ICPD 20 and Beyond

1. ICPD20 and Beyond

2. Paradigm Shift in Population and Development • It’s comprehensive vision for development took into account the inextricable link between population dynamics and sustainable development. • It acknowledged people as the most important resource of a country and stressed their entitlement to a healthy and productive life, free from discrimination and stressed promoting individual rights and dignity as vital for economic growth and sustainable development.

3. Central Pillars • Supporting access to family planning, • Sexual and reproductive health and rights, including HIV • Advancing gender equality, • Insisting on equal access to education for girls, • Eliminating violence against women, • Focusing on issues relating to population data and Protecting the environment.

4. Indicators • % of Primary Health care facilities offering Integrated Reproductive health services • Contraceptive Prevalence Rate • % of births attended by a trained (midwifery) heath personnel • % of population with access to primary health services • Maternal Mortality ratio

5. Caribbean Context • Mainly small island developing countries, majority with populations below 1 million • Significant progress and most classified as middle-income countries (2nd in world) • Economic base not diversified, and liable to shocks • Geographically vulnerable to natural disasters • High indebtedness - very little fiscal space to invest in development • Migration of trained persons

6. Significant progress • Stabilization of population growth – access to FP, decline in fertility • Commitment to adult SRH - • Maternal Mortality rates relatively low, but stagnant • Life expectancy increased • HIV prevalence still around 1%, but decline in new infections and in deaths

7. Change in Age Structure 2000-2010

8. Significant Progress • Gender laws, policies in place in some countries • HIV prevalence still around 1%, but decline in new infections and in deaths • Progress in women’s education, participation in public life - 2 female Prime Ministers • Willingness to adopt an evidence-based approach increasing – census conducted • Signatories to conventions, proud of leadership in NCDs, gender and youth.

9. Maternal Mortality Ratio

10. Lags in achieving the PoA: Maternal Mortality • Maternal • Stagnated over past several years in several countries –why? • Related to quality of care, scarce human resources (esp. midwives and nurses), NCDs, monitoring systems. • Cultural and social factors • Human Resources (esp. midwives and nurses), NCDs, monitoring systems.

11. Universal Access to Sexual and Reproductive Health • Legal and cultural barriers to access to SRH services for persons below the age of 18 • Absence of youth-friendly services • Resistance to sexuality education in schools • High stigma, discrimination and even violence against LGBT community, and lack of access to services • HIV prevalence high (Decline 25% in several countries)

12. Teen-Pregnancy • High proportion of births (about 20%) to teen mothers • Mis-match between laws on age of sexual consent (16 years) and maturity for access to contraception and HIV testing (18 years) • Pregnant girls and teen mothers drop out of education system – policy results in continuing cycle of lack of opportunity and exclusion • Little support from “baby fathers” , and family • Some good examples, but contradictions make effective implementation difficult • “Choice”? Planned? • Need for comprehensive policy

13. Gender Equality • Violence and citizen security major concerns • Violence against women, especially sexual violence, very high - between 3 and 8 times global average • Concerns around self-image, opportunities and mental health of young men, expressed as domestic violence/violence against women • Cultural norms see male violence as justified and “sign he cares”

14. Data and evidence • Limited national and sub-regional capacity for data collection, analysis, use • Insufficient inter-censal data collection • Lack of trust makes collection of data difficult • Lack of evidence –based planning • Insufficient attention to linking different sectors for a holistic understanding of issues, and the development of multi-sectoral solutions.

15. Risk-factors to Progress • Legislative and policy barriers • Cultural , religious beliefs and leadership • Popular conceptions of sexuality • Capacity gaps – small size, migration • Planning gap – including cross-sectoral • Resource gaps – especially linked to Middle-Income status, HIV • Lack of investment in health, SRH • Lack of equity

16. Favourable Trends • Reviews of legislation, policies in several countries • Willingness to draft new policies on population, SRH, gender, youth, migration • Debate and dialogues on difficult issues now in public space – eg MSM • Re-vitalisation of sub-regional mechanisms, CARICOM • Willingness to reach out to communities, young people, use social media,

17. Favourable Trends • Good examples of what does work, good practice (SRH and disability, teens , youth parliament and YAGs) • Effective engagement of key stake-holders –eg FB leaders, parliamentarians • Renewed emphasis on Family Planning - focus on sexual decision-making, especially for adolescents • Strong Political Commitment , including from highest levels, following visit of ED

18. Achievements Inclusive approach – commitment to participation of a wide range of stake-holders, the community. Empowerment-oriented Move from Targets which mask vast disparities, to “universal access” and equity. Partnerships for development Accountability

19. . PARTNERSHIPS Broad partnership is needed between governments and NGOs to assist in the formulation, implementation, monitoring and evaluation of population and development objectives and activities. NGOs are important voices of the people, and are well known for their innovative, flexible and responsive programme design and implementation including grass roots participation, and because quite often they are rooted in and interact with constituencies that are poorly served and hard to reach through government channels.

20. THANKS!