Promoting Maternal Health and Empowerment of Women in Diverse Cultural and Religious Settings

2 December 2009
Author: UNFPA

Honourable participants,
Colleagues and friends,

It is wonderful to be here in Melbourne with all of you. I would like to thank Australia for hosting the Breakthough Summit for Asia and the Pacific.

Last year I had the pleasure, and privilege, of attending the first Breakthrough Summit at the majestic Washington Cathedral in Washington D.C., and, I must admit, it was a dream come true for me.

Why Women, Faith and Development?

For a long time, I shared the vision of bringing together the three communities of women, faith and development and it seemed like I was a lone voice in the United Nations.

But I persisted because we can accomplish so much more when we join hands and work together, respecting each other’s mandate and reaching common ground. UNFPA’s State of Population Report for 2008 was about reaching common ground among the very actors who are the heart of this conference.

I would like to share some of my impressions from last year’s global Breakthrough Summit which overlap with UNFPA’s engagement in such an alliance, and our unique global Interfaith Network for Population and Development.

It was at the Washington DC Summit where the Women, Faith and Development Alliance launched its international action and advocacy campaign to end global poverty by empowering girls and women. Mary Robinson, Co-Chair of the Summit, called this a “true integrated alliance of unprecedented public action”.

Participants announced commitments to take this work forward. On behalf of UNFPA, I announced last year a commitment of US$500 million dollars–the goal for the UNFPA Maternal Health Trust Fund to improve the health of women and mothers. Today, it is my pleasure to announce UNFPA’s commitment from the Regional Programme for Asia and Pacific totalling US$ 19 million for the period 2008 to 2011.

There were many highlights at the Washington, D.C. meeting but, to me, one of the most touching was the video message of Archbishop Desmond Tutu. He said that, “religion has too often been used as a tool to oppress women…and too often we have not named, and condemned roundly, culturally and traditionally rooted discriminatory practices like child marriages, genital mutilation, and violence against women and children”.

It was important to come together, he said, “as people of faith, and stand up for women and girls by addressing these issues from every pulpit and platform in the synagogues, mosques, churches and other places of worship.” He further underlined the spirit of the Alliance when he called for the interfaith community to join with leaders in other sectors to demand more resources so that – and I quote again – “women and girls can change their own lives and those of their families and their communities”.

Yet, I often hear from some women’s groups and activists that they do not appreciate UNFPA’s partnership with development oriented faith-based organizations (FBOs). We at UNFPA have learned from over 60 years of development experience that change has to find roots in people’s minds, behaviours, language and interactions. For change to be effective, it must be catalysed and owned by the people and their institutions in which people believe, to which they are attached, and which often provide them with many of the basic health and education needs - often in the absence of public services.

There is also a misperception that FBOs are all against the empowerment of women and gender equality including the right to sexual and reproductive health. In reality, FBOs are not monolithic; they play different roles and have diverse positions on culturally and religiously sensitive issues such as sexual and reproductive health.

In UNFPA, we noted that the international debate on reproductive health and rights and gender equality was, and still remains, rarely technical - it was and remains about beliefs and values. Therefore, we must understand culture (including religion) as it affects human experiences and lives, and support communities to bring about positive change from within.

And this is what is so special about this Alliance - women, faith, and development. You have certainly closed the circle for what is needed to respond in a comprehensive way to women’s needs in many developing communities - including the Asia and Pacific region.

And that is why I am delighted to be here with all of you to take this powerful partnership and vision forward together in this region — in concrete and inspiring ways to create hope and bring about change.

Gender Equality and Maternal Health

Today I will address two shared development priorities: advancing gender equality and improving maternal health, which are organically linked to one another. The loss of women’s lives is a human right violation.

We, Faith, Women and Development Alliance, can no longer accept that half a million women die every year from preventable complications of pregnancy, childbirth and unsafe abortion—one woman every minute. No woman should die giving life.

We can no longer accept that women constitute 70 per cent of the world’s poor.

We can no longer accept that women and girls are routinely subjected to abuse and violence that threatens to break their hearts, minds, bodies and spirits.

We can no longer accept that millions of girls are missing because they have been eliminated due to son preference.

We can no longer accept that women continue to be under-represented in parliaments and government, where their perspectives, experiences and voices need to be heard.

When human rights are being violated on a massive scale, we, Faith, Women and Development Alliance, have to take concerted action.

We are gathered here in Melbourne because we believe that time is running out for promoting the rights of all human beings, especially girls and women in diverse communities, who are often the most vulnerable of all. We know what can be done and we must ensure the necessary change comes from within.

Principles of Engagement

We at UNFPA recognize the need to work through positive values that exist in all countries and in all cultures to realize further progress. We have learned through country experiences that culture matters. And, therefore, we are committed to deliberately, systematically and strategically institutionalizing a culturally sensitive approach to development.

Our work on culture (which is where we locate religion) is based on eight principles:

  • Principle 1 is that cultures are the realities within the contexts in which development takes place and that people seek religious leaders and institutions for guidance, comfort and support.
  • Principle 2 is that people are the products of their culture and also its creators. As such, they are not simply passive receivers but active agents who can reshape cultural values, norms and expressions.
  • Principle 3 is that cultures are neither static nor monolithic. Every culture is characterized by diversity, contestability and private and public space for mediation and negotiation and diverse interpretations. This also includes interpretations of religious texts that are made by “men” and I mean “men” and that can be changed by the engagement of both men and women of faith.
  • Principle 4 is that cultures have a strong impact on the social sectors and on social relations, but especially on gender power relations.
  • Principle 5 is that it is through change from within societies/communities that cultural norms, traditions and expressions are changed.
  • Principle 6 is respect for cultural independence and cultural diversity with the acknowledgement that change can be mediated in favour of human rights and gender equality.
  • Principle 7 is that cultures and religions share common denominators with universal standards, such as human equality, compassion and tolerance and that their manifestation and/or interpretations can be a force to promote or obstruct human rights.
  • Principle 8 is that human rights can be recognized and internalized through a culturally sensitive approach that gives social basis and support to the legal approach and that builds on positive cultural values and religious interpretations that strengthen human rights principles.

Success, we have learned, requires patience, a willingness to listen carefully, a respect for cultural diversity, and learning to find different ways to express culturally-loaded issues. The point is that we cannot achieve human rights for people; achieving human rights is the responsibility of the people themselves, but we can support their efforts in this process.

Three youth participants at the Breakthrough Summit last year ended their presentations by saying “we want to make a difference, and the difference starts with us”.

MDG 3: Empowerment of women and gender equality and MDG 5: Improve maternal Health

Millennium Development Goal 3 to advance women’s empowerment and gender equality, and MDG 5, the mother of all MDGs, to improve maternal health and reduce maternal mortality, are intrinsically linked to each other. For as long as women are not valued, maternal health will suffer. And as long as women cannot determine the timing, number and spacing of their children, gender equality and the empowerment of women will not be achieved.

We are here in Melbourne because we believe that maternal death and disability is one of the greatest moral, human rights and development challenges of our time. It is impossible to achieve the empowerment of women and gender equality if the simple right of women not to die from preventable complications of pregnancy and delivery is not achieved.

Governments have agreed to guarantee universal access to reproductive health; this basically means the empowerment of women to make decisions about all matters related to their own lives, beginning with their right to determine the timing, number and spacing of their children. This includes having access to a package of comprehensive services that meet their needs, including safe motherhood, family planning, and HIV prevention, treatment, care and support.

But although there is agreement at the global and national levels, challenges requiring greater change at the community level, remain. These challenges underline the need for us to come together as partners from the women’s movement, the faith groups, and the international development sector, to support the engagement of communities in demanding, effecting and sustaining this change.

Concerted Action to Improve Maternal Health

Because no woman should die giving life, UNFPA is intensifying action with partners to achieve MDG 5 and universal access to reproductive health by 2015.

We are proud of our collaboration in the so-called H4 health partnership, where UNFPA, UNICEF, the World Health Organization and the World Bank - and now to be joined by UNAIDS – have come together at the global, regional and country levels to accelerate progress to save the lives of women and newborns, and to promote transfer of knowledge from one country to another. And we are also proud of our collaboration with parliamentarians, civil society and faith-based organizations – the substance of this Women, Faith and Development alliance.

Progress is being made in many countries around the world, including those in this Asia-Pacific region.

In Nepal, the Government will scale up free maternity services. This will enable a million and a half women to have a safer delivery over the next 5 years.

In Bangladesh, the rates of child and maternal mortality were cut by half in the past decade due to concerted efforts by the government, in partnership with international development actors and civil society.

In Cambodia, Buddhist monks and nuns are working to promote reproductive health and HIV prevention among adolescents and they are joined by several international NGOs as well as various local partners. Also in Cambodia, midwives are being retrained and employed to make childbirth safer. Experience shows that this cultural practice of relying on midwives can be harnessed with the right training, to continue to provide life-saving services.

In India, political, community, civil society and religious leaders have joined together to address India’s Missing Daughters and take action against Sex Selection.

In Indonesia, Muslim leaders and Islamic institutions for population, reproductive health and gender equality issues are partnering with pasantren (Islamic boarding schools) to address gender-based violence.

In Pakistan, partners are working together across sectors to address sensitive issues such as honour killings.

In Papua New Guinea, UNFPA is working with partners such as the YWCA, the National Council of Women, the Catholic and Anglican Churches, the Seventh Day Adventist Church, the Salvation Army and the Marie Stopes International Australia to raise awareness of reproductive health for adolescents and young people.

In Sri Lanka, UNFPA supports Muslim, Hindu and Christian faith-based organizations and religious leaders to promote reproductive health and rights and gender equality, and to end violence against women. Efforts focus in part on promoting the positive role and responsibility of men.

Much of this progress is attributed to community engagement and mobilization, including the participation of religious leaders—35,000 imams and more than 3,000 Hindu and 300 Buddhist leaders are now trained on issues of reproductive health and rights, AIDS, and gender equality.

In every region, exciting things are happening. But it is not enough. Of all the MDGs, MDG5 is the goal lagging the furthest behind, representing a glaring deficit in social justice and equity.

Today maternal mortality is the world’s largest health inequity. Women who are poor and young people have the least access to needed services. While most countries in this region have made progress, many will fall short of the MDG target to reduce maternal mortality by 75 percent by 2015. Of particular concern is South Asia, which has the highest maternal mortality ratio outside of Africa; and the lowest proportion of births assisted by skilled health personnel. Also of concern are some parts of the Pacific, where progress is also lagging.

We know what works and needs to be done. And with just five years remaining in the countdown to 2015, we need urgent action.

I am optimistic because compared to just a few years ago, women’s health has gained increased attention and there is growing momentum. Men leaders are now speaking out for maternal health and against maternal mortality as a human rights violation. It has strongly resurfaced on the political agenda.

I believe that we have reached a unique point in time. If we commit ourselves to support and expand many ongoing concrete actions, we will finally see the curve of maternal mortality steadily decline.

I have three main messages to tip the scale toward maternal health:

My first message is that improving maternal health and achieving the empowerment of women is a political decision at all levels from households to parliaments to the presidential palaces. To save the lives women, we must scale up and deliver a comprehensive package of sexual and reproductive health information, supplies and services.

This includes services for safe delivery such as skilled attendance at birth and emergency obstetric care, as well as HIV prevention and one of the most cost-effective interventions in development—family planning.

Women are the weavers of the fabric of society, and targeted investments in reproductive health have a dramatic and lasting impact on the status of women as well as economic and social health of their families, communities and nations.

On the other hand, if we fail to meet our targets on maternal health, we will never overcome poverty and illiteracy, reduce child mortality, achieve universal education and gender equality, and meet other development challenges.

Now to my second point, leadership and resources will mean the difference between success and failure.

A health system that can deliver for women when women are ready to deliver is a health system that will benefit all.

We know what it would cost to meet our goals and, sadly, we know the cost of too little action.

During this decade, funding for reproductive health including family planning has remained at the same level while funding for other areas of health has increased substantially. To move ahead we must match growing momentum with rising resources. And we must place maternal health and MDG 5 at the centre of global health initiatives, health system strengthening and funding mechanisms.

It would cost the world $23 billion per year to fund reproductive health including family and maternal health. This amounts to less than six days of global military spending.

And this brings me to my third point – solidarity and partnerships are the only way forward.

Solidarity and partnership brought governments and partners together 15 years ago at the International Conference on Population and Development, and they agreed for the first time that everyone has the right to sexual and reproductive health.

Solidarity and partnership brought about significant milestones during the past 15 years.

In South Asia, primary enrolment increased from less than 80 per cent to 90 per cent during this decade; in the Pacific primary enrolment increased significantly in most countries; South-East Asia, primary school enrolment has remained at 94 per cent during this time; in East Asia, primary enrolment rose from 95 to 99 per cent from 2000 to 2007.

The gender gap in education is getting smaller. In South Asia, girls’ primary enrolment in relation to boys jumped from 84 per cent to 95 per cent this decade; in the Pacific, gender parity rose from 89 to 91 per cent; in South-East Asia gender parity is nearly achieved having risen from 96 to 98 per cent, and gender parity has been achieved in East Asia.

Moreover, the proportion of deliveries attended by skilled personnel in South-East Asia rose from less than half in 1990 to nearly two-thirds in 2006. For most of the Pacific islands, this figure is in excess of 88 per cent. In East Asia, 98 per cent of all births are now attended by skilled health personnel.

And we know that rates of maternal mortality have declined. East and South-East Asia showed declines of 30 per cent or more between 1990 and 2005, though progress has been insufficient to meet the target. South Asia reports a decline of more than 20 per cent over the same period (having said that, the number of deaths in that sub-region still remains unacceptably high). The Pacific reports a decline of 16 per cent in maternal mortality in the past 15 years.

Progress is also being made to address AIDS. Today stronger action is being taken to link policies and programmes for HIV and AIDS and sexual and reproductive health to save more lives. And gender and reproductive health are now addressed more than ever before in humanitarian response benefiting displaced persons and refugees.

In every country in this region, partners are joining together to improve the health and well-being of women and girls.

Our challenge is to ensure that programmes are scaled up to reach those most in need. This includes the poor and rural and marginalized populations, including adolescents, refugees, migrants, displaced, people living in slums and people living with HIV. We need to address persistent inequities, stigma and discrimination.

We know we still have a long way to go, but we have also witnessed how solidarity and partnership propel us forward. The greatest challenge can be overcome when people are united by a common cause – as this Alliance is capable of meeting this challenge.

UNFPA looks forward to working with all of you to advance women’s empowerment, gender equality and the right to sexual and reproductive health.

Thank you.

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