
USUN PRESS RELEASE # 44A (02)
April 1, 2002
Statement by Ambassador Sichan Siv, United States Representative on
the United Nations Economic and Social Council, on Agenda Item 3:
World Population Monitoring, 2002, Reproductive Rights and
Reproductive Health with Special Reference to HIV/AIDS, in the
Commission on Population and Development, April 1, 2002
Introduction.
Mr. Chairman, my delegation would like to thank the Population
Division for the reports prepared under this agenda item on
reproductive rights and reproductive health, with special reference to
HIV/AIDS (E/CN.9/2002/2 and
E/CN.9/2002/3). These reports
reveal a significant level of progress in implementing a more
comprehensive approach to reproductive health. We support elements of
the reports that discuss efforts to address the HIV/AIDS epidemic,
including an integrated approach to prevention, care and treatment, as
well as the need to involve a broad range of stakeholders, including
community and faith-based organizations, health providers, the
research community, and political leaders. However, we have serious
concerns about other elements of the reports, which I will address
later in my statement.
The United Nations (UN) General Assembly
Special Session on HIV/AIDS
in June 2001 demonstrated the profound impact of the epidemic and the
growing political commitment to a global response. The same
concerted, comprehensive approach needed to control the spread of
HIV/AIDS as set out in the
Declaration of Commitment adopted at the
Special Session is also required to make further progress in
implementing other key components outlined in the reports before us.
The United States is committed to providing assistance to help achieve
the three principal 2015 goals adopted in the
ICPD Program of Action.
First, to make reproductive health care accessible to all individuals
of appropriate ages through the primary health care system (para
7.6). Second, to significantly reduce maternal mortality (para
8.21). And third, to ensure universal access to primary education
(para 11.6).
In order to achieve these goals, however, we must focus on sound
evidence-based strategies to improve the lives of women rather than
using dated or non-existent data as the basis for analysis. This is
most apparent in the section on abortion. A lack of current,
accurate, and comprehensive data in this section results in questions
regarding the validity, purpose and intent of the analysis. In fact,
key actions in the ICPD Program of Action called upon governments to
take appropriate action to help women avoid abortions. Yet, progress
made in this area is absent from the report. Furthermore, we do not
view the terms "reproductive health care" and "reproductive health
services” as interchangeable. For purposes of this debate and any
subsequent decisions or resolutions on this agenda item, the United
States does not accept the use of the term "reproductive health
services" because the term can be interpreted to include
promoting the legalization or expansion of legal abortion
services.
Reproductive rights and
reproductive health, with special reference to HIV/AIDS.
Mr. Chairman, because HIV/AIDS is the
special reference in this year’s monitoring reports, our comments
address the intersections between the epidemic and progress that has
been made toward achieving the ICPD 2015 goals.
Access to Reproductive Health Care through the Primary Health Care
System. Access by individuals of appropriate ages to
reproductive health care through the primary health care system has
improved steadily in most countries over the past nine years.
However, the HIV/AIDS epidemic has and will continue to introduce new
challenges to health care access.
The HIV/AIDS epidemic has opened the
world’s eyes to the threat it poses to the health of young people. In
Africa and many parts of Asia, HIV incidence and prevalence are
highest among adolescents and young adults. More than 10 million
people between the ages of 15 and 24 are now living with HIV/AIDS.
Half of all new infections occur among young people. Young women
everywhere, but especially in the developing world are particularly
vulnerable to HIV infection. In some urban African settings, young
women aged 15 to 19 have rates of HIV infection six times higher than
males in the same age group. Furthermore, high-risk groups for
HIV/AIDS include very high numbers of young people, often due to
economic stress. For instance, many involved in the sex trade are
there to support themselves and their families or because they have
been trafficked into prostitution.
Lack of accurate information, a sense of invulnerability about the
risk and the often high incidence of non-consensual sex among young
people help fuel these high rates of infection. While there are
relatively few programs aimed at preventing coerced sex, those that
show greatest promise focus on raising community awareness about the
practice and the conditions that foster it.
We are pleased to see an emphasis in
the reports on prevention and the ongoing challenges countries face to
improve awareness campaigns to inform those at risk, especially youth,
about ways to protect them against infection. Abstinence and
postponement of initial sexual activity play important roles in the
promotion of adolescent health and well-being, including the
prevention of HIV/AIDS. Age-appropriate messages encouraging
abstinence for young people are key to HIV/AIDS and pregnancy
prevention programs for youth around the world. As President Bush
said only a few weeks ago, "Abstinence is the surest way and the only
completely effective way to prevent unwanted pregnancies. We must
promote good choices."
Domestically, the United States has
adopted several objectives on abstinence, such as increasing the
percentage of adolescents aged 15 to 17 years who have never engaged
in sexual intercourse, as part of the United States'
Healthy People
2010 initiative. [The HP 2010 target is 75 percent for both males and females
against a 1995 baseline of 63 and 57 percent, respectively.]
We also remain committed to programs that address greater male
involvement in pregnancy prevention and voluntary family planning
efforts. Clearly, the practices of delaying sexual initiation,
abstinence, monogamy, fidelity, partner reduction and condom use are
increasingly needed to prevent HIV infection. The United States
remains committed to all of these strategies.
Mr. Chairman,
while the reports do provide evidence-based information on voluntary
family planning, current levels of use and trends, and link well to
the sections on sexually transmitted infections (STIs), the HIV/AIDS
epidemic and maternal mortality, they unfortunately do not present
data concerning the objectives set forth in the ICPD Program of
Action's
chapter on the family. The important value of strong and
stable families in preventing risky behavior among young people is
widely recognized. Moreover, research findings from many different
settings indicate that parents are often the most powerful protective
influence on young people. Family stability and well-being not only
promote positive behaviors while discouraging risk-taking behavior,
but are also a crucial resource for providing care and support for
people living with HIV/AIDS. President Bush, in a recent major
address on welfare reform, stated, "[T]he most effective, direct way
to improve the lives of children is to encourage [family] stability."
The reports unfortunately contain only scant references to the
influence of family stability, the role of fathers and parent-child
communication on abstinence, delaying sexual initiation, and
responsible sexual behavior.
The HIV/AIDS
epidemic underscores the need to expand access to voluntary family
planning as infected or at-risk women seek to avoid a pregnancy that
may worsen their own condition or produce a child who may not survive
infancy. There is ample and growing evidence that men and women
throughout the world want to plan the number and spacing of their
children and that the principal barrier they face in doing so is lack
of access to voluntary family planning. According to the worldwide
Demographic and Health Surveys (DHS) program sponsored by the
U.S.
Agency for International Development, demand for voluntary family
planning is increasing, thus creating high levels of unmet need. The
spread of HIV/AIDS has is no way diminished women’s and men’s need for
voluntary family planning.
The growing size
of the population of reproductive age in many developing countries,
combined with the desire for smaller family size on the part of an
increasing number of couples is creating a surge in demand for family
planning. When the gulf between demand and supply is great, many
women can expect to experience unplanned pregnancies and poor
prospects for their children whose birth is seen as an additional
burden rather than a source of joy.
A growing body of
evidence exists to support President Bush’s
statement that “[O]ne of
the best ways to prevent abortion is by providing quality voluntary
family planning services.” Where voluntary family planning is widely
available, abortion rates are low.
Reduced Maternal Mortality.
The reports note
that more than half a million women die from pregnancy-related
complications every year, almost all of them in the developing world.
An additional 15 million women suffer painful and debilitating
pregnancy-related injuries and infections each year. The reports note
further the striking disparities across regions and sub-regions in the
lifetime risk of experiencing a maternal death, which point to equally
striking disparities in the conditions in which women in different
parts of the world experience pregnancy and childbirth. The United
States provides assistance to improve maternal nutrition before,
during and following pregnancy; prepare women and communities for a
healthy birth; train health personnel so that more women can receive
skilled assistance at the time of delivery; and train midwives and
physicians in life-saving skills.
One of the tragic
consequences of the HIV/AIDS epidemic is the mother-to-child
transmission of HIV. Mother-to-child transmission is especially
widespread in Africa, where approximately 600,000 newborns become
infected with HIV each year. The best way to prevent mother-to-child
transmission of HIV is to prevent HIV infection in the first place.
Recognizing that women do become infected, the United States, in
addition to our efforts to prevent the spread of HIV/AIDS, also
provides assistance for the millions of infected women to reduce the
likelihood of transmitting HIV to their infants. Our assistance is
comprehensive and includes improved antenatal care, voluntary and
confidential counseling and testing, short-course anti-retroviral
prophylaxis for HIV-infected women, counseling and support for safe
infant feeding practices and postpartum voluntary family planning. We
plan to expand our assistance to include a broad range of post-natal
medical and social support, including anti-retroviral therapy to
mothers, treatment of opportunistic infections, and nutritional
counseling.
Universal Access to Primary Education.
While universal access to primary education is not specifically
mentioned in the reports, we wish to briefly comment on this important
ICPD 2015 objective. More than 110 million children worldwide are not
attending school. Those not attending school include a
disproportionate numbers of girls, ethnic minorities and the poor or
otherwise disadvantaged. The benefits of education, especially girls’
education, are well documented and recognized. A mother’s level of
education is the single most important determinant of child survival.
Likewise, women with seven years or more of formal schooling commonly
have two to four fewer children than women who have never attended
school, further increasing their children’s chances of receiving
better nutrition, health care and education. However, in Africa
especially, the AIDS epidemic has taken a huge toll in terms of
teacher attrition and absenteeism, introducing unanticipated
challenges to achieving the objectives of universal education over the
past decade. Studies also show that children, particularly girls, are
more likely to have to drop out of school to nurse sick family members
or take care of their orphaned siblings.
Financial Resources for Assisting in
the Implementation of the ICPD Program of Action.
Finally,
Mr.
Chairman, I would like to express my delegation’s appreciation for the
concise and informative report (E/CN/9/2002/4) on recent trends in
resource flows for implementation of the ICPD Program of Action.
Although international assistance for population activities has been
increasing steadily, we continue to fall considerably short of
established resource mobilization goals.
My government is
committed to increased funding to support the creation of new
knowledge through research and development. President Bush is
committed to a five-year plan to double the budget of the
National
Institutes of Health within our Department of Health and Human
Services. Women's health issues, including reproductive health, and
HIV/AIDS are critical components of our national research agenda. The
United States is also the largest bilateral donor of population and
HIV/AIDS assistance. The Bush administration is committed to
maintaining this leadership role, as indicated in its $425 million
request level for bilateral population assistance in our fiscal year
2002 budget, the same level of funding the administration supported
for bilateral population assistance in 2001. In 2002, the United
States will be providing $990 million in international assistance for
HIV/AIDS.
However, even as
the generosity of the United States grows, the needs continue to
outpace the resources available to achieve the objectives agreed to in
the Program of Action. The United States hopes that the Commission
will reaffirm the resource goals agreed to in the ICPD Program of
Action and agree to redouble efforts to achieve these goals.
Conclusion. In conclusion, Mr. Chairman, vulnerability to poor
reproductive health can be reduced through focusing on the key actions
of the ICPD Program of Action, including evidence-based strategies and
investments in universal education and basic health care. For the
poor, and especially poor women and their families, improved access to
health care and education can contribute to stable environments, more
informed choices and better health outcomes. In turn, they are part
and parcel to improving the status of women so that they are able to
participate fully in their country's social, economic and political
development.
Thank you, Mr. Chairman.