“No new promises are needed—only following through on commitments already made.” — UN Millennium Project
The world has an unprecedented opportunity to realize the promise of equality and freedom from want. During the next decade, hundreds of millions of people can be released from the stronghold of poverty. The lives of 30 million children and 2 million mothers can be spared.(1) The spread of AIDS can be reversed. Millions of young people can play a larger role in their countries’ development and, in turn, create a better world for themselves and generations to come.
Gender equality and reproductive health are indispensable to the realization of this promise.
In the year 2000, leaders from 189 countries met at the United Nations Millennium Summit and forged a unique global compact to reduce poverty. From the Summit’s declaration, eight Millennium Development Goals (MDGs) were derived, with 2015 set as the date for their achievement. In 2002, the UN Millennium Project brought together more than 250 leading experts to advise the UN Secretary-General on how to implement the MDGs. Their conclusions are reflected throughout this year’s State of World Population report.
Gender equality is a human right, one of the Millennium Development Goals and key to achieving the other seven. The UN Millennium Project concluded that reproductive health is essential to achieving the MDGs, including the goal of gender equality. Investments in gender equality and reproductive health offer multiple rewards that can accelerate social and economic progress, with lasting impact on future generations.
Gender Equality and Equity: The costs of gender discrimination are highest for low-income countries, and within countries, for the poor. Women constitute a large share of the labour force and play a central role in rural economies and food production. They are also primary guardians of the next generation. Gender discrimination squanders human capital by making inefficient use of individual abilities, thus limiting the contribution of women. It also undermines the effectiveness of development policies.(2) When discriminatory burdens are removed, the capacity and earning power of women increase. Furthermore, women tend to reinvest these gains in the welfare of their children and families, multiplying their contributions to national development. Empowering women propels countries forward towards the MDGs and improves the lives of all.
Reproductive Health and Rights: The considerable, and largely preventable, burden of poor reproductive health falls most heavily on the poorest women and their families, who can least afford its consequences. The ability to make free and informed choices in reproductive life, including those involving childbearing, underpins self-determination in all other areas of women’s lives. Because these issues affect women so profoundly, reproductive health cannot be separated from the wider goal of gender equality.
The Equality Dividend: Strategic Investments, Large Payoffs
Countries will need to invest scarce resources wisely if they are to meet the MDGs by the fast-approaching 2015 deadline. As discussed in Chapter 2, experience shows that simultaneous investments in three areas can be particularly effective in spurring progress at the country level: education for girls and women; reproductive health information and services and women’s economic rights.(3) Women engaged in the political process, as individuals or members of civil society organizations, can help keep these priority issues high on national agendas, and hold governments and other key actors accountable to commitments made.
Expanding Education for Girls and Women: The gender gap in education has left nearly twice as many women as men illiterate. In the poorest regions, more girls than boys are out of school, and the gap widens at the secondary level—even though secondary and higher education for girls is especially significant in reducing poverty. Educational attainment increases women’s income-earning potential, reduces maternal and infant mortality and improves reproductive health overall. It is associated with lower rates of HIV. Educated girls are more likely to delay marriage and childbearing, and instead acquire skills to improve economic prospects for themselves and their families. The multiple benefits of girls’ education also lead to better health and education for the next generation.
Improving Reproductive Health: Reproductive health problems comprise the leading cause of death and disability for women the world over.(4) Most are preventable. Universal access to reproductive health services is an international commitment and a human rights imperative. It is also a powerful investment for countries fighting poverty.
Impoverished women and adolescent girls with limited access to reproductive health care suffer the most. These women and their families are least able to afford the consequences of reproductive health conditions: The costs of health care, the loss of a woman’s contributions to family survival and the impact of AIDS can push poor families into destitution. The opportunity to pursue other productive and community activities, and to secure stable employment and higher wages, is compromised when a woman is unable to determine the number, timing and spacing of her children.
The costs to national development and public budgets are considerable. According to some estimates, reproductive health conditions result in 250 million years of productive life lost each year worldwide and reduce the overall productivity of women by as much as 20 per cent.(5) Adolescent pregnancy, the AIDS epidemic, and excess fertility due to lack of family planning services further strain national budgets, slow social and economic development and deepen poverty.
Providing Economic Opportunities: Although women have entered the paid workforce in increasing numbers, they confront many forms of discrimination, including restricted choice of occupations and lower wages. Entrepreneurial efforts may be frustrated by laws and customs that combine to prevent women from owning property, acquiring credit or controlling income. In some regions, women cannot inherit, even from deceased husbands. Many end up working in the informal sector, where work is unregulated, poorly paid, insecure and often unsafe.(6)
The labour of rural women accounts for 60 to 80 per cent of food production in developing countries,(7) but many face restrictions on the rights to own, use and inherit land. Research in some sub-Saharan African countries found that output could increase by up to 20 per cent if more women had equal access and control over farm income, agricultural services and land.(8) In many of these countries, AIDS further limits the productivity of women, who often struggle with few social supports to both provide for their families and care for the sick.
1 | 2005: MILESTONES IN THE COUNTDOWN TO THE MDGS
This year begins the 10-year countdown to the 2015 deadline for achieving the Millennium Development Goals. It also offers several milestones by which to measure progress and intensify action to improve the human condition. The year 2005 marks:
- The 10th anniversary of the Fourth World Conference on Women
- The 30th anniversary of the First World Conference on Women
- The 60th anniversary of the 1945 United Nations Charter, which enshrined “the equal rights of men and women” in its Preamble
- The 10-year review of the World Programme of Action for Youth to the Year 2000 and Beyond.
The year 2005 also follows closely after the 10-year anniversary of the 1994 International Conference on Population and Development that reaffirmed gender equality and reproductive health and rights as cornerstones of sustainable development.
The Promise of Human Rights
One of the proudest achievements of the 20th Century was the establishment of an international human rights system affirming the equal rights of all. The MDGs are grounded in respect for human rights—to human dignity, to personal security and to freedom from want, fear and discrimination. Achieving them, as discussed in Chapter 3, is not a matter of charity: It is both an ethical obligation and a collective responsibility. Meeting the MDGs and furthering human development requires empowering the poor, especially women, young people and marginalized populations, who are often doubly or triply disenfranchised.
The framework for the human rights of women is well established. International and regional conventions, and national constitutions and laws in many countries enshrine protections for women’s rights. Nevertheless, in practice, the denial of the human rights of women remains persistent and widespread. Where laws safeguarding women’s rights exist, enforcement is often weak and undermined by limited budgets. Gender biases permeate social institutions charged with upholding women’s rights. In many countries, custom and tradition take precedence over official policy. Women and under-age girls are married against their will; violence against girls and women is tolerated; rapists are e xonerated; and women are denied their equal rights within the family and marriage to property and inheritance and in other areas as well.
Reproductive rights are central to human rights, especially the human rights of women. They derive from the recognition of the basic right of all individuals and couples to make decisions about reproduction free of discrimination, coercion or violence. They include the right to the highest standard of health and the right to determine the number, timing and spacing of children. They comprise the right to safe childbearing, and the right of all individuals to protect themselves from HIV and other sexually transmitted infections.
Social and cultural contexts present both challenges and opportunities for promoting the human rights of women. Culturally sensitive approaches build on positive values, enlist the support of community leaders and influential individuals, and mobilize broad-based community ownership of initiatives that promote human rights and gender equality.
The rights of marginalized groups merit priority attention. These groups account for a large proportion of the global population, and many live in poverty. Disabled persons make up 10 per cent of the world population (or 600 million).(9) An estimated 370 million indigenous people live in some 70 countries.(10) International migrants number an estimated 175 million people.(11) Gender inequality compounds the multiple forms of discrimination women from these groups already face.
Reproductive Health: A Measure of Equity
Reproductive health bears directly on three MDGs—reducing child mortality, improving maternal health, and combating HIV/AIDS—and has implications for all of the others, as discussed in Chapter 4. No other area of health presents such large disparities between rich and poor, within and among countries.(12) And no other area of health so clearly demonstrates the impact of gender inequality on women’s lives.
Virtually all—99 per cent—of maternal deaths occur in developing countries. The lives of most of these women—and those of their newborns—could be saved through emergency care readily available to wealthier women. Every minute a woman dies from the complications of childbirth or pregnancy, and another 20 are seriously injured or disabled.(13) And when a mother dies giving birth, her infant’s chances of survival plummet. Motherless newborns are three to 10 times more likely to die than others.(14) Preventing unintended pregnancies through access to family planning could avert 20 to 35 per cent of maternal deaths,(15) saving the lives of more than 100,000 mothers each year.
The rapid spread of the AIDS epidemic further highlights the consequences of gender disparities for reproductive health: Three quarters of all HIV infections are sexually transmitted between men and women—many by husbands to their wives. Although transmission is preventable, the ability of women to protect themselves against HIV is often restricted by imbalances in decision-making power, gender-based violence, economic insecurity and harmful practices. Up to half of new HIV infections are among young people. Young women are at especially high risk. Those who are poor, female and young often have the least power and opportunity to protect themselves.
Gender inequality fuels the epidemic. In many societies, social norms and expectations that idealize male prowess and strength legitimize multiple partners for men and their authority in decision-making. The consequences—for individual men and women, for the children who have lost one or both of their parents to AIDS, and for entire nations—are tragically well known. Limited access to education and health services keeps prevention and treatment out of reach for millions of poor people.
Adolescents and Youth: The Unmapped Journey
With nearly half of the world’s population (almost 3 billion) under the age of 25, young people are crucial to poverty reduction and development. Today’s generation of young people is the largest in history. Over 500 million youth (ages 15 to 24) live on less than $2 per day.(16) They are growing up in a different world than their parents: AIDS, information and communications technologies and globalization are powerful forces shaping their lives.
Youth comprise half of the world’s unemployed. While work affords some the opportunity to earn, learn and develop new skills, many others are trapped in low-wage, low-skill sectors with few opportunities to advance or to escape poverty.(17) Many of those who begin working in adolescence or as young children are subject to abuse and exploitation, as discussed further in Chapter 5.
Adolescence—defined here as from ages 10 to 19— is a critical time to learn and acquire skills and values that can last a lifetime. For those living in poverty it can be a time of diminished freedom and increased risks. Many adolescents are obliged to abandon their schooling to help support their families or because they become pregnant or get married. Adolescent girls are particularly vulnerable to early pregnancy, sexual abuse, child marriage and other harmful practices such as genital mutilation/cutting. In the next 10 years, 100 million girls are likely to be married before the age of 18.(18) Every year, some 14 million adolescent girls give birth.(19) They are also two to five times as likely to die owing to pregnancy-related complications than women in their twenties,(20) and their babies are less likely to survive as well. Poverty leads many to resort to transactional sex to procure bare essentials for themselves and their families. For the 15 million AIDS orphans(21) left on their own to survive and provide for siblings, and for the legions of others around the world abandoned and living on the streets, the challenges and risks are magnified many times over.
The poorest countries have the highest percentage of young people. Yet adolescents and youth have received only limited attention from policymakers and are largely invisible in the MDGs. A growing number of policymakers now grasp the urgency of investing more in the education, reproductive health, well-being and the future prospects of young people, especially adolescent girls, as a matter of both human rights and of national self-interest. Large numbers of poorly educated young people without employment prospects is a recipe for continued poverty, inequality and civil unrest.(22) A large and skilled population of young people entering their most productive years, on the other hand, can give a powerful boost to development, as the economic growth of the “Asian Tigers” has demonstrated.
Partnering with Boys and Men
Because gender norms and stereotypes limit the possibilities of both women and men, gender equality can be a winning proposition for both— “double happiness” in the words of one campaign to encourage men to take on more domestic responsibility.(23) Men themselves are increasingly challenging notions of “masculinity” that restrict their humanity, limit their participation in the lives of their children, and put themselves and their partners at risk. Many want to become more supportive husbands and fathers, but need support to overcome deeply entrenched ideas about gender relations. Moreover, because they bear responsibility for many reproductive health problems, men play an indispensable role in their solution.
Around the world many innovative programmes are leveraging the positive involvement of men in the struggle for equality and reproductive health. Some initiatives encourage joint participation in decisions about contraception, emergency plans for pregnancy and labour and voluntary HIV testing. Others emphasize men as agents of positive change and encourage them to question gender norms more broadly. Some work with adolescent boys at a formative and potentially risky time in their lives. A few initiatives manage to reach large numbers of men in their places of employment or in military or police institutions. Most programmes, however, are small compared to the scale of the challenge of transforming gender relations. As discussed in Chapter 6, stronger efforts to involve men more fully in reproductive health, family life and gender equality are urgently needed.
Gender-based Violence: A Price Too High
Gender-based violence knows no boundaries— economic, social or geographic. Overwhelmingly perpetrated by men against women, gender-based violence both reflects and reinforces gender inequity. The toll it extorts on the dignity, autonomy and health of women is shocking: Worldwide, one in three women has been beaten, coerced into unwanted sexual relations, or abused—often by a family member or acquaintance.(24) At the start of the 21st century, violence kills and harms as many women and girls between the ages of 15 and 44 as cancer.(25) The costs to countries—in increased health care expenditures, demands on courts, police and schools and losses in educational achievement and productivity—are enormous. In the United States, the figure adds up to some $12.6 billion each year.(26)
Gender-based violence takes many forms, from the domestic confrontations that leave millions of women living in fear to sexual abuse and rape, to harmful practices ranging from female genital mutilation/cutting to “honour killings” and dowry-related violence. In Asia, at least 60 million girls are “missing” due to prenatal sex selection, infanticide or neglect.(27) Each year, up to 800,000 people are trafficked across borders— as many as 80 per cent of them women and girls, mostly exploited in the commercial sex trade.(28) Within borders, the numbers are even higher. Chapter 7 explores the global prevalence, causes and consequences of gender-based violence, and the steps now being undertaken to combat this global epidemic.
Women and Young People in Humanitarian Crises
Conflict has erupted in more than 40 countries since the 2000 UN Millennium Summit.(29) Natural disasters are becoming more frequent and are affecting larger numbers of people than ever before. The tsunami in 2004 caused the deaths of 280,000 people and displaced another one million.(30)
The collapse of social systems as a result of conflict or disaster leaves women and young people especially vulnerable. During conflict, rape is commonly used as a weapon of war, leaving millions of women traumatized, forcibly impregnated or infected with HIV. Crises lead to the disintegration of community and family protections. Gender-based violence is a constant risk. The lack of health services often causes infant and maternal mortality rates to increase sharply. Armed groups forcibly recruit children and adolescents as soldiers, or force them to serve as domestic servants or sexual slaves. Women are often left to both fend for themselves and their children and to care for survivors. For these and other reasons, humanitarian crises often lead to long-term economic and social insecurity. Of the 34 countries farthest from reaching the MDGs, 22 are in, or emerging from, conflict.(31)
Peacebuilding and reconstruction offer a chance to correct the inequities that led to conflict in the first place. Chapter 8 details efforts to address the needs and rights of women and young people in the aftermath of crises. Their participation is essential in establishing equitable and sound poverty reduction action plans in the post-crisis transition. This chapter also highlights the plight of internally displaced persons and describes efforts in some post-conflict countries to make a fresh start in creating gender equitable societies.
2 | THE ICPD AND THE MDGS: LINKAGES FOR POVERTY REDUCTION,
GENDER EQUALITY AND REPRODUCTIVE HEALTH
MDG 1: Eradicate extreme poverty and hunger
- Investments in the economic rights of women—equal employment opportunities and wages, credit, agricultural resources, inheritance and property rights—increase productivity, farm yields, and family well-being. Women’s control over household resources leads to higher investments in children’s health, nutrition and education.
- Many of the poorest countries are those in or emerging from conflict. Investing in women and young people furthers the rebuilding of societies and economies, poverty reduction and lasting peace and stability.
- Reproductive health problems disproportionately affect women and the poor and can push families deeper into poverty.
- Smaller families help reduce hunger and increase investments per child. This leads to a healthier and better skilled labour force, slower population growth, reduced public expenditures, increased savings and investments, and accelerated social and economic development.
MDG 2: Achieve universal primary education
- When mothers are educated and families are smaller, the likelihood that all children will go to school increases.
- Gender biases keep many girls from school, often to help mothers care for siblings and manage household needs. For many families, the priority is educating boys. Eliminating school fees and supporting poor families can ensure that all children complete their education.
MDG 3: Promote gender equality and empower women
- Gender inequality slows development. Equal political, economic, social and cultural rights are required to reduce poverty.
- Women’s ability to decide freely the number and timing of children is key to their empowerment and expanded opportunities for work, education and social participation.
- Men play a pivotal role in achieving gender equality, poverty reduction and development goals, including improved infant and maternal health and reduced HIV transmission and genderbased violence.
- Violence against women and girls results in high social and economic costs—to individuals, families and public budgets.
- Eliminating child marriage, enabling adolescent girls to delay pregnancy, ending discrimination against pregnant girls, and providing support to young mothers can help ensure that girls complete an education. This can help break the cycle of intergenerational poverty.
- Girls’ secondary education provides high payoffs for poverty reduction, gender equality, labour force participation and reproductive health, including HIV prevention and women’s and children’s health and education status overall.
MDG 4: Reduce child mortality
- Reproductive health can improve infant survival and health. Birth spacing and maternal health care can help prevent infant deaths. Family planning also prevents unintended pregnancies: Unwanted children are more prone to illness and premature death.
- Screening pregnant women for HIV and other sexually transmitted infections can prevent infant illness, disability and death.
- Empowering adolescent girls to delay pregnancy can prevent many newborn deaths. Babies born to adolescents face higher mortality rates than those born to older women.
MDG 5: Improve maternal health
- Key reproductive health components—family planning, skilled birth attendance and emergency obstetric care—save lives.
- Family planning can reduce maternal mortality by 20 to 35 per cent.
- Improved quality of care and access to maternal health services (prenatal, during delivery, post-partum) improves women’s health and quality of life for them and their families.
MDG 6: Combat HIV/AIDS, malaria and other diseases
- Reproductive health care includes prevention and management of sexually transmitted infections, including HIV/AIDS.
- Gender discrimination fuels the HIV/AIDS epidemic, placing adolescent girls and women at risk, including within marriage. Reproductive health programmes counsel individuals and couples on prevention, prevent mother-to-child transmission and unwanted pregnancies in HIV-positive women, and offer options should they wish to have children.
MDG 7: Ensure environmental sustainability
- In developing countries, women are the primary food producers and managers of community and household water and fuel resources. Investments in safe water, sanitation, time-saving technologies and skills training can improve sustainable resource management, food security, nutrition and health, and lessen time spent on collecting water and firewood. This releases girls and women for educational and other productive activities.
- Environmentally-friendly sources of energy can protect women and children from the harmful effects of pollutants and cooking fires.
- Family planning and the prevention of unwanted births, can help stabilize rural areas, slow urbanization and environmental pressures, and ease demands on public services, thereby balancing natural resource use with the needs of the population.
MDG 8: Develop a global partnership for development
- Decent work for youth—one of the goal’s targets—coupled with enlightened socio-economic policies can increase savings, productivity and living standards. Among these policies is family planning, which enables young people to delay having a family until they have acquired the skills and experience to earn a viable income.
- Increased income-earning opportunities offer young women alternatives to early marriage and childbearing and sexual exploitation.
- Global partnership to secure adequate supplies of essential reproductive health drugs and commodities for poor countries— including contraceptives, testing kits and treatments for HIV and other sexually transmitted infections—is critical for achieving poverty reduction, gender equality and health goals.
Making Poverty History
The world has an unprecedented opportunity to “make poverty history”.(32) With nearly 3 billion people(33) struggling to live on less than $2 a day, over half a million women dying needlessly every year from pregnancy- related complications, 6,000 young people acquiring HIV daily, and millions of women and girls living in fear of violence, the ethically-acceptable response is self-evident: to fulfil the promises for global action, equality and equity espoused at the United Nations conferences of the 1990s and at the 2000 UN Millennium Summit.
The conclusions of the experts are clear: Investing in gender equality, reproductive health and young people’s development has short- and long-term social and economic multiplier effects. Launching national campaigns on violence against women; promoting women’s property and inheritance rights; expanding access to reproductive health care and closing funding gaps for supplies and contraceptives; and ensuring that women are involved in the formulation of MDG follow-up policies and strategies are among the high-impact “quick-wins” identified by the UN Millennium Project.(34)
Implementing these strategies calls for a longterm, guaranteed commitment of resources at a consistently higher level than at present. The costs are moderate in relation to the benefits they offer. The investments required to achieve the foundation for human dignity and human security, and for expanding freedoms and choices for the world’s poorest people, amount to a fraction of what the world spends on military purposes.(35) The entire MDGs package could be funded if industrialized countries simply fulfilled an agreement made 35 years ago to assign 0.7 per cent of their gross national income to official development assistance. Improved governance and transparency, reduced corruption, increased debt relief and removal of agricultural subsidies in wealthy countries are among the elements of the global compact to end poverty.
The world has reached an unprecedented consensus to end poverty. The strategies and know-how are available. The leadership and resources required can be mobilized. As 2004 Nobel Peace Prize Winner Wangari Maathai told the world in her acceptance speech, “there comes a time when humanity is called to shift to a new level of consciousness, to reach a higher moral ground. That time is now….There can be no peace without equitable development.”(36)