"Marie Stopes: Universal Principles and Cultural Values", Statement at the Stopes Memorial Lecture, in London.
13 March 2001
13 March 2001
Thank you for inviting me to present myself as the new Executive Director of UNFPA through the Stopes Memorial Lecture. It is a great opportunity to be among such a distinguished audience and I look forward to a meaningful exchange of views and discussion.
We are here to celebrate an anniversary, the anniversary of the first family planning clinic that Marie Stopes opened, 80 years ago. I am delighted to be able to join your party and to help you celebrate that anniversary. May the vigour of MSI never flag and may your enterprising spirit never fail.
From the distance of 80 years, Marie Stopes, and her clinics, and her books, look quite harmless, even a little quaint. The historian A J P Taylor describes her first book Married Love as "somewhat gushing". As she says in the book, "it is never easy to make marriage a lovely thing"—but that is what she was trying to do.
Taylor credits Marie Stopes with "making contraception respectable"-and that might seem a modest enough contribution. But as he says, quite rightly, Marie Stopes deserves to be remembered "among the great benefactors of the age". In her time it was quite impossible to discuss sexual relations and contraception. It was unheard of to make family planning freely available, especially to poor women. Marie Stopes knew what had to be said, and she was brave enough to say it. She knew what had to be done and she was brave enough to do it.
Marie Stopes was a product of her time. She had some of the faults of her time, and some that were all her own. We don't share all her values, but we do share her one driving concern: the well-being of women. I believe that we can still look to her for inspiration. We can remind ourselves that her ideas appeared divisive in 1921; yet in 2001 her moral sense seems like common sense.
We still face some of the obstacles that stood between Marie Stopes and her work. And we still face many of the same wrongs that she set out to right. There are still poor women desperate to avoid yet another pregnancy. There are still young girls betrayed by their own ignorance. There are still people whose misguided sense of morality would keep family planning out of the hands of poor women; and there are still people who hold on to the past as if that could save them from the future. And there are new threats to women's health and lives, more terrible than Marie Stopes could have imagined.
A gulf wider than time separates us from the Society for Constructive Birth Control, and that first clinic in Holloway. It is a gulf of cultural change. Across it we can dimly see the world of 1921, so different from ours that we can barely recognise it. I would like to talk a little about that gulf, the way that we as societies and individuals cope with change, and how organisations such as yours and mine can help the process. I would like to mention some of the challenges that face us. Perhaps I may be allowed a few words about UNFPA, and what I see as our way forward.
Difficult Times—What Were Women For?
In order to go forward, let us think back a bit. The cultural reality of sex in Marie Stopes's Britain was far more complex than the stereotype. One of the reasons for the stereotype was that the intimate relationship between husband and wife, let alone sex, sexuality and contraception and family planning, could hardly be discussed, and certainly not in public. The publication of Married Love, and subsequent books which were much more explicit about contraception, raised a storm of controversy. Marie Stopes was furiously attacked from the pulpit, from Fleet Street and from many parts of what we would now call Middle England—and you can't help feeling that many of these critical voices are with us today, as we begin the 21st Century.
She also had many vigorous and vocal supporters; there were many more who were less vocal, but who felt equally strongly—the women, and some men, who felt that, for the first time, someone had spoken out for them.
Eventually Marie Stopes prevailed because she was saying what millions of people could not say for themselves. Married Love may sound quaint to us with its flowery prose, but its message was finely tuned to its time, and firmly couched in familiar and understandable terms. Controversy may have obscured the fact, but by 1921 England had changed. England was ready for Marie Stopes, and the English were ready for modern concepts of family planning and contraception.
A Question Of Cultural Values
I think we can look to the cultural experience of Marie Stopes to teach us something about the contemporary world and our place in it. In particular, we can apply her lessons to those developing countries which are on the cusp of change, just as England was in 1921; and where some people still feel that family planning and the rights of women will threaten the very fabric upon which society is built—that is, the family.
Remember that Marie Stopes was very concerned to show that she wasn't advocating anything immoral. Her appeal was to a universal morality. Remember too that although she was very controversial in her time-and wasn't afraid to seek controversy-her arguments were based on science, on reason and finally on the ineffable power of love between married people. She believed she could win her point simply by saying what she knew to be true, and acting on it. And time has proved her right.
Marie Stopes sends us four clear messages which we can apply to our work in all countries and all cultures:
First, the opposition may be strident, but that is a sign of weakness rather than strength-these days, the more the opposition turns up the volume, the happier I feel. It means we have won the argument in all its essential points: the quiet voices of millions of women and men talking to each other are more powerful than any amount of loud and nervous objections.
Second, voices are as variable as cultures. Reasonable people can disagree with each other. We should not forget that. But, equally, reasonable people can have reasonable conversations. Our task is to keep the conversation going. What we must do is make it possible for all reasonable people, whatever their backgrounds, whatever their preconceptions, to accept-in their own terms-what their reason tells them. We will not convince anyone. They will convince themselves.
Third, we must remember that conversations go two ways. We do not have a monopoly of right. I am not saying we should give up any of our principles. What I am saying is that there is a wonderful variety of ways of thinking, and they come out of countless generations of human experience. That variety is, in the best sense, culture. We must be immensely, carefully, aware and respectful of other approaches to our issues. We must be prepared to listen, and to respond.
Finally we must be determined. The argument may be won, but that will not guarantee its practical application. We have some strong opponents, but the strongest of all is the tendency to do nothing if doing something may be even slightly risky. Whether it is in international conferences, or national programmes, or in reproductive health service delivery at the local level, we must be vigilant, we must be organized, we must be courageous and we must be persistent.
Reconciling Change And Culture
Let me turn to some of these practical applications. In the past thirty years population has gone from being the stepchild of international action to being the poster child for its success. Thousands of people can take the credit, from international organisations to the host of dedicated workers on the ground. Together, we have shown that programmes in various aspects of reproductive health, including family planning, are not only acceptable in a very wide variety of cultures, but highly effective. They respond to people's needs.
In those thirty years, family size in developing countries has fallen from six children to three. The voluntary use of family planning has risen from about 15 per cent of couples to around 60 per cent. Although pregnancy and childbirth remain a risk to women's lives and health in many countries, family planning has saved the lives of millions of women by permitting them to avoid pregnancy. Overall life expectancy in developing countries has increased from 59 to 66 years.
As programmes have become stronger and more widely accepted, the parallel process of international discussion has moved on. In all, it took some 25 years to complete what is now known as the Cairo process. That process involved discussions extending over months and years, culminating in the International Conference on Population and Development in Cairo in 1994, known as ICPD, and including a wide variety of groups and individuals; immensely careful negotiations leading up to and during the conference; patient writing and rewriting which resulted in 179 countries accepting a very clear and strong Programme of Action; and then five years of experience culminating with a highly successful intergovenmental review at the United Nations General Assembly Special Session held in June 1999. What happened during that time was that programmes and process reinforced each other. Successful programmes show what works. Countries can agree on that, and in the process validate and encourage further action.
This long evolution—admittedly, at times both tortuous and torturing—has been called a triumph for the United Nations and its patient and inclusive way of doing things. It may be so: but it is not a triumph for any ideology or any particular view of population. It is a triumph for toleration, compromise and common sense. It is a triumph for the values that brought us, governments and NGOs to Cairo. It is a triumph for humanity.
The 1994 Programme of Action on population and development is a compromise document, adopted by all the 179 countries, albeit with some reservations. We would not have achieved consensus otherwise. But it is quite uncompromising on one issue. There are universal values: we are human and as humans share one thing in common; respect for humanity and for human life. However imperfect it may be, the Declaration of Human Rights expresses these universal values; and the success of Cairo was that all countries agreed finally that reproductive health should be recognised as a human right.
Now, how that universal message is translated into the voices of all the world's different cultures and ways of life is another matter. And that is our challenge today. In reproductive health, one size doesn't fit all. Programmes must be carefully constructed and adapted according to the needs of the people who will use them.
The women of the world—and to some extent the men—know implicitly that what they want for their families is morally justified. Their desire to have their children in safety; to protect themselves and their children from unwanted pregnancy and from sexually transmitted diseases, is fully in accordance with their cultural beliefs and values. As my courageous predecessor, Dr. Nafis Sadik, who is credited with ICPD, said: What culture worth the name would deny women the right to safe motherhood? What value system would send young people ignorant into the world, when a little knowledge might save their lives?
Again, all parents want the best for their children. In today's world that means education, some understanding of the wider world and the chance to take their place in it, girls as well as boys. It means some specific education on sexuality and on the responsible practice of sex. This education should include the virtues of abstinence, but it should also recognise that virtue is not universal.
What we are doing now is to translate individuals' implicit understanding into explicit agreement on the part of decision-makers, and society at large. We are translating the generalities of the Programme of Action into specific terms suited to each country and each culture We are bringing the Programme of Action home, where it belongs. We need to identify what is positive in each culture, what is pro-life, pro-women and pro-family, and to demonstrate through these positive aspects the universal principles of the Cairo Programme of Action.
Today political leaders accept the consensus of Cairo, but how far does their understanding extend, across the various ministries and offices of government? The consensus has profound moral implications; but do all religious leaders understand it as an ethical document that gives highest value to human life, to the right of individuals, especially women, to make choices in their lives? The concept of reproductive health has reached deep into the structure of primary health care services, but has it reached the people who take the decisions about how resources for health are allocated? Finally, do women's understandings of their needs match the understanding of the programme designers and service providers, who have the task of responding to them?
What we are trying to do, I believe, is to make the Programme of Action understandable and relevant to everyone in every society, no matter to which culture they belong. It is not a matter of this or that culture or stage of development: it is matter of expressing universal principles in programme terms, terms everyone can accept and act on.
This may be a little hard to understand in the abstract, so let me put it in personal terms. I came from a middle class Saudi Arabia family with firm roots in Medina, the second Muslim holy city. Both of parents were brought up in the religious traditions of the city. My father was educated in the Madrassa in the Prophet's Mosque and had a solid Islamic education. Both of my parents believed that they had an obligation, as Muslim believers, to educate all their children—both boys and girls—because knowledge is an essential principle in Islamic teachings. The very first Aya of the Quran is an order to "Read". This order has become an obligation of all Muslims to ensure that their children read, that they are educated. It became also the right of every child to get an education.
I also grew up with the traditional saying that "knowledge is light." Knowledge allows people to assess their lives and their society; to identify what is positive and build on it; and to see what is negative and work to change it, with courage and confidence. Knowledge also allows people to make decisions based on facts and information, in other words to make informed decisions about the choices they have to make in their lives and about their lives. With informed decisions, comes both responsibility and accountability.
That is the context in which I was brought up. Through the support of my parents, but especially of my father, as the head of the household, I was able to pursue my education to the highest level, to choose my specialization, choose my husband, plan my family, work and pursue a professional career of the highest quality.
Throughout my university and postgraduate education, I was supported by a scholarship from the Government of Saudi Arabia, because its leadership believed too that knowledge is a true Islamic principle, a duty of and a right for both men and women.
In many ways, I was lucky—because my parents, but especially my father, saw Islam as force for social progress and development, of both individuals and societies. I could have been brought up in a totally different setting, where parents did not fulfil their religious obligation and where children were unable to practise their rights. I was lucky because I grew up in an enabling environment that allowed me to attain knowledge and to make choices about my life.
In many ways, I am what the Cairo Programme of Action is all about—allowing women to make choices in their lives, taking into consideration the particular historical moment, social conditions and cultural context. The Cairo Programme of Action is also about ensuring that parents, brothers and husbands are supportive, understanding and act as full partners. I am an example of what governments and NGOs in each country are striving to achieve by implementing ICPD recommendations, as well as the recommendations of the other global conferences. Unknowingly and in many different ways, my parents ensured that I exercised my right to development as an individual, and my government ensured my right to development as a citizen.
I am, if you like, the very positive and concrete result of a relevant, well-managed and effective social agenda.
What is important is that my story is not unique. There are millions of such women in the countries that we serve, and in the various cultural settings with which we deal. We just need to identify these experiences, we need to show that supporting women to have choices in their lives does not threaten the social fabric of the society: rather, it is the way the society enacts its duties and ensures the full enjoyment of the rights of its people. It is the way societies are energized and are empowered to move forward. It is the power to change.
The Role Of UNFPA
Now let me turn to the organisation I am privileged to lead. UNFPA has a big responsibility in helping countries implement the tasks they set themselves as a result of the Cairo process. Donor Western countries and developing/programme countries alike look to us to help keep the focus on population; to ensure that it takes its proper place in national planning for development; to help solve the problems of implementation as they arise, and to encourage innovation and good practice. And we have to find the resources to do this.
I can tell you, after two months and two weeks experience, that this responsibility is quite challenging. There were 179 countries at Cairo, 185 at the Cairo+5 review. They all know exactly the framework of ICPD and its principles and they work towards translating these universal principles into programmes that respond to their community needs and their positive cultural values.
The first challenge facing me in leading UNPFA is ensuring the financial stability of the organization. UNFPA is a small organization with 1000 staff members globally. It has 70 representatives covering 146 countries and 9 technical teams that provide advice in the various regions.
In 1995, UNFPA's core resources were $312 million, a 17.8 per cent increase over the previous year and the Fund's highest total funding ever. We took this as a sign of donors' commitment, and we looked forward to steady increases.
On the contrary, contributions began to fall. By 1999, the Fund's core resources had dropped to pre-ICPD levels. We had to cut country programmes. We pared down, postponed or even cancelled some activities. It was a painful experience for us—but far more for the millions of people we serve. This shortfall of funds means more unwanted pregnancies, abortions and maternal deaths and increasing AIDS.
The financial situation improved somewhat in 2000 and 2001, but still it is US$ 50 million below the 1995 level. Core resources have increased slightly, and supplementary resources increased dramatically, thanks to generous support for contraceptive security from the Netherlands and the UK. And I would like to say as special word of appreciation to Ms Clare Short, who has been a wonderful friend and a true ally in all our work.
On the surface, our resource picture may look quite healthy. But core resources still are far short of the $310 million we projected for this year.
Nor does this take into account the growing demand for UNFPA services, nor the incalculable cost of the momentum we have lost in implementing ICPD and ICPD+5 because of shortage of resources. We estimate that there are 120 million women worldwide who would be using a modern family planning method if information and affordable services were easily available. Today there are about 485 million couples using family planning in developing countries; that number is projected to reach 745 million by 2015 since many of the present young generation will be entering their reproductive years.
We have not lost our optimism. We are pressing ahead with re-aligning the Fund to be a strong, results-oriented organisation that donors may be confident to support and programme countries may rely on. We must be an outward-looking organisation; we must lead, and we must be seen to lead.
Funding and realignment are two of our sharpest challenges. The third challenge takes us back to the question of values.
What we saw during the long debates in the ICPD+5 and Beijing+5 reviews was not so much about the content of the documents, the technical aspects, as about what some saw as a contradiction between universal principles and cultural values.
Countries want to implement Cairo, but they want to do it in their own way. That seems perfectly reasonable to me; but the debates in the +5 reviews showed me that there is still a gap between principle and practice. Closing the gap is the challenge, and I hope in my four years in this post to help countries interpret universal principles, to translate them into culturally sensitive messages and programmes, programmes that people can really feel are their own.
This is a vital matter. We know what to do. We are absolutely confident that we can help women and men build their lives together; protect and promote their children's health and well-being; strengthen their family life and the lives of the communities in which they live.
We can help countries rescue themselves from HIV/AIDS, the starkest challenge to human development we have seen in our lifetimes. We can help countries realise their deeply felt desire for development.
We can only do this if we keep close to our hearts the conviction that brought us to Cairo, that each human life is uniquely valuable, and that the right to development is the right for men and women to express the full measure of their humanity. Cultural values are important. They are the bedrock of society, and we must build on them.
Just like Marie Stopes, our aim is to remove obstacles to the individual expression of cultural values in practical terms. But like her, we must be prepared for criticism. We can respect principled critics—but we will reject criticism from those who misuse ethical arguments to promote ideologies that are against human life and the well being of women, and that are against human rights, especially the very basic right for women to a life free of death or disease resulting from what we consider as being healthy and natural—that is, pregnancy and childbirth. Such critics threaten the very institution they say they want to preserve—the family. Society is changing, and family life changes with it: but the values underlying family life do not change..
UNFPA does not have an ideology or a message for others to hear - we want to open our ears and hear the messages of those for whom we work.. The challenge for UNFPA is to help countries as we always have—with no agenda of our own; with sensitivity towards unique cultural values; with an infinite willingness to work with whatever is positive; and with a determination to help countries and people turn universal principles into concrete action.
The Need for Action
New figures on population just released by the United Nations show that we have a huge task in front of us. World population is now growing by 77 million people a year. According to the "most likely" projection, it will grow from 6.1 billion today to 9.3 billion, by 2050. This is 413 million higher than the last projection made two years ago All of this growth will take place in today's developing countries.
Six countries account for half of the expected growth: India, China, Pakistan, Nigeria, Bangladesh and Indonesia.
The 48 least-developed countries will nearly triple in size, from 658 million to 1.8 billion people.
The new report says that HIV/AIDS will result in 15.5 million deaths in the 45 most-affected countries in the next five years. By 2015, life expectancy in those countries will be 60, 5 years lower than it would be in the absence of AIDS. A report by the Secretary-General of the United Nations says that AIDS is now found everywhere in the world but has hit hardest in sub-Saharan Africa. Africa is the home to 70% of adults and 80% of children living with HIV, and to three-quarters of the people worldwide who have died of AIDS since the epidemic began. During 2000, it is estimated that 3.8 million people became infected with HIV in sub-Saharan African and 2.4 million died.
Nevertheless, population growth is expected to continue because of continued high fertility. Even in Botswana, where HIV prevalence is 36 per cent, a 37 per cent population increase is projected by 2050.
These figures make me gasp. But they conceal rather than express the human tragedy and suffering that lies behind them. They do not say that a woman dies every minute as a result of pregnancy. They do not talk of the families destroyed by AIDS. They cannot tell us of the 2 million girls between 5 and 15 who are introduced into the commercial sex market each year, or the 2 million at risk of female genital mutilation.
The figures do not speak of the implications of rapid population growth for the world's environment. Nor do they say anything about how environmental change, for example climate change, will affect the lives of people in poor countries.
But we should and must speak of these things. The countries which met at the Cairo conference were very clear that stabilising population growth is in our best interest, and the interest of the planet we live on: and they were equally clear that stable population growth will only be reached through the choices of each one of us, acting of our own free will.
Girls are not free if they cannot go to school. Women are not free if they are expected to marry early and bear many sons. Women whose every pregnancy is a death threat are not free. HIV/AIDS spreads in many cases because women are not free to make their own decisions about sex.
Women today want fewer children than their mothers did. Will they be free to act on their preference? Men today increasingly want to be full partners in the family, starting with decisions about family size. Will they be free to make that choice?
All vibrant cultures change, and in today's world, cultural change is faster and more profound than ever before. Accepting the need for change and making sure that changes are positive will do more than anything to set people free to choose.
Finally let me say that Marie Stopes International is one of UNFPA's most valued partners in the great work we are doing together. You are the heirs to more than Marie Stopes's name. MSI's horizons are global, just as Marie Stopes's were. MSI has Marie Stopes's courage and conviction. Like your founder, MSI is used to blazing trails and taking the heat of criticism. Your role is to lead, to show the way where others can follow. You help to ease suffering, but you also help open the way to opportunity. Women look to you for help, and for hope. You have a worthwhile, and, I would say, a noble role. I wish you all the best for your next 80 years.