific employment situations.

29.  ILO organized a first gathering of the High-Level Meeting on
Employment and Structural Adjustment in November 1987, which
recognized the gravity of the world economic situation,
characterized by indebtedness and the growth of unemployment and
poverty.  Special attention was given to measures to be devised to
achieve adjustment and growth with minimum social cost and to
promote participation and dialogue between social groups, including
employers' and workers' organizations.  As the reforms envisaged
and the changes that have taken place since 1987 have not yet begun
to remove, particularly in Africa, the deep-seated structural
problems such as low productivity, underdeveloped human capital and
lack of investment that are the root cause of poverty and lack of
employment, amendments are urgently needed.  A second High-Level
Meeting is foreseen in the period 1994-1995 to examine the next
phase of structural adjustment programmes and to discuss strategies
to improve labour market policies, to make environmental policies
compatible with employment creation and poverty alleviation, and to
ensure a balance between labour protection and employment
promotion.  It will also examine ways of managing the transition
from state-run to market-oriented economies, of privatizing
state-owned enterprises, and of responding to increased migratory
pressure.


             Issue No. 3.  Population, the environment and
development

30.  One of the objectives of the World Population Plan of Action
is to advance national and international understanding of the
complex relations among the problems of population, resources,
environment and development, and to promote a unified analytical
approach to the study of these interrelationships and to relevant
policies (para. 15 (d)).  The Plan of Action explicitly affirms
that in the democratic formulation of national population goals and
policies, consideration must be given, together with other economic
and social factors, to the supplies and characteristics of natural
resources and to the quality of the environment (para. 14 (j)). 
The continuing debate over the connection between population
growth, development and environmental impacts has been a major
concern of the international community since the 1974 World
Population Conference in Bucharest.  Recommendation 4 of the Mexico
City Conference urged Governments to adopt and implement specific
policies, including population policies, that would contribute to
redressing imbalances between trends in population growth and
resources and environmental requirements and promote improved
methods of identifying, extracting, renewing, utilizing and
conserving natural resources.

31.  A major impetus to the current concern about the linkages
between population factors and the environment was given by the
publication in 1987 of the report of the World Commission on
Environment and Development popularly known as the Brundtland
Commission, 16/ whose perhaps most important message was the
introduction of the concept of sustainable development.  The report
observed that rapidly growing populations could increase the
pressure on resources and slow any rise in living standards; thus
sustainable development could only be achieved if population size
and growth were in harmony with the changing productive potential
of the ecosystem.

32.  Two years later, in November 1989, the International Forum on
Population in the Twenty-first Century adopted the Amsterdam
Declaration on A Better Life for Future Generations, 17/ which
acknowledged, inter alia, that population, resources and the
environment were inextricably linked and stressed the commitment of
the Forum's participants to bringing about a sustainable
relationship between human numbers, resources and development
(preamble, para. 1).

33.  In 1990, the report of the South Commission 18/ acknowledged
that in several developing countries, the pressure of growing
numbers on the limited fertile land was accelerating the
degradation of land and water resources and causing excessive
deforestation.  The Commission found that the present trends in
population, if not moderated, had frightening implications for the
ability of the South to meet the twin challenges of development and
environmental security in the twenty-first century.

34.  Agenda 21, 19/ adopted in 1992 by the United Nations
Conference on Environment and Development, recognizes that
demographic trends and factors and sustainable development have a
synergistic relationship, and reiterates that the growth of world
population and production combined with unsustainable consumption
patterns places increasingly severe stress on the life-supporting
capacities of the planet.  The pivotal contribution of the United
Nations Conference on Environment and Development was its strong
emphasis on the cross- sectoral linkages between issues of
development and the environment.  Among other important matters, it
addressed the connection between demographic dynamics and
sustainability, thereby extending and reinforcing the earlier
references in the World Population Plan of Action and the
recommendations for its further implementation.  In chapter 5 of
Agenda 21, five key objectives are identified within the main
programme areas:  (a) to incorporate demographic trends and factors
in the global analysis of environment and development issues; (b)
to develop a better understanding of the relationships among
demographic dynamics, technology, cultural behaviour, natural
resources and life support systems; (c) to assess human
vulnerability in ecologically sensitive areas and centres of
population to determine the priorities for action at all levels;
(d) to fully integrate population concerns into national planning,
policy- and decision-making processes, with full recognition of
women's rights; (e) to implement population programmes along with
natural resource management and development programmes at the local
level to ensure sustainable use of natural resources, improve the
quality of life of the people and enhance environmental quality.
20/  Agenda 21 calls for developing and disseminating knowledge
concerning the links between demographic trends and factors and
sustainable development and, on this basis, for formulating
integrated national policies and local programmes for population,
the environment and development.

35.  Population, development and environmental issues are linked in
complex ways.  The ecological impacts of population factors are
shaped by the characteristics of the physical environment, as well
as by the type of social organization (which includes a complex set
of cultural values that determines patterns of consumption), the
level of economic development and the available technological
options.  If the prospects for future generations are not to be
compromised, important changes must be made towards the adoption of
a sustainable pattern of development, one that maintains a balance
between population size and environmental capacities and also
succeeds in lightening the grinding burden of poverty that afflicts
a large portion of the world population.  A large amount of
research has been done on each of the three components -
population, the environment and the process of development - but of
particular interest is the proper understanding of the
interrelations among them.  Brief illustrations of some of the
linkages among population, the environment and socio-economic
development are presented below.

Land use and deforestation

36.  The state of the environment in rural areas is of particular
importance since such areas currently account for two thirds of the
population of developing countries.  In those areas, where
agriculture remains the major economic activity of increasing
numbers of poor people, it is necessary to exploit excessively the
limited agricultural resources, and this thus puts at risk the
basis for further production.  In particular, the growth of rural
populations plays an important role in the process of deforestation
through the clearing of land on the margins of tropical forest and
through the quest for firewood.  In the early 1980s, it was
estimated that tropical deforestation was proceeding at a rate of
11.4 million hectares per annum.  Recent estimates have pushed the
rate up from 17 million to 20 million hectares per annum in the
late 1980s.  The latest statistics suggest that the overall rate of
tropical deforestation in the 1980s was 0.9 per cent per annum. 
About 1.3 billion people live in areas where fuelwood is consumed
faster than trees can regrow.

37.  Population pressure on land resources also leads to
fragmentation of landholdings, shortening of fallow periods, and
cultivation of erosion-prone hillsides, all of which contribute to
soil degradation.  The phenomenon of landlessness is also
widespread; the proportion of agricultural landless households is
estimated to be 17 per cent in Latin America,  11 per cent in the
Middle East, 15 per cent in South Asia and 6.5 per cent in Africa. 
Even more important is the proportion of smallholder households,
whose landholdings are too small to provide a sustainable
livelihood, with the proportion being about 60 per cent in the
developing countries as a group.  Under the norms of partible
inheritance of land that are typical for most developing countries,
rapid population growth contributes in a significant way to the
fragmentation of agricultural holdings.  To the extent that land
fragmentation is not matched by the introduction of intensive and
environmentally sustainable agricultural techniques, the farmers
with exceedingly small plots are forced to "mine" their land or
migrate and engage in ecologically destructive practices of land
extensification on marginal lands where soil and climatic
conditions are poorly suited to annual cropping.  As a result of
rapid population growth, combined with the aforementioned
institutional factors and lack of development, some 7-8 million
hectares of rain-fed croplands and 1.5 million hectares of
irrigated land are currently lost every year, while another 20
million hectares lose virtually all their agricultural
productivity.  Rapid population growth has also been identified as
one of the factors contributing to the excessive exploitation of
pastures, destruction of vegetation on mountain slopes, siltation
of rivers and increasing incidence of floods.

Water resources

38.  The phenomenon of freshwater scarcity is increasing rapidly
with a growing world population and urbanization as well as with
the process of economic growth.  Currently, 80 countries with 40
per cent of the world population suffer from serious water
shortages.  Given existing climatic conditions and current
population projections, it is estimated that the per capita global
water-supply will decline by 24 per cent by the end of the century.

Projections made by hydrologists indicate that meeting demands by
the year 2000 will require virtually all the usable freshwater
supplies in North Africa and the Middle East; 15-25 Northern
African and sub-Saharan African countries may face serious problems
with water shortages by the year 2025.

39.  With regard to water resources, in the report of the
Secretary-General to the General Assembly at its forty-fifth
session, concerning the achievements of the International Drinking
Water Supply and Sanitation Decade 1981-1990, it was  pointed out
that in spite of progress achieved concerning service coverage
during that period, the situation in urban areas of developing
countries, particularly in large cities, could become alarming in
years to come. 21/  Given the high rate of growth in the urban
centres, the number of people in urban areas without adequate
water-supply facilities could increase by as much as 83 per cent,
and the number of dwellers without adequate sanitation services, by
as much as 68 per cent.  As a result, there could be a vast number
of urban and rural poor lacking suitable water-supply and
sanitation services and increasingly vulnerable to water-borne
diseases.  At the same time, too often water resources projects
have failed to benefit the urban and rural poor.

40.  The projected high rates of population growth in urban areas
will bring with them a rapid rate of growth in the demand for water
for domestic, municipal and industrial uses, which will often
strain existing water-supply capabilities, and the provision of
additional supplies will often require the development of costlier
sources.  In addition, demands for urban water-supplies will
compete increasingly with growing demands for irrigated
agriculture.  Besides the fact that water is in short supply in a
number of countries, much of what is available is not safe to
drink.  With regard to water quality, in the report of the
Secretary-General (to the Committee on Natural Resources at its
twelfth session, held in 1991) on strategies and measures for the
implementation of the Mar del Plata Action Plan in the 1990s, it
was pointed out that increasing population pressures and the rapid
growth of urbanization were causing dangerous concentration and
acceleration of pollution and the deterioration of water quality in
surface waters and groundwaters.  That report also pointed out that
in many cases, the waste-assimilative capacity of freshwater bodies
adjacent to towns had been outstripped, and that in many major
centres the situation had reached dangerous proportions.  In
addition, there was also concern about the increasing entry of
agricultural chemicals into surface waters and groundwaters. 22/

41.  Given those considerations, both the International Conference
on Water and the Environment, 23/ which was part of the preparatory
process of the United Nations Conference on Environment and
Development, and chapter 18 of Agenda 21 of the United Nations
Conference on Environment and Development, stressed, inter alia,
the concept of a holistic approach to water resources development
and management, including the interrelationship between land and
water, and the efficient use of the resource through demand
management; the need for a participatory approach to development
through management at the lowest appropriate level; the use of
appropriate technologies; and capacity-building.   

42.  In 1990, in spite of dramatic improvements in the standards
and levels of services in drinking-water supply and sanitation
achieved in the past two decades, especially in the rural areas of
developing countries, 1.2 billion people did not have access to
clean water-supplies and 1.7 billion people were not served by
adequate sanitary facilities.  The problems of the urban
environment are taking on an ever-increasing importance as the
process of urbanization continues at a rapid pace in many
countries, both developed and developing.  Many cities are unable
to expand their infrastructures rapidly enough to cope with the
environmental requirements of their burgeoning populations.  In
addition to the problems related to water-supply, sanitation and
waste-water treatment, the disposal of solid wastes is another
major environmental problem facing cities.  Most settlements in
Africa and Asia, including many cities with 1 million or more
inhabitants, have neither sewerage systems nor refuse-collection
systems.  An estimated 30-50 per cent of solid wastes generated
within cities is left uncollected and 90 per cent of the sewage
that is collected is discharged without treatment, thereby
polluting the area's water and soil.  According to a recent
assessment, improvements in water- supplies and sanitation can
bring a median reduction of 22 per cent in morbidity from
diarrhoea, which causes about 900 million episodes of illness each
year, a 28 per cent reduction in morbidity from roundworm
infection, which afflicts at any one time 900 million people, and
a 73 per cent reduction in morbidity from schistosomiasis, which
afflicts 200 million people.

Atmospheric pollution

43.  Atmospheric pollution remains an important health hazard for
urban populations throughout the world.  The United Nations
Environment Programme (UNEP) Global Environment Monitoring System
estimates that nearly 900 million urban-dwellers, mostly in
developing countries, are exposed to unhealthy levels of sulphur
dioxide and that more than 1 billion people are exposed to
excessive levels of particulates.  National trends in emissions and
concentrations of these substances are mixed.  While significant
progress was made in the past two decades by countries of the
Organisation for Economic Cooperation and Development (OECD), there
has been little or no improvement at all in the heavily polluted
industrial areas of Eastern Europe and the former Union of Soviet
Socialist Republics, and in the developing countries the typical
trend is towards the rise of air pollution.  Environmental
conditions are particularly precarious in overcrowded slums and
squatter settlements, which are home to an estimated 25-50 per cent
of the urban population of developing countries.  The use of
chlorofluorocarbons (CFCs) and other ozone-depleting substances
that have implications for the habitability of the planet, demand
the adoption of strict measures.

Energy resources

44.  In some respects, the situation concerning energy is similar
to that concerning water resources.  The growth of urban centres
and increased requirements for industrial production translate
themselves into growing demands for energy resources.  At the same
time, however, the urban and rural poor continue to suffer from
inadequate sources and in many developing countries rely on
fuelwood for most of their requirements.  In paragraph 9.9 of
Agenda 21 it is pointed out that much of the world's energy is
currently produced and consumed in ways that could not be sustained
if technology were to remain constant and if overall quantities
were to increase substantially.  It is further pointed out that the
need to control atmospheric emissions of greenhouse and other gases
and substances will increasingly need to be based on efficiency in
energy production.  Agenda 21 calls, inter alia, for the
identification of economically viable and environmentally sound
energy sources; the formulation of energy policies integrating
economic and environmental considerations; the promotion of the
research, development, transfer and use of improved
energy-efficient technologies, including new and renewable sources
of energy; and the promotion of capacity-building.

45.  With regard to rural energy, the General Assembly urged that
greater attention be given to the development of new and renewable
sources of energy for the rural sector and to their integration
into the overall rural economy, bearing in mind the depletion of
the fuelwood supply taking place in many regions of the world. 24/ 
Chapter 14 of Agenda 21 calls for the promotion of a mix of
cost-effective fossil and renewable energy resources that is
sustainable and ensures sustainable agricultural development; the
promotion of pilot projects that are appropriate and likely to be
adequately maintained; the initiation of rural energy programmes
supported by technical training, banking and related
infrastructure; and the intensification of research and
development, diversification and conservation of energy (paras.
14.93 and 14.95). 

Conclusion

46.  Recent decades have witnessed rapid population changes and
socio-economic development but this has been accompanied by
increasing environmental stresses at global, regional and local
levels.  In some cases, deteriorating environmental conditions have
had adverse effects on both the populations themselves and the
economies that support them.  Reversing or even moderating those
trends will require efforts on many fronts - those of reassessing
national policies, redefining political commitments, and
identifying priorities for international cooperation, to name a
few.  From the conceptual side, careful attention should be given
to the examination of two notions in particular that have become
very popular when this kind of issue is discussed.  The first
notion involves the carrying-capacity of an ecosystem, which is
generally understood to refer to the number of people that the
ecosystem can support at an acceptable level of quality of life. 
The second notion involves the identification of possible
environmental discontinuities, which are understood to refer to the
critical thresholds of irreversible injury to the environment that
emerge when ecosystems have been mistreated over long periods of
high stress without prominent signs of damage.  It is equally
important to take into account the following (and thus address some
puzzles in terms of future environmental stress):  in the not very
distant future, the very large numbers of people who are living in
what are now called less developed regions will be reaching the
consumption and production levels that are current at present in
the more developed countries.  It is nevertheless expected that as
a result of simultaneous efforts on all of the above fronts, it
will be possible to develop a set of economic, social and
demographic policies that both improve the state of the environment
and increase the quality of life of the world population.  It
should be acknowledged that substantial progress has been achieved
over the years with respect to the traditional topics of population
research, as well as on natural resources and energy consumption
patterns.  What has been slow to develop is the interdisciplinary
linkage between this type of research, which would make possible
better forecasting and projections of environmental effects, and
the manner in which the different factors interact with each other.

Furthermore, a better understanding of the connections and mutual
interactions among the three elements, as proposed by the World
Population Plan of Action, still remains an unresolved issue and
one of great concern.


                  III.  GENDER EQUALITY AND EMPOWERMENT OF WOMEN

47.  The equality of women and men is recognized in the Universal
Declaration of Human Rights 25/ and other important international
instruments, including the World Population Plan of Action and the
recommendations for its further implementation.  More recent
international conferences, such as the United Nations Conference on
Environment and Development 26/ and the World Conference on Human
Rights 27/ have reaffirmed the international commitment to gender
equality and have urged the adoption of measures to improve the
status of women.  The Plan of Action (paras. 14 (b), 15 (e) and
41-43) and recommendations 5 through 10 of the Mexico City
recommendations express the urgency of promoting the status of
women as an end in itself and emphasize the close relationship
between the condition of women and other demographic phenomena. 
Although no single indicator can capture the multiple dimensions of
the condition of women, the discussion of the two following issues,
gender equality and education, provides some examples that help to
assess the degree of progress made.  The sections below on
adolescents (para. 139) and maternal mortality (paras. 160-174)
also provide relevant information on the condition of women.


                      Issue No. 4.  Achieving gender equality

48.  It has been widely accepted that the elimination of
discrimination against women and the achieving of gender equality
are aims grounded in basic human rights, whose realization is also
essential to achieving sustainable development.  In response to the
principle of gender equality reiterated at the 1975 World
Conference of the International Women's Year, 28/ in the Convention
on the Elimination of All Forms of Discrimination against Women,
29/ adopted in 1979 by the General Assembly, at the 1980 World
Conference of the United Nations Decade for Women:  Equality,
Development and Peace, 30/ and in the 1985 Nairobi Forward-looking
Strategies for the Advancement of Women, 31/ the need to achieve
the full integration of women in society on an equal basis with men
has moved to the forefront of the global agenda, and female
education has been identified as a priority area for national
action in many countries.

49.  Progress towards achieving gender equality is being reviewed
as part of the preparations for the Fourth World Conference on
Women, to be held at Beijing in 1995.  According to recent data on
social indicators aimed at capturing the condition of women world
wide, 32/ it can be observed that despite the availability of a
large number of internationally approved instruments and the
important progress made in implementing them, the improvement of
women's situation has been found to be much slower than expected. 
Although institutional and legal barriers to the emancipation of
women have been removed increasingly, change in deep-rooted beliefs
and habits that govern gender relationships has been slow.  In
1990, the Commission on the Status of Women undertook a five-year
review and appraisal of the implementation of the Nairobi
Forward-looking Strategies, and found that the situation of women
had deteriorated in many parts of the world, especially in the
developing countries where economic stagnation, rapid population
growth, the growing burden of debt and the reduction of public
expenditures on social services had constrained the opportunities
for enhancing women's situation in the spheres of education,
employment and health.

50.  It is encouraging to observe that since the adoption of the
Convention on the Elimination of All Forms of Discrimination
against Women, the number of Governments that have signed and
ratified or acceded to it had increased from 51 to 94 by 1989; by
the end of 1993, 130 States had ratified or acceded to the
Convention.  While considerable progress has been achieved in
eliminating de jure discrimination, less has been made in
eliminating de facto discrimination.  The Commission on the Status
of Women found that many States are beginning to make use of
positive action as a means of reducing the gap between
discrimination in law and that in practice. 33/  There are many
areas that are related to gender equality and population variables.

Among those that have been studied most are those involving women's
education and economic participation, which have been found to have
powerful relationships with the major demographic variables.  The
impact of women's education is considered separately below in the
discussion of issue No. 5.

51.  Women's employment and income-earning ability have important
effects on their own status as well as on such demographic and
family processes as marriage, level and timing of fertility, and
arrangements for care of dependants (see chap. IV below).  Even
though the economic contribution of women is greatly underestimated
in the statistics on labour force participation, currently
available data indicate that in all parts of the world women make
up substantial proportions of the economically active populations. 
In 1990, 34 per cent of the labour force world wide was female. 
The proportion varies considerably from region to region.  In
industrialized countries, it was somewhat larger (42 per cent) than
in developing countries (33 per cent).  In most regions the
proportion of women counted as being economically active has been
increasing.

52.  Working women tend to be paid less than men, both because
women are concentrated in low-wage occupations and because they
often receive less for performing the same or similar jobs. 
However, information about the degree of wage disparity is not
often available at the national level.  A review of wage levels of
women and men for 14 developed countries and 10 developing
countries found that, in no case did women's wages equal those of
men.  The closest was Iceland, where women's wages came to 90 per
cent of men's wages in 1986, and the disparities tended to be small
in the Scandinavian countries as well.  At the other extreme,
women's earnings were only 52 per cent of those of men in Japan and
50 per cent in the Republic of Korea. 34/

53.  Most women's household work is not counted as economic
activity, and much of women's work outside the formal, wage sector
is missed in standard statistics dealing with employment.  Women's
work in agriculture, especially subsistence agriculture, is often
undercounted.  Recent years have seen considerable attention being
given to ways of improving statistical indicators of women's
economic activity and, more broadly, gender differences in economic
status.  At the international level, the Statistical Division of
the Department of Economic and Social Information and Policy
Analysis of the United Nations Secretariat, ILO and the
International Research and Training Institute for the Advancement
of Women (INSTRAW) have been working actively in this area, with
attention being given to changes in the way key concepts are
defined, problems of achieving adequate measurement in practice,
and the publication of economic statistics on a gender-specific
basis.  However, classifications of economic activity and
production that are employed for national economic accounting
purposes cannot be expected by themselves to provide adequate
information for the range of policies and programmes related to
gender, population and development issues.  The United Nations
Expert Group Meeting on Population and Women, held in preparation
for the 1994 International Conference on Population and
Development, noted a number of critical data and research needs,
including information on women's and men's and children's diverse
economic, domestic and resource management roles, and use of time
to fulfil those roles.

54.  Another area receiving increasing attention is the one related
to male responsibilities and participation.  The 1984 International
Conference on Population recommended the active involvement of men
in all areas of family responsibility, including family planning,
child-rearing and housework, so that family responsibilities could
be fully shared by both partners (recommendation 9).  There is
clear recognition that men should assume major responsibilities in
controlling their own sexual behaviour and the consequences of that
behaviour, and take part more actively in family planning and other
family responsibilities, to ensure safe motherhood, respect for
girls' and women's rights, and support of gender equality, as well
as the elimination of all forms of violence, including physical
violence, of which women are victims.

55.  During the period under consideration, it was also widely
recognized that achieving gender equality and improving the status
of women were ends in themselves, regardless of any demographic
goal.  At the same time, it has been recognized that improving the
status of women has important demographic impacts, particularly on
mortality and fertility levels, and that attention to gender issues
within population activities needs to be more explicitly
articulated and strengthened.  It is recognized that women face
great difficulties in protecting themselves and their children from
sexually transmitted diseases, including human immunodeficiency
virus (HIV) and acquired immunodeficiency syndrome (AIDS), and that
improving women's status may be vital for combating the spread of
these diseases.  There is an urgent need for programmes aimed at
halting the spread of AIDS and other sexually transmitted diseases
to be tailored to the specific needs for information and services
of women and men.  The following critical areas of concern and
action in the coming years have been identified during the
preparatory process for the International Conference on Population
and Development (Cairo, 1994) and the Fourth World Conference on
Women (Beijing, 1995):

     (a)  The persistent and growing burden of poverty on women;

     (b)  Inequality in access to education, health and related
services and means of maximizing the use of women's capacities;

     (c)  Violence against women;

     (d)  The effects of armed or other kinds of conflict on women;

     (e)  Inequality between men and women in the sharing of power
and decision- making at all levels;

     (f)  Insufficient mechanisms at all levels to promote the
advancement of women;

     (g)  Lack of awareness of, and commitment to, internationally
and nationally recognized women's rights;

     (h)  Insufficient use of mass media to promote women's
positive contributions to society;

     (i)  Lack of adequate recognition of and support for women's
contribution to managing natural resources and safeguarding the
environment.


            Issue No. 5.  Women's education and its demographic
impact

56.  One key element of the situation of women that has received
major attention, particularly in the context of developmental
strategies and population policy, is education.  In most of the
developing world, the long, historical neglect of women's education
has left very high illiteracy rates, especially among older and
rural women.  According to UNESCO sources, in 1990 there were 346
million illiterate men and 602 million illiterate women
(constituting 34 per cent of the adult female population).  The
numbers are even more striking for some regions:  it is estimated
that about three quarters of women aged 25 years or over in
sub-Saharan Africa, and in Southern and Western Asia, cannot read
or write.  For those women, illiteracy contributes to their
marginalization within the family, the workplace and public life.

57.  Better prospects are observed among younger generations.  The
rapid expansion of the national educational systems in the
developing countries during the past three decades has led to a
significant reduction in illiteracy rates among young women. 
During the period 1970-1990, for instance, the percentage of
illiterate women aged 20-24 fell from 19 to 8 per cent in Latin
America, from 38 to 12 per cent in Eastern and Western Asia, and
from 80 to 49 per cent in sub-Saharan Africa.

58.  The unanimous adoption of universal primary education as a
fundamental right and as an explicit developmental objective led to
a significant growth in educational investment and to a rapid
expansion of schooling systems during the 1960s and the 1970s, and
this resulted in a dramatic global increase in enrolment rates. 
Educational gains for girls in the developing world were
substantial.  The estimated proportion of girls aged 6-11 enrolled
in schools in developing countries rose from 38 per cent in 1960 to
66 per cent in 1985.  Female enrolment in primary school increased
from 24.5 to 60 per cent in Africa, from 43 to 65 per cent in Asia
and from 57 to 83 per cent in Latin America and the Caribbean. 
Important, though more modest, enrolment increases for girls in
secondary and higher levels of education were also recorded.

59.  Until recently, women have been universally underrepresented
at all levels of education.  Except for Latin America and the
Caribbean, the situation still prevails in most developing
countries.  Women's enrolment in primary and secondary education
lags behind men's by at least 10 percentage points in 66 of 108
countries.  The gender gap in educational attainment is greatest in
low- income countries, and increases at higher levels of training. 
However, throughout most of the world, a steady trend towards a
narrowing of gender disparities in school enrolment is manifest.

60.  Rapid population growth in many developing countries is
outpacing educational efforts.  Although the proportion of youth
enrolled in school has experienced a substantial expansion, the
absolute number of children not attending school has actually
increased.  The difficulty of keeping pace with a rapidly growing
school-age population usually translates into shortages of school
facilities and into impacts on the quality of educational
programmes.  This trend is expected to continue into the
twenty-first century and may further undermine the achievement of
educational parity for boys and girls.  In this respect, the
observed trends that were mentioned above regarding food production
and nutrition in sub-Saharan Africa are a matter of major concern.

61.  The links between female education and demographic behaviour
are extensively reviewed in the literature, and increasingly taken
into account in policy-making.  Numerous studies indicate that
education influences decisively a woman's overall health, her
access to paid employment and her control over family size and
birth-spacing, as well as the education and health of her children.

Education empowers women with knowledge that allows informed choice
in family and non-family matters, enables them to assume a status
and identity beyond those connected with child-bearing, and
provides exposure to new values that are likely to enhance their
autonomy.  The need to improve women's education has been advocated
repeatedly at both academic and political forums as a means of both
promoting development and reducing the levels of fertility in the
developing world.

62.  Much research has been devoted to exploring the links between
women's education and fertility.  The World Fertility Survey (WFS)
and the more current Demographic and Health Surveys (DHS)
programme, which cover a large number of developing countries, have
greatly enlarged the empirical basis for documentation of this
relationship and for development of new theoretical perspectives. 
National and cross-national studies based on the data obtained have
shown that the association between education and fertility is far
more complex than was assumed in the past, since it is contingent
on level of development, social structure and cultural milieu. 
Those studies have explored the multiplicity of channels through
which education affects reproductive behaviour.  In particular,
they have documented how female education delays entry into
marriage, influences the normative orientation towards smaller
families, and increases awareness and acceptability of, and access
to, fertility regulation.

63.  In the poorest and least literate rural societies, small
improvements in female education may, in the short run, result in
an increase in fertility through improvements in maternal health
and reductions in breast-feeding and post-partum abstinence. 
However, there is sound evidence that changing reproductive norms
and contraceptive behaviour through enhanced women's education will
lead to fertility reduction in the long run.  Even at low levels of
development, education has a sizeable negative effect on fertility
after a threshold, which is usually identified with the level of
completed primary education, is reached.  The consistent finding
that female education has a larger impact on fertility than does
male education gives strong support to the general argument for
reducing gender disparities in educational attainment.

64.  Most studies have focused on the effect of parental education
on fertility, but there is increasing evidence that the schooling
of children has an important link with fertility as well.  The
universalization of mass education modifies not only the perception
of children-related costs but also intergenerational attitudes and
economic relationships within the family, and this leads to lower
fertility.  The relationship between education and health is also
firmly established in the literature.  Education is closely linked
to child mortality, disease and nutrition.  The evidence is
unequivocal:  educated parents, particularly educated mothers, have
better-nourished children and are better health-care providers;
consequently, their children are less likely to die in infancy and
childhood.  The Demographic and Health Surveys, which provide more
detail on children's health than was previously available, confirm
these conclusions, namely, that maternal education plays a larger
role in determining a child's chances of survival than any other
socio-economic factor.

65.  Governments are increasingly aware of the links between
women's education and demographic goals; according to information
from the Population Policy Data Bank, two thirds of Governments
consider that the status of women has a significant influence on
demographic goals.  The same source indicates that 56 per cent of
Governments have adopted measures related to improving the status
of women with a view to influencing demographic trends as well. 
The role of international organizations has been important in
raising awareness regarding the need to enhance women's conditions
of life.  At the present time, there is a widely shared realization
that the implementation of demographic goals requires the promotion
of women's status.

66.  However, despite universal recognition that women's education
is crucial in the development process and that gender-based
inequality of access to educational and training resources has
critical consequences for women's productive and reproductive
roles, as well as for their health status and families, the
achievement of universal literacy and educational parity with men
is still far from being reached.  Hence, the implementation of
programmes aimed at enhancing women's educational assets needs to
be further strengthened.


              IV.  THE FAMILY:  ITS ROLES, COMPOSITION AND
STRUCTURE

67.  The World Population Plan of Action affirms that the family is
the basic unit of society and should be protected by appropriate
legislation and policy (para. 14 (g)).  In all parts of the world,
families perform important socio-economic and cultural functions. 
In spite of the many changes that have altered their roles and
functions, families continue to provide the natural framework for
the emotional, financial and material support essential to the
growth and development of their members, particularly infants and
children, and for the care of other dependants, including the
elderly, disabled and infirm.  The family in all its forms is the
cornerstone of the world community.  As primary agents of
socialization, families remain a vital means of preserving and
transmitting cultural values.  In a broad sense, families can, and
often do, educate, train, motivate and support their individual
members, thereby investing in their future growth and acting as a
vital resource for development.  Families are also important agents
of sustainable development at all levels of society and their
contribution is decisive for success in this area.  The specific
functions of families include establishing emotional, economic and
social bonds among all family members; providing a framework for
procreation and sexual relations between spouses; protecting family
members; giving a name and status to family members, especially to
children; and providing basic care, socialization and education of
children. 

           Issue No. 6.  Diversity of family structures and
composition

68.  Along with the almost universally recognized roles attributed
to the family, it is important to acknowledge the numerous forms in
which families are organized.  Such variety is a concomitant of the
multiplicity of the forms of social organization, and cultural and
religious values.  In this respect, the Plan of Action does not
endorse any particular form of family over others.  As a social
unit, the family has been undergoing radical transformations in its
formation and structure in the past two decades, owing to
demographic as well as major socio-economic changes.  In the
developed countries, with the end of the marriage boom in the
post-1960s, the entry into matrimony and hence the formation of
families has been considerably delayed.  Formalized marriage has
been losing its status, especially in Western countries, where
cohabitation without marriage has increased, at least before
children are born.  Those changes have been affecting family
formation in general, and have led particularly to a decrease in
the overall prevalence of marriage among women.  The number of
divorces has also been rising in most countries.  Severe
inequalities in the division of labour and in the distribution of
power also exist within many families.  The discussion on the
rights of children to decide on their own affairs has only just
begun.  Egalitarian possibilities for both genders are but words in
most families and a true partnership between men and women on the
basis of equal rights and responsibilities is the challenge of
modern families.  Many of those changes are now beginning to appear
in the developing countries.

69.  In the developing countries exhibiting a rapid process of
modernization, the mean age at marriage has risen significantly,
owing particularly to a notable increase in female education, and
this has implied a delay in the formation of families.  Data
confirm that in almost all industrialized and developing countries
between the 1960s and the 1980s, and even more so between the 1970s
and the 1980s, the singulate mean age at marriage of women
increased. 35/  The magnitude of those increments varies, however,
from region to region.  In Africa, despite signs of a trend towards
postponement, the average age at marriage for women is still quite
early, and hence contributes to the maintenance of high-fertility
patterns in most countries, especially in sub-Saharan Africa where
most countries have a singulate mean age at marriage below 21
years.  In Latin America and the Caribbean, by the 1980s the
singulate mean age at marriage usually exceeded 20 years, but the
effect of marriage postponement as opposed to the effect of
contraceptive use on fertility levels is more difficult to
ascertain in countries of high prevalence of consensual and
visiting unions.  In Asia, marriages have been delayed to varying
degrees in recent years and by the late 1980s, the singulate mean
age at marriage exceeded 21 years among women, except in Southern
Asia.

70.  The less developed regions are also characterized by
traditionally larger differences between the sexes in the singulate
mean age at marriage than the more developed countries.  During the
1980s, differences exceeding five or six years were not uncommon in
the less developed regions, whereas in most countries of the more
developed regions they generally varied from two to three years. 
Northern America, Europe and the former USSR were also
characterized by a considerable increase in mean age at first
marriage, a significant decline in marriage prevalence and an
increase in the proportion of those remaining unmarried.  In the
Scandinavian countries, the proportions of those ever married were
very low.  The increase in the proportion remaining unmarried,
however, has been largely accompanied by the increase in unmarried
cohabitation in those countries.  During the period 1974-1994, it
could also be observed that Governments made important advances in
eliminating forms of coercion and discrimination in relation to
marriage.

71.  Family structures and composition are also affected by other
socio-economic and political changes.  In the 1970s and 1980s, for
example, some Asian and African countries experienced large-scale
international migration owing to a great shortage of labour in the
oil-rich countries and internal political conflict in some
countries of the regions.  Recently, there has been large-scale
migration from Eastern to Western Europe owing to political changes
and conflicts.  The effects of these large-scale migrations on
family formation and structure are yet to be known but they need to
be considered while formulating policies.

72.  Family formation and structure are also influenced by changes
in the value system of societies.  In fact, the process of
modernization has heightened the value of achieving higher
education and entering the labour market, while the attraction of
a traditional child-bearing career for women has declined and, in
fact, an increasing number of women are achieving higher education
and entering the labour market.  These changes in the developed
countries have significantly modified the lifestyles of both men
and women and have produced new aspirations that aim at a smaller
number of children.  Similar trends are gradually appearing in the
developing countries where rapid industrialization and economic
development are taking place.

73.  The significant breakthroughs in contraceptive technology have
made possible the achievement of low fertility levels in the
developed countries and the initiation of a process of rapid
fertility decline in many developing countries.  Such rapid
declines in fertility in some Asian and Latin American countries
have contributed to declines in the size of households. 

74.  In all developed countries except the former USSR, the average
household size declined through the 1970s.  Given the already small
size of households, the absolute changes during that period were
small - in many cases, between 0.2 and 0.4 persons or less. 
However, the trend was discernible, and seemed to be continuing
through the 1980s, in countries where data were available.  For
instance, the North American household continued to shrink in size
from 3.1 persons in 1970 to 2.7 in 1980, and further to 2.6 persons
in 1990.  Reduction in household size is also a trend that
characterizes most countries in Eastern and South-eastern Asia and
in Latin America.  China, which contains more than one fifth of the
world population, had a moderate household size of 4.4 persons in
1982 and 4.0 persons in 1990.  The decline in household size was
particularly evident among countries that experienced a significant
decline in fertility.  On the other hand, there were countries in
Africa and in Southern and Western Asia where increases in average
household size were reported.  For example, the average household
size in Algeria increased from 5.9 persons in 1966 to 7.0 persons
in 1987.  In Pakistan, the size grew from 5.7 persons in 1968 to
6.7 persons in 1981.  All countries in Western Asia, except Israel
and Turkey, reported an increase in their already high average
household size of six or more; this was largely due to a decline in
mortality among children as well as among the older age groups
between the 1970s and the 1980s.

75.  Household composition varies within and between regions.  In
the majority of African countries, average household size is almost
equally divided between children and adults, with a range of five
to six members per household.  In most Latin American countries the
mean number of adults per household in the 1980s was close to 3.0
and was higher than the number of children.  Similarly, the
majority of Asian countries had 3.0 or more adult members per
household and the mean number of children per household was always
smaller than that of adults.  In China, Hong Kong, the Republic of
Korea and Singapore, a small but growing percentage of the urban
elderly no longer live with their adult children.  However, the
norm is still the extended family and in rural areas there has been
little change from the traditional family structure.  The pattern
of household composition observed in the developed countries was
significantly different from that of developing countries.  In the
1980s, the mean number of children per household varied in the
narrow range of 0.5-0.9 and that of adults per household was in the
range of 1.9-2.6; however, most of the countries had households
with about 2.0 adult members.  The presence of two adult members
per household in the developed countries is an indication of the
predominance of the nuclear type of family; on the other hand, the
presence of more than two or three adult members per household in
the developing countries indicates the prevalence of an extended
type of family or of a nuclear type of family with adult children
present.

76.  In the developed countries, the remarkable increase in the
number of one-person households has been another important
demographic change that has contributed to the size reduction of
households.  Between the 1970s and the 1980s, the developing
countries were experiencing a drastic decline in the proportion of
households of five persons or more, possibly suggesting the
dissolution of the extended type of household.  Also, there had
been an increase in the number of one-person households, although
the proportions of single- person households in the developing
countries, as compared with those of the developed countries,
remained relatively small.  This tendency is more noticeable in
those developing countries that are engaged in a rapid process of
modernization.

77.  From the policy perspective, one notable change in family
formation and structure is the increasing number of households
headed by single persons, particularly women.  Female headship is
common in many parts of the world and its prevalence is growing in
many societies, in both the developed and the developing regions. 
The proportion of female-headed households among the total number
of households ranges from less than 5 per cent in Kuwait and
Pakistan to 45 per cent in Botswana and Barbados.  A great
diversity in the prevalence of female-headed households is observed
in each region of the world.  Around 1980, both in Latin America
and in Africa, the proportion of female-headed households ranged
from 10 to over 40 per cent.  In Asia, the figures vary within a
narrower range at a lower level.  No Asian country reports that
more than 20 per cent of their households are headed by women.  In
the developed countries during the 1980s, the range of
female-headed households varied from 16 per cent in Spain to 38 per
cent in Norway.  The chance for formerly married women (widowed,
divorced or separated) to become household heads is much higher
than for single or married women everywhere in the world.  The
female headship rates for widowed and divorced/separated women were
somewhat higher among the developed countries, where 60-80 per cent
of those women were household heads.  The corresponding figures for
Latin American countries fell in the range of 40-60 per cent. 
Although the available data refer only to a limited number of
African and Asian countries, the headship rates for formerly
married women vary greatly within the regions.  These trends are
seen as signs of the vitality and resilience that the family as an
institution has shown despite the many pressures and challenges
that it has faced.  New forms of family life are developing to meet
the challenges of the modern world. 

                Issue No. 7.  Socio-economic support to the family

78.  To a large extent, perceptions, attitudes and aspirations
affecting demographic variables are acquired by individuals through
their family life.  Families and broader kinship-based support
systems, as noted earlier, provide the natural framework for the
emotional and material custody essential to the growth and support
of their members.  Although it is recognized that families should
aim at achieving self-sufficiency, in many circumstances families
are not and cannot be wholly self-sufficient.  The reasons for and
the solutions to family problems cannot be found solely in families
themselves, but rather must include the socio-economic and cultural
context in which they exist.  This observation highlights the need
to develop effective legislation, family policies, services and
benefits aimed at strengthening basic family functions, taking into
account variations in cultural, social and religious customs, and
protecting the basic human rights of family members.  Beyond this,
there is a need to develop "family-sensitive" social and economic
strategies, policies and programmes aimed not only at responding to
the needs of vulnerable families, but also at identifying the
"family impact" of policies and programmes more generally. 

79.  The Plan of Action and the Mexico City recommendations contain
a series of provisions aimed at supporting families in fulfilling
their roles in society (para. 39 and recommendation 34,
respectively).  Families have been affected by the dynamics of the
societies in which they exist.  Over the past few decades, the
family has undergone varying degrees of changes in structure and
functions, some of which have increased their vulnerability and
need for socio-economic support, largely depending upon the level
of national economic development and diversification.  This process
has been accelerated by advances in technology and changes in mores
and values.  In addition to those long-term sustained influences,
some short-term influences, such as the migration of workers,
natural disasters, war and drastic deterioration in economic
conditions, have placed severe pressure on families and family
structure in many developing countries.  In performing functions
vital to the well-being of its members and society, the response of
the family to those changes has ranged from adaptation without
significant dysfunction to total breakdown.  Where the family
system has broken down, the pressure on social institutions has
generally been extreme.  In contrast, where supporting social and
economic mechanisms were still in place, adaptation occurred, with
less disruptive effects.

80.  In some developed countries, both new laws and social welfare
programmes have been instituted to respond to some of the problems
that have emerged.  Responses to social and economic changes are
still evolving in most societies.  As the family is such a
fundamental unit of society, a more comprehensive understanding of
the consequences of those changes for both individuals and society
as a whole must be sought before the appropriate social mechanisms
can be put in place.  Among the social issues affecting the
performance of family functions today is the increasing number of
vulnerable families, including single-parent families headed by
poor women, destitute families, families that are separated owing
to the working conditions of their members, refugee and displaced
families, and families with members disabled or affected by
diseases, as well as families afflicted with drug abuse,
disintegration, domestic violence and child abuse or neglect.  Of
particular importance is the recognition that single mothers with
children form a disproportionate share of the poor.  The economic
and social insecurities associated with the female-headed household
is a matter of great concern, particularly for the development of
young children.

81.  There is a continuing need for data collection and analysis
directed towards monitoring changes in the structure and dynamics
of the family, as well as towards an understanding of the ways in
which economic and social trends and policies affect and are
affected by changes within families.  Some of the important areas
needing improved understanding are child-care arrangements and,
more broadly, the interactions among women's, men's and children's
diverse roles, including their use of time, access to and control
over resources, participation in decision-making processes, and
changes in their norms, values and beliefs.

82.  Family well-being may depend, to an important degree, on the
ability of families to make informed choices concerning fertility. 
Such choice is a basic right which also has important benefits for
maternal and child survival and health.  Increased efforts are
needed to ensure adequate family-life education which should
address such issues as reproduction, sexuality, birth-spacing, and 
information about sexually transmitted diseases (including AIDS). 
Equally important are parenting skills which are essential for
promoting a deeper understanding of responsibilities in a familial
and interpersonal context, as well as family values.  Families also
play a crucial role in meeting the health requirements of all their
members; there is a need to support families in this vital role.  

                        V.  POPULATION GROWTH AND STRUCTURE

83.  The following discussion is based on the United Nations 1992
Revision of demographic estimates and projections. 36/  The
revision includes estimates of population size and structure, as
well as levels of fertility, mortality and migration for the world,
the more developed and the less developed regions, seven major
areas, 22 regions and 223 countries, areas and territories.  On the
basis of such estimates and other analyses, the United Nations also
prepares population projections, which are presented in three
variants:  high, medium and low.  The medium variant indicates the
most likely future prospect on the basis of the information and
knowledge available for each particular country.  All three
variants assume, in general, further reductions in current levels
of mortality and fertility.  Table 1 presents a set of major
demographic indicators for selected years and periods over the
period 1950-2015 for the world and major areas.

84.  The Plan of Action invited Governments that considered that
their current or expected rates of population growth hampered their
goals of promoting human welfare to consider adopting population
policies, within the framework of socio-economic development (para.
17).  A similar recommendation was made by the 1984 International
Conference on Population, Mexico City (recommendation 13). 
Governments' perceptions of their population growth rates have
changed considerably over the past two decades, with an increasing
number of countries viewing their growth rates as too high (see
table 2).  In 1993, only 11 per cent of countries perceived their
population growth rates as too low (13 per cent of the developed
countries and 10 per cent of the developing countries); 45 per cent
perceived their rates to be satisfactory (87 per cent of the
developed countries, compared with only 28 per cent of the
developing countries); and only one of the developed countries (the
former Yugoslav Republic of Macedonia) perceived its rates to be
too high, compared with 61 per cent of the developing countries.
37/

===================================================================
 Table 1.  Major demographic indicators by major area, 1950-2015
                       (see attached file)
=================================================================
  Table 2.  Governments' perception of rates of population growth,
                            1976-1993
                                
                    (Percentage of countries)

                                                                  
        

Year         Too low        Satisfactory       Too high     Total 

1976         25.0             47.4             27.6         100.0a/

1986         16.5             45.3             38.2         100.0b/

1993         11.0             45.3             43.7         100.0c/
                                                                  
        

Source:  The Population Policy Data Bank maintained by the
         Population Division of the Department for Economic and   
         Social Information and Policy Analysis of the United     
         Nations Secretariat.

          a/   Representing 156 countries.
          b/   Representing 170 countries.

          c/   Representing 190 countries.


85.  Many Governments have adopted policies aimed at influencing
their population growth rate; others follow a policy of no
intervention.  Since the adoption of the Plan of Action in 1974, an
increasing number of countries have decided to adopt policies aimed
at lowering their growth rates.  Table 3 displays the evolution of
the types of interventions followed by Governments during the past
two decades.  In 1993, 34 per cent of the developed countries had
policies aimed at maintaining their current growth rates, compared
with only 4 per cent of the developing countries; and only 2 per
cent of the developed countries had policies aimed at lowering
their growth rates, compared with 53 per cent of the developing
countries.

86.  The number and proportion of people disabled due to health
hazards, accidents or violence is another matter of major concern. 
The situation of disabled people is critical among poor
communities, particularly in the developing countries.  In general,
people with disabilities are more vulnerable to physical abuse and
discrimination than any other group.  Unfortunately, the pressing
issue of effective measures to prevent disability, to facilitate
rehabilitation and, particularly, to fully integrate disabled
persons into society remains unresolved; and in many circumstances,
when resources for social programmes are scarce, the disabled
community is among the first to suffer from budgetary cuts.  On the
other hand, more recently, Governments have adopted legislative
measures addressing the situation of the disabled.  The level of
awareness has been enhanced by the United Nations Decade of
Disabled Persons (1983-1992) and the adoption of the World
Programme of Action concerning Disabled Persons. 38/ 


   Table 3.  Governments' policies aimed at influencing rates
                 of population growth, 1976-1993

                    (Percentage of countries)

                                                                  
        

                         No
Year       Raise     intervention     Maintain      Lower     Total

                                                                  
1976      19.9         55.1           55.1        25.0      100.0a/

1986      15.9         44.7            8.2        31.2      100.0b/

1993      11.6         37.4           13.2        37.9      100.0c/
                                                                  
Source:  The Population Policy Data Bank maintained by the
     Population Division of the Department for Economic and Social
     Information and Policy Analysis of the United Nations        
     Secretariat.

          a/   Representing 156 countries.
          b/   Representing 170 countries.
          c/   Representing 190 countries.


87.  Another group that has been receiving increased attention is
that of indigenous people.  In many regions of the world,
indigenous communities experience discrimination and are unable to
participate in the mainstream of the process of social and economic
development.  Many of those communities manifest particular
demographic characteristics that are different from those exhibited
by the national populations among which they live.  While in some
cases indigenous communities have manifested rapid rates of
population growth as a consequence of declining mortality
(associated with better access to health and welfare services), in
other instances those communities have not been able to receive the
benefits of social and material progress and their survival is in
danger.  In many instances, they have been forced to leave their
natural habitat.  Activities aimed at increasing awareness about
the rights and concerns of indigenous people have been carried out
by UNESCO for some decades, and that awareness has now been
enhanced by the strong support manifested at the United Nations
Conference on Environment and Development in 1992 and more recently
by the proclamation by the General Assembly of 1993 as the
International Year of the World's Indigenous People. 39/ 

               Issue No. 8.  Diversity of rates of population
growth

88.  The world population will have grown from 4 billion since the
adoption of the World Population Plan of Action in 1974 to 5.7
billion at the time of the International Conference on Population
and Development (September 1994).  The amount of the increase over
20 years, 1.7 billion, is equivalent to two fifths (more
accurately, 42.5 per cent) of the population of the world in 1974. 
It is interesting to observe that it took the world 123 years to
pass from the first billion around 1804 to the second in 1927.  The
next increment of 1 billion took 33 years (the world population
reached 3 billion in 1960) and the next took 14 years (the world
population reached 4 billion at the time of the United Nations
World Population Conference at Bucharest).  Only 13 years elapsed
before the world population reached 5 billion (in 1987) and it is
estimated that it will take only 11 years more for it to reach 6
billion (in 1998).  Over 90 per cent of the recent population
increase will have occurred in the less developed regions of the
world.

89.  From 1.96 per cent per annum in the period 1970-1975, and a
steady 1.73-1.75 per cent per annum in 1975-1990, the world
population growth rate is expected to decrease to 1.68 per cent per
annum during the quinquennium 1990-1995.  This growth rate would be
the lowest of the post-Second World War period.  Nevertheless, the
decline has not yet been translated into one in absolute numbers;
the annual increment, which was 47 million in the early 1950s,
reached 88 million between 1985 and 1990 and is expected to
continue to increase to 98 million between 1995 and 2000.  Such
declines in the rate of growth are projected assuming a firm
continuation of present efforts and policies.

90.  Since 1975, the annual growth rate in the less developed
regions has decreased slightly, from 2.38 per cent in the period
1970-1975 to 2.01 per cent in the period 1990-1995.  The rate in
the more developed regions has decreased from 0.86 per cent in the
period 1970-1975 to 0.54 per cent in the period 1990-1995.

91.  Within the less developed regions, the group of the least
developed countries has been growing at an even faster pace; its
growth rate has increased from 2.47 per cent in the period
1970-1975 to 2.94 per cent in the period 1990- 1995.  This group is
composed of 47 countries and does not represent a large proportion
of the world population.  Those countries made up 8 per cent of the
world population in 1974 and 10.0 per cent in 1992; by the year
2015 they will constitute 13 per cent of the world population (and
14 per cent in 2025).  The rate of growth of those countries, which
has been increasing until now, is expected to begin to decline at
the end of the present quinquennium.

92.  The extremely varied range of national rates of population
growth that characterizes the world at present, resulting from
various combinations of different levels of fertility and
mortality, reflects the position reached by countries in the
various stages of transition.  One can distinguish four phases of
population growth:  (a) an increase in the growth rate to very high
levels, due to decreasing mortality coupled with high fertility;
(b) a decline in the growth rate, due to fast declining fertility
coupled with declining mortality at moderate levels; (c) a
stagnation of the growth rate at the intermediate level, due to
moderate-level crude death rates and crude birth rates declining at
about the same pace; and (d) a further decrease to low levels of
growth, due to low fertility coupled with an increasing crude death
rate resulting from the ageing of populations.

93.  Of the 223 countries, areas and territories included in the
above-mentioned World Population Prospects:  The 1992 Revision,
about half (104), containing more than two thirds of the total
world population, had rates of population growth between 1 and 3
per cent per annum in the period 1985-1990.  Among the other
countries, 53 (representing 11 per cent of the world population)
had growth rates of 3 per cent or more per annum; most were in
Africa (24 countries) or in Asia (16 countries).  At the other
extreme, 66 countries, with 21 per cent of the world population,
had growth rates below 1.0 per cent per annum; a majority of them
were European countries (32 countries), but there were also 15 from
Latin America, 3 from Asia and 2 from Africa.

94.  In addition to the observed differences in the rates of
population growth between the more developed and the less developed
regions, it is important to observe that while there is a certain
degree of homogeneity among members of the first group, such is not
the case for the latter.  A certain degree of homogeneity in growth
rates was perceptible in the period 1965-1970 when Africa, Asia and
Latin America had growth rates ranging from 2.4 to 2.6 per cent per
annum.  However, those rates increased in Asia, and particularly in
Central America and later on in Africa, as mortality rates
declined, while South America's rate held steady, owing to
concomitant fertility change.  During the period 1985-1990 the
growth rate increased in Africa to 3.0 per cent per annum, whereas
in Asia and Latin America the rates declined to 1.9 and 2.0 per
cent, respectively.

95.  The above variations in growth rates are even more pronounced
for regions within the major areas.  The lowest rates are found in
Eastern Asia and the Caribbean (1.3 and 1.5 per cent respectively),
whereas the highest rates belong to Eastern and Western Africa (3.2
per cent).  As a result of such trends, the distribution of the
world population will manifest important transformations.  The
population of Europe, which already decreased between 1950 and 1990
from a figure representing 16 per cent of the world population to
one representing 9 per cent of the world population is expected to
represent no more than 7 per cent of the world population in the
year 2015; and a similar path will be followed by Northern America
and the former USSR (representing 6.6 and 7.2 per cent respectively
of the world population in 1950; 5.2 and 5.4 per cent respectively
of the world population in 1990; and 4.5 and 4.3 per cent
respectively of the world population in 2015).  While Asia will
continue to hold more than half of the world population (55 per
cent in 1950 and 59 per cent in 2015), it is the group of African
countries that will increase their proportion significantly (from
9 per cent in 1950 to 17 per cent in 2015).

96.  Among the most recent United Nations long-range population
projections, the medium-fertility extension assumes that fertility
will ultimately stabilize at the replacement level around the year
2100.  In this case, it is projected that the world population will
increase by 89 per cent between 1990 and 2050, reaching a size of
10 billion, then expand by 12 per cent during the following 50
years (2050-2100) to a size of 11.2 billion, and by 3 per cent
during the next 50 years (2100-2150) to a size of 11.5 billion. 
The world population may stabilize ultimately at 11.6 billion
people shortly after the year 2200.  This figure is higher than
that calculated a decade ago which indicated a stabilization at
10.2 billion around the year 2100.

97.  Other long-range projections produce a wide range of projected
population sizes.  For example, assuming that fertility stabilized
at 5 per cent above the replacement level (in other words, at a
total fertility rate of 2.17, instead of 2.1, children per woman),
the world population would reach 20.8 billion in the year 2150 and
would still be growing.  If fertility stabilized at 2.5 (high
variant), the size would be 28 billion in the year 2150 and still
growing.  If, however, fertility could stabilize at the level of
1.96 children per woman, the world population in the year 2150
would be just 5.6 billion and declining.  It is important to take
into account that the level of fertility and the speed of attaining
stabilization in the future will depend on the level of social and
economic development of each country as well as the effectiveness
of Governments' policies and programmes. 

                 Issue No. 9.  Changes in the population structure

98.  The age structure of the population varies among countries and
changes over time, with various types of economic and social
implications.  In the 1950s and 1960s, special attention was drawn
to the rapid growth of the child population in the developing
countries.  The growth of the child population was faster than that
of adults who were responsible for raising and supporting them, and
thus was considered a threat to the economic and social development
of those countries.  This problem remains serious in countries that
still have high levels of fertility.  In recent years, increasing
attention has been given to the ageing of populations in many
countries.  This demographic trend is considered to have
significant economic and social consequences in many areas,
particularly for pensions, the size of the labour force, medical
care, services for the disabled, family structure and residential
patterns.

99.  For the purpose of analysing differential trends of age
distribution, it is useful to classify countries in terms of the
timing of the initiation of significant fertility decline.  The age
distribution of the pre-initiation countries, where significant
fertility decline had not started by 1990, was very young in 1950
and became increasingly younger for the period 1950-1990.  The
proportion under age 15 increased from 42 to 46 per cent, the
proportion of those aged 65 or over decreased from 3.5 to 2.8 per
cent, and the median age declined from 19.1 to 17.0 years.

100. The trend in age distribution of the late-initiation countries
changed its direction around 1970, when those countries, on the
average, started their fertility decline.  Their age distribution
had become increasingly younger in the 1950s and 1960s but became
increasingly older in the 1970s and 1980s.  The proportion under
age 15 increased from 37 per cent in 1950 to 42 per cent in 1970,
and then declined to 33 per cent in 1990.  The proportion of those
aged 65 or over tells a slightly different story:  it remained at
about 4 per cent in the 1950s and 1960s, then rose to 4.9 per cent
in 1990.

101. Trends in the early-initiation countries, where fertility
decline had started before 1950, were marked by an acceleration of
the ageing of their population.  The proportion under age 15 in
those countries was 28 per cent in 1950, a figure that was
considerably lower than those of the pre-initiation and the
late-initiation countries.  It rose slightly to 29 per cent in
1965, reflecting the so-called baby boom observed in a number of
countries after the Second World War, then declined steeply to 21
per cent in 1990.  The proportion aged 65 or over grew rapidly,
from 8 per cent in 1950 to 10 per cent in 1970, and further to 12
per cent in 1990.  The median age increased from 28 years in 1950
to 34 years in 1990.  The pre-initiation pattern of age
distribution trends characterized the least developed countries,
mostly in Africa, Southern Asia and Western Asia; the
late-initiation pattern was followed by the other less developed
regions, mostly in Latin America, Eastern Asia and South-eastern
Asia; and the early-initiation pattern was followed by the more
developed regions, mostly in Northern America, Europe, Oceania and
the former USSR.

102. It is estimated that as of mid-1990, the proportion of the
world population under age 15, and aged 65 years or over, was 32
per cent and 6 per cent, respectively.  In other words, about 1 out
of 3 persons on the earth was a child, and 1 out of 16 was an older
person.  The median age was 24 years, indicating that the world
population is still relatively young.  There are marked
geographical differences in the current age distribution as shown
in table 4, reflecting different past levels of and trends in
fertility and mortality.  The youngest populations are found in
Africa, particularly in Eastern Africa and Western Africa.  In
those two regions, the proportion under age 15 is about 47 per
cent, the proportion aged 65 years or over is below 3 per cent, and
the size of the child population is 17 times that of the elderly
population.  Located at the other end of the spectrum are Northern
Europe and Western Europe, where the proportion of those aged 65
years or over is about 15 per cent, and the proportion under age 15
is less than 20 per cent.  The sizes of the two groups are
comparable in those two regions.  The populations of Eastern Europe
and the former USSR are relatively younger than those of the other
more developed regions.  Falling between the young-age
distributions in Africa, and the relatively old-age distributions
in Northern America, Europe, Oceania and the former USSR, are the
age distributions of Latin America and Asia.  In these two major
areas, the proportion aged 65 years or over is about 5 per cent and
the proportion under age 15 constitutes about one third of the
population.

103. The proportion of the world population under age 15 is
projected to decrease from 32 per cent in 1990 to 27 per cent in
2015, and the proportion aged 65 or over will increase from 6 per
cent in 1990 to 8 per cent in 2015.  Considerable geographical
differentials in age distribution are projected to remain during
the next few decades.  In 2015, Africa will have the highest
proportion under age 15 (the projected figure is 40 per cent).  At
the other end of the spectrum, in Europe and Northern America, the
proportion will be about 18-19 per cent.  Located in between are
Oceania, the former USSR, Asia and Latin America, for which the
proportion of those under age 15 is projected to be 23-26 per cent
in 2015.  The largest regional variations within a major area are
expected for Asia where the proportion under age 15 in 2015 will
range from 19 per cent (in Eastern Asia) to 34 per cent (in Western
Asia).

104. The order is reversed for the projected proportion aged 65
years or over.  The highest proportions are expected for Northern
America (14 per cent in the year 2015) and in Europe (17 per cent),
followed by the former USSR (11.5 per cent) and Oceania (11 per
cent).  The lowest proportion (3 per cent) is projected for Africa.

Again, Latin America and Asia (7 per cent) will fall between Africa
and the major areas composed entirely or predominantly of more
developed regions.

===================================================================
   Table 4.  Estimates and projections of proportions of the 
             population under age 15 and age 65 years or
             over, by major area, 1950-2015 


Major area/region                    1950     1975    1995     2015


World
    Under 15                          34.5     36.9      31.9  27.1
    Aged 65 years or over              5.1      5.7       6.5   7.8

Developed regions
    Under 15                          27.7     24.8      20.9  19.5
    Aged 65 years or over              7.6     10.7      12.9  15.4

Developing regions
    Under 15                          39.9     41.4      34.9  28.9
    Aged 65 years or over              3.8      3.8       4.8   6.2

Least developed countries
    Under 15                          41.3     44.7      44.1  39.6
    Aged 65 years or over              3.3      3.1       3.0   3.2

Africa
    Under 15                          42.6     44.9      44.8  40.0
    Aged 65 years or over              3.2      3.0       3.1   3.3

Asia
    Under 15                          36.7     39.9      32.2  25.6
    Aged 65 years or over              4.0      4.1       5.4   7.3

Europe
    Under 15                          25.4     23.9      19.0  18.2
    Aged 65 years or over              8.7     12.3      14.1  16.8

Latin America
    Under 15                          40.4     41.2      33.8  26.4
    Aged 65 years or over              3.5      4.1       5.1   7.1

Northern America
    Under 15                          27.2     25.3      21.8  19.0
    Aged 65 years or over              8.1     10.3      12.6  14.4

Oceania                                         
    Under 15                          29.7     31.0      26.4  24.2
    Aged 65 years or over              7.4      7.5       9.5  11.1

USSR (former)
    Under 15                          30.2     26.1      25.1  23.6
    Aged 65 years or over              6.0      9.5      10.9  11.5


Source:  World Population Prospects:  The 1992 Revision (United   
         Nations publication, Sales No. E.93.XIII.7). 
=================================================================
105. The above trends and perspectives can be better perceived when
represented in the form of dependency ratios (the number of
children under 15 years and of adults aged 65 or over per 100
adults in the age group 15-64).  At the global level, it can be
observed that the world passed from a dependency ratio (minors and
elderly per 100 adults) of 66 in 1950 to one of 74 in 1975, and it
is expected that the dependency ratio will be 62 in the year 1995
and 54 in the year 2015.  While dependency ratios are expected to
continue to decrease in the future, owing mainly to the decline in
the proportion of those aged less than 15 years, their values will
increase by about 7 per cent in the more developed regions, as the
number of those regions' elderly will be augmented substantially. 
A similar pattern may be followed by the less developed regions but
not before the middle of the next century.

106. According to the information available in the Population
Policy Data Bank    for the late 1980s, only 11 per cent of
Governments were satisfied with their respective country's age
structure; 40 per cent were unsatisfied; and 7 per cent were very
unsatisfied (the remaining 42 per cent did not have any official
position on this point).  Those Governments that appeared to be
unsatisfied were particularly concerned about the high proportion
of the population that was below age 15.  Among the Governments
that specifically alluded to their views on the proportion of the
population below age 15, only 7 per cent of Governments reported
that they were satisfied.

107. The World Population Plan of Action has various provisions
aimed at protecting the condition of children, such as the
elimination of child labour and child abuse (para. 32 (e)), the
equalization of the legal and social status of children born in and
out of wedlock as well as children adopted (para. 40 (a)), and the
establishment of the legal responsibilities of parents towards the
care and support of all their children (para. 40 (b)).  The Plan of
Action asks Governments to take fully into account the implications
of changing structures of the population in the formulation of
their development policies and programmes (para. 63). 
Deteriorating social and economic conditions of society usually
have a devastating impact on children.  In many instances such
decay is strongly associated with, or is the root cause of, the
growing number of street children, children engaged in
prostitution, and child labourers.  The girl child is particularly
vulnerable to gender inequalities among some social groups:  she
can be the victim of neglect and discrimination with regard to
health care, nutrition and education, and in her socialization. 
Effective action from Governments to protect children from abuse,
to prevent child exploitation, and to deter the increased sex and
organ trade which affects children, has been weak.  On the positive
side, and among important recent achievements, the World Summit for
Children, held in September 1990, led to the adoption of a plan of
action that contains major goals regarding the survival, protection
and development of children by the year 2000. 40/ 

108. The issue of changing population structure is of critical
importance to policy makers as well as to those in the private
sector, because there are considerable age variations for many
types of economic and social activities and characteristics,
including labour force participation, income and needs for a
variety of goods and services.  People in different age groups are
in different stages of the life cycle, so that they have different
demands for goods and services.  Typical goods and services that
are closely related to a particular life-cycle stage include
paediatric care, school education, different types of housing,
family-planning services and obstetric care, nursing homes and
other services for the elderly, and geriatric care.

109. In societies with a growing proportion of aged people, new
requirements are appearing and new allocations are in demand.  Of
particular importance is the recognition that among the most
vulnerable old people are the rapidly increasing proportion of very
old women.  To respond to the new demands, different societies have
established a wide variety of mechanisms and measures to achieve a
certain degree of "intergenerational equity", mainly through
health-care and income support systems.  There is ample evidence
that a large majority of the frail elderly have been receiving
support from their relatives, particularly their spouses and
children.  Equally revealing is the finding that the elderly and
their families may accept assistance from the formal care sector
only as a last resort.  In spite of the significant progress made
in creating awareness about the contribution that the elderly can
continue to provide to society, as well as in adopting measures to
respond to the needs of older persons, 41/ it is important to
indicate how little advancement has been made in assessing the
magnitude of the physical and human resources needed to accommodate
the increasing number of very old people, as well as in preparing
guidelines on the appropriate balance between social and family
support for them. 

                 VI.  REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH AND
                      FAMILY PLANNING

110. During the past two decades, an increasing number of countries
have adopted varied measures aimed at modifying their fertility
levels, the expansion of the availability of family-planning
services being the most common among them.  In addition, increasing
numbers of couples and individuals have created a strong demand for
such services and are demanding the improvement of their quality. 
Particularly important is the new emphasis on reproductive rights,
reproductive health and family planning.  Reproductive health is
conceived of as a condition that facilitates the completion of the
reproductive process in full physical, emotional and social
well-being.  The role played by reproductive rights, which refer to
a set of prerogatives and responsibilities on the part of couples
and individuals, is a crucial one for the attainment of
reproductive health.  Access to family-planning information and
services is an important instrument for the exercise of
reproductive rights.  In this chapter, three major issues, namely,
the diversity of reproduction patterns and policies, the
availability of and access to family planning, and adolescent
fertility, are examined. 

          Issue No. 10.  Diversity of reproduction patterns and
policies

Levels and trends of fertility

111. Fertility levels, measured by the total fertility rate (the
average total number of children that a woman would have by the end
of her reproductive life if current conditions remained unchanged),
continued to decline in all of the world regions in recent decades
and are expected to continue to do so in the coming years.  World
fertility fell by 10.5 per cent - from 3.8 to 3.4 births per woman
- between the periods 1975-1980 and 1985-1990, and the magnitude of
the decline was projected to reach 13.2 per cent by the period
1990-1995.  According to World Population Prospects:  The 1992
Revision, the total fertility rate varied from 8.5 (the highest: 
Rwanda) to 1.3 (the lowest:  Italy).  Virtually all developed
countries have fertility rates that are below the population
replacement level (2.1 births per woman).  The less developed
regions have experienced a significant decline in their level of
fertility, from 6.2 births per woman in the period 1950-1955 to 3.6
in the period 1990-1995, and the level is projected to be 2.75 in
the period 2010-2015, according to the medium-variant projection of
the United Nations.  The group of least developed countries has
experienced the highest fertility levels, with at least six births
per woman, on the average, throughout the period.  However, in some
of the least developed countries, fertility levels have started to
decline and the average is projected to be 4.3 in the period
2010-2015.  112. In the less developed regions, the decline in
total fertility rates reached 15 per cent during the periods
1975-1980 and 1985-1990 and is expected to exceed 21 per cent by
the period 1990-1995.  There are, however, differences within the
less developed regions themselves.  In most of the regions of
Africa, fertility rates remained high, often above six births per
woman, and the fertility decline was very small.  In the Asian and
Latin American regions, fertility tended to converge from rates
exceeding 4-5 births per woman towards more moderate levels of 2-4
births per woman, and fertility levels are projected to continue to
proceed in this direction.  Thus, by the period 1985-1990 the range
of average fertility rates had widened among the less developed
regions:  it was as low as 3.4 in Latin America and 3.5 in Asia,
and as high as 6.3 in Africa.  It is important to indicate that the
observed reductions in the number of births per woman did not
produce a comparative decline in the average number of births; in
fact, the annual number of births continued to increase.  During
the past 15 years, in Africa, for example, fertility rates declined
by 9.1 per cent, while the number of births increased by 44.1 per
cent.  At the world level, while rates declined by 13.2 per cent,
the number of births increased by 19 per cent during the same
period. 42/

113. This situation reflects both the past and the current social,
political and economic conditions of those regions.  Such
conditions affect both economic and social development as well as
the degree of success of policies to reduce fertility.  Indeed, in
general it is in the least developed countries, where the level of
development and family-planning programme efforts is lowest, that
steady high fertility rates are observed.  Conversely, among the
more modernized countries of Asia and Latin America, where
development is progressing and fertility regulation methods are
more readily available, fertility has been declining steadily, and
sometimes sharply, as is the case in Eastern Asia, for instance,
where fertility fell from 2.8 to 2.3 births per woman between the
periods 1975-1980 and 1985-1990.  In  Japan, Singapore, the
Republic of Korea and Hong Kong, notably, the total fertility rate
fell below the replacement level; and by the late 1980s the total
fertility rate had reached levels as low as 1.3 births per woman in
Hong Kong.

114. In the more developed regions, where fertility rates below the
replacement level were reached as early as the 1970s in a number of
countries, fertility has also continued its downward trend.  By the
period 1985-1990, fertility rates were below 2 births per woman in
most developed regions.  By 1990, only a few countries, namely,
Albania, Ireland, Sweden and the former USSR, had fertility rates
exceeding 2.1.  On the other hand, exceptionally low rates - as low
as 1.3 births per woman - were recorded in Italy and Spain as early
as 1989.  In recent years, however, a turning-point seems to have
been reached in some countries where a slight upward fertility
trend has been observed.  This is the case notably in the United
States of America, several countries of Northern and Western
Europe, and New Zealand. 43/

115. The significance of those fertility patterns differs
substantially, however, for the more developed and the less
developed regions when changes in fertility are examined also in
terms of changes in average annual number of births.  Indeed, in
the less developed regions, between the periods 1975-1980 and
1985-1990, the annual average number of births continued to
increase, sometimes considerably, mainly as a consequence of the
population momentum resulting from the increase in the number of
women of reproductive age, which itself resulted from the high
fertility of the past.  This increase in the number of births,
together with the effects of declining mortality, continues to fuel
the increments in population size despite the decline in fertility
rates.  Conversely, in Europe, where the overall total fertility
rates declined during the past two decades, the average annual
number of births also fell.  Thus, despite the overall fertility
reductions in the world, many countries of the less developed
regions still continue to be concerned about increasing population
size, whereas countries of the more developed regions have been
facing other concerns related to fertility decline, notably an
increased ageing population, a shrinking of the labour force and
immigration issues.

Age patterns of fertility

116. Besides the differences in their levels of fertility, world
regions also show differences in their age patterns of fertility. 
Those age patterns are influenced by the timing of family formation
and the mean age at first marriage, as discussed above (chap. IV,
paras. 70 and 71).  Assumptions for age-specific fertility rates
for the period 1990-1995 show that the less developed regions
experience their highest fertility (205 births per 1,000 women) in
the age group 20-24, whereas in the more developed regions the
highest age-specific fertility rate (only 126 births per 1,000
women) is found in the age group 25-29.  When the less developed
regions are compared, Africa appears to have the highest
age-specific fertility, with an average broad peak pattern of about
275 births per 1,000 women for women aged 20-24 years in the period
1990-1995.  Subregional differences reveal, however, that fertility
in Northern and Southern Africa is highest at ages 25-29, whereas
in the other subregions the peak value occurs at ages 20-24.

117. A broad peak also prevails in Asia and Latin America, even
though, with an average rate of about 192 births per 1,000 women in
Asia and 173 births per 1,000 women in Latin America at ages 20-24,
the peak maximum is much lower than in Africa.  In Latin America,
however, it is expected that completed fertility will be achieved
at a younger age than in Asia.  Indeed, in Latin America, it is
expected that about two thirds of total fertility will be achieved
by age 30, as opposed to less than 60 per cent for the Asian
subregions, except Eastern Asia where 80 per cent of total
fertility has occurred by age 30 (figures derived from the values
presented in table 5).

118. In Europe and Northern America, peak fertility occurs at ages
25-29; in this age group, the fertility rate is 117 births per
1,000 women in Europe and 124 births per 1,000 women in Northern
America.  Overall levels are considerably lower than in the less
developed regions and completed fertility is achieved even earlier:

it is expected that about 70 per cent of total fertility will be
completed before age 30.  In Australia and New Zealand, the
fertility tempo is only slightly slower, with 66 per cent of
overall fertility achieved before age 30.  The former USSR and
Eastern Europe deviate significantly from the overall fertility
pattern just described:  peak fertility is expected to occur in age
group 20-24, and in the former USSR reproduction ceases early, with
almost 80 per cent of total fertility completed by age 30 (figures
derived from table 5).


   Table 5.  Age-specific fertility rates for major areas and
        regions of the world, 1990-1995                 
                       (see attached file)

Policies aimed at affecting fertility levels

119. It is important to take into account that although fertility
levels are conditioned by complex social and economic structures,
the impact of these structural determinants is mediated by three
major intermediate sets of variables:  (a) factors affecting
exposure to intercourse (for example, age at entry into sexual
unions and abstinence); (b) factors affecting conception (for
example, levels of fecundity/infecundity and contraception); and
(c) factors affecting gestation and parturition (for example,
foetal mortality, abortion).  Governments wishing to modify the
fertility levels of their country may design policies aimed at
modifying the social and economic determinants of, and/or the most
immediate factors affecting, fertility.  The World Population Plan
of Action recognizes, as one of its principles, the basic right of
couples and individuals to decide freely and responsibly the number
and spacing of their children (para. 14 (f)).  It also acknowledges
the variety of national goals with regard to fertility (para. 27),
recommends criteria to be followed in the formulation and
implementation of fertility policies (para. 29) and recognizes a
series of instruments available to affect fertility (paras. 30-32).

The International Conference on Population (Mexico City) not only
reaffirmed the provisions of the Plan of Action but also adopted
other complementary recommendations asking Governments to make
family planning universally available, to provide education and
suitable family-planning information to adolescents, to improve the
quality of services, to provide the necessary resources for those
programmes, and to adopt fertility goals and policies ensuring that
programmes were neither coercive nor discriminatory
(recommendations 25, 27-33 and 35).

120. Governments' views on fertility levels, and their policies,
have changed since the adoption of the World Population Plan of
Action in 1974.  Since then, the number of countries perceiving
their fertility levels as too high has been increasing (see table
6).  In 1993, 45 per cent of all countries viewed their level of
fertility as too high.  This number represented 67 per cent of the
world population.  The gradual shift towards viewing fertility as
excessive is the continuation of a long-term trend that was already
under way during the period 1976-1986, when the percentage
increased slightly from 35 to 40 per cent.  The percentage of
countries that viewed fertility as too low dipped from 14 per cent
in 1986 to 12 per cent in 1993, while those viewing fertility as
satisfactory declined from 50 to 44 per cent between 1986 and 1993.


121. Regarding the policies undertaken to influence the level of
fertility (see table 7), the trends closely parallel those in the
perceptions of fertility already noted.  The percentage of
countries intervening to lower fertility increased from 26 to 41
per cent between 1976 and 1993, while the percentage of countries
with policies to raise fertility increased slightly during the same
period, from 9 to 12 per cent.  Those countries with a policy of
non-intervention declined sharply from 51 to 33 per cent.  Such a
global analysis, however, masks much of the diversity that is
apparent at a lower level of aggregation.  For example, as of 1993,
while 63 per cent of the developing countries viewed their
fertility level as too high, only one country in the more developed
region (Turkey) held this perception.  Slightly more than two
thirds of developed countries (71 per cent) viewed their fertility
level as satisfactory.  Those developing countries (5 per cent)
that viewed their fertility level as too low were for the most part


=================================================================

   Table 6.  Governments' views on fertility levels, 1976-1993
                                
                    (Percentage of countries)

Year      Too low        Satisfactory        Too high       Total

1976       11.5            53.2               35.3        100.0 a/
1986       14.1            50.0               40.0        100.0 b/
1993       11.6            43.7               44.7        100.0 c/


Source:  The Population Policy Data Bank maintained by the        
         Population Division of the Department for Economic and
         Social Information and Policy Analysis of the United     
         Nations Secretariat.

            a/   Representing 156 countries.
            b/   Representing 170 countries.
            c/   Representing 190 countries.

=================================================================

       Table 7.  Aim of Governments' policies to influence
                   fertility levels, 1976-1993

                    (Percentage of countries)

Year      Raise     Maintain       Lower     No
                                         intervention      Total 

1976      9.0        14.1          25.6     51.3          100.0 a/
1986     11.8        11.2          32.4     44.6          100.0 b/
1993     12.1        13.7          41.1     33.2          100.0 c/
     
Source:  The Population Policy Data Bank maintained by the        
         Population Division of the Department for Economic and   
         Social Information and Policy Analysis of the United     
         Nations Secretariat.

     a/   Representing 156 countries.
     b/   Representing 170 countries.
     c/   Representing 190 countries.

=================================================================

countries with  relatively small populations and low population
densities (these countries have about 1 per cent of the population
of the less developed regions).  In 1993, 45 per cent of the
developed countries adopted a policy of no intervention and 29 per
cent desired to maintain their current fertility levels, whereas 28
per cent of the developing countries adopted a policy of no
intervention and only 8 per cent desired to maintain their current
fertility levels.  For the same year, 12 per cent of Governments
had adopted policies aimed at increasing their fertility levels (25
per cent of the developed countries and only 5 per cent of the
developing countries); and while only one developed country had
adopted a policy to lower its fertility level, 57 per cent of the
developing countries had done so.  On the more general level, it
could be observed that the promotion of social justice to be
achieved, inter alia, through a more equitable distribution of
income, land, social services and amenities, as proposed by the
Plan of Action (para. 32 (c)), is a goal that has not been achieved
by many Governments, partially owing to the impact of the severe
global economic stagnation and recession that have affected many
countries during the past two decades.

122. There is also an increased concern about the effect on human
reproduction of new biotechnologies that make possible artificial
insemination, in vitro fertilization, embryo transfers, surrogate
motherhood, cryogenic storage of sperm and ova, genetic selection,
and prenatal diagnosis, including sex determination.  Some of these
technological achievements raise such important questions in the
field of reproductive rights and reproductive health as:  Should
embryo studies leading to eugenic practices be permitted?  Under
which circumstances could these new biotechnologies be used for
demographic purposes?  Should women beyond a certain age be
permitted to have access to medically assisted reproduction, and
receive embryo transfers, for example, or be artificially
inseminated?  Although most of these technologies have as yet no
significant demographic impact, of particular concern are issues
such as ethical values, human rights violations, and the potential
for future alteration of some demographic characteristics,
especially the sex composition of populations. 44/  The
international community should begin to address the above issues
and discuss the possibility of adopting a set of international
standards, perhaps in the form of a protocol, on use of and access
to the new biotechnologies.

123. Observation of sex ratios at birth (the number of male births
per 100 female births) in some countries and some provinces shows
a disproportionate number of boys, above the normal range of
values.  Some societies have a strong patriarchal tradition and
therefore a strong preference for sons.  Where prenatal diagnostic
techniques are available to identify the gender of the unborn, the
use of abortion could explain the irregularities in sex ratios. 
Concerned by this practice, at least one state government in India
has adopted legislation to control the abuse of prenatal diagnostic
procedures that would encourage the use of abortion for
gender-selective purposes.

Abortion

124. The recommendations adopted by the International Conference on
Population, held in Mexico City in 1984, include a passage that
urges Governments to take appropriate steps to help women avoid
abortion, which in no case should be promoted as a method of family
planning, and whenever possible, provide for the humane treatment
and counselling of women who have had recourse to abortion
(recommendation 18, subpara. e).  This recommendation was the
subject of a heated debate in 1984 and was one of the few instances
where a government delegation requested that a separate statement
be included indicating that while joining the consensus, the
delegation wanted to affirm that one step towards the elimination
of illegal abortion, which represented a very serious health
hazard, was the provision of access to abortions that were legal
and safe.

125. One of the major limitations in understanding the nature and
the extent of the demand for abortion is the limited availability
of reliable statistics.  The most common sources refer to official
statistics provided by Governments, surveys and hospital
admissions. 45/  It has been estimated by WHO that approximately
half a million women die every year for reasons associated with
their reproductive life, and that about 30 per cent of those deaths
are due to unsafe abortion.  The incidence of abortion varies
widely between the countries for which abortion data are available.
46/  In 1987, in China and India for instance, the number of
abortions per 100 live births was estimated to be about 45 and 2
respectively.  In the Eastern European countries this ratio
sometimes exceeded 100, although it rarely exceeds 30 in the other
European regions.  It has been estimated that in 1987, between 26
million and 31 million legal abortions, and between 10 million and
22 million clandestine abortions, were performed world wide. 
Action towards a greater liberalization of abortion has been
growing recently in many countries, notably in Belgium, Romania and
Spain, where access to legal abortion has been made easier by
recent legislation, although abortion is far from being available
on request.  In other European countries, however, notably in
Ireland, such efforts were less successful and in Poland recent
legislation restricted access to abortion to cases where it would
be necessary for health reasons.

126. Information available in the Population Policy Data Bank
indicates that in 1993, for the 190 countries for which there was
such information, 173 countries granted access to abortion when the
purpose was to save the life of the mother and 41 made abortion
available on request (see table 8).  No Government appears to have
ever sanctioned the use of compulsory abortion to comply with
demographic targets. 
=================================================================

         Table 8.  Grounds for permitting abortion, 1993

Access granted                     Number of      Percentage      
                                   countries     of countries
---------------------------------------------------------------
To save the life of the mother        173             91 
To protect the physical health of 
   the mother                         119             63
To protect the mental health of 
   the mother                          95             50
In case of rape or incest              81             43
In case of foetal impairment           78             41
In case of economic hardship           55             29
On request                             41             22


Sources:  Abortion Policies:  A Global Review, vol. I, Afghanistan 
          to France (United Nations publication, Sales No.        
          E.92.XIII.8); vol. II, Gabon to Norway (United Nations  
          publication, Sales No. E.94.XIII.2); and vol. III, Oman
          to Zimbabwe (United Nations publication, forthcoming).
================================================================== 
        
    Issue No. 11.  Availability and access to family planning

127. As has been mentioned earlier in this report, there has been
an expansion of family-planning services around the world.  Such
expansion has taken place as a consequence of the recognition of
the right of couples and individuals to decide the number and
spacing of their children, as a means to achieve demographic
purposes, or as a health measure, considering that early, late,
numerous and frequent pregnancies are all detrimental to maternal
and child health.  Recent data indicate in general some major
shifts in the way family- planning programmes are conceived and
organized:

     (a)  Emphasis is increasingly being placed on the needs of
users, not just on aggregate acceptor figures, and on human rights
and health benefits, not just on the demographic impact of
programmes;

     (b)  There is increasing criticism of traditional target
systems for family-planning workers and more emphasis on
integrating such services into health programmes;

     (c)  There is extensive recognition of the fact that incentive
and disincentive schemes to lower or raise fertility have only a
marginal impact on fertility levels and in some cases are
counter-productive;

     (d)  There is wider acceptance of family-planning programmes
as constituting good vehicles for confronting the spread of HIV and
other sexually transmitted diseases.

Contraceptive use

128. According to data available through 1993 (see table 9), in
1990 approximately 57 per cent of couples in the world with the
wife in the reproductive ages were currently using contraception -
about 72 per cent in the developed countries and 53 per cent in the
developing countries.  Considering the lag between the time of data
collection and the current period, the level of contraceptive use
in the developing countries is likely to have been about 55 per
cent in 1993.  Regional differences in levels of use remain large.

129. Methods used by women make up about two thirds of
contraceptive practice world wide, and such methods have been
increasing their share in total contraceptive use.  The most widely
used methods are female sterilization, accounting for 30 per cent
of contraceptive use world wide, intra-uterine devices (IUDs) (21
per cent) and oral pills (14 per cent).  The main male methods,
condoms and vasectomy, each account for 9 per cent of contraceptive
use, while "couple" methods  chiefly natural family planning
(rhythm) and withdrawal (coitus interruptus)  account for about 13
per cent of contraceptive use.  While there remain many countries
in Africa and several in other regions where the level of
contraceptive use is still very low, most developing countries that
have available data on trends have experienced a substantial
increase in the level of contraceptive use.  Even in sub-Saharan
Africa, recent surveys show an increase in levels of use in several
countries:  Botswana, Cameroon, Kenya, Lesotho, Namibia, Rwanda,
Swaziland, South Africa and Zimbabwe.

==================================================================
            
     Table 9.  Average prevalence of specific contraceptive
                    methods, by region, 1990
                       (see attached file)

=================================================================

Availability of contraceptives

130. The World Population Plan of Action considers that the
recognition of the above-mentioned right of couples and individuals
also implies the provision by Governments of the means to achieve
the desired number and spacing of children (see Mexico City
recommendations 25, 27 and 28).  Government policies towards access
to contraceptive methods changed during the period 1974-1993.  The
major change was reflected in the fact that an increasing
proportion of Governments provided direct support for modern
methods of contraception.  For example, the proportion of countries
where government policy limited access to contraceptive methods
declined from 7.1 per cent in 1974 to 3.5 per cent in 1986 and to
less than 2 per cent in 1993.  In 1974, direct support was provided
by 55.1 per cent of Governments; this proportion increased to 71.8
per cent in 1986 and to 81.6 per cent in 1993 (see table 10).  A
greater proportion of the developing countries (86.4 per cent)
provided direct support for contraceptives as compared with the
developed countries (73.2 per cent) in 1993.  In 1974, 70.5 per
cent of Governments offered direct or indirect support for modern
methods of contraception; in 1986, 85.9 per cent of Governments
provided direct or indirect support; and by 1993, this proportion
had reached 89 per cent (85.7 per cent of the developed countries
and 90.3 per cent of the developing countries). 47/
=================================================================
              
      Table 10.  Governments' policies concerning access to
                contraceptive methods, 1974-1993

                    (Percentage of countries)

                       Access not limited

              Access                   Indirect   Direct 
Year          limited    No support    support    support   Total 

1974           7.1         22.4         15.4       55.1    100.0 a/
1986           3.5         10.6         14.1       71.8    100.0 b/
1993           1.6          9.5          7.4       81.6    100.0 c/
     

Source:  The Population Policy Data Bank maintained by the
         Population Division of the Department for Economic and   
         Social Information and Policy Analysis of the United     
         Nations Secretariat.

     a/   Representing 156 countries.
     b/   Representing 170 countries.
     c/   Representing 190 countries.

=================================================================

131. In 1993, as mentioned above, 89.0 per cent of Governments were
providing direct or indirect support to family-planning programmes.

The 1980s saw rapid progress in extending the availability of
contraception in the developing countries. 48/  Asia (except
Western Asia) and Latin America are the developing regions where
contraceptives are most widely available.  Availability continues
to be most limited in sub-Saharan Africa (where it is estimated
that under 40 per cent of the population has ready access to any
method), followed by Northern Africa and Western Asia.  The
countries in transition from centrally planned to market economies
manifest a high over-reliance on abortion for fertility regulation
purposes and women in those countries clearly need access to
contraception on an urgent basis.  However, all regions have
experienced an impressive increase in contraceptive availability in
the past two decades, particularly, between 1982 and 1989, as shown
in table 11.

132.  Although availability of all the major contraceptive methods
increased during the 1980s, there is still no wide choice of
methods in most developing countries.  A survey covering 97
developing countries has estimated the percentage of each country's
population that had ready and easy access to specific contraceptive
methods in 1989.  Widespread availability of at least one method -
defined as ready access for four fifths or more of the national
population - was estimated to exist in 28 per cent of the
countries.  However, in only 8 per cent was there widespread
availability of four or more methods.  Using a lower standard, the
survey showed ready availability for half or more of the national
population, ready access to at least one method in 50 per cent of
the countries, and availability of four or more methods for only
one quarter of the countries. 49/


133. Contraceptive availability does, however, tend to be above the
average in most of the largest nations, including Bangladesh,
Brazil, China, India, Indonesia and Mexico.  The most widely
available methods are condoms and oral contraceptives ("the pill"),
estimated to have been readily available to roughly 70 per cent of
the population of the developing countries in 1989 (table 11). 
Female sterilization is judged to have been readily available to 65
per cent of the population, IUDs to 62 per cent and male
sterilization to 57 per cent, in 1989. 50/

134. Providing access to modern contraceptive methods is only one
of the requirements for an effective family-planning programme. 
For instance, people also need to have complete and accurate
information about contraception, including both the benefits and
the risks of each method; they need access to follow-up services;
and they may need information about and help with other elements of
reproductive health.  Improving the quality of care, taking into
account the client's viewpoint in service design and evaluation,
and integrating family planning with other health services are
areas needing increased attention.  Most family-planning clients
are women, and there is an increasing interest to engage men as
clients and to involve women in much larger numbers at the planning
and managerial levels of programmes, as well as in service
delivery.

==================================================================

                   Table 11.  Availability of
         contraceptive services in developing countries,
                    by region, 1982 and 1989
                       (see attached file)

==================================================================

135. It is estimated that over 80 per cent of users of modern
contraception receive their supplies and services from public
sector programmes, most of which provide services and supplies of
at least some contraceptive methods free of charge or at a heavily
subsidized price.  Reliance on public services tends to be heaviest
in Asia, although the public sector is a major source of services
in all regions.  In some countries, particularly in Latin America,
not-for-profit non-governmental organizations are also major
suppliers of subsidized services.

Financial resources

136.  One aspect of programme financing that has received increased
attention lately is the growing difficulty of paying for the
contraceptives themselves.  Contraceptive commodities account for
an important part of donor assistance, although the greatest
portion of the cost is borne by developing-country Governments,
which in 1990 paid for approximately 60 per cent of contraceptive
commodities used in the developing countries.  UNFPA projects that
the annual cost of contraceptive commodities in developing
countries will increase by almost 60 per cent between 1990 and
2000, based on current prices, in order to meet the needs of the
growing number of couples of child-bearing age and the projected
continuing increase in contraceptive prevalence. 51/  Although new
and improved methods, such as the NORPLANT hormonal implant, offer
important advantages to users, there is a serious risk that the
relatively high cost of such methods will deter developing-country
programmes from promoting their introduction on a wide scale.

137. It is unclear how the rising costs of programmes can be met. 
Governments will find it difficult even to maintain their current
share of costs into the future, particularly considering that the
expansion of the number of couples and individuals needing services
will occur disproportionately in poor countries.  Other
possibilities include increasing international donor support,
expanding local production of contraceptives in selected countries,
and exploring possibilities for reducing the level of subsidy 
through contraceptive social marketing and public sector
cost-recovery.  To promote cost-sharing, Governments must have
better information on the effects of price changes on use.  Care
must be taken particularly to ensure that those living in poverty
have access to the services they need, if they are to realize their
basic right to decide freely and responsibly the number and spacing
of their children. 

                   Issue No. 12.  Adolescents

138. More than 50 per cent of the world population is under age 25
and 80 per cent of the 1.5 billion young people aged between 10 and
24 years live in developing countries; furthermore, in those
countries social conditions are changing rapidly and therefore the
opportunities for young people to become productive and fully
integrated into society are very much restricted.  Urbanization,
the extension of education, the explosion of telecommunications and
the strains on family functioning influence the behaviour adopted
by adolescents throughout the world which will likely persist
throughout adulthood.

139. Concern about the sexual behaviour of adolescents continues to
increase as the recognition of the health, population and
socio-economic consequences of precocious pregnancy and sexually
transmitted diseases, including HIV/AIDS, becomes widespread.  The
practice of female genital mutilation in some parts of the world is
a matter of increasing concern; it is a form of violence against
women that constitutes a form of violation of basic rights as it is
a major lifelong risk to women's health.  While there is a paucity
of reliable information about sexual behaviour, some decline in
age-specific fertility rates of women aged under 20 years has been
observed in some but not all regions.  However, indications that
abortions are increasingly becoming the main response to unwanted
pregnancies, and the high prevalence of sexually transmitted
diseases among young people, demonstrate that unprotected sexual
activity is taking place.  At the same time, a belief in the social
desirability of early marriage and early child-bearing continues to
prevail in many countries.

140. Although fertility levels have been decreasing in many regions
of the world, the fertility rates of adolescents are very high and
in some cases are even increasing.  At present, it is estimated
that close to 15 million infants born per annum (10 per cent of
total births) are from adolescent mothers.  Interest in adolescent
health is evident in the increasing number of Governments that are
formulating policies to improve programmes and of non-governmental
organizations that are initiating activities, often focusing on
reproductive health, consistent with the recommendations of the
World Population Plan of Action.  However, these actions have
remained much too limited in scope and coverage to have had
significant impact on adolescent reproductive behaviour.  The
recent Expert Group Meeting on Population and Women, 52/ held in
Gaborone, Botswana, from 22 to 26 June 1992, and the Expert Group
Meeting on Family Planning, Health and Family Well-Being, 53/ that
were convened in preparation for the International Conference on
Population and Development, strongly recommended that Governments
strengthen programmes to provide adolescents of both sexes with the
information and means to prevent high-risk pregnancies and births
and to protect themselves from sexually transmitted disease,
including HIV/AIDS.

141. The following obstacles to the prevention of pregnancy and
sexually transmitted diseases among young people persist.  The
first is the inadequacy and inconsistency of policies and
legislation curbing early marriage and facilitating the provision
of reproductive health services.  In order that policies may
reflect public concern and support for the healthy development of
adolescents, increased advocacy is required in most countries,
based on sound information on the health needs of young people and
existing responses in each country.  Often, policy provisions do
not specifically address adolescent needs or there is confusion
among community leaders, professionals and adolescents about
legislation affecting the health and behaviour of adolescents and
its application.  A second factor is the insufficient knowledge
about the sexual and fertility behaviour of adolescents, especially
in the developing countries.  Such knowledge is important in order
to overcome myths about adolescent behaviour and to assist
programme design.  A third factor is the scant provision of
information, education and counselling on family planning,
maternity, and prevention and control of sexually transmitted
diseases, with particular attention to adolescents' needs and their
help-seeking behaviour.  Frequently, there are legal and social
barriers to using existing services which are all too often
launched by individuals without sufficient understanding of
adolescent development and training in listening skills to
encourage two-way communication.

142. Recognition of the above barriers is implicit in the Plan of
Action and the Mexico City recommendations, and concentrated
efforts are required in the future to secure their adequate
implementation, thus assuring improved reproductive health among
adolescents.


                   VII.  HEALTH AND MORTALITY

143. Recent mortality declines can be attributed to advancement in
health technology, and to socio-economic development, particularly
as expressed in improved living standards, better nutrition,
increased education and improved status of women.  Longevity has an
intrinsic value, as it permits people to achieve their goals and
aspirations.  The following discussion focuses on three issues: 
the goals and targets specified in the World Population Plan of
Action; maternal mortality; and the demographic aspects of AIDS.


   Issue No. 13.  Goals and targets in morbidity and mortality

Levels, trends and prospects of mortality

144. Mortality levels, trends and prospects are presented through
three indicators:  (a) life expectancy at birth (the expected
average number of years to be lived by a person newly born,
assuming a fixed schedule of age-specific mortality rates); (b) the
infant mortality rate (the probability of dying between birth and
exact age 1); and (c) mortality of children under age 5, also
called the under-five mortality rate (the probability of dying
between birth and exact age 5).  Table 12 presents numerical
information on these three mortality indicators.  Maternal
mortality is discussed separately in paragraphs 160-174 below.

145. At the world level, for the quinquennium 1990-1995, life
expectancy is estimated at 64.7 years (62.7 for males and 66.7 for
females), representing an increase of 41 per cent from the figure
of 46.4 years estimated for the period 1950-1955.  A large
proportion of that increase took place during the 1950s and early
1960s, and a slow-down was recorded during the 1970s.  The
medium-variant projections indicate a life expectancy of 70 years
in 2010-2015 (68 for males and 72.5 for females). 54/  There have
also been important improvements in the infant mortality rate.  The
infant mortality rate for the world declined from 155 deaths per
1,000 live births in 1950-1955, to the current figure of 62 per
1,000 in 1990-1995, and is projected to reach 40 per 1,000 in
2010-2015.  A similar picture can be obtained by observing the
evolution of the under-five mortality rate, which evolved from 240
per 1,000 births in 1950-1955 to a current value of 83 per 1,000,
and is projected to decline to 57 per 1,000 in 2010-2015. 
Nevertheless, behind such spectacular achievements there are wide
disparities in mortality levels between regions, countries and
provinces, as well as by gender.

===================================================================

           Table 12.  Mortality indicators, 1950-2015

                       (see attached file)
==================================================================

146. In 1950-1955, the gap in life expectancy between the more
developed and the less developed regions was about 25 years.  Since
then, improvements in mortality have been more rapid in the less
developed regions, so that by 1992 that difference had narrowed to
12 years.  In fact, the more developed regions have passed from a
life expectancy of 66 years in 1950-1955 (63.3 for males and 68.6
for females) to a current life expectancy of 74.6 years (71 for
males and 78 for females) in 1990-1995, and the figure is projected
to reach 77.5 years in 2010-2015 (74.4 for males and 80.7 for
females).  Currently, Japan has the highest life expectancy, 78.7
years (75.9 for males and 81.6 for females).  Infant mortality in
the more developed regions passed from 56 per 1,000 births in
1950-1955 to the current level of 12 per 1,000, and is projected to
decline to 8 per 1,000 in 2010-2015.

147. Compared with the range in current levels of life expectancy
in the more developed regions (from about 70 to 77 years), the
range in the less developed regions is large.  Life expectancy by
region ranges from 49 years in Eastern Africa to 72 years in
Eastern Asia.  Most of Africa has a life expectancy of about 53
years; Asia, 65 years; and Latin America, 68 years.  In Eastern
Asia, life expectancy is currently estimated at 72 years and all
countries, except Mongolia, have current values of over 70 years.

148. Sub-Saharan Africa continues to have the highest level of
mortality in the world.  The impressive mortality declines that
occurred in other regions of the developing world with the
introduction of health interventions that reduced mortality caused
by infectious and parasitic diseases have not yet been realized in
the regions of sub-Saharan Africa.  Although the AIDS pandemic is
dealt with below as a separate issue, it is important to mention
here that it is particularly severe in Eastern Africa, Middle
Africa and Western Africa, and that it has further compromised any
effort at improving life expectancy.  In the particular case of
Uganda, for example, it is estimated that in the absence of AIDS,
its current life expectancy of 41.8 years (40.8 for males and 42.9
for females) would have been 50 years. 55/

149. With regard to infant mortality, there has been a significant
reduction of the gap between the developed and the developing
countries.  From 180 per 1,000 in 1950-1955, the infant mortality
rate among the less developed regions is currently estimated to
have declined to 69 per 1,000, and it is projected to reach 44 per
1,000 in 2010-2015.  Similar dramatic declines can also be observed
in terms of the under-five mortality.  From 240 per 1,000 in
1950-1955, the under-five mortality rate for the world has declined
to a current value of 83 per 1,000 and is projected to be 57 per
1,000 in 2010-2015.

150. It is important to note the increasing sex differential in
life expectancy at birth:  the number of additional years of life
expectancy enjoyed by females compared with males rose, in the more
developed regions, from 5.3 years four decades ago to 7 years
currently.  A similar pattern can be observed in the less developed
regions, where the gap between female and male life expectancy
increased from 1.5 to 2.8 years during the same period.  Such
changes suggest that women have benefited more from improvements in
living standards than men, because of genetic differences,
behavioural factors (particularly women's low consumption of
alcohol and tobacco), and differential working conditions. 
Nevertheless, the sex differentials for some European countries
have begun to exhibit a plateau and even a decline.  These trends
may indicate that women's lifestyles are changing and becoming
closer to those of men and that men's health standards have
recently improved.

151. The mortality trends presented above reflect the different
phases of an epidemiological transition.  According to estimates
from WHO, infectious and parasitic diseases account for almost half
of all deaths and remain the leading cause of mortality in the
developing countries (45 per cent of deaths, compared with only 4.7
per cent in the developed countries).  More than 2 billion people
living in about 100 countries are currently exposed to malaria,
which has manifested an upward trend in some Latin American and
Asian countries.  Schistosomiasis is also endemic in 76 countries
where about 200 million people are reported to be infected.  It is
estimated that in 1990 some 1.7 billion people around the world
were infected by tuberculosis and that more than 20 million were
suffering from the disease, 95 per cent of whom were living in the
developing countries.  In the developed countries, cardiovascular
diseases are the leading cause of morbidity and mortality, followed
by cancer and malignant neoplasms.  More recently, tuberculosis has
made a powerful comeback in some developed countries, particularly
among the underprivileged.

Policies aimed at reducing mortality

152. The Plan of Action set explicit quantitative targets for a
reduction in the levels of mortality, indicating that the world as
a whole should achieve a life expectancy at birth of 62 years by
1985 and of 74 years by 2000 (para. 22).  These figures have often
been cited as implicit goals for mortality improvement at the
regional level as well.  It is possible only now to verify whether
the target that the Plan of Action set for 1985 has been reached,
since the data needed to estimate mortality levels during the 1980s
for a large number of developing countries were not available
earlier.  At the world level, although life expectancy was
estimated to have just met the target of 62 years set for 1985 by
the Plan of Action, it is expected to fall short of the target set
for the year 2000 (the projected value is 67.5 for 2000-2005). 
Although impressive gains in survivorship have been made in the
less developed regions as a whole, life expectancy in those regions
fell short of the target set by the Plan of Action for 1985 by two
years and is not expected to meet the target set for the year 2000.

153. The Plan of Action also set targets for countries with the
highest mortality levels:  by 1985 they should have reached a life
expectancy at birth of at least 50 years and an infant mortality
rate of less than 120 deaths per 1,000 live births (para. 23).  The
International Conference on Population (Mexico City) revised the
targets for the year 2000 (recommendation 14) and proposed that
countries with higher mortality levels should aim for a life
expectancy at birth of at least 60 years and an infant mortality
rate of less than 50 per 1,000 live births and that countries with
intermediate mortality levels should aim to achieve a life
expectancy at birth of at least 70 years and an infant mortality
rate of less than 35 per 1,000 live births.

154. According to The 1992 Revision, none of the regions of Africa
met the target for life expectancy set by the Plan of Action for
1985, nor did nearly half of the African countries; and less than
half met the target for infant mortality.  Projections to the year
2000 suggest that an even greater number of countries in Africa are
unlikely to meet the targets for either life expectancy or infant
mortality set for that year.  However, four countries (Cape Verde,
Mauritius, Runion and Tunisia) are expected to meet the targets
(for both life expectancy and infant mortality) set for countries
with intermediate levels of mortality.

155. In Asia, the situation was mixed.  Eastern Asia and Western
Asia exceeded the target in 1985 but Southern Asia lagged behind
the target by six years and South-eastern Asia by two years.  Six
countries (three in South-eastern Asia, two in Southern Asia and
one in Western Asia) did not meet the targets for life expectancy
and infant mortality for 1985.  Bangladesh just met the target for
life expectancy but fell short of the target for infant mortality. 
The same six countries are not expected to reach a life expectancy
of 60 years and infant mortality of less than 50 per 1,000 live
births by the year 2000.  An additional six countries (mostly in
Southern Asia) are not expected to meet the target for infant
mortality, although life expectancy is expected to be above 60
years by the year 2000.  The targets set for intermediate-mortality
countries are likely to be met by 23 countries in Asia, including
all of Eastern Asia (except Mongolia), Western Asia (except Yemen
and Iraq), 6 countries in South-eastern Asia and 2 countries in
Southern Asia.  The Philippines and Viet Nam are expected to reach
the target for infant mortality, although their life expectancy
levels may fall short of the target.

156. In Oceania, the 1985 target was met by all countries and by
the year 2000, it is expected that only Papua New Guinea will not
meet the target set for intermediate-mortality countries.  All
Latin American countries met the infant mortality goals and
exceeded the 1985 target for life expectancy by at least five
years.  By the year 2000, of the 28 countries with intermediate
mortality in Latin America, 17 are expected to meet the targets for
life expectancy and infant mortality.  Only Haiti is not expected
to reach the target for either life expectancy or infant mortality.

Bolivia and Peru are expected to reach the target for life
expectancy for the year 2000 but it is expected that their infant
mortality will still exceed 50 per 1,000.  The Dominican Republic
is expected to reach the target for life expectancy but not that
for infant mortality.

157. In general, recent trends permit the conclusion that no
developing region is expected to reach the target set for the year
2000.  Among the more developed regions, Eastern Europe and the
former USSR are expected to reach life expectancies of 73 and 72
years respectively by the year 2000 (still falling short of the
target of 74 years).

158. The Plan of Action recommended, as one of its priorities, the
reduction of child mortality (recommendation 24 (a)).  This goal
was reaffirmed by Governments at the 1990 World Summit for
Children.  Through improvements in immunization coverage (the goal
of 80 per cent immunization coverage was reached in 1990), oral
rehydration therapy and basic sanitation, important progress has
been made in the reduction of deaths of children under age 5. 
Child death rates have been halved in almost every region of the
developing world (except in sub- Saharan Africa) since at least
1960.  There has been a decrease not only in the rates for, but
also in the absolute numbers of, child deaths (the annual number of
under-five deaths was close to 20 million in the early 1950s, but
declined to nearly 15 million in 1980-1985 and is currently
estimated to be close to 13 million).

159. The results of the eighth report on the second monitoring of
progress in the implementation of the Global Strategy for Health
for All by the Year 2000 indicate that in countries where the
prevalence of infectious and parasitic diseases is high, about one
half of all deaths typically occur before the age of five.  Most of
the infant and under-five morbidity and mortality, however, could
be prevented through the provision of adequate water supply and
sanitation facilities at the community level.  The International
Conference on Population (Mexico City) urged the provision of a
sufficient supply of potable water and adequate sanitation
facilities for the eradication or control of infectious and
parasitic diseases (recommendation 22).  The year 1990 marked the
conclusion of the International Drinking Water Supply and
Sanitation Decade (1981-1990).  During that period the percentage
of population covered with essential services increased, but
millions of people remain without access to water and sanitation
services and to the basic elements of care because the increases in
services have not kept pace with the increases in population.

160. Despite the availability of modern technologies, the major
obstacle to improving health conditions in the developing countries
is the weakness of the health infrastructure and the lack of
adequate human resources.  Infectious and parasitic diseases
continue to pose serious risks to child and adult health in the
developing countries.  Although gaps between the developing and the
developed countries have been significantly reduced, particularly
in relation to mortality levels, it is important to emphasize that
improved levels of survival do not necessarily mean that the
population is enjoying better health conditions.  More effort is
required to increase awareness, at all levels, about the important
contribution that primary health care can make to the process of
development and about the fact that universal access to such
services is of high priority. 

                Issue No. 14.  Maternal mortality

161. Maternal mortality is one of the leading causes of death among
women of reproductive age in the developing world.  However, it was
not until recently that the magnitude of the problem was
recognized, largely as a result of the growing number of surveys
that permit estimation of maternal mortality rates where such rates
cannot be derived from registration sources.  Maternal mortality is
measured as the annual number of deaths of women related to
pregnancy and childbirth per 100,000 births.

162. The main causes of maternal death are haemorrhage, infection,
toxaemia and obstructed labour.  Studies have shown that the
factors that contribute to maintaining high maternal mortality in
the developing countries include the relatively large number of
pregnancies among women at the extremes of the child- bearing range
(maternal mortality rates for women below the age of 20 are between
five and seven times those of women aged 20-24 years in some
countries), maternal depletion through pregnancies that are too
closely spaced and the high prevalence of high-parity births.  The
risk of death related to pregnancy is further exacerbated if women
are poor, malnourished, uneducated or beyond the reach of adequate
health care.  In the developing countries, mortality resulting from
the complications of poorly performed abortion, as was indicated
above, accounts for a significant proportion of maternal deaths
estimated at about 30 per cent.

Levels, trends and prospects

163. Among the demographic and public health variables, maternal
mortality is the indicator that exhibits the widest disparity among
countries.  On the basis of data tabulated by WHO, it has been
estimated that at least half a million women die from causes
related to pregnancy and childbirth each year.  All but about 4,000
of those deaths take place in developing countries.  The incidence
of maternal mortality ranges from almost non-existent (Iceland
reported only one maternal death in 1987 and one in 1990, Malta has
had none since 1986 nor Finland since 1989) to very high (above
1,000 deaths per 100,000 births in some rural areas of Africa). 
Scattered information suggests that in some countries, one fourth
to one half of all deaths of women of child-bearing age result from
pregnancy and its complications.  The risks associated with
pregnancy and childbirth seem, at the global level, to be about 5
per cent lower than they were five years ago.  However, because the
number of births increased by some 7 per cent over the same period,
the total number of maternal deaths has remained almost unchanged.

164. In a majority of the developed countries, maternal mortality
rates registered recently were below 10 deaths per 100,000 live
births (rates below 4 per 100,000 are common among northern
European countries) and only in Hungary, Romania and the former
USSR was the rate above 20.  In Romania, the maternal mortality
rate in 1990 was 83 per 100,000 live births.  According to WHO
estimates, the maternal mortality rate for developed countries in
the aggregate declined from 30 to 26 per 100,000 live births
between 1983 and 1988.  Reaching and maintaining low levels of
maternal mortality have been significant achievements in public
health in the developed world.  Advancements in obstetric and
prenatal care, the introduction of antibiotics and blood
transfusions, the increasing proportion of deliveries taking place
in hospitals, and the better general health and nutritional status
of pregnant women, along with the introduction of effective means
of contraception and the provision of safe abortion have all been
important factors in the reduction of maternal mortality in the
developed countries.

165. In contrast, the estimated maternal mortality rate for the
less developed regions was, around 1988, 420 deaths per 100,000
births, a figure that was about 5 per cent lower than it had been
five years earlier.  For the group of least developed countries,
the rates are estimated at about 700 per 100,000 live births. 
Although data on maternal mortality are still very scanty, WHO has
estimated that Africa has the highest rate (630 per 100,000
births), followed by Asia (380) and Latin America (200).

166. Comparing new information on maternal mortality with that
available five years ago suggests that pregnancy and childbirth
have become somewhat safer for women in most of Asia and in parts
of Latin America.  In contrast, the situation has changed very
little in most parts of sub-Saharan Africa, where the increase in
the number of births has led to a parallel increase in the number
of maternal deaths.  This situation has been aggravated in some
cases by real increases in maternal mortality.  However, it is not
immediately apparent which of the changes mentioned in this
paragraph and paragraph 164 are real and which are due to better
information having become available in the mean time.  The
resulting situation is the worst in the world and reflects the
deteriorating economic and health conditions in the sub-Saharan
region.

Policies aimed at reducing maternal mortality

167. The Plan of Action calls for national and international
efforts to reduce general morbidity and mortality, and particularly
vigorous efforts to reduce foetal, infant and early childhood
mortality and related maternal morbidity and mortality (para. 24
(a)).  The International Conference on Population (Mexico City)
adopted more precise guidelines to achieve this goal and urged
actions in relation to prenuptial medical examinations; prenatal
and perinatal care, with special attention to high-risk
pregnancies, and safe delivery by trained attendants; nutritional
needs of pregnant women; avoidance of abortion and provision of
humane treatment and counselling of women who had had abortions;
access to family planning for preventing high-risk pregnancies; and
education to change attitudes about early child-bearing
(recommendation 18 (b)-(g)).  The Mexico City recommendations also
set the goal of reduction of maternal mortality by at least half by
the year 2000 in countries where such mortality was higher than 100
maternal deaths per 100,000 births (recommendation 18 (a)).  The
Economic and Social Council, in its resolution 1989/92, after
discussing the results of the third review and appraisal conducted
in 1989, urged Governments and international organizations to
strengthen their efforts to achieve the targets established by the
International Conference on Population for the reduction of
mortality in general and child and maternal mortality in
particular; 56/ it also identified many of the factors associated
with high levels of maternal mortality:  pregnancies in the
youngest and oldest ages of the reproductive period; pregnancies
too closely spaced; high-parity births; lack of access to health
services; lack of trained birth attendants; and complications of
unsafe abortions. 57/

168. In various forms, most countries with high maternal mortality
have adopted the goal of reducing it by 50 per cent by the year
2000.  Since that goal was formulated at the Nairobi International
Safe Motherhood Conference 58/ and reiterated in a number of
regional conferences, many nations have formally endorsed it.  It
is also stated in the Goals for children and development in the
1990s (contained in the Plan of Action for Implementing the World
Declaration on the Survival, Protection and Development of Children
in the 1990s, adopted by the World Summit for Children in September
1990 (see A/45/625, annex, appendix, sect. I (b)), which have been
accepted by the great majority of countries.

169. In response to that call, WHO, along with four other United
Nations organizations and two non-governmental organizations (the
United Nations Development Programme (UNDP), UNFPA, the United
Nations Children's Fund (UNICEF), the World Bank, the International
Planned Parenthood Federation (IPPF) and the Population Council),
agreed in 1987 to collaborate in a safe motherhood initiative. 
They have been meeting semi-annually ever since as an inter-agency
group to coordinate their efforts to reduce maternal mortality.  At
their most recent meeting, in November 1992, they recommitted
themselves to intensifying their efforts and further improving the
coordination of their activities in order to accelerate the
process.  In addition to IPPF and the Population Council, the
following organizations have also joined the inter-agency group: 
Family Health International (United States), which has recently
established a department of maternal and neonatal health; Sant
maternelle internationale (International maternal health) (France);
and Family Care International (United States), to name a few.  Many
other organizations contribute to the reduction of maternal
mortality by promoting family planning and reproductive health
around the world.

170. A number of bilateral agencies have joined the effort to
reduce the unacceptably high number of maternal deaths.  The
Governments of Australia, Denmark, France, Germany, Italy, Japan,
the Netherlands, Norway, Sweden, the United Kingdom of Great
Britain and Northern Ireland and the United States, to name a few,
have provided funds and/or technical cooperation to developing
countries for the improvement of maternal health.  Those
Governments also exchange information with the inter-agency group
to ensure further coordination.

171. In some countries, it has been established that the increased
provision and improvement of existing maternity services at all
levels of the health system are the most effective means of
reducing maternal mortality.  In addition, family-planning
programmes together with good primary health care represent
important interventions to achieve reductions in maternal
mortality.  The efficacy of such programmes in achieving this end
would be greatly enhanced by the inclusion of safe and readily
accessible contraceptive methods, and, where appropriate, access to
safe abortion services.

172.  Most of the above-mentioned Governments, agencies and
organizations share the common strategy of cooperating with
countries that have demonstrated strong political will to:  (a)
assess maternal health needs; (b) develop national plans of action
(which are parts of, or integrated with, the overall national
health plan) aimed at meeting the assessed needs; and (c) implement
the plan of action as quickly and efficiently as possible.  This
process has begun or is being initiated in Bangladesh, Bolivia,
Guinea, Indonesia, the Philippines, Senegal and the United Republic
of Tanzania, to name a few.  Guidelines are now being written on
safe motherhood programme development and implementation that
include standards for maternal health services delivery and
management.  As countries proceed to develop and implement national
strategies, those materials will prove invaluable.

173. The above actions illustrate some of the aggressive efforts
that have been made to reduce maternal mortality.  Nevertheless,
the total number of maternal deaths worldwide has not yet started
to decrease.  This suggests that the implementation of the
recommendations of the Plan of Action had a slower start than
anticipated.  This may have been due partly to competition for
scarce resources, compounded by global recession and the emergence
of other crises such as overwhelming famine and the AIDS pandemic
that have required large sums of financial aid, and partly to a
lack of a sense of urgency on the part of many countries and
agencies about acting aggressively enough at the beginning.  The
lack of a sense of urgency has been largely overcome by the
information and advocacy efforts of Governments and many agencies,
but the problem of restricted resources has not abated and can be
expected to continue for the foreseeable future.

174. Another difficulty has been the size and multisectoral nature
of the problem.  The approach used until recently by most agencies
has been to develop discrete, time-limited, self-contained
projects.  This has proved completely inadequate for dealing with
such a complex problem as maternal mortality reduction.  To make
motherhood safer requires a massive and simultaneous attack on all
the elements contributing to the problem, including the health
sector, education, legislation, social services, and rights of
women; in the health sector alone, the entire infrastructure of the
health system needs strengthening in most countries where maternal
mortality is high.  This means building new structures, renovating
existing ones, providing equipment and supplies, training
personnel, and improving management and supervision practices,
among other things.

175. The complexity of the problem requires broad vision on the
part of planners and concerted, integrated efforts on the part of
Governments, funding agencies and technical cooperation
organizations.  Efficient methods for planning safe motherhood
programmes are of recent origin.  Previous instructions were
imprecise and did not provide guidance in pointing the way for
countries desiring to start the process.  In addition, coordination
of the activities of a large number of agencies is difficult at
best and many agencies are only beginning to identify ways of
working effectively with others.  All these obstacles have delayed
the building up of the necessary momentum to reduce maternal
mortality.  However, early indicators now suggest that many of
those obstacles have been or are being overcome and momentum is
building up. 

    Issue No. 15.  Acquired immunodeficiency syndrome (AIDS)

176. The rapid spread of HIV, the causal agent of AIDS, is a cause
for great concern.  AIDS emerged as a major health problem in the
mid-1980s, in both the developed and the developing countries,
threatening to undermine major gains in the reduction of morbidity
and mortality.  The victims of AIDS have most often been adults in
their prime, representing the loss of a valuable resource to their
families, communities and countries (the adverse effect of poor
health on working-age populations and their productivity is
mentioned in para. 24 (e) of the Plan of Action).  The number of
infants born with HIV infection has been increasing and it is
feared that this trend could jeopardize gains in child survival
anticipated from immunization programmes and other child-health
initiatives.  In addition, the enormous costs of caring for the
number of AIDS patients expected in the near future may divert
resources from other health programmes, with adverse consequences
for future improvements in survivorship.  The AIDS pandemic will
have substantial negative effects on social organization and
economic development in some countries.  The Plan of Action of 1974
understandably did not mention the issue of AIDS, a disease first
defined in 1982.  The Mexico City Conference in 1984 also did not
explicitly address it because the magnitude and implications of
AIDS were still unclear to many health authorities.  However, the
devastating toll from AIDS with respect to population loss and
mortality has implications for the implementation of the Plan of
Action and the Mexico City recommendations (recommendations 19, 22
and 23).  Projections show that the epidemic is expected to worsen
in the 1990s, so that efforts to combat AIDS need to be explicitly
articulated.

Levels, trends and prospects

177. WHO estimates that well over 14 million adults and children
have been infected with HIV since the start of the pandemic, and
projects that this cumulative figure may reach 30-40 million by the
year 2000.  It is estimated that over half a million children have
been infected with HIV from their infected mothers and that 5-10
million children will be orphaned by AIDS by the year 2000.  The
epidemic incapacitates people at the ages when they are most needed
for the support of the young and the elderly.

178.  The majority of the world's HIV cases have resulted from
infection through heterosexual transmission, which together with
homosexual transmission accounts for about three quarters of HIV
infections worldwide.  Two other modes of transmission of this
infection are (a) through blood and blood products, from the
transfusion, and from injections, of infected blood; and (b) from
mother to child, including both perinatal and post-partum
transmission.  Virtually all persons diagnosed as having AIDS die
within a few years.  In infants born infected with HIV, the
progression to AIDS is more rapid than in adults.  Survival after
diagnosis has been increasing in the developed countries from an
average of less than one year to between one and two years at
present.  However, survival after the onset of AIDS in the
developing countries remains short - an estimated six months or
less.  Longer survival periods seem to be directly related to the
routine use of antiviral and prophylactic drugs and a better
overall quality of health care.

179. The AIDS epidemic is most devastating in sub-Saharan Africa. 
WHO estimated that by 1992, 1.5 million adults in the region would
develop AIDS and more than 7 million would be infected with HIV. 
In this region, HIV transmission is predominantly through
heterosexual relations; and among the infected population, men and
women account for nearly equal proportions.  Since many women of
child- bearing age are infected, HIV transmission from an infected
woman to her child before, during or shortly after birth is
widespread and a growing problem in the region.  According to the
United Nations, 59/ this epidemic may bring to a halt future
improvements in survivorship for some countries in Africa.  In the
15 countries in Eastern, Central and Western Africa where the
proportion of those infected (technically called HIV
seroprevalence) was above 1 per cent among the adult population in
1990, the already low level of life expectancy at birth (of about
50 years in 1985-1990) is projected to remain unchanged through the
year 2000.  AIDS is likely to cause an additional annual 2.9 deaths
per 1,000 population in those countries by 1995-2000.  Because as
many women as men carry the virus, WHO estimates that child
mortality may increase by as much as 50 per cent through
mother-to-child transmission in much of sub-Saharan Africa during
the 1990s, thereby offsetting gains in child survival achieved over
the past two decades, as sought by the International Conference on
Population (Mexico City) (recommendation 17).

180. Transmission of HIV in Northern America, Europe and Australia
occurred, at the beginning, predominantly through homosexual
contact.  Increasingly, injecting drug users and heterosexuals are
the agents of transmission, especially in Northern America.  WHO
estimated that 1.6 million cases of HIV infection might have
occurred in these regions by 1992 (about two thirds in the United
States) and close to 350,000 or more cases of AIDS may have
occurred by that time.  It is expected that through the 1990s,
homosexual men and injecting drug users will continue to be the
population groups most affected by AIDS in the above-mentioned
regions, but new infections will occur predominantly in
heterosexual men and women having multiple sex partners.

181. In Latin America, the main mode of transmission of HIV was, in
the early stages, predominantly through heterosexual and bisexual
men and injecting drug users.  Since the mid-1980s, heterosexual
transmission, initially mainly between bisexual men and their
female partners, has become more important.  The Caribbean and the
urban areas of Brazil are the worst affected in the region.  It is
estimated that currently about 1 million people in the region may
be infected with HIV.

182. The AIDS epidemic took hold in Asia in the second half of the
1980s.  Initially, injecting drug users constituted the group most
affected but heterosexual transmission has been increasing and is
now the predominant mode of transmission.  Currently, India and
Thailand are the countries worst affected in the region.  Estimates
of the size of the HIV-infected population are not available for
the region as a whole but in India, as of mid-1992, the estimate of
the number of HIV-infected persons was up to 1 million and in
Thailand, the estimate was about 400,000.

Action and policies

183. WHO established a Global Programme on AIDS at the beginning of
1987.  By 1990, more than 150 countries had established national
AIDS committees to coordinate national control programmes.  The
Global Strategy for the Prevention and Control of AIDS (known as
the Global AIDS Strategy) was initially drawn up by WHO in
1985-1986 and unanimously approved by the fortieth World Health
Assembly (May 1987), and the Venice Summit of the Heads of State or
Government (June 1987).  Since that time, it has served as the main
policy framework for the global response to the pandemic, and it is
directed and coordinated by WHO in keeping with its mandate from
the General Assembly. 60/  The Strategy calls for direct action, as
well as research, to lessen this impact and, in particular, to
reduce the burden on women, who often carry the primary
responsibility for providing AIDS care.  The Global AIDS Strategy
was revised in 1991 and endorsed by the World Health Assembly and
the General Assembly in 1992.  While the three main objectives of
the Global AIDS Strategy remain the same (namely, to prevent
infection with HIV, reduce the personal and social impact of HIV
infection, and mobilize and unify national and international
efforts against AIDS), the revised version reflects the new
challenges of the evolving pandemic.  These include (a) increased
emphasis on care; (b) better treatment for other sexually
transmitted diseases; (c) greater focus on HIV prevention through
improvement of women's health, educational, legal and social
status; (d) a more supportive environment for prevention
programmes; (e) provision for the socio- economic impact of the
pandemic; and (f) greater emphasis on explaining the public health
dangers of stigmatization and discrimination.

184. The Global AIDS Strategy outlines various approaches to
overcoming official denial of the existence of HIV infection by
national authorities as well as complacency about its current and
expected magnitude and the attitudes reflected in the general
public.  Another challenge is discrimination against people with
HIV/AIDS, an irrational response which often stems from the stigma
attached to sexually transmitted diseases and mistaken belief that
HIV can be transmitted through casual social contact. 
Non-discrimination is thus vital, not only for the sake of human
rights, but also because of its strong public health rationale.

185. In its policy and intervention development, social,
behavioural and biomedical research and information/education
activities, the Global Programme on AIDS pursues a gender-specific
approach aimed at benefiting women.  The Programme has developed a
comprehensive strategy on women and AIDS to guide the development
of policies and interventions at both global and country levels. 
The Global AIDS Strategy emphasizes women's physical, social and
economic vulnerability to HIV infection and recommends action in
each area.  In addition, the need to reduce the social and personal
impact on women (including their disproportionate share of
care-giving in relation to the pandemic) and the links between
reducing HIV infection and developing comprehensive approaches to
women's health are also addressed.  Specific reference is made to
ensuring women's reproductive rights, including improved access to
barrier methods of contraception that prevent both pregnancy and
infection from HIV and sexually transmitted diseases, and a wide
range of family-planning services.

186. The Programme support is geared above all to the
implementation of effective strategies and interventions for
prevention and care, and to the strengthening of national
managerial capacity.  A strong management structure is essential
for implementing an intersectoral AIDS programme.  To enable
country programmes to develop as rapidly and as effectively as
possible, the Programme has developed programme manager training
courses for national senior-level staff from various sectors. 
Those courses cover planning, implementation, monitoring and
evaluating national AIDS programmes.  The Programme initiates and
supports research to identify and develop effective interventions
and approaches for the prevention and management of HIV/AIDS. 
Furthermore, it provides guidance, educational materials and
technical assistance to national AIDS programmes and a wide range
of other partners in the implementation of approaches and
interventions, especially at the country level.

187. The Programme also coordinates, supports and promotes various
types of clinical and biomedical research.  Key areas of research
include vaccine development; clinical research and drug
development; diagnostics; and epidemiological research,
surveillance and forecasting.  Finally, the Programme has been
actively involved in efforts to improve coordination of HIV/AIDS
activities at both global and country levels.  This has included
the organization of an assessment of coordination of HIV/AIDS
activities in six countries (October 1992), the strengthening of
the Inter-agency Advisory Group on AIDS (IAAG), and the
establishment of a Task Force on HIV/AIDS Coordination that reports
to the Programme's Management Committee.  Continued attention will
be given to this area in the coming years. 

          VIII.  POPULATION DISTRIBUTION, URBANIZATION
              AND INTERNAL MIGRATION               

188. According to current estimates, by the end of the twentieth
century, the world will have, for the first time in history, more
urban than rural people.  This transformation has affected every
aspect of human life and accompanied other important social and
economic transformations, particularly in the group of developing
countries.  Urbanization, or the increase in the proportion of the
population living in the urban areas, is the result of three major
components:  migration to the urban areas; areal reclassification;
and natural increase in the urban areas.  Although it is very
difficult to estimate the exact contribution of each of the three
components, the figure for urbanization due to internal migration
and areal reclassification ranges between 40 and 50 per cent, with
the rest due to natural growth.

189. The levels of urbanization are continuing to rise, slowly in
the more developed regions and more rapidly in the less developed
ones. 61/  In 1990, 43.1 per cent of the world population (2.3
billion people) lived in urban areas (72.7 per cent in the more
developed regions and 34.3 in the less developed regions).  Such
levels are in contrast with those determined in 1950, when 29.3 per
cent of the world population lived in urban areas (54.3 per cent in
the more developed regions and 17.0 per cent in the less developed
regions).  It is projected that such proportions will increase to
55.6 per cent by the year 2015.  At the same time, urbanization in
the less developed regions will climb from 34.3 to 50.1 per cent.

190. Most Governments currently recognize that urbanization is an
inevitable and irreversible process, and that as an integral part
of economic and social development it needs to be guided rather
than obstructed.  There is ample empirical proof that urbanization
has many beneficial effects, including the acceleration of economic
growth, the improvement of the social and cultural environment, the
amelioration of education and health services, the more efficient
use of land, and even reductions in fertility rates.  It is also
being increasingly recognized that voluntary migration is a
rational response to spatial inequalities and that urbanization is
an intrinsic part of the development process.

191. As the urbanization trend has demonstrated for decades,
policies to control the growth of large cities have rarely been
successful.  According to the information contained in the
Population Policy Data Bank, only 7 per cent of national
Governments consider their own national population distribution
pattern to be satisfactory; 25 per cent regard a minor change as
desirable; and 45 per cent believe that a major change is required.

192. It must be borne in mind, however, that the growth of urban
agglomerations should be accompanied by an allocation of adequate
resources to cope with the scale of new demands for employment,
housing, infrastructure and services.  Efficient management based
on integrated urban policies is a necessary condition for
beneficial exploitation of the potentials of urbanization and
minimization effects.  Sound rural development policies are equally
important since they promote creation of new markets for urban
goods and services and at the same time improve the living
conditions of rural areas.  The role played by intermediate and
small cities in supporting rural development should also be
recognized.  If properly managed, these settlements could, in
attracting potential migrants, act as counter-magnets with respect
to large urban agglomerations. 

 Issue No. 16.  Population growth in large urban agglomerations

Levels, trends and prospects

193. At the global level, the urban population has been growing
steadily throughout the past four decades:  it grew from 737
million in 1950 to 2,282 million in 1990, and according to the
latest United Nations projections, it is expected to reach 2,962
million by the year 2000 and 4,232 million by the year 2015.  While
the overall rate of growth of urban population is gradually
decreasing, the rate for the developing countries will remain above
3 per cent per annum up to the year 2010.  Most of the urban
population increase will occur in the developing countries.  During
the 1990s, it is estimated that the urban population in the
developed countries will increase by approximately 90 million,
whereas in the developing countries this increase will be as much
as 590 million.  How much of this growth occurs in the largest
urban agglomerations will depend on how successful developing
regions are in restructuring the hierarchy of their urban places.

194. Current trends in the process of urbanization in the
developing regions are marked by the concentration of a country's
urban population in a single large city (a phenomenon called
"primacy"), as well as by the increasing replacement, by natural
population increase in the urban areas, of rural-urban migration as
the predominant cause of urban growth.  Large urban agglomerations
have been growing and are continuing to grow in size and number. 
In 1950 only New York had more than 10 million inhabitants; by 1970
two Asian cities, Tokyo and Shanghai, had grown to be as large. 
Two decades later, in 1990, 13 urban agglomerations had at least 10
million residents, and the number of such urban agglomerations is
projected to double, to 26, by the year 2010.  All but one of the
new cities are in the less developed regions.  Nine of the 13
largest urban agglomerations in 1990 were in the less developed
regions; the proportion is expected to increase to 21 out of a
total of 26 in the year 2010.

195. With 25 million inhabitants in 1990, Tokyo was by far the
largest urban agglomeration in the world, but by 2010, urban
agglomerations exceeding a population size of even 20 million will
have become more common.  So Paulo (Brazil), Bombay (India),
Shanghai (China) and Lagos (Nigeria) are all projected to have at
least 20 million residents in 2010.  Table 13 shows the population
size at three points in time for the 26 urban agglomerations
projected to exceed 10 million by 2010.  Some cities show enormous
growth during the 40-year period between 1970 and 2010.  Lagos
(Nigeria) and Dhaka (Bangladesh), for example, began the
time-period with relatively small populations (2.0 million and 1.5
million, respectively), but they are expected to be among the
world's 10 largest urban agglomerations by the year 2010.  Their
annual growth rates were among the highest in the world in the
period 1970-1990, 6.7 per cent and 7.4 per cent, respectively, and
they are expected to continue to show rapid growth to the year
2010.

196. By contrast, urban agglomerations in the more developed
regions generally exhibited little increase in population size and
low rates of growth during the period.  New York actually had a
small population loss between 1970 and 1990, although Los Angeles
and Tokyo both registered fairly robust growth for cities belonging
to the group of more developed regions.  Two European cities,
London and Paris, were respectively the sixth and seventh largest
in the world in 1970.  By 1990, after a growth rate in the 20-year
period of 0.47 per annum, Paris became the fourteenth largest urban
agglomeration in the world; London's growth rate during the period
was negative (-0.79), and by 1990 it was number 23 in population
size among the world urban agglomerations.

197. Table 13 also shows the annual rates of growth for the largest
urban agglomerations for two 20-year periods.  For most cities, the
rate of population increase is expected to decline during
1990-2010, although four of them - Bombay (India), Jakarta
(Indonesia), Karachi (Pakistan) and Delhi (India) (in addition to
Lagos and Dhaka) - are still projected to grow at a rate of more
than 3 per cent per annum.  All of the fastest-growing largest
urban agglomerations, except Lagos, are in Asia.

===============================================================
Table 13.  Population size of urban agglomerations with 10 million
           or more in 2010, for the years 1970, 1990 and 2010, and 
           their average annual rate of growth, 1970-1990 and     
           1990-2010  (see attached file)       

================================================================= 
                                                                
198. City size and rates of growth should be examined in the
context of a nation's urban structure, which often reflects the
level of development in the country.  Generally, the phenomenon
described above as "primacy" or the predominance of a single
"mega-city" in the hierarchy of urban places is characteristic of
less developed regions.  In the more developed regions, the pattern
is more likely to show a number of large cities, each with a
relatively small percentage of the country's total urban
population.

199. Primacy in a country has been associated with the beginning of
economic development and modernization, when investment, resources
and infrastructure are concentrated in one place to maximize
economic efficiency.  Employment opportunities in newly established
manufacturing industries attract migrants from rural areas.  In
rapidly growing cities, immigration usually accounts for a larger
share of growth than natural increase.  As development proceeds, it
is expected that its effects will expand to other areas of the
country.  Employment opportunities and infrastructure will in turn
be created in smaller cities and towns, and the primate city will
exhibit a declining share of the nation's urban population.  A more
balanced urban structure - one with a network of alternative urban
centres with transportation and communication among them - will
begin to emerge.  The growth of secondary cities often signals the
diversification of economic activity, as well as a more equitable
distribution of the benefits of development.

200. In 1990, primacy was apparent in a number of the largest urban
agglomerations.  Bangkok (Thailand), Lima (Peru) and Buenos Aires
(Argentina) all had more than 40 per cent of their country's urban
population.  Four other cities - Cairo (Egypt), Dhaka (Bangladesh),
Seoul (Republic of Korea) and Metro Manila (Philippines) - had more
than 30 per cent of the urban population.  United Nations
projections show that all seven of those urban agglomerations are
expected to lose urban share by the year 2010.  None will actually
lose population - in fact, all but Buenos Aires and Seoul will grow
at a rate of more than 2.2 per cent per annum - but growth in other
urban areas will outstrip the population increase in those primate
cities, leading to a somewhat more balanced distribution of urban
population.

201. Three countries in Asia are exceptions to the general
observation about primate cities.  China and India, the two most
populous countries in the world and both in less developed regions,
do not have primate cities, although both are home to some of the
largest urban agglomerations in the world.  In 1990, 38 cities in
China had at least 1 million residents.  Its largest urban
agglomerations were Shanghai (13.4 million in 1990), Beijing (10.9
million) and Tianjin (9.2 million), but together they constituted
only 11.1 per cent of China's urban population.  India, too, has
very large urban agglomerations without having primate cities. 
Bombay, a city of 12.2 million in 1990, along with Calcutta (10.7
million) and Delhi (8.2 million), had 14.4 per cent of India's
urban population.  This proportion is expected to change slightly
by 2010.  The third Asian country that does not conform to
expectations about primacy is Japan.  As a developed country, Japan
would be expected to have no dominant primate city; but in 1990
Tokyo had 26.2 per cent of Japan's urban population, up from 22.2
per cent in 1970, and its share is still increasing slowly.  By the
year 2010 it is expected to be home to just over 27 per cent of
Japanese urban-dwellers.  The second largest urban agglomeration,
Osaka, had 11 per cent of the urban population in 1990.

Policies

202. The World Population Plan of Action emphasizes, inter alia,
the need for the integration of population distribution policies
with economic and social policies, and urges Governments to promote
more equitable regional development, develop a network of small-
and medium-sized cities and improve economic and social conditions
in rural areas (paras. 44-50).  Recommendations made at the 1984
International Conference on Population (Mexico City) further urged
that Governments should review their socio-economic policies in
order to minimize any adverse spatial consequences, as well as to
improve the integration of population factors in territorial and
sectoral planning, implement population distribution policies
through incentives, rather than migration control measures, and
adopt effective policies to assist women migrants (recommendations
39-44).

203. Governments throughout the world have adopted and implemented
a variety of policies to influence population distribution and
internal migration, including incentives and disincentives to
influence location decisions of household and firms.  In terms of
approaches to influencing the spatial distribution of population,
Governments continue to pursue, inter alia, strategies aimed at
countering primacy by promoting growth of small towns and
intermediate cities, creation or strengthening of rural growth
centres, development of lagging regions, and overall rural
development to retain the rural population.  In order to implement
these population distribution strategies, Governments have taken
measures that include subsidies for public infrastructure; grants,
loans, or other incentives for relocation of industries and
workers; decentralization of administrative, educational and
research facilities; and provision of housing and social services
on a decentralized basis.

204. The results of these actions have been mixed, with failures
outnumbering success cases.  Administrative and legal measures have
had only a modest impact.  For example, while opening new lands for
settlements has benefited a small proportion of the rural
population, it has not been effective in restraining rural-urban
migration on a significant scale.  Integrated rural development
policies, which intended to raise agricultural income and thus
persuade people to remain on the farm, have proved overly complex
and lacked the necessary resources for effective implementation. 
In recent years, the implementation of a number of the costlier
population distribution policies, such as relocation of national
capital cities and establishment of new towns, has been abandoned
or curtailed as a result of adverse economic conditions. 


                  IX.  INTERNATIONAL MIGRATION

205. Growing economic interdependence among countries encourages
and is, in turn, encouraged by international migration. 
International migration is a rational response of individuals to
the real or perceived economic, social and political differences
between countries.  Most international migration flows are of a
regional nature; however, interregional migration, particularly
that directed to the more developed regions, has been growing.  It
is estimated that there are more than 125 million people outside
their country of birth or citizenship in the world and that half of
them are from developing countries.  A large proportion of
international migrants reflect voluntary movements; on the other
hand an increasing number comprises displaced persons and refugees.

206. Table 14 presents the views and policies of Governments in
relation to immigration and emigration.  In 1993, 2.6 per cent of
countries perceived their levels of international immigration as
too low; 74.6 per cent perceived their immigration levels as
satisfactory; and 22.6 per cent perceived those levels as too high.

Among the 190 countries, 1.2 per cent adopted policies to raise
their levels, 60.5 per cent desired to maintain their levels, and
35.3 per cent adopted policies to lower their levels.

207. In relation to emigration, for the same reporting date (1993),
3.1 per cent of countries perceived their levels as too low, 75.2
per cent perceived those levels as satisfactory, and 21.7 per cent
perceived those levels as too high.  In terms of emigration
policies, 3.2 per cent of countries sought to raise emigration,
77.4 per cent to maintain current levels, and 19.5 per cent aimed
at lowering emigration levels.

208. The World Population Plan of Action recognizes that the
significance of international migration varies widely among
countries, depending on their area, population size and growth
rate, social and economic structure, and environmental conditions. 
This chapter covers three distinct types of international migrants:

documented, undocumented and refugees. 

================================================================

Table 14.  Governments' perceptions and policies concerning
           level of immigration and emigration, 1976-1993  
                       (see attached file)

=================================================================

               Issue No. 17.  Documented migrants

Trends

209. Trends in documented migration at the global level remain
difficult to assess because many countries known to receive
significant numbers of legal migrants either lack adequate flow
statistics or fail to disseminate them.  In addition, the lack of
comparability of available statistics severely limits the
inferences that can be made from them.  Thus, although there is
some evidence suggesting that legal migration to the industrialized
Western bloc countries increased between the early and the late
1980s, this assertion must be qualified.  The countries of
permanent immigration, for instance, admitted about 4 million
immigrants during 1980-1984 and some 4.5 million in 1985-1989, with
these numbers excluding the 100,000 or so persons admitted annually
as temporary migrants and the nearly 3 million undocumented
migrants whose status was regularized by United States authorities
in the late 1980s and early 1990s.  In comparison, the main
receiving countries of Northern and Western Europe recorded about
4.6 million incoming migrants during 1980-1984 and 6.3 million
during 1985-1989.  However, most of those migrants were not
admitted on a long-term basis.  Indeed, when emigration is taken
into account, the main receiving countries in Europe registered net
migration losses during 1980-1984 followed by a net migration gain
of over 2 million persons during 1985-1989.  The increased
emigration of ethnic Germans from Eastern Europe to the former
Federal Republic of Germany, where they had the right to
citizenship, accounted for a major portion of that gain; more
generally, the relaxation of exit restrictions resulting from the
changes taking place in Eastern Europe and the former USSR during
the 1980s was largely responsible for the increases in net
migration to Western European countries during that decade.

210. The oil-producing countries of Western Asia constituted
another important focus of attraction for documented migrants
during the 1980s, although their importance declined somewhat
during the decade as falling oil prices slowed their economic
growth and their labour-force needs fell.  Although there are no
adequate statistics on the number of migrant workers admitted by
those countries, data gathered by the main sending countries
indicate that the outflow of temporary workers from the latter
averaged about 1 million persons per annum during the 1980s and
that, towards the end of the decade, increasing proportions of
workers headed towards destinations other than those in Western
Asia.  In particular, Japan and the newly industrializing economies
of Eastern and South- eastern Asia began attracting foreign workers
towards the end of the 1980s as their local labour markets became
increasingly tight.  During the early 1990s, the Gulf crisis forced
the repatriation of some 700,000 foreign workers from Western Asia
but once it was over, migration to the region seems to have
resumed.

Policies

211. The Plan of Action addresses the needs of documented migrants
by focusing mostly on those admitted as workers.  Thus, it
instructs Governments of receiving countries to provide proper
treatment and adequate welfare services to migrant workers and
their families (para. 55), and to prevent discrimination against
them in the labour market and in society, to preserve their human
rights, to combat prejudice against them and to eliminate obstacles
to the reunion of their families (para. 56).  The International
Conference on Population reiterated this appeal (recommendations 48
and 49) and invited Governments to use relevant ILO conventions as
guidelines in achieving their aim (recommendation 48).  Progress in
the implementation of those recommendations has been slow.  In the
main receiving countries, few measures have been taken to improve
the rights or the situation of documented migrant workers during
the past decade.  In Europe, the high unemployment rates recorded
in a number of countries during the late 1980s and early 1990s
fuelled anti-immigrant feelings and led to more restrictive
migration policies, especially in relation to family reunification.

In most of the receiving countries of Western Asia, migrant workers
are still far from enjoying equality of opportunity and treatment
with nationals in terms of working conditions; and the effective
protection of the basic rights of female migrant workers remains a
cause for concern.  Furthermore, the Gulf crisis, by forcing the
repatriation of large numbers of migrant workers, accentuated their
vulnerability.

212. Advances in the implementation of international instruments
related to migrant workers have also been modest.  Thus, between
1982 and 1991, 3 States ratified the ILO Convention concerning
Migration for Employment (No. 97) and another 3 acceded to the ILO
Convention concerning Migrations in Abusive Conditions and the
Promotion of Equality of Opportunity and Treatment of Migrant
Workers (No. 143), bringing to 38 and 15 respectively the total
number of States parties to such Conventions. 62/  Consequently,
although the adoption in 1990 by the General Assembly of the
International Convention on the Protection of the Rights of All
Migrant Workers and Members of Their Families 63/ represented a
major step towards ensuring the international protection of migrant
workers, its ratification is expected to proceed slowly.  By the
end of 1993, only Mexico and Morocco had signed the Convention. 
Ratification by 20 States is needed for the Convention to enter
into force.  The Convention sets forth the basic principles
concerning the treatment of migrant workers and members of their
families and distinguishes the rights that are to be accorded to
all migrant workers, irrespective of the regularity of their status
in the receiving State, from those that apply only to migrant
workers in a regular situation (part IV of the Convention).  It
thus establishes standards for the treatment of both documented and
undocumented migrants.
 213. Both the Plan of Action (paras. 57 and 58) and the Mexico
City recommendations (recommendation 46) address the issue of the
outflow of skilled workers from developing countries and suggest,
among other things, that the Governments of countries of origin
expand employment opportunities to retain those workers.  Although
data on the migration of skilled personnel are far from ideal, the
evidence suggests that during the 1980s developing countries
themselves were increasingly the destination of skilled migrants
originating in both other developing countries and the developed
world.  Some programmes, such as that instituted in 1974 by the
International Organization for Migration (IOM), have assisted
skilled workers to return to their countries of origin.  Thus,
since 1974, 13,000 professional, technical and kindred workers have
returned to Latin America with IOM assistance and almost 600
returned to Africa during 1983-1988.  In the United Nations system,
experts assigned to developing countries with skill shortages are
increasingly recruited from developing countries.  However, most
skilled personnel migrate in response to market forces and their
convergence on certain developing countries results from the
favourable opportunities that they offer.  Persons with needed
skills are expected to be in high demand, both in the developed and
in the most economically dynamic developing countries.  It is
noteworthy that in amending their immigration laws in 1990, both
Japan and the United States accorded higher priority to the
admission of skilled migrants.

214. The Plan of Action calls for developed countries to cooperate
with developing countries to create more favourable employment
opportunities in countries of origin through the increased
availability of capital, technical assistance, export markets and
more favourable terms of trade (para. 54).  Improving the access to
export markets of the products of developing countries has been the
subject of negotiations in the context of the multilateral trade
liberalization negotiations, known as the Uruguay Round, which was
successfully concluded in early 1994.  While freer trade is not
expected to replace international migration, it is generally
acknowledged that in the long run, trade liberalization will foster
development and thus eventually reduce pressures to migrate from
the developing countries. 

              Issue No. 18.  Undocumented migrants

Trends

215. Considering that the main receiving countries are increasingly
restricting the admission of documented migrants, undocumented
migration is probably on the rise, though by its very nature it is
difficult to quantify.  During the 1980s, the United States was the
country hosting the largest undocumented population in the world,
amounting to several million persons.  In addition, the former
labour-sending countries of southern Europe began to attract
migrants, most of whom had little choice but to be undocumented,
given the lack of provisions for their legal admission.  Towards
the end of the 1980s, Japan also emerged as an important
destination of irregular migration and so did some of the newly
industrializing countries of Eastern and South-eastern Asia.  In
fact, migration between developing countries has often been of an
irregular nature, since receiving countries generally lack both the
provisions and the enforcement mechanisms to control international
migration.

Policies

216. Both the Plan of Action (para. 56) and the Mexico City
recommendations (recommendations 52 and 53) urge Governments to
respect the basic human rights of undocumented migrants, to prevent
their exploitation and to combat the activities of those inducing
or facilitating undocumented migration.  As already noted, the
International Convention on the Protection of the Rights of All
Migrant Workers and Members of Their Families has established
international standards regarding the rights of undocumented
migrant workers.  The Convention grants those migrants and members
of their families equality of treatment with nationals with regard
to remuneration and conditions of work, social security, and access
to urgent medical care and education.  The Convention also urges
Governments to impose sanctions on the employers of undocumented
migrants and on those who organize irregular migration.  It further
provides guidelines for Governments that wish to regularize the
status of undocumented migrants.

217. During the 1980s a number of countries adopted measures to
control undocumented migration.  In 1986, the United States adopted
the Immigration Reform and Control Act (IRCA) which established
provisions for the eventual regularization of nearly 3 million
undocumented migrants and imposed sanctions on employers who
knowingly hired undocumented migrants.  IRCA allowed for the
regularization of two groups of undocumented migrants:  illegal
aliens who had been in the United States since before 1 January
1982 and those who had been employed in seasonal agricultural work
for at least 90 days during the year ending on 1 May 1986.  By the
end of 1991, 2.5 million undocumented migrants had been granted
permanent residence status under the provisions of IRCA.  The
success of employer sanctions in curbing the inflow of undocumented
migrants to the United States has been mixed, in part because of
their weak enforcement.

218. In the late 1980s, Italy and Spain also undertook
regularization drives for undocumented aliens as part of the
process of framing new immigration laws.  In Italy, about 105,000
aliens qualified for legalization during 1987-1988 and another
216,000 in 1990, while in Spain, a total of 177,000 undocumented
migrants applied for legalization under campaigns carried out in
the period 1985-1986 and 1991.

219. In the European Community, the drive to create a single market
and eliminate internal border controls has triggered a range of
measures aimed at controlling undocumented migration into Community
territory.  Apart from increasing the surveillance of their
external borders, countries that signed the Convention on the
Application of the Schengen Agreement concluded a readmission
agreement with Poland, by which Poland agreed to take back
undocumented Polish migrants.  In addition, in 1991 member States
of the European Community agreed on a list of countries whose
nationals needed visas to enter Community territory.  Increasingly,
the adoption of visa requirements, the imposition of fines on
airlines that carry passengers without valid documents and the
outright deportation of undocumented migrants have been used as
measures to curb irregular migration throughout Europe.  In
addition, countries such as France and the Netherlands have
increased the penalties imposed on employers of undocumented
migrants and Germany has adopted a series of measures facilitating
the control of migrant workers. 

                     Issue No. 19.  Refugees

220. Refugee movements are a facet of broader migratory movements. 
While there might be a number of contributory factors to refugee
outflows, their specificity derives from the determination of what
constitutes a refugee.  The Statute of the Office of the United
Nations High Commissioner for Refugees (UNHCR) identifies as
refugees those persons who flee their country or stay away from it
because of a well-founded fear of persecution for reasons of race,
religion, nationality or political opinion. 64/  A similar
definition is found in the Convention relating to the Status of
Refugees and its 1967 Protocol, the latter containing in its
definition membership in a particular social group as a ground for
fear of persecution.  Somewhat refined definitions are found in the
1969 Convention of the Organization of African Unity (OAU) 65/ and
in the 1984 Cartagena Declaration on Refugees, adopted by the
Colloquium on the International Protection of Refugees in Central
America, Panama and Mexico; both documents take into account
refugee-generating factors such as external aggression, occupation,
foreign domination or events seriously disturbing public order,
internal conflicts, and the massive violation of human rights. 
These two regional definitions refer in fact to categories of
persons to whom UNHCR has extended protection and assistance since
the late 1950s.  On the basis of these legal instruments and the
Cartagena Declaration, a broad spectrum of causes have been
identified that allow for the recognition of refugee-type movements
within the wider phenomenon of migratory movements.

221. Currently, the international community is confronted with
humanitarian emergencies on a hitherto unknown scale.  It is
becoming ever more important to understand the underlying
political, social, economic, demographic and environmental reasons
that compel people to move.  It is only through a better
appreciation of the complexity and interrelatedness of the causes
of displacement that a comprehensive approach to the refugee issue
will be found.

Trends

222. UNHCR estimates that in 1993 there were some 18 million
refugees, 66/ not to mention the estimated 24 million people
displaced within their own countries, often for refugeelike
reasons.  Between 1984 and 1991, the number of refugees in the
world doubled, reaching 16 million in early 1991, and this figure
excludes the 2.5 million Palestinian refugees under the mandate of
the United Nations Relief and Works Agency for Palestine Refugees
in the Near East (UNRWA).  Worldwide, nearly 9 out of every 10
refugees have found asylum in developing countries, some of which
are among the poorest in the world.  No region in the world is
spared the impact of the tragic and increasingly complex refugee
phenomenon.  The presence of refugees has therefore imposed
considerable strains on the meagre resources of certain countries,
particularly those in Africa.  Developed countries have also had
difficulties in coping with the growing numbers of asylum-seekers
whose cases sometimes take years to be adjudicated and who often do
not qualify for refugee status.  In response to such developments,
a number of developed countries have adopted measures to streamline
their asylum adjudication procedures and to control the admission
of would-be asylum-seekers so as to prevent the abuse of the asylum
system.

223. A significant number of refugees in the world are women and
children; this has important programmatic implications for UNHCR
activities in the areas of international protection and assistance.

It is for that reason that the Executive Committee of UNHCR
highlighted the importance of comprehensive refugee statistics,
especially in planning gender-sensitive programmes.  In one among
the various decisions and conclusions of the Executive Committee of
the Programme of the United Nations High Commissioner for Refugees
- issuing from its forty-third session (held at Geneva in October
1992) and set forth in its report on the work of that session, 67/
- on these two potentially vulnerable groups, the Committee called
on the High Commissioner to pursue her efforts to increase public
awareness of the rights and protection needs of refugee women and
girls, inter alia, (a) through further sensitization of bodies
concerned with the status of women, and (b) by promoting and
supporting the inclusion of the issue of the rights of refugee
women on the international human rights agenda (para. 21 (j)).  In
regard to the protection and well-being of refugee children, the
Executive Committee emphasized the particular situation of
unaccompanied minors.

224. Large numbers of refugees in the world are still to be found
in the least developed countries.  The problem of refugees and that
of their impact on national socio-economic infrastructures and the
development process itself cannot be treated in isolation from each
other.  Likewise, the socio-economic situation prevailing in the
refugee's country of origin cannot be disregarded in any
comprehensive analysis of contributory factors to the root causes
of refugee outflows.

Policies

225. The General Assembly recently re-emphasized the need to keep
issues related to refugees, displaced persons, asylum-seekers and
other migratory flows firmly in the international political agenda,
especially the question of solution- oriented approaches to deal
with such contemporary problems and their causes. 68/  Nobody can
ignore the socio-economic factors that contribute to displacement
or hinder the attainment of durable solutions.  It is felt that the
deepening global economic crisis, greater environmental
degradation, the heavier debt burden and conditions of absolute
poverty, as well as the failure of the international community to
develop a strategy to address those issues, could most likely
aggravate the refugee problem.

226. Given that the 1951 Convention relating to the Status of
Refugees and its 1967 Protocol constitute the basis for the
international asylum system, the Mexico City recommendations urge
Governments to accede to those instruments (recommendation 54). 
Progress on that front has been substantial, with over 20 States
having acceded to those instruments during 1982-1992.  As of August
1992, 111 States were parties to either the 1951 Convention or the
1967 Protocol.

227. The Mexico City recommendations also urge Governments and
international organizations to find durable solutions to the
problems related to refugees, particularly by providing assistance
to first-asylum countries, creating conditions conducive to the
voluntary repatriation of refugees, and facilitating the local
integration of those refugees for whom resettlement or repatriation
is not possible (recommendation 55).

228. With the easing of international tensions, there are, of late,
increased opportunities for voluntary repatriation.  Such return
movements need to be completed by development initiatives, as the
country of intended return is frequently one affected by extreme
poverty and having virtually no productive capacity and very
limited basic facilities and infrastructure.  The significant
contribution that development assistance can make towards the
preferred solution of voluntary repatriation 69/ needs to be
emphasized.  UNHCR has been making particular efforts to involve
development agencies in voluntary repatriation drives, hoping
thereby to assure the durable nature of voluntary repatriation
movements. 

229. During the late 1980s, a number of successful repatriation
drives were carried out in the developing countries, particularly
in Africa where they involved, among others, Ethiopian, Namibian
and Ugandan refugees.  The end of the cold war raised expectations
regarding the solution of long-standing conflicts that would have
important implications for refugee populations.  Thus, the peace
agreement concluded in 1992 between the warring parties in
Mozambique raised hopes for the eventual repatriation of the
current largest refugee population in Africa.  Similarly, the
process of normalization of political life that is taking place in
Cambodia and that started in October 1991 when the four warring
factions signed agreements on a comprehensive political settlement
(the Paris Agreements) has allowed the repatriation of over 300,000
displaced Cambodians.  In Central America, the peace process made
possible by the reduction of super-Power rivalry has led to a
significant reduction in the refugee and displaced population in
the region.  However, in several cases the resolution of conflict
has failed to materialize.  Thus, although the 1988 Geneva accords
(Agreements on the Settlement of the Situation Relating to
Afghanistan) raised prospects for the repatriation of the more than
5.5 million Afghan refugees in the Islamic Republic of Iran and
Pakistan, civil war prevented their return.  In 1992, however, over
half a million Afghan refugees opted for repatriation.  Similarly,
the continuation of the conflict in Angola has prevented the
repatriation of Angolan refugees.

230. A major change occurring during the 1980s was the increase in
the number of persons seeking asylum directly in the developed
countries.  Until the early 1980s, most of the refugees admitted by
those countries had been resettled from countries of first asylum
and could therefore be screened abroad.  In many of the receiving
countries, the need to examine asylum claims on a case-by-case
basis soon led to considerable backlogs.  The practice of granting
work permits to asylum-seekers while they awaited the result of the
adjudication procedure provided an incentive for abuse of the
system.  These developments have led developed countries,
particularly those in Europe and Northern America, to adopt
measures that both control the growth of asylum claims and prevent
abuse.  Thus, in June 1990, member States of the European Community
adopted the Dublin Convention which determined which State would be
responsible for adjudicating an asylum request, thus preventing the
making of simultaneous claims in several States.  In addition, a
variety of measures have been taken by European and North American
countries to remove manifestly unfounded claims at an early stage
of the asylum procedure and even to prevent claims from being filed
altogether.  The use of the "safe country" principle, for instance,
prevents citizens of countries deemed safe from applying for
asylum.  Germany, one of the major destinations of asylum-seekers,
changed its constitution in 1993 so as to be able to apply such a
principle.

231. Such developments, together with those mentioned above in
connection with the control of undocumented migration (the
imposition of visa requirements or of fines on airlines
transporting passengers without proper documentation), have
effectively increased the barriers to international population
movement and as a result are likely to prevent not only the entry
of undocumented migrants but also that of bona fide refugees in
need of protection.  In particular, the safe- country principle
established by the 1951 Convention may infringe the individual's
right to seek asylum and the practice of sending back migrants
without proper documentation may be inconsistent with the principle
of non-refoulement (that is to say, the principle of no forcible
return of persons to places where their lives or freedom might be
threatened).

232. The changes that have taken place since the end of the cold
war have had important implications for the international refugee
regime.  Such changes have created a new spirit of international
cooperation favourable to the resolution of the regional and
internal conflicts that were at the root of many of the world
refugee problems.  With many conflicts thus resolved, some 2
million refugees were able to return home in 1992.  However, in
areas that previously were under strong super-Power influence,
there has been a recrudescence of pronounced nationalist sentiments
and ethnic tensions that have led to conflicts and new
displacements.  Such displacements, with ethnic conflict a common
denominator, are becoming more and more typical of the present
refugee outflows.

233. Currently, refugees are often fleeing not individual
persecution but rather generalized violence, ethnic conflict or
civil war.  Refugee movements at this time are thus more than a
serious humanitarian and human rights issue; often they reflect
destabilizing situations that affect international security. 
Furthermore, there is a growing appreciation of other contributory
factors to migratory and refugee movements, namely, developmental
and environmental considerations, and a greater sensitivity to the
demographic make-up of refugee populations.  Whereas in the past,
individuals fleeing communist regimes were automatically considered
refugees by Western bloc countries and were generally granted
permanent settlement rights because they were deemed unlikely to
return to their countries of origin, in the 1990s more people are
being granted only temporary protection while the situation that
gave rise to their flight subsides.  Furthermore, new modes of
protection are emerging.  Thus, the end of super-Power rivalry has
allowed the international community to intervene on behalf of
internally displaced persons.  The creation of safe havens for the
Kurdish population within northern Iraq in 1991 and of protected
areas in Croatia in 1992 provides salient examples of this trend.

234. The United Nations Conference on Environment and Development
provided UNHCR with the opportunity to reflect on the relationship
between environmental degradation and population movements. 
Environmental degradation can itself be a contributory factor
towards refugee flows.  In cases where environmental changes are a
consequence of or lead to the violation of basic human rights,
there could be a valid claim for international protection on the
part of those who flee.  In addition, environmental considerations
can and do influence asylum policies of receiving countries,
particularly when large numbers of refugees arrive in ecologically
fragile areas.

235. UNHCR is now emphasizing the pursuit, where possible, of a
strategy involving preventive activities, including protection of
displaced persons in their country of origin.  Such an endeavour
could be described as comprising efforts to attenuate or avert
refugee flows.  While prevention is a promising strategy, it has
its limits and is not a substitute for asylum.

     X. POPULATION INFORMATION, EDUCATION AND COMMUNICATION

236. Since the adoption of the World Population Plan of Action in
1974, there have been important efforts to promote awareness and
understanding of population issues among Governments,
non-governmental organizations, communities, families and
individuals.  Such efforts have also aimed at mobilizing the
support of national administrators, decision makers and opinion
leaders in favour of population policies and programmes.  The basic
goal has been to provide access to clear and accurate population
information.  Although it is difficult to measure the impact of
such efforts on different audiences, it has been widely accepted
that activities of this type drive policies and programmes, as well
as individual and community behaviour.

237. The term "population information, education and communication"
(IEC) alludes to a large variety of activities usually having a
broad mandate and complex functions, and involving many different
audiences, messages and channels of communication.  Nevertheless,
IEC is normally used to refer to the fostering of interest in a
particular subject, such as population, or the environment, for
example.  In the area of, say, family planning, the term could
allude to a series of specific goals, such as (a) creating public
awareness about the need for family planning; (b) increasing
knowledge about the use and risks of family- planning methods, or
about where to obtain contraceptives; and (c) motivating couples
and individuals to visit family-planning services.

238. IEC has its roots in the field of agricultural extension,
although its principles have been adapted successfully for other
purposes, for example, in population programmes.  When specific
target audiences are identified, it is expected that IEC-type
information will produce a kind of behavioural modification in the
intended group, as is the case in the promotion of "safe sex" for
the prevention of AIDS.  In the field of population, in general,
target audiences of IEC activities are more and more concentrated
at the grass-roots level.

239. Nevertheless, the term IEC has some unclear connotations
because it may refer to different types of information.  For
example, IEC could be used as an umbrella term to refer to
"technical information", which is different in its content and
goals from activities aimed at motivating certain type of
behaviour.  This chapter takes into account these two broad types
of information and concentrates on two particular issues, namely,
the accurate and objective information that is needed for
policy-making and programme management, and activities aimed at
increasing the level of awareness about population issues.


         Issue No. 20.  Technical population information

240. The term technical information includes (a) basic data,
collected using reliable scientific methods such as censuses and
surveys; and (b) the findings and implications of objective
research studies.  Accurate up-to-date technical information is
needed by policy makers and programme managers for the formulation
of policies and programme goals, as well as for the preparation of
the operational plans needed to achieve those goals.  Technical
information constitutes the knowledge base upon which to build
sound population policies and programmes.  Such information is
found in a variety of printed and electronic forms.  Users of this
type of information may address their requests to national
statistical offices, population research institutes and
universities, but more and more, such requests are being directed
to population information centres that have been specifically set
up for this purpose.

241. Many countries lack adequate resources and institutional
mechanisms for the collection, storage and processing of their
population data.  Shortages of trained manpower, the lack of
appropriate technology and inadequate financial resources also
contribute to the absence of national information infrastructures,
particularly in the developing countries.  As indicated in Agenda
21, even where information is available, it may not be easily
accessible either because of the lack of technology for effective
access or because of associated costs, especially for information
held outside the country and available commercially. 70/

242. Population information centres have three main functions:  (a)
to identify, collect, organize and store population-related
information; (b) to analyse, synthesize, tailor and repackage the
data and information to suit the needs of the various types of
users they serve; and (c) to retrieve and disseminate that
information in both its original and its repackaged formats.  The
information that is needed for the monitoring and evaluation of
programme performance is generally gathered through management
information systems (MIS) that have been established for that
purpose.

243. The Plan of Action includes various recommendations on the
dissemination of information and research results (paras. 88, 91
and 92), which were echoed at the International Conference on
Population (Mexico City recommendation 76).  Concerning the
dissemination and exchange of technical information, it is
important to mention that the field of population has been well
served through an array of serial publications that have a long
tradition of high standards.  Periodicals such as the
English-language journals Demography, Population and Development
Review, and Population Studies, and the French-language journal
Population, are well known among scholars and constitute an
additional source of technical information beyond the technical
publications of the United Nations which include the Population
Bulletin of the United Nations, the Demographic Yearbook and the
periodical publications of the regional commissions. 71/

244. One of the most significant recent developments is the spread
of national, regional and international information databases and
networks.  A notable example is the global Population Information
Network (POPIN).  (In its resolution 1979/33, the Economic and
Social Council requested the Secretary- General, inter alia, to
facilitate the establishment of POPIN.)  It is a decentralized
network for the coordination of population information activities
in the various regions and the facilitation of worldwide access to
population information; and it links more than 100 libraries,
clearing-houses and documentation and information centres for the
purpose of improving the circulation of population information. 
There are regional POPIN networks in Africa (POPIN-AFRICA), Asia
(ASIA-PACIFIC POPIN) and Latin America (Information Network on
Population for Latin America and the Caribbean (IPALCA)).  The
availability of population information and literature has also been
enhanced through the use of electronic resources such as the POPIN
Gopher, and by the establishment of computerized international,
regional and national bibliographic databases, such as POPLINE
(maintained by the Population Information Programme of Johns
Hopkins University and Princeton University); DOCPAL (maintained by
the Latin American Demographic Centre/Economic Commission for Latin
America and the Caribbean (CELADE/ECLAC), Santiago, Chile); the
Population File of ESCAP Bibliographic Information System (EBIS
POPFILE) (maintained by the Economic and Social Commission for Asia
and the Pacific (ESCAP), Bangkok); POPINDEX-Africa (maintained by
POPIN-AFRICA/Economic Commission for Africa (ECA), Addis Ababa);
DOCPOP (maintained by the Fundao Sistema Estadual de Anlise de
Dados (SEADE), Sao Paulo, Brazil); and RESADOC (maintained by the
Sahel Institute, Bamako).

245. In order to promote both effective and equitable access to
population information, the United Nations system should encourage
and facilitate initiatives to strengthen national information
capabilities and, whenever possible, should promote the
establishment and use of electronic links for sharing information,
providing access to databases and other sources of information,
facilitating national and international communication, and
transferring data. 

              Issue No. 21.  Creation of awareness

246. Through various means and channels - including population
education in schools, non-formal educational programmes serving
people of different ages, extension programmes in health, nutrition
and agriculture, and the broad utilization of traditional media -
population-related knowledge and motivation have been provided;
this has fostered interest, created demand and otherwise supported
population programme activities.  Experience gained in the
implementation of population education and information activities
in the past 20 years suggests three important criteria to be taken
into account:  (a) use of the most modern media available for
maximum effectiveness; (b) use of multimedia that tries to reach a
maximum coverage; and (c) use of traditional media and local
entertainment events in order to reach grass-roots communities and
the illiterate audience. 

Population education

247. Mass media can play an important role in raising awareness of
population issues, the importance of family planning and the
location of services, and in establishing a positive atmosphere for
national population programmes and family-planning activities. 
Nevertheless, it has been increasingly recognized that attitudes
that form the basis for behaviour and views on population issues
are often formed early in life.  For this reason, an approach
beginning long before adulthood, such as population education in
the school system, is required.  Secondary education should
reinforce the learning promoted through primary education and
should take into account the specific needs of the school- age
population.  Population education may take place in many settings. 
It may begin with educational activities for newly-wed couples,
followed by parent education to help partners educate their own
children; and the cycle may continue with the education of children
in schools.

248. During the past decade, the number of countries offering
national population education activities in their formal and
non-formal education systems increased considerably.  At present,
population education programmes are found in over 80 countries in
the developing world.  Their aims vary from country to country, but
they are generally designed to introduce understanding and a sense
of responsibility regarding population issues.  An increase of 54
per cent was registered in the number of countries that had
population education programmes carried out in collaboration with
UNESCO and UNFPA, notably in Africa.  Over the past two decades,
important efforts have been made to develop and improve the
contents and messages to be incorporated in national population
education programmes.  The conceptual and methodological
approaches, comparative analytical studies and prototype
teaching/learning materials produced have made important
contributions to the advancement of population education.  The
provision of technical assistance services has included training
workshops, awareness and orientation programmes for educators.

249. In spite of the above progress, most national population
education programmes have experienced constraints that have reduced
their effectiveness, threatened their continuity and delayed their
expansion.  These include:  limited political support and
commitment at various levels; absence of a firm policy and its
implementation on a continuing basis; limited availability of
national data and relevant social research findings on the effects
of sociocultural factors on demographic change; shortage of
resource materials and teaching staff adequately trained in all
aspects of population dynamics; and limited financial support from
national and international agencies.

250. Considering that the majority of the population in the
developing countries is rural, and that rural/agricultural
households' demographic behaviour possesses specific traits that
ought to be carefully considered when designing population IEC
activities, a specific area under development at FAO is population
education in agricultural extension.  Target groups for such
activities are agricultural education and extension staff (trainers
and subject- matter specialists, trainees and in-service extension
workers) and farming families, with particular attention to their
youth.  Population education topics concretely related to
agricultural production, farm management, sustainable agricultural
development and environment have been integrated into agricultural
extension curricula in selected countries.  Methodological
adaptation, material production and dissemination effort will
continue in this area at least until 1995.

251. Another area of activities has been the design and production
of materials and training of trainers in the context of informal
education programmes for out-of-school rural youth.  Booklets have
been developed to disseminate knowledge and generate discussions at
the community level on human reproduction, family life, population
and agriculture, natural resources and the environment.  FAO has
conducted fieldwork to test the material in selected countries of
Africa and Asia with the cooperation of local associations of rural
youth and young farmers.  This line of activities is also expanding
to all the developing regions.

252. Population education is also part of women in development
programmes.  The target group is rural women of child-bearing age
who are beneficiaries of agricultural development programmes and
projects.  FAO has conducted a series of baseline studies on the
linkages between rural women's productive and reproductive roles,
and the effects of such linkages on family size and structure and
on agricultural production and rural development.  Results have
been instrumental in the preparation of outline formats for
non-formal population education activities addressed to rural
women.

253. FAO has also been innovative regarding the introduction of
population education elements into programmes and curricula geared
to nutrition education (an area that has been steadily developing
since the late 1970s for the benefit of field programme staff and
formal training institutions).  Pedagogic supplements on relevant
population factors and their relationship with nutrition factors
have been developed, tested, translated, adapted and widely
applied.

254. With the emergence of AIDS and its sociodemographic
consequences, the need for preventive education has acquired a new
dimension.  As a follow-up to the UNESCO International Conference
on Education convened at Geneva in 1986, teaching materials have
been prepared taking into account the sociocultural aspects of AIDS
transmission, awareness and orientation seminars have been
organized, and pilot activities have been launched within the
framework of population education programmes at the regional level.

At the country level, most programmes have introduced elements of
AIDS prevention under the sex and family component of population
education.

255. UNESCO and UNFPA jointly organized the First International
Congress on Population Education and Development held in Istanbul,
Turkey, in April 1993.  In preparation for the Congress, UNESCO
organized five regional meetings in 1990 and 1991 with the
participation of more than 130 specialists from 85 countries and
international organizations.  The Congress, which was attended by
representatives of 91 Governments (including 20 ministers),
underlined the strong global support for population education in
school systems.  It adopted the Istanbul Declaration on the Role of
Population Education in and Its Contribution to the Promotion of
Human Development.  The Congress also adopted an Action Framework
for Population Education on the Eve of the Twenty-first Century,
intended as a reference and a guide for Governments, international
organizations, bilateral aid agencies and non-governmental
organizations when formulating their plans to implement the
Istanbul Declaration.

256. In order to meet the challenges of training the younger
generations of administrators, decision makers, policy makers and
teachers of the twenty-first century who are currently students in
various universities and institutions of higher education in all
parts of the world, and as a follow-up to the Congress, which
stressed the need for the extension of population education to all
educational levels, including that of higher education, efforts
need to be made to promote the teaching of population education at
the university level.  Inter-university cooperation in the field of
population education between countries could be established through
university twinning and other linking arrangements in connection
with the UNESCO Twinning Arrangements (UNITWIN) project and through
the establishment of UNESCO Chairs in population education and
sustainable development.

257. Population education is a rapidly developing field that is
already consolidating its approaches and methods.  There are,
however, new challenges to be met in its conceptualization and
institutionalization, as well as in the expansion of population
education to encompass all levels of formal and non-formal
education in all countries.  Like any other subject, population
education needs to adapt itself to changing needs and situations. 
In view of the expanded vision of the role of education, as
advocated in the 1990 World Conference on Education for All, held
in Jomtien, Thailand, and in the Rio Declaration on Environment and
Development, 72/ adopted at the 1992 United Nations Conference on
Environment and Development, it has become more important than ever
to broaden the scope of population education to address in an
integrated way the issues of population, development, the
environment and gender relations.  Various other needs, such as the
training of teaching staff, coordination among different
educational institutions, knowledge gaps to be filled,
sensitization of policy makers, production of a variety of teaching
materials, and timely evaluation of related activities, should be
emphasized.

Population communication

258. During the past two decades the world has also experienced a
significant revolution in the field of communication, which has
been stimulated by (a) rapid urbanization (which creates
ever-larger audiences with wider access to mass media); (b) a large
number of young people who are more closely attuned to the impact
of mass media; (c) an increasing access to audiovisual
communication techniques and widespread use of radios, televisions
and video cassette recorders; 73/ and (d) development of new
technologies for storage and processing information (for example,
compact discs, easy-to-use data transmission, microcomputers, and
software).  Such developments have reached a large range of
audiences (including local grass-roots ones) and have been
accompanied by the recognition of the need to improve the quality
of communication between providers of services and their clients.

259.  Special efforts have been made to organize population
training workshops and courses for professional communicators who
work in development programmes.  These training programmes provide
both communication skills and knowledge for the application of
information technologies to addressing population issues and
strengthening the management of population communication
programmes.

260. A large number of projects have provided technical assistance,
training and equipment for the production and distribution of
population communication materials aimed at establishing links with
regional media networks and national broadcasting institutions in
order to promote population issues in their programming.  In line
with priority activities to enhance the status of women in society,
a number of projects were launched by UNESCO in cooperation with
national radio and television stations, including the production of
television spots and drama on topics related to improving the
status of women through education, family planning, changing gender
roles and marriage counselling.  Note should be taken of the
importance of such activities in conveying appropriate messages
effectively to target audiences. 

261. UNESCO has a joint project with UNEP called the International
Environmental Education Programme (IEEP).  This project and the
UNFPA/UNESCO action scheme on population information, education and
communication are two key mechanisms for inter-agency cooperation. 
A new UNESCO interdisciplinary and inter-agency cooperation
project, Environment and Population Education and Information for
Development, which was approved by UNESCO's General Conference at
its twenty- seventh session in November 1993, aims at the 
development of education, training and information activities
designed to deal with the interwoven issues of population,
environment and human development, including gender perspectives,
in an integrated manner, with emphasis on specific and
problem-solving research and action.

262. Population communication efforts for rural populations have
undergone continuous development.  The emphasis has been on
developing methods to address illiterate populations at the
community grass-roots level.  Rural radio has been used in many
contexts.  Community-participative approaches to identifying topics
for communication programmes (and select visual aids) on the basis
of sociocultural research have been used extensively.  FAO has
reviewed its own development support communication programmes, to
introduce population-related topics where applicable.

263. FAO has designed programmes aimed at improving the
capabilities of agricultural policy makers and programme managers
to disseminate knowledge on population issues and render it
operational.  Since the launching of the general awareness-raising
programmes among agricultural planners in the 1970s, FAO has
developed tools that help policy makers analyse trends in the main
determinants of the agricultural resources/requirements equation. 
Two of the main tools, the Agro-Ecological Zones/Potential
Population-Supporting Capacity and the Computerized System for
Agriculture and Population Planning and Analysis (CAPP), integrate
population data and analytical means to study the impact of
population dynamics on prospects for land and agricultural
development.

264. Recent years have also seen a growing emphasis on the
development of software to sensitize policy makers to the
interactions between population and development and their causal
mechanisms.  Such computer-based programmes help leaders to become
aware of the impact of relevant policy interventions.  Other
software packages have been developed that strengthen national
capabilities for future data collection and analysis.

265. The convening of meetings on population has also contributed
to increased awareness and greater understanding of population
issues.  Of particular interest is the case of several conferences
of parliamentarians on population issues, which not only have
helped government officials and the public to gain a better
understanding of the relationships between population and
development but also have strengthened the role of parliamentarians
as the crucial link between the Government and the people, in
particular as a channel of communication for the articulation of
the people's needs.  Among the important meetings in this regard,
the following may be mentioned:  the Third Conference of the Asian
Forum of Parliamentarians on Population and Development (1990); the
Second Western Hemisphere Parliamentarians Conference on Population
and Development (1990); the First Asian Women Parliamentarians
Conference on Population and Development (1990); and the Fifth and
Sixth Asian Parliamentarian Meetings (1989, 1990).

266. Another important meeting that took place in the recent past
was the already mentioned International Forum on Population in the
Twenty-first Century, 74/ in which delegates from 79 countries
participated.  It was a notable international gathering that
focused the world's attention on the significance of global
population growth.  The Forum adopted by consensus the Amsterdam
Declaration on a Better Life for Future Generations (A/C.2/44/6,
annex), which laid down a blueprint for needed urgent action in the
population field.  The Declaration was noted with appreciation by
the General Assembly at its forty-fourth session. 75/

267. With the advent of UNFPA's programme review and strategy
development (PRSD) exercises in developing countries, signifying a
new approach to population programming, the importance of
comprehensive IEC strategies has become increasingly evident.  The
need for such strategies, and for the coordination they imply, is
accentuated by the need to take action simultaneously on several
fronts in order to achieve programme goals.  In response to those
needs, there has been an increase in the attention given to
strategy development and to IEC research in the training carried
out for IEC specialists, particularly the development of skills in
research, audience segmentation and media mix.  The choice of the
medium and target audience and the adaptation of the message to fit
local social and cultural realities are increasingly viewed as
crucial to provision of effective population information and
education, and to effective population-related communication.

268. Another facet of the creation of awareness of population
issues is the training of cadres capable of staffing population
units and interpreting demographic data to decision makers.  The
previously existing and newly created regional population training
centres have provided relevant training to national experts. 
UNFPA's Global Programme of Training in Population and Development
has also expanded to provide training in the Spanish language and
will soon transfer the French-language course to a site in western
sub-Saharan Africa.

269. Innovative approaches to reaching young people with population
messages have, in the past few years, involved organizing painting
and other competitions to engage young minds in the critical
analysis of the impact of population growth on such issues as the
pollution of the environment and the depletion of natural
resources, in terms both of survival and of sustainable
development, quality of life and availability of food.  In
addition, the increased involvement of non-governmental and other
organizations in the field of youth and population (for example,
the Boy Scouts, the Young Women's Christian Association, and IPPF)
has resulted in a variety of learning activities for youth that
have in many cases harnessed the energy of this group and made its
members activists in the population field.  The facilitation of a
two-way dialogue between policy makers and youth organizations has
been an important product of this trend.

270. Finally, among the important events contributing to
awareness-creation on population matters throughout the world is
the annual celebration of World Population Day on 11 July.  It is
accompanied by a wide range of activities and special events for
groups ranging from parliamentarians and academics to professionals
and young people.  Another event is the annual presentation of the
United Nations Population Award to individuals or institutions who
have been chosen to be honoured for their outstanding contributions
in the area of increasing awareness of population issues and
working towards their resolution. 

            XI.  TECHNOLOGY, RESEARCH AND DEVELOPMENT

271. Demographic data of sufficient quantity and quality are a
prerequisite for the formulation and implementation of appropriate
population policies.  Population issues must be properly documented
and interpreted; otherwise, policy makers and programme officers
will not be able to perceive the importance and urgency of such
issues, understand their determinants and identify the actions that
are required to address them.  For this reason, the collection,
analysis and research of population and other socio-economic
variables constitute a fundamental part of the process that
embraces the identification of issues, the formulation and
implementation of policies and programmes, and the evaluation of
such actions.  The present chapter concentrates on two particular
issues, data collection and substantive and operational research.

      Issue No. 22.  Balanced programme of data collection

272. The Plan of Action (paras. 72-77) and the Mexico City
recommendations (recommendations 60-68) provide guidance in the
area of data collection and analysis.  Such directives have been
extremely useful and have been translated into important
improvements.  At present, for virtually every nation in the world,
there is available a set of basic indicators, actual and estimated
or projected, on population trends.  Those basic indicators include
population size, distribution by sex and urban/rural residence, and
rates of increase, crude death and birth rates, total fertility
rates, infant mortality and life expectancy at birth.  These data
correspond to estimates and projections covering the period
1950-2025.  Estimates and projections on internal and international
migration are almost non-existent in the majority of countries, and
in the area of maternal mortality, which requires complete civil
registration of mortality statistics to obtain accurate data, only
recently has attention been focused on improving statistics for
countries that lack such a system.  For the past two decades, many
countries have made progress in obtaining demographic data,
including data disaggregated by gender through censuses, surveys
and civil registration/vital statistics systems.  However, owing to
the scarcity of statistics on the environment, it is difficult to
fully assess the interaction between population, development and
the environment.  There is also insufficient utilization of data
disaggregation by gender in many countries and some countries do
not make such disaggregation available.

273. In relation to the data originating from population censuses,
the past 20 years have witnessed important improvements.  During
the 1980s, 192 countries or areas took a census; during that
decade, in particular, the African Census Programme (50 out of 54
countries participating) and the 1982 Population Census of China
were both undertaken.  The decade 1985-1994 was designated by the
United Nations as the 1990 census decade and the 1990 World
Population and Housing Census Programme was launched in 1985.  In
the present decade, 206 countries or areas have carried out or are
planning to carry out a population and housing census.  In some
countries, census preparations had actually been made but for
various reasons the census was postponed to a date after 1994 or
cancelled.  In other countries, population registers and
administrative records systems were used to provide census-type
data on population and housing.  By the end of 1994, it is expected
that 96 per cent of the world population will have been enumerated.

274. Since the 1990 census decade has been witnessing a wide use of
microcomputers in the processing and dissemination of data, the
United Nations has responded by preparing various publications to
assist countries in planning using centralized and decentralized
methods for census processing and tabulation.  The use of
microcomputers has also facilitated the development of local census
statistics for analysis of population trends and characteristics
for policy purposes.

275. Furthermore, a wide range of technical cooperation activities,
funded by UNFPA as well as by other donors, were carried out during
the past two decades in a large number of developing countries in
connection with the successful completion of their national
censuses.  Those activities included the provision of census
experts; advisory services; equipment (including computer hardware
and software); and a series of training workshops at both the
regional and the national level.  The training workshops covered,
inter alia, advanced techniques in census cartography, census
planning, sampling procedures, methods for collecting economic
statistics, data processing, and database development.  Of
particular importance was a census training programme for
sub-Saharan Africa that was funded by the Government of Canada
under multi-bilateral arrangements with UNFPA and executed by the
Department for Economic and Social Information and Policy Analysis
of the United Nations Secretariat, with ECA as the associate
executing agency.

276. Another area that receives attention in the Plan of Action is
the establishment of national vital statistics systems (para. 75). 
The continuing implementation of the World Programme for the
Improvement of Vital Statistics was intensified with the launching
of the International Programme for Accelerating the Improvement of
Vital Statistics and Civil Registration Systems in 1991.  The
International Programme was co-sponsored by the Statistical
Division of the United Nations Secretariat, UNFPA, WHO and the
International Institute for Vital Registration and Statistics.  A
series of workshops were held in the ECLAC, ESCAP and ESCWA
regions, and two others are planned in Africa.  Other activities
include the preparation and dissemination of several methodological
reports and studies for assisting countries to assess the current
situation and to implement needed reforms and measures for
achieving complete coverage and timeliness of registration and
vital statistics.  

277. A particular area that has been receiving considerable
attention is migration (both internal and international, but
especially international).  Migration statistics are very
deficient, even in the more developed regions.  This fact was
recognized by the International Conference on Population (Mexico
City) and migration was identified as the least developed area of
current demographic statistics (recommendation 64).  Part of the
difficulties are related to the lack of data, but even if data
exist, there are still difficulties in terms of concepts,
definitions and classifications of migrants.  Therefore, a rational
strategy in this area should include the revision of definitions
and classifications, as well as the preparation of guidelines for
the collection, tabulation, publication and dissemination of data
gathered from multiple sources (population censuses, sample surveys
and administrative record systems).  Concrete steps in this
direction have been taken by the Organisation for Economic
Cooperation and Development with the establishment of the
Continuous Reporting System on Migration (SOPEMI) that recounts the
evolution of international migration flows to and from its member
States as well as their policies.

278. An annual publication of the United Nations, the Demographic
Yearbook, has been disseminating a variety of demographic and
social statistics during the past four decades.  These data, which
exist on the mainframe computer, have been made available on
computer tapes, on an ad hoc basis, to private clients and national
offices, as well as to other users in the international system.  In
recent years, as microcomputers have become more widespread, the
demand for demographic data on microcomputer media has increased. 
In order to meet these needs, a three-year project has been
undertaken to strengthen the existing database.  Upon completion,
the database will contain time-series on demographic and social
statistics since 1950 and will permit their rapid retrieval and
efficient use for international population research, including the
study of special population groups.

279. Distinct improvements in the area of sample surveys have been
made in the past two decades.  Some major examples should be
mentioned in this respect.  First, the World Fertility Survey
(WFS), the largest social survey ever undertaken, was launched in
1972.  It was carried out by the International Statistical
Institute, in collaboration with the United Nations and the
International Union for the Scientific Study of Population (IUSSP),
with the financial support of UNFPA, the United States Agency for
International Development (USAID) and the Overseas Development
Administration (United Kingdom).  WFS provided not only a set of
comparable data covering 20 developed and 42 developing countries
but also manuals on survey design, training to nationals of
participating countries, data-processing software, standard data
tapes and a series of illustrative analyses.  As it ended in 1984,
the Institute for Resource Development of Macro Systems launched
the programme of Demographic and Health Surveys (DHS), which has
been considered the successor of the WFS surveys.  On a smaller
scale, in the context of the National Household Survey Capability
Programme (NHSCP), the United Nations, in collaboration with
UNICEF, UNFPA and IPPF, and with financial assistance from the Arab
Gulf Programme for United Nations Development Organizations
(AGFUND), has been undertaking a project called the Pan-Arab
Project for Child Development (PAPCHILD) which is aimed at the
collection of data on health for policy and programming.

280. Several activities have been designed to address special
population groups, such as children, persons with disabilities, and
the elderly.  Such activities include, inter alia:  (a) development
of concepts, definitions and classifications; (b) design of
strategies for data collection and development of international
databases; (c) preparation of training manuals and handbooks; and
(d) technical cooperation activities, including training workshops
and advisory services.  With respect to people with disabilities,
notable advances have been made in data compilation and
dissemination.  The international Disability Statistics Database
(DISTAT) comprises 12 major socio-economic and demographic topics
concerning disability.

281. The implementation and monitoring of international instruments
related to the full integration of women into society on an equal
basis with men require a solid data foundation.  Of particular
interest has been the preparation of the Women's Indicators and
Statistics Database (WISTAT) and The World's Women, 1970-1990: 
Trends and Statistics. 76/  WISTAT is an integrated, readily
available, comprehensive database for microcomputers.

282. The above account shows that some important successes have
been achieved in the area of data collection; nevertheless, much
work remains to be done.  Indeed, in many developing countries,
basic data are deficient and incomplete; analyses based on current
direct observations are still lacking; the institutional basis for
the collection, processing and dissemination of statistical
information is weak; and, particularly, there is a need for
improving the quality of human resources committed to these
activities.  From the above experience, a major lesson can be
learned, namely, that the data collected from censuses, civil
registration systems, household surveys, and any other source, can
only be considered complete when those data are evaluated,
disseminated and analysed to provide demographic knowledge
concerning trends and their socio-economic correlates.  Each of the
different systems of data collection has its own merits, but
becomes more powerful when complemented by the others.  In this
respect, the third review and appraisal of the Plan of Action
concluded that a balanced programme of data collection and analysis
for any given country would aim at gradual and harmonious
improvement in the different systems of collection and analysis
which would fit the particular conditions of the country, and that
such a programme should consider particular information needs in
terms of specific groups of the population. 77/


       Issue No. 23.  Substantive and operational research

283. The Plan of Action (paras. 78-80) and the Mexico City
recommendations (recommendations 69-72) give strong emphasis to
research activities relating to population and identify the
priority areas requiring research to fill gaps in knowledge.  As
part of the preparatory activities for the 1994 International
Conference on Population and Development, six expert group meetings
were convened to discuss various population issues, provide
substantive basis for assessing the Plan of Action, address the
issues of the coming decade, and recommend actions.  Each of the
meetings examined the level of understanding of particular issues
and identified gaps and limitations.  Many of the conclusions have
been valuable inputs in the preparation of the present report.

284. The principal areas covered by research during the past two
decades ranged from social, cultural and economic determinants of
population variables in different developmental and political
situations to social indicators reflecting the quality of life and
the interrelationships between socio-economic and demographic
phenomena.  Renewed attention has also been paid to population,
environment and development issues, which had already figured
prominently in the preparations for the World Population Conference
in 1974.  During the same period there was accumulated a
significantly large body of qualitative and quantitative
information obtained from a worldwide research effort.  There have
also been major advances in the research of census, survey and
registration methods used in the collection of such qualitative and
quantitative information, as well as in the dissemination of
information and research results to users.  A review of recent
research reveals shifts in emphasis among the different research
areas and points to important advances as well as gaps that require
further research.

285. Important research work has been carried out at the
interregional and regional levels.  Studies in this area have
focused on the interrelationships among socio-economic and
population variables, population and development, and the
demographic aspects of development planning.  At the country level,
research has given particular emphasis to the analysis of
population growth, population distribution and the determinants and
consequences of migration, migration and unemployment, and human
resource development.  Although considerable research has been
carried out, an array of research questions, especially at the
operational level, remain to be addressed in specific country
situations.  In general, it should be recognized that the research
infrastructure in many developing countries is weak, particularly
in the least developed countries.  In many cases, research has been
"donor driven" and has not involved the national officers who are
expected to apply the results of research to their programmes.  A
paucity of human and financial resources has contributed to this
situation.

286. Recent trends in the analysis of population dynamics have
shifted from fact-finding studies to more focused analyses of how
population issues are integrated into socio-economic development
planning and programming.  A trend in recent years, and one likely
to gain momentum in the future, is the growing recognition of the
importance of policy-oriented research on sociocultural factors
affecting human reproductive behaviour, not only in relation to
reproduction but also as regards morbidity, mortality, migration
and urbanization.  The International Forum on Population in the
Twenty-first Century recommended an expansion of research to
encompass the determinants of fertility and family-planning
attitudes and behaviour, as well as family relationships, sexual
behaviour and cultural barriers impeding the integration of women
in the overall development process. 78/

287. Research efforts on the interactions between population and
the environment over the past 20 years have, on the one hand,
sought, with varying degrees of success, to create macro-level
analytical frameworks and, on the other, applied themselves to
empirical investigations at the micro-level.  Perhaps the most
critical shortfall exists in the area of empirical micro-level
studies of particular localities.  However, a number of potentially
significant projects at both levels are being undertaken at
present, reflecting the renewed interest on issues of long-term
sustainability, highlighted by the United Nations Conference on
Environment and Development.  The study on the relationship among
population pressures, poverty and environmentally endangered zones
is a field of research that should be given high priority in the
coming years.

288. Over the past 20 years the topic of migration has been
perceived to be an increasingly crucial demographic and political
problem.  Spurred by the paucity of research on both internal and
international migration, research on migration has been growing
very fast, being focused mainly on the analysis of present and
future emigration pressures on the developed countries.  Relatively
little research exists, however, on movements between the
developing countries.  There is also a lack of serious research on
refugees, particularly within the developing countries. 

289. In recent years, increasing attention has been given to the
ageing of populations in many countries.  This demographic trend is
considered to have significant economic and social implications
which vary considerably according to country-specific circumstances
and include the effects of ageing on pensions, the labour force,
medical care, family structure and residential patterns.  The focus
of research on age structure has not been limited to the growth of
the elderly population but has considered age distribution in its
entirety in a broad framework of global and historical changes. 
Much research attention has been paid to the causes of change in
age structure, and its consequences for public revenue and
expenditure and the labour force, as well as to the identification
of possible adjustment mechanisms and approaches to improving
demographic policies. 

290. Research in human reproduction with specific focus on the
needs of developing countries has been expanding.  During recent
years, considerable progress has been made in the area of research,
development and assessment of fertility-regulating methods,
including male fertility methods, although practical applications
are still some years ahead.

291. In the past few years, the role of males in fertility, and
particularly male responsibility for family planning, has become an
important research topic.  More studies, however, need to be done,
especially at the operational level, to discover effective means of
involving male partners in family-planning decisions.  The
investigation of operational questions such as these has been taken
up by several national non-governmental organizations that probably
have a comparative advantage by virtue of their grass-roots
character.

292. In spite of a considerable amount of operational research
carried out on the provision of family-planning services, needs in
this area are still great because of the growing demand for
cost-effectiveness and self-financing of programmes in the context
of increasing financial constraints.  Operational research and
specific micro-level surveys have yielded many operational answers
to programmatic questions about service delivery, including quality
of care, sociocultural sensitivities, women's needs and more
effective cost-recovery strategies.  Nevertheless, in many cases,
operational research has been limited and rarely institutionalized
as part of delivery systems.

293. At the operational level, recent research has branched into
several specific topics designed to improve the quality and
accessibility of family-planning services.  An international
programme to estimate contraceptive requirements to the year 2000
has made good progress and helped the coordination of international
efforts in contraceptive commodities procurement, although more
efforts in this area are needed if the expected growth in demand in
developing countries is to be met in the next few years.  More
systematic research into the legal impediments to family-planning
practice, ranging from import restrictions to civil laws affecting,
for example, availability of contraceptives to adolescents, has
also accelerated in recent years.

294. In the area of health, recent research has focused on maternal
mortality, on maternal and reproductive morbidity and on
assessments of unmet needs for family planning.  Important advances
have been made in the understanding of the interactions among
family planning, maternal mortality and child survival. 
Epidemiological and operational research remains a vital instrument
in the efforts to reduce maternal morbidity and mortality.

295. In the next decade, further research will be needed for the
development and adaptation of the appropriate technologies and
methodologies necessary to reduce high levels of severe morbidity
and maternal mortality, as well as for the investigation of their
underlying causes.

296. Recent years have seen emphasis on the development of methods
for making rapid assessments of social and economic events that are
important in understanding the interaction between population and
development, providing substantive and technical bases for
policy-relevant research, and establishing quick baselines for the
evaluation of programme efforts.

297. Numerous sociocultural research studies conducted during the
past 20 years have provided considerable input for the development
of information, education and communication activities.  However,
there is still a lack of knowledge about the sociocultural and
psychological profiles of specific target groups, including
cultural acceptability of the concept of contraception and the
specific methods for achieving it.  Among other key areas for
future studies is research on sociocultural factors affecting
demographic behaviour in urban squatter settlements.  Desegregation
of quantitative and qualitative information by gender, essential
for sociocultural research, has advanced in recent years, but
remains inadequate.

298. Another important challenge confronting researchers is to make
the best possible use of the microcomputers that are becoming
widely available.  Microcomputer technology has now been used
extensively in assisting the collection, processing, organization,
storage and analysis of population information.  The dissemination
of a large quantity of complex data to users through magnetic means
can be carried out effectively to supplement the traditional
printed publications.  The use of microcomputers could contribute
greatly to the decentralization to subnational levels of research,
which would thus become more programme-oriented, but achieving this
will require methodological and substantive work at all levels.

299. Among the issues that merit more attention and further
investigation in the area of population and development are the
following linkages:  the effect of population growth on the ability
to increase human resource investments; poor governance in the face
of mounting population pressures; unsustainable efforts to increase
food production; strains on water resources; and costs associated
with a lower versus a higher degree of population stabilization.


                      XII.  NATIONAL ACTION

300. The World Population Plan of Action recognizes the sovereign
right of nations to respond to their own population and development
issues and affirms that the success of the Plan of Action will
largely depend on the actions undertaken by national Governments
(para. 96).  In this sense, the ultimate responsibility for action
or inaction in population matters belongs to national Governments. 
Action undertaken by countries to address their population
problems, in a broadened context of social and economic
development, encompasses a large variety of activities to be
carried out by many different actors, such as national government
ministries and agencies, regional and local authorities,
legislators, non-governmental organizations and the private sector,
local communities, families, couples and individuals.  In an
increasing number of countries, Governments have recently been
modifying the manner in which they manage their national affairs,
in particular by giving greater recognition to the larger role to
be played by market forces and private initiatives, as opposed to
public regulation.  National Governments, when making collective
decisions and choices, tend more and more to foster the
participation of the different actors that constitute the social
web of nations.  This chapter concentrates on three key issues: 
the integration of population concerns into development planning
and programming; the management of programmes; and the achievement
of self-reliance.


  Issue No. 24.  Integrated approaches for population policies

301. Comprehensive population policies facilitate the consideration
of the various relationships between population factors and
socio-economic development in a manner that minimizes policy
contradictions and promotes internally consistent and harmonious
development.  Beginning in the early 1960s, many developing
countries started to be involved in preparing their plans and
strategies for social and economic development.  In many instances,
population was included in the planning process, at least as a
reference point for defining the current and projected magnitude of
needs and resources.

302. The Plan of Action states, in its principles and objectives,
that population and development are interrelated:  population
variables influence development variables and are also influenced
by them (para. 14 (c)).  In recognition of these linkages, the Plan
of Action recommends that population measures and programmes should
be integrated into comprehensive social and economic plans and
programmes and that this integration should be reflected in the
goals, instrumentalities and organizations for planning within the
countries.  It is suggested that in general a unit dealing with
population aspects be created and placed at a high level of the
national administrative structure and that such a unit be staffed
with qualified persons from the relevant disciplines (para. 95).

303. According to information in the Population Policy Data Bank,
the vast majority of Governments at present have units responsible
for taking into account population variables in development
planning within their central planning or programming agencies.  A
large proportion of the developing countries (more than 75 per
cent) have a national development plan currently in effect and two
thirds of the Governments have at least one agency for formulating
or coordinating population policies and a unit for taking into
account population variables in development planning within the
central planning agency.

304. In recent years, considerable efforts have been made to
establish institutional mechanisms to heighten awareness of
population issues and to lobby for effective resolution of those
issues.  Many developing countries have organized national
population commissions or councils that are high-level government
bodies.  These councils or commissions are usually charged with the
responsibility for making decisions or giving advice on population
matters in general, or for spearheading the formulation of
population policies and coordinating all population programmes in
both public and private sectors.  In many cases, these commissions
are also charged with the responsibility of channelling financial
and technical assistance for population programmes.  The location
and effectiveness of these commissions and councils are influenced
by the degree of national commitment to population and development
issues.

305. In addition to these commissions or councils, there are also
population units in planning, health and education ministries in
over 70 developing countries.  Those commissions, councils and
units, by formulating comprehensive population policies, have
played a leading role in legitimizing the idea that population is
also a programmable sector, as well as in promoting the acceptance
of population activities.  In many countries where commissions or
councils exist, the population units act as technical secretariats.

306. Considerable efforts have been made to assist national
Governments in organizing and equipping the units in order to
effectively undertake and promote research, policy development,
programming, and coordination activities.  A variety of training
programmes have been used, inter alia, on-the-job training assisted
by full-time international experts and consultants and the
provision of practical methodological tools, including
microcomputer-based user-friendly software (with training provided
for their use), and the provision of administrative and logistical
support.  Similar efforts have been made in relation to national
research institutions.

307. Beyond the considerations presented above, evaluating
international progress on the integration of population into
development policies and vice versa appears to be as difficult as
the task of integrating population and development planning itself.

This area of the Plan of Action seems to have received less
attention than many of the other areas, in spite of its recognized
importance.  One reason for the relative lack of attention to the
issue of integration is the uncertainty concerning the meaning of
the term.  Integration may be used to address different concerns,
namely those involving (a) the use of demographic data to project
the size of various groups likely to demand specific services
(school-age child labour, the elderly and so on); (b) the
recognition that policies designed for a given purpose (for
example, increased spending on education of females to improve the
labour force and raise household incomes) might produce a
significant impact on certain population variables (for example, in
this case perhaps the lowering of fertility); and (c) the modelling
of the linkages and feedback mechanisms among economic, social and
demographic variables when development strategies are being
prepared.  All of the above types of integrations can be found in
the multitude of national planning experiences around the world,
although the latter type is the most in line with the ideal type of
integration envisioned by the Plan of Action.

308. In addition to the intellectual difficulty of defining
integration, there are also problems related to the implementation
of population policies.  Among those problems, the most common is
determining the exact linkages between population and development,
and developing techniques for modelling them.  Another reason for
the insufficient progress deserved in this area is the weak level
of communication between policy makers and researchers; a more
effective constructive dialogue between them would help the
identification of options for policy-making and programming
decisions.  Other key problems are the availability of trained
human resources for such sophisticated analyses and the collecting
of the necessary data on demographic, economic and social
variables.  Information from the Population Policy Data Bank
indicates that more than half of Governments in the developing
countries regard the following factors as obstacles to the
integration of population variables into the development planning
process:  lack of appropriate methods for assessing the data they
have; inadequacy of data on the linkages between population and
development; and lack of trained personnel.

309. Sub-Saharan Africa is likely to remain the priority region for
population planning.  Population problems (especially rapid
population growth, refugee and other migration issues, urbanization
and spatial distribution) and their complex interactions with such
factors as poverty, underemployment and environmental degradation,
and the effective implementation of national population policies,
deserve continued attention and support.  Most countries in
sub-Saharan Africa have weak analytical and planning capacities,
and only recently have they begun to recognize that demographic and
related factors play a crucial role in the development process, and
hence that active intervention policies may be required.  Over the
past decade or so, a great deal of effort has gone into the
establishment of the minimum conditions necessary for integrated
planning in those countries.  Sensitization and awareness-creation
activities formed a major component of the international assistance
provided by the United Nations system, with the aim of building a
national consensus so that designing public policy could become
population-oriented.

310. In contrast to sub-Saharan African countries, many Asian and
Latin American countries have already relatively developed
analytical and institutional capacities for planning.  As far as
Asia is concerned, there is also a well- established tradition of
intervention in the population field.  These are countries where
the conditions for effective integrated planning have largely been
met.  Their needs for technical assistance are more specialized and
refer to areas such as sectoral planning, migration and
urbanization, incorporation of gender concerns into policy,
specific policy advice on such issues as population and the
environment, and technical aspects of modelling and the use of
advanced software packages.  Many of those countries also need
assistance for undertaking planning at the subnational level.

311. Many countries in Northern Africa and Western Asia may be
placed in between these two groups.  They have relatively developed
analytical and planning capacities but, as in the first category,
population issues tend to receive inadequate attention in public
policy.  In these cases, the initial requirement is to create
favourable conditions for taking proper account of population
factors in human resource development strategies and programmes,
for example, through the establishment and strengthening of
population units and through sensitization activities.

312. In many countries, mainly outside Africa, population and human
resource development policies and activities have often been
undertaken in the absence of a comprehensive framework.  While such
an approach may have the advantage of focusing attention and scarce
resources on very specific priorities, it may lead to the neglect
of some  otherwise important factors or have unanticipated effects.

Indeed, efforts have at times been limited to the pursuit of
population-influencing strategies, particularly family planning, to
the neglect of the equally important population-responsive policies
needed in such areas as health, education and employment.

313. The experience gained in the implementation of technical
cooperation projects in the area of integration of population into
development shows a great diversity in the analytical and planning
capacities among regions.  Two crucial conditions must be met if
integrated population and development planning is to be achieved. 
The first condition is that a political climate in which population
issues are considered to be central to public policy be created. 
A major step towards the achievement of such political climate is
the organization of sensitization and awareness-creation activities
targeted at all levels of opinion formation and decision-making,
and reaching down ultimately to the general population.  The second
crucial condition for effecting integrated population and
development planning is that an adequate institutional and
technical capacity be created.  The experience gained in the past
two decades indicates that a major means for attempting to achieve
such integration is the establishment and/or strengthening of the
population units mentioned above.  Those units should be composed
of an adequate number of competent personnel, linked to key
policy-making bodies and to other relevant ministries, having
access to basic demographic and socio-economic data and to
analytical tools and planning methodologies that can be adapted to
suit local conditions.

314. Countries that have recently adopted or are in the process of
formulating national population policies require substantial
assistance in the preparation and implementation of detailed and
well-coordinated global and sectoral action plans.  Their needs go
well beyond technical advice in the formulation of policies and
programmes:  to make an informed choice between alternative
instruments and strategies, planners and decision makers need to
have an idea of the level of resources that can be made available,
inter alia, for the development and implementation of specific
measures and programmes, and for the setting up of coordination,
monitoring and evaluation mechanisms.  A high degree of commitment
to population policy implementation is therefore essential.

315. The information presented above does indicate that there are
indeed serious barriers to be overcome in the integration of
population variables into the development planning process, but it
also points to ways of overcoming those barriers.  Recommendations
concerning ways in which the institutions of the United Nations
system can help overcome these obstacles include mention of the
following:  (a) continued support for institutional
capacity-building in developing country Governments, including data
collection, research and analysis; (b) training programmes focusing
on appropriate methods for modelling the linkages among economic,
social and demographic factors; (c) further research into the
mechanisms through which population and development variables are
linked; and (d) policy dialogue in support of (i) the establishment
of agencies devoted to the integration of population and
development for those countries that do not yet have them, and (ii)
the improvement of those agencies in such countries as already have
them. 

             Issue No. 25.  Management of programmes

316. Achieving self-reliance, by building the capacity of
Governments, non-governmental organizations and the private sector
to address the population issues of their countries, requires the
participation of skilled workers and the establishing of a proper
administrative environment.  The Plan of Action (para. 81) and
particularly the Mexico City recommendations (para. 36 and
recommendations 73 and 77) recognize such needs and suggest
establishing monitoring and evaluation systems, strengthening
administrative and managerial capacity and involving communities
more actively.  More precisely, the Mexico City International
Conference on Population focused on three main specifications for
the management of population programmes:  (a) management should be
strengthened through appropriate training activities; (b) all
regional and interregional agencies and national Governments should
lend their full support to the management of population programmes
and national Governments should seek ways of promoting technical
cooperation among developing countries (TCDC) in this respect,
paying special attention to training of trainers and emphasizing
women's participation in all phases of the process; and (c)
awareness-raising should be addressed through special programmes
for decision makers, administrators, media communicators and other
relevant actors.

317. In the past two decades, efforts to improve the management of
population  programmes have taken many forms.  Those efforts have
included reorganizing programme structures; establishing new
systems of monitoring and decision-making; improving management
training; upgrading service delivery and its support services with
a view to enhancing quality of care; and improving logistics and
management information systems.  International organizations,
donors, Governments and non-governmental organizations are making
efforts to tailor training activities to meet the specific
requirements of programmes.  There is also a great opportunity for
successful technical cooperation among developing countries in the
area of population programme management.

318. These efforts have, in many cases, been hampered by human,
financial and technical resources constraints.  Many Governments,
for example, need to recruit local programme management personnel
for their maternal and child health care and family planning
(MCH/FP) programmes among those who, although they have already
demonstrated their abilities in managing public and/or private
sector programmes in other areas, do not have prior experience in
MCH/FP activities.

319. Although there has been some progress in integrating gender
concerns in programme planning and programme management, much more
needs to be done to ensure the full incorporation of gender issues
into population programmes.  A number of programmes in the area of
MCH/FP, as well as in information, education and communication,
that are generally addressed mainly to women, have been found to be
seriously deficient because the specific needs of women were not
considered in project design and implementation.  Women have not
always been consulted or asked to participate in needs
identification, programme development and management and
decision-making.

320. Management of family planning programmes, already difficult in
many countries, is often made more so by a lack of adequate
managerial training.  Although women constitute the majority of
health-care providers in many societies, they seldom occupy
managerial-level positions in the health and family-planning
system.  There is a particular need for women-centred and
women-managed facilities to ensure that their MCH/FP needs are
taken fully into consideration.  

321. The area of training has been signalled as a major concern. 
In many cases, national project personnel, although given
responsibility for a wide variety of tasks, has received little
management training.  Top managers often still lack specialized
management skills and training.  Rapid changes in management and
administrative technology have, in some cases, fostered a
dependence on international experts.  The management of population
programmes continues to demand recruitment of good managers and the
development of managerial skills through well-planned training. 
The aim should be to maintain and expand a critical mass of
high-level administrators of population programmes.

322. Responding to this need, training programmes have been
designed to strengthen the management capabilities of
family-planning organizations, with particular emphasis on
improving quality and access to services.  While some progress has
been made in inserting appropriate public administration and
management components into the training of some population
specialists and some skills in this area are being built among
population scientists, the inclusion of relevant population themes
in the curricula of public administration and management programmes
has been less successful.  Yet, without such expertise and
conviction on the part of public administrators, well-founded
population concerns will continue to remain largely restricted to
academic circles only.  Therefore, special curricula focusing on
population issues designed to meet the needs of public
administrators and managers should be urgently developed.  In
designing such programmes special attention should be paid to the
multisectoral nature of population issues.

323. Another area where action has been slow is the identification
of the actual managerial needs of population programmes.  It is not
enough to emphasize the substantive and academic skills that are
required for further programme development and enhancement; due
attention must be paid to the managerial instruments that are
needed to run programmes in a more effective fashion.

324. It was indicated, in relation to issue No. 22 above, that in
the area of data collection and analysis, many developing countries
have reached some form of self-reliance.  However, what needs to be
strengthened further is the managerial components of the
dissemination of data and the results of analyses and the promotion
of data-user services.  Regarding the incorporation of population
elements in national and sectoral development plans and programmes,
while many Governments have become increasingly aware of those
elements, methodologies, tools and measures are still lacking and,
where they exist, are weak.  Hence, further work in this area is
critical. 

325. One of the most important issues facing managers and
administrators is the expansion and improvement of family-planning
services.  Countries with a high success rate in expanding the
accessibility and reach of their delivery systems have been
successful largely by improving contraceptive logistics and
utilizing private-sector efficiency at local and national levels,
although the importance of the private sector varies considerably
among relatively successful programmes in different regions. 
Experience has shown that even minimum strategic interventions on
a broad scale will most likely lead to the success of country
population programmes when they are accompanied by improvements in
the quality of services and increased community participation.  In
the case of family planning, strategic management should give
priority to improving distribution of a broad range of
contraceptive methods, monitoring of contraception continuation
rates, raising the quality of client-oriented services, and
promoting gender balance in senior management positions.  There is
also a growing recognition that sustained political commitment and
cooperation among all relevant governmental and non-governmental
personnel and institutions are key components in managing
population programmes.

326. The inadequate development or use of MIS has been identified
as an important obstacle to effective management of national
population programmes, particularly MCH/FP programmes, around the
world.  Several programmatic and managerial issues regarding MIS in
support of MCH/FP programmes were identified during the UNFPA
diagnostic surveys conducted in Africa, Asia and Latin America and
the Caribbean in 1989.  Those issues included, among others, lack
of focus on management-related indicators; lack of feedback to
local levels; lack of accuracy and timeliness of information; and
the shortage of trained personnel for interpreting and analysing
MIS data for planning and management of family- planning
programmes.

327. Attempts to improve MIS in the area of family planning have
included efforts to simplify existing systems so that they provide
accurate and timely information and to provide training for
management, supervisory and service personnel in the correct
production and use of information.  The challenge in the coming
years will be to develop and implement inexpensive and easy-to-use
MIS for monitoring the quality and quantity of programme
performance and impact.

328. Another common managerial problem is the lack of
organizational clarity concerning which government bodies have
responsibility for population programmes.  Such imprecision has
adversely affected the administration and management of population
programmes.  Many programmes are also faced with problems in
internal management, field and client relations, relations with
other sectors of the Government, and proper management of political
linkages with international agencies.

329.  Improving the quality of services has become a major concern
in the management of programmes.  The target-oriented approach of
many family-planning programmes in the past has contributed to
several problems:  high discontinuation rates; excessive reliance
on non-reversible contraceptive methods; persistence of high rates
of induced abortion; and, in some cases, an excessively unbalanced
sex ratio owing to son preference.  In the 1990s, attention has
turned away from the target-oriented to the quality-oriented
approach in family-planning services.  Recent studies have shown
that wherever management offered a genuine choice of methods, with
good information and counselling, there were fewer drop-outs and
more satisfied users.  The consensus is that satisfied users are
not only the key to high continuation rates but also the most
effective promoters of family planning.  Programme managers should
therefore make continuous strategic improvements in the quality of
care because such improvements will not only help users to achieve
their reproductive goals but, by doing so, will also promote higher
contraceptive prevalence and lead to reductions in fertility. 
Managing and improving quality services will require a genuine
commitment of all levels of management to offering services of high
quality and to striving for a better understanding of clients'
needs and preferences.

330. UNFPA has, in recent years, given serious attention to
improving not only its management strategies for field operations,
but also its own internal management.  The Governing Council of
UNDP noted that by 1990 several steps had been taken to strengthen
UNFPA's programme management capability:  an improvement in the
procedures for the recruitment of staff; rotation of staff between
the field and headquarters; greater emphasis on confidence-building
within the organization; and the increased decentralization of
decision-making to the field.  UNFPA's leadership has also taken
steps to expand technical support at the regional level through the
Technical Support System (TSS) and by improving strategic planning
in country programmes through the already-mentioned programme
review and strategy development country missions.  Such innovations
have significant potential to increase the effectiveness of
country-level operations.

331. In conclusion, the experience of the past 20 years indicates
that good management is a key factor in determining the success or
failure of population programmes.  To improve the managerial
capacities of countries with respect to operating their population
programmes, particular attention should be given to improving the
quality of their human resources; establishing/strengthening their
MIS; reorienting their programmes towards a more client-oriented
approach; and involving their communities more extensively in the
planning and implementation of programmes.  In the area of
family-planning programmes, particular attention should continue to
be given to a large variety of tasks such as improving the
availability and accessibility of contraceptive services that are
of high quality, affordable and culturally acceptable; providing
varied options and approaches for different target groups;
providing a broad range of contraceptive methods; utilizing
appropriate information, education and communication programmes;
and monitoring and evaluating all programme components on a timely
basis.


             Issue No. 26.  Achieving self-reliance

332. As mentioned above, both the Plan of Action and the Mexico
City recommendations give explicit recognition to the vital role of
independent, sovereign, national action in the population field. 
At the same time, it is also recognized that national decision
makers could face many impediments in this area, including
administrative and managerial weakness; a shortage of the human and
capital resources necessary for effective population programme
implementation; inadequate monitoring and evaluation systems to
provide decision makers with appropriate feedback in order to
devise more effective approaches; and lack of adequate mechanisms
to ensure that international assistance is provided under
arrangements and on conditions that are adapted to the
administrative resources of the recipient country (recommendation
77 (c)).

333. The goal of achieving self-reliance has been on the agenda of
major population and development meetings.  In addition to the
calls made at Bucharest in 1974 and at Mexico City 10 years later,
there have been similar ones at many other gatherings.  In 1984,
for example, African Governments in the Kilimanjaro Programme of
Action, 79/ proposed accelerating self-reliant, social and economic
development for the well-being of African peoples.  In 1992, the
African Governments noted that despite the increased number of
explicit population policies formulated in the continent, the
implementation rate of the Kilimanjaro Programme of Action had
remained low and reiterated a similar call for self-reliance in the
draft Dakar/Ngor Declaration on Population, Family and Sustainable
Development. 80/  Similar proposals were made by other regional
meetings.  More recently, the Tenth Conference of Heads of State
and Government of the Non-Aligned Movement (Jakarta, Indonesia,
September 1992) called for an early ministerial meeting on
population of the non-aligned movement.  Such a meeting took place
in 1993 and considered a series of means to achieve self-reliance
that include:  (a) the intensification of exchange of information
regarding member countries' experience with population policies and
family- planning programmes; (b) the organization of South-South
technical cooperation and assistance agreements with respect to
education and awareness-raising activities, safe motherhood and
family-planning programmes; and (c) the establishment of joint
cooperation for the production of medical supplies required in
programmes. 81/

334. In regard to political commitment, countries with strong
population policies have typically been able to mobilize sustained
commitment not only at the highest level but down to local leaders
at the grass-roots level as well.   There is also a growing
realization that population policies will not be successful and
sustainable unless the beneficiaries, especially women, are fully
involved in their design and subsequent implementation.  The
reviews of progress in these areas, carried out in 1984 and 1989,
revealed that while significant progress had been made in achieving
self-reliance, particularly in countries where there was a strong
governmental commitment, in many other developing countries the
common responsible factor was the lack of adequate resources.

335. The role of institutions is also crucial in promoting
self-reliance in managing population programmes.  A significant
number of Governments throughout the developing world, as mentioned
above, have established population commissions, councils and units.

Despite the widespread establishment of those entities, many issues
still need to be dealt with.  One of the most important is
clarifying the mode of interaction between the population unit and
sectoral ministries with responsibilities in population-relevant
areas.  Increasingly, the recognition that sound
institution-building should be multisectoral, broad- based and
extended to the district level has been growing.

336. As noted above, a foundation for national self-reliance in
population programming has been established in many countries.  In
most cases, however, it is a bare beginning and much more needs to
be done to better set up and institutionalize national capacity for
population programme implementation.  The growing collaboration
between governmental, non-governmental and regional organizations,
the renewed emphasis on people's participation at the community
level and the mainstreaming of the role of women in development are
all efforts that should be continued.

337. To achieve self-reliance and the integration of population and
development planning, there must be a network of local capabilities
in the collection, research and analysis of data on the
interrelationships among population and development, policy
formulation and programme development.  Multilateral and bilateral
agencies have continued to assist in the development of a national
self-reliant capacity to collect, analyse, use and disseminate
population- related data.  Those efforts have been aimed at
enhancing national capacity and self-reliance in formulating,
implementing, monitoring and evaluating population policies and
programmes.  A notable contribution in this direction has been the
organization of the programme review and strategy development
missions by UNFPA, which aim at the establishment of a concrete
strategic framework for a country's population programme on the
basis of an in-depth review of the achievements of and the
constraints in current population activities and the need for
future action.

338. Efforts to better orchestrate and coordinate international
assistance have also been strengthened by UNFPA's policy guidelines
on national execution.  Such efforts are in accord with recent
provisions made by the General Assembly that emphasize, inter alia,
the need to ensure maximum utilization of national capacity
through, in particular, government/national execution of projects,
a more programme-oriented approach and regular and timely provision
of technical advice and backstopping by agencies at the country
level. 82/  The above provisions led UNFPA to review and expand its
technical activities through the new Technical Support System
(TSS), and to prepare major revisions of the terms of collaboration
between UNFPA and other United Nations agencies and
non-governmental organizations.  Under this revised strategy,
considering that the emphasis was to be placed increasingly on the
execution of programmes by the Governments themselves, what was
sought was to combine such a trend with substantive support to be
provided by multidisciplinary teams of specialists, whose location
would be at subregional centres in all five major areas of the
developing world, bolstered by a thinner layer of agency
state-of-the-art specialists located in their respective
headquarters.  To date, for the activities sponsored by UNFPA, the
estimated proportion of projects executed directly by the
Governments themselves (execution ratio) for 1993 is 31 per cent,
as compared with 25.7 per cent and 20.9 per cent in 1991 and 1992,
respectively.

339. As part of its effort to enhance the operational activities of
the United Nations system by encouraging greater coordination at
the country level, the General Assembly adopted its resolution
47/199.  A central aspect of enhanced coordination will be the
Country Strategy Note (CSN) in the elaboration of which relevant
units, bodies and organizations of the United Nations, including
UNFPA, will participate.  It is expected that CSN will focus on
areas where the United Nations system can make a significant
difference in a concerted team effort.

340. Information from the Population Policy Data Bank indicates
that the majority of countries that have expressed the need for
assistance in the field of population during the next decade, have
mentioned the area of training in population as a means of
achieving self-reliance.  Similar findings have been gathered by
UNFPA through a number of assessments in the area of training.  In
fact, the ability of national Governments to achieve self-reliance
in managing their population programmes is often constrained by
inadequate and insufficient attention to human resource
development.  This has resulted in weak mechanisms for supervision
and control, and insufficient attention to staff development and
training.

341. With the increased awareness that human resources development
is critical for promoting and enhancing national self-reliance, a
growing number of Governments, with the assistance of international
agencies and donor organizations, have been giving priority to
training issues, especially those relating to the development of
administrative capabilities in the population field.  Human
resource development calls for dynamic partnerships, employing
multidisciplinary approaches, among teaching, training and research
institutions in academic environments, as well as among
governmental, semi-public and community-level agencies involved in
planning and policy formulation.  It seems reasonably clear that
Governments are becoming increasingly self-reliant at the higher
professional levels of the population field, hence the lower
overall demand for resident United Nations technical advisers.  At
the same time, however, the emphasis that continues to be placed on
training activities of all kinds, including institution-building
and development of permanent in-country training capacities,
suggests that the goal of becoming entirely self-reliant in this
area is far from having been attained in many countries.

342. On the basis of the experience gained, it can be concluded
that future demands for international assistance will be expressed
particularly in the area of training, including the
institutionalization of certain training functions within the
developing countries themselves.  New linkages need to be fostered
between academic training/research institutions and government
agencies mandated to deal with development planning and population
policies and programmes.  One particularly important area that
requires further attention is training in management itself. 
Experience has shown that short-term intensive training in this
area can be highly effective, and some expertise already exists in
the specific field of management for population specialists.  Much
more remains to be done, however, and it is therefore recommended
that future efforts be concentrated in this area, as well as in the
general areas mentioned above.

343. The importance of coordination of population activities has
been stressed in the Plan of Action and in the Mexico City
recommendations, as well as at recent gatherings such as the
Amsterdam International Forum on Population and the Development
Assistance Committee meeting on population.  There is an emerging
consensus among national Governments and donor agencies regarding
the need for a mechanism for coordinating all international
assistance in the field of population.  In some cases, the lack of
coordination of project activities has not only hindered the design
and fulfilment of population policies at national and local levels
but also duplicated programme efforts and wasted resources.  The
growing realization that collaboration and coordination at both
national and international levels could play a critical role in
strengthening national capability in managing population policies
and programmes has encouraged some agencies to coordinate their
programme efforts with those of Governments and other donors.  To
facilitate and enhance efforts in this direction, Governments and
agencies would need to stipulate clearly the terms and conditions
for assistance adapted to each country's situation and resources.

344. In their efforts to achieve self-reliance in mobilizing and
managing resources for population programmes, Governments have
increasingly been focusing their attention on such management
efficiency issues as decentralization and accountability.  The
decentralization of the delivery of services for population
programmes and the participation of local communities, and
non-governmental and private-sector organizations in all population
areas have been gaining momentum.  Additionally, many national and
local institutions have demonstrated that they can be efficient
executing agents in cost-sharing and cost-recovery schemes,
particularly when they have reliable accounting, recording,
reporting and auditing systems together with strong managerial
capabilities.

345. Experience over the past two decades with regard to
family-planning programmes has shown that good-quality service,
with sound management support systems and innovative public
education efforts, could produce very rapid changes in reproductive
behaviour in different socio-economic and cultural settings.  In
addition, there is a growing realization of the urgent need to
extend quality services to underserved areas, since people will use
them if they are available.  In their efforts to combine easy
access, privacy and high- quality services and products with
affordability, developing countries have tried a number of
initiatives.  Some of the most successful recent initiatives
include community-based distribution and social marketing
programmes.  Currently, contraceptive social marketing programmes
are in place in many developing countries and some have achieved
complete self-sufficiency.

346. The growing relative scarcity of financial resources for
population programmes in developing countries has given rise to the
implementation of more market-oriented strategies for contraceptive
mix, service quality and cost-recovery, all aimed at cutting costs.

There is agreement that closer coordination between health and
family-planning services and giving higher priority to the
strengthening of family-planning services within existing health
facilities could contribute to more cost-effective and efficient
use of scarce financial and human resources.  Increasingly, family
planning is being coupled with maternal and child health services
and even with primary health-care packages.  Other efficient
measures include linking family planning to agricultural extension
programmes, industrial work settings, social work programmes and
community participation.

347. The present review of the level of implementation of the Plan
of Action indicates that although the goal of population and
development assistance is to foster self-reliance, and that
approximately two thirds of the costs of basic population
programmes are covered by the developing countries themselves, it
is important to recognize that in economically strapped developing
nations the risk of project activities' coming to a halt upon
cessation of external funding is great.  Without external
assistance, some Governments can barely continue much less expand
population programmes.  Moreover, attempts in most countries to
redefine the role of the State by transferring government-owned
enterprises to the private sector and the decentralization of
decision-making are factors that could continue to affect the
thrust and direction of population policies and programmes and,
concomitantly, their sustainability and self-sufficiency.

348. National self-reliance, the ultimate objective of technical
assistance, demands that in the long run, both the financial and
the human resources required for population programmes should come
from domestic resources.  There is no simple formula that applies
equally to every country.  However, the following elements need to
be present:  strong political commitment; strategic planning; and
strong institutional and, in particular, managerial capabilities to
plan, implement and coordinate population programmes.  The
involvement of women in all stages of planning and execution of
programmes is also fundamental.  Increasingly, there is recognition
of the need not only to meet the existing demand for family
planning but also to increase it by reaching hitherto relatively
neglected groups, especially teenagers and men.  Experience has
shown that efforts to meet existing demand with sensitive and
varied programmes have helped to create new demand.  In keeping
with this recognition, Governments should set clear population
objectives, establish targets and plans, and ensure that adequate
budgetary allocations are made for reproductive health programmes,
including family planning as well as complementary socio-economic
programmes that are in accord with those objectives.  Governments
should also direct their efforts to generating and mobilizing
domestic resources in order to implement such objectives in an
efficient and timely manner.


                XIII.  INTERNATIONAL COOPERATION

349. International cooperation is increasingly perceived as
essential to the achievement of long-term planetary security.  The
modern expression "technical cooperation" has almost completely
replaced the old term "technical assistance".  This has been the
result of recognizing that development activities need the
participation of many actors on an equal footing, with the
recipient country, the donor community and the provider of
technical assistance perceived as partners in the same enterprise. 
Technical cooperation and financial assistance have played a
crucial role in promoting and supporting population programmes in
the developing countries, and the Plan of Action recognizes this
role in achieving its goals and objectives (para. 100).  The Plan
of Action also invites countries to share their experiences, and
urges developed countries to increase their assistance to
developing countries and the United Nations system to ensure a
proper response to the issues raised in the Plan of Action (paras.
101, 102 and 104).  The present chapter concentrates on two
particular issues:  the priority areas for technical cooperation,
and the strengthening of the population programme of the United
Nations system. 


      Issue No. 27.  Priority areas for international
                     cooperation

350. The preceding sections of the present report have illustrated
some of the many positive developments that have taken place since
the adoption of the World Population Plan of Action in 1974.  Many
of those developments have been possible because of the recognition
accorded to population as an important sector of international
cooperation by national Governments and the international
community.  Developing countries have made significant progress in
formulating population policies and programmes.  However, economic
recession, rising debt burdens and misplaced priorities, occurring
simultaneously with those remarkable achievements, have limited,
and in many countries reduced, the availability of funds hitherto
programmed for population activities.  During the period under
review, the need for technical cooperation in population increased
significantly.  Although the amount of financial assistance has
grown over the years, the gap between needs and resources has not
been reduced significantly.  Three major sources have been
consulted to prepare this chapter:  the Plan of Action and the
recommendations for its further implementation; the identification
of priority areas for assistance by the Governments themselves; and
the experience gained by multilateral organizations in undertaking
programmes of technical cooperation.

Priorities according to the Plan of Action

351. The Plan of Action offers a series of recommendations for
implementation, such as the respect of national sovereignty, the
value of sharing mutual experiences, the need to increase
assistance to developing countries, and the role to be played by
the United Nations system and by non-governmental organizations. 
The Plan of Action singles out the area of training in the field of
population for special attention (paras. 100-106).  The Mexico City
recommendations, building upon the provisions of the Plan of
Action, are more specific and place special emphasis on a number of
areas such as integration of population factors into development
planning; improvement of the status and participation of women;
collection and analysis of data; biomedical and social research;
identification of successful programmes and dissemination of such
findings; and implementation of monitoring and evaluation systems,
as well as training (recommendation 81).

352. The Economic and Social Council studied the findings of the
third review and appraisal of the Plan of Action in 1989 and
recommended that the Governments concerned and the international
community give the highest priority to assisting the population
programmes of the least developed countries that had large
populations and high rates of population growth, in particular
those in sub-Saharan Africa. 83/

Priorities according to national Governments

353. Information from the Population Policy Data Bank indicates
that an overwhelming majority - 9 out of 10 developing countries -
consider that they will need the support of international technical
cooperation at least for another decade.  The programme areas that
have been identified by Governments as of the highest priority are
information on population dynamics, followed by population policy
formulation, data collection and processing, and family- planning
programmes.  In spite of the high level of concern expressed by
Governments on many occasions on issues related to population
redistribution, technical cooperation programmes on these issues
have been signalled as having the lowest priority or no priority at
all. 84/  Undependable funding or reduced levels of funding, as
well as slowness in implementation, have been identified by
Governments of countries receiving financial assistance as the two
major difficulties confronted.

354. With respect to the priorities given to the different specific
components of current and future technical cooperation, national
Governments have given the highest preference for computer
equipment and software, as well as in-service and short-term
training programmes.  The lowest priority has been given to the
provision of resident experts.

355. In relation to the technical cooperation programmes among
developing countries, the experience during the period under
consideration has been limited particularly because of the lack of
available resources for such a purpose.  Nevertheless, many
Governments have indicated that in the field of population, such
technical cooperation has an important potential for fostering a
stronger political commitment to the solution of population issues
and facilitating the exchange of similar experiences under similar
conditions.

Priorities according to the multilateral organizations

356. Financial assistance for technical cooperation activities in
the field of population flows from the donor community (Governments
from developed countries and private sources, principally
foundations) to the recipients (developing countries and national
non-governmental organizations) through three major channels: 
bilateral, multilateral and private sector.  According to
information on expenditures for population assistance compiled by
UNFPA (which includes data from 17 donor countries that are members
of the Development Assistance Committee of OECD, 9 multilateral
organizations of the United Nations system and 37 international
non-governmental organizations), in 1991 there were 141 countries
that benefited from financial population assistance.  During the
same year, those 141 countries expended US$ 732 million (39 per
cent was channelled through bilateral, 34 per cent through
multilateral and 27 per cent through non- governmental
organizations). 85/  Data from table 15 indicate an absolute
increase in funds during the period 1982-1991, a proportional
increase in bilateral funds, a relative decline in multilateral
funds and relative proportional stability of non-governmental
resources.  In considering those figures, it should be borne in
mind that many activities included in the Plan of Action and
receiving the support of the international community are not
classified as population assistance but appear under other labels;
this is the case, for example, of technical cooperation to reduce
mortality which usually appears as health assistance.  

==================================================================
      
  Table 15.  Expenditures for population assistance by channel
                  of distribution, 1982-1991 a/
                       (see attached file)
=================================================================

357. According to the same source of information, during the period
1982-1991, the commitments made by donor countries to the field of
population assistance evolved from 1.12 per cent of their official
development assistance in 1982 to 1.34 per cent in 1991 (the
highest value during the period 1982-1991, although the
corresponding figure in the early 1970s was 2 per cent).  The
corresponding values of those commitments as a proportion of gross
national product devoted to population assistance were 0.0071 and
0.0092 per cent respectively.  Such assistance represented US$ 0.18
per capita in 1991 as compared with US$ 0.134 per capita in 1982
(both figures in constant 1985 United States dollars). 86/

358. It is very difficult to find complete information on the
distribution of commitments or expenditures by programme area for
all sources or channels of financial assistance.  UNFPA started in
1985 a biannual compilation of such data for all sources of
population assistance.  Table 16 presents the amount of donor
expenditures by programme area, using the Standard Classification
of Population Activities that has been adopted by ACC and employed
by UNFPA since 1976.  Table 17 shows UNFPA expenditures by
programme distribution; the figures are part of total donor
expenditures.  The distribution by programme area provides an
indication of the priorities established by UNFPA and the donor
community.  In both cases, family-planning activities accounted for
a high proportion of population assistance (with a tendency towards
increase among the total donor community during the period under
consideration); communication and education accounted for the
second highest proportion in 1991, reflecting a trend towards
expansion.  The proportion of assistance for basic data collection,
on the other hand, tended to decrease proportionally during the
period, particularly at UNFPA; the trend was due to increased
national investment in this area and the dependence of such
expenditures on the cycles of census activity.

359. UNFPA was directed by the UNDP Governing Council to allocate
80 per cent of its annual country programme resources to priority
countries by 1994.  Priority countries qualify for priority status
if they first meet a gross national product per capita requirement,
then fall within established threshold levels for two of the
following five criteria:  absolute annual population increase;
infant mortality; fertility; female literacy; and agricultural
population per hectare of arable land.  This ensures that UNFPA
concentrates its assistance on activities in countries most in need
of support.  This strategy also assures that UNFPA support to
national programmes is consistent over time yet flexible enough to
meet changing population programme needs, which are assessed by
UNFPA with independence from external political considerations. 

===============================================================
         
     Table 16.  Total donor expenditures by programme area,
                            1982-1990
                       (see attached file)
                                   
================================================================

        Table 17.  UNFPA expenditures by programme area,
                            1975-1991
                       (see attached file)
                                   
================================================================

360. It is important to acknowledge again some of the major
achievements in the field of technical cooperation during the past
two decades.  Among them was the recognition, among the donor
community and Governments in the developing countries, that
population was an important component of the development equation,
and that technical cooperation was a key complement to national
efforts but never a substitute for them.  The donor community has
been respectful of the sovereign right of countries to define their
national population programmes and the neutrality exhibited by
multilateral assistance has been highly appreciated by developing
countries.  Technical cooperation activities have been better
employed by countries having a strong political commitment and
institutional support, including the competence to coordinate such
assistance, as well as the appropriate provision of local human and
budgetary resources.  Many examples illustrate that technical
cooperation was rendered more productive where national Governments
worked in strong partnership with the private sector, community
organizations and other grass-roots non-governmental organizations.

361. To meet future needs, just in the area of human reproduction,
additional resources are required for expanding services to respond
to the unmet demand for family planning, and particularly for
creating the social and economic conditions that are more conducive
to reducing the demand for additional children.  However, it is
also essential that those resources be used effectively. 
Adequately estimating resource requirements and planning their
effective utilization require accounting for a variety of programme
elements, in terms of what they will contribute to the satisfaction
of unmet needs and what they will cost.  It is important to take
into account that the future expansion of services should satisfy
both current unmet needs and the future demand generated by the
improvement in the quality of current services and the adoption of
better strategies.  Indeed, the pressures of increased numbers to
be served, combined with the budget squeezes in which many
developing countries now find themselves, could erode service
quality and further swell the pool of the underserved.

362. Future technical cooperation is crucial for achieving the
population goals and objectives agreed upon by the international
community.  Increased funding, based on careful assessments of
resource requirements, is fundamental.  It is currently estimated
that international assistance would need to cover about one third
of the total cost of the major components of population programmes
in the developing countries.  The Amsterdam Declaration of 1989
called for a doubling of the level of annual global funding of
population and reproductive health programmes in the developing
countries, from US$ 4.5 billion to US$ 9 billion by the end of the
1990s.  Some progress has been made in moving towards this goal,
but it is still far from clear that it will be reached.

363. In the context of the preparatory activities for the 1994
International Conference on Population and Development, it has been
estimated that the total annual cost of four basic packages of
population activities would be (in 1993 United States dollars) US$
17.0 billion in the year 2000 and US$ 21.7 billion in 2015,
decomposed as follows:

     (a)  A core package composed of family-planning commodities
and service delivery; many components of primary health care and
maternal and child health; information, education and communication
activities; family-planning training; and management information
activities.  Cost:  US$ 10.2 billion in the year 2000 and US$ 13.8
billion in 2015;

     (b)  An expanded package for reproductive health care going
beyond the usual components of family-planning programmes but still
feasible in the context of primary health care:  education and
services for prenatal, normal delivery and postnatal care;
prevention and treatment of reproductive health conditions,
including infertility; information, education and counselling on
human sexuality, sexual and reproductive health, and responsible
parenthood; and referral of sexually transmitted diseases and
HIV/AIDS.  Cost:  US$ 5.0 billion in the year 2000 and US$ 6.1
billion in 2015;

     (c)  A third package of activities for the prevention of
sexually transmitted diseases (including HIV infection) consisting
of mass media and school education programmes and expanded condom
distribution.  Cost:  US$ 1.3 billion in the year 2000 and US$ 1.5
billion in 2015;

     (d)  A fourth package of activities that include population
data collection, analysis and dissemination, and policy
formulation.  Cost:  US$ 220-700 million per annum (depending on
the decennial population census cycle).

               

      Issue No. 28.  Strengthening the population programme
                  of the United Nations system

364. Since its inception, the United Nations has been involved in
a variety of population activities.  During the past two decades,
more than 20 units, bodies and organizations of the United Nations
system have been carrying out activities that include, inter alia,
data collection, research and analysis, dissemination of
information, training, provision of technical cooperation and
financial assistance, and monitoring and evaluation of projects and
programmes.  Such activities are coordinated by the Economic and
Social Council and for this purpose, the Council is advised by the
Population Commission.  The Population Commission was established
in 1946 and its terms of reference remained almost unchanged until
the 1974 World Population Conference, when the Council requested
the Commission to examine on a biennial basis the implementation of
the Plan of Action and to contribute to its quinquennial review and
appraisal.  After the 1984 International Conference on Population,
the Council reaffirmed the role of the Commission as the principal
intergovernmental body to arrange for studies and advise the
Council on population matters. 87/

Population activities of the United Nations system

365. Within the Department for Economic and Social Information and
Policy Analysis of the United Nations Secretariat there are two
important units:  the Population Division and the Statistical
Division.  The Population Division, which is the technical
secretariat of the Population Commission, is in charge of
monitoring world population trends and policies through the study
of mortality, fertility, internal and international migration and
urbanization, and other demographic phenomena, as well as of
coordinating the quinquennial review and appraisal of the progress
made in achieving the goals and objectives of the Plan of Action. 
It also estimates and projects population size and structure,
examines the relationships among population change, resources, the
environment and socio-economic development, participates in
technical cooperation activities, and houses the coordinating unit
of the global Population Information Network (POPIN) mentioned in
paragraph 243 above.  The Statistical Division, which is the
technical secretariat of the Statistical Commission, collects,
compiles and disseminates demographic and related statistics
produced by Governments; it engages in the research and development
of methods of data collection on population and housing censuses,
civil registration and vital statistics, and household surveys, and
promotes the development of demographic statistical databases for
population and development analysis; it also prepares handbooks and
technical studies, and participates in technical cooperation
activities.

366. A trust fund for population activities was established in July
1967 by the Secretary-General; two years later, it was renamed the
United Nations Fund for Population Activities (UNFPA) and was put
under the administration of UNDP.  At present, the Fund supports
population programmes in 137 countries and territories and has
field offices, each headed by a country director, in 58 of them. 
Assistance at the country level is being provided, in most cases,
as part of a country programme that defines the objectives and
strategy for UNFPA assistance in the framework of national
population and development objectives.  Those country programmes,
which used to be based on "needs assessment" exercises, have been
developed since 1988 on the basis of programme review and strategy
development (PRSD) exercises.  UNFPA also funds regional and
interregional activities and services that supplement and
complement activities at the country level.  For example, the Fund
extends technical assistance and advisory services to country
programmes through its recently established Country Support Teams
(CSTs) system.  That system, which became operational in 1992,
comprises eight multidisciplinary teams located in the developing
regions.  Participating in the CSTs system are the Department for
Economic and Social Information and Policy Analysis of the United
Nations Secretariat, the regional commissions, ILO, FAO, UNESCO,
WHO and non-governmental organizations.

367. Each of the five regional commissions has a population unit
whose programme of work includes research and analysis,
dissemination of information and, in some cases, also technical
cooperation.  The specific contents of their programmes of work
vary according to the characteristics of each region and are
supervised by the corresponding regional intergovernmental body. 
Some of the regions have adopted regional programmes or plans of
action that are reviewed every 10 years and may be conceived as the
regional variants of the World Population Plan of Action.

368. Other programmes and bodies of the United Nations include in
their programmes of work population-related activities.  The United
Nations Centre for Human Settlements (Habitat) assists countries in
some actions that have implications for the distribution of
population over the territory concerned.  UNICEF cooperates with
countries in their activities pertaining to the protection of
children and participates in family-planning actions that are part
of maternal and child health programmes.  The United Nations
Conference on Trade and Development (UNCTAD) includes in its
programme of work activities related to the situation of migrant
workers and other population matters related to international
trade.  UNEP has been involved in research and analysis on the
relationships among population, resources and the environment. 
After the 1992 United Nations Conference on Environment and
Development, it was planned that UNEP and the Department for Policy
Coordination and Sustainable Development of the United Nations
Secretariat would strengthen their efforts in this area.  UNHCR is
in charge of providing protection to refugees, finding durable
solutions to their problems and dispensing assistance towards
self-sufficiency and emergency relief.  Finally, the World Food
Programme (WFP), in addition to its many activities that have a
clear impact on morbidity and mortality levels, has many programmes
that include components affecting fertility or migration patterns.

369. Some of the specialized agencies undertake population
activities and their work is coordinated by the Economic and Social
Council.  Their activities include, in general, research and
analysis, technical cooperation, and dissemination of information. 
IL0 conducts research on the demographic aspects of employment and
social security, provides information on family planning and other
population-related matters, and assists Governments in
formulating/implementing their population policies, as well as in
establishing their population units.  FAO provides advice and
technical assistance to countries on matters related to rural
populations; its programme of work also includes research and
analysis, and population education and communication aimed at
creating awareness.  UNESCO concentrates its work on the creation
of awareness about population issues and assists countries in their
population information, education and communication programmes. 
WHO assists countries in the provision of family planning within
maternal and child health-care systems, education and training for
health workers, research and training in human reproduction,
development of technologies in maternal and child health care, and
promotion of breast-feeding and the use of appropriate weaning
foods and nutrition programmes.  The United Nations Industrial
Development Organization (UNIDO) has in its programme of work
activities related to population, such as the local production of
contraceptives.  Finally, the World Bank provides financial
assistance in the field of population, directly or through its
concessional lending affiliate, the International Development
Association (IDA), in the form of credits and loans to borrowers. 
The Bank also conducts research in and analysis of population and
economic conditions at the global level and in those developing
countries in which population and development are matters of
concern.

Coordination

370. There are various mechanisms that ensure the harmonization,
cooperation and coordination of population activities within the
United Nations system.  The Committee for Programme and
Coordination (CPC), a standing committee of the Economic and Social
Council, and the principal subsidiary body dealing with matters
related to planning, programming and coordination, assists both the
Council and the General Assembly in their sector-by-sector
examination of the programme of work of the United Nations to
guarantee the harmonization and complementarity of the different
activities.  CPC also proposes guidelines and recommends actions to
appropriate units and organizations on their programmes of work and
carries out assessments of legislative decisions on matters
pertaining to coordination of activities.  Population is one of the
topics that has been included in the programme of work of CPC. 
After the 1984 International Conference on Population (Mexico
City), it was agreed that relevant portions of the report of the
UNDP Governing Council (the body then overseeing UNFPA's programme)
should be made available to the Population Commission and vice
versa.

371. ACC was established in 1947 as an inter-agency structure to
ensure harmonization, cooperation and coordination within the
United Nations system.  It is composed of the executive heads of
the agencies, programmes and organs of the system and is chaired by
the Secretary-General himself.  An ACC Subcommittee on Population
functioned between 1968 and 1977 as an inter-agency coordinating
entity but was abolished in 1977, as a result of the restructuring
of the social and economic sectors of the United Nations system. 
Nevertheless, in 1979 ACC established the Ad Hoc Inter-agency
Working Group on Demographic Estimates and Projections.  As part of
the preparatory work of the 1984 and 1994 population conferences,
ACC established ad hoc task forces for those conferences.

372. In addition to the safe motherhood initiative mentioned in
issue No. 14 above, other important coordinating mechanisms in the
field of population include the Inter-Agency Consultative Committee
(IACC), which was established by UNFPA in 1970 to discuss the
Fund's programmes, policies, procedures and coordination issues;
and the Joint Consultative Group on Policy (JCGP), which was
established in 1981 by the executive heads of UNICEF, UNDP, UNFPA
and WFP to promote the consideration of child survival, family
planning and the needs of vulnerable groups in their programmes of
work.  JCGP has been very active in other areas such as women and
development, structural adjustment, training of personnel, and
programme collaboration and coordination in Africa (including the
sharing of common premises and services).

373. Population has been recognized as one of the fields where the
United Nations has been successful.  In spite of the controversial
character of population issues, the United Nations has served as a
forum for open debate on such issues and the negotiation of common
strategies.  Through its programme of research and analysis, it has
accomplished pioneering work in the development of new
methodologies for demographic data collection, demographic
analysis, and, particularly, in creating awareness of the key role
that population variables play in social and economic development. 
Its activities in technical cooperation and financial assistance
have been appreciated by developing countries because of the
neutral character of multilateral assistance and the high quality
of the services provided.  Population is one area where effective
coordination has been demonstrated within the United Nations
system.  Since the role of the United Nations in the field of
population has been recognized by the international community and
the public in general, and because of the growing interest of
countries in this area, the population programme of the United
Nations needs to be strengthened.

374. Although the Population Commission guides only the work
programme of the Population Division of the Department for Economic
and Social Information and Policy Analysis of the United Nations
Secretariat, it also receives periodic reports from UNFPA, as well
as reports on the activities of the United Nations system
(including the World Bank) and intergovernmental and
non-governmental organizations.  Furthermore, at every session of
the Population Commission, representatives of the Statistical
Division, the United Nations regional commissions, programmes and
bodies, and the specialized agencies make statements on their
organization's activities.  This de facto arrangement has
facilitated the work of the Economic and Social Council with
respect to its coordination function within the system, although de
jure the Commission does not have such a mandate.  Therefore, the
strengthening of the population programme of the United Nations
also requires the strengthening of the corresponding
intergovernmental machinery. 

         XIV.  PARTNERSHIP WITH NON-GOVERNMENTAL SECTORS

375. It is widely recognized that many of the socio-economic issues
that are part of the work programme of the United Nations at
present were covered in the pioneering activities of
non-governmental organizations before the United Nations decided to
confront them.  Non-governmental organizations have been
established on a voluntary basis by individuals or groups
interested in a particular issue.  Their purposes are diverse: 
some of them are professional associations (for example, of public
health workers); others are groups consisting of a particular
segment of the population (for example, the elderly and women);
others are affiliate members of a specific religion or political
orientation; some are interested in a particular humanitarian
cause; others are organizations devoted to teaching, conducting
research or disseminating information.

376. Non-governmental organizations can be local, national or
international, or they can belong to the profit-oriented private
sector.  Those having an international status may have national or
local affiliates, but the majority of them carry out their
activities within the boundaries of their country.  Those in the
private sector, including national and transnational corporations
and their representative associations, play a valuable role in the
social and economic development of the world.  In many instances,
they have the capability and capacity to produce and deliver goods
and services in an efficient manner.  They are able to use
available communications facilities to conduct a dialogue with
their staff and the public, and to take voluntary initiatives in
the social sphere.  The Charter of the United Nations (Article 71)
deems that the Economic and Social Council may make suitable
arrangements for consultation with non-governmental organizations
that are concerned with matters within its competence.  For this
purpose, the Council has established a series of mechanisms and
procedures for the granting of consultative status to such
organizations. 88/  In this task, the Council is assisted by the
Committee on Non-Governmental Organizations. 

        Issue No. 29.  Strengthening the partnership with
                    non-governmental sectors

377. In the field of population, many non-governmental
organizations have been conducting research, creating awareness and
providing services well in advance of many Governments and
intergovernmental organizations.  On many occasions, once national
Governments had decided to act in a particular field,
non-governmental organizations worked in partnership with the
public sector in the delivery of services and implementation of
programmes.  Such collaboration has been instrumental in ensuring
that national policy goals are achieved.  Non-governmental
organizations have also acted as catalysts for change, often
serving as a voice for previously unrecognized concerns, reaching
underserved groups, setting quality standards more responsive to
the needs of beneficiaries, and developing innovative and
cost-effective approaches.

378. Many of the non-governmental organizations that participate in
the work of the United Nations have an international character and
are not-for-profit.  Nevertheless, in the field of population, at
both the international and particularly the national levels, there
is a substantial number of for-profit organizations that have
contributed greatly to the understanding of population issues and
to the implementation of programmes, through contract work
performed for government agencies as well as for other
non-governmental organizations and for the United Nations system. 
In many countries, population activities have benefited from the
strengthening of the private sector; the private, profit- oriented
sector is in many cases contributing to the development of local
financial, managerial and technological capacity for the production
and distribution of commodities and services in an effective and
cost-efficient manner.  In such instances, an increasing number of
Governments are tending to rely more on the effectiveness of the
private sector, thus creating new forms of partnership.

379. Another cluster of non-governmental organizations that are
receiving increased attention is that consisting of local community
organizations.  Some of them have been created by the public
sector, while others came into existence by the will of the
communities themselves.  In terms of their character, they exhibit
a wide range extending from simple kinship structures to more
complex political, social, economic, religious and educational
groups.  Because their existence usually transcends the short life
duration of other types of organizations, for local communities,
particularly those that are isolated from the mainstream of
national life, they are an important (if not the only) source of
social cohesion, thereby providing support to the needs of families
and individuals.  Finally, considering their proximity to the grass
roots of society, local community organizations are an important
link with local governments and other non-governmental
organizations, thus forming part of the network that constitutes
the fabric of society.

380. The significant financial contribution of non-governmental
organizations to population activities is another illustration of
their particular interest in this area.  Data presented in table 15
indicate that during the period 1982-1991, of the total
expenditures for population assistance (US$ 1,532.3 million) one
third was channelled through international non-governmental
organizations, of which about US$ 400 million (26 per cent) was
committed directly by the non-governmental organizations
themselves. 89/  Such figures constitute just a small visible part
of the iceberg because they refer only to international
non-governmental organizations:  If the contribution made by
national, and particularly local, non-governmental organizations
were added to those figures, the total would be significantly
higher.

381. Taking into account the mutual benefits obtained from the
closer collaboration between non-governmental organizations and the
United Nations, as a follow-up to the Mexico City International
Conference on Population, the Economic and Social Council requested
the Secretary-General to prepare periodic reports on the work of
intergovernmental and non-governmental organizations in the
implementation of the World Population Plan of Action.  To date,
four of such reports have been prepared, covering an increasing
number of organizations, and providing the Population Commission
and the Council with valuable information on the characteristics
and scope of the organizations, their human and financial
resources, and their areas of work.

382. The report of the Secretary-General on the work of
intergovernmental and non-governmental organizations in the
implementation of the World Population Plan of Action
(E/CN.9/1994/7), prepared for submission to the Population
Commission at its twenty-seventh session (March 1994), includes a
listing of 135 international non-governmental organizations that
carry out important population activities; close to half of them
are not in consultative status with the Economic and Social
Council, either because they have not applied for such status or
because they are for-profit organizations, although their
activities are very close to the goals of the Plan of Action. 
Among the organizations that should be mentioned because of their
significant contribution to the population field are:

     (a)  The International Planned Parenthood Federation (IPPF),
which was established in 1952, and is the largest international
private voluntary organization.  It affiliates independent
family-planning associations in over 135 countries;

     (b)  The Population Council, which was also created in 1952,
and is involved in biomedical research in the field of human
reproduction, social science research, and technical cooperation in
family planning and other population-related programmes;

     (c)  The International Union for the Scientific Study of
Population (IUSSP), which was established in 1924, and is the
leading international professional association for individuals in
the field of population.  It groups close to 2,000 professionals
from 124 different countries.

383. Recognizing the pioneering role and the important contribution
of non-governmental organizations, the Plan of Action invited them
to collaborate in the implementation of the Plan of Action and
urged Governments to utilize fully the support of intergovernmental
and non-governmental organizations (para. 96).  The International
Conference on Population (Mexico City) not only recognized and
commended the contributions of non-governmental organizations but
also emphasized the involvement of those organizations and urged
Governments to encourage the innovative activities of
non-governmental organizations and to draw upon their expertise,
experience and resources in implementing national programmes
(recommendation 84).  Therefore, enhancing the partnership with
non-governmental organizations will generate mutual benefits for
local and national Governments, the United Nations and the
non-governmental organizations themselves. 

              XV.  MONITORING, REVIEW AND APPRAISAL

         Issue No. 30.  Monitoring, review and appraisal

Monitoring of population trends, policies and programmes

384. The World Population Plan of Action recommended that a
monitoring of population trends and policies should be undertaken
continuously as a specialized activity of the United Nations and
reviewed biennially by the appropriate bodies of the United Nations
system (para. 107).  The Mexico City recommendations added that the
monitoring of multilateral population programmes of the United
Nations system aimed at the further implementation of the World
Population Plan of Action should be undertaken by the
Secretary-General of the United Nations, through appropriate
arrangements (recommendation 88). 90/

385. The monitoring of population trends is an activity that has
been undertaken continuously since the initiation of the population
programme of the United Nations in 1946.  The first United Nations
Population Inquiry among Governments was made in 1963-1964, with 53
Governments and the Holy See responding on their perceptions and
policies.  The results were instrumental in triggering a series of
actions that were initiated by the Population Commission (March
1965), endorsed by the Economic and Social Council (July 1965), and
finally ratified by the General Assembly, authorizing, inter alia,
the provision of assistance for national family-planning
programmes. 91/  However, it was only after 1974 that the United
Nations received the mandate to conduct the monitoring of trends
and policies in a systematic manner.

386. Within the United Nations, the Population Division of the
Department for Economic and Social Information and Policy Analysis
of the United Nations Secretariat is responsible for conducting and
reporting on the monitoring of population trends and policies
biennially, in collaboration with other units, bodies and
organizations of the United Nations system.  The first in the
series of monitoring reports was prepared and published in 1977 and
succeeding reports in 1979, 1981, 1983, 1987, 1989 and 1991.  A
concise version of the report is also prepared and published
biennially.  The report usually includes a wide range of
information about basic population variables and the views and
policies adopted by national Governments on such topics as
population growth and size; mortality; fertility; urbanization;
internal and international migration; and the main structural
elements, namely, sex, age, labour force participation, demographic
dependency and groups of special social and economic importance. 
The report also includes information on the interrelationships
between population and other areas such as employment, women, food
and nutrition, and socio-economic development and the environment. 
During the past bienniums, the report also contained a more
detailed treatment of a special topic such as key issues in
fertility and mortality; population trends and policies among the
least developed countries; age structure; and refugees.  Major
sources of information include the outcome of demographic
assessments, demographic research and studies, the findings of the
United Nations Population Inquiries among Governments (the seventh
of which has just been completed), and other relevant information
available in the Population Policy Data Bank maintained by the
Population Division.

387. A series of mechanisms have been established for the purpose
of monitoring the multilateral population programmes of the United
Nations system, since the United Nations received the mandate to
participate in technical cooperation activities and to provide
financial assistance.  The Mexico City International Conference on
Population requested the Secretary-General to undertake the
monitoring of multilateral population programmes of the United
Nations system aimed at the further implementation of the World
Population Plan of Action.  In his report on the follow-up to
General Assembly resolution 39/228 (A/41/179- E/1986/18), the
Secretary-General recommended that UNFPA continue to monitor the
multilateral population programmes and projects that it funds.  The
first report on multilateral population assistance was prepared in
1989 (E/1989/12), the second in 1991 (E/CN.9/1991/8) and the third
in 1994 (E/CN.9/1994/6).

388. Also, as a follow-up to the Mexico City recommendations, the
Economic and Social Council requested the Secretary-General to
submit periodic overviews of the activities of the United Nations
system in the field of population and periodic reports on the
activities of intergovernmental and non-governmental organizations
in the implementation of the Plan of Action (Council resolutions
1985/4, 1986/7 and 1987/72).

389. With these reports, the United Nations governing bodies and
national Governments have a general overview of the level of
implementation of the Plan of Action.  More exactly, these reports
provide information on population trends and tendencies,
governmental views on these trends, and activities that have been
undertaken by Governments, by the United Nations system and by
other intergovernmental organizations, as well as by
non-governmental organizations.  Information concerning bilateral
assistance, as mentioned above, is periodically collected by UNFPA
and by OECD.

Review and appraisal of the World Population Plan of Action

390. The Plan of Action also specifies that a comprehensive and
thorough review and appraisal of progress made towards achieving
the goals and recommendations of the Plan of Action should be
undertaken every five years by the United Nations system, and that
the findings of such systematic evaluations should be considered by
the Economic and Social Council with the object of making, whenever
necessary, appropriate modifications of the goals and
recommendations of the Plan of Action (para. 108).  The
International Conference on Population simply reiterated these
provisions.

391. In accordance with the above provisions, the Population
Division of the Department for Economic and Social Information and
Policy Analysis of the United Nations Secretariat has had the
responsibility for coordinating the four assessments that have been
undertaken.  The first (1979) was conducted with the assistance of
an Ad Hoc Group of Experts on Review and Appraisal of the World
Population Plan of Action; the findings of the Fourth Population
Inquiry among Governments, along with input from the regional
commissions, the specialized agencies and other United Nations
bodies and organizations, contributed to the assessment, mainly
through the aforementioned Subcommittee on Population of ACC.  The
results were presented to the Population Commission and the
Economic and Social Council, and the Council approved the findings
and adopted 16 recommendations for the further implementation of
the Plan. 92/

392. The Economic and Social Council decided that the 1984
population conference should be devoted to the discussion of
selected issues of the highest priority, with the aim of
contributing to the process of review and appraisal of the World
Population Plan of Action and to its further implementation. 93/ 
Inter-agency participation for preparing the report was provided
through the ACC Ad Hoc Task Force for the Conference mentioned
above.  The report was submitted to the Preparatory Committee for
the Conference and their comments were used to prepare a revised
version that was presented to the International Conference on
Population.  Subsequently, on the basis of the deliberations held
at the Conference, a final version was prepared. 94/  The
Conference produced 88 recommendations for the further
implementation of the Plan of Action.

393. The third assessment was produced in 1989.  It concentrated on
a set of 31 selected issues.  This time, inter-agency participation
was provided by the former Consultative Committee on Substantive
Questions (Programme Matters) of ACC.  The results of the Sixth
Population Inquiry among Governments, as well as the responses from
intergovernmental and non-governmental organizations, were
important sources of information.  The Population Commission
recommended the approval of the report and the adoption of 13
recommendations by the Council. 95/

394. From the above presentation, it follows that important
progress has been made in the directions set forth in the Plan of
Action.  The findings of the present report invite to conclude,
using the same words employed by the Economic and Social Council
after reviewing the findings of the third review and appraisal of
the Plan of Action, that the World Population Plan of Action is an
international instrument that has served as a standard reference
and continues to rest firmly on a global consensus.  Although there
are many reasons for such achievements, it is important to
emphasize the benefits that have resulted from bringing together
the political will of Governments, and the scientific and
professional skills of many units of the United Nations and of
numerous academic centres and professional associations and other
non-governmental organizations. 96/ 

                              Notes

     1/   Report of the United Nations World Population Conference,
1974, Bucharest, 19-30 August 1974 (United Nations publication,
Sales No. E.75.XIII.3), chap. I.

     2/   See Review and Appraisal of the World Population Plan of
Action (United Nations publication, Sales No. E.79.XIII.7); Review
and Appraisal of the World Population Plan of Action:  1984 Report
(United Nations publication, Sales No. E.86.XIII.2); and Review and
Appraisal of the World Population Plan of Action:  1989 Report
(United Nations publication, Sales No. E.89.XIII.11).

     3/   See Report of the International Conference on Population,
1984, Mexico City, 6-14 August 1984 (United Nations publication,
Sales No. E.84.XIII.8 and corrigenda), chap. I, sect. B (III and
IV).

     4/   Official Records of the Economic and Social Council,
1989, Supplement No. 6 (E/1989/24), paras. 11-21.

     5/   See "Report of the ACC Ad Hoc Task Force for the
International Conference on Population and Development, 1994"
(ACC/1992/22), para. 17; and "Report of the ACC Ad Hoc Inter-Agency
Meeting for the International Conference on Population and
Development" (ACC/1993/17), para. 10.

     6/   World Population Monitoring, 1991, Population Studies,
No. 126 (United Nations publication, Sales No. E.92.XIII.2).

     7/   World Population Monitoring, 1993 (United Nations
publication, forthcoming).

     8/   Economic and Social Council resolution 1981/87, para. 3.

     9/   General Assembly resolution 45/199 of 21 December 1990,
annex (General Assembly resolutions 1710 (XVI) and 1715 (XVI) on
the first United Nations Development Decade were adopted on 19
December 1961.  Assembly resolution 2626 (XXV) on the International
Development Strategy for the Second United Nations Development
Decade was adopted on 24 October 1970.  The International
Development Strategy for the Third United Nations Development
Decade is contained in Assembly resolution 35/56 (adopted 5
December 1980), annex).

     10/  See Review and Appraisal ... 1984 Report ... chap. I,
introductory paragraphs.

     11/  See General Assembly resolution S-18/3 of 1 May 1990,
annex, para. 2.

     12/  General Assembly resolution 41/128 of 4 December 1986,
annex.

     13/  See Review and Appraisal ... 1984 Report ... chap. I,
section on "Food and agriculture".

     14/  See Review and Appraisal ... 1989 Report ... chap. I,
para. 8.

     15/  For a full assessment, see FAO/WHO, Nutrition and
Development:  A Global Assessment, International Conference on
Nutrition (Rome, December 1992).

     16/  Our Common Future.  The Report of the World Commission on
Environment and Development (Oxford and New York, Oxford University
Press, 1987).

     17/  Report of the International Forum on Population in the
Twenty-first Century, Amsterdam, the Netherlands, 6-9 November 1989
(New York, United Nations Population Fund, 1990), annex.

     18/  The Challenge to the South:  The Report of the South
Commission (New York, Oxford University Press, 1990).

     19/  Report of the United Nations Conference on Environment
and Development, Rio de Janeiro, 3-14 June 1992, vol. I, Resolution
Adopted by the Conference (United Nations publication, Sales No.
E.93.I.8 and corrigendum), resolution 1, annex II.

     20/  Ibid., paras. 5.5, 5.17 and 5.43.

     21/  See document A/45/327, para. 76.

     22/  See document E/C.7/1991/8, in particular para. 82.

     23/  See Report of the International Conference on Water and
the Environment:  Development Issues for the Twenty-first Century,
26-31 January 1992, Dublin, Ireland.  The Dublin Statement and
Report of the Conference (Geneva, World Meteorological
Organization, 1992). 

     24/  General Assembly resolution 41/170, para. 8.

     25/  General Assembly resolution 217 (III) A.

     26/  See Report of the ... Conference on Environment ...,
para. 24.1.

     27/  See Report of the World Conference on Human Rights,
Vienna, 14-25 June 1993 (A/CONF.157/24 (part I)).

     28/  For the World Plan of Action for the Implementation of
the Objectives of the International Women's Year, see Report of the
World Conference of the International Women's Year, Mexico City, 19
June-2 July 1975 (United Nations publication, Sales No. E.76.IV.1),
chap. II, sect. A.

     29/  General Assembly resolution 34/180 of 18 December 1979,
annex.

     30/  See Report of the World Conference of the United Nations
Decade for Women:  Equality, Development and Peace, Copenhagen, 14
to 30 July 1980 (United Nations publication, Sales No. E.80.IV.3
and corrigendum).

     31/  Report of the World Conference to Review and Appraise the
Achievements of the United Nations Decade for Women:  Equality,
Development and Peace, Nairobi, 15-26 July 1985 (United Nations
publication, Sales No. E.85.IV.10), chap. I, sect. A.

     32/  See The World's Women, 1970-1990:  Trends and Statistics
(United Nations publication, Sales No. E.90.XVII.3).  An updated
version of the report is being prepared by the Statistical Division
of the Department for Economic and Social Information and Policy
Analysis of the United Nations Secretariat, as part of the
preparations for the Fourth World Conference on Women (Beijing,
1995).

     33/  Report of the Secretary-General entitled "Priority
themes:  Equality:  Elimination of de jure and de facto
discrimination against women" (E/CN.6/1992/7), para. 5.

     34/  See The World's Women, 1970-1990 ..., p. 89.

     35/  The singulate mean age at marriage is a good estimate of
the average age at marriage obtained from census figures and
independent of differences in the age distribution of the
population.

     36/  World Population Prospects:  The 1992 Revision (United
Nations publication, Sales No. E.93.XIII.7).

     37/  See World Population Monitoring, 1993 (United Nations
publication, forthcoming).

     38/  See the Standard Rules on the Equalization of
Opportunities for Persons with Disabilities, contained in General
Assembly resolution 48/96, annex.

     39/  See General Assembly resolution 47/75.

     40/  See First Call for Children (New York, United Nations
Children's Fund, 1990), or A/45/625, annex, for the World
Declaration on the Survival, Protection and Development of Children
and the Plan of Action for Implementing the World Declaration on
the Survival, Protection and Development of Children in the
1990s, adopted at the World Summit for Children, held in New York
in September 1990.  These instruments recognized that the
implementation of the Convention on the Rights of the Child
(adopted by the General Assembly in 1989), is essential to
improving children's lives.  At the end of 1993, 154 countries
had ratified the Convention. 

     41/  See Report of the World Assembly on Ageing, Vienna, 26
July to 6 August 1982 (United Nations publication, Sales No.
E.82.I.16), chap. VI, sect. A, containing the International Plan of
Action on Ageing.

     42/  See World Population Monitoring, 1993 ... .

     43/  See Patterns of Fertility in Low-fertility Settings
(United Nations publication, Sales No. E.92.XIII.11), table. 1.

     44/  See Population and Human Rights:  Proceedings of the
Expert Group Meeting on Population and Human Rights, Geneva, 3-6
April 1989 (United Nations publication, Sales No. E.91.XIII.8).

     45/  See Abortion Policies:  A Global Review, vol. I,
Afghanistan to France (United Nations publication, Sales No.
E.92.XIII.8); vol. II, Gabon to Norway (United Nations publication,
Sales No. E.94.XIII.2); and vol. III, Oman to Zimbabwe (United
Nations publication, forthcoming).

     46/  Ibid.

     47/  See World Population Monitoring, 1993 ... .

     48/  The estimates of contraceptive availability are
approximate, based on country-specific estimates provided by
knowledgeable observers (see World Population Monitoring, 1993).

     49/  Ibid.

     50/  Ibid.

     51/  UNFPA, "Future contraceptive requirements and logistics
management needs", paper presented at the Expert Group Meeting on
Family Planning, Health and Family Well-being (Bangalore, 26-30
October 1992).

     52/  See document E/CONF.84/PC/6.

     53/  See document E/CONF.84/PC/7.

     54/  The figures on life expectancy at birth and infant
mortality rates are taken from World Population Prospects:  The
1992 Revision.

     55/  Ibid., chap. III, sect. G (a).

     56/  See Economic and Social Council resolution 1989/92,
annex, sect. B, recommendation 6.  That resolution is contained in
Review and Appraisal ... 1989 Report ... .

     57/  See Review and Appraisal ... 1989 Report ..., para. 35.

     58/  See World Bank/WHO/UNFPA.  Preventing the Tragedy of
Maternal Deaths: Report on the International Safe Motherhood
Conference, Nairobi, Kenya, February 1987 (Washington, D.C., World
Bank, 1987).

     59/  See World Population Prospects:  The 1992 Revision ...
chap. III.

     60/  See General Assembly resolution 43/15.

     61/  The data used in this discussion are from World
Urbanization Prospects:  The 1992 Revision (United Nations
publication, Sales No. E.92.XIII.11).

     62/  Unlike the World Population Plan of Action or the
recommendations, resolutions and decisions adopted by the
International Conference on Population (Mexico City), ILO
conventions are international legal instruments that enter into
force and become binding upon ratification by the States parties to
such conventions.  In effect, they become part of the States' laws
and thus overrule contrary domestic laws.  Moreover, their
application is supervised by an independent international committee
of experts.

     63/  General Assembly resolution 45/158 of 18 December 1990,
annex.

     64/  See General Assembly resolution 428 (V) of 14 December
1950, annex, para. 6 (A) (ii).

     65/  See OAU Convention Governing the Specific Aspects of
Refugee Problems in Africa, 1969 (1001 UNTS 45).

     66/  Refugee statistics available to UNHCR as at 30 June 1992
(EC/1992/SC.2/CRP.27).  The Executive Committee of the Office of
the United Nations High Commissioner for Refugees recently stated
(A/AC.96/804, para. 32 (r)) that it recognized the difficulties
associated with the compilation of refugee statistics but, given
the importance of such statistics especially for gender-sensitive
programme planning, urged UNHCR to pursue the proposals as set out
in its Information Note on UNHCR's Refugee Statistics
(EC/1992/SC.2/CRP.16).

     67/  Official Records of the General Assembly, Forty-seventh
Session, Supplement No. 12A (A/47/12/Add.1).

     68/  General Assembly resolution 47/105, para. 3.

     69/  Ibid., para. 9.

     70/  Report of the United Nations Conference on Environment
and Development, ..., para. 40.18.

     71/  Other periodic publications of the United Nations that
systematically include substantive analyses of population issues
are the annual World Economic Survey and the Report on the World
Social Situation.

     72/  Report of the United Nations Conference on Environment
and Development, Rio de Janeiro, 3-14 June 1992, vol. I,
Resolutions Adopted by the Conference (United Nations publication,
Sales No. E.93.I.8 and corrigendum), resolution 1, annex I.

     73/  According to the British Broadcasting Corporation,
between 1985 and 1991 the number of television receivers had
increased by 57 per cent in Latin America, by 81 per cent in
sub-Saharan Africa, by 95 per cent in the Arab world, by 168 per
cent in China (tripling in six years), and by 1,639 per cent in
India (almost doubling every year).

     74/  See Report of the International Forum on Population in
the Twenty- first Century ... .

     75/  See General Assembly resolution 44/210, para. 2.

     76/  United Nations publication, Sales No. E.90.XVII.3.

     77/  Review and Appraisal ... 1989 Report ..., para. 65.

     78/  See Report of the International Forum on Population in
the Twenty- first Century ..., p. 9.

     79/  "Kilimanjaro Programme of Action for African Population
and Self- Reliant Development" (E/ECA/CM.10/14, annex II).  This
document was adopted by the Second African Population Conference
and endorsed by the Economic Commission for Africa, at its
nineteenth session, held from 26 to 30 April 1984.  The Programme
of Action was also the African contribution to the 1984
International Conference on Population (see E/CONF.76/6, annex V).

     80/  "Report of the Third African Population Conference,
Dakar, Senegal, 11-12 December 1992" (E/CONF.84/PC/13), annex,
annex II.

     81/  See the Denpasar Declaration on Population and
Development, adopted at the Ministerial Meeting on Population of
the Non-Aligned Movement, Bali, 9-13 November 1993 (A/48/746, annex
III).

     82/  General Assembly resolution 44/211, para. 25.

     83/  Economic and Social Council resolution 1989/92, annex,
recommendation 13 (reproduced in Review and Appraisal ... 1989
Report ...).

     84/  This information refers to the aggregate situation of the
group of developing countries.  The countries belonging to the
ECLAC region usually give a higher priority to cooperation in the
field of population redistribution than countries belonging to
other regions.

     85/  UNFPA, Global Population Assistance Report, 1982-1991
(New York, 1993), p. 18.

     86/  Ibid., table 3, and addendum, tables A.2 and A.3.

     87/  Economic and Social Council resolution 1985/4 of 28 May
1985, para. 1.  See also Council resolutions 3 (III) of 3 October
1946 and 150 (VII) of 10 August 1948, and decisions 87 (LVIII) and
89 (LVIII) of 6 May 1975.

     88/  See Economic and Social Council resolution 1296 (XLIV) of
23 May 1968.

     89/  Data obtained from UNFPA, Global Population Assistance
Report, 1982-1991 ..., table 2.

     90/  Concerning recommendation 88 of the Mexico City
International Conference on Population, the Governments of Mexico
and India stated that, while joining the consensus, they considered
that it was not for the Secretary-General to keep the
implementation of population programmes funded by multilateral
assistance under review, as this was exclusively the prerogative of
Governments.  In that sense, the Secretary-General might only keep
under review the use of the assistance provided by United Nations
agencies (footnote to recommendation 88).

     91/  See the report of an ad hoc committee of experts to the
Population Commission (E/CN.9/182); Economic and Social Council
resolution 1084 (XXXIX) of 30 July 1965; and General Assembly
resolution 2211 (XXI) of 17 December 1966.

     92/  See Council resolution 1979/32 of 9 May 1979 and Review
and Appraisal of the World Population Plan of Action (1979 report)
... .

     93/  See Economic and Social Council resolution 1981/87 of
25 November 1981, para. 2.

     94/  Review and Appraisal ... 1984 Report ... .

     95/  Economic and Social Council resolution 1989/92 of 28 July
1989.

     96/  Ibid., annex, para. 2.
