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Ambassador Sichan Siv
United States Representative on the UN Economic and Social Council
Statement to the Commission on Population and Development on World Population Monitoring and Reproductive Rights and Reproductive Health with Special Reference to HIV/AIDS
April 1, 2002


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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 ActionFinally, 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.

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