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Programme of Action of the International Conference on Population and Development
Chapter 7 : Reproductive Rights and Reproductive Health
A. Reproductive rights and reproductive health
B. Family planning
C. Sexually transmitted diseases and prevention of human immunodeficiency virus (HIV)
D. Human sexuality and gender relations
E. Adolescents
7.1. This chapter is especially guided by the principles contained in Chapter 2 and in
particular the introductory paragraphs.
A. Reproductive rights and reproductive health
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Basis for action
7.2. Reproductive health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity, in all matters relating to the
reproductive system and to its functions and processes. Reproductive health therefore
implies that people are able to have a satisfying and safe sex life and that they have the
capability to reproduce and the freedom to decide if, when and how often to do so.
Implicit in this last condition are the right of men and women to be informed and to have
access to safe, effective, affordable and acceptable methods of family planning of their
choice, as well as other methods of their choice for regulation of fertility which are not
against the law, and the right of access to appropriate health-care services that will
enable women to go safely through pregnancy and childbirth and provide couples with the
best chance of having a healthy infant. In line with the above definition of reproductive
health, reproductive health care is defined as the constellation of methods, techniques
and services that contribute to reproductive health and well-being by preventing and
solving reproductive health problems. It also includes sexual health, the purpose of which
is the enhancement of life and personal relations, and not merely counselling and care
related to reproduction and sexually transmitted diseases.
7.3. Bearing in mind the above definition, reproductive rights embrace certain human
rights that are already recognized in national laws, international human rights documents
and other consensus documents. These rights rest on the recognition of the basic right of
all couples and individuals to decide freely and responsibly the number, spacing and
timing of their children and to have the information and means to do so, and the right to
attain the highest standard of sexual and reproductive health. It also includes their
right to make decisions concerning reproduction free of discrimination, coercion and
violence, as expressed in human rights documents. In the exercise of this right, they
should take into account the needs of their living and future children and their
responsibilities towards the community. The promotion of the responsible exercise of these
rights for all people should be the fundamental basis for government- and
community-supported policies and programmes in the area of reproductive health, including
family planning. As part of their commitment, full attention should be given to the
promotion of mutually respectful and equitable gender relations and particularly to
meeting the educational and service needs of adolescents to enable them to deal in a
positive and responsible way with their sexuality. Reproductive health eludes many of the
world's people because of such factors as: inadequate levels of knowledge about human
sexuality and inappropriate or poor-quality reproductive health information and services;
the prevalence of high-risk sexual behaviour; discriminatory social practices; negative
attitudes towards women and girls; and the limited power many women and girls have over
their sexual and reproductive lives. Adolescents are particularly vulnerable because of
their lack of information and access to relevant services in most countries. Older women
and men have distinct reproductive and sexual health issues which are often inadequately
addressed.
7.4. The implementation of the present Programme of Action is to be guided by the above
comprehensive definition of reproductive health, which includes sexual health.
Objectives
7.5. The objectives are:
(a) To ensure that comprehensive and factual information and a full range of
reproductive health-care services, including family planning, are accessible, affordable,
acceptable and convenient to all users;
(b) To enable and support responsible voluntary decisions about child-bearing and
methods of family planning of their choice, as well as other methods of their choice for
regulation of fertility which are not against the law and to have the information,
education and means to do so;
(c) To meet changing reproductive health needs over the life cycle and to do so in ways
sensitive to the diversity of circumstances of local communities.
Actions
7.6. All countries should strive to make accessible through the primary health-care
system, reproductive health to all individuals of appropriate ages as soon as possible and
no later than the year 2015. Reproductive health care in the context of primary health
care should, inter alia, include: family-planning counselling, information, education,
communication and services; education and services for prenatal care, safe delivery and
post-natal care, especially breast-feeding and infant and women's health care; prevention
and appropriate treatment of infertility; abortion as specified in paragraph 8.25,
including prevention of abortion and the management of the consequences of abortion;
treatment of reproductive tract infections; sexually transmitted diseases and other
reproductive health conditions; and information, education and counselling, as
appropriate, on human sexuality, reproductive health and responsible parenthood. Referral
for family-planning services and further diagnosis and treatment for complications of
pregnancy, delivery and abortion, infertility, reproductive tract infections, breast
cancer and cancers of the reproductive system, sexually transmitted diseases, including
HIV/AIDS should always be available, as required. Active discouragement of harmful
practices, such as female genital mutilation, should also be an integral component of
primary health care, including reproductive health-care programmes.
7.7. Reproductive health-care programmes should be designed to serve the needs of
women, including adolescents, and must involve women in the leadership, planning,
decision-making, management, implementation, organization and evaluation of services.
Governments and other organizations should take positive steps to include women at all
levels of the health-care system.
7.8. Innovative programmes must be developed to make information, counselling and
services for reproductive health accessible to adolescents and adult men. Such programmes
must both educate and enable men to share more equally in family planning and in domestic
and child-rearing responsibilities and to accept the major responsibility for the
prevention of sexually transmitted diseases.
Programmes must reach men in their workplaces, at home and where they gather for
recreation. Boys and adolescents, with the support and guidance of their parents, and in
line with the Convention on the Rights of the Child, should also be reached through
schools, youth organizations and wherever they congregate. Voluntary and appropriate male
methods for contraception, as well as for the prevention of sexually transmitted diseases,
including AIDS, should be promoted and made accessible with adequate information and
counselling.
7.9. Governments should promote much greater community participation in reproductive
health-care services by decentralizing the management of public health programmes and by
forming partnerships in cooperation with local non-governmental organizations and private
health-care providers. All types of non-governmental organizations, including local
women's groups, trade unions, cooperatives, youth programmes and religious groups, should
be encouraged to become involved in the promotion of better reproductive health.
7.10. Without jeopardizing international support for programmes in developing
countries, the international community should, upon request, give consideration to the
training, technical assistance, short-term contraceptive supply needs and the needs of the
countries in transition from centrally managed to market economies, where reproductive
health is poor and in some cases deteriorating. Those countries, at the same time, must
themselves give higher priority to reproductive health services, including a comprehensive
range of contraceptive means, and must address their current reliance on abortion for
fertility regulation by meeting the need of women in those countries for better
information and more choices on an urgent basis.
7.11. Migrants and displaced persons in many parts of the world have limited access to
reproductive health care and may face specific serious threats to their reproductive
health and rights. Services must be particularly sensitive to the needs of individual
women and adolescents and responsive to their often powerless situation, with particular
attention to those who are victims of sexual violence.
B. Family planning
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Basis for action
7.12. The aim of family-planning programmes must be to enable couples and individuals
to decide freely and responsibly the number and spacing of their children and to have the
information and means to do so and to ensure informed choices and make available a full
range of safe and effective methods. The success of population education and
family-planning programmes in a variety of settings demonstrates that informed individuals
everywhere can and will act responsibly in the light of their own needs and those of their
families and communities. The principle of informed free choice is essential to the
long-term success of family-planning programmes. Any form of coercion has no part to play.
In every society there are many social and economic incentives and disincentives that
affect individual decisions about child-bearing and family size. Over the past century,
many Governments have experimented with such schemes, including specific incentives and
disincentives, in order to lower or raise fertility. Most such schemes have had only
marginal impact on fertility and in some cases have been counterproductive. Governmental
goals for family planning should be defined in terms of unmet needs for information and
services. Demographic goals, while legitimately the subject of government development
strategies, should not be imposed on family-planning providers in the form of targets or
quotas for the recruitment of clients.
7.13. Over the past three decades, the increasing availability of safer methods of
modern contraception, although still in some respects inadequate, has permitted greater
opportunities for individual choice and responsible decision-making in matters of
reproduction throughout much of the world. Currently, about 55 per cent of couples in
developing regions use some method of family planning. This figure represents nearly a
fivefold increase since the 1960s. Family-planning programmes have contributed
considerably to the decline in average fertility rates for developing countries, from
about six to seven children per woman in the 1960s to about three to four children at
present. However, the full range of modern family-planning methods still remains
unavailable to at least 350 million couples world wide, many of whom say they want to
space or prevent another pregnancy. Survey data suggest that approximately 120 million
additional women world wide would be currently using a modern family-planning method if
more accurate information and affordable services were easily available, and if partners,
extended families and the community were more supportive. These numbers do not include the
substantial and growing numbers of sexually active unmarried individuals wanting and in
need of information and services. During the decade of the 1990s, the number of couples of
reproductive age will grow by about 18 million per annum. To meet their needs and close
the existing large gaps in services, family planning and contraceptive supplies will need
to expand very rapidly over the next several years. The quality of family-planning
programmes is often directly related to the level and continuity of contraceptive use and
to the growth in demand for services. Family-planning programmes work best when they are
part of or linked to broader reproductive health programmes that address closely related
health needs and when women are fully involved in the design, provision, management and
evaluation of services.
Objectives
7.14. The objectives are:
(a) To help couples and individuals meet their reproductive goals in a framework that
promotes optimum health, responsibility and family well-being, and respects the dignity of
all persons and their right to choose the number, spacing and timing of the birth of their
children;
(b) To prevent unwanted pregnancies and reduce the incidence of high-risk pregnancies
and morbidity and mortality;
(c) To make quality family-planning services affordable, acceptable and accessible to
all who need and want them, while maintaining confidentiality;
(d) To improve the quality of family-planning advice, information, education,
communication, counselling and services;
(e) To increase the participation and sharing of responsibility of men in the actual
practice of family planning;
(f) To promote breast-feeding to enhance birth spacing.
Actions
7.15. Governments and the international community should use the full means at their
disposal to support the principle of voluntary choice in family planning.
7.16. All countries should, over the next several years, assess the extent of national
unmet need for good-quality family-planning services and its integration in the
reproductive health context, paying particular attention to the most vulnerable and
underserved groups in the population. All countries should take steps to meet the
family-planning needs of their populations as soon as possible and should, in all cases by
the year 2015, seek to provide universal access to a full range of safe and reliable
family-planning methods and to related reproductive health services which are not against
the law. The aim should be to assist couples and individuals to achieve their reproductive
goals and give them the full opportunity to exercise the right to have children by choice.
7.17. Governments at all levels are urged to institute systems of monitoring and
evaluation of user-centred services with a view to detecting, preventing and controlling
abuses by family-planning managers and providers and to ensure a continuing improvement in
the quality of services. To this end, Governments should secure conformity to human rights
and to ethical and professional standards in the delivery of family planning and related
reproductive health services aimed at ensuring responsible, voluntary and informed consent
and also regarding service provision. In-vitro fertilization techniques should be provided
in accordance with appropriate ethical guidelines and medical standards.
7.18. Non-governmental organizations should play an active role in mobilizing community
and family support, in increasing access and acceptability of reproductive health services
including family planning, and cooperate with Governments in the process of preparation
and provision of care, based on informed choice, and in helping to monitor public- and
private-sector programmes, including their own.
7.19. As part of the effort to meet unmet needs, all countries should seek to identify
and remove all the major remaining barriers to the utilization of family-planning
services. Some of those barriers are related to the inadequacy, poor quality and cost of
existing family-planning services. It should be the goal of public, private and
non-governmental family-planning organizations to remove all programme-related barriers to
family-planning use by the year 2005 through the redesign or expansion of information and
services and other ways to increase the ability of couples and individuals to make free
and informed decisions about the number, spacing and timing of births and protect
themselves from sexually transmitted diseases.
7.20. Specifically, Governments should make it easier for couples and individuals to
take responsibility for their own reproductive health by removing unnecessary legal,
medical, clinical and regulatory barriers to information and to access to family-planning
services and methods.
7.21. All political and community leaders are urged to play a strong, sustained and
highly visible role in promoting and legitimizing the provision and use of family-planning
and reproductive health services. Governments at all levels are urged to provide a climate
that is favourable to good-quality public and private family-planning and reproductive
health information and services through all possible channels. Finally, leaders and
legislators at all levels must translate their public support for reproductive health,
including family planning, into adequate allocations of budgetary, human and
administrative resources to help meet the needs of all those who cannot pay the full cost
of services.
7.22. Governments are encouraged to focus most of their efforts towards meeting their
population and development objectives through education and voluntary measures rather than
schemes involving incentives and disincentives.
7.23. In the coming years, all family-planning programmes must make significant efforts
to improve quality of care. Among other measures, programmes should:
(a) Recognize that appropriate methods for couples and individuals vary according to
their age, parity, family-size preference and other factors, and ensure that women and men
have information and access to the widest possible range of safe and effective
family-planning methods in order to enable them to exercise free and informed choice;
(b) Provide accessible, complete and accurate information about various family-planning
methods, including their health risks and benefits, possible side effects and their
effectiveness in the prevention of the spread of HIV/AIDS and other sexually transmitted
diseases;
(c) Make services safer, affordable, more convenient and accessible for clients and
ensure, through strengthened logistical systems, a sufficient and continuous supply of
essential high-quality contraceptives. Privacy and confidentiality should be ensured;
(d) Expand and upgrade formal and informal training in sexual and reproductive health
care and family planning for all health-care providers, health educators and managers,
including training in interpersonal communications and counselling;
(e) Ensure appropriate follow-up care, including treatment for side effects of
contraceptive use;
(f) Ensure availability of related reproductive health services on site or through a
strong referral mechanism;
(g) In addition to quantitative measures of performance, give more emphasis to
qualitative ones that take into account the perspectives of current and potential users of
services through such means as effective management information systems and survey
techniques for the timely evaluation of services;
(h) Family-planning and reproductive health programmes should emphasize breast-feeding
education and support services, which can simultaneously contribute to birth spacing,
better maternal and child health and higher child survival.
7.24. Governments should take appropriate steps to help women avoid abortion, which in
no case should be promoted as a method of family planning, and in all cases provide for
the humane treatment and counselling of women who have had recourse to abortion.
7.25. In order to meet the substantial increase in demand for contraceptives over the
next decade and beyond, the international community should move, on an immediate basis, to
establish an efficient coordination system and global, regional and subregional facilities
for the procurement of contraceptives and other commodities essential to reproductive
health programmes of developing countries and countries with economies in transition. The
international community should also consider such measures as the transfer of technology
to developing countries to enable them to produce and distribute high-quality
contraceptives and other commodities essential to reproductive health services, in order
to strengthen the self-reliance of those countries. At the request of the countries
concerned, the World Health Organization should continue to provide advice on the quality,
safety and efficacy of family-planning methods.
7.26. Provision of reproductive health-care services should not be confined to the
public sector but should involve the private sector and non-governmental organizations, in
accordance with the needs and resources of their communities, and include, where
appropriate, effective strategies for cost recovery and service delivery, including social
marketing and community-based services. Special efforts should be made to improve
accessibility through outreach services.
C. Sexually transmitted diseases and prevention of human immunodeficiency virus (HIV)
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Basis for action
7.27. The world-wide incidence of sexually transmitted diseases is high and increasing.
The situation has worsened considerably with the emergence of the HIV epidemic. Although
the incidence of some sexually transmitted diseases has stabilized in parts of the world,
there have been increasing cases in many regions.
7.28. The social and economic disadvantages that women face make them especially
vulnerable to sexually transmitted infections, including HIV, as illustrated, for example,
by their exposure to the high-risk sexual behaviour of their partners. For women, the
symptoms of infections from sexually transmitted diseases are often hidden, making them
more difficult to diagnose than in men, and the health consequences are often greater,
including increased risk of infertility and ectopic pregnancy. The risk of transmission
from infected men to women is also greater than from infected women to men, and many women
are powerless to take steps to protect themselves.
Objective
7.29. The objective is to prevent, reduce the incidence of, and provide treatment for,
sexually transmitted diseases, including HIV/AIDS, and the complications of sexually
transmitted diseases such as infertility, with special attention to girls and women.
Actions
7.30. Reproductive health programmes should increase their efforts to prevent, detect
and treat sexually transmitted diseases and other reproductive tract infections,
especially at the primary health-care level. Special outreach efforts should be made to
those who do not have access to reproductive health- care programmes.
7.31. All health-care providers, including all family-planning providers, should be
given specialized training in the prevention and detection of, and counselling on,
sexually transmitted diseases, especially infections in women and youth, including
HIV/AIDS.
7.32. Information, education and counselling for responsible sexual behaviour and
effective prevention of sexually transmitted diseases, including HIV, should become
integral components of all reproductive and sexual health services.
7.33. Promotion and the reliable supply and distribution of high-quality condoms should
become integral components of all reproductive health-care services. All relevant
international organizations, especially the World Health Organization, should
significantly increase their procurement. Governments and the international community
should provide all means to reduce the spread and the rate of transmission of HIV/AIDS
infection.
D. Human sexuality and gender relations
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Basis for action
7.34. Human sexuality and gender relations are closely interrelated and together affect
the ability of men and women to achieve and maintain sexual health and manage their
reproductive lives. Equal relationships between men and women in matters of sexual
relations and reproduction, including full respect for the physical integrity of the human
body, require mutual respect and willingness to accept responsibility for the consequences
of sexual behaviour. Responsible sexual behaviour, sensitivity and equity in gender
relations, particularly when instilled during the formative years, enhance and promote
respectful and harmonious partnerships between men and women.
7.35. Violence against women, particularly domestic violence and rape, is widespread,
and rising numbers of women are at risk from AIDS and other sexually transmitted diseases
as a result of high-risk sexual behaviour on the part of their partners. In a number of
countries, harmful practices meant to control women's sexuality have led to great
suffering. Among them is the practice of female genital mutilation, which is a violation
of basic rights and a major lifelong risk to women's health.
Objectives
7.36. The objectives are:
(a) To promote adequate development of responsible sexuality, permitting relations of
equity and mutual respect between the genders and contributing to improving the quality of
life of individuals;
(b) To ensure that women and men have access to the information, education and services
needed to achieve good sexual health and exercise their reproductive rights and
responsibilities.
Actions
7.37. Support should be given to integral sexual education and services for young
people, with the support and guidance of their parents and in line with the Convention on
the Rights of the Child, that stress responsibility of males for their own sexual health
and fertility and that help them exercise those responsibilities. Educational efforts
should begin within the family unit, in the community and in the schools at an appropriate
age, but must also reach adults, in particular men, through non-formal education and a
variety of community-based efforts.
7.38. In the light of the urgent need to prevent unwanted pregnancies, the rapid spread
of AIDS and other sexually transmitted diseases, and the prevalence of sexual abuse and
violence, Governments should base national policies on a better understanding of the need
for responsible human sexuality and the realities of current sexual behaviour.
7.39. Active and open discussion of the need to protect women, youth and children from
any abuse, including sexual abuse, exploitation, trafficking and violence, must be
encouraged and supported by educational programmes at both national and community levels.
Governments should set the necessary conditions and procedures to encourage victims to
report violations of their rights. Laws addressing those concerns should be enacted where
they do not exist, made explicit, strengthened and enforced, and appropriate
rehabilitation services provided. Governments should also prohibit the production and the
trade of child pornography.
7.40. Governments and communities should urgently take steps to stop the practice of
female genital mutilation and protect women and girls from all such similar unnecessary
and dangerous practices. Steps to eliminate the practice should include strong community
outreach programmes involving village and religious leaders, education and counselling
about its impact on girls' and women's health, and appropriate treatment and
rehabilitation for girls and women who have suffered mutilation. Services should include
counselling for women and men to discourage the practice.
E. Adolescents
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Basis for action
7.41. The reproductive health needs of adolescents as a group have been largely ignored
to date by existing reproductive health services. The response of societies to the
reproductive health needs of adolescents should be based on information that helps them
attain a level of maturity required to make responsible decisions. In particular,
information and services should be made available to adolescents to help them understand
their sexuality and protect them from unwanted pregnancies, sexually transmitted diseases
and subsequent risk of infertility. This should be combined with the education of young
men to respect women's self-determination and to share responsibility with women in
matters of sexuality and reproduction. This effort is uniquely important for the health of
young women and their children, for women's self-determination and, in many countries, for
efforts to slow the momentum of population growth. Motherhood at a very young age entails
a risk of maternal death that is much greater than average, and the children of young
mothers have higher levels of morbidity and mortality. Early child-bearing continues to be
an impediment to improvements in the educational, economic and social status of women in
all parts of the world. Overall for young women, early marriage and early motherhood can
severely curtail educational and employment opportunities and are likely to have a
long-term, adverse impact on their and their children's quality of life.
7.42. Poor educational and economic opportunities and sexual exploitation are important
factors in the high levels of adolescent child-bearing. In both developed and developing
countries, adolescents faced with few apparent life choices have little incentive to avoid
pregnancy and child-bearing.
7.43. In many societies, adolescents face pressures to engage in sexual activity. Young
women, particularly low-income adolescents, are especially vulnerable. Sexually active
adolescents of both sexes are increasingly at high risk of contracting and transmitting
sexually transmitted diseases, including HIV/AIDS, and they are typically poorly informed
about how to protect themselves. Programmes for adolescents have proven most effective
when they secure the full involvement of adolescents in identifying their reproductive and
sexual health needs and in designing programmes that respond to those needs.
Objectives
7.44. The objectives are:
(a) To address adolescent sexual and reproductive health issues, including unwanted
pregnancy, unsafe abortion 20/ and sexually transmitted diseases, including HIV/AIDS,
through the promotion of responsible and healthy reproductive and sexual behaviour,
including voluntary abstinence, and the provision of appropriate services and counselling
specifically suitable for that age group;
(b) To substantially reduce all adolescent pregnancies.
Actions
7.45. Recognizing the rights, duties and responsibilities of parents and other persons
legally responsible for adolescents to provide, in a manner consistent with the evolving
capacities of the adolescent, appropriate direction and guidance in sexual and
reproductive matters, countries must ensure that the programmes and attitudes of
health-care providers do not restrict the access of adolescents to appropriate services
and the information they need, including on sexually transmitted diseases and sexual
abuse. In doing so, and in order to, inter alia, address sexual abuse, these services must
safeguard the rights of adolescents to privacy, confidentiality, respect and informed
consent, respecting cultural values and religious beliefs. In this context, countries
should, where appropriate, remove legal, regulatory and social barriers to reproductive
health information and care for adolescents.
7.46. Countries, with the support of the international community, should protect and
promote the rights of adolescents to reproductive health education, information and care
and greatly reduce the number of adolescent pregnancies.
7.47. Governments, in collaboration with non-governmental organizations, are urged to
meet the special needs of adolescents and to establish appropriate programmes to respond
to those needs. Such programmes should include support mechanisms for the education and
counselling of adolescents in the areas of gender relations and equality, violence against
adolescents, responsible sexual behaviour, responsible family-planning practice, family
life, reproductive health, sexually transmitted diseases, HIV infection and AIDS
prevention. Programmes for the prevention and treatment of sexual abuse and incest and
other reproductive health services should be provided. Such programmes should provide
information to adolescents and make a conscious effort to strengthen positive social and
cultural values. Sexually active adolescents will require special family-planning
information, counselling and services, and those who become pregnant will require special
support from their families and community during pregnancy and early child care.
Adolescents must be fully involved in the planning, implementation and evaluation of such
information and services with proper regard for parental guidance and responsibilities.
7.48. Programmes should involve and train all who are in a position to provide guidance
to adolescents concerning responsible sexual and reproductive behaviour, particularly
parents and families, and also communities, religious institutions, schools, the mass
media and peer groups. Governments and non-governmental organizations should promote
programmes directed to the education of parents, with the objective of improving the
interaction of parents and children to enable parents to comply better with their
educational duties to support the process of maturation of their children, particularly in
the areas of sexual behaviour and reproductive health.
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