UNITED NATIONS, March 12-- Family planning is a central component of reproductive health as defined by the 1994 International Conference on Population and evelopment (ICPD) . But the Conference gave reproductive health a broad-based character by linking family planning with the treatment and prevention of sexually transmitted diseases, the reduction of maternal mortality and the promotion of maternal health and sexual and reproductive health of both men and women. Within this comprehensive framework of reproductive health, the ICPD Programme of Action proposes that "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.'' (2) Subsequent to the ICPD, the goal of universal reproductive health was endorsed by a number of other major international conferences. However, due to political manoeuvring by a small group of countries, the goal of universal reproductive health by 2015 was not included among the goals of the Millennium Declaration (pdf) adopted by the heads of state and government at their summit at the United Nations in 2000. This situation could only be rectified in 2005 when the MDG+5 Summit agreed to include the reproductive health goal as an additional target to be achieved by 2015.

While the goal of universal reproductive health services, including family planning, is clearly a priority for the international community progress towards implementing this goal at the national level has run into several obstacles and difficulties. First of all, there is the problem of integrating separate services in the area of reproductive health. These include family planning, treatment of sexually transmitted diseases has been traditionally provided in these countries through other parts of the health system and HIV/AIDS related services. Both the World Health Organization (WHO) and the United Nations Population Fund (UNFPA) take the position now that family planning and HIV/AIDS services should be integrated as far as possible and are urging countries to move in this direction. However, there is resistance to such integration from separately entrenched programme managers and civil servants as well as from many international donors.

Then there are the problems relating to cultural or religious traditions. What kind of sexual or reproductive health information should be provided to adolescents? And further on, what kind of access should adolescents have to contraceptive supplies and services? The international consensus as outlined at Cairo, on this subject, is in favour of giving adolescents much greater access to information and services than is available in many countries. But how this consensus is interpreted at the country level depends on how a national consensus on this question is developed and civil society organizations should play a major role in building up such a consensus, taking due account of cultural sensitivities.

Abortion is another subject that arouses serious debate and passion. Cairo agreed that abortion is not to be regarded as a method of family planning, but that it is a serious health concern and should be treated as such at the national level. Whether abortion should be legal or not is ultimately a question to be resolved under by laws and regulations under national jurisdiction; and where it is legal, it should be safe. This consensus has held at the international level despite acrimonious debates in several international meetings.

Costs become a paramount consideration when the governments, in partnership with the private sector and the civil society, seek to achieve the goal of providing universal reproductive health services by 2015. Over all, developing countries are allocating increasing large amounts to provision of health services, including family planning; but the total allocations in this sector hide the fact that a few large countries in Asia account for the major part of these allocations; and most of the countries in Sub-Saharan Africa remain woefully short of the resources required to make the ICPD goal a reality. The problem is further aggravated by the fact that international assistance for the sector presents a very distorted picture compared to what was envisaged at Cairo. Since Cairo, the percentage of international assistance allocated to family planning has gone down from 55 percent to 9 percent. While support for HIV/AIDS services is now running at $10-12 billion a year, support for family planning , has not grown much; it has in fact remained more or less stagnant.

Similarly, support for maternal health services remains quite low, while the estimates for maternal deaths that can be attributed to pregnancy- related causes have not gone down in 20 years. The basic research, data and population policy analysis programmes also suffer from totally inadequate funding. Our goal in the immediate future should be to refocus both national and international attention on strengthening political commitment and support for the achievement of the ICPD goal of universal reproductive health services, including family planning, by 2015, The achievement of this goal must be seen as part of the comprehensive efforts to implement the Millennium Development goals.

(1) Jyoti Shankar Singh is the Permanent Observer to the United Nations of 'Partners in Population and Development', an intergovernmental organization.

(2) Chapter VII, paragraph 7.3, and Chapter VII, paragraph 8.25: Reproductive rights and health, morbidity and mortality
These chapters of the Programme of Action define reproductive rights and call on governments to regard unsafe abortions as a major public health concern, improve family planning services to avoid abortions, provide health care and guidance for women who have unwanted pregnancies, and urge the implementation of policies and changes in the approach to abortion on a national and local level, in accordance with national legal systems, declaring that 'in all cases women must have access to quality services to manage complications arising from abortions. Post-abortion counseling, education and family planning services should be offered promptly, helping women to avoid repeat abortions'; also asserting the need 'to revise the laws that penalize women who have illegal abortions'.