Podium: The spread of contraception

George Foulkes

From a speech by the development minister

to the United Nations Hague Forum

on population

WHAT ARE our priorities for action? Nowhere is support more needed than for HIV/Aids, which threatens single-handedly to wipe out the development gains of the last three decades. The latest figures predict that 40 million people may be living with HIV by 2000.

Prevention must be the priority for the global response. We now know more than ever how to prevent HIV and we must continue to do more of what works: information powerful enough to change behaviour, condoms, treatment for sexual infection and safe blood.

We must also intensify our efforts to get the science right and find both a vaccine and a female-controlled protection product such as a microbicide. These products, as with condoms and contraception, will need to be subsidised - from government and donors' funds - to ensure that poor people will be able to benefit from them.

Nowhere is the inequality and inequity between rich and poor, women and men more starkly illustrated than by the number of women who die every year as a result of pregnancy and childbirth.

Let us be clear what the challenge here is: it is the right to life of 8 million women between now and 2015 and the right to survival and quality of life of their dependants.

Maternal mortality statistics are the barometer for the extent to which health systems do or do not function.

We must work to ensure that health sector development delivers improved maternal and other reproductive health outcomes. We need standards for the care women should expect and authoritative guidance on the functions that health systems should perform. While the so-called "population explosion" may be over, we should not forget that more than 1 billion young people - the largest generation in human history - are now entering their reproductive years.

It is the choices made by these young people that will determine the prospects for a fair, healthy and stable world fit for future generations. We must defend their right to be given a choice.

This includes helping them to make wise decisions, without coercion, about when to commence sexual activity. It includes making sure that they have access to services and products to protect themselves against sexual infection and pregnancy if and when they do become sexually active.

In development, we talk about food security. With HIV prevalence as high as one in four in parts of urban Africa, reproductive health commodities, such as male and female condoms, are basic needs. We know also that around 120 million couples are still unable to access the contraception that they want when they need it.

We need to make contraceptives and condoms - both male and female - easier to get hold of. If Coca-Cola can be everywhere in the developing world, why not these essential commodities? We think the notion of "contraceptive security" highly relevant to meeting people's sexual and reproductive health needs in the next 15 to 20 years or so.

So what does this mean for the way we work?

First, coherence. International action directed to these priority actions must be coherent and it must be taken in concert. We need strong, strategic leadership. The United Nations system provides this, but we believe that its constituent parts could do more to work together as global champions on HIV, maternal health and contraceptive security. It is essential that we are able effectively to monitor the goals, the outcomes, agreed at Cairo. We believe that new objectives to accompany the Cairo goals are urgently needed to intensify action to combat the progression of HIV. For example, what changes should we be aiming for between now and 2005, 2010 and 2015 in the proportion of young people infected with HIV?

And, last but not least, cash.

There is no "something for nothing". Overall resource commitments have not met the expectations of Cairo. Delivering the Cairo agenda does depend on governments - both north and south - finding new resources for sexual and reproductive health. But we must be focused on outcomes and driven by what works best.

So, let's ensure that the report of the UN Secretary General agrees the kind of key future actions and practical measures needed.

We must adjust our horizons and our time-frames. We need to engage in partnerships over the next 10 to 20 years.

And let's be clear that while knowledge, know-how and good practice matter, progress is determined more by political choice and will.