It’s time to revisit the Cairo Consensus

Just over a quarter century ago, the so-called ‘Cairo Consensus’ was forged, fundamentally improving how governments worldwide, international organisations, and the NGO community approached women’s reproductive health and reproductive rights on the world stage. Yet, the deafening silence this consensus offered on issues of runaway population growth has had massive repercussions on the world we live in today, with the ever-increasing human footprint fuelling climate change and ecological destruction on a scale that was entirely predicted. Given what we know now about how empowering, just and ethical strategies focused on women and girls can effectively bend the global population curve, it is time that we revisit the Cairo Consensus.


Putting the Cairo Consensus in context
In the Fall of 1994, in Cairo, the United Nations' International Conference on Population and Development convened voices from around the world to reformulate the UN's thinking around issues of population and development. At this formative event, much progress was made in how the world grappled with these issues, particularly related to women's reproductive health and reproductive POPULATION AND SUSTAINABILITY VOL 5, NO 2, 2021 rights. The so-called 'Cairo Consensus' was forged, placing women's health, empowerment, and rights at the center of discussions around population and development. This was a huge step forward in our global thinking about the centrality of women and girls to the fate of our global community, and to the notion that women's rights are human rights.
One important issue was lost in the shuffle -runaway population growth. From 1994 forward, there was a formalization of the American diplomatic silence on issues of runaway population growth that had begun under President Reagan, permeating deep into the United Nations community. This was an enormous change in direction. This topic of runaway population growth had been a mainstay of UN World Population Conferences in 1954(Rome), 1965(Belgrade), 1974(Bucharest), 1984, and even as far back as 1927 (Geneva) under the League of Nations. The global community had watched with grave concern as the world population more than doubled between 1900 and the 1965 conference (from 1.6 billion to more than 3.3B), with another doubling projected by the end of the 20th century. Serious attention had been paid to the issue by world leaders, resulting in a 1967 statement by world leaders signed by 30 heads of state including US President Lyndon Johnson that cast a spotlight on runaway population growth, and the criticality of international family planning to human rights, global development, and international security (Dunlop, 2000).
So, what happened between 1967 and 1994 -other than the addition of more than 2 billion more people to our planet in this very short period of time? How did the intense focus on runaway population growth lead to utter silence on the issue in the world of international affairs? Some participants in the Cairo process attribute it to an oversight, with experts in reproductive health playing more prominently in the process and simply overlooking the historical focus on population growth as they worked hard to bring focus to their important issues. Others attribute it to an effort to turn the page on a dark chapter of history that had brought racist, eugenicist, nativist, and paternalistic impulses to the population discussion. Still others attribute it to an active lobbying effort by the Vatican to shape the population discussions they had opposed for decades. No doubt a swirl of dynamics led the Cairo Conference to institutionalize what became known as the Cairo Consensus. In turn, this consensus shaped strategies within the UN's various institutions, by national governments, by major foundations and NGOs over the following decades -leaving the issue of runaway population growth unaddressed as it spiralled out of control at a critical moment in human history, and the history of our planet (Sinding, 2016).

Shedding the dark past of population debates
The historical turn embodied in the Cairo Consensus was in no small part an attempt to shed the dark past of population debates that had shaped international development for decades. One does not have to look hard to find plenty of unsavoury undertones and overtones in the population debates of the 20th century. To this day, one can still find those whose animating concerns around population dynamics are racist, eugenicist, nativist, and paternalistic.
The history of this dark past is, of course, complicated, fraught with misinterpretation and wilful misrepresentation, and grounded in some inescapable truths. It is useful to examine two historical moments that collided to produce such a complex set of controversies that they are frequently re-adjudicated to this day.
As far back as 1912, Margaret Sanger, who popularised the term "birth control," advocated contraception as a means of avoiding "back alley abortions" (Cox, 2005). Seeing the connection between contraception and working-class women's empowerment, Sanger came to believe that a transformation toward women's equality would only be possible if they were liberated from the risk of unwanted pregnancy. Her initiative on this issue, of course, was in the midst of the suffrage movement and early American feminism. Additionally, early on during her time in England, Sanger came to share the concerns of English Neo-Malthusians around overpopulation. Sanger's insights and advocacy forever transformed the future for women and families around the world. Moreover, she will always be labeled a firebrand for being early and outspoken in her own unique mix of feminism, antireligion, sexual frankness, and social activism on issues of race, class, and fertility.
Still, her public association with eugenicist organizations forever tainted her legacy, and equipped opponents of family planning with an effective rhetorical weapon with which they could attack the entire enterprise -to this day. Sanger's relationship with the eugenics movement was complex -part strategy and part ideology. Yet, many historians now believe that Sanger opposed eugenics along POPULATION AND SUSTAINABILITY VOL 5, NO 2, 2021 racial lines, and opposed eugenicists' notions that poverty, criminal behaviour and other social problems were hereditary. Indeed, she saw intentional family planning as a tool that empowered the downtrodden, rather than a tool for weeding out 'bad genes' (Chesler, 2011;Latson, 2016).
It was Francis Galton, Charles Darwin's half-cousin, who in 1883 captured the minds of elites in America, England, Germany and beyond with his twisted reading of Gregor Mendel's pea plant breeding experiments and Darwin's survival of the fittest. Galton provided a scientific veneer to the notion that many social ills were caused by the genetic proliferation of the wrong sort of people. Galton postulated that this problem could be addressed with the introduction of eugenics -a term he coined in 1883. It is no surprise that he also introduced the phrase "nature versus nurture." In America, the Carnegies, Rockefellers and Harrimans became acolytes of this worldview, and funded the practice and teaching of eugenics. Theodore Roosevelt, Alexander Graham Bell, John D. Rockefeller, Jr. and many other prominent citizens were outspoken supporters. Scientific American published articles in support of the concept. The American Museum of Natural History hosted conferences on the subject. The Cold Spring Harbor Laboratory had a Eugenics Record Office, which was an epicenter of research in the field, and home to Harry Laughlin, perhaps the most influential eugenics advocate in America. Eugenics became taught in schools, celebrated in exhibits at the World's Fair, preached in pulpits, advocated by respected scientists at Stanford, Yale, Harvard, and Princeton, and implemented in state and Federal policy. Thirtytwo states passed eugenic-sterilization laws during the twentieth century. The Immigration Act of 1924 excluded eugenically undesirable races from entry to the United States. And Supreme Court Justice Oliver Wendell Holmes wrote in the seminal case Buck v Bell "It is better for the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind" (quoted in DenHoed, 2016).
Race theory and race science, based on faked and untested data, served eugenicists' racist goals. Mixed with a pre-existing Neo-Malthusian strain of thought, this led to a dark interpretation of who was responsible for perceived overpopulation, and how it should be dealt with.
This moment in Western thought informed decades of gruesome theory and action, culminating in Nazi Germany's abominable atrocities, but by no means solely restricted to the Third Reich. Credible and exhaustively cited historical analysis has even rooted Nazi eugenics in British and American thought leadership. Perhaps this is why eugenicist thought, and its racist, nativist and paternalistic impulses, continued on past WWII, before the label was widely abandoned by the mid 20th century. It is the deeply held suspicions of those who rightfully oppose these impulses that often motivate them to avoid or actively oppose discussions of runaway population growth -even long after humanity has exceeded Earth's carrying capacity.
More recently, of course -and with different cultural origins -thoughtful and righteous objections have been raised over China's One Child Policy and policies by other authoritarian regimes that have sought to harness coercive measures to oppress women or eradicate minorities through the use of forced sterilization or forced abortion. In the wake of the Cairo Consensus, proper attention was paid to the inhumane practices being embraced under the guise of "population control," which disproportionately affected women and girls around the world. In some cases, a connection could be drawn to old eugenicist thinking in Western cultures, repackaged by the dominant racial or ethnic group in power in non-Western nations. In other cases, similar oppression by authoritarian regimes has been undertaken with no need for philosophical foundations, though delivering the same effect.
This dark history has led many who are firmly ensconced in the Cairo Consensus to be deeply averse to re-opening discussions about runaway population growth. Others avoid population discussions in the hope that the global population curve will bend as global health and wealth improve -as the great Swedish physician and health statistician Hans Rosling insisted it would. To be comfortable with a Roslingesque worldview, one must avoid the fact that humanity long ago overshot our planet's carrying capacity. Others, particularly from the climate action community, demand that we avoid population discussions, and focus entirely on consumption and carbon emissions. They correctly point out that the developed world, which indeed is guilty of creating the vast majority of the historic carbon burden on our climate, should not be allowed to shift the blame on to poor, Black and Brown communities around the world, who consume far less per capita, just because of POPULATION AND SUSTAINABILITY VOL 5, NO 2, 2021 their fertility rate. Yet, they fail to grasp the rate at which the developing world is projected to join the global middle class over the next decade, taking on a decidedly bigger per capita human footprint. As such, we should all be concerned about population growth even if it is consumption in the developed world that has led to our environmental crisis (Hickel, 2018;O'Neill, 2018).

Lessons learned and embracing our future
Because of the dark past of population debates, it is far too easy to ignore runaway population growth despite the ample scientific evidence that humanity's size and our rate of growth is crushing our planet and undermining its ability to support us as a species. This dark past makes an already awkward discussion about runaway population growth downright unpalatable. It enables a sort of intellectual cowardice -letting some advocates for the reduction of humanity's carbon footprint ignore the inexorable realities of runaway population growth. It allows valid claims of racism, colonialism, and paternalism to be wielded as a means of silencing those who raise issues of runaway population growth. This is a particularly potent argument in a world that continues to be filled with racism, and a future where most Western populations are already below replacement value fertility, while large parts of Africa, Asia, and South America are projected to grow their populations substantially over the coming decades (Vollset, et al, 2020).
In any discussion of population dynamics, we must learn from this deeply troubling past and its echos into our present. Despite this reality, we must also embrace the lessons that have been learned about the just, ethical and empowering strategies available to us which could bend the global population curve. We have learned that the empowerment of women and girls leads to the reduction in fertility rates. In many geographies where women and girls are empowered, educated, integrated into the workforce and given access to family planning technologies, that they are allowed to harness for their own bodily autonomy, we see below replacement value fertility (Sachs, 2005). This is because such factors lead to smaller, educated, and prosperous families -a virtuous circle in development that naturally bends the fertility curve in the geographies where these factors take hold.
This means that there is a real nexus between the truths elevated in the Cairo Consensus and the building blocks required to bend the global fertility curve. This makes it all the more mysterious that the Cairo Consensus was devoid of any real notion how many people the Earth can support, and the need to shift fertility norms in a way that can bring our species into balance with our planet. If it were not, the Cairo Conference deliberations would have begun with a discussion of whether the 5.6 billion souls inhabiting the planet in 1994 exceeded our planet's carrying capacity. And reasonable discussions would have been had around feasibility of near-term reductions in consumption, given the projected population growth already baked into our demographics. This would have immediately led to a discussion not only of the empowerment of women and girls, and a focus on reproductive health and women's rights as human rights. It would also have led to a real discussion about the need to shift reproductive norms away from the norm of children having children, to a more modern fertility norm of relatively small families. The Cairo Consensus would have rallied around the need for small, educated and prosperous families with healthy and empowered women and girls. But, this is not the form that the Cairo Consensus took, and now humanity has hurtled from 5.6 billion to 7.8 billion with no end in sight and with nothing less that the fate of our planet and our species at stake. If Cairo had truly been a conference on population and international development -rather than a much needed effort to recenter the empowerment, reproductive rights, and welfare of women and girls on the world scene -a frank discussion would have occurred about the actual fertility rate (e.g., the current slope of the curve) and the path toward not only bending the global fertility rate to below replacement value, but the time horizon by which this change must occur if we were to avert climate catastrophe and ecological destruction. In 1994, both climate catastrophe and ecological destruction loomed large.
I have proposed a goal of achieving a total fertility rate (TFR) 1.5 by 2030, to not only help us avert 1.5C in temperature rise, but also to begin lightening the overall human footprint (not just our carbon footprint) at a rate that could bring our species into balance with of our planet's carrying capacity soon after 2100 (Tucker, 2020). Whether my assumptions and calculations are correct should be something debated and decided in any adjustment to the Cairo Consensus. Whatever the actual resulting population decrease, aspiring to an average global fertility rate of 1.5 by 2030 would massively increase the prospect of averting ecological catastrophe and widespread misery -especially for the poorest in the world. Perhaps another such goal is more appropriate. I welcome the debate. POPULATION AND SUSTAINABILITY VOL 5, NO 2, 2021 Updating how the United Nations thinks about population In a way, it is unfair to saddle the Cairo Consensus with sole responsibility for the UN's failure to properly consider runaway population growth in our collective global strategies for achieving long term sustainability. The UN did, after all, spearhead the development of the Sustainable Development Goals (SDGs), which also were silent on issues of population. Nevertheless, one can, perhaps, blame the Cairo Consensus' silence on population growth for shaping the fundamental assumptions underlying the UN's SDGs. The SDGs weirdly take the UN's population projections as immutable, with 17 goals that the global community must collectively meet even as humanity continues to grow in numbers and in its massive ecological footprint. Goal 5 does call for Gender Equality, which is a useful hook for a larger discussion around fertility and population dynamics. But, other than that, the SDGs are silent on this issue. Of course, so many of the SDGs are actively being undermined by runaway population growth.
An 18th SDG, focused on ending runaway population growth, stabilizing population, and decreasing it to a lower more sustainable population plateau would go a long way to helping in the achievement of the other 17 SDGs. Alas, it seems that the SDG process is considered unchangeable, even as we observe global society overshooting its SDGs, year after year. The day that the SDG community begins openly discussing runaway population growth and its deleterious effects on our planet and our global society will be a watershed moment.
The UN could also contemplate the creation of a United Nations Framework Convention on Population Growth, as was proposed by planetary health activist Rob Harding. Modelled on the United Nations Framework Convention on Climate Change, this approach would allow us to recognize that we (e.g., humanity) have exceeded our planet's carrying capacity, and that we are accruing long term ecological debt that is threatening our planet and its ability to support us as a species (Harding, 2018). Such a Framework Convention on Population Growth would allow us to collectively set goals for bending the global population curve in a particular time frame. Goals, after all, are nothing without a target date for their accomplishment.
Again, my goal of 1.5TFR by 2030 would only be a proposal that would have to be negotiated in this context. The United Nations Framework Convention on Climate Change has negotiated targets for carbon emissions. Yet, it completely failed to appreciate the role of runaway population growth in fuelling climate change. History will look back on this failure with contempt. As a UN Secretary General who is so passionate about climate action, António Guterres could help empower the global community by advancing this proposal for a United Nations Framework Convention on Population Growth.
It is easy to anticipate that climate activists and global leaders might simply call for amending the UN Framework Convention on Climate Change to include population references. However, this is much bigger than climate. Remember, the UN is also the home for the UN Decade of Ecosystem Restoration, led by the UN Environment Program (UNEP) and the Food and Agriculture Organization of the United Nations (UN FAO), with the aim of restoring degraded and destroyed ecosystems, contributing to efforts to combat climate change and safeguard biodiversity, food security, and water supply. Runaway population growth is not just fuelling climate change, it is annihilating natural habitats at an alarming rate. Our collective carbon footprint is only one small part of our much larger human footprint. And, to properly grapple with runaway population growth, a substantial agreement with many moving pieces would be required. It is not as simple as setting targets. Population issues touch every single Sustainable Development Goal, and every aspect of human rights discussions across the UN and its member nations.
We have it at our fingertips to embrace just, ethical, and empowering strategies -particularly focused on women and girls -that can help us bend the global population curve, but all nations would need to agree to them. It is abundantly clear that the international community should build on the Cairo Consensus by establishing a UN Framework Convention on Population Growth.

Establishing new fertility norms for a sustainable future
Any agreement would, in effect, call on the self-conscious establishment of a new species-wide fertility norm. To some geographies, where below replacement value fertility has already become the norm, this will be no real imposition. To others, the establishment of a norm that is substantially lower than the TFR in their region will be quite a heavy lift. However, when in this discussion people are led to realize that fertility is not some exogenous factor or inexorable process, the dialog will get interesting. This global dialog will lead them to realize that if only women and girls are empowered, educated, integrated into the workforce (at the appropriate age), and given access to family planning technologies that allow them bodily autonomy, then not only will fertility drop, but the multiplicity of benefits tied to education will be unleashed, and economic prosperity will abound. Furthermore, ecological calamity will no longer loom large. Small, educated and prosperous families capable of making deliberate choices about their impact on our planet will become the species wide norm. What a change that will be.
Norms are not policy mandates. They are not "population control". If we have learned anything over the past century, such mandates and policies do not work. Only empowering strategies deployed at global scale can work. And these can only work when implemented within a global discussion about the kinds of fertility norms that could help humanity live within the ecological constraints of our planet, in the here and now. The 2020s are a fundamentally different moment in time than 1994, when the Cairo Conference was held. The global community has come to appreciate acutely the burden humanity's growing numbers have come to place on our fragile and finite planet -including the global community of scientists (Ripple, 2019). By situating the welfare and rights of women and girls at the center of our approaches to international development, the Cairo Conference did us all a favour. By sidelining discussions around runaway population growth, the Cairo Conference did us all, and our planet, a huge disservice. We now have the opportunity to collectively make a course adjustment that could mean the difference between prosperous sustainability and oblivion.
The time for action is now.