United Nations E/CN.9/2002/2 Distr.: General Economic and Social Council Original: English Commission on Population and Development Thirty-fifth session 1-5 April 2002 Item 3 of the provisional agenda∗ Follow-up actions to the recommendations of the International Conference on Population and Development Concise report on world population monitoring, 2002: reproductive rights and reproductive health with special reference to HIV/AIDS Report of the Secretary-General Summary The present report has been prepared in accordance with the terms of reference of the Commission on Population and Development and its topic-oriented prioritized multi-year work programme, which was endorsed by the Economic and Social Council in its resolution 1995/55. The Commission, in its decision 2000/1 decided that the theme for the Commission at its thirty-fifth session in the year 2002 should be “Reproductive rights and reproductive health, with special reference to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)”. The report provides a summary of recent information on selected aspects of reproductive rights and reproductive health and covers topics such as entry into reproductive life; reproductive behaviour; family planning; abortion; maternal mortality and morbidity; sexually transmitted infections; human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); and policy issues related to reproductive rights. The preliminary, unedited version of the full report is available as a working paper in document ESA/P/WP.171. The report was prepared by the Population Division of the Department of Economic and Social Affairs with contributions by the World Health Organization and the Joint United Nations Programme on Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) (UNAIDS). ______________ ∗ E/CN.9/2002/1 1 Contents Page Introduction............................................................................................................................ 2 I. Entry into reproductive life .................................................................................................... 6 II. Reproductive behaviour ......................................................................................................... 12 III. Family planning...................................................................................................................... 20 IV. Abortion ............................................................................................................................ 27 V. Maternal mortality and morbidity........................................................................................... 34 VI. Sexually transmitted infections............................................................................................... 40 VII. Human immunodeficiency virus/acquired immunodeficiency syndrome ............................... 44 VIII. Reproductive rights ................................................................................................................ 50 Tables 1. Timing and marital context of the initiation of sexual activity among men and women aged 20-24, selected regions ........................................................................................................... 8 2. Total fertility rate, major areas and regions, 1970-1975 and 1985-2000......................................... 12 3. Total fertility rates according to women’s level of education, selected developing countries ......... 16 4. Average prevalence of specific contraceptive methods, by major and region ................................. 21 5. Reported legal abortions, most recent year ..................................................................................... 28 6. Legal status of Mifepristone (RU-486) ........................................................................................... 32 7. Estimates of maternal mortality by region, 1995............................................................................. 36 8. Trends in percentage of deliveries assisted by skilled attendants for 53 countries, 1989-1999....... 39 9. Estimated prevalence and annual incidence of curable sexually transmitted infections by region, 1999............................................................................................................... 41 10. Regional HIV/AIDS statistics and features, end of 2001 ................................................................ 45 11. Regional HIV/AIDS prevalence among young people aged 15-24................................................. 46 12. Government policy towards access to contraceptive methods, by level of development, 1999 ...... 51 Figures 1. Distribution of countries according to average age at marriage for men and women, most recent data............................................................................................................................... 11 2. Age-specific fertility of women aged 15-19, late 1990s.................................................................. 19 3. Percentage of currently married women whose family planning need for spacing or for limiting births is satisfied, by major area, late 1990s................................................................. 25 4. Adolescent pregnancy outcomes, 1999 or most recent year............................................................ 31 5. Trends in maternal mortality, selected countries in Latin America, 1980-1999 .............................. 37 6. Trends in maternal mortality, selected countries in Asia, 1980-1997.............................................. 37 7. Trends in maternal mortality, selected countries in Eastern Europe, 1974-1997............................. 38 Box 1. Reproductive rights and reproductive health as defined in the Programme of Action of the International Conference on Population and Development ................................................... 5 2 Introduction At the twenty-first special session of the General Assembly for the review and appraisal of the implementation of the Programme of Action of the International Conference on Population and Development, held in New York in 1999, Governments affirmed their renewed and sustained commitment to the principles, goals and objectives of the Programme of Action, including those related to reproductive rights and reproductive health (United Nations, 2000a). The Programme of Action of the International Conference on Population and Development in Cairo in 1994 (United Nations, 1995a) defined reproductive health in a comprehensive manner to encompass physical, mental and social well-being in all matters relating to the reproductive system, and to its functions and processes (see Box 1). Thus, in contrast with previous approaches that focused on specific aspects of reproductive health, such as safe motherhood, maternal and child health and family planning, the reproductive health approach is concerned, not only with pregnancy-related health issues, but also with health and human rights issues relevant to reproduction and sexuality that arise within and outside the childbearing ages. The broad definition of reproductive health implies that the health and survival of infants and children are important indicators of reproductive health. Child survival is viewed as being closely linked, not only to the timing, spacing and number of births, but also to the health of mothers. Adolescence is a period during which the prospects for a healthy reproductive life can be compromised. Major risk factors include premature entry into sexual relationships, multiple partners, early childbearing, high-risk sexual behaviour, unsafe abortion1 and lack of basic health information and services. Sexually transmitted infections, especially the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) pose major threats to adolescents. The childbearing ages, which have traditionally been the focus of family planning programmes and maternal and child health programmes, have also become the ages of significant risks of contracting and dying from HIV/AIDS. In contexts where the epidemic is most severe, unprotected heterosexual sex and having sexual relations with multiple partners appear to be the most important factors accounting for the rapid spread of the epidemic (UNAIDS, 2000). The reproductive health approach also recognizes that reproductive health problems can occur well beyond the childbearing years. In women, menopause can trigger many biological and physical changes that may lead to alterations in the skeletal and cardiovascular systems. In men, tumours of the prostate gland are relatively common in the later adult years and can impair sexual function and can result in death. In both men and women, early sexual initiation and multiple partners increase the risk for reproductive cancers. Since 1994, Governments, civil society and the international community have made efforts to implement the agreements reached in Cairo with respect to reproductive rights and reproductive health. Many countries have also made policy, legislative and institutional changes to better support the implementation of reproductive health programmes. The five-year review and appraisal of the implementation of the Programme of Action showed that important achievements had been made in improving reproductive health (United Nations, 1999a; 2000a). In particular, the broad-based definition of reproductive health is being accepted by an increasing number of countries.