Address by Deputy Minister of Social Development, Dr Jean Swanson-Jacobs on the occasion of World Population Day, Voortrekker Monument Hall, Pretoria

Programme Director, Mr Jacques van Zuydam
Chief Operations Officer, Mr Zane Dangor
UNFPA Representative, Professor Arowolo
Representative of the Department of Health, Mr Sikhonjiwe Masilela
Religious leaders
Youth groups and young people present here today
Esteemed guests
Ladies and gentlemen

It is an honour to address this seminar on the occasion of commemorating World Population Day, which seeks to focus attention on the urgency and importance of population and development issues. Let me begin by expressing my appreciation to Mr George Nsiah of the United Nations Population Fund (UNFPA) and Mr Jacques van Zuydam, Chief Director Population and Development and their respective staff for their hard work in organising this seminar and ensuring that population issues remain on the national and development agenda.

Let me also acknowledge the presence of one of the world-renowned expert in the area of maternal and child health, Professor Eddie Mhlanga, the head of Obstetrics and Gynaecology at the University of KwaZulu-Natal. The celebrations of this year's World Population Day coincide with a very interesting milestone in the world: For the first time in history, more than half of the world's population, 3.3 billion people are living in urban areas. The State of World Population Report (2007) estimates that this number is expected to increase to five billion by 2030.

Ladies and gentlemen, the very timely theme of this year's celebrations, "It's a right let's make it real", has important implications for human rights. Reproductive rights are indeed human rights. The theme commit us as development practitioners to ensure that people have the freedom and the means to make their own informed decisions about the very private aspects of their lives that is sexual relations and pregnancy free of violence, discrimination and coercion.

In addition this implies that individuals and couples can choose the number, timing and spacing of their children. More importantly, we should enable people, particularly women and the girl child to protect themselves from unwanted pregnancy and HIV infection.

It gives me great pleasure to join you in these discussions because historically, discussions of issues pertaining to reproductive health and family planning often concentrate on women, ignoring the crucial role that men ought to play to make this a reality. The composition of this seminar attests to this statement.

It is refreshing to see young people actively participating in discussions of matters relevant to them fertility and reproductive health. This affirms our assertion that young people are an integral part of the solutions to challenges confronting us. It is also encouraging to have religious leaders with us here today because I believe the church and the religious sector as a whole, has a critical role to play in instilling moral values in young people.

Gone are the days when teaching about sex and reproductive health in church was regarded as taboo. The very topic of discussion here today family planning has been central to the church's teachings and still remains relevant to this day.

In 1968, world leaders proclaimed that individuals have a basic human right to determine freely and responsibly the number and timing of their children. Fourteen years ago in Cairo, 179 countries agreed on the goal of universal access by the year 2015 to reproductive health services to family planning, safe motherhood, prevention of sexually transmitted infections including HIV and AIDS, and an end to gender violence.

The resolutions of the conference, known as the Cairo Consensus were adopted by the International Conference on Population and Development with the specific goal to empower women, promote gender equality, slow and eventually stabilise population growth, and foster sustainable economic growth in the world's poor countries.

Reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system and to its functions and processes. It implies that people have the capability to reproduce and the freedom to decide if, when and how often to do so.

Implicit in this is the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility, which are not against the law, and the right of access to health care services that will enable women to go safely through pregnancy and childbirth. Reproductive health care also includes sexual health, the purpose of which is the enhancement of life and personal relations.

Reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other relevant UN consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health.

Family planning is the conscious effort of couples to regulate the number and spacing of births through artificial and natural methods of contraception. Family planning is a fundamental component of reproductive health as it allows for determining the spacing of pregnancies. Studies show that family planning has immediate benefits for the lives and health of mothers and their infants.

Ensuring basic access to family planning could reduce maternal deaths by a third and child deaths by as much as 20%. Family planning is also an effective means in the fight against poverty. Parents can plan ahead and devote more of their resources to the education and health of each child, which benefits the family, community and nation.

Programme Director, the Constitution of the Republic of South Africa (1996) contains a Bill of Rights that enshrines freedom and security of a person. Thus the right to bodily and psychological integrity, which includes the right to make decisions concerning reproduction.

In keeping up with the Cairo Consensus, the South African Population Policy in (adopted in 1998) shifted from the conventional family planning methods to place population within the development paradigm. This is in view of the fact that population and development are inextricably linked, and that empowering women and meeting people's needs for education and health, including reproductive health, are necessary for both individual advancement and sustainable development.

At the core of the policy is the need to keep gender equality, HIV and AIDS and reproductive health at the top of the development agenda with a specific focus on improving the status rural women and adolescents to exercise their rights with respect to reproductive health.

The policy further recognizes that population and development are cross-cutting issues which cannot be successfully addressed by one entity or department. As such the Policy further promotes a co-ordinated, multi sectoral, interdisciplinary and integrated approach in designing and implementing programmes and interventions that impact on population concerns.

Data from recent studies indicate a decline in fertility in South Africa. The mid-year estimates (Statistics South Africa, 2004) gave national total fertility rate of 2.8 children per woman of reproductive age, while the 2006 mid-year estimates gave a total fertility rate of 2.7, and the 2007 mid year estimates gave an estimate of 2.69 children per woman.

The decline in fertility may be attributed to better access to primary health care services and improved levels of schooling among children, especially the girl child. While population growth and fertility rates are declining, the need for accessible, quality reproductive health services continues to be great and continues to grow. This is true in light of the drop in age of sexual experimentation.

The health of mothers and children has remained a worrisome issue in the attainment of better health for all in Africa particularly in the era of HIV and AIDS pandemic. Maternal mortality refers to the number of women who die as a result of childbearing, during pregnancy or within 42 days of delivery or termination of pregnancy, in a given year.

Measures of maternal and infant mortality are critical as they reflect on the availability and accessibility of essential health care services during pregnancy and child birth, but also on the quality of services and broader underlying factors including general health and nutritional status, family planning, financial resources and education.

The reduction of the maternal mortality rate by three quarters is one of the millennium development goals, which South Africa has committed to achieve by 2015.

Ladies and gentlemen, a comparison of data on child mortality rates from the five year period before the Demographic and Health Survey (DHS, 1998) and the five year before the DHS (2003) shows that it was 45.5 in 1998 and 42,5 per 1 000 live births in 2003 respectively.

The figures showed a slight decrease during that period and years thereafter. In 2004 infant mortality rate was estimated at 38.1 per 1000 live births. While these figures are encouraging, much more still need to be done to improve the quality of life of mothers and their children because infant mortality rate is the best indicator of quality of life for both mother and child.

The fact that women constitute a majority (55% of HIV positive people) in South Africa is a worrying factor as this has huge implications for reproductive health as well as family planning practices. As you all know, the health of the mother and child are inextricably linked.

Given the large number of maternal deaths attributed to HIV and AIDS, this has a direct impact on children's subsequent care arrangements and survival outcomes. As it was noted at the recent 118th Assembly of the Inter-Parliamentary Union in Cape Town, HIV and AIDS remains one of the leading causes of mortality, especially among children under the age of five as well as the 25 to 44 age groups for both males and females.

One relatively straightforward area where we need to intensify our efforts is in preventing transmission of HIV to women, and from parent to child. In many parts of Africa, the epidemic continues to undermine our quest to improve maternal health. While information on maternal mortality in South Africa is incomplete and inadequate, data from maternal mortality estimates shows an alarming increase.

According to Statistics South Africa, birth registration shows that in 1997 maternal mortality figures were 80,67 per 100 000 live births and was 123, 71 in 2002.This is actually an upward trend which is still prevailing even today and therefore a cause for concern.

The trends of both indicators, maternal and infant mortality rates show that much work still has to be done to improve the quality of life of mothers and their children.

Ladies and gentlemen, our ability to respond effectively to these challenges is hampered by the critical shortage of skilled health professionals, especially in rural areas. Central to reducing health risks for mothers and children is the need to increase the proportion of babies that are delivered with assistance of medically qualified health professionals.

Since maternal and child health conditions are worse in the rural areas, innovate ways to attract and retain health workers are urgently needed. In this regard, we welcome the implementation of the Occupation Specific Dispensation in the health sector to address the identified challenges.

Data on antenatal care from District Health Information System (DHIS) is encouraging as it shows increasing proportion of women coming for at least one antenatal visit. Between 2000 and 2003 the proportion of women accessing antenatal services increased from 78,8 to 95,5%. Similarly, there was an increase in the proportion of births assisted by medically trained personnel from 84% to 92% in the five years preceding.

Programme Director, the benefits for women who are able to control their fertility should be recognised. They should be helped to make such choices themselves, as well as in discussion with their partners. The ability to do so by choice and not by chance is a principal component of women's physical and mental health and social well being.

Access to adequate fertility control methods is necessary to enable women to participate fully in all aspects of economic, political and cultural life as active decision makers, participants and beneficiaries; and to ensure that all women receive the education required to meet their basic human needs and to exercise their human rights.

Education is a key factor in sustainable development and having fewer, healthier children can reduce the economic burden on poor families and allow them to invest more in each child's care and schooling, helping them to break the cycle of poverty. Education is a component of well being and a means to enable the individual to gain access to knowledge, improve the quality of life and promote genuine democracy.

The increase in the education of women and girls contributes to women's empowerment, to postponement of marriage and to reductions in family size. When mothers are better educated, their children's survival rate tends to increase. Family planning is critical to achieving two Millennium Development Goals those relating to both AIDS and maternal and child health.

The need for responsive reproductive health programmes remains more evident amongst adolescents and young people in this country. Teenage girl pregnancy remains a challenge for the education sector. According to the South African Education Status Report (2005), the majority of school girl pregnancies are unplanned and unwanted.

The most salient social consequences of teenage pregnancy are: school drop-out or interrupted education; vulnerability to or participation in criminal activity; abortion; child neglect and abandonment; poverty, repeat pregnancies and interrupted education which compromise their future.

The report also makes connection between the high levels of sexual violence against children and teenage pregnancy. Thus pregnant girls form a social group with specific needs for survival, growth and development.

Like many other age groups in South Africa, teenagers are greatly impacted by the HIV and AIDS pandemic. But this is even more the case during these ages (15 to 19 years) or even earlier than 15 years of age, as children are likely to become sexually active during this stage of development, the outcome of which could be detrimental to their wellbeing if safe sexual behaviour is not practiced.

Data from extensive national antenatal surveys show that HIV prevalence among adolescent girls and young women in the age group 15 to 19 years may be stabilising, although at very high rates.

Pregnancy at a young age is more likely to result in pregnancy complications that can lead to the death(s) of the young mother and/or her baby. Other associated factors include increased risk of infant morbidity, and a range of adverse social, psychological and economic effects which perpetuates poverty.

Knowledge of the status of teenage pregnancy is thus crucial if we are to begin to look at advancing adolescent health. Factors that can contribute to the number of teenagers who fall pregnant are, for example gender power imbalances, lack of bargaining power about the use of contraceptives, lack of access to quality contraceptives and family planning services, and even inadequate information on sexual reproductive health.

Ladies and gentlemen, although South Africa has among the lowest teenage fertility rates in Africa, the rate is considerably higher than in more developed countries. For the period 2000-2005, average adolescent fertility rate was estimated at 61 births per 1000 women aged 15 to 19.

According to the Department of Health, pregnant women under the age of 20 years continue to show a significant decline from 16,1% in 2004 to 13,7% in 2006. A comparison of District Health Information System from 1998 to also shows that though remaining unacceptably high, teenage pregnancies had declined.

Since 1994 the government has implemented a number of innovative programmes and progressive legislation based on human rights approach. Under the new dispensation, reproductive health is a right guaranteed by the constitution.

One of the innovative programmes is the national adolescent friendly clinics that offer health services to young people through peer education and support. Other initiatives include the partnership with love Life and the Planned Parenthood Association of South Africa (PPASA).

Central to the successful implementation of strategies targeting young people is the need to advance gender equality, elimination of violence against women, prevention of sexually transmitted infections including HIV and AIDS, and ensuring women's ability to control their own fertility.

The empowerment of the girl child and young women, and the improvement of their status are important ends in themselves and are essential for the achievement of sustainable development.

As I said earlier, men play a key role in bringing about gender equality since, in most societies; they exercise power in nearly every sphere of life. The objective is to promote gender equality and to encourage and enable men to take responsibility for their sexual and reproductive behaviour and their social and family roles. To this end, government supported men's involvement in reproductive health at the 1999 review of the Programme of Action. Specifically, men should:
* Protect women's health, including supporting their partners access to sexual and reproductive health services.
* Prevent unwanted pregnancies.
* Shared control in and contribution to family income and children's welfare.
* Prevent sexually transmitted diseases, including HIV and AIDS and
* Promote the elimination of harmful practices, such as female genital mutilation and sexual violence.

As parents and leaders in our respective spheres, we should ensure that attitudes that are respectful of women and girls as equals are instilled in boys from the earliest possible age. Reproductive health-care programmes should be designed to serve the needs of men.

Innovative programmes must be developed to make information, counselling and services for reproductive health accessible to adolescents and adult men. Such programmes must both educate and enable men to share more equally in family planning, domestic and child-rearing responsibilities and to accept major responsibility for the prevention of sexually transmitted infections.

We must educate men in our society that reproductive health is a shared responsibility between men and women. These issues remain our biggest challenge in the attainment of equality for wom