This compendium of profiles for 30 Latin American and Caribbean countries includes 10

Transcription

1 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23 4: This compendium of profiles for 3 Latin American and Caribbean countries includes 1 from the Caribbean, eight from Central America and 12 from South America. Haiti is the only least-developed country in the region. At the beginning of 23, the region s total population was 534 million and was growing at a rate of 1.46 per cent down from 1.72 per cent during Throughout the region, development needs, including needs related to population and reproductive health, remain pressing. Meeting these needs and meeting the goals and targets for 215 set down in the 1994 ICPD Programme of Action and the Millennium Summit of 2 will require concerted and continuous interventions aimed at further improving economic and social conditions. Aggregate gross domestic product (GDP) for the economies of the region registered essentially no per capita growth in either 21 or 22, largely because of exterl shocks. Through the end of 22 the hoped-for positive effects of globalization, privatization, austerity and freer trade have remained disappointing, despite the considerable reform efforts made by many countries. Problems of poverty and inequality are, however, generating increased interest, as the results of recent elections (in Ecuador and Brazil, Latin America s biggest country) underscore. In addition, issues such as HIV/AIDS, intertiol migration and ageing are assuming higher priority in policies and programmes, along with support of social programming and decentralization. The failure as of early 23 to include sexual and reproductive health and rights as a priority in poverty reduction efforts continues to be disappointing, undermining long-term prospects. While progress continues to be made in the supply of services, progress in addressing sexual and reproductive rights and health concerns is mixed. Women s groups and their allies, despite their long tradition of support for women s health and empowerment, will need to find new ways of mobilizing social and political leverage if they are to be successful in this important area. Alyses indicate that differentials in access to sexual and reproductive health information and services (particularly family planning, antetal care, safe delivery and the prevention of sexually transmitted infections) are more tied to income levels than in other regions. While progress has been made over the past 12 years in improving antetal care and in promoting safe motherhood in the region, women s lifetime risk of dying in pregncy or childbirth remains far too high, 1 to 16. The Millennium Development Goal of lowering the materl mortality ratio by three quarters deserves to be included (and is indeed being accorded a high priority) in ongoing poverty reduction efforts. Most countries of the region have elaborated formal public policies related to gender equality and have created women s institutes or offices. The main challenge continues to be to improve this institutiol base, while moving forward towards more effective strategies in empowering women economically, politically and socially. The region has taken notable steps in addressing gender violence. 214

2 Latin America and the Caribbean In recent years contraceptive prevalence levels for modern methods have continued to rise in the region, reaching 59.9 per cent according to a United Nations report using data available as of 3 June 21. This is a level somewhat above the average prevalence rate for the world (55.6 per cent), for more-developed regions (59.2 per cent), or for the less-developed regions as a whole (54.9 per cent). During the past decade, the use of modern methods increased annually by more than 2 percentage points in three countries in the region, with large gains also occurring in at least 1 other countries. But at least three countries continue to experience large unmet needs for contraception of over 2 per cent. With the high risk of HIV/AIDS infection and a high teege fertility rate (estimated for 2-25 at 71 births per 1, girls aged 15-19), the countries of the region need to continue to build upon their efforts to meet adolescents needs for reproductive health information and services. Confronting sexually transmitted infections, including HIV/AIDS, remains one of the region s most daunting challenges. The Caribbean has the second highest incidence of HIV/AIDS, after sub-saharan Africa, of any subregion in the world. On the positive side, Brazil has made a breakthrough in providing drugs and services free or at an affordable cost. This initiative has been coupled with growing prevention and advocacy efforts (supported by many concerned partners, including governments and intertiol and domestic organizations). Various events in Latin America and the Caribbean have advanced earlier policy and programme initiatives. The Second Forum on HIV/AIDS/STDs, held in Cuba in April 23, built on the first such forum and on the Conference of Horizontal Technical Cooperation on HIV/AIDS/STDs, both held in Brazil in 2. These efforts involved many concerned NGOs, networks, regiol public and private institutions and intertiol agencies in the process of sharing experience, technical knowledge and best practices. Recent regiol initiatives concerning reproductive health are being undertaken with diverse support, including from foundations, the European Commission and the OPEC (Organization of Petroleum Exporting Countries) Fund. With assistance from the United Nations system, including the Bretton Woods organizations, many countries are increasingly utilizing more systematic approaches in their efforts to promote sustaible economic and social development, with a special emphasis on reducing poverty within the framework of the Millennium Development Goals. For example, UNDP s 22 Human Development Report states that 22 Latin American and Caribbean countries have produced one or more human development reports. The countries of the region have also been active in drafting Common Country Assessments (CCAs), United Nations Development Assistance Frameworks (UNDAFs), Sector-Wide Approaches (SWAps) and Poverty Reduction Strategy Papers (PRSPs) and in enhancing ownership of policies and programmes. These efforts are beginning to pay dividends to a growing number of countries in the region. Such dividends include HIPC debt reductions, grants and Intertiol Development Association loans linked to governments poverty reduction efforts. 215

3 Argenti Overview An overview with policy information was not available in time for this release. Updated material will be made available on the internet at Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman , , , Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent Materl Mortality Ratio per 1, Live Births (MMR) 85 MMR, Lower Bound 44 MMR, Upper Bound 9 Infant Mortality Rate per 1, Live Births 21.8 Under Age 5 Mortality Rate, Total 23 Under Age 5 Mortality Rate, Female 21 Under Age 5 Mortality Rate, Male 26 Life Expectancy at Birth, Combined, Years 72.9 Life Expectancy at Birth, Female, Years 76.8 Life Expectancy at Birth, Male, Years 69.7 Population 6 Years and Over, Per Cent 13.6 Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost Indicators for Population and Reproductive Health % Living on less than $1 per day % Deliveries with skilled attendant.6 % HIV/AIDS Prevalence, year olds Contraceptive Prevalence, any method, per cent 216 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

4 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 12,377 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification -.5 Upper middle income O Population Below $1/Day, Per Cent Access to Improved Water Supply, Per Cent 79 Deliveries Attended by Skilled Attendants, Per Cent 98 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female 119 Secondary School Enrolment, Gross Per Cent of School Age 91 Population, Male Secondary School Enrolment, Gross Per Cent of School Age 97 Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators ARGENTINA for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands , INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: Latin America and the Caribbean 217

5 Bahamas Overview An overview with policy information was not available in time for this release. Updated material will be made available on the internet at Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent 61.7 Materl Mortality Ratio per 1, Live Births (MMR) 1 MMR, Lower Bound 5 MMR, Upper Bound 2 Infant Mortality Rate per 1, Live Births 18.7 Under Age 5 Mortality Rate, Total 23 Under Age 5 Mortality Rate, Female Under Age 5 Mortality Rate, Male Life Expectancy at Birth, Combined, Years 69.1 Life Expectancy at Birth, Female, Years 73.5 Life Expectancy at Birth, Male, Years 64.8 Population 6 Years and Over, Per Cent 9. Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost Indicators for Population and Reproductive Health % Living on less than $1 per day % Deliveries with skilled attendant 2.8 % HIV/AIDS Prevalence, year olds Contraceptive Prevalence, any method, per cent 218 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

6 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 17,12 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification 5.3 High income: non-oecd O Population Below $1/Day, Per Cent Access to Improved Water Supply, Per Cent 96 Deliveries Attended by Skilled Attendants, Per Cent 99 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male 6 4 Primary School Enrolment, Gross % of School Age Population, Female Secondary School Enrolment, Gross Per Cent of School Age Population, Male Secondary School Enrolment, Gross Per Cent of School Age Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators BAHAMAS for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: 66.7 Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: 71. Latin America and the Caribbean 219

7 Belize Overview An overview with policy information was not available in time for this release. Updated material will be made available on the internet at Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent Materl Mortality Ratio per 1, Live Births (MMR) MMR, Lower Bound MMR, Upper Bound Infant Mortality Rate per 1, Live Births Under Age 5 Mortality Rate, Total Under Age 5 Mortality Rate, Female Under Age 5 Mortality Rate, Male Life Expectancy at Birth, Combined, Years Life Expectancy at Birth, Female, Years Life Expectancy at Birth, Male, Years Population 6 Years and Over, Per Cent Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost Indicators for Population and Reproductive Health % Living on less than $1 per day % Deliveries with skilled attendant 1.6 % HIV/AIDS Prevalence, year olds Contraceptive Prevalence, any method, per cent 22 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

8 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 5,66 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification 1.3 Lower middle income B Population Below $1/Day, Per Cent Access to Improved Water Supply, Per Cent 76 Deliveries Attended by Skilled Attendants, Per Cent 77 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female 13 Secondary School Enrolment, Gross Per Cent of School Age 72 Population, Male Secondary School Enrolment, Gross Per Cent of School Age 72 Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators BELIZE for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: 51.9 Latin America and the Caribbean 221

9 Bermuda Overview An overview with policy information was not available in time for this release. Updated material will be made available on the internet at Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent Materl Mortality Ratio per 1, Live Births (MMR) MMR, Lower Bound MMR, Upper Bound Infant Mortality Rate per 1, Live Births Under Age 5 Mortality Rate, Total Under Age 5 Mortality Rate, Female Under Age 5 Mortality Rate, Male Life Expectancy at Birth, Combined, Years Life Expectancy at Birth, Female, Years Life Expectancy at Birth, Male, Years Population 6 Years and Over, Per Cent Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost Indicators for Population and Reproductive Health % Living on less than $1 per day % Deliveries with skilled attendant % HIV/AIDS Prevalence, year olds Contraceptive Prevalence, any method, per cent 222 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

10 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification High income: non-oecd O Population Below $1/Day, Per Cent Access to Improved Water Supply, Per Cent Deliveries Attended by Skilled Attendants, Per Cent Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female Secondary School Enrolment, Gross Per Cent of School Age Population, Male Secondary School Enrolment, Gross Per Cent of School Age Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators BERMUDA for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Children Underweight Under 5, Moderate: Age-Specific Fertility Rate, Years: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Severe: Latin America and the Caribbean 223

11 Bolivia Overview While Bolivia does not have an explicit population policy, the Government s Poverty Reduction Strategy Paper, Natiol Dialogue Law, health and education reforms, Universal Materl and Child Insurance Law, and the ICPD Programme of Action all provide focal direction to ongoing programmes in the population sector. Bolivia, a multi-ethnic country, saw its total fertility rate decrease by more than 12 per cent from 1992 to 21 (from 5 to 4.4 children per woman). However, poverty has increased in absolute terms in both urban and rural areas, and the rural-urban gap has widened. With the second-highest materl mortality rate in Latin America (according to the 1994 Demographic and Health Survey), 38.5 per cent of its population under 15 years of age, and sexual and reproductive health (SRH) services that do not yet respond to the needs of adolescents, the country faces great challenges as it strives to empower women, elimite gender inequities, overcome sociocultural barriers in reproductive health services (which still do not respond to the needs of rural and indigenous populations), and build a better understanding of the relationship between poverty, social exclusion, gender, SRH and population dymics. Bolivia is expanding its safe motherhood efforts through the Universal Materl and Child Insurance Law, which provides free health services for women during their pregncies and for six months after childbirth, and for children under 5. The Government considers its under-5 and materl mortality rates as ucceptably high. The Government has created the Population Council to coordite all activities related to population and development issues. The Council is chaired by the Ministry of Sustaible Development and Planning. Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman , , , Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent 27.3 Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent 53.4 Materl Mortality Ratio per 1, Live Births (MMR) 55 MMR, Lower Bound 37 MMR, Upper Bound 74 Infant Mortality Rate per 1, Live Births 65.6 Under Age 5 Mortality Rate, Total 75 Under Age 5 Mortality Rate, Female 7 Under Age 5 Mortality Rate, Male 8 Life Expectancy at Birth, Combined, Years 61.4 Life Expectancy at Birth, Female, Years 63.2 Life Expectancy at Birth, Male, Years 59.8 Population 6 Years and Over, Per Cent 6.4 Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost Indicators for Population and Reproductive Health % Living on less than $1 per day % Deliveries with skilled attendant.1 % HIV/AIDS Prevalence, year olds Contraceptive Prevalence, any method, per cent 224 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

12 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 2,424 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification 2.4 Lower middle income B Population Below $1/Day, Per Cent 14.4 Access to Improved Water Supply, Per Cent 79 Deliveries Attended by Skilled Attendants, Per Cent 59 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female 117 Secondary School Enrolment, Gross Per Cent of School Age 81 Population, Male Secondary School Enrolment, Gross Per Cent of School Age 76 Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators BOLIVIA for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: Latin America and the Caribbean 225

13 Brazil Overview Brazil has seen significant reductions in its mortality and fertility rates, due to a rapid expansion in contraceptive use (76.7 per cent in 1996), improved access to health services and education, an advanced urban transition, and an influx of women into the labour force. The 2 census estimated population at 169 million. High levels of poverty (34.1 per cent, with 14.5 per cent in extreme poverty), social margilization, inequality, and regiol disparities, especially among the black and mixedrace population, constitute the core of Brazil s social and economic challenges. The materl mortality ratio, estimated at over 26 deaths per 1, live births, is likely much higher, due to under-reporting and variations in rates by region. The total fertility rate is 2.3 children per woman, according to the 2 census, which also found that fertility among youth (aged 15-19) had increased by 6 per cent. From 198 to the most recent estimate, over 215, cases of AIDS have been reported. Systematic advocacy and monitoring on the part of organized civil society have been effective in influencing government policy and programming related to gender, reproductive heath and population and development issues. Despite advances in the legal, normative and regulatory frameworks with regard to the rights-based approach to sexual and reproductive health, these have not been adequately applied in jurisprudence, especially at the local level. In addition, contraceptive coverage in the Unified Health System is still not universal. Brazil has ratified the Convention on the Elimition of All Forms of Discrimition against Women. In the health sector, programmes have been expanded and new initiatives launched, including Integral Assistance for Women s Health, the Natiol Plan for the Reduction of Materl Mortality, the Programme for Prevention of Cancer of the Uterus, the Family Health Programme, the intersectoral initiative to prevent adolescent pregncy, and the incorporation of a gender perspective into HIV/AIDS programmes. With respect to population and development strategies, Brazil has a large pool of available expertise and data, yet problems persist concerning the insufficient use of sociodemographic data and alyses by decision makers; the high cost of training; and the limited utilization of demographic data and methodologies for planning purposes. Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman ,2.6 88, , Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent 7.3 Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent 76.7 Materl Mortality Ratio per 1, Live Births (MMR) 26 MMR, Lower Bound 19 MMR, Upper Bound 34 Infant Mortality Rate per 1, Live Births 42.1 Under Age 5 Mortality Rate, Total 44 Under Age 5 Mortality Rate, Female 38 Under Age 5 Mortality Rate, Male 5 Life Expectancy at Birth, Combined, Years 67.2 Life Expectancy at Birth, Female, Years 71.4 Life Expectancy at Birth, Male, Years 63.5 Population 6 Years and Over, Per Cent 8.5 Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost % Living on less than $1 per day Indicators for Population and Reproductive Health 88. % Deliveries with skilled attendant.6 % HIV/AIDS Prevalence, year olds 76.7 Contraceptive Prevalence, any method, per cent 226 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

14 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 7,625 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification 4.5 Upper middle income B Population Below $1/Day, Per Cent 11.6 Access to Improved Water Supply, Per Cent 87 Deliveries Attended by Skilled Attendants, Per Cent 88 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female 17 Secondary School Enrolment, Gross Per Cent of School Age 98 Population, Male Secondary School Enrolment, Gross Per Cent of School Age 19 Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands BRAZIL , , ,126.2 INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: Latin America and the Caribbean 227

15 Chile Overview Chile has made significant economic and political progress in the last decade. Levels of poverty were cut in half, though recent surveys suggest the number of people living in extreme poverty has stabilized. In the area of sexual and reproductive rights and women s rights, advances have been slow. The performance of the country on the 22 Human Development Index (38 th in the world, in the ranks of more developed countries) is not matched on the Gender Equality Index. A vote on the ratification of the Optiol Protocol of the Convention on the Elimition of All Forms of Discrimition against Women was delayed after clerical opposition. Media campaigns to combat HIV/AIDS have faced censorship. On the positive side, the Government has appointed a Natiol Commission on AIDS to dissemite information about sexuality and health and has provided fincial resources and personnel to it. Public debate and action have led to legal tests concerning emergency contraception in a country that outlaws abortion. While the country does not have a comprehensive policy on sex education, a programme of training workshops about relationships and sexuality has gained popular support. Promotion of adolescent sexual health and rights has been initiated through peer activities, development of educatiol materials and a dedicated web site. Non-governmental organizations supportive of women s rights (including reproductive rights) have maintained a high degree of coordition and cooperation. A network of social organizations and academics has organized to develop a legal framework for sexual and reproductive rights. Civil society also worked for legislation regulating voluntary sterilization and vasectomies in establishments dependent on public support. An interministerial commission (including Health, Education and the Natiol Women s Service) works together in municipalities on projects to address responsible sexuality. The Government considers HIV/AIDS and adolescent fertility to be issues of major policy concern. Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman ,72.1 7, , Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent Materl Mortality Ratio per 1, Live Births (MMR) 33 MMR, Lower Bound 11 MMR, Upper Bound 95 Infant Mortality Rate per 1, Live Births 12.8 Under Age 5 Mortality Rate, Total 14 Under Age 5 Mortality Rate, Female 12 Under Age 5 Mortality Rate, Male 15 Life Expectancy at Birth, Combined, Years 74.9 Life Expectancy at Birth, Female, Years 78.3 Life Expectancy at Birth, Male, Years 72.3 Population 6 Years and Over, Per Cent 11.2 Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost <2. % Living on less than $1 per day Indicators for Population and Reproductive Health 1. % Deliveries with skilled attendant.2 % HIV/AIDS Prevalence, year olds Contraceptive Prevalence, any method, per cent 228 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

16 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 9,417 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification 5.4 Upper middle income C Population Below $1/Day, Per Cent <2 Access to Improved Water Supply, Per Cent 94 Deliveries Attended by Skilled Attendants, Per Cent 1 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female 19 Secondary School Enrolment, Gross Per Cent of School Age 87 Population, Male Secondary School Enrolment, Gross Per Cent of School Age 88 Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent 2 ICPD Goals MDG Indicators CHILE for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: Latin America and the Caribbean 229

17 Colombia Overview Since 1999, Colombia has experienced a rapid deterioration of its economic, social and political situation, aggravated by armed conflict, which has contributed to the most acute crisis in Colombian history. Intensification of violence and armed conflicts caused massive interl population displacement and worsened the socio-economic conditions of many groups: tiol poverty levels reached 64 per cent and unemployment, 19.2 per cent. Most affected were the urban poor, women, and young people. In 22, 23 per cent of the overall population lived in extreme poverty. poverty reached 8 per cent. Several sexual and reproductive health indicators continue to be favourable. Use of contraceptive methods continues to increase, and the use of modern methods is high. The total fertility rate is moderate, the rural-urban fertility gap has rrowed. Most childbirths occur in health institutions. Infant mortality has diminished recently, but the number of materl deaths has increased. Under President Uribe s administration, sexual and reproductive health issues have been given high priority in the development and public health agendas, building on previous gains. A Sexual and Reproductive Health Policy has been formulated that focuses on reducing materl deaths and adolescent fertility. This policy foresees implementation of an integrated rights-based approach to reproductive health and the development of norms and standards allowing access to services for those not covered by the health system. The policy also calls for social mobilization to promote rights and prevent risks associated with sexual and reproductive health for adolescents. The earlier model for addressing sexual violence will be expanded tionwide and will be broadened to include other gender violence, including domestic violence. Attention will be given to the displaced population, which experiences the worst sexual and reproductive health outcomes, according to PROFAMILIA (the largest NGO in the population field). The Government s commitment is also expressed in its voluntary budgetary contributions. The Ministry of Environment, environmental groups and academic centres will continue to integrate population variables into environmental policies and land magement efforts. In partnership with a private research centre, population factors are being considered in poverty surveys for the alysis of the current social, political, and economic crisis. Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent 64. Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent 76.9 Materl Mortality Ratio per 1, Live Births (MMR) 12 MMR, Lower Bound 4 MMR, Upper Bound 32 Infant Mortality Rate per 1, Live Births 3. Under Age 5 Mortality Rate, Total 33 Under Age 5 Mortality Rate, Female 3 Under Age 5 Mortality Rate, Male 35 Life Expectancy at Birth, Combined, Years 7.4 Life Expectancy at Birth, Female, Years 74.3 Life Expectancy at Birth, Male, Years 67.3 Population 6 Years and Over, Per Cent 7.5 Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost % Living on less than $1 per day Indicators for Population and Reproductive Health 86. % Deliveries with skilled attendant.5 % HIV/AIDS Prevalence, year olds , , , Contraceptive Prevalence, any method, per cent 23 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23

18 Indicators SOCIO-ECONOMIC & HEALTH Gross Domestic Product Per Capita, Purchasing Power Parity, 6,248 Intertiol Dollars Gross Domestic Product Growth Rate, Annual Per Cent Income Group per World Bank Classification UNFPA Country Priority Classification 2.8 Lower middle income C Population Below $1/Day, Per Cent 19.7 Access to Improved Water Supply, Per Cent 91 Deliveries Attended by Skilled Attendants, Per Cent 86 Family Planning Programme Effort Index, 1999 (Total Mean Score) Illiteracy Rate, Per Cent of Population Age 15 and Over, Male Illiteracy Rate, Per Cent of Population Age 15 and Over, Female Primary School Enrolment, Gross % of School Age Population, Male Primary School Enrolment, Gross % of School Age Population, Female 113 Secondary School Enrolment, Gross Per Cent of School Age 67 Population, Male Secondary School Enrolment, Gross Per Cent of School Age 75 Population, Female Children Underweight Under 5, Male, Per Cent Children Underweight Under 5, Female, Per Cent Stunted Children Under 5, Moderate, Per Cent Stunted Children Under 5, Severe, Per Cent Wasted Children Under 5, Moderate, Per Cent Wasted Children Under 5, Severe, Per Cent ICPD Goals MDG Indicators COLOMBIA for updates, please visit our web site: ADOLESCENT REPRODUCTIVE HEALTH Proportion of Population Age-Specific Fertility Rate per 1 Women, 15-2 Mean Age at Marriage, Male Mean Age at Marriage, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Female HIV/AIDS Prevalence, 15-24, Upper Bound, Female HIV/AIDS Prevalence, 15-24, Lower Bound, Male HIV/AIDS Prevalence, 15-24, Upper Bound, Male GENDER EQUALITY Labour Force Participation Rate, 15-64, Total Labour Force Participation Rate, 15-64, Male Labour Force Participation Rate, 15-64, Female Women in Magerial or Technical Positions, Thousands Seats in Parliament Held by Women, Per Cent REPRODUCTIVE HEALTH COMMODITY SECURITY Age 2-215, Thousands Age 2-215, Per Cent Unmet Need for Family Planning, Spacing, Per Cent Unmet Need for Family Planning, Limiting, Per Cent Unmet Need for Family Planning, Total, Per Cent Unmet Need for Family Planning, Thousands , INTERNAL DISPARITIES Total Fertility Rate per Woman 15-49: Infant Mortality Rate per 1, Live Births: Age-Specific Fertility Rate, Years: Adolescent Women Begun Childbearing: Deliveries Attended by Skilled Attendants: Modern Contraceptive Prevalence Rate for Women 15-49: Children Underweight Under 5, Moderate: Children Underweight Under 5, Severe: Latin America and the Caribbean 231

19 Costa Rica Overview When compared with other Central American countries, Costa Rica is characterized by higher levels of social investment, lower percentages living in poverty and a stable democracy. The Government regards average life expectancy and levels of under-5 and materl mortality as acceptable. The annual population growth rate of around 2. per cent (in recent estimates) reflects low mortality, decreasing fertility and increased in-migration. The tion faces a number of challenges, however, including the ageing of its population. In 2, 8 per cent of the population was over 6; this percentage is projected to rise to 23.3 per cent by 25. Addressing this issue, the country approved the Comprehensive Law for the Elderly in 1999 and launched an Action Plan for The Responsible Paternity Law (April 21) recognizes the right of every child to know his or her biological father, and obliges the father to support the child fincially. Another positive development is the growing interest regarding the role of men toward sexual responsibility, family planning and infectious disease. In June 21 the Natiol Council for Education endorsed the Policy for Sexual Education, mandating the integration of sexuality education into the curricula of all levels of the formal education system, though its implementation has met some challenges. In response to a 21 UN inquiry, the Government indicated that it viewed the adolescent fertility level and HIV/AIDS as critical areas of concern. The Natiol Adolescent Health Programme, which is integrated into the tiol Social Security system, seeks to provide both curative and preventive services, and to promote the participation of adolescents in the elaboration of information, education and communication materials and strategies. In April 22, a Law for the Development of Youth was approved. The law created a tiol council charged with formulating policies for the large age group. Regarding HIV/AIDS, the Natiol Board for HIV/AIDS, the Joint United Nations Programme on HIV/AIDS, and non-governmental organizations have begun to coordite their activities. A strategic issue yet to be faced is the integration of sexual and reproductive health concepts and principles within the context of the ongoing health sector reform. Statistics POPULATION Population in Thousands, 21, Total, Male Population in Thousands, 21, Total, Female Population Growth Rate, Per Cent Crude Birth Rate per 1, Population Crude Death Rate per 1, Population Population, Per Cent Sex Ratio at Birth, Male Births per Female Birth Women 15-49, Thousands Women 15-49, Per Cent Total Fertility Rate per Woman , , , Contraceptive Prevalence Rate for Women 15-49, Modern Method, Per Cent 64.6 Contraceptive Prevalence Rate for Women 15-49, Any Method, Per Cent 75. Materl Mortality Ratio per 1, Live Births (MMR) 35 MMR, Lower Bound 29 MMR, Upper Bound 6 Infant Mortality Rate per 1, Live Births 12.1 Under Age 5 Mortality Rate, Total 13 Under Age 5 Mortality Rate, Female 11 Under Age 5 Mortality Rate, Male 15 Life Expectancy at Birth, Combined, Years 76. Life Expectancy at Birth, Female, Years 78.9 Life Expectancy at Birth, Male, Years 74.3 Population 6 Years and Over, Per Cent 8.1 Estimated Annual Resource Requirements for Population Programmes Years (in millions $US) Date Cost % Living on less than $1 per day Indicators for Population and Reproductive Health 98. % Deliveries with skilled attendant.4 % HIV/AIDS Prevalence, year olds 75. Contraceptive Prevalence, any method, per cent 232 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 23