Thank you for the opportunity to come here to celebrate 58 years of good work done by EngenderHealth. Let me raise my voice with those who think that, at least in this case, 50 years is not enough! (No offense to my panel colleague, World Bank official, Karen. Just joking).

The organizers asked me to address the theme of rights. This is very close to my heart. I strongly believe the language of human rights is the language of progressive change today. There is a revolutionary potential in the fundamental notion that every human being, simply by virtue of being human, is entitled to certain basic protection. 

Human rights have a glorious history and a fascinating evolution of its concepts and instruments. The focus on violations by the state has been expanded to include individuals, corporations and other non-state actors. Issues of universality and indivisibility are still very much the subjects of discussion. The schism between civil and political rights, on the one hand, and social and economic and cultural, on the other, is still not well resolved. 

Women's rights — by their very nature — span the whole spectrum from the civil to the economic. Women's lives are daily demonstrations of the indivisibility of rights. The human rights community has made great progress in recognizing women's human rights. The Vienna Human Rights Conference in 1993 was a huge step forward. Many human rights organizations are now promoting women's rights. Rape, trafficking in women and the whole area of sex related violations have received increased attention. Still there is a long way to go.

These are interesting issues in themselves and have wide implications for our work. But today I want to focus on a specific area where the rights approach has made great inroads but faces new challenges. I want to focus on population policies. And the specific question I want to address is whether human rights and demographic goals are compatible or not. Do these two approaches to population policies work at cross-purposes, or do they reinforce each other?

I guess you all agree that the rights based approach was a major achievement of the Cairo Platform of Action. You probably know by heart the language. But let me repeat it once more. Cairo says that reproductive rights "rest on the recognition of the basic rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, and to have the information and the means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their rights to make decisions concerning reproduction free of discrimination, coercion and violence" Beautiful, isn't it? And revolutionary!

Well, as we all know, not everybody was happy with that! The religious fundamentalists, to be sure. But some natural allies also did not like the changes introduced in Cairo. Some were not happy because their major concern was population growth. They were worried that a focus on individual rights would dilute efforts to curb fertility at the ground level. This is ironic on two levels. First, decades of research have shown strong correlations between lower fertility and enabling conditions for the exercise of reproductive rights. Second, the rights advocates brought new life to the population field. Population efforts at the ground level are ultimately dependent on political will at higher levels. Conversely, policy makers from both the industrialized and the less developed countries tend to develop that political will when they see a broad base of support. And the enormous growth of reproductive rights advocacy throughout the world in the nineties has brought new life to a field previously restricted to a small constituency. (I will come back to that, when discussing the issue of financial support.)

In fact, many of those whose major interest is population growth now see this synergy between population and reproductive rights. Still, they would prefer that rights be seen as secondary. Rights should be seen as no more than a by-product of policies. A desirable by-product, to be sure. But not their major goal. They fear that resources will not be forthcoming for programs that do not have population growth as the major concern.

And indeed, resources do remain much below expectations. They do not meet the world's needs. But, would the level of resources be higher today if the demographic rationale was more prominent? I have serious doubts. For example, let us take the case of the US Government population assistance. As the largest contributor among industrialized countries, the US has a major influence on the amount of donor assistance available. In Congress, the fiercest opponents of assistance have religious motivations opposed to reproductive rights, not to demographic concerns. Conversely, its staunchest advocates come from the rights perspective. 

One could also argue that the paltry level of contributions from the industrialized countries has more to do with the indifference of the majority than with the strong views of the opponents of population policies. This is probably true of the US Congress. Population explosion alarmists have tried to shake up this indifference for decades. But, as recent surveys and focus group research have shown, the general public is much more receptive to messages linking foreign assistance to women's rights than to the traditional population concerns. 

Still, overall official development assistance is extremely low. The public would support a much higher level, if not for their widely inflated notion of the actual level. Advocates have not yet found the way to correct this gross misperception. The reason is probably that foreign assistance as a whole is not high on the agenda of many. I believe we could strengthen the case for increased foreign assistance, if the values of human rights were more aggressively promoted. How could we tolerate the meager response of the US to the devastation of the AIDS epidemic in Africa, if we were committed to human rights?

Official population assistance has shown little progress but funds from private foundations have grown very fast in the last few years. For many foundations, the basic motivation is to curb the rate of growth. I would say that, for all foundations, this motivation plays some role, in one way or another. The question before us then is: does it matter? Is the population stabilization approach compatible with the rights approach? This question is obviously not new. I myself have presented a conciliatory point of view during the very celebration of AVSC's anniversary some years ago. But today the circumstances are new. We should pause to examine them in some detail.

Let us begin with some history. Rights advocates have strongly opposed the demographic perspective because they feared the overriding concern with growth could lead to coercion and other kinds of abuses. Their fears were not unfounded. Some of the rhetoric and the practices of population control enthusiasts reinforced these fears. 

But today, funders concerned with population growth have realized that draconian methods do not work. Funders recognize that curbing growth is better achieved through the empowerment of women and the provision of better quality services. From this point of view, the two approaches are quite compatible today.

There is another point, however, where the conflict between the two approaches is still quite real. I am referring to the focus only on programs that might have a direct impact on population growth. Programs to fight violence against women, for instance, have a hard time to get funds. The problem of neglect of anything not directly related to population growth gets worse with the decline in fertility in certain regions of the world. Latin America is no longer on the map of many donors. Issues of sexual rights also tend to be left out of donors' programs. This is a sad irony: by neglecting the issues that are dear to rights advocates, and the geographic areas where rights advocacy is more developed, donors miss the opportunity to strengthen the most committed and effective supporters of their own agenda. With different motivations, rights advocates have supported policies, which have the end result of curbing population growth because, when individuals have the right to choose, they usually prefer small families. (The point I am trying to make here is similar to the one about the US constituency that counteracts the opposition from religious fundamentalists.) It is to the advantage of both rights advocates and those with population growth concerns to maintain an alliance, and the alliance cannot survive if rights are subordinated.

There is still another trend among donors that is also quite problematic for the rights perspective. That is the widespread adoption of results-based management. This, in itself, is quite positive. It points towards greater accountability. Exempt from taxes, Foundations should be accountable for the production of public goods. However, foundation officers are being asked to define results in strictly quantifiable terms. And the measurement of the achievement of rights is still in its infancy. The data is simply not there. The methodology for getting valid measurement of rights is just being developed. In the rush to get numerical results, funders are tempted to focus on the more tangible indicators of fertility and reproductive behavior.

Finally, there is a last aspect of some private foundations that presents obstacles to rights advocacy. And that is the uneasy relationship foundations may have with advocacy itself. This uneasiness perhaps starts with the law that establishes limits on what foundations can do regarding lobbying. The law is actually quite ample in what it permits. But foundations tend to be extraordinarily cautious. They usually avoid anything that may appear to break the law.

But the uneasiness with advocacy goes beyond a conservative interpretation of the law. Some foundations tend to shy away from more controversial issues. They feel more comfortable with supporting neutral research, avoiding taking sides. They may feel that their tax-exempt status may be on the line if they promote an agenda of their own. Conservative foundations do not seem to care. They openly support their causes. Foundations which are sympathetic to the human rights cause may feel more vulnerable. Or they may fear they may not be as widely respected. Many in the foundation world came from academia, where reputations are built by drawing a clear line of demarcation between scientific objectivity and ideological commitment. 

I point to all these obstacles not because I think foundations have failed in this area. On the contrary. First as a grantee, and for the past eleven years as a member of the staff, I am extremely grateful for the opportunities foundations have given me particularly, and to the field as a whole. I would claim that, in spite of all the obstacles, foundations have done a superb job. Without their support, those working for social changes in many fields would have a much harder time.

Let me conclude going back to my initial question. Is there a synergy between rights and population concerns? My personal answer is yes. There is a natural synergy on the ground. And the synergy could be indeed very great, if adequately nurtured. Donors should help maintain this synergy by keeping the rights agenda in the forefront.

Population & Reproductive Health, Health, Human Rights, Population