§ Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]
9.33 am§ Mr. Tony Worthington (Clydebank and Milngavie)The Cairo conference held in 1994 was an enormously significant event, as 180 nations gathered together to sign a declaration of commitment to put human rights at the centre of reproductive health. Since Cairo, the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and, most important, to have the information and means to do so has been accepted, thus giving people the right to attain higher standards of sexual and reproductive health.
We are, however, a long way from realising that ideal. More than 580,000 women—99 per cent. of them live in developing countries—die each year as a result of pregnancy or childbirth. It is estimated that about 20 million unsafe abortions occur each year, resulting in about 70,000 deaths and millions of disabilities. At any one moment, 120 women who do not want to get pregnant do so for lack of access to contraception. Each year, between 15 million and 19 million young girls give birth. Between 100 million and 132 million women and girls have been subjected to female genital mutilation. More than 30 million people live with HIV/AIDS, the vast majority of them—85 per cent.—in Africa or Asia. That is a catalogue of totally avoidable disaster.
The technology and resources to avoid such disasters are easily available and not expensive, and success in that field would mean that all people would win, wherever they live in the world, but especially women and children living in the poorest parts of the world. The hon. Member for South-West Devon (Mr. Streeter) recently accompanied me to Nigeria, where we saw a country whose per capita income is plummeting; one of the many reasons for that is that the population is soaring. In Nepal, the population is rising rapidly and people are fleeing the hillsides because of deforestation and because those areas cannot support a growing population. In Botswana and Namibia, rapidly growing populations are making the shortage of water more acute, with waterholes drying up and people having to leave the surrounding area.
World population is surging upwards by about 78 million each year. This year, slightly more than 10 years after reaching 5 billion, the number of people will reach 6 billion. We cannot go on at that rate: population growth is the world's biggest sustainable development 824 issue. To an overwhelming extent, that growth has occurred in the poorest parts of the world. One fact that staggers me is that, in 1900, Europe had three times the population of Africa; by 2050–150 years later—Africa will have three times the population of Europe, including Russia. Nevertheless, the greatest numerical increase will have occurred in Asia.
Because these children have already been born and because the developing world's population is so young, nothing can avert huge population growth in the near future; but the sooner the world's population is stabilised because that is what people want, the better it will be for everyone. Throughout western Europe, whether in Britain, Italy, Sweden or Spain, we choose to have small families. I want to ensure that every woman and every family in the world has the right to make the same choice.
The timing of the debate is impeccable. In February, a major forum for non-governmental organisations will be held in The Hague; and a conference of parliamentarians to assess Cairo-plus-five will take place at roughly the same time. The all-party group on population, development and reproductive health, chaired by my hon. Friend the Member for Clwyd, South (Mr. Jones), has taken a prominent role in the planning of those conferences. The United Nations Commission on Population and Development meets in March; and, from 30 June to 2 July, there will be a special session of the United Nations General Assembly to consider progress since Cairo. Today's debate gives the House a chance to assess progress since Cairo, and to hear from the Government their evaluation of the progress made and their policy for the future.
Let us first address the issue of resources. The funding target agreed in Cairo in 1994 was £17 billion, of which two thirds was to be provided by developing countries and one third by developed countries. By the end of 1995, the developing countries had spent £7.5 billion on population development and reproductive health activities. Donor countries had contributed £2 billion. Those were early days post-Cairo, but in order to reach the agreed target by 2000, donor countries must increase their contributions by 23 per cent. each year.
Any funding shortfall is not academic but has profound consequences for individuals. The United Nations Fund for Population Activities has calculated that the current rate of underfunding will result in 120 million unwanted pregnancies, 49 million additional abortions, 5 million deaths of infants and young children and 65,000 maternal deaths over the years 1995 to 2000.
How is Britain doing as a nation? To their credit, the previous Government increased the amount of aid resources devoted to reproductive health. However, they did so within the restrictions of a constantly falling aid budget. The research organisation Population Aid International has evaluated the performance of all donor nations. Only the Scandinavians get A grades; we receive a B-minus. Of course, the organisation evaluated the performance of the previous Government; it did not take into account our creation of the Department for International Development or the wonderful 28 per cent. increase in DFID's aid budget following the comprehensive spending review. We have put much more energy into debt and trade issues that will help developing countries.
825 Today's debate will give the Government a chance to reaffirm our commitment to reproductive health and to commit ourselves to further development of our contribution to this field of human rights. Britain is commended for our technical expertise, and I praise the first-rate efforts of NGOs such as Marie Stopes International and Population Concern, which are respected throughout the world for their contributions. I also commend the BBC World Service and the International Planned Parenthood Federation for their highly successful "Sexwise" radio programmes that are aimed at young people. The programmes were first broadcast in south Asia, but will now go worldwide to eastern Europe, central Asia, Africa, the Americas, the Arab world and south-east Asia. Radio has enormous public education potential in countries with vast distances and poor services. I was pleased to hear from the BBC that the story in The Observer about reductions in the World Service is wrong and that it is planning further investment after years of cuts.
What are the Government's plans? I applaud the start made by DFID, but the Population Action International report says that the British contribution will have to treble if it is to be a fair per capita share of a fully subscribed and honoured Cairo commitment. It is particularly important that Britain should do well because of worries about the contribution of others, particularly the world's major economies. I shall mention three in particular.
The United States has the worst record of all developed nations in terms of its failure to meet the United Nations aid commitment of 0.7 per cent. of gross domestic product. It is unlikely—although I have not managed to check—that President Clinton gave a commitment to any improvement in his state of the union address yesterday. The United States appears to give a substantial amount to family planning services, but that is merely a reflection of its huge economy. The funding is extremely volatile and cannot be relied upon. It depends on who has the upper hand in Congress at a particular time.
The moral McCarthyites are uppermost at the moment and forbid any expenditure where there is even the suspicion that money is being spent on abortion. Unfortunately, in their desire to protect the unborn, those fundamentalists withhold money that would save the lives of women in childbirth. Women are killed by unsafe abortions, and countless thousands of infants and children die because of a lack of resources. It is a strange morality that kills the born so as theoretically to protect the unborn. We cannot rely on the Americans to honour their commitment to Cairo.
The Japanese are also big givers, but there must be question marks over the stability of their contribution given the turmoil in the far eastern economy. There are also doubts about how much of Japan's contribution is devoted to reproductive health as compared with general welfare. There is a trend in Japanese giving to distribute aid to neighbouring countries rather than to the areas of most need and greatest poverty. It is strange that, although the Japanese play a prominent role in international organisations that are concerned with population development and reproductive health, the pill is not available in Japan. That greatly weakens Japan's credibility in human and women's rights terms. It is therefore doubtful whether Japan will be able to contribute as much as we had hoped to the Cairo commitment.
826 Another of the potentially big givers with which we are concerned is the European Union. I hope that there can be much improvement in this area. The Government are also concerned about the issue, and the Select Committee on International Development is investigating the situation. The EU performance gives me and many others cause for concern. It is the most constipated of donors: a great deal seems to go into the organisation's mouth and great intentions are spouted, but little seems to come out easily from the other end.
In 1994, the Commission announced its intention to increase funding for population programmes more than tenfold by 2000. What has happened? Is the EU contribution skewed to the poorest nations? No, in recent years there seems to have been a greater concentration of funding to Mediterranean countries. There also appears to be a shortage of expertise, which is scattered around the multiple directorates-general that have some responsibility for development.
European NGOs and others have extreme difficulty understanding the EU system. It is hard to find one's way around a system that is interminable in terms of delivery. Organisations, particularly poor organisations in developing countries, simply lose patience with a system that can take years to process a proposal. When proposals are processed, the funding is often unreliable. I welcome the Government's views on the likelihood of change.
I turn to other areas of particular concern. I shall not refer to the importance of services for young people because my hon. Friend the Member for Calder Valley (Ms McCafferty) will seek to catch your eye, Madam Speaker, to talk about her valuable work in this connection. In this country and elsewhere in the world, we cannot adopt the posture of the ostrich and simply wish that young people would stop doing it. It is futile simply to aim our services at married couples and those whom we deem to be mature. In sub-Saharan Africa, eight out of 10 young people are sexually active. Many babies are born to very young women—there are 15 million births a year to girls aged 15 to 19. I applaud NGOs such as Population Concern that are involved in this difficult work which is often greeted with hostility. Unless those young people are fully aware of AIDS and how to combat it, for example, they will simply never become adults.
The IPPF and others are doing valuable work in eastern and central Europe of a very different focus. Those countries often had services that have collapsed with the disintegration of the USSR. They are becoming poorer and poorer. Those countries had services, but they were the wrong services because they were based on abortion, so in many countries there were as many abortions as there were live births. It is not allowable under the Cairo protocol, and rightly so, to use abortion as a method of birth control.
It is my belief that, sadly, the biggest challenge to face this country and Europe in the next 10 years will be a further collapse of the area of the former USSR. We must not forget the reproductive needs of people in those countries. I commend the Europe section of the IPPF for the work that it has been doing. I support the—often new—family planning associations in those countries where there has been no tradition of volunteering and where civil society has had to be built up. Women there now have to pay for services that previously were free.
827 Those are volatile countries where the threat of fascism and further social upheaval is constantly present. We have to support the family planning associations and other volunteers who are emerging, often in a hostile atmosphere. What reassurance will the Minister give me that such work is of great importance to the Department for International Development and that he will ensure that we and the European Union generally support it?
Finally, I turn to the scourge of HIV and AIDS. The figures are nightmarish. More than 33 million people are affected worldwide and they are overwhelmingly in the poorest parts of the world. For example, in Botswana, 25 per cent. of the population is HIV positive. An increasing proportion are women who have been infected by their straying husbands. Already in Botswana—this figure is stark—the life expectancy of the population has fallen from 61 to 47. The number of orphans is sky-rocketing as the vast majority of those who die are aged 20 to 50. At clinics that I visited in Tanzania, staff could not dream of testing pregnant women for HIV because women would no longer attend clinics that tested them and gave them bad news about themselves and their babies.
It is difficult in humanitarian terms to think of a more pressing case in respect of which the Cairo commitments should be honoured. Will the Minister tell me whether there are any international signs of optimism in policy approaches or of countries successfully reducing rates of infection?
I am grateful to the House and the Minister for listening to those points. I hope that the whole House and the country will back the Government in their work to support the outcome of the 1994 Cairo conference. I look forward to hearing from the Minister how the Government are approaching the deliberations on Cairo plus five years.
§ Mr. Richard Ottaway (Croydon, South)As one who was part of the delegation at the Cairo conference, I thought that I should make a short speech today. I was rather tied up on the Greater London Authority Bill all day yesterday and will be again today, so my preparation is not what it might have been. I congratulate the hon. Member for Clydebank and Milngavie (Mr. Worthington) on securing the debate, and I agreed with almost every word that he said.
I have drawn the attention of the House to population growth on many occasions during the past decade. The bare statistics are horrifying. When one considers that between the time that we adjourned the House last night and today, another 100,000 people came into the world, one begins to realise the consequences of population growth on the globe and its environment. Another statistic reveals that a third of the world's population is under the age of 15. Those people are tomorrow's parents, and population growth will continue relentlessly.
There are, of course, signs of encouragement. Those of us who have taken an interest in the subject over the years will have received Population Concern's regular data sheets. Before the debate, I picked up two at random—one from 1983 and one from 1993—as a matter of interest and to find out what projections were being made in those years. In 1983, it was forecast that by 2020, the world population would be 7.8 billion. The best comparative statistic is that in that year the world's population was 828 projected to double within 39 years. A decade later, the projection was that the world's population would double in 42 years. That is a clear sign that the policies that have been put into effect in the past two decades are beginning to work.
Population growth has a serious impact on any nation. Whatever one may say about China's population policies—none of us feels entirely comfortable with them—they are achieving results. It is only by addressing the threat to stability in China that its Government have been able to stabilise population growth. I drew attention to the reduction in the doubling time for the world's population; much of that is attributable to the stabilisation of population growth in China.
The threat of population growth to any country is obvious. If a population is growing by 3 per cent. a year, that country must provide 3 per cent. more jobs, 3 per cent. more schools, 3 per cent. more electricity and other resources. If the economy is growing at 2 per cent., the country is going backwards. That is the stark truth.
I am proud that the previous Government recognised the problem—although they took some persuading—and the hon. Member for Clydebank and Milngavie was right to draw attention to that. I recognise that the present Government have, by and large, continued the previous Government's policies, and I pay tribute to that. The Under-Secretary of State for International Development, who will reply to the debate, has a long tradition of involvement in the issue and is supportive, although the restraints of office may, now and again, have an impact on his thinking.
I pay tribute to the key non-governmental organisations in this country who have done so much in this field. Two are outstanding: Population Concern, whose data sheets I referred to, and Marie Stopes International. For a number of reasons, not everyone feels comfortable with the work of MSI—although I am very comfortable with it—but its contribution and role are unparalleled. I remember visiting one of its clinics in Ethiopia, one of the poorest countries in the world, and seeing the dramatic impact that it was having in the suburbs and inner-city areas of, for example, Addis Ababa. MSI tries to make its clinics self-financing by making a small charge for contraception. Having got a clinic up and running, the organisation moves on and opens another.
The 1994 Cairo conference was set in changing circumstances. It took place at the end of the Reagan era in the United States, and a more enlightened view was taken by the US Government, who were relaxing their opposition to support for global population programmes. On the other hand, the Roman Catholic Church was still determinedly opposed to any such programmes. It was the leader of the opposition at the Cairo conference. However, the conference was essentially a triumph.
Until Cairo there had been no global programme and no recognition across the world that population growth was a problem. As the hon. Member for Clydebank and Milngavie said, it was within the gift of the conference to do something about that. The protocol that emerged recognised the problem and provided a solution. It recognised that there was a right of reproductive health and enshrined the phrase "reproductive health" in the world language. The mood at Cairo was that something had to be done. Of the 130 or so countries that participated, all bar two or three signed up to the final declaration.
829 There was also a parliamentary fringe at Cairo, and I had the privilege of making a speech in the chamber of the Egyptian Parliament. The Parliament had shut down for a week—perhaps it was in recess—and representatives from the 130 countries spoke about this most important issue.
Where have we got to in the post-Cairo era? The commitment remains, but I do not know whether it is being matched financially. The hon. Member for Clydebank and Milngavie was right to draw attention to the nations that could improve their performance in funding programmes. I also sense that, to some extent, the heat has gone out of the issue. Cairo put the heat into it, and perhaps in five years' time the 10-year successor to Cairo will inspire an escalation of interest in it again. One or two of the donor nations could be doing more than they are at present.
There is also a certain squeamishness among some Governments and NGOs as to whether or not they should be making a full-bloodied commitment to what are effectively family planning programmes. There is no question but that family planning without education is unacceptable. The people who are to receive family planning must be educated, but some groups still feel that that is a bit too up front and that family planning should be packaged with other issues such as maternal health, women's rights and many others that I could think of if I concentrated a little harder. However, if a programme covers all these things, the family planning element is watered down. We must not lose sight of the fact that contraception is the basic need, whatever else is included in a programme, and the watering down of the family planning element must be tackled.
None the less, the Cairo conference was a success. Indeed, as I said earlier, it was a triumph. It achieved its objectives and set in train a momentum. I hope that will be the tone of the next five years as we build up to the successor conference.
§ 10.2 am
§ Mr. Martyn Jones (Clwyd, South)I congratulate my hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) on securing this debate. It is an important time to discuss the issues surrounding Cairo-plus-five. I must apologise to my hon. Friend and to the House because I have to leave early. I have to chair a meeting of the Select Committee on Welsh Affairs at 11 am, so I shall not be able to hear all the winding-up speeches.
The all-party group on population, development and reproductive health which, as my hon. Friend said, I chair, sponsored a reception in the House last November by Marie Stopes International to mark the 10th anniversary of the safe motherhood initiative. I shall focus on the way that the Cairo conference moved the debate on from a purely demographic way of thinking about population programmes towards the broader concept of sexual and reproductive health, including family planning, and an emphasis on the importance of women's interests, needs and rights as essential components of development.
Among the challenges facing the world is, as well as the horrendous list that my hon. Friend outlined, the fact that every minute of every day, a woman dies from causes 830 related to pregnancy and childbirth, most of which are preventable. Also, the vast majority—99 per cent.—of the 585,000 deaths that occur each year take place in the developing world. For every woman who dies, approximately 30 more suffer injuries, infections or disabilities, some of which have lifelong consequences. Some 3 million families endure the death of their newborn in the first week of life. As a result of the 100 million or so acts of sexual intercourse that take place each day, there are also an estimated 900,000 new cases of sexually transmitted diseases and 8,500 new HIV infections. Women are increasingly being affected by these infections. The statistics show clearly that sexual activity and reproduction still pose considerable threats to women's health and well-being.
The all-party group welcomes the Government's commitment, set out in the White Paper, to reduce maternal mortality by 75 per cent. by 2015. To do that, we must face the challenge of unsafe abortion. There are 20 million a year, resulting in 70,000 deaths and literally millions of disabilities. The Cairo programme of action recognised the health impact of unsafe abortion as of "major public health concern". Of course, we must recognise the difficulties in tackling the issue.
Parliamentarians from around the world attended a seminar in Brussels last year. Some Latin American Members of Parliament had a problem with incorporating the resolution on unsafe abortion in an agreed statement. They eventually acknowledged that it was a problem, and rightly so. We must call on countries like ourselves—for example, Denmark, Sweden and Finland—which have safe legal abortion services to work for similar conditions for women worldwide. If the European Union could take unsafe abortion on board as a public health issue, it would be a great step forward for global human rights.
As a priority, abortion needs to be integrated into a broad reproductive health service, offering a wide range of contraceptive choices, including emergency contraception, good technical care and easy access. Once a woman has decided on the option of abortion, she should have the possibility of early and quick referral for advice, counselling and treatment.
Action can be taken to make progress by reallocating and using efficiently public and private funds in support of various initiatives. Education and information need to be available through multiple channels, including the media, women's organisations and professional associations.
§ Mrs. Teresa Gorman (Billericay)The hon. Gentleman mentioned emergency contraception. Did he see the reports in our press last week, which stated that hospitals were refusing women emergency contraception after unprotected intercourse, and that that was affecting younger women in particular? I am sure he will agree that it is necessary to keep our eye on the domestic problem as well as the worldwide problem.
§ Mr. JonesI wholly agree with the hon. Lady. The all-party group acknowledges that we do not have all the answers, but I am stressing that at least we have safe clinical abortion available in this country when absolutely necessary. I also agree that emergency contraception is paramount in preventing unnecessary abortions. I hope that we make further progress in this country because teenage pregnancy is our black spot. I was going to say 831 that we should institute sexual education in schools and health facilities because that is another means of preventing teenage pregnancies.
We should educate health care providers, physicians and other professionals in the specifics of abortion laws and regulations, emphasising providers' responsibilities to deliver services to the fullest extent allowed by law. We should also have advocacy services, and should build the broad political will, as well as the commitment of health care officials and providers in particular, to ensure that safe services are available to all women to the full extent of existing law. Such services must be affordable by all women.
We must remove barriers to access to good quality, gender-sensitive sexual education for people of all ages. Where abortion is allowed on a range of legal grounds, we should design and enforce policies to ensure that good quality, affordable services are available to all women. Achieving the social and policy changes necessary to enable women and men to achieve sexual and reproductive health will entail another effort of co-operation between NGOs and Governments.
Quality reproductive and sexual health services clearly respond to people's needs better than a service offering only fertility regulation, although that is better than no service at all. Societal changes are necessary for those services to become a priority, and achieving the new priorities of women's empowerment and equity in a climate of reduced funding calls for a respect for human rights and for the wisdom of Governments who are currently having to cope with these sexual and reproductive health needs.
I know that we are preaching to the converted when addressing our Secretary of State and Under-Secretary of State for International Development on such matters—at least I hope so. The all-party group and I wish them well in their negotiations with colleagues on Cairo-plus-five for the environment, the well-being of men and women and the future of the human race.
§ Mr. David Heath (Somerton and Frome)I congratulate the hon. Member for Clydebank and Milngavie (Mr. Worthington) on giving us the opportunity to debate this very important issue. This is one of the splendid occasions on which there is much all-party consensus. In their excellent speeches, the hon. Members for Croydon, South (Mr. Ottaway) and for Clwyd, South (Mr. Jones) described different aspects of the problem. The difficulty is that, if we are not careful, we overwhelm ourselves with statistics, quoting one after the other to persuade ourselves that the problem is intractable. I do not believe that that is so. I share the view of the hon. Member for Croydon, South that there are distinct signs of hope in what has happened since Cairo.
I am particularly privileged to be able to speak on this issue. Normally, I would not be allowed to do so because the Liberal Democrats have a much better qualified colleague in my hon. Friend the Member for Richmond Park (Dr. Tonge), who would have been delighted to participate in today's debate had she not been in southern Sudan and, therefore, not easily available. I know that she would have made a valuable contribution.
Let us reiterate the fact that, as the world population approaches the 6 billion landmark, it is growing by 78 million people a year. The hon. Member for Croydon, 832 South drew a telling analogy in saying how many people had been added to our population since last night. To put it another way, 78 million people is the population of France, Greece and Sweden combined. That is the scale of the issue.
Population concerns are at the heart of sustainable development strategies because rapid growth and high fertility hold back development and help perpetuate poverty. They make it hard for countries to concentrate on the future as they would want, because they are running to keep pace with current needs. One of the great achievements of the Cairo conference was to move away from a view based on coercion, setting targets and a top-down approach. Instead, emphasis was placed on individual decisions and prospects, and the various factors that affect such personal decisions. The conference moved towards integration of services, education and quality of care, and emphasised meeting individual needs. Once such needs are met, there is a chance that better educated personal decisions will be made.
In making such moves, the conference rightly laid stress on some social factors that might not otherwise have been prominent, such as equality, equity and the empowerment of women, which are very important in this context. Saying to women in some developing countries, where such concepts are not the historical norm, that there are alternatives to child bearing extends their educative process—if education is at all available—therefore delaying the start of child bearing, and enhancing education and the career and life style opportunities that that provides. The conference stressed the involvement of men, and how they should understand that women have rights. It considered the operation of such a big change in cultural norms, and placed emphasis on social practices, some of which are quite inimical to the progress that one hopes will be made. That is why we are right to emphasise that discrimination against girls in their education and against women in their social rights is critical.
No one can deny that there is a link between population, poverty and development. However, the link between economic factors and population growth is not simple or a straight quid pro quo. There is not necessarily a reduction in population growth as a result of economic growth. Indeed, economic drivers are very often the reason for large families, simply because such families are a necessity if one is to protect oneself in later years and provide for the family unit.
Let us remember that, of the 4.4 billion people in developing nations, a fifth have no access to health services, such as those that we would describe as health services, a quarter no adequate housing, a third no access to clean water and 60 per cent. no access to safe sewers. Such statistics are important because they extend the argument beyond population issues to other areas of international development. There is a seamless robe between the two; one cannot separate them.
Another key point is that the environment and population growth are inextricably linked. If one cares about the environment, one must care about poor countries, where substantial population growth contributes to its despoliation. Such despoliation, however, occurs at both ends of the economic spectrum. A very small part of the population—those in the richest countries—consumes the majority of the world's resources. The richest fifth of the world consumes 86 per cent. of all goods and services and causes 83 per cent. of all carbon dioxide emissions. 833 At the same time, market systems subsidise environmentally damaging practices. It is a paradox that the greatest environmental threat is caused by both the wealthiest billion and the poorest billion people in the world, who are struggling to stay alive, feed families and ensure that their families have some life.
I would not do justice to my hon. Friend the Member for Richmond Park if I did not spend a moment addressing the issues of AIDS and HIV. She is one of the foremost advocates in the House and elsewhere of the need to address such important matters. Of the 33.4 million people who are infected with AIDS, 1.3 million are children. In 1998, 70 per cent. of the 5.8 million infections were in sub-Saharan Africa. That is the great motor for all manner of difficulties. The people who are affected are the economically active part of the population. As a result of the epidemic—a pandemic in parts of the world—there is a motor for poverty, instability and all manner of future problems, which will be extremely difficult to solve if we do not address them properly.
§ Mrs. Ann Winterton (Congleton)I am grateful to the hon. Gentleman for giving way on the subject of HIV and AIDS. Does he agree that Governments of the sub-Saharan nations, including Zimbabwe, are not entirely blameless for the spread of HIV and AIDS, given that Zimbabwe's Health Minister stood in their Parliament more than 10 years ago denying that there was such a thing—apart, perhaps, from that which could be caught by eating food that had not been grown in Zimbabwe? If we face such comments, which are not just ignorance but propaganda, how on earth can pandemics be stopped in their tracks? We must surely ensure that Governments are on board, spreading a good message rather than a predominantly evil one.
§ Mr. HeathI am grateful to the hon. Lady. I agree that Governments have a special role to play. Governments elsewhere in the world have shut their eyes very tightly to the problem, too, hoping that it would go away—or, worse, spreading untruths about the nature of the epidemic and the way in which it can be countered. That is an enormous tragedy. However, we have probably made substantially progress. Governments now recognise that they have a massive problem on their hands. They recognise—but sometimes cannot meet—the needs that exist. That is where the countries of the rich world have a serious part to play.
I conclude with a simple thought. In this subject area, the outstanding fact is that partnership works—partnership between Governments, or between Governments, non-governmental organisations, Churches and so on. Preventive education works. Economic stability combined with adequate health services works. There has been a positive development since the Cairo summit: people no longer believe that population control is something that the north tells the south to do, and occasionally sends missionaries out to help it to do. Instead, a dialogue has started between the southern nations, which has worked much more effectively. Occasionally, the south now tells the north how to do it right, which is equally healthy in the modern world.
834 I hope that the Minister can reinforce those positive signs. I hope that he will tell us that the Government will continue to work to make some of the aspirations of the Cairo summit a reality, and to continue the progress that has been made in the past five years.
§ Ms Chris McCafferty (Calder Valley)I congratulate my hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) on securing this debate on a subject that is so close to my heart, and so important.
The first Cairo conference was a watershed for global population and development issues. Countries now accept that—as the hon. Member for Somerton and Frome (Mr. Heath) eloquently said—rapid population growth, high fertility and gender inequality hold back development and help perpetuate poverty. The conference recognised that the keys to smaller families and slower population growth are empowerment and free choice, not demographic targets. Most women, given the choice, will have fewer children than their mothers did. Choice means more access to reproductive health care, including family planning.
Today's world has the largest ever population of young people—about 1.1 billion, of whom 913 million live in the less-developed world. The problems that those young people face in sexual and reproductive health are huge. Every year, 15 million 15 to 19-year-olds give birth, and 13 million of those are in Asia, Africa and Latin America. We have heard that some 10 per cent. of the 45 million abortions taking place each year are to 15 to 19-year-olds, and nearly half those are unsafe. Every year, one in 20 teenagers will contract a sexually transmitted disease. Deep-rooted discrimination against the girl child at every level in some societies compounds the problems that surround reproductive and sexual health.
It was against that background that the all-party parliamentary group on population, development and reproductive health decided to look in more detail at the challenges that face young people in managing their sexual and reproductive lives, and to identify the actions that we, as parliamentarians, can take to help them to face those challenges successfully.
Our approach was to hold two hearings in May 1998, which I was privileged to chair, and our report, "Taking Young People Seriously", was launched in December. That documents the facts—sometimes brutal—of young people's lives in developed and developing countries.
The experience of our two hearings was memorable, and sometimes profoundly shocking. The evidence was presented by 12 NGOs working with young people in the developed and the developing world. As a result, we made six recommendations; I should like to say briefly why we made each one. However, I could ask all hon. Members to read the report for the rich variety of information and experience that it documents.
Our first recommendation was that Governments and other agencies should acknowledge that young people have sex and take a realistic and proactive approach to policy and public education, nationally and internationally, about young people and sexual and reproductive health.
I have outlined some statistics that our witnesses gave us, from which it is clear that young people are sexually active. The risks of death are two to four times greater for 835 mothers under 20 than for mothers aged 20 or more. Ten per cent. of the 45 million abortions that take place every year are to girls aged between 15 and 19 years—and half those abortions are unsafe. When HIV and AIDS and other sexually transmitted diseases are put into that equation, the size of the challenge becomes obvious.
Our witnesses pointed out that adolescent sexual and reproductive health was seen as an unpopular issue. Dealing with adolescent sexuality presented a challenge for all NGOs working in the field. They felt that there was a need to move away from the negative approach of "limiting the damage" caused by teenage pregnancy to addressing teenagers' needs more positively.
Even in the United Kingdom there are many challenges. About 10 per cent. of girls start their periods unaware of periods, because no one has talked to them about the subject. A third to a half of young people under 16 are already having penetrative sex. The UK has the highest teenage pregnancy rate in western Europe—9.4 per 1,000—and an increasing rate of sexually transmitted diseases.
§ Mrs. Ann WintertonThe hon. Lady is painting a dismal—and recognizable—picture. We have free contraception, and abortions are available in the place of contraception in this country, yet rates of under-age sex, abortion and pregnancy are rising. Can she explain that? Secondly, does she believe that parents have a right and a responsibility for their under-age children, and that they should be aware when abortions are carried out on their children or contraception provided to those children?
§ Ms McCaffertyI believe that, if the hon. Lady is patient, she will find that the replies to her questions are in the responses that were made to the parliamentary hearings, and the group's recommendations. It is more a question of how things are done than of what is being done. I believe that, if the hon. Lady is patient, she will be able to take a different view.
Some developing countries are reluctant to recognise sexual activity in young people, and believe that to give young people information and services would be to impose a western model, which they see as promiscuous. As has been said, they associate the idea of sex education with the idea of increasing sexual activity for young people, and deny the existence of sexual activity among their own young people.
Our second recommendation was that Governments and other donors should give high priority to encouraging new approaches to sexual and reproductive health programmes, especially those that involve young people in their design and implementation, and provide on-going sustainable funding for such initiatives.
It emerged clearly from what our witnesses said that, for services and projects to be successful, it was necessary to listen to what young people wanted, respond to those needs and involve young people in the implementation of projects—and that projects that did not do so were bound to fail. Interestingly, young people the whole world over want the same things. Research shows clearly that young people want confidential sex advice centres free of charge and without appointments. They do not like words such as "family planning" or "drop in". Young people in Ireland, Zambia and South Africa want exactly the same things. They want to be involved in the design and implementation of projects that involve their sexual and reproductive health.
836 We heard of a variety of outreach projects in the United Kingdom, including youth panels. Particularly impressive is a programme in Zambia where young peer counsellors of a very young age are proud to wear tee-shirts proclaiming, "I am a peer counsellor". That is a good example of where the south can teach the north something about sexual and reproductive health and how to get through to young people and ensure a positive response. However, all these things are only drops in the ocean. They need replicating on a huge scale.
Another crucial fact to emerge from our hearings was the need for sustainable funding. It was clear to me and to the other members of the panel that for the foreseeable future sustainable funding will have to be from government and other official sources.
We had explicit evidence of how difficult it is to obtain financial support from private donors. Some manufacturers of products rely heavily on sexuality in youth for selling their products. Hon. Members will have heard the slogan "Everybody snogs in Joe Bloggs". However, Joe Bloggs is not interested in supporting young people's sexual health projects. This attitude seems to be shared by both Levi Strauss and Coca-Cola, both of which use sex as a method of selling their products. They appear to be unwilling to take responsibility for making that same sex safer for young people.
The perennial headache for NGOs is how to cope with success. New services rapidly attract clients, but the funding stays the same. Success for Belfast Brook meant that, in 12 months, it saw 5,000 young people. However, it was funded for only 3,500. If we are to take the need for young people's services seriously, that situation is clearly unacceptable. Governments and other official donors must take long-term responsibility for supporting services in the developed and developing world. That is the key message for the Department for International Development, the Department of Health and the European Commission.
Our third recommendation was that Governments and agencies should recognise the need for safe legal abortion as an integral part of sexual and reproductive health services for young people, and provide full, on-going funding for such services. The United Kingdom Government should, in particular, take measures to deal with the anomaly of the right to legal abortion services for the women of Northern Ireland.
The statistics have already been quoted and they speak for themselves. The need to pay attention to adolescent childbirth and unsafe abortion is a matter of life and death for young people in less-developed countries. In Zambia, a quarter of maternal deaths due to self-inflicted abortion are of girls under 19. The vulnerability of young women is forcefully illustrated by the rape statistics in South Africa, where one rape occurs every 50 seconds. In Northern Ireland, which is, of course, part of the UK, there is little sex education. There is a high rate of sexual abuse and both teenage pregnancies and abortion exist. Abortion is a sensitive issue, but it is essential to address it if progress is to be made in providing sexual and reproductive health services for young people.
Our fourth recommendation was that Governments and agencies should ensure that health professionals who work with young people are committed to and fully trained in confidentiality, that they understand its importance and understand also what it means in practice. It is clear that young people do not trust health professionals when they 837 consult them about sexual and reproductive health matters. It is of paramount importance for success that a service is confidential. It is a real issue for young people. They do not trust grown-ups, and that applies across the board; they do not trust them at all.
A young person's right to confidentiality and to receive health information and services is recognised under the United Nations convention on the rights of the child, which has been ratified by all but two member countries. The convention lays a responsibility on health professionals to provide adolescents with information and services, even if that goes against the parents' wishes, provided that the child has developed the necessary capacity and maturity to understand the nature and consequences of the information and services to be provided. The Cairo and Beijing women's conferences criticised the failure of health professionals to observe and respect informed consent and confidentiality in respect of adolescent girls. It was clear that all the NGOs working with young people were aware of the importance of confidentiality. That needs to be translated into practice by ensuring that health professionals are equally committed.
Our fifth recommendation was that Governments and agencies should encourage and provide sustainable funding for the provision of support and information for parents to help to facilitate their communication with their children on sex and sexual relationships. Parents emerged as a neglected species. There was general recognition that they needed help to fulfil their roles and to know how to support their children's needs. There is evidence to show that young people want their parents to talk to them and be willing to talk about sex. However, it seemed that many parents found that difficult.
Our final recommendation was that Governments and agencies should take measures to make emergency contraception as widely available as possible for young people. The hon. Member for Richmond Park (Dr. Tonge) is a long-standing family planning doctor. She has called for emergency contraception to be made freely available to young people. Research demonstrates clearly how difficult it is for young people to obtain emergency contraception. Many do not even know who to approach or, as the hon. Member for Billericay (Mrs. Gorman) so starkly said, they are refused help when they seek it.
At 1.1 billion, this is history's largest generation of young people between the ages of 15 and 24, and their numbers are rapidly increasing in many countries. The reproductive behaviour of all these young people will determine our planet's future. It is critical that all societies address their education, employment and, especially, health needs. I hope that the Government will take a lead.
§ Mr. Gary Streeter (South-West Devon)This is the first time that I have taken part in a debate in the House on population and development. I pay tribute to the hon. Member for Clydebank and Milngavie (Mr. Worthington) who, unlike me, has been an instigator of and regular contributor to debates on population growth. I pay tribute to his expertise, which was very much in evidence today. I pay tribute also to my hon. Friend the Member for Croydon, South (Mr. Ottaway), who is a regular 838 contributor to this important subject and someone whom I would consider to be an expert on it. I think that it is obvious to us all that population growth is a serious issue and a real danger, given the finite resources of our world.
In one sense, the statistics say it all. However, the evidence of our eyes as we travel confirms and underlines the statistics. As I have travelled to various parts of the world over the past six years, three things have struck me that relate to the subject that we are discussing. When I went to India for the first time, I was struck more than anything else, apart from the poverty, by the sheer volume of people in every city, town and village. It seemed that they were living their lives by the side of the road. Nine hundred million people is an awful lot of people.
I went to Nigeria shortly before Christmas. Again, I was struck by the sheer volume of people. There are 120 million in that relatively small country. A fifth of all black Africans are Nigerians; the sheer numbers are overwhelming.
The second striking feature that I have observed in my recent escapades is the staggeringly high percentage of young people in those countries. The percentage of the population below the age of 20 in Kenya is a bewildering 58 per cent. In Nigeria, 55 per cent. of the population is below the age of 20. The corresponding figure in Zimbabwe is 57 per cent. and in Uganda, 50 per cent. of the population is aged 14 and under. Those are young, fertile people who will make their own contribution to the subject under discussion.
The third fact that I have observed as I have travelled is that middle-class families tend to have three or four children, whereas poor families have eight, nine or perhaps more children. The reasons are obvious and frequently rehearsed. It is worth saying that the situation used to be the same in Britain and throughout the now industrialised world.
The inevitable conclusion is that population growth is clearly related to poverty, lack of education and lack of access to good-quality family planning and reproductive health services. The 1994 international conference on population and development in Cairo was an important event. For the first time ever, a consensus emerged among most nations on a raft of measures to be implemented over a 20-year period. A programme of action was settled.
Five years on, few of us would dispute that the right objectives were set: sustained economic growth in the context of sustainable development; education, especially for girls; and universal access to reproductive health services, including family planning and sexual health. There is no need for wholesale review or reform of those objectives, which have stood the test of time. The difficulty, as ever, is in the implementation. There is no magic bullet.
It is clear that restricting population growth in the developing world is part of the wider issues of poverty and lack of opportunity which afflict too many people around the world, although in that context, the issue requires a special focus. Population constraint should not be seen as separate from the wider development agenda; it is part of the same development challenge. As more and more communities achieve sustainable development, access to education, better health care, rising living standards and a greater sense of security and stability, as surely as night follows day, the number of children per household will fall.
839 There are examples of success. In the Indian state of Kerala, remarkable progress has been made in reducing the birth rate to half the Indian average and less than that of China. Although I accept that that is not directly related to economic success, it follows an enlightened commitment to investment in health, education and more equitable social relations. Infant mortality rates are a quarter of the average for India and half that of China. In India as a whole, one in two girl children drops out of primary school. In Kerala, completion of education is almost universal. Investment in education and health care in Kerala has played a central role in reducing fertility rates to levels comparable to those of industrialised countries.
In South Korea, the combination of rapid economic growth, universal access to primary health care, education and employment opportunities have caused the population growth rate to tumble. Those are examples of best practice and progress, from which we can take encouragement. The situation is not hopeless—it is simply immensely difficult.
The issue of population growth is not a separate agenda. It should motivate us to redouble our efforts to reduce poverty, build capacity, boost health care and education, and increase economic activity and opportunity throughout the world.
I have just returned from a visit to east Africa. I have seen slums in other parts of the world, but the slums that I saw in Nairobi last week were among the worst that I have ever seen. It is offensive, unnecessary and unacceptable in the modem world that people living in such circumstances do not have choices. We must all redouble our efforts to help.
I support the efforts of the British Governments, both before and after the election on 1 May 1997. We have a good track record, and I am sure that under the current Secretary of State, that progress will continue. I take this opportunity to say something that I have said in many meetings outside the House. I think that we were wrong under the previous Government to cut the aid budget. We are a rich nation, even in recession. I understand the pressures on the Treasury, but it is important that a nation such as ours should be compassionate and generous, provided that we make sure that our aid programme is effective.
Too many millions of pounds have been wasted in the past. We must continue to give a lead through our compassion and our generosity. We are a rich nation and we can make a difference. Many mistakes have been made by Governments, development agencies, aid agencies, NGOs and all of us over the past 30 years in aid and development policy. Perhaps a new consensus is emerging. There is increasing recognition of the importance of good governance, market-based economies, capacity building, empowering women, and access to education and health care, so that we can build on the lessons of the past and do more to bring about sustainable development in the developing world.
There are grounds for cautious optimism. It is important that we do not abandon hope; if we do, nothing will change. In one of the slums in Nairobi, I spoke to a young lady called Benedict, who was a grandmother at 30. We had a long conversation, at the end of which she told me that at the age of 30, she had given up hope that her life could change, or that things would ever be any different 840 for her. She had nothing. I urged her not to give up hope, but of course I felt as I spoke that my words were empty. Even if she gives up hope, we must not give up hope on her behalf. It will not be easy, but we can make a difference. Many projects, NGOs and people all over the world are making a difference. I therefore welcome this important debate.
I shall finish with a word about coercion. There is a consensus in the House, but we must spell it out. Coercion in family planning matters is always wrong. Our approach to family planning for the developing world must be guided by the values that we embrace for ourselves. Enforced sterilisation is wrong in the UK and in the developing world. Using abortion as a form of family planning is wrong in the UK and in the developing world. If we do not approach the subject from a framework of values, we will come horribly unstuck.
In the light of those clear guiding principles, I remain uncomfortable with the fact that our Government since the election, as before, continue to contribute towards the Chinese family planning programmes. We have heard horror stories for many years. I admit that I have never seen firm evidence, yet the stories and doubts continue. I know that Ministers will say, "Give us the evidence and we will look into it." Will the Minister call on the United Nations to commission an extensive independent inquiry into the matter, so that we can get to the truth? If all is well, let us reassure ourselves and continue the programme. If all is not well, let us use whatever leverage we have to bring to an end the horrendous practices that we hear about. I ask the Minister to respond to that point.
Once again, I pay tribute to the hon. Member for Clydebank and Milngavie for raising this important subject. I pay tribute to the Government's work. They will have the support of those on the Conservative Benches as they continue that important undertaking.
§ The Parliamentary Under-Secretary of State for International Development (Mr. George Foulkes)Like all hon. Members who have spoken, I join in the congratulations to my hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) on securing time for a debate on such an important issue and, as he said, at such an appropriate time. I thank all those who contributed to the debate, which has been well informed and almost entirely united. That is a testimony to the work done by the all-party group.
As my hon. Friend and others remarked, Cairo was a landmark agreement for international development. We cannot overestimate its impact on the way in which Governments, international organisations, donors and civil society think about and deal with population issues. The debate has made that clear.
The Cairo conference asked fundamental questions about people and poverty—as hon. Members said, we have to address issues beyond only population and reproductive health—and about the future prospect for the sustainable development of our planet. It also agreed a set of bold solutions, with a focus on individuals' right to the highest possible standards of reproductive health. The goals agreed at Cairo form the basis of many of the international development targets that inspire the British Government's strategy for improving all aspects of poor people's lives.
841 In less than six months, a United Nations General Assembly special session will decide what progress the world has made in implementing the Cairo goals. As I said, today's debate has given hon. Members an opportunity to provide early input into that process. The Government greatly encourage such early debates on international discussions. As the review commences, I am pleased to share some of the Government's perspectives on progress made, lessons learned and obstacles encountered in taking forward the Cairo agenda, and on how we must do better in future.
I am grateful to hon. Members for their contributions to the debate. I am particularly grateful to the hon. Member for South-West Devon (Mr. Streeter) for his wholehearted support of the Government's action. In the House's previous debate on the issue, I was the Opposition spokesman and said almost exactly the same as he said today. That is an encouraging development—although it is even more encouraging that I am now on the Government Benches. However, that is another matter.
As hon. Members said, our planet's population has almost doubled since the 1960s. As the hon. Member for Somerton and Frome (Mr. Heath) rightly said, evidence suggests that the world grows more unequal as it grows more populous. The gap in per capita income between the richest and poorest fifth of the world has also doubled since 1960.
Although population growth rates have peaked, the world continues to grow by more than 80 million people a year. If our newspaper headlines are right in saying that the "population explosion" is over, they should also deal with the fact that the children of the population explosion—1 billion young people, the largest generation in human history—are now entering their reproductive years. As my hon. Friends said, the choices made by those young people will determine the prospects for a fair, healthy and stable world which is fit for future generations. We have to ensure that those young people are given a choice, and that they are not denied the means to make their choice.
As the hon. Member for Croydon, South (Mr. Ottaway) said, 10 years ago, we expected that, in the next century, the world population would reach about 14 billion before levelling off. Today, thankfully, the UN expects 10 billion to be the upper population limit. How did that remarkable change occur? The answer, as he said, has been in modern family planning. It is encouraging that 57 per cent. of the world's couples are now using modern family planning methods, compared with 9 per cent. 30 years ago. There has been a great improvement.
§ Mrs. Ann WintertonI had rather understood my hon. Friend the Member for Croydon, South (Mr. Ottaway) to say that part of the success demonstrated by the figures that the Minister is quoting was attributable to events in China. My hon. Friend was not proud of those events—the one-child policy, forced sterilisation, forced abortion until birth and the killing of girl babies. What part have those events played in the figures that the Minister is quoting?
§ Mr. FoulkesThe hon. Lady is on one of her hobby-horses. As it has been raised, I should perhaps deal now with the important issue of China.
842 We are concerned about reports of reproductive abuses in China. We regularly raise the issue of human rights in our dialogue with Peking, both bilaterally and with our European Union partners. We all want there to be changes in policy and practice in China, and we fully support constructive engagement by responsible international organisations.
When I was in China, some years ago, I saw in practice the type of independent evaluation requested by the hon. Member for South-West Devon. I also read the results of that evaluation, which does not reach the same conclusions as the hon. Member for Congleton (Mrs. Winterton). I am sure that the hon. Member for Croydon, South will be the first to agree that change is required not only in China, but in many other places, too.
I should like very briefly to deal with a few other points made in the debate. My hon. Friend the Member for Clydebank and Milngavie has asked whether the United Kingdom is contributing its fair share towards fulfilling the Cairo commitments. United Kingdom assistance for population and reproductive health accounts for 3.5 per cent. of our total aid spend. Moreover, that figure does not include the money that we are giving to the World bank and to the European Commission. We are, therefore, making a very substantial commitment.
My hon. Friend the Member for Clydebank and Milngavie and other hon. Members also asked about what the European Community is doing to address the issue. We have encouraged the EC to do more, and have now seconded a United Kingdom national expert to the Commission to work on the matter. Although we have seen changes, we shall press for more action by the EC.
My hon. Friend the Member for Clydebank and Milngavie also asked what we are doing to deal with the human immune deficiency virus and the acquired immune deficiency syndrome. We are making a huge, and increasing, contribution to dealing with that problem. Three weeks ago, in South Africa, my right hon. Friend the Prime Minister announced our commitment to programme £100 million on HIV-AIDS work over the next three years. The bulk of that will be targeted on sub-Saharan Africa. It is a huge, and increasing, contribution.
I do not have time to deal with all the issues that have been raised in the debate, although I shall write to hon. Members if I have been unable to reply to specific points. However, I should deal with the abortion issue, which has been raised by several hon. Members.
The Cairo consensus on abortion is clear and—as far as the Government are concerned—non-negotiable: abortion must not be promoted as a method of family planning, and we must work to avoid the need for it. Family planning plays an essential role in achieving that goal. However, we must recognise the reality of abortion. There are many reasons why a woman may seek to terminate a pregnancy. If freely chosen, a woman should be able to do so without risk of life-threatening consequences to her health. I hope that all hon. Members will realise that unsafe abortion is a serious public health risk in developing countries.
I should now like to try to deal with the main question asked by hon. Members—what will the Government do to follow up the Cairo conference? As my hon. Friend the Member for Clydebank and Milngavie said, next month, in The Hague, there will be an intergovernmental forum, 843 as a precursor to the General Assembly meeting in New York. Moreover, the Secretary of State herself will lead the United Kingdom delegation at the United Nations General Assembly special session, to underline our commitment to the international conference on population and development-plus-five process.
Cairo brought together 180 countries in unprecedented agreement about the type of action needed to make a real difference to reproductive heath and the rights of all people. Hon. Members who were there, or who read about it in the media, will remember how narrowly that consensus was achieved. Therefore, Cairo-plus-five must, first, move the debate forward, not reopen it.
Secondly, the ICPD must reinvigorate international political will. Thirdly, the review must consolidate progress. It must identify the strategies that worked best in advancing the Cairo goals, understand them better and ensure that they are disseminated and put into practice more widely.
Fourthly, we must focus attention on priorities in which intensified support is needed. We believe that more concerted and coherent global action is needed—on HIV-AIDS, on maternal health, on meeting the needs of young people and on contraceptive supplies.
In development, we talk about food security. As HIV prevalence is as high as one in four people in parts of urban Africa, reproductive health commodities, such as male and female condoms, are also basic needs. The international community, therefore, must work harder to ensure contraceptive security. To do that, we have to achieve agreement on a set of effective milestones in better monitoring ICPD implementation.
The Cairo strategy, and all the international development goals, stand or fall on Governments' ability to judge the progress that they are making. We have to support developing countries' capacity in statistical analysis and data gathering. In 1994, the ICPD did not foresee the need for a new benchmark on the global progression of HIV. As I said, we believe that such a benchmark is now urgently needed to spur more intensive efforts in preventing the spread of HIV.
Fifthly, we must position reproductive health as a central priority for international action, and further clarify the role of relevant multilateral actors, particularly the international UN architecture.
Finally, we must distil key "take home" messages to direct coherent and concerted international action in the coming years. They should—like Cairo itself—resonate and stick in the mind of policy makers. As the hon. Member for Somerton and Frome rightly said, we shall achieve our objectives through partnership.
The Government look forward to working on the issue with the House in the coming six months and beyond. Subsequent debates in the House on the issue will inform the action and encourage the work undertaken by the Government on behalf of the House.