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20391                                            FOR OFFICIAL USE ONLY

                             BY FAX

                          June 1, 1994

To:       Ellen Marshall, State  663-3068  663-3094
          Nils Daulaire, AID     647-8415  647-8595
          Sarah Kovner, HHS      690-6347  690-7098
          David Ogden, Treasury  622-0764  622-1228
          Bob Ward, EPA          260-2785  260-3828

FROM: Jane Bradley, OEP/NSC

SUBJECT: Revisions to Draft PDD on Global Population Issues

Thanks again for your help today in reviewing and recasting 
revisions to the draft Presidential Decision Directive on 
population.  Attached is the revised version resulting from our 
meeting.  Please let me know by c.o.b. Friday if your agency has 
any problems with the revisions.  If I don't hear from you, I'll 
assume clearance.





SUBJECT:    Policy on Global Population Issues

Rapid global population growth is an urgent and substantial 
threat to international stability and sustainable development. 
This Presidential Decision Directive articulates objectives for, 
and guides the implementation of, United States policy on global 
population growth.  The policy demonstrates our recognition of 
the linkages between population growth and long-term security, 
between population growth {-in developing countries-} and high 
rates of consumption {-in developed countries-} as they impact on 
the environment, and between US leadership in addressing the 
population issue and the global effort to promote sustainable 
development.  In addition, the policy is deeply-rooted in such 
fundamental national values as human rights, gender equality, and 
the rights of individuals and couples to determine the number and 
spacing of their children.

The United Nations estimates that the world's population in 2050 
is likely to be between 7.8 and 12.5 billion people, compared 
with today's 5.5 billion, with ninety percent of this growth 
occurring in developing nations.  High rates of growth in these 
nations are expected to exacerbate existing dilemmas of 
unemployment, stagnant economic development, depressed wages, 
declining per capita availability of cropland, food scarcity, 
rapid urbanization, depleted natural resource base and 
environmental degradation.  The UN Food and Agriculture 
Organization estimates that by the year 2000, 31 low-income 
countries will be unable to feed their projected populations 
using their own land, and many will find it difficult to purchase 
food to meet shortfalls.{-,  resulting-}  This may result in: 
disruptive migration flows {-within and-} between {-developing 
countries, as well as significantly increased pressure to 
immigrate to the US and other developed countries-}; an 
increasing burden on the local ecosystems and the global 
environment; and threats to local and regional political 

The goal of US policy on global population growth is to marshall 
an immediate, concerted and comprehensive international response 
to population growth trends, based on three mutually reinforcing 
objectives:  {-promoting-} respecting the rights and capabilities 
of individuals and couples to freely and responsibly determine 
the number and spacing of their children; improving individual 
reproductive health, with special attention to the reproductive 
health needs of women and adolescents, and the general health 
needs of infants and children; and reducing the rate of 
population growth as rapidly as possible to levels consistent 
with sustainable development.

The strategy for achieving this goal includes the following 
areas:  fostering an international consensus for action; 
promoting targeted assistance to developing countries through 
both bilateral and multilateral channels; and demonstrating 
leadership by example in the United States.  In each strategic 
area, US policy shall comprehensively target the determinants of 
fertility by addressing the unmet demand and need for family 
planning and reproductive health services, the desire for large 
families, and the impacts of current population growth momentum. 
Female education, gender equality -- legal, economic and 
political -- and efforts to reduce maternal and infant 
mortality can have a significant impact on population trends and 
sustainable development.  Particular attention shall be paid to 
promoting the rights and roles {-and responsibilities-} of women.

The Department of State shall continue to coordinate overall 
interagency policy development and information clearinghouse 
functions for global population issues.  In order to promote the 
Administration's policy on global population growth, the 
Department of State, in coordination with other appropriate 
agencies, shall develop and make available a public statement 
which articulates the policy set forth in this PDD and expresses 
the positive linkages to other Administration policies relating 
to global population issues.


A collective will toward action is fundamental to addressing 
global population growth.  Therefore, at the International 
Conference on Population and Development (ICPD) scheduled for 
September 1994 in Cairo (and at the forthcoming World Summit for 
Social Development, the International Conference on Women, and in 
other relevant international fora) the US shall seek a consensus 
that provides a strong foundation for future international 
cooperation on population, consistent with US policy. 
Specifically, while avoiding quantitative near-term fertility 
reduction targets, the US shall seek an international consensus 
on long-term programmatic approaches to {-goals for-} reducing 
population growth on both global and regional bases.  The US 
shall also seek to reinforce {-strengthen-} the recommendations of 
previous conferences {-in areas such as reproductive rights, 
including the obligations of governments to enable people to 
exercise these rights.-} to ensure that individuals and couples 
have the right to freely and responsibly decide the number and 
spacing of their children, and that governments respect this 
right.  In addition, the US shall ensure that policy statements 
on global population growth reference mutually strengthening 
commitments on closely related issues, such as reproductive 
health, child survival, environmental protection, development 
cooperation, women's rights and migration.  In preparation for 
the ICPD, the Department of State, in consultation with other 
appropriate agencies, shall develop for interagency review by 
[ONE MONTH AFTER SIGNATURE] a work program to finalize a strategy 
for achieving US objectives for the conference.  The work program 
shall ensure that adequate time is allocated for consultation and 
cooperation with non-governmental organizations and other 
governments in finalizing the strategy.  In addition, the 
strategy for achieving US objectives should include a role for 
non-governmental organizations at the Conference.


The US currently provides assistance through both bilateral and 
multilateral channels aimed at mitigating population growth in 
developing countries.  The level of US budgetary commitment to 
overseas family planning programs should continue to reflect 
their high priority within the overall development assistance 
effort.  Therefore, their importance in the functional 
development assistance budget shall be maintained.

The US will continue its leadership role in supporting population 
assistance programs, implemented primarily through the Agency for 
International Development.  Consistent with the overall 
restructuring of US foreign assistance, the determination of 
which recipient countries should have priority for future 
bilateral assistance in the area of population shall be based on 
the following criteria:  a) global impact, as reflected in such 
indicators as overall contribution to population increases, 
levels of unmet need for contraception, lack of access to 
reproductive health services, maternal and child mortality, and 
population-related degradation of the global environment; and b) 
local and regional impacts, where population growth and 
reproductive conditions are key impediments to sustainable 
development.  However, the US shall avoid attaching population 
conditions to efforts in other areas.  Because population 
assistance should also be viewed as humanitarian, the US shall to 
the greatest possible extent avoid denying population assistance 
to countries due to concerns in other areas and shall seek to 
amend existing laws requiring such denial.

The emphasis for US bilateral assistance programs shall be based 
on a comprehensive approach to reproductive health that:  a) 
incorporates multiple models of service delivery aimed at both 
men and women (including adolescents and young adults); b) links 
contraceptive information and services closely with other 
reproductive and primary health care intervention as appropriate; 
and c) addresses a broad range of reproductive health objectives 
(including screening and prevention of sexually transmitted 
diseases and reproductive tract infections).  US assistance 
programs shall strengthen their current emphasis on quality of 
care and informed choice, while increasing the role of women in 
all phases of program design and implementation.  In addition, 
attention shall also be paid to the need for additional 
investments in primary health care, HIV/AIDS prevention and 
services, maternal and child health, the role of women in 
development and female education.

Appropriate utilization of multilateral channels for population 
assistance is also of critical importance to a concerted 
international response to global population growth.  As a result, 
the Administration shall endeavor to ensure that adequate 
resources are directed to such multilateral programs as the 
United Nations Population Fund, the World Health Organization 
Human Reproductive Research Program, as well as appropriate 
private voluntary and non-governmental organizations.  In 
addition, the Department of State, the Agency for International 
Development and the Department of Treasury, in cooperation with 
other relevant agencies, shall undertake a review of the profile 
of assistance by other bilateral donors and multilateral 
organizations in population and human resource sectors in order 
to develop a strategy for coordinating these modes of assistance, 
avoiding duplication, and increasing participation.


Efforts toward international leadership by the US on goals 
addressing health, security and sustainable development concerns 
resulting from population growth must be supported by a 
commitment to strive for these goals ourselves.  The Domestic 
Policy Council and the Department of Health and Human Services, 
in consultation with other appropriate agencies, shall develop a 
statement describing US policies and programs that address the 
broad range of population issues.

At the same time, the US and other developed countries must 
maintain an awareness of the{-ir disproportionate-} impact{-s-} on 
the global environment of their consumption and production 
patterns. {-through consumption patterns that are at several times 
the level of developing countries.-}  To effectively achieve the 
goal of marshalling an international response to population 
growth trends, the US must also demonstrate leadership by example 
in addressing the implications of these {-consumption-} patterns, 
with an aim toward reducing their negative global environmental 
impacts.  {-of consumption of goods and services in the United 
States.-}  _The Environmental Protection Agency, in coordination 
with the Departments of Energy, {-and-} Transportation, 
Treasury, and other appropriate agencies, shall develop a 
statement articulating US strategies for reducing such negative 

Finally, the State Department, {-and-} Agency for International 
Development, {-and-} the Department of Health and Human Services 
{+and EPA-}, in consultation with other appropriate agencies, 
shall review and report on the potential for the US to 
demonstrate leadership with new initiatives in the following 
areas:  research and development of new methods of fertility 
regulation, particularly those methods that are especially 
designed to respond to unmet needs in developing countries, to 
give women greater control and also to protect against sexually 
transmitted diseases; reproductive health information and 
services for adolescents; access to safe abortion and related 
services and counselling; coordination of services and prevention 
of HIV/AIDS and other sexually transmitted diseases with family 
planning and other reproductive health programs; reproductive 
health needs of the Former Soviet Union and Central and Eastern 
Europe; and policy and _program-relevant research_, especially 
_on population/environment interrelationships_, migration and 
urbanization, the population/food situation, and 
interrelationships among population growth, development, and 
sexual and reproductive behavior.  A report on the potential for 
new initiatives in the above areas should be presented to the 
National Security Council by {-July 1, 1994-} [ONE MONTH AFTER 
SIGNATURE], in order to maximize their utility for {-the ICPD 
process-} implementing the ICPD action program.


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