UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)

94-09-07: Statement of UNICEF, Mr. James P. Grant


The electronic preparation of this document has been done by the

Population Information Network(POPIN) of the United Nations Population

Division in collaboration with the United Nations Development Programme



Statement by Mr. James P. Grant

    Executive Director of the United Nations Children’s Fund (UNICEF)

                                 at the

          International Conference on Population and Development

Cairo – 6 September 1994

     Since the conference on population in Mexico City in 1984, it has

become increasingly clear that development must be responsive to a new

paradigm. If it is to be sustainable today, development must not only

produce economic growth, sustainable in the environmental sense. It also

must be sustainable in a human sense — it must break the grip of

poverty on the bottom half or third of society and slow population

growth, while sustaining democracy, human rights, people’s participation

in the development process and peace.

     This conference can reap the fruits of two decades of deepening

understanding of population growth and its determinants by embracing the

“total approach” that is reflected in the draft Programme of Action.

This approach recognizes that the only hope we have of obtaining a world

population compatible with sustainable development is by combining

universal access to better health services, resulting in lower child and

maternal death rates; progress toward gender equality; universal access

to effective education (particularly for girls); and the universal

availability of family planning information and services adapted to each

country’s needs and values.

     This will hasten solutions to the main problems that vex and

threaten humankind on the threshold of the 2l st century — the problems

of poverty, population, and environmental degradation that feed off of

one another in a downward spiral that brings instability and strife in

its wake.

     My message to you today is simply this: these actions are now

within our grasp. They are possible. They are achievable within a decade

or two. They would be politically popular in both developing and

developed countries. They would respond to the needs of women and

children, of families and communities. The synergism of simultaneous

action could produce results beyond the expectations of most by the

years 2000, 2015 and 2050. This is the historic challenge of the last

phase of the 20th century success would lay the foundation for more

balanced development in the 2l st century.

     All of these improvements in the human condition would cry out

to be achieved even if there were no such thing as a population

challenge.. But it is population  growth that is now transforming

social development goals of this kind from being timeless  issues of

primary concern to the poor into a race against time in which all  have

a stake. Strategies of development which involve rather than

marginalize the poor, which create productive and remunerative work  for

the vast majority, and which meet basic human needs for  adequate

nutrition, clean water, safe sanitation, primary health  care, primary

education, and family planning, have become not only  a moral minimum

for our civilization but a practical minimum for  ensuring its survival.

Children are at the heart of Cairo deliberations

     It is impossible to talk about population and development  without

talking about children. A quarter million of them will  come into the

world today — and a quarter million will die this  week,

unceremoniously ushered into the next world by poverty and  neglect.

Children — their survival, development and protection  – are at the

heart of our deliberations  here this week, no less  than women.

     For UNICEF, concerned so directly with children and women, the

importance of this conference is clear. Birth spacing and  responsible

parenthood are vital ingredients for child survival and  development,

and vital also for improvements in women’s health.  Many studies from

all parts of the world show that child mortality is significantly

reduced when there is an interval of two years or  more between births.

Moreover, births that are too early or too  late in a mother’s life,

certainly before 18 and after about age  35, are also associated with

increased risks and increased rates of  child and maternal mortality.

     Experience has demonstrated the importance of child survival

strategies in combination with family planning, education of girls  and

women, and basic health care for mothers and children. Each of  these

interventions can make a contribution toward reducing under  five

mortality and slowing population growth. Collectively the  interventions

act powerfully and synergistically to accomplish  these ends.

The child survival-population link

     A principal reason that dramatically improving the survival of

infants and children slows rather than accelerates population  growth is

that parents gain the confidence they need to more widely  space

childbirth’s and to successfully aim for a smaller completed  family

size on average. Of particular importance in both areas is  widespread

and effective access to family planning information and services. Such

interventions as female education, and maternal and child health care

also play crucial and synergistic roles.

     Up to a quarter of all deaths of women of reproductive age in

developing countries are due to pregnancy-related complications. Through

reproductive health programmes, including Safe Motherhood efforts and,

more recently, the Mother-Baby Package of interventions, we can halve

maternal mortality and reduce neonatal and peri-natal mortality by 30-40

per cent by the year 2000. Where women receive proper health care —

particularly during pregnancy and child birth — fertility rates tend to

decline, births are spaced further apart, and family size becomes a more

conscious choice on the part of women and couples.

     Under five mortality and fertility rates are today so closely

linked, and respond so powerfully to such interventions as greatly

broadened access to primary health care and basic education, that

declines in one are unlikely to take place in the absence of declines in

the other. This suggests that, to achieve their own goals, those who work

to stabilize world population early and at relatively lower levels could

virtually adopt as a priority the achievement of the World Summit for

Children goal of reducing under five deaths. Conversely, those who seek

the greater survival of infants and children could well seek as their

own priority the spacing of births and responsible parenthood.

     The reality, of course, is that neither group needs to abandon its

own cause. They have only to make common cause, because achievement of

either goal — increased child survival or slowed population growth —

virtually presupposes and requires accomplishment of the other.

Effective child survival strategies work in tandem with effective family

planning services to significantly weaken the links among poverty,

population growth and environmental deterioration.

     Last year, Population Council President Margaret Catley Carlson

proposed, in her Paul Hoffman Lecture, that “a ‘child first’ policy

should be explored as a basis for policies and programs among those

concerned with population.” She noted that early population activists

used to stress that ‘every child should be a wanted child’. She


     “I am not sure at the time we understood what this could actually

     mean. Armed with the information we have about the possibility of

     discrimination among children and the daily evidence on the

     streets of many large cities of the abandonment of children, it is

     time that child rights, along with adults’ reproductive rights,

     enter into thinking about what human rights, when fully explored,

     Will mean to population policy. Among other things, we must

     increase children’s claim on the emotional and economic resources

     of both their parents.”

The great potential of this conference

     This meeting holds the promise of being a most historic world

gathering. The several reasons include:

     First, the great breakthrough at the core of the Programme of

Action awaiting your endorsement is the recognition that only a holistic

approach to problems of population and development can succeed. If

effectively carried out, this approach can produce results that few

envisage today. For the first time, the world community is coming

together behind a common understanding of the inter-relationships and

synergisms between improved family planning information and services;

efforts to reduce infant, child and maternal mortality; literacy and

basic education; gender equality and empowerment of women throughout the

life cycle, starting with girls — which are the main factors

influencing the choices of individuals and couples regarding family


     As noted in the Preamble, implementing the goals and objectives of

the present 20 year Programme of Action would address many of the

fundamental population, health, education and development challenges

facing the entire human community. What is more, it would also result in

world population growth during this period and beyond at levels close to

the United Nations low variant — that is, peaking in the year 2050 at

less than 8 billion and declining thereafter.

     Discussing population in the context of sustainable development

also helps us to avoid some of the pitfalls that have made the debate on

population issues so difficult. Most importantly, the emerging Cairo

consensus does not “blame the victim”; that is, the population problem

is not reduced to blaming the poor, especially poor women, for having

too many children. This simplistic and quite frankly, dangerous thesis

gave rise to population control efforts which — however well-

intentioned -were widely interpreted as thinly disguised campaigns

against the poor and to control women’s lives.

     The sustainable development perspective says that population is

not merely an issue of numbers, but primarily one of poorly distributed

and wasted resources, of unsustainable production and consumption

patterns. Population is now being viewed both as a common problem of the

wasteful, overconsuming North as well as of the rapidly-growing,

underdeveloped South. What is needed, then, is a partnership of North

and South to chart a path toward population policies rooted in equitable

and sustainable development for all. Instead of coercion, the new

approach to population policy must broaden the rights, opportunities and

choices of women and families.

     From this common understanding of the problem, a concerted, global

effort needs to be mounted without delay.

     Second, by embracing the concrete goals set forth in the Programme

of Action, this conference can help accelerate momentum in an area where

unprecedented progress is already underway -improvements for children —

which will in turn have a major synergistic impact on slowing population


     At the 1990 world Summit for Children — the first-ever global

summit, the world’s leaders noted the important impact of reductions in

child mortality on fertility levels. In their Plan of Action, they

pointed out that:

     “Achievement of the goals for children and women [goals

     subsequently endorsed by the Earth Summit and incorporated into

     Agenda 21, I would add parenthetically] would also contribute to

     lowering population growth, as sustained decline in child death

     rates towards the level at which parents become confident that

     their first children will survive is, with some time lag, followed

     by even greater reduction in child births.”

     The child survival effect is especially strong when women and

couples also have access to education and family planning information

and services.

     I have recently seen a draft study presented at Harvard’s Center

for Population and Development and soon to be published by the

University of Pennsylvania that attempts to quantify the

interrelationship of child mortality reduction and fertility change,

along with many of the other factors directly and indirectly influencing


     This work-in-progress suggests that achievement of the child

mortality reduction goal of the World Summit for Children — a one third

reduction by the year 2000 — would contribute to a world population

that is even lower than the UN’s low projection.

     I emphasize this not to single out child mortality reduction as

the principal driving force for slowing population growth — we know

this is not the case — but simply to stress its importance alongside

the other major factors and conditions that converge and inter-act to

enable individuals and couples to choose to have smaller families. No

population in the developing world has experienced a sustained fertility

reduction without first having gone through a major decline in infant

and child mortality.

Progress for the world’s children

     We have seen great progress in preventing child deaths over the

past three decades. When I came to the United Nations Children’s Fund in

1980, 15 million children were dying every year of largely preventable

causes; today, with births more than 15 per cent greater, the

figure has been brought down below 13 million. With our vastly greater

capacity to reach all children with the fruits of modern science and

medicine, we now have a good shot at cutting 1990 levels by another 2

million annually by the end of next year if a series of mid-decade goals

already agreed to by the developing countries in the follow-up to the

World Summit for Children are met by December 1995. This will give us

momentum to achieve the year 2000 goals that will cut further millions

from this obscene and unnecessary death toll. National Programmes of

Action to meet these goals have been issued or drafted by some 120

countries to date and now cover about 90 percent of the world’s


     A good start has been made, as reflected in achievement of the

1990 goal of immunizing fully 80 per cent of all the world’s children

against the six main killer diseases of childhood. It is also now clear

that a majority of developing countries are already on track to achieve

a majority of the 13 mid-decade goals; with a concerted international

effort over the next 16 months, both of these majorities could be

increased significantly.

     Pursuing today’s low-cost opportunities to protect the health,

nutrition, and education of women and children in the developing world

is one of the most immediately available and affordable ways of

weakening the grip of poverty, population growth, and environmental

deterioration, which are among the greatest threats facing humankind on

the threshold of the 21st century.

     For these reasons, we are confident that this conference will

unbracket the language contained in Chapter VIII of the Programme of

Action, action point 8.16, which reaffirms the World Summit goals for

infant and child mortality reduction and calls for further progress

beyond the year 2000. Failure to remove the brackets on this section

would set the dangerous precedent of diminishing the commitments made by

the heads of state and governments of 155 countries.

     Third, this conference’s recognition of the centrality of women is

absolutely crucial, paving the way toward the World Social summit in

Copenhagen and the Beijing conference on women next year — and,

hopefully, toward major changes in the lives of women everywhere. The

draft Programme of Action in its entirety captures the simple,

incontrovertible truth that there will be no sustainable development, no

stabilization of populations at manageable levels, no lasting solution

to the problems of environment, no true democracy, and no peace, just so

long as half of humanity continues to be subject to gross discrimination

and abuse. We are also particularly gratified that the Programme of

Action recognizes that gender-based discrimination against women can

best be overcome by constructive action throughout the life cycle. Such

action must begin with the girl child, where the foundations will be

laid for equality and empowerment later on in life.

     Women have clearly taken the lead in the struggle for an end to

gender discrimination. But speaking as a man and as the father of three

sons, I can say that we males have our work cut out for us; we have a

great deal of learning to do, and a great deal of changing to do, if

gender equality is ever to be achieved.

     In your deliberations on the Programme of Action, I urge you to

build on the text of the World Summit for Children Declaration and Plan

of Action, which sets the goal of ensuring “access… to information and

services to prevent pregnancies that are too early, too closely spaced,

too late or too many” — and let me say in this connection that when we

speak of family planning, we are not talking about abortion, which

should not be a method of family planning.

     The World Summit Plan of Action also set the goal of empowering

“all women to breastfeed their children exclusively for four to six

months.” It is worth emphasizing that in addition to all its many

extraordinary benefits to children, women and families, breastfeeding

has played and still plays a major supporting role in slowing population

growth, especially in the poorer countries. How many of us are aware

that if there were no breastfeeding tomorrow, births would increase by

an estimated 20 30 per cent? The Institute for Reproductive Health at

Georgetown University estimates that breastfeeding averts between 70 and

90 million births a year. Families, institutions and society at large

must provide women who are mothers with the support and encouragement

they need to breastfeed and thus have healthier children, more space

between births, and greater personal health.

     Let me say a word about the importance of youth in the context of

population and development. Investing in the health and development of

young people, particularly adolescents, is one of the most important

actions we can take today. Teens need support, guidance and respect if

they are to safely navigate the difficult transition from childhood to

adulthood and establish healthy behaviours that will stay with them for

the rest of their lives. To do this, we must understand their realities

and listen to their concerns; youth need to be well-informed and

actively involved in all efforts to promote their health and


     Unfortunately, for too many girls around the world, with

adolescence comes motherhood, and an overnight leap into adulthood. This

is a cause for concern because young girls are not emotionally or

physically ready for childbearing. Teenage pregnancies both within and

outside marriage diminish young women’s opportunities and increase their

vulnerability to disease, maternal morbidity and mortality and poverty.

As outlined in the Programme of Action, basic education, especially for

girls, is critical to preventing a cycle of early pregnancy and

impoverishment. This, along with access to appropriate information and

services, and the development of “life-skills”, will help young people

make informed decisions to prevent early parenthood and to enhance the

quality of their lives as they grow into the adults of the 2l st

century. And recent studies have shown that delays of just a few years

in marriage and childbearing could significantly contribute to slowing

population growth.

     In short, we must see to it that women are empowered to control

their lives and their fertility, through education, jobs and access to

health care, including family planning information and services. We must

place special emphasis on informing, supporting and facilitating the

participation of young people in their quest to live healthy and

productive lives. And we must help men become responsible and

participatory parents.

The 20/20 joint initiative

     My fourth and final point refers to the vital question of

resources. The modest funds required to implement the strategies and

meet the goals established in the Programme of Action must be made

available quickly and without conditionalities. There are indications

that, with this conference, greater funding may be forthcoming for

mainly one aspect of the action plan that is before us. As welcome as

any sectoral increases obviously are, it is important to keep in mind

the essential breakthrough taking place at this conference: recognition

that any solution to population and development problems will require a

holistic approach. And holistic funding, too — which ideally, given the

urgency of the inter-related threats facing one and all in the global

village, should involve significant increases in resource availability

for meeting the most critical goals.

     Without for a moment renouncing our quest for increases toward

meeting the long established goal of allocating 0.7 per cent of

industrial countries’ GDP to official development assistance (ODA) — a

goal inspired both by justice and prudence — I commend to your

attention the 20/20 initiative being promoted jointly by the United

Nations Development Fund, the United Nations Population Fund, and

UNICEF. It is alluded to on two occasions in the draft Programme of

Action that is before you — both of them in brackets. It is precisely

the kind of holistic approach urgently needed for reallocating current

levels of funding in order to jump-start implementation of the Programme

of Action.

     Simply put, what is involves is ensuring that national governments

devote at least 20 per cent of their domestic budgets to providing basic

social services — primary health care including family planning, basic

education, nutrition, and low cost water and sanitation for rural and

peri-urban areas — and that donor countries see to it that at least a

similar proportion of their ODA goes to support these strategic areas

for sustainable human development. On average, current funding is much

less a share of national budgets and of ODA.

     From UNICEF’s vantage-point of efforts for children in over 120

developing countries, we see significant progress in the 20/20 direction

mostly on the developing country side. The donor community — which has

done so much to alert the world to the severity of the interlocking

problems that confront us — must do its part if these inescapable

problems are to be tackled in time.

     If this conference is followed by serious action to increase and

wisely reallocate resources for population and development in the

holistic manner I described, we will truly be tapping the potential of

the post-Cold War era for international cooperation.

A crisis point in history/an opportunity for concerted action

     Before closing, permit me to quote from the Joint Statement on

World Population issued last year by 56 of the world’s Scientific


     “History is approaching a crisis point with respect to the

     interlocking issues of population, environment, and development.

     Scientists today have the opportunity and responsibility to mount

     a concerted effort to confront our human predicament. But science

     and technology can only provide tools and blueprints for action

     and social change. It is the governments and international

     decision-makers, including those meeting in Cairo … who hold the

     key to our future. We urge them to take incisive action now and to

     adopt an integrated policy on population and sustainable

     development on a global scale. With each year’s delay the problems

     become more acute. Let 1994 be remembered as the year when the

     people of the world decided to Act together for the benefit of

     future generations.”

     And I would like to emphasize the “act together”. We must not

allow well-publicized disagreements to obscure or undermine the

unprecedented consensus that has consolidated around the bulk of the

Programme of Action. The extraordinary breadth of agreement that now

exists on most of the fundamentals of population and development is what

must be preserved and enhanced here this week — and especially in the

weeks, months and years of concerted global action ahead.

     Our children and grandchildren — and unborn generations to come –

– are depending on us here in Cairo to make the wise decisions that will

determine their future. The choice is in our hands.