The power to say yes, the right to say no,

29 March 2021

Guest lecture at the London School of Economics 

Hosted by the LSE Global Health Initiative



Thank you, Dr Rishita, for your kind introduction, and my thanks to the London School of Economics Global Health Initiative. It is a pleasure to be here with all of you.

Somewhere today at this moment…

…an adolescent girl is waking up. She’ll discover she is expected to undergo a rite of passage, forever to be wounded by female genital mutilation (FGM).

…another girl is being told to get dressed because today will be her wedding day. She’s scarcely 13 years of age.

…and a woman has been walking for a couple of hours, headed to her village health centre to seek contraception. When she arrives she’ll be sternly informed that there will be no prescription without her husband’s consent.

Allow me then, to get straight to the heart of the matter: Who is the owner of a girl’s body? Is a woman’s body her own? Is it her right to say yes or say no?

I’ve just returned from a humanitarian mission to Yemen, where I spoke to young girls and pregnant women who had to flee for their lives and seek protection at a UNFPA-supported shelter. They told harrowing stories of over six years of grinding conflict, now made worse by Covid-19 and a looming famine. Families are desperate, and many are marrying off their daughters very young.

I met Alea. At 13, she was given to a 30-year-old man. “When I told my father I didn’t want to get married,” she told me, “he said by getting married I would have a better life. But my life only got worse.”

She complained when her husband sold off her wedding jewelry. In response, he beat her. When she ran back to her father’s house for protection, he beat her too and chased her back to her husband. “I had nowhere left to go,” she said.

Fortunately, a kind neighbour phoned the UNFPA supported hotline and helped Alea escape. Now Alea lives at the locally run UNFPA shelter, where she attends training workshops and receives psychosocial support to help her recovery. She dreams of returning to school one day.

Her story is not unique. It’s one I heard repeatedly from girls in Yemen, and time and again in many countries around the world. In essence, the abrupt disruption of the lives of women and girls whose bodies have not been respected as belonging to them.

A recent UNFPA study in 57 developing countries found that nearly half of women lack the power to make their own decisions…

...About whether to have sexual relations with their partner.

...About the use of contraception.

...Or when to see a doctor or nurse.

Often these very intimate decisions about their own bodies are taken out of women’s hands by another – their male partner, their family, their societies – even their governments.

Fundamentally, bodily autonomy is about power and agency; it’s about choice. Above all, it’s about human dignity.

Intertwined is the right to bodily integrity — the ability to live free from physical acts to which one does not consent.

It’s gratifying to see the significant gains in advancing such rights in recent decades.

Today, more women than ever have access to modern contraception. More girls attend school. More communities are abandoning child marriage, female genital mutilation and other harmful practices.

I applaud the increasing activism to stand up to end sexual harassment and abuse – from the global “Hands Off” and “MeToo” movements to important local campaigns like “Don’t Look Away” in Sri Lanka, aimed at calling out harassment on buses and public transport.

These growing movements show us that change is possible, that UNFPA’s goal of an end to gender-based violence by 2030 and the United Nations Secretary-General Antonio Guterres’s call to Member States for ‘peace in the home’ are within reach.

Still, for too many, especially women and girls, life is fraught with violations of their bodily autonomy and integrity.

We see the desperation when a lack of contraceptive choice leads to unintended pregnancy.

We see it in the unspeakable, intolerable bargain to exchange unwanted sex for a home, food or aid.

We see it in life-derailing practices such as child marriage.

Autonomy is violated when someone of a diverse sexual orientation or gender identity cannot walk down a street without fear of assault or humiliation.

When someone with a disability is stripped of their right to self-determination, to be free from violence, to enjoy a safe and satisfying sexual life.

Some violations, such as rape, may be criminalized but not always prosecuted. Others go unchallenged, reinforced by community norms, practices and laws.

Marital rape remains legal in 34 countries. And in some places, a rapist escapes penalty by marrying his victim.

During war and conflict women’s bodies literally become a battleground. Rape and sexual slavery are horrifically being used as tactics of war.

And if you’re paying attention you know that femicide, deaths of women too often at the hands of a domestic partner, is rampant — as is impunity for the perpetrators.

Now COVID-19 is setting women back even further. Sexual and gender-based violence has skyrocketed around the world. Child marriage, female genital mutilation and adolescent pregnancy, once receding, are again on the rise.

UNFPA projects that progress towards ending gender-based violence and female genital mutilation could be reduced by one third due to the pandemic.

The far-reaching economic consequences of the pandemic have disrupted programmes to end child marriage by 2030. This could result in an additional 13 million child marriages that otherwise would not have occurred.

Overstretched health systems find it too easy to scale back sexual and reproductive health services, often deemed less essential. At times, Covid-related movement restrictions and fear of infection keep women from seeking care they need. UNFPA estimates almost 12 million women lost access to family planning services since the pandemic began, already resulting in almost one and a half (1.4) million unintended pregnancies.

Analysis of six countries in Latin America and the Caribbean shows it is adolescent girls who face the greatest barriers in accessing services, leading to projections of half a million additional teen pregnancies over the course of the pandemic.

Within Africa, Kenya and other countries already have seen spikes in teenage pregnancy. School closures and movement restrictions leave girls more vulnerable to sexual coercion and violence.

As children stay home and family members fall ill, it is women who bear the burden of care. Economists report women increasingly dropping out, rolling back decades of hard-won progress in women’s labour force participation.

Even before the pandemic, every single day women and girls were logging some 12 billion hours of unpaid care work around the world — three times more than men. None of it accounted for in GDP.

When women have an income, abundant evidence shows they, more likely than men, will invest in their families and communities, thereby strengthening economies and making them more resilient. Supportive policies that enhance women’s opportunities and empowerment make sense, to the benefit of everyone.

The realization of bodily autonomy is at the heart of sexual and reproductive health and rights and all we do at UNFPA: it’s our purpose. It’s also the topic of our flagship State of World Population report this year, which we’ll release on April 14.

Bodily autonomy is a pre-condition for reaching UNFPA’s three ambitious aims – our three zeros – by the year 2030: zero unmet need for family planning, zero preventable maternal deaths, and zero gender-based violence and harmful practices. All based on quality census and survey data to ensure that no one is left out or left behind. These three zeros, again as regards: contraception, mother and newborn survival, and an end to sexual and gender based violence — underpin the whole of gender equality and they bear on world success in achieving all of the 17 Sustainable Development Goals.

As the United Nations sexual and reproductive health agency, UNFPA’s programmes are guided by the Programme of Action of the ICPD, the International Conference on Population and Development, which was adopted by member states in Cairo in 1994. It made empowerment and autonomy of women a basis for global action towards sustainable economic and social progress.

As the world’s largest provider of donated contraceptives in low- and middle-income countries, UNFPA works to strengthen health systems and to dismantle barriers to services. I’m proud that we are leading advocates for youth-friendly services, because for young people who do wish to act responsibly, information about sexuality and reproductive health is empowering.

The nurses and midwives UNFPA trains and deploys, in my opinion, are heroes, true angels on Earth. They willingly cross rivers and move mountains, to make life-saving reproductive health services more accessible and affordable to women, even in the most remote and underserved areas.

Working jointly with UNICEF and with civil society groups and the private sector, we are helping end practices like child marriage and female genital mutilation to uphold girls’ autonomy and protect them from violations of their bodily integrity.

Part of the solution is girls confidently knowing they have rights from an early age. UNFPA advocates for girls to complete their schooling, including comprehensive sexuality education. Girls and boys, too, must know about healthy relationships and consent, and must be equipped with the vital knowledge to protect themselves from unintended pregnancy, all too commonplace violence, and HIV and other sexually transmitted infections.

And during times of crisis, UNFPA leads coordination of the humanitarian community’s gender based violence prevention and response efforts.

We are passionate and relentless in our advocacy for greater progress because, despite gains in advancing sexual and reproductive health and rights and bodily autonomy in recent decades, the pace of change is not fast enough. We simply can’t afford to wait another 25 or 50 years!

At the recent Nairobi Summit commemorating the 25th anniversary of the Cairo ICPD, leaders from around the world — from presidents to the grassroots, youth activists to private sector CEOs – pledged to pick up the pace. They envisioned a world where every pregnancy is intentional because every woman has voluntary access to the contraceptive she wants, and where no woman dies giving life. They foresaw an end to violence and practices that harm women and girls. And they made more than 1250 concrete commitments to turn that vision into reality.

The march from Cairo to Nairobi continues onward. The movement for universal sexual and reproductive health and rights and bodily autonomy gains further momentum this year, as the Generation Equality Forum in Mexico and France accelerates progress since the historic Beijing Women’s Conference in 1995.

Gender inequality is a most insidious and pervasive impediment to bodily autonomy.

Gender-unequal norms and attitudes buttress the power imbalance that constrains women’s autonomy. Those norms and attitudes drive the expectation that women will defer to their husbands or partners, in all aspects of their lives.

We see these harmful norms and attitudes reverberating in the increasing political pushback against women’s rights. The personal ‘is’ political.

Issues even tangentially related to gender equality and sexual and reproductive health and rights do not have universal buy-in, shall I say, and are perpetually subject to intense negotiations in multilateral spaces.

We see growing polarization, rising populist nationalism — and the space for civil society participation, including women’s rights groups, ever shrinking. More and more we witness regressive forces coming together to counter progress for women and girls, whose health and rights are being traded in a game of geopolitical football.

Yet, despite the strong headwinds in many places, there is a stronger movement pushing forward – of governments, civil society and grassroots activists, business and community leaders, and faith-based organizations. The energy and commitments coming out of the Nairobi Summit speak to it. And we see it in the follow-up actions to make commitments to women and girls real where it matters most, in countries, on the ground.

The UN Secretary-General has called for a renewed and inclusive multilateralism to meet the complex global challenges we face.

There is optimism.

When women and girls are able to make the most fundamental choices about their bodies, they gain in terms of autonomy, yes, but society gains also, through advances in health and education, income and safety. These add up to a world of greater justice and human well-being, which benefits us all.

So how can we ensure that everyone is able to exercise these fundamental rights and choices?

First, uproot the harmful attitudes and gender norms that hold women and girls back. This requires slow, steady work in community after community. But it is possible – and it is happening.

London writer Justina Kehinde laid down the challenge in her poem for the International Day for the Elimination of Female Genital Mutilation this year. Quoting her:

“Not everything we inherit is a gift to be passed on.
We gain more than we lose when we choose to move on."

Another thing: Women and girls must claim their rights. States must uphold these rights. And men must be willing to step forward and step away from dominating roles that privilege their power and their choices over women’s.

Adolescent boys will need far more positive notions of what constitutes manhood during a time of life when harmful gender norms start to crystallize.

As the writer Chimamanda Ngozi Adichie puts it: “Masculinity is a hard, small cage, and we put boys inside this cage.”

I believe it’s long past time to free boys from it. Comprehensive sexuality education for boys, age appropriate, instills the values of respect, equality, and consent.

In UNFPA clubs in Zambia, adolescent girls and boys can safely express their fears and aspirations, and learn how to better relate to one another.

In Niger and across West Africa, UNFPA runs very popular community ‘husbands’ schools’ that constructively engage men and boys, and cultural and religious leaders, in support of family planning and women’s participation.

In Georgia, UNFPA supports a programme called MenCare, which promotes men’s involvement as loving fathers and equitable household caregivers.

In the Sahel region of West Africa, UNFPA and the World Bank partner with local communities to support women’s economic empowerment. The countries involved reap a ‘demographic dividend’ through a package of interventions to keep girls in school while delaying marriage and childbearing.

Research tells us that for every $4.60 invested in an adolescent girl’s physical, mental, sexual and reproductive health, the return is at least 10 times as much, in benefits to society.

Lastly, action is needed to tackle laws and policies that reinforce discriminatory norms.

In the Republic of Korea, for example, reforms in labour laws were a key driver in shifting old norms about son preference, the value of girls, and age of marriage.

Most economies are structured to concentrate resources and decision-making in a few privileged “hands of Adam,” hands that mostly belong to men.

The #MeToo movement, and surveys, show us just how bad it is for women in terms of choice and autonomy, when it comes to their power to say no.  Ending impunity for sexual violence and harassment in all forms is essential, and overdue.

Women’s empowerment and autonomy require substantial and sustained investment. National gender equality action plans and institutions remain chronically underfunded. True also for women’s groups on the front lines of providing vital protection services that assist survivors of gender-based violence.

UNFPA, Johns Hopkins University and other academic partners estimate that it will take investments of around 264 billion US dollars (or just over $26 billion a year) to achieve the ‘three zeros’ — to end the unmet need for family planning, stop preventable maternal deaths, and end gender-based violence by 2030.

Of this $264 billion sum, only $42 billion is currently projected to be provided by donors. That’s in the form of usual development assistance over the course of the next decade.

This means that the remainder, the new investment of $222 billion, would need to come from a combination of shifts of domestic government spending, additional international development assistance, the private sector, civil society and philanthropy. These resources likely will be even harder to come by as countries grapple with the economic fallout of COVID-19.

The impact of the pandemic on aid budgets and other types of development assistance is not yet clear, but there are worrying signs.

According to the OECD Global Outlook on Financing for Sustainable Development 2021, private financing has already collapsed – falling $700 billion in 2020.

While ODA specifically to the sexual and reproductive health sector saw gradual increases over the years, it peaked in 2017 at a little over 11 billion USD, and by 2019 support had fallen back to just under US$8 billion.

The United Kingdom, in recent years UNFPA’s largest and most steadfast bilateral donor, just announced cuts to its global aid budget. While thankfully the UK remains a strong political supporter of UNFPA and our sexual and reproductive health and rights mandate more broadly, the budget cuts will be felt keenly by UNFPA and reverberate throughout the sector.

This economic and financial uncertainty is why we strive to get the partnerships piece of the equation right. For UNFPA, we build on our relationships with governments, international financial institutions, with communities and the private sector to help countries unlock and implement the financing that’s so needed by vulnerable women and girls.

Data is also key. It is said that only what gets measured gets done. If so, there is cause for concern when it comes to bodily autonomy.

Just 13 per cent of countries have a dedicated budget to collect and analyze gender statistics, an information gap, an information abyss really, that makes it difficult to develop services and policies to effectively support gender equality and autonomy.

Issues like gender-based violence and unpaid care work remain invisible, under the radar, uncounted and unaddressed. Gender-disaggregated data for adolescents, and for socially excluded girls, are particularly scarce.

Data invisibility also affects LGBTI people of sexual diversities, people with disabilities, and anyone who is discriminated against or denied autonomy because of their race, ethnicity or economic status.

We can do better. Governments, social and economic institutions, communities, families and men can all do better. I will challenge you, to please challenge discrimination wherever and whenever you encounter it. Don’t be complacent about it and don’t be complicit.

It also means keeping up pressure on governments to act, and holding leaders accountable for making good on commitments to gender equality, to official development assistance and domestic spending.

I’m so happy about the presence of so many young people here today.

Use your power. You are more connected than any generation before you, and your voice and channels raise awareness, challenge harmful attitudes, norms and practices, and you’re vociferous in your demands for inclusion, equality and change.

Your commitment to social responsibility and ethics, to climate action, to making societies and the world a better place, inspires me and reassures me that we will succeed in living our values.

Transforming the balance of power and upholding individual human rights. That’s fundamental to our common humanity — and as a matter of practice, also essential if we are to conquer today’s biggest challenges – from poverty and inequality to sexism, racism and the climate crisis. Whereas these challenges historically are the result of decisions taken primarily by certain men, always they have had a disproportionate impact upon women and girls. Therefore, women and girls know what works – and they must be fully part of the solution.

The power to say yes, the right to say no. My purpose today was to convince you to help stop the annihilation of the spirit that lack of bodily autonomy represents for women and girls. I pray I’ve succeeded.

Working hard for full equality for all of us in all our beautiful diversities, the United Nations stands with you, walking the path to peace, towards a safer and more just world. A world where all peoples live in dignity, where a girl wakes up knowing that she alone owns her body, that her society will protect her, that as she says Yes to the future that beckons, it’s a future that is hers to determine.


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