Population
Speakers: Dr. Allan Rosenfield (click here for biography)
Soap Summit 1

Transcript of Proceedings
October 22, 1994

SONNY FOX: Allan Rosenfield is the Dean of the School of Public Health at Columbia University. He is also chairman of the board of the Guttmacher Institute. He has been on the board of Planned Parenthood for twelve years, and chairman of that board for two years. Has worked with the Population Counsel. Is renowned throughout not this country, but all over the world. Anytime you get into this area you mention the name, "Allan Rosenfield" people smile and nod and say "Yeah." So I smile and I nod and say "Yeah." Here's Allan Rosenfield.

DR. ALLAN ROSENFIELD: I'm going to talk a little about Cairo, and what happened there. But before I do that, let me just give you some facts to back up what Charlie Westoff discussed. There are some 2.5 billion sexually active people on earth today. Someone has figured out that there are roughly 100 million acts of intercourse every day. I'm not sure the basis of the data. (Laughter) There are 700,000 conceptions, roughly, every day, most of which, or half of which, are unplanned. About 400,000 live births daily. 50 thousand abortions, daily. 1,400 maternal deaths, or pregnancy-related deaths daily, or some half a million each year. And about 250,000 people are added to the earth's population every day, or each year, some 90 million or more. To put into perspective, on Charlie's numbers, it took all of our history to reach the first billion around the middle of the 19th century. We now add one billion people around every 11 or 12 years. Clearly the population issues are part of the major reason for the Cairo conference and its two predecessor conferences -- 1974 in Bucharest, 1984 in Mexico City.

There were sort of three major issues that were of concern as we moved towards Cairo. The first are the population issues that Charlie has discussed. The second, the past decade or so the concerns about the environment and the role of rapid rates of population increase and its impact on the environment, and finally, a broad range of issues related to reproductive health and reproductive rights. And within that agenda we're talking about pregnancy-related deaths. I've just mentioned some half a million each year. 98% or 97% of those taking place in developing countries. And the vast majority of them from causes that are totally preventable. At least the deaths are preventable, if not the causes. There are some perhaps 60 to 100 thousand deaths each year from abortion, and untold additional numbers of complications from a botched, unsafe abortion. There are issues related to sexually-transmitted diseases throughout the developing world and HIV/AIDS, which increasingly is affecting women as well as men. And finally, female genital mutilation, a procedure that millions of young girls are subjected to each year.

Leading up to Cairo we did have two prior meetings. The first was in 1974 in Bucharest. And that particular meeting the United States was somewhat of a hawk on the population issues and was accused by developing countries of sort of imperialism, trying to hold down the colored races of the world, the people of color of the world. And it really turned into a meeting of a great deal of North-South debate on the North's impact on poor, developing countries. In Mexico City in 1984, things had changed. The developing world, by in large, was concerned with the types of data that Charlie showed, but the U.S. in the administration that Mr. Reagan and Mr. Bush had decided that population was not a problem, that people were good, and the answer to population problems was a free market enterprise, and if everybody had free-market systems, the other issues would disappear. And, in addition, abortion was a bad thing, and many of the issues the Vatican raised at this meeting were supported by the U.S. in 1984. The Vatican and the U.S. were allies.

Leading up to Cairo this past year, was a series of preparatory meetings in New York. A bunch of regional meetings and meetings of a variety of non-governmental organizations around the world. And there were sort of two themes that people thought would be the debates. One would be those who believe the population imperative is the key driving force and it must be dealt with as one of the world's great problems -- environmentalists joining in that population growth is a major problem -- vs. the Women's Movement, stating that women's reproductive rights and health are key issues, and if those are met the other issues will in effect take care of themselves.

That strong debate didn't take place for two reasons. One, the two groups did have a variety of meetings trying to come to some common grounds, and, perhaps more importantly, by the third preparatory meeting in New York in April, the Vatican had taken a very strong stance against the draft documents, against almost any term that they felt could lead to a discussion of abortion. So in the U.N. parlance, if you can't in the preparatory meetings agree on a phrase or a term or a paragraph, you put it in brackets. And the Vatican was given, for reasons that have elicited much debate since the meeting, essentially pseudo-nation status, and they functioned there with a delegation as though they were a country. As someone has described it, it is a country about a mile and a half across, that is populated totally by men, so it makes an interesting...and celibate men by in large...an interesting country. Nonetheless, they played a major role, the bracketed family planning, they bracketed reproductive health, they bracketed safe motherhood, they bracketed almost every term that they thought could in one way or another could lead to a discussion of abortion. And following the New York preparatory meeting they went on a major campaign to convince governments that the document was evil and should not be supported.

They were singlehandedly responsible for the scare that was placed before many of the delegates as to what the Islamic fundamentalist community might do in Cairo. Friends of mine in Egypt said they weren't involved in this, didn't care about this particular meeting or the issues, until they had been motivated by the Vatican's efforts, about how evil the document was, that led them then to make the statements they made.

In Cairo there were some 170 countries,, and a huge number of non-governmental agencies. There were two meetings that take place simultaneously, the governmental meeting, and then the non-governmental meeting off to the side. And the NGO community had a major impact on the various government delegations. And several of them, including our own, had as part of the official delegation, a large number of people from the private sector. Charlie is correct.

The meeting did not focus in the ways the previous meetings had on population issues, but I still think the meeting had a positive outcome, although 1 too would like to have seen more attention to the population side of the agenda. The media attention at this meeting was probably unprecedented. I don't know of any international meeting that attracted front-page stones in The New York Times and other major newspapers every day of the meeting. Incredible CNN coverage, network coverage, and network coverage throughout the world in other countries. And a large part of that perhaps was do to the great attention given to the abortion debate with the Vatican.

Mr. Gore, in his opening address, gave really a quite eloquent speech that both help to defuse the issue on the U.S. promoting abortion, and also assuming responsibility in the environmental debates that, yes, population is a major issue in relation to environmental degradation, but so are developed countries. And you have a document from the Pew group in your folder which describes the contri-bution of western nations to the degradation of the environment as well as from the developing world. And his two statements really defused the issues -- I think played a major role from what I was told by many of my Muslim friends in taking the Muslim group countries from the Vatican camp and into the camp of the majority at this meeting.

We spent an immense amount of time, as you all read in the newspaper, debating one paragraph. For those who that were there, it was paragraph 8.25, and I guess all of us who were there will remember that particular 8.25, because it went on for two and a half days. It's a short paragraph. Many of you have probably seen it. But I think there were three important things that came out of that long debate, that were signed on by the world's countries. One, although abortion was not promoted as a prime means of family planning, there was recognition that unsafe abortion is a major public health problem. That's never been stated in a public forum of this type before. Further, that it should be reduced to expanded and improved family planning services. And finally, and I think of particular importance, that where there has been an unsafe abortion, women should have access to early treat-ment and management of that abortion. That will allow, I hope, countries to distribute the type of equipment, called suction curettage, that will allow one to very early on intervene and safe a poten-tially fatal complication, by completing the abortion early with this equipment. It happens that the equipment to treat an abortion is the same equipment that one uses to induce an early abortion, but it would be distributed for its treatment purposes, not for the other.

Other issues that caused a great deal of debate were an issue that I think we're going to spend a fair amount of time on today -- adolescent pregnancy and adolescent sexuality. There was among the Muslim countries, and several of the Catholic countries, a great deal of difficulty in discussing this issue, and I don't think the final statements were quite what I would like to see in terms of the rights of the adolescent vs. the rights of the parent. Most of us feel that while we'd like parental involvement, and we think it's very important, in the final analysis, teens are going to have to make the decisions for themselves, and where parental consent is required, it will drive many teens from any kind of effective support.

There was a lot of discussion about what is meant by reproductive and sexual health. In some coun-tries the translation of sexual health translates to intercourse, and some countries did not want that in the title of a paper. But there was much more recognition of sexuality and the importance of sexuality. Finally, I think the two key areas that are important from Cairo relate to human rights and reproductive rights as a human right and the empowerment of women -- the education of girl children, employment equity issues, equality issues -- and the women's movement played a very important role at this meeting. In terms of women's reproductive rights and reproductive health, the meeting was a major step forward. It didn't say as much, perhaps, as we would have liked on the population issues, but I think there is enough in that document that will allow those international agencies and organizations to promote active family planning programs to meet the rights and needs of women, and at the same time meeting the demographic imperatives. That will include messages to help motivate women to make use of these services, and I think what we're talking about here in terms of the use of soap operas around the world, and in our country as well, is a tremendously important step forward. There's tremendous misunderstanding about the issues, about contraception, about the pill, for example, in our country, and I think the use of the media, and particularly the soap opera approach, can play a major role in changing the situation in our country, as well as what we're seeing in other countries of the world. Thanks.

(Applause)