1994: International Conference on Population and Development
The PoA clearly defines the concepts of sexual and reproductive health (SRH) and reproductive rights, including universal access to related services and commodities. It also addresses concerns such as universal access to education, with special attention to closing the gender gap in primary and secondary education; universal access to primary health care; reduction in infant, child and maternal morbidity and mortality; and increased life expectancy. It includes recommendations on gender equality and the empowerment of women; the family; sustainable development; the environment, including climate change; and migration. The PoA established a historic global paradigm shift from a population control development approach to one that is both people-centered and rights-based.

1999: ICPD + 5
The first review of progress made in the implementation of the ICPD PoA took place in 1999. In February of that year, the United Nations Population Fund (UNFPA) held an inter-regional 2-day Hague Forum, which was preceded by an NGO Forum. Later in the year the 21st special session of the UN General Assembly was held, at which the Key actions for the further implementation of the Programme of Action of the International Conference on Population and Development (Key Actions) were agreed.

2004: ICPD@10
In 2004 the second review took place. By this time the international political climate had changed with new opponents to the Cairo agenda, including the US government under its new President George W Bush. No major inter-governmental meeting was held, although there were regional meetings and technical meetings and a commemorative session of the General Assembly. An NGO Global Roundtable organized by the Countdown 2015 Initiative, under the leadership of the International Planned Parenthood Federation, Population Action International and Family Care international, took place in London. In addition a review of in-country progress was carried out with the results being published by UNFPA – Investing in People: National Progress in Implementing the ICPD Programme of Action.

2009: ICPD at 15
This year, the third review of the progress made in implementing the ICPD PoA takes place. Again there is no global inter-governmental meeting, with the exception of a commemorative event at the UN General Assembly. Technical meetings and regional meetings will also take place and Global Partners in Action: NGO Forum on Sexual and Reprodcutive Health and Developemnt – Invest in Health, Rights and the Future is being held in Berlin 2-4 September, co-hosted by the UNFPA and the Government of Germany. Other NGO events are also taking place in 2009, including the 5th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR) to be held in Beijing, China from 17-20 October 2009, as well as other regional and sub-regional meetings.

ICPD and the Millennium Declaration and Development Goals
While the focus in the early 1990s had been on major international conferences addressing specific topics and often accompanied by parallel NGO Forums, at the beginning of the 21st century the pattern for promoting sustainable development changed with the adoption of the Millennium Declaration and the subsequent introduction of the Millennium Development Goals (MDGs). Regrettably sexual and reproductive health and reproductive rights were omitted from the eight MDGs. However, at the World Summit held in 2005, Heads of Government committed themselves to achieving universal access to reproductive health by 2015. In turn this led to an additional target MDG Target 5B.

A unique document for sexual and reproductive health and rights
The ICPD PoA is unique in defining sexual and reproductive health and reproductive rights. Reproductive health as included in para 7.2 is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system that implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.” Men and women should be informed and have access to “safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods for the regulation of fertility which are not against the law”. Reproductive health care is also “defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being…” These are further enumerated in para 7.6 Sexual health is also included in para 7.2 “the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.” Reproductive rights are included in para 7.3 and are based on “the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so.”

The PoA includes carefully crafted language on which the largest number of United Nations member states gathered in Cairo could reach consensus such as that on the rights of adolescents to information and services and unsafe abortion. Some of the language was ‘moved forward’ in the Key Actions, for example that on HIV/AIDS, for which the magnitude of the problem had not been realized in 1994, and on the training of health professionals for abortion services where it is not against the law. Subsequently both NGOs and governments have concentrated on ensuring that there has been no backtracking on the Cairo Agenda. Both the Programme of Action and the Key Actions include specific goals, in some cases with indicators for their implementation. These form the basis for some of the MDG goals and targets, the most notable being the targets for some of the health-related MDGs, particularly MDG5, namely the reductions in maternal mortality and universal access to reproductive health by 2015. The ICPD PoA is unique insofar as it includes a costing of the resources necessary for its implementation; however, while financial targets have been set, substantial shortfalls in funding, particularly from donor countries, have impeded progress in its achievement.

Five years to go for both ICPD and the MDGs
2015 will mark both the end of the period for the ICPD PoA and the MDGs. As such now is an appropriate time to renew efforts to achieve their targets and goals in the area of sexual and reproductive health and rights. In this regard the 2009 session of the Commission on Population and Development was particularly important insofar as it demonstrated on behalf of governments an unprecedented emphasis on human rights, including in regard to sexuality; a new commitment to “comprehensive education on sexuality and gender equality,” access to male and female condoms and reproductive health services for adolescents without the usual restrictive language on culture, religion, parental rights, etc; the importance of integrating HIV and SRH, particularly for girls and women; the need for a priority for maternal mortality and morbidity, as well as for reproductive health overall in health systems strengthening; and the first intergovernmental statement recognizing MDG target 5b (universal access to reproductive health). Before the end of the year other initiatives will be in place to assist in moving forward, including a new report by the Guttmacher Institute  – Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health.

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