Population and Family in the Low Countries 1994: Selected Current Issues

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Although disease patterns change constantly, communicable diseases remain the leading cause of mortality and morbidity in least and less developed countries. This raises some urgent concerns. The first is that despite policies and interventions to prevent and control communicable diseases, most countries have failed to eradicate vaccine-preventable diseases.

Second, sustainable financing to scale up interventions is lacking, especially for emerging and re-emerging diseases that can produce epidemics. Finally, in the present global economic and political context, it is important to understand how international aid agencies and donors prioritize their funding allocations for the prevention, control and treatment of communicable diseases.

Prioritization is especially critical if one accepts the global public good character of communicable diseases. This paper analyses the current burden of communicable diseases in the region and explores whether the current levels and trends in funding suffice to meet the needs for their control, prevention and treatment. We attempt to understand whether the current focus of disease prevention is appropriate and to ascertain what changes in direction might enable national and global policy-making to deal more effectively with communicable diseases. Although these three causes combined pose a lesser burden than non-communicable diseases, they will remain important causes of mortality in the next 25 years in low-income countries.

The region bears a disproportionate share of diseases such as Japanese encephalitis, leprosy and dengue, which have been eliminated from most of the world. Countries of the region also contribute a higher share of DALYs due to childhood cluster and tropical cluster diseases than the rest of the world. Some of the highest annual incidences worldwide of diarrhoeal diseases, lower respiratory infections, malaria, measles and dengue appear in the region.

Relatively older diseases such as TB, malaria, cholera and meningitis have recently recrudesced worldwide. At the same time, newer or re-emerging diseases such as infection with influenza A H5N1 virus avian flu , severe acute respiratory syndrome SARS and chikungunya have reached epidemic proportions in some countries. In the region, Thailand has reported the most deaths from pandemic influenza, and India and Indonesia have reported a fairly rapid increase in the number of cases.

In , India and Indonesia were among the top five countries in the region in terms of the total number of TB cases. The five infectious and parasitic diseases that contribute the most DALYs lost are generally the same in all countries of the region although variations in the rank order exist.

Countries of the region are thus facing huge challenges from diseases generally associated with underdevelopment, poverty and a less-than-effective health system, as well as from emerging infectious diseases. In-country estimates of disease burdens are the best tools for guiding prioritization, but a reliable analysis of how countries set their priorities is not easy because information and data are lacking on internal processes that lead to resource allocation. Unfortunately, ongoing burden of disease calculations are still not a priority in the region, and sustainable technical expertise for these analyses is also lacking.

National health accounts, if available, are of some help but may not in themselves make comprehensive accounting of resource allocations for communicable diseases possible. Also, not all countries in the region have national health accounts in a format that allows comparisons of aggregates across countries, and this is true for communicable diseases.

If functional allocations are assumed to be indicators of prioritization, then countries appear to be giving different weights to communicable diseases. For example, total health expenditure on the prevention and control of communicable diseases in India 1. Most countries in the region now have Global Fund resources for the prevention and treatment of these three diseases. Although this funding should be used for additional activities and interventions, there are no data or analyses that clarify whether they have complemented or substituted for the resources regularly allocated to communicable diseases.

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Because most discussions of MDGs centre on Goal 6, attention is detracted from other conditions whose reduction would lead to a lower burden of communicable diseases. For example, improving maternal health would have a direct, positive impact on child health and reduce child mortality. However, it is not clear whether funds are effectively allocated to the various diseases comprised by the three MDGs. For example, there are large global funding windows for the diseases targeted by Goal 6 but fewer windows for childhood disease interventions that go beyond vaccination and attempt to address other fundamental health and development sector issues.

Current funding criteria may thus limit the effectiveness of existing strategies. Addressing other MDGs, such as the eradication of poverty and hunger, would also go a long way towardsmeeting health-centred MDGs. In the region, HIV infection is concentrated among populations that are marginalized, have adverse human development indicators and are mobile mostly because of economic reasons. For example, undernutrition is an underlying cause of child deaths associated with diarrhoea, pneumonia, malaria and measles. A look at the contributions from the region to world DALYs lost on account of different infectious and parasitic diseases Fig.

In contrast, Japanese encephalitis, leprosy, dengue and childhood cluster diseases in the region contribute much more to the total DALYs lost globally. Eradication of vaccine-preventable diseases could reduce disease burdens effectively. An analysis of data from 97 developing countries shows that immunization coverage is a statistically significant predictor of the infant mortality rate.

With vector-borne diseases on the rise, there are concerns about the ability of resource-deficient countries to combat large outbreaks. The prevention of outbreaks itself is challenging because of their complex determinants. This situation makes developing countries especially susceptible because the health sector can only play a relatively small role in prevention.

The development of specific "ageing policies" is all the more important since the already high expenditure for health and retirement benefits is likely to increase with ageing. It should be realized that the issue of ageing is complex and is a challenge to those societies in which longevity has been increasing for some time.

This achievement leads to new developments in the nature of the social contract which binds generations together. With regard to international migration it was noted that, whatever their inclination, most European countries had, as in the case of the United States and Canada, a considerable net influx of migrants. Because of worldwide economic and social disparities and political conflicts, the region will have to deal with long-term migration pressures from other parts of the world.

Obviously the most crucial questions to be faced are how to control and manage the migratory flows to and within Europe in a humane and effective way and how to achieve a desirable level of integration. Apart from family migration which is, or is becoming, the largest flow of legal migration, two other categories of migrants have emerged preeminently on both sides of the Atlantic: asylum-seekers and irregular migrants.

Asylum procedures are being increasingly used not only by genuine refugees but also by migrants whose motivation is economic. It is also important to keep in mind that while western Europe, through the European Community and its cooperation with the countries of the European Free Trade Association, is basically committed to the free movement of people within its area, this "openness" is difficult to achieve or maintain. There is a clear need for increased cooperation within Europe in the field of international migration.

It is in the interest of both the sending and the receiving countries to see that ways are found to ameliorate the short-term crises and the long-term deprivation which lead to uncontrolled migration flows. Furthermore, countries in transition may be both generating and hosting substantial flows of migrants in the coming years.

International cooperation already exists among the countries of Europe and North America and the developing countries, as well as within the region. A major challenge is to continue to support the developing countries in their developmental and population programmes while at the same time intensifying similar activities with the countries in transition. The imbalance between population dynamics and, economic and social development, and its perceived impact at the world level on the environment has contributed to increasing awareness of the complex interdependency between different regions of the world.

Considering decision G 40 of the Economic Commission for Europe, which requested the Executive Secretary to collaborate with the United Nations Population Fund in convening periodically a regional meeting of experts on population for consultations amongst Governments and for the dissemination and exchange of information on population problems and policies in the ECE region;. Aware of the political changes which have occurred recently in Europe and of their positive impact on the development of cooperation between all countries of the region;.

Mindful that despite the ,diversities of their socio-economic, political, cultural, demographic and environmental conditions, the countries of the region share important common concerns in regard to population;. Aware of the specific needs of the countries in transition in the field of population, particularly in the context of the economic reforms under way there;. Mindful also that the developed and the developing countries in the perspective of sustainable development share common ground and interest on population matters, and are desirous to cooperate in this area;.

Reaffirming, that population policies including migration policies, should be consistent with and observe the Universal Declaration of Human Rights , the International Covenants on Civil and Political Rights and on Economic, Social and Cultural Rights , the European Convention for the Protection of Human Rights and Fundamental Freedoms and its additional protocols, the United Nations Convention on the Elimination of all Forms of Discrimination against Women , the Convention and the Protocol relating to the status of refugees and similar international instruments;.

Conscious of the principle of equity in health and the policy targets as stated in the Health for All Strategy by the year of the World Health Organisation and of the European Charter on Environment and Health, Frankfurt, ;. Stressing the importance of the activities initiated in the context of the Conference on Security and Cooperation in Europe which contribute to the observance of human rights, to conflict prevention, and the improvement of living conditions of the population of the countries concerned;.

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Reaffirming the outcomes of the United Nations Conference on Environment and Development UNCED held in Rio de Janeiro in June , and the commitment demonstrated by this Conference that all concerns of sustainable development, including those related directly to population, should be addressed in a fully integrated manner;.

Recognising with appreciation the valuable role international governmental organisations, including the Council of Europe and United Nations organisations, and non-governmental organisations have played and can play in promoting greater awareness of the nature of population problems and the need for effective action;.

Reviewing recent population trends and policies, and future prospects of demographic development in the region, as described in the documents submitted to the Conference and summed up in Section 1. Adopts the recommendations contained below and requests the Executive Secretary of the United Nations Economic Commission for Europe to transmit these recommendations to the Preparatory Committee of the International Conference on Population and Development.

Recognizing that sustainable development on the global scale is a common responsibility to be shared by the Governments of the region and those of the developing countries, the former should actively participate in all necessary joint efforts to be undertaken in this respect. Governments of the region should in particular be aware that poverty, population growth and environmental degradation are closely interrelated. While population growth and poverty result in certain kinds of environmental stress, the major causes of the continued deterioration of the global environment are the unsustainable patterns of consumption and production, particularly in industrialized countries.

Common targets should be the promotion of patterns of consumption and production that reduce environmental stress, and the encouragement of social and economic development that meets basic needs and allows for better living conditions and appropriate fertility rates. Population-related activities touching upon the most personal sphere of life should, as a prerequisite, be implemented in accordance with human and fundamental rights. They should in particular contribute to the improvement of the role and status of women, the reduction of large discrepancies in living standards and the peaceful settlement of religions, ethnic, political and economic conflicts.

A more child-friendly and family-friendly environment should be promoted in all spheres of society such as housing, child-care programmes, working conditions, time schedules and recreational facilities.

Population Trends and Challenges in the Middle East and North Africa

Governments, in cooperation with the private sector and the social partners, should help the ever-increasing number of parents who desire to achieve fulfilment through both professional life and parental roles. In addition, they should encourage other measures to facilitate work outside the family by either parent, such as part-time activity and flexible schedules. Particular attention should be given to the needs of women, who still bear a disproportionate burden of the responsibility in the family, by introducing measures which encourage men to share these responsibilities.

Governments and private organizations as appropriate, should consider measures which compensate, at least partially, for the costs of child-bearing and child-rearing, particularly for those with limited resources. These measures may include direct financial and other support, tax incentives, and low-cost or free child and maternal welfare services. In order to develop better gender equality, Governments should promote conditions that further political, economic and social equality between men and women, including equal opportunities for education, training and employment, and equality in family responsibilities.

Governments and private organizations, as appropriate, are encouraged to develop more targeted programmes focusing on vulnerable groups of the population and families which bear special burdens. An objective is to address persistent and ever-growing poverty and low income among those sections of the population by such measures as income maintenance, job creation, housing support, free or subsidized training, and preferential child care. In their social and family policies, Governments should adopt measures to enable individuals and couples to exercise their right to decide freely and responsibly the number and spacing of their children.

These measures should increase the access of individuals and couples to education, information and the means of regulating their fertility, including the treatment of infertility, regardless of overall demographic goals. Counselling and quality family planning services should be provided and supported to reduce the number of induced abortions. In view of the current situation in countries in transition, Governments of these countries should strengthen their services in reproductive health, including family planning, and encourage non-governmental organizations in this field.

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Although most countries are experiencing favourable trends towards the use of medically-approved family planning methods, there are still groups which need particular attention. Governments should seek to increase access to appropriate information, family planning services and educational programmes for these groups. Public authorities at national and local levels, non-governmental organizations and other institutions concerned should support non-coercive family planning services, which respect the values of recipients, together with maternal and child health programmes and related reproductive health services.

Family planning associations and other concerned non-governmental organizations should be involved in the design and implementation of these programmes and services. In promoting the development of family planning services, particular attention should be given to the quality of the services. As new methods of medically-assisted reproduction and their use are developing rapidly, Governments should provide for mechanisms to examine the ethical dimensions of the application of these methods and their social, economic, legal and health consequences.

International exchanges on these questions should be organized by the Council of Europe and other international organizations. According to WHO Health for All Targets towards the year , Governments should encourage popular participation in designing and executing health policies. Different forms of self-care based on recent knowledge and information should be developed. Governments should consider health promotion a principal strategy for improving health and prolonging a healthy life.

Health promotion consists of the following: a the transmission of knowledge regarding disease prevention and health-maintaining behaviour to the general public as well as to specific risk groups, such as teenagers; b the internalizing and application of knowledge by the respective target groups, resulting in changes in personal behaviour, such as ceasing to smoke, lower or no consumption of alcohol and drugs, eating a more balanced diet, more responsible driving behaviour, performing physical exorcises and practising safe sex.

Governments should also consider education programmes as well as taxes and other financial mechanisms to discourage the excessive use of substances such as tobacco and alcohol, and the abuse of psycho-active drugs. The needed infrastructure should be provided by Governments, the private sector and by communities. Governments in collaboration with the private sector should recognize the link between the commitment to policies that lead to ecologically sustainable development, the prevention and control of risks, and equitable access to a healthy environment, as stated in the European Charter on Environment and Health, in the UNCED recommendations and in WHO documents.

This includes, among other things, ensuring water and air quality, food quality and safety, waste management, chemical safety, health of people at work, safe housing and supportive environments for each generation. An initial indispensable step consists of monitoring air, water and soil pollution and its impact on the health of human beings, particularly of vulnerable groups, such as children, the elderly and workers at risk.

Governments should identify and monitor the causes of socio-economic and regional mortality and morbidity differentials, and subsequently make efforts to reduce them. Governments should ensure that families, and in particular women and children, have access to a full range of appropriate, quality health services and programmes. This includes family planning and reproductive health services entailing preconceptual, prenatal and postnatal care.

Such services should be accessible to all women and also contribute to reducing infant and maternal mortality and morbidity and promote healthy birth outcomes and healthy development of children, now and in the future, in keeping with the goals of the declaration and plan of action adopted at the World Summit for Children, Particular attention should be given to the protection of pregnant women and to breast- feeding mothers at the workplace. Governments should provide and promote appropriate services, care and support to elderly people in need, implement strategies to increase the number of disability free years and improve their quality of life.

Governments are urged to reform health systems so as to increase their cost effectiveness and efficiency and to improve their responsiveness to the needs of the respective populations. The need for reform of the health system is particularly obvious in countries in transition, where recent changes have not only exposed the extent of the health crisis but also have further exacerbated the crisis due to the austerity measures necessary to implement the transition to a market economy.

Governments as well as private and public organizations concerned should make every effort to maintain an adequate level of medical and social protection for disadvantaged groups in light of the fact that financial difficulties faced by social security systems and the lack of health insurance coverage of various groups, in addition to persistently high levels of unemployment, entail inadequate medical protection for parts of the population. In the formulation and implementation of their health policies, Governments should pay attention to the problem of insufficient availability of qualified personnel in certain categories of health personnel e.

They are therefore invited to consider adjusting training curricula and facilities. They should encourage adapting working conditions and improving social status and salaries accordingly. Governments should also ensure that women have an important role in decision making for health.

In their economic and social policies, Governments should take into account the consequences of the fluctuating numbers of population in different age groups resulting from past demographic changes. Knowledge of demographic trends should be given due consideration by policy-makers. These policies should focus on the effects of population fluctuations on the education system, the labour market, and on the social and health services for the elderly. Governments and policy makers should ensure that short-term policies work in conjunction with long-term policies to address the consequences of population ageing.

1. Overview

Governments should appreciate that, while certain imbalances in the labour market may be compensated for by immigration, immigration may not be a full solution for the adjustment of the age structure. Heavy reliance on immigration to solve demographic imbalances could in the long run lead to substantial fluctuations in the age structures of national populations.

Governments should give high priority to the development of human resources as a way of dealing with the adverse effects of population ageing. Suitable measures should include the training of both young and adult persons, and incentives for a better use of the older members of the labour force and of those retirees able and willing to remain economically active.

The valuable contribution that the elderly make to society, especially as volunteers and care-givers, should be given due recognition. Governments should seek to enhance the self-reliance of the elderly and to facilitate their continued participation in society.

2019 Fertility Rate By Country

Governments should ensure that the necessary conditions are created to enable elderly people to lead self-determined lives and to make full use of the skills and abilities they have acquired in their lives for the benefit of society. Governments should consider, as appropriate, social security system reforms to ensure greater intergenerational and intragenerational equity and solidarity.

Such reforms should also deal with the potential imbalances between revenues and expenditures in the pension programme. Those no longer capable of working should be assured reasonable benefits, irrespective of age. Policies should stimulate different forms of care for older populations, which will increase substantially in numbers, especially in the highest age brackets.

Frequently Asked Questions (FAQ)

Special efforts should be made to enable older persons to remain in their homes and communities, as far as possible, by providing greater home and community health care and social services, improving coordination of community services, expanding rehabilitation programmes, and giving financial and other incentives to assist families and individuals in taking care of the elderly. Governments should also elaborate policies to address the growing need for organized care in public and private sectors.

Governments should ensure adequate quantitative and qualitative recruitment of human resources to cope with the growing needs of the formal old-age care sector already faced with severe pressures on human resources. Governments, local authorities and organizations should implement measures to improve the status and working conditions of those professional groups. In addition, the contribution of families and volunteers should be recognized and encouraged by all organizations concerned but should not be considered as a substitute for formal care.

Wider discussion of the economic, social, cultural and political implications of migration should be undertaken in order to elaborate or improve appropriate policies. Governments of sending and receiving countries should improve the dissemination of information and promote consultations with a view to reaching a broad national and international consensus on these questions. Cooperation in the field of migration should also be considered in the context of economic, social and legal cooperation. Governments of countries of origin and destination should seek to redress the causes of emigration in order to alleviate the massive and uncontrolled international migration flows.

The redressing of these causes would require increased effort to achieve sustainable economic and social development, avoid international and internal conflicts, respect the rule of law, promote good governance, strengthen democracy, promote human rights, support education, nutrition, health and population-relevant programmes, and ensure effective environmental protection.

This may require financial assistance, the reassessment of commercial and tariff relations and full access to world markets, and stepped-up efforts on the part of developing countries to create the framework for a market oriented economy and a liberal trading system. The economic situation in these countries is likely to improve only gradually and, therefore, migration flows from these countries will decline only in the long-term; in the interim, the acute problems currently observed will cause migration flows into the region.

In addition, Governments of countries of destination should acknowledge the influence of economic "pull" factors on international migration. Governments of countries of destination have the right to control access to their territory and adopt policies which shape immigration flows. Such measures should conform with universally recognized international standards. As movements of persons are part of the process of development of free societies and market economies, host countries should also adopt policies which allow legal migrants the option of remaining, either on a temporary or permanent basis.

Forms of temporary migration, such as short-term and project-related migration, might offer the Governments of the region an opportunity to improve the skills of nationals of developing countries and countries in transition; they should therefore be considered, if appropriate, in the national and regional context through both bilateral and multilateral intergovernmental agreements.

Appropriate steps should be taken to safeguard the wages and working conditions of both migrants and nationals in the affected sectors. In view of their responsibilities under the United Nations Charter, and consistent with their obligations under the existing international instruments in the field of human rights, Governments should do everything in their power to avoid new massive flows of refugees and displaced persons. Accordingly, they should respect the rights of individuals belonging to minorities and refrain from creating or contributing, by their domestic policies, to causes and factors which generally lead to massive flows of refugees and involuntary migration.

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This implies, among other things, a condemnation of all kinds of "ethnic cleansing" whether it is the responsibility of Governments or local groups within a country. Women and children comprise the overwhelming majority of the worldwide refugee population. Protection and assistance programmes can be effective only if they are planned and implemented with full recognition of the needs of women and children.

The active involvement of refugee women in all stages of programme development and service delivery is essential. Confirming their commitment to the relevant international instruments concerning protection of refugees, Governments should do their utmost to ensure protection and assistance to refugees and displaced persons, with the aim of finding durable solutions, and to support all efforts to this end. They should harmonize as far as possible their asylum policies and regulations in accordance with international instruments and in a way that does not add to the suffering already experienced by refugees and displaced persons.

They recognize that solutions to the problem of refugees and displaced persons may best be achieved through a comprehensive approach. In cases of sudden and massive arrivals of refugees and displaced persons in need of international protection, they should be accorded at least temporary protection and treatment in accordance with the national practices and regulations and internationally recognized humanitarian standards, until a solution is found.

Governments should encourage persons in need of international protection to stay, to the extent possible, in the safe areas nearest to their countries of origin. Availability of aid and the strengthening of protection mechanisms in these areas should contribute to this objective, while at the same time building confidence among the persons concerned.

The principles of collective cooperation and international solidarity should be applied in assisting host countries, if requested. Governments and international organizations should support the voluntary repatriation of refugees and displaced persons as a durable solution. Governments should apply fair, efficient, expeditious and reliable procedures to deal with asylum applicants.

Governments are urged to further promote coordination and consultation to prevent the misuse of humanitarian instruments which in the long run might negatively affect the right of asylum. Governments should aim to prevent uncontrolled influxes of migrants by making potential migrants aware of the legal conditions for entry, employment and stay in host countries through information activities in the countries of origin, making use of the facilities of international organizations where appropriate.

Governments should also take action against traffickers and employers of illegal immigrants. For efforts to control migration, in particular illegal migration and illegal stay, to be successful, countries should devote appropriate financial, political and diplomatic resources to them. Governments of countries of origin of illegal migrants and rejected asylum-seekers should not impede the re-entry and re-integration of these persons. In addition, Governments of countries of origin and destination should try to find satisfactory long-term solutions to the problems caused by illegal migration through multilateral and bilateral negotiations, for example by readmission agreements.

As a consequence of the irregularity of their situation, illegal immigrants are particularly vulnerable to all forms of exploitation and discrimination. Governments of receiving countries should ensure that their basic human rights are respected. The social and economic integration of resident legal migrants, a common responsibility of the host society and the migrants themselves, should also be a major objective of government policy.

Security of residence, especially after a number of years, is an essential condition for successful integration.

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Where legal immigration has proved to be of a long-term nature, naturalization should normally be available, especially for second generation immigrants; civil and political rights and responsibilities should be extended to long-term legal immigrants, as appropriate. It is a basic function of Governments to ensure the protection of all residents -- including foreigners -- against violence and the threat of violence.

Governments should urgently develop strategies to combat racist or xenophobic violence and threatening behaviour, especially through information, education and the promotion of tolerance and understanding. Public authorities at the national and local levels, the private sector and the non-governmental organizations should take into account the different national, ethnic and cultural origins of immigrants and show an open attitude towards their cultural, religions and other values, as long as these are compatible with the laws and fundamental values of the host societies.

Equality of opportunity should, as far as possible, be granted to resident legal immigrants. At the same time, Governments as well as immigrants should recognize that action to enable resident legal immigrants to have access to education, training, employment and housing, and to achieve a high level of competence in the languages of host societies, in accordance with national legislation, are crucial to the success of integration strategies. In this context special efforts should be made in favour of migrant women, children and other vulnerable groups.

The United Nations Conference on Environment and Development has highlighted the interaction between population, environment and sustainable development. An increasing number of countries is aware that rapid population growth imposes growing constraints on social and economic development, with negative effects in particular on the environment and on the natural resource base.

To help solve these problems is also a challenge for the United Nations member countries of the region. Moreover, the political, social and economic transformations of historical importance, and the birth of the new democracies in the countries in transition, have created new possibilities for European cooperation. In recognizing that international cooperation, especially that to support the efforts of countries with rapid population growth, is more urgent than ever, member countries should seize the opportunity for closer cooperation within the region as well as with the developing countries, which has been created by the end of the East-West conflict and the consensus on the elements of a global partnership for development.

This cooperation in the field of population should be permanently based on respect for fundamental human rights and the responsible exercise of such rights for all individuals. Governments should, as a matter of urgency, assist countries in transition in the field of population issues. Key elements of such assistance should be financial support through bilateral and multilateral channels. Technical backstopping, training, exchange of information, experience and expertise should be used to strengthen data collection and research capabilities.

Governments and regional organizations, in collaboration with international organizations, should elaborate and implement a coordinated strategy to assist countries in transition in the field of reproductive health, including family planning, in the implementation of reforms in health systems, and in the field of migration. Governments and organizations concerned should assist countries in transition to develop policies and implement integrated activities relating to health-population-environment issues.

Cooperation with developing countries should be built upon a strengthened partnership based on the recognition of sovereign equality, mutual interest and shared responsibility with mutual commitments. While developing countries have a primary responsibility for their own economic and social development, including the formulation and implementation of appropriate national policies relating to population and development, developed countries have a special responsibility to help create a favourable international economic environment and to increase the quantity and quality of their assistance, particularly in the field of population.

The rate of population growth is acknowledged to have a major influence on global prospects for economic and social development. A broad consensus has emerged on the complex interrelationships between poverty, population growth, human rights, environment, and economic, social and human development. Even though fertility rates in many countries have decreased substantially, the high rate of population growth is still a fundamental problem in a large number of developing countries, adversely affecting individual health and welfare, national economic progress and employment, and the natural resource base; the rapid population growth is also putting strong pressure on health services, education systems, social services and housing.

Governments, regional institutions and non-governmental organizations of the region should give a high priority to cooperation with developing countries, supporting their efforts to achieve population growth rates and distributions which strike an optimal balance between their population, the natural resource base and the environment. Special attention should be given to the African region, where population-related problems are particularly serious. In doing so, Governments, regional institutions and non-governmental organizations should give high priority to population issues in their development assistance strategies, to help to improve the quality of human resources and the status of women, to answer unmet demands for reproductive health services, including family planning services, and to promote health in its various aspects.

They should address these issues continuously in their policy dialogues with partner-countries, both at the bilateral and the multilateral levels. There is already a large, and growing, unmet demand in developing countries for family planning services. UNFPA estimates that million women world-wide would like to use family planning services but do not enjoy the fundamental human right of access to them, nor do they have the ability to plan freely and responsibly the number and spacing of their children.

Efforts should thus be intensified to ensure the availability of family planning services to all who wish to make use of them. Such efforts can be expected to help in achieving population growth rates which contribute to a sustainable use of natural resources. Developing and developed countries alike should increase their political commitment to population-related programmes and policies, in accordance with their national priorities and goals and with due respect for fundamental human rights.

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