Caribbean Forum on Population, Migration and Development Georgetown, Guyana, 9-10 July 2013

1. Caribbean Forum on Population, Migration and DevelopmentGeorgetown, Guyana, 9-10 July2013 Implementation of the Cairo Programme of Action in the Caribbean: Evaluating Progress and Renewing Commitment

2. Introduction • Part I

3. ICPD Beyond 2014 • The Cairo Programme of Action (1994) was originally envisaged as a 20 year programme of action • However, in 2010 the United Nations General Assembly decided to extend the Cairo Programme “beyond 2014” • Much has been achieved, but significant gaps remain in the implementation of the programme • The goals and objectives of the Programme remain highly relevant to the Caribbean

4. About this Presentation Part 1: Introduction Part II: Population, Sustained Economic Growth, Poverty and Inequality Part III: International Migration and Development: Challenges and Opportunities Part IV: Population Ageing and the Rights of Older Persons Part V: The Rights of Persons with Disabilities Part VI: Gender Equality, Equity and Empowerment of Women and Girls Part VII: Sexual and Reproductive Rights and Health Part VIII: Achieving Universal Access in HIV Prevention, Treatment, Care and Support Part IX: Conclusions and Recommendations for the Further Implementation of the ICPD programme of Action Beyond 2014

5. Part II Population, Sustained Economic Growth, Poverty and Inequality

6. Recent Trends in Growth, Poverty and Inequality • Relatively strong growth for much of the 1990s and 2000s until 2008. • The Caribbean has been hit hard by the global economic crisis • Continuing high levels of inequality • Extreme poverty largely eliminated except from Belize, Suriname, and Guyana. • Poverty , measured against national poverty lines (a more relative concept of poverty), persists

7. Determinants of Poverty and Inequality • Unemployment and underemployment • Low skill, low productively, low pay work • Extensive informal sector in some countries • Weak social protection systems • Single parent households • Adolescent pregnancy • Urban Rural differentials • Chronic-non communicable diseases

8. Poverty Alleviation Strategies in the Caribbean • Economic restructuring, diversification, raising productivity • Promotion of Small and Medium Enterprises (SMEs) • Micro-credit schemes (e.g. The Micro Enterprise Loan Facility, Trinidad and Tobago) • Extension of social protection systems (e.g. Non-contributory pensions, free health care or medication) • Conditional cash transfer programmes (e.g. PATH, Jamaica; BOOST, Belize)

9. The Way Forward • Social, labour market and economic policy should target reductions in inequality. • Productivity and competitiveness must be upgraded to reignite growth particularly in labour intensive, job creating sectors • Strengthen investment in human capital • Introduction of a social protection floor with gradual improvements to the level of coverage. • Invest in children and adolescents to break intergenerational transmission of poverty • Labour market information systems should be strengthened to facilitate the skills match required by employers

10. Part II • International Migration and Development: Challenges and Opportunities

11. Trends in Migration • Emigration from the Caribbean is long established • By 2010 there were 6.7 million people born in the Caribbean living outside the region (compared to a domestic population of 43 million). • Predominantly in the United States, and to a lesser extent Europe and Canada. • The global economic global crisis reduced migration flows to some extent • But demand for skilled labour in developed economies is likely to remain a strong pull factor • Intra-Caribbean migrants (0.75 million in 2010) mainly migrate from lower income to higher income countries

12. International Migration: Barrier or facilitator to Development? • Loss of skilled workers and costs associated with their training, a situation that is particularly acute in the health and education sectors. • Breakdown/disintegration within family – particularly impact on children left behind by migrant parents • Migration also brings benefits: • to the migrant themselves through the acquisition of skills or better employment • remittances • the contribution of the diaspora including investment; development of businesses; the transfer of knowledge and skills ; and the development of beneficial networks

13. International Migration: Barrier or facilitator to Development? • Return migration – between 2 and 10 per cent of most Caribbean countries are return migrants • Regional integration and economic development under CSME, as yet not fully realised. • Access to health, education and related services especially for dependants is unevenly addressed under CSME • Lack of implementation of the CSME migration policy

14. Policies to Leverage Migration for Development • Engage the diaspora in national development • Meet skills shortages through managed immigration • Renewal of efforts to liberalise the movement of people within the CARICOM Single Market and Economy CSME • Facilitate flows of remittances through the development of relevant financial services • Build capacity to manage borders in order to reduce undocumented migration including trafficking in persons, and ensure that the human rights of migrants are protected

15. Part IV Population Ageing and the Rights of Older Persons

16. The Caribbean Population by age group(Millions of persons)

17. Economic Security of Older Persons • Only those in formal sector employment receive earnings related pensions • Some countries provide non-contributory pensions although in most cases they are very low • Many older persons do not receive a pension • Some older persons working beyond retirement age although often in informal employment • Ability to work, however, limited because of age, health or disability

18. Healthcare and Non-Communicable Diseases • Provision of high quality health care for the ageing population will be a challenge • Changes in morbidity profile of the population: epidemiological transition will lead to more chronic and degenerative ailments • NCDs already a major problem for the sub-region • Risk factors linked to unhealthy lifestyles • Access to services, treatment and drugs • Greater demands by the elderly – limited provision of free care • Costs are both human and financial - will require increased government expenditure

19. Living arrangements, Care Services, and Long Stay Institutions • Creation of an enabling environment for independent living and self reliance – key ICPD objective for older persons • Support for independent living – programmes e.g. home help; home nursing and day care have been promoted • Despite the choice towards independence – many live with other family members • Often this leads to mutual resentment and abuse • Elder abuse a major concern • Long stay institutions are increasingly used as an option for the aged – these need to be regulated and monitored

20. Social Participation of Older Persons, Equality, and Protection against Discrimination • Loneliness and isolation a major problem for older persons – men more likely to report loneliness • Financial situation, health and geographic location - limits social participation • Formation of Associations to enhance the quality of life and represent the interests of older persons • Promotion of positive image of older persons through organisation of activities focussing on older persons • To enhance quality of life – focus and commitment should be include necessary social and financial support systems • The rights of older persons needs to be enshrined in legislation – to protect against discrimination and ill-treatment at all levels

21. Part V The Rights of Persons with Disabilities

22. Legislation relating to disabilities • Eight Caribbean countries have now ratified the Convention on the Rights of Persons with Disabilities (CRPD) and four have signed the Optional Protocol which establishes monitoring procedures. • Guyana passed the Persons with Disabilities Act in 2010, although more generally there is a lack of comprehensive anti-discrimination legislation protecting the rights of persons with disabilities

23. Progress made to include people with disabilities in the region • Attempts made to make the education system more accessible and inclusive to children with disabilities through teaching Braille and sign language in some countries (Barbados and Dominica among others). In Trinidad and Tobago and Jamaica support assistants enable children with disabilities to attend mainstream schools. • Provision of vocational training and sheltered employment to persons with disabilities. The Government of Jamaica is targeting 5 per cent of jobs to be filled by persons with disabilities • Progress in infrastructure and building codes which facilitates equal participation in social, economic and cultural life by persons with disabilities • Governments in collaboration with NGOs have been working to improve habitation and rehabilitation services through provision of prostheses, assistive devices, and training. • Provision of sexual and reproductive health information and services

24. The Way Forward • All governments should ratify and implement the International Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol • Governments should seek to increase participation by persons with disabilities within mainstream education. • Workplaces should be forced to make reasonable adjustments to enable them to hire more persons with disabilities. Provision of more employment opportunities to persons with disabilities through sheltered or supported employment if necessary. • All new buildings and public spaces to be accessible to persons with disabilities • Persons with disabilities should have access to sexual and reproductive health and family planning services

25. Part VI Gender Equality, Equity and Empowerment of Women and Girls

26. Progress made in the region Legislation and Policies that promote gender equality • Ratification and accession of CEDAW; the Belém do Pará Convention; the ICPD Programme of Action and the Beijing Platform of Action • Development and implementation of National Gender Polices Participation in the labour market • An expansion of opportunities for women in the labour market with increases in the female labour force participation rate in most Caribbean countries • Implementation of policies aimed at encouraging women’s participation in the formal economy

27. Progress made in the region Women’s Representation in Political Processes and Public Life • Four Female Prime Ministers over the last 15 years • Increase in education, training and support to women who are interested in politics and decision-making Gender Based Violence • Countries have developed and implemented action plans to prevent gender based violence • Policies and legal frameworks implemented to protect victims of domestic violence • Improved coordination between different agencies • Training for front-line intervention workers that deal with cases of domestic abuse.

28. Best Practices aimed at promoting gender equality in the region • The Caribbean Institute for Women in Leadership (CIWIL) • In Belize, the Women in Politics (WIProject) that provided training to women who wanted to enter local or national politics (or who were already active in politics). • Implementation of a domestic violence protocol in Belize in partnership with ECLAC • A domestic and sexual violence prevention protocol developed with the support from UNFPA and UN Women in Suriname. • In Belize with the assistance of UNICEF, the National Women’s Commission established the Belize Gender Info database which serves as a primary monitoring tool that tracks the progress on the implementation of the national gender policy.

29. Challenges • Women still concentrated in the informal sectors or in certain sectors of employment (for example tourism or the public sector). Women’s work in the home and as carers makes a substantial but largely unrecognised contribution to national economies • Most Caribbean countries continue to fall short of the threshold of 30 % considered necessary by the Inter-Parliamentary Union for female parliamentarians to have an impact on decision-making. • The Caribbean still has one of the highest rates of sexual violence in the world (UNODC and WB; 2007) • Data gaps as Caribbean statistical offices are characterised with very limited resources, limited specialist skills (for example experts in statistics, demography and geographic information systems), and high turnover of staff.

30. Way Forward • In order to continue progress towards the goal of equal access for women to the labour market and social security, policies should focus on three broad areas: equalities legislation and mechanisms for enforcement of legislation; job creation and stimulation of employment for women especially in rural areas; and policies to help women combine work with caring responsibilities. • Government and employers should also support women and men in sharing responsibilities and combining work and family life. • Use quotas to increase female participation in national politics. • Better coordination amongst the various providers of services in order to reach victims of gender based violence • Improve the response from the key institutions such as the police, health, social services and the legal system • Need for institutional strengthening and capacity development of National Women’s/Gender Bureaux.

31. Part VII Sexual and Reproductive Rights and Health

32. Progress of SRH made in the region Legislation and Policies • Belize, Suriname, Trinidad & Tobago, St. Lucia and Grenada have developed their Sexual and Reproductive Health National Policy • Increase in women’s access to sexual and reproductive health services including information, counselling, educational and awareness programmes Adolescent sexual and reproductive health • A decrease in adolescent fertility • Development of youth friendly spaces for the delivery of services and youth-friendly information

33. Progress of SRH made in the region Health and Family Life Education (HLFE) Programmes • HFLE programmes are being implemented in out-of-school settings in some countries Inclusion of men in SRH services • Other countries are taking men's SRH clinics to work places (Saint Lucia, Saint Vincent and the Grenadines, Guyana), emphasizing detection and treatment for prostate cancer (Cuba, Jamaica) and training of people who work with men, for example prison offices (Dominica) Improving maternal health • Maternal mortality is being reduced

34. Best Practices • Jamaica has recently developed a Policy for the Reintegration of Adolescent mothers into the formal education system. • A Caribbean Regional Curriculum Framework for Health and Family Life Education to be used and adapted by member states and implemented in schools across the region (UNICEF, CARICOM and EDC, 2008).

35. Challenges • Women’s access to sexual and reproductive health services in rural areas, women living in poverty, and adolescents is an ongoing challenge • While it is policy to supply contraceptives through clinics, it is common that supplies are exhausted. Individuals (mostly women) then have to seek it at higher cost elsewhere • In the area of adolescent sexual and reproductive health, there are inconsistencies between law and policy regarding access to contraceptives. • Even though adolescent fertility has fallen, it is still too high

36. Way Forward • Political leaders are encouraged to play a highly visible role in the promotion and legitimisation of family planning services and to expand and upgrade training. • The supply of contraceptives through the primary health care system needs to be more reliable • Protocols for safe abortions or treating unsafe abortions are needed in the Caribbean. • More SRH programmes should be designed to serve the needs of adolescents, and particular attention paid to those who are victims of sexual violence

37. Part VIII Achieving Universal Access to HIV Prevention, Treatment, Care and Support

38. Caribbean: New Infections per year

39. Caribbean: AIDS-Related deaths

40. National Responses Programme responses • National responses focus on prevention, treatment and care • Much attention given to PMTCT programmes and on voluntary testing and counselling • Behaviour change communication interventions have also been developed Policies and Plans • All countries have national HIV Strategic plans and a few (Barbados & Guyana) have national HIV & AIDS policies • A number of plans have incorporated a gender component • Many countries have national workplace policies and/or developing policies

41. Most at risk groups • Men who have sex with men (MSM) • Female partners of MSM • Commercial sex workers • Clients of commercial sex workers

42. Challenges Access to Funding and ARV Medication • Funding is a major challenge because many Caribbean countries are not eligible for funding Stigma • Infringement of fundamental human rights - stigma and discrimination – discriminatory laws • Behaviour change remains an intractable problem

43. The Way Forward • HIV programmes need to become more efficient and should be integrated with sexual and reproductive health services • Target interventions to address local infection patterns among most at risk groups • AIDS related deaths should be eliminated through the universal provision of treatment and care • Ending stigma and discrimination for persons living with HIV • Continue to improve the quality of information available about HIV and AIDS

44. Part IX Conclusions

45. Conclusions • The Cairo Programme set out an ambitious set of goals and objectives aimed, ultimately, at “meeting the needs and improving the quality for life of present and future generations” • This review has shown that population concerns, and the ICPD Programme, remain of critical importance to the future sustainable development of the Caribbean. • Therefore completion of the Cairo Programme should form a central part of the post 2015 development agenda.