Paying for Essentials A Policy Paper Series The Reproductive Health Approach to Population and Development By Shepard Forman and Romita Ghosh Center on International Cooperation New York University February 1999 The long-term vision of the reproductive health approach warrants reaffirmation. Approved by 180 governments, the reproductive health approach embodied in the Programme of Action of the 1994 International Conference on Population and Development (ICPD), in Cairo, Egypt, represented a major departure from previous thinking on population and development. The Programme of Action reaffirmed the importance of slowing population growth for social and economic development, but it also called for a significant shift in strategies to achieve this goal — an emphasis on meeting the needs of individual women and men rather than on achieving demographic targets. Building on the outcomes of the World Population Conference in Bucharest in 1974, the International Conference on Population in Mexico City in 1984, and decades of experience and research, the ICPD Programme of Action calls for an approach to reproductive health that is comprehensive and client-centered, based on the interrelationship between population, human rights and sustainable development, and the principles of choice, gender equality, equity, and the empowerment of women. To satisfy reproductive health needs during all stages of the life cycle, it recommends that all countries provide, through the primary health care system, a range of information and services, including but not limited to family planning. The reproductive health approach endorsed at the ICPD has permeated policies and programs to varying degrees in each of the countries on which this report is based. While the language of reproductive health has entered population and family planning discourse, in some countries it is still contested terrain, as overriding concern with population growth dominates population and family planning policy. In others, the integration of family planning and reproductive health envisioned in Cairo is slowly taking place, albeit constrained by established patterns of funding, bureaucratic prerogatives, organizational barriers, lack of popular understanding of the reproductive health approach and limited training opportunities for health service providers. In several cases, reproductive health inroads into the family planning agenda are due to the impetus of donor funding. CONTENTS Preface Executive Summary I. International Consensus On The Reproductive Health Approach The Reproductive Health Approach International Endorsement II. Implementing The Reproductive Health Approach Progress to Date Challenges to Progress III. Financing The Reproductive Health Approach International Financing National Financing IV. Sustaining The Reproductive Health Approach Conclusions Recommendations Appendices For a hard copy email cic.info@nyu.edu