Population and Reproductive Health: Culture and Religion Matter

Statement by Thoraya Ahmed Obaid, Executive Director, UNFPA

Honourable Dr. Susilo Bambang Yudhoyono, President of Indonesia

Honourable Agung Laksono, Speaker of the Parliament of Indonesia

Excellency Mr. Yaoshio Yatsu, Chairperson of AFPPD

Excellency Ibu Hj. Aisyah Hamid Baidlowi, Chairperson of IFPPD

Excellencies,

Distinguished Delegates,

Ladies and Gentlemen,

Colleagues and Friends,

It is always a pleasure to be in Asia and this occasion is no exception.

I would like to thank the Government of Indonesia for its warm hospitality and for hosting this important Conference. And I would like to thank the Asian Forum of Parliamentarians on Population and Development for bringing all of us together for their 8th General Assembly.

Over the past few days, I had the opportunity to talk with ministers and senior officials here in Jakarta to better understand issues of population and reproductive health of women, men and young people as they related to the three national strategies of the Government: pro-poor, pro-livelihood, and pro-economic growth. I have also held similar discussions with officials and community leaders in Aceh, where all of us from the United Nations and the international community are supporting the Government’s effort to cement peace and to move the stricken province from humanitarian assistance to reconstruction and development. In all cases, we know that population issues and reproductive health are directly linked with the health of the people, their quality of life, the services that the government and civil society provide, and the economic health of the country. The impact of cultural practices and religious interpretations were often highlighted.

We meet at a critical time.

The World Summit Commitments

Just two months ago at the 2005 World Summit, leaders from around the world committed themselves to a better quality of life for all individuals based on human rights. They clearly committed themselves to achieving universal access to reproductive health by 2015, as set out at the International Conference on Population and Development (ICPD). This signifies the highest-level of endorsement for the Cairo goal on reproductive health, which basically includes safe motherhood, family planning, prevention of sexually transmitted infections and HIV and AIDS, and gender equality and empowerment of women, including ending violence against women.

At the Summit, leaders agreed to integrate in 2006 this goal in national strategies in order to achieve the eight Millennium Development Goals.

At the World Summit, Heads of State and Government made strong commitments to eliminate gender discrimination and violence, and they proclaimed that progress for women is progress for all. They recognized that women’s rights are human rights and they are to be protected and achieved if we want to have success in any of the development efforts.

My message today is simple. Our leaders spoke at the Summit about what should be done and achieved. Therefore, we should now focus on actions and on monitoring the results of our actions. We should discuss how we can be more effective and achieve sustained results. And we need to accelerate action. We need to build on the momentum of the World Summit to turn these words into concrete action. And to be more effective in reaching communities and impact on people’s daily lives, we have to recognize that culture matters.

Culture and Religion Matter

Culture matters because as we move forward to expand access to reproductive health information and services, as world leaders agreed at the Summit, we need to use culturally sensitive approaches to ensure better understanding of the human rights content of the Millennium Development Goals and the promotion and achievement of equity and equality between women and men.

I say this because I know that reproductive health, women’s empowerment and gender equality are culturally sensitive issues. Oftentimes, political debates and decisions on these issues have cultural undercurrents that could delay their achievement, but other times we find support for change in cultural values and practices and religious interpretations. To make progress, we need to understand these currents. We need to discuss these issues openly. And we need to identify the positive cultural values and religious interpretations which would facilitate moving forward in the promotion of human rights, including the right to reproductive health.

The essence of the reproductive health approach is that it is holistic and comprehensive. It moves beyond the traditional focus on maternal and child health to include ending violations of the rights of women across their life cycle, so that they can live a life of total health, both in terms physical and mental well-being. We know that investing in reproductive health has been effective in producing the desired social and economic results in many countries, which ensured that all individuals who want to plan their families can do so; that all young people have the information and services needed to protect themselves from HIV and AIDS and prevent early pregnancy; that all women are treated with dignity and free of violence and all forms of discrimination; and that the necessary investment in education and health of children and young people are achieved. These are quick wins that can go a long way to strengthening the capacities of countries to fight poverty.

Over the past 50 years with much debate, family planning has progressively continued to become a success story. The percentage of women and couples using family planning has risen from 10 per cent 50 years ago to 60 per cent today; although there is still high unmet need, with 200 million women who want to make decisions about spacing their children who currently cannot do so. We also know that the concept of family planning has expanded, with reproductive health becoming the comprehensive approach to the well-being of both women and men. In fact, reproductive health, including family planning, is recognized as one of the best investments in the development package.

Much of this success can be attributed to the consensus building, among 179 governments representing all cultures and religions, non-governmental organizations and others that produced the ICPD Programme of Action in Cairo in 1994. The Programme of Action clearly respects national priorities and national sovereignty as well as for cultural values and religious beliefs within the context of internationally agreed human rights.

Culture and ICPD Implementation

Despite a great deal of progress, we know that challenges remain.

These challenges are highlighted in a survey that UNFPA conducted in 2004 to measure progress in implementing the Cairo Programme of Action. The survey covered 165 developing countries and countries in transition, with 152 of them responding.

The majority of countries considered cultural factors to be a constraint in implementing the Cairo Programme of Action for gender equality, reproductive health and rights, adolescent reproductive health and HIV/AIDS. However, in many cases, culture and religion were viewed as both positively contributing factors as well as constraints.

For instance, countries in all regions said that talking about sexual health was widely regarded as taboo, especially where adolescents were concerned, which made it difficult to meet the needs of young people, especially in places where child marriage was common.

Patriarchal and male-centred attitudes, rooted deeply in both cultural practices and religious interpretations, were also regarded as constraints in all regions.

Many countries across the globe indicated that cultural practices and norms and inflexible religious interpretations encouraged the stigmatization of people living with HIV and AIDS. On the other hand, religious and traditional family values were also cited as contributing to the care and support of the victims of HIV and their families. This finding points to the need to address stigma and discrimination and to build on those positive values that would help fight the epidemic and provide care for those infected and their families that are affected. The most successful HIV/AIDS campaigns have broken the silence on these issues and many of them were led by religious leaders who spoke loudly about compassion and solidarity among people.

The survey also revealed that a number of cultural practices related to marriage are harmful. These include child marriage and dowries.

In Asia, other negative factors revealed in the survey include son preference.

The preference for sons has led to prenatal sex selection and female infanticide, and ultimately to the loss of over 60 million girls. In this case, a social imbalance has led to a demographic imbalance, which has lasting and serious implications, including moral implications.

I believe it is clear from these findings that culture does matter. It matters because it provides a menu of many possibilities and choices that can promote or obstruct human rights. It can provide a wealthy base from which we can develop arguments and articulate strategies for the well-being of people or for their misery, for their freedom or their enslavement and for the promotion of their productive capacities or their loss.

Parliamentarians—Voices of the People

You might ask why I am addressing issues of culture and religion in a meeting of Parliamentarians for Population and Development. The answer is simple. As parliamentarians, you can help policy makers to understand that a healthy population is the greatest asset that a country can have to meet current and future challenges. You can enact supportive laws and policies to support women’s empowerment, gender equality and reproductive health and rights and also to put in place mechanisms to monitor the implementation of these laws and policies. You can bridge the gap between the sensitivity of cultural practices and religious interpretations and issues of population and reproductive health through the legislations you adopt and the budgets you allocate. You can create an enabling environment for the promotion and implementation of reproductive health legislations by your capacity to understand and mobilize the positive forces of our cultures and beliefs. Reproductive health and rights are absolutely fundamental to the individual well-being of people and the prosperity of communities and nations. And it is part of the legitimate scope of human rights and public policy, for which you are primarily responsible.

All over the world, the countries that have made the most progress during the past few decades have invested in education and health, including reproductive health and family planning. Health and education are investments in human capital, in other words, in people, who are the building blocks of healthy families, stable communities, productive societies and, thus, prosperous nations.

Your Excellencies,

Together, we have to ensure that reproductive health is part of every nation’s development and poverty reduction plan, integrated into the primary health system and national budgets.

Together, we need to ensure the integration of reproductive health and HIV/AIDS programmes, especially in view of the rising infection rates in Asia and Pacific, especially among women. It is time to integrate reproductive health and rights in all national AIDS plans. And it is time to include HIV prevention in reproductive health programmes, including family planning and maternal health services. This is the most cost-effective approach and, most importantly, it will save lives.

The best way to reach women and young people is through established affordable, accessible and sustainable reproductive health services. It can protect its generation of productive people and can ensure prosperity and progress.

Excellencies, Ladies and Gentlemen,

Following the World Summit, we are in a period of opportunity and the challenge is to accelerate action.

While some progress has been achieved, the importance of investing in reproductive health has not been sufficiently appreciated by many policy makers in Asia. And the meager sums that are allocated to this sector are not equitably distributed across various groups.

Today, inadequate resources and persistent gaps in serving the poorest populations are impeding further progress. And the health of women, youth and children suffers the most.

There is a need for increased spending on population and reproductive health. At the international conferences in Ottawa and Strasbourg, parliamentarians from around the world—and many of them are with us here—agreed that 10 per cent of national development budgets should be devoted to these important areas. Given the severity of the AIDS pandemic, a new study suggests that the total amount needed globally for population and reproductive health, including HIV/AIDS, is $45 billion annually, rather than the $18.5 billion agreed at the Cairo Conference.

The point is that there are pressing human needs that cannot wait. Urgent decisions must be made and urgent actions must be taken. I am sure that these needs, and rights, will be addressed at this meeting and also at the Third International Parliamentarians’ Conference on the Implementation of the ICPD Programme of Action, which will take place one year from now, next November, in Bangkok.

Listen to the People

In closing, I would like to stress the importance of reaching out to people, listening to their concerns, bringing their voices into policy debates, and being active mediators of change. Your courage in dealing with sensitive but also life and death issues is what is required at this particular juncture in the history of your countries. And who would be most appropriate and most qualified to do so except you, parliamentarians. You are the voices of the people that carry the messages from the communities to the chambers of your honourable parliaments.

The formulation of health policies that respond to the needs of the people will happen only when there is greater participation of the community in policy-making and debate. And here again, parliamentarians have a role to play. Giving people and communities a strong voice in policy-making is key to effective development.

While equitable laws and policies are essential, they are not enough to bring about real change. Advocacy is also needed. And here again, parliamentarians can play a critical role in using your speaker power to call for equality and an end to gender discrimination and violence. Eliminating the causes of discrimination will require policies that tackle the power gap between men and women. Decisions about education, health, nutrition, child-bearing, and money are made within the family. It is this dynamic that policy makers must understand and influence if the fundamental gender inequalities are to be addressed.

As officials and parliamentarians, we have to accentuate the positive. Cultures are not static; they are in a state of constant change. Many aspects of culture are good and we must capitalize on them to create an enabling legal and policy environment, as well as effective mechanism for monitoring implementation. You are best suited to reach out to people and empower them to change practices that violate their rights.

Thank you.