Population and reproductive health: where do we go next?

American Journal of Public Health 1845 Adrienne Germain is president of the International Women’s Health Coalition, New York, NY. Requests for reprints should be sent to Adrienne Germain, International Women’s Health Coalition, 24 E 21st St, New York, NY 10010 (e-mail: [email protected]). This editorial was accepted August 2, 2000. Since the 1994 International Conference on Population and Development (ICPD), analysts concerned about population growth have explained the Cairo paradigm shift as a triumph of feminist ideology over demographic analysis (see Presser for an overview). These analysts bemoan what they see as a dramatic shift away from demographic concerns, as a proscription of demographic targets, and as a downplaying of vertical family planning programs in favor of broader approaches to sexual and reproductive health that are premised on individual rights, especially women’s rights. (Actually, the ICPD Programme of Action recognized national “population-related goals” as legitimate, but it proscribed the use of demographic targets to define service provider standards and priorities.) They assert that the ICPD’s approach to reproductive health, development, and rights is too complicated and too expensive to be implemented by resourcepoor countries (see, for example, Lush et al. and Wheeler). The Cairo agenda is admittedly challenging. In formulating the agenda, however, the ICPD responded to women’s demand for better-quality health and family planning services. The ICPD also took into account the need to remove social barriers to access and the imperative to modify policies and programs to meet the demographic realities of the 21st century. Let us take each of these concerns in turn. Adrienne Germain, MA