on population, reproductive health & ethics

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Boston Globe Editorial, September 1, 2004

Beyond birth control

TEN YEARS AGO this month amid the teeming streets of Cairo, representatives of 179 nations hammered out a new way of thinking about global population. It was already received wisdom that overpopulation cause poverty, hunger, and disease. But the delegates to the United Nations Conference on Population and Development dared to consider the equation the other way around: What if poverty and disease actually created the conditions for unsustainable population growth? The words "paradigm shift" are almost a cliche, but the agreement reached that year to attack poverty, illiteracy, and ill health -- especially among women -- as a means to achieve sustainable development had profound implications.

The focus shifted from top-down policies promoting birth control in traditional societies to a bottom-up approach aimed at improving education and opportunities for women and girls. Simple public health strategies such as clean water, nutrition, and training midwives improved infant survival rates. Local community and religious leaders were invited to join international aid workers, who addressed people in their native or tribal languages. Contraception became more widely accepted, part of a holistic health approach including vaccines, vitamins, and prevention of sexually transmitted diseases such as AIDS.

Today, though the world's population has climbed to 6.3 billion, the rate of growth has slowed considerably, and a worldwide Malthusian disaster seems unlikely. Thanks to the programs of action outlined in Cairo, more girls are in school and more women have economic and social opportunities. Still, teenage pregnancy rates are alarmingly high, and with half the world's population under age 24, sex education and reproductive health care are more crucial than ever. "This is the largest youth generation in human history," said Thoraya Obaid, director of the United Nations Population Fund. "There must be services available to allow this generation to control their lives."

Obaid and others are in London this week for a 10-year retrospective on the Cairo conference. Tim Wirth, the former Colorado senator who is president of the UN Foundation, says the United States has become "obstructionist." The Bush administration's insistence on abstinence-only approaches, he says, and its global gag rule preventing women's health clinics from discussing abortion -- even in countries where the procedure is legal -- as well as its refusal to fund its share of UN family planning services have made the United States "no longer a gracious and progressive force in the world."

Ultimately, the issue of sustainable population is not about abortion but whether women and children in the world's poorest countries will live or die. In sub-Saharan Africa, one in 16 women dies in childbirth, compared with one in 2,800 in the developed world. A woman dies every 7 minutes from an unsafe abortion. Five million people were infected last year with HIV.

Far from political poll results or fund-raising totals, these are the numbers that should command attention this campaign year.

© Copyright 2004 Globe Newspaper Company.

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