Population and sustainable development
In a space of 30 years, there has been remarkable progress in the health and population sector
In recent years, population and sustainable development issues are increasing priorities of the governments, political parties, development partners, youth-led civil society, media, private sector and communities at large. Looking back at history, the landmark International Conference on Population and Development (ICPD) was held in Cairo in 1994. This conference enormously transformed the global thinking as well as narratives of population and development with a bold political and development agenda. More importantly, placing people’s dignity and rights are at the heart of sustainable development.
While 179 countries including Nepal adopted the key strategic priorities of the ICPD, there is increasing recognition that inclusive sustainable development demands a clear focus on human rights, including reproductive rights, empowering women and girls, and addressing inequalities as well as the needs, aspirations and rights of people. Therefore, the national commitments of the ICPD have been highly relevant to adapt to inclusive development policies, strategies, plans and programs, which help promote people-centered development.
Almost 30 years after the ICPD conference, among many others, there has been remarkable progress in the health and population sector. Despite significant health gains, there still are challenges to ensure the rights and choices of women and girls, mitigate the impact of the Covid-19 pandemic and the full realization of the sexual and reproductive health and rights agenda. The ICPD agenda and Sustainable Development Goals (SDGs) are closely aligned to eliminate poverty, achieve gender equality and secure the health and well-being of all people.
Considering the emerging needs of advancing the ICPD agenda in the context of formulating 16th Periodic Plan which is led by the National Planning Commission, the Ministry of Health and Population recently organized a national conference on population and development with support from UNFPA and other partners. The conference provided a unique opportunity for governments, political leaders, development partners, youth-led civil society, media and communities to share the country progress of the ICPD and discuss critical issues, challenges and opportunities for actions.
More importantly, among many others, Nepal’s commitments and progress in the health and population sector were reviewed and discussed at the conference. These include integration of comprehensive sexuality education in school curriculum, legalization of safe abortion, ensuring availability and accessibility of safe abortion services and adolescent-friendly health services. There has been remarkable progress in improving access to sexual and reproductive health services, advancing gender equity and women's empowerment, and integrating population dynamics in development policies, strategies and plans.
While reviewing some health and population indicators, the maternal mortality ratio has come down from 281 per 100,000 live births (2006) to 151 (2021). The births attended by skilled health personnel have gone up from 9 percent (1996) to 80 percent (2022). The total fertility rate has decreased from 4.6 (1996) to 2.1 (2022). The adolescent fertility rate has decreased from 127 (1996) to 71 (2022). The modern contraceptive prevalence rate has gone up from 26.0 percent (1996) to 43.0 percent (2022), whereas the unmet need for family planning has slightly dropped from 24.6 percent (2006) to 20.8 percent (2022).
Nepal has given priority and respect for international human rights treaties and signed political commitments that recognise reproductive rights. The Constitution of Nepal, 2015 guarantees the right to safe motherhood and reproductive health as fundamental rights. Over the years, the government has adopted several policies, strategies and plans to guarantee women’s access to reproductive health services. In 2018, the government enacted the Safe Motherhood and Reproductive Health Rights Act, which defines the right to reproductive health and provides the necessary foundation for safe, accessible and quality reproductive health services.
Despite these significant gains, it is necessary to strengthen health systems so that they can deliver equitable health outcomes on the basis of a comprehensive approach. There are increasing needs for health financing, human resources for health, strengthening procurement and distribution of medicines and vaccines, infrastructure, information systems and service delivery at the local level.
On the other side, governments should focus on universal access to comprehensive and integrated quality sexual and reproductive health services for all women, men and young people to reduce the unmet need for family planning. Particular attention is needed in ensuring access for adolescents and youth for universal access to HIV prevention, treatment, care and support.
More notably, the Nairobi Summit on ICPD+25 took place in Nairobi, Kenya from 12 to 15, November 2019, to mark the 25th anniversary of the International Conference on Population and Development (ICPD+25). During the Nairobi Summit, Nepal made important national commitments to advance the ICPD agenda that largely focuses on universal access to sexual and reproductive health rights, women’s empowerment and their rights in order to achieve sustainable development goals (SDGs).
The commitments largely aim to end violence against women and children, early and forced marriage, ending preventable maternal deaths and ending unmet need for family planning. We need significant investments in young people including their health and well-being by ensuring that they are able to exercise their reproductive rights through upscaling of adolescent-friendly services and comprehensive sexuality education.
There are critical needs to ensure the basic humanitarian needs of affected populations, including sexual and reproductive health care and gender-based violence prevention and response, are addressed in humanitarian contexts. Moreover, health financing policies, instruments and structures are essentially needed to ensure effective implementation of the strategic priorities of the ICPD agenda in the changed context.
In order to accelerate the progress of the ICPD agenda in the federal context, Nepal has prioritized poverty reduction, health, sexual and reproductive health rights, education, gender equality and women empowerment, adolescence and youth, international migration, urbanization, data and evidence for policy-making.
Population aging is also a matter of concern for development. At the implementation level, there are increasing needs of capacity enhancement of provincial and local governments to mainstream the ICPD priorities in their policies, plans and budget. Meaningful participation of adolescents, youth, people with disability, migrants, sexual and gender minorities, media and civil society representatives from poor and marginalized communities can ensure the inclusive population and development policies at all levels.
Additionally, there are emerging challenges of climate change, pollution, food insecurity, increasing risks of non-communicable diseases, health emergencies, pandemics, disasters and migration for foreign employment. In order to effectively address these issues, multi-sector coordination mechanisms or platforms are needed to harness the partnerships and collaborative actions to create synergies at all levels.
While population and sustainable development are inextricably linked, it is also necessary to consider the population distribution, socio-cultural and political dynamics, ethnic and indigenous diversity, religion and sustainable livelihoods of communities across the country. With a holistic people-centered approach, the essence of ICPD agenda and SDGs can be further harnessed.
The author is Health and Population Consultant at UNFPA
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