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Frank E. Loy Under Secretary for Global Affairs Address to the American Association for the Advancement of Science Washington, DC, December 1, 1998.

I come to my present job after many years of active work in the NGO community, including NGOs that are active in the population field. The issues that bring us all together here today--women, population, and science--are, I assure you, close to my heart and my job. And I intend to pursue them with the same kind of energy and dedication that you bring to the table. That's a pledge.

I can't come here to AAAS without mentioning the State Department's responsibility for the management of international scientific issues and the interest AAAS President Greenwood and the rest of the organization have in ensuring that the Department manages that responsibility as effectively as possible. Although I have only recently been confirmed, it is apparent to me that the management of international science and technology is an area that deserves significant attention. In the next few months, I intend to consult with the scientific community on the role of the Department regarding international science. I hope that early next year, AAAS will give me another opportunity to talk with the organization on this issue, because I'll be dealing with it very lightly today.

Secretary Albright has often said that, as a girl, she never even dreamed of becoming Secretary of State. The idea was not within the realm of the possible. Of course, I also failed to imagine that I would grow up to work for a female Secretary of State. But then, I missed a few other things as well: the tripling of the world's population in my lifetime--so far; the appearance of a baseball player who could hit 70 home runs in a season; the development of science that could perform laser surgery and send email around the world--all, I might add, without curing the common cold or producing an easy-to-operate VCR.

Our ability to predict the future is flawed, but we have proven from time to time, most particularly at the conference we honor today--the International Conference on Population and Development in Cairo--that as we grapple with some of the tough problems we face, we can learn from the past, from experience, and from empirical research. And we brought that to bear at Cairo.

As we begin to assess where we are, we need to look at what Cairo really said to us all. We knew before Cairo that rapid population growth strains resources, slows development, and helps perpetuate poverty. At Cairo, we converted this knowledge held by scientists: the fact that smaller families and slower population growth depend not on "population control" but on free and informed choice, to a belief shared by policymakers. We agreed at Cairo that promoting women's education was a very effective means--along with providing family planning services--to lower family size and improve family health.

Specifically, in the Cairo Program of Action, 180 nations agreed that our focus must be not on targets and quotas but on the needs and desires of individuals and families. We agreed on the singular importance of empowering women--both as a worthy goal in itself and because we had seen in nation after nation, study after study, that when women gain control over their lives and their bodies, health improves, maternal and child mortality declines, rates of sexually transmitted disease decrease, population growth rates stabilize, and societies prosper. And let me just note that what we learned then, and what the past 5 years has proven, is that population and development challenges will not be solved until women are afforded equal opportunity and access to education, jobs, health care, legal rights, and political participation.

To get the job done, we put together a plan at Cairo to achieve three goals over 20 years: first, making a full range of family planning and other basic health services universally available; second, cutting infant, child, and maternal mortality; and third, ensuring universal access to education, especially for girls. We also made a collective commitment to pay for it, counting on international and private organizations, as well as developed and developing nations. Cairo, in short, gave us the blueprint for achieving sustainable development.

So the question before us today, and throughout the ICPD+5 review, is: How are we doing? There is little doubt that the inspiration shared at Cairo has produced remarkable results around the world. Community organizers from Brazil to Bangladesh are using the Program of Action to plan for the future--and to insist that governments fulfill their pledges.

Girls' school enrollment is up over 70% in Malawi, has increased more than 10-fold in parts of Egypt, and continues to rise significantly throughout the developing world. India has dropped its demographic targets and is focusing instead on improving community health and the quality of family planning services. In parts of the former Soviet Union, where access to family planning services has increased, abortion rates have declined by as much as 40%.

In the U.S., implementation of Cairo has also seen some wonderful success stories. With the leadership of the First Lady, Secretary Albright, and USAID Administrator Brian Atwood, we have become major promoters of better health, education, opportunity, and equity for women and girls around the world.

Led by USAID, the United States has helped put Cairo into action in over 50 countries, revamping and improving our programs to focus on all the aspects of the Cairo consensus. We are working to address the special needs of adolescents, to promote men's involvement in child-rearing and health issues, and to advance women's political participation. USAID's Democracy and Governance Initiative in Nigeria, for example, has helped mobilize about 127,000 women to vote in just the past 2 years.

But before we get carried away by the new approaches I have discussed, let me say something about a central part of the picture--family planning assistance. With financial contributions of $385 million a year, and immeasurable contributions of technical assistance, we in the U.S. remain the largest, single bilateral donor of family planning assistance in the world. We know that family planning reduces maternal mortality; improves children's health; expands life options for women, so they can be more productive members of their societies; and reduces the burden on schools, public services, and the environment. Simply put, family planning saves lives.

For 30 years, USAID has been the leader in designing and delivering high quality, voluntary, and client-oriented family planning services in the developing world. Today, with family planning services more widely available than ever--and budgets tighter than ever--USAID continues to work to improve quality of care, expand the choice of contraceptive methods, and train medical professionals and community leaders to provide these services.

Concurrently, here at home in the U.S., we have heightened attention to women's health issues in government and the academic and scientific communities. And Congress this year required that insurance companies cover the cost of a range of contraceptives under the health benefits for every federal employee.

So my short answer to "How have we done?" is this: We have accomplished a great deal that might never have been done without Cairo. And we ought to celebrate that and take pride in it. At the same time, there is no denying that we still have far to go to meet the commitments we made at Cairo.

Here in the U.S., the rate of teen pregnancies remains among the highest in the industrialized world. Forty thousand new HIV infections occur each year, disproportionately affecting minority groups.

Almost 150 million women in developing countries still want, but don't have access to, family planning services. There are at least 100 million unintended pregnancies in the world each year; the majority of which end in abortion. Over 33 million people around the world live with HIV/AIDS. And every day, 1,600 women die in pregnancy or childbirth--over half a million each year.

Everyone in this room knows that we are not keeping up with the problems, with the pace that the Program of Action's 20-year framework requires, with the challenges stemming from the fact that one-sixth of the Earth's population, more than 1 billion people, are between the ages of 15 and 24, ready to enter the job market and to start families. And the generation behind them is even larger--the largest in history.

We can't be complacent. The challenge of Cairo is by no means met. We need to do much better.

With a group like this, it is not useful to simply lament the situation, so let me be a bit more concrete and focus on three specific areas where I think we must do better. First, the devastation being wrought by HIV/AIDS and the need to better integrate our fight against AIDS into our population policies and programs. Second, the need to harness the products of cutting-edge science in our efforts. And last but by no means least, the question with which the United States is already struggling--how to pay for all of this. The scourge of HIV/AIDS makes our job--promoting human development--much, much harder--and for very understandable reasons. It is hard to think of increasing resources for child health when children are becoming infected at birth and when parents dying of AIDS won't be around to care for them. It is hard to plan for productive lives when life expectancy drops to 47 years in Botswana and 44 in Zimbabwe. And it is hard to promote family planning when families are straining to bury their dead.

Especially today, on World AIDS Day, we remember that the AIDS pandemic is a health disaster that is choking the life out of entire societies. Governments, NGOs, and international organizations must do better at overcoming bureaucratic obstacles and fundraising difficulties to see that family planning and AIDS prevention are both high priorities. Integration of family planning and AIDS education programs must become a powerful and cost-effective part of comprehensive strategies for reproductive health.

As policymakers and advocates, we need to walk the fine line between understanding what science--and the progress and products it brings forth--can do for us and expecting science to solve all our problems that we can't handle by other means. And that is true whether the topic is contraceptive research, AIDS vaccines, or technology to deal with the consequences of population growth.

We need to get better at making use of the things that science produces for us. When we fail to do so, we risk misfires like the introduction of Norplant, particularly in the United States. In that case, hard science had provided a new contraceptive with tremendous potential, but the marketing and supervision of the product was often inadequate. Poorly trained and insensitive health practitioners often made some women regret having tried Norplant. As a result, donors are now more reluctant to provide it, and much work needs to be done to restore the trust of thousands of women.

Finally, no matter how much inspired research is being done, and how well programs are designed and implemented, without funding, our programs will not reach people in need. At Cairo, developing countries agreed to contribute $11.3 billion to population programs by the year 2000. They're two-thirds of the way there. The donor community pledged to contribute $5.7 billion. We're only a third of the way there.

It is sad, but true, that the country which risks being the biggest Cairo deadbeat of all is the United States. In 1995, the first year after Cairo, we were well on track. But our bilateral funding for international family planning programs, which reached $540 million that year, was regrettably cut by Congress--by 35%. And it has stagnated since, as has our funding for other Cairo priorities. We would need to triple our contributions over the next year in order to reach our ICPD goal for the year 2000.

Fortunately, American non-governmental organizations and foundations have made a heroic effort to step into the gap left when our funding has been slashed or eliminated. I want to thank you for what you've done and ask you to hang in there. But I also want to tell you that we are not giving up.

The Clinton Administration is firmly committed to Cairo's objectives; to maintaining American leadership in reproductive health, including family planning, to girls' education, and women's empowerment; and to supporting UNFPA and other international efforts. I view this as a personal challenge.

Our loss of funding for UNFPA is a particularly painful topic. But I want to assure you that we are actively exploring possibilities to resume our funding for UNFPA as soon as possible. Those efforts will be one of my top priorities.

Why is funding for UNFPA so important? UNFPA works to provide voluntary family planning services, maternal and child health care, and sexually transmitted disease prevention in more than 160 countries, including many that American programs don't or can't reach.

Cuts to UNFPA have terrible, immediate human consequences. UNFPA estimates that, in one year, our contribution would have prevented the deaths of 1,200 mothers and 22,500 babies. Our funding would have provided contraceptives to prevent half a million unwanted pregnancies. In the absence of better family planning, UNFPA believes, 200,000 of those pregnancies will end in abortion.

Now, I don't believe that is what Congress intended. Nor do I believe Congress--or the American people--want to see the health of mothers and children suffer.

Clearly, we have more work to do in building support for reproductive health programs, including family planning, in this country. Many of us in the field may be guilty of taking Cairo's consensus for granted--and not taking enough care to get the word out about exactly how we are going about stabilizing population growth.

We know that the best programs are not about distributing thousands of doses of some contraceptive method or meeting numerical targets for population growth rates. We know that the best, most sustainable programs help women and men stay healthy, have strong families, and make their own informed choices about child-bearing--basic freedoms Americans take for granted. And we know that family planning is a part, but only a part, of that effort.

What the congressional debate demonstrated to me was that we have not done enough to discredit the belief that population programs the world over consist of forced abortions, forced sterilizations, and heaven knows what else. We know that there are occasionally problems and abuses. We ought always to react firmly to allegations of coercion or abuse--and we will.

We must also remember that those abuses cast a long shadow--perhaps none longer than the coercive, invasive reproductive health practices documented over the years in China.

But for several years now, Chinese demographers and academics have reached conclusions familiar to any veteran of Cairo. Mandatory, punitive programs and targets don't work they say. What works is raising incomes, providing choices, and offering women the opportunity to shape their own destinies and make their own health decisions.

UNFPA has begun a promising program in 32 Chinese counties to demonstrate just how productive the voluntary approach can be. In those counties, China has agreed to make its programs, clinics, activities, and records available to international scrutiny, comment, and change. And China has agreed to abide by UNFPA's--and the international community's--standards for noncoercive family planning.

This program was designed very carefully and deliberately, with input from a number of countries and experts. Nonetheless, we've asked our embassy in Beijing and our consulates throughout China, to be very active in monitoring the UNFPA program and to report on how they're doing.

We don't expect to see radical changes everywhere overnight, but our staff has already seen some changes for the better: Rural women are receiving reproductive health care for the first time--and from someone they could trust. And doctors are better equipped to act in the best interests of their patients.

Cairo and UNFPA have played major roles in promoting and furthering these changes. The United States should be encouraging these advances, not hampering UNFPA in its efforts to help millions of people worldwide.

Despite the funding difficulties we face, I do not want for a minute to lose sight of the outstanding progress that has been made in so many areas. I am very proud to be part of an Administration that has constantly challenged attempts by Congress since 1994 to chisel away our reproductive health programs. I am proud to work with people like Madeleine Albright and Brian Atwood, who have put women, population, and sustainable development at the very heart of American foreign policy. And I am proud to work with a team that has shown such unprecedented openness to the NGO community.

For little of what we've achieved, from before Cairo through today, would have been possible without NGOs leading the way. NGOs have formed grassroots networks here and around the world, to help people get the health care and family planning they want. They have lobbied to let governments know what is needed and to make sure they come through. They have done much of the cutting-edge research, led outstanding assistance programs, and held the international community's feet to the fire again and again to hold up our end of the Cairo promise.

I am firmly committed to working with you and to building on the ties I inherited from my predecessor, Tim Wirth. And I want to begin a dialogue that goes beyond day-to-day issues to the more strategic questions as well: What are the respective roles of NGOs and government in an age of shrinking public resources and technological advances? How can we avoid working at cross-purposes? How can we tap into the resources and expertise that the private sector, here and around the world, has to offer?

Those are just some of the questions we will be asking as we evaluate our progress since Cairo and as we look at the road ahead. Today, your discussions will begin to formulate some answers, and I look forward to hearing them. I am proud to work with the NGO community and proud of our record to family health. I look forward to making Cairo+5 a good review of what we've done, but most of all, I look forward to working with you in the weeks, months, and years ahead.

[End of Document]

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