Holding our Ground focuses on one of the most contested of the agreements hammered out at the International Conference on Population and Development in Cairo in 1994 - reproductive rights.

Ten years on, there’s been some progress. Six percent more couples use modern contraception. There’s an increase in attended births and emergency obstetric care, and fewer maternal deaths. Adolescent reproductive health is now a worldwide concern and campaigns counteracting violence against women are increasing. But there’s a long way to go. More than 350 million couples still don’t have access to family planning services. Complications in pregnancy and childbirth mean 529,000 women still die every year. And in many countries, reproductive health and rights remain the focus of fierce arguments.

Filipino kids

In the Philippines there are almost 85 million people – a figure set to rise to over a hundred million by 2015. Here, the average Filipino family has three or four children. But the poorest fifth of the population have between 9 and 12. Only a third of married women use contraception – and then not always very effectively.

Dr Sylvia Estrado-Claudio, Chair of Likhaan, a Centre for Women’s Development, says that the Philippine Government has not lived up to the pledges it made at Cairo: “For the first time in the history of these conferences we had a document that asserted women’s rights. We have the language now sometimes to fight and to ask for these policies, but are we better off? I think we’re far worse off because the government will not follow the ICPD to which it is a signatory.”

The Government did table two important bills in 2001 – one on population and development, the other on reproductive health. But the Catholic Church exercises a pervasive influence on Filipino society. For three years, opposition from the Catholic Church and conservative lobby groups has held up the passage of the Reproductive Health Bill through parliament, arguing the proposed legislation is ‘anti-life’.

The Cairo agreement also pledged to address adolescent reproductive health, including providing information and services to prevent unwanted pregnancy and sexually transmitted diseases. In Latvia – one of the newest members of the European Union – surveys show that young people are having sex earlier than their parents did, and a fifth of all women aged 15-25 have had abortions. One of the main obstacles is overcoming the social taboos about sex.

Latvian youth group

Papardes Zieds is Latvia’s Family Planning and Sexual Health Organisation. Diana is a member of one of their Youth Groups: “There are many questions about first time sex. And question number one unfortunately is ‘I am pregnant, what should I do?’ It’s very sad to hear this from very young girls. Girls between 15 and 18 write to us about it very often.”

Teenage abortions have fallen by a third in Latvia over the last seven years. Along with eight out of 10 countries reporting since Cairo, it says cultural attitudes remain the main obstacle to better sexual health services for adolescents. Worldwide, as more young people are sexually active before marriage – often with no knowledge or means to protect themselves - young women are especially at risk.

Childcare is another widespread problem for women in the industrialized countries. A recent report suggests Japan’s lack of child care facilities is one of the causes of the country’s declining birth rate – now well below zero growth. Japan also has the world’s fastest growing elderly population which means the dwindling workforce will struggle to provide future care for the elderly.

Atsuko Sato

Entrepreneur Atsuko Sato saw an opportunity to help both groups. She’s developed a day centre that brings together young and old under one roof. “I thought that what I had to do was not just about helping working women, but also helping nuclear families to communicate with other generations,” she says. “Recently one of the positive results has been the increase in mothers who want to have another child, two or three years after the birth of their first. I know that many Japanese women would like to have two or three children if they could continue with their careers and if they had enough support to bring up the children.”

Not everyone can afford private nurseries like Atsuko’s. But because women’s labour is now urgently needed in Japan’s shrinking workforce, the government has now promised to provide enough day care centres for all working mothers.

Thoraya Obaid, Executive Director, UN Population Fund (UNFPA) - the first Saudi head of a UN agency - gives her thoughts on the support that women need:

Thoraya Obaid

“One is I think fathers need to step in and help much more. Two – there have to be institutions in the country to help the women do both roles that are their right – which are motherhood, as well as being a productive person in the society. The private sector also has responsibility. Community-based services have to be available, even if it is the community themselves coming together and doing it.”

Another problem is the preference for boys in many societies. This is especially the case in India. Punjabi housewife Lakshmi explains: “Women fear being deserted if they are unable to have a son, they are constantly under pressure from their husbands’ families.”

Ultrasound scan - open to abuse.

Now technology is compounding the problem of discrimination. The pre-natal ultrasound scan designed to improve health care for women is being used to select for boys rather than girls. Despite a 1996 law banning the use of this technology for sex selection, illegal abortions of female foetuses have dramatically increased over 10 years. In 2002, the UN reported that fewer than 90 girls are being born for every 100 boys in India, compared to the worldwide average where girls outnumber boys by 105 to 100.

In May 2004 the Indian Supreme Court instructed the government to crack down on unscrupulous medics performing sex selection and abortion of female foetuses. But in a country the size of India, this is easier said than done. Thoraya Obaid comments: “It’s both economic and it’s a cultural practice. There have been laws put in place. But we might have the best laws in the world, but if there is no system of monitoring and actually punishing those who commit a crime of that sort, the practice will continue. We need to train people in communities who can identify the human rights violation, who can provide such information so that the community itself becomes aware of this wrong practice, and then educate them to move along to change it.”

Access to reproductive health linked to equality and reducing poverty was key to the Cairo agreement. Ten years later almost all countries report they have included reproductive health in their health reforms. But there are still huge gaps.

Policy makers have been slow to make sure the poor have equal access to health information and services.

But accessing reproductive rights is a vital step towards ending poverty. Thoraya Obaid: “Reproductive rights are basic in terms of empowering women with the autonomy of the body, also allows her to get the skills that are necessary for her to become economically active and have an income for the family, and therefore fight poverty in its own way.”

TRANSCRIPT Read the full transcript of Holding our Ground