Protecting Women's Reproductive Health and Saving Women's Lives

Global Health Council Directors' Policy Dialogue Dinner

It is my pleasure and honour to join you today.

I would like to thank you for organizing this dinner and bringing us together tonight.

I would also like to express my gratitude to all of you for your continued support to UNFPA, the United Nations Populations Fund. My colleagues and I are very pleased to work with you. It is nice to be surrounded by friends in this capital city.

We are here tonight to discuss how best to make our collective efforts for reproductive health and rights more effective.

And I would like to focus on five key areas:  

1. Follow-up to September’s 2005 World Summit, where Heads of State and Government reaffirmed the Cairo goal of universal access to reproductive health by 2015 and linked it to the achievement of the Millennium Development Goals (MDGs); 
2. The unfinished agenda of family planning and the need for stronger advocacy, resources and programmes in this critical area;
3. Better linkage of sexual and reproductive health and HIV/AIDS—this is extremely important as we gear up for the AIDS Review next week in the United Nations General Assembly,
4. How to scale up our work on safe motherhood, averting maternal deaths and disability, and preventing and treating fistula; and
5. Underlying all of this, reproductive health commodities and making sure there is an adequate supply and that national systems are in place for sustainability.

I believe these are key issues as we move towards the deadline of 2015. I also believe that we should focus more on adolescent sexual and reproductive health, particularly younger adolescents. And tonight, I will address all of these issues briefly within the context in which we are working—in an environment where ideology sometimes trumps science, where it sometimes seems that we take one step forward and one step back, and where United Nations reforms and changing systems of funding and operating—with health-sector reforms and more assistance going directly to governments—present new challenges and opportunities for all of us.

Follow-up to the World Summit,

Let me start with follow-up to the World Summit.

As you know, we registered a great success at the Summit. Explicit mention of reproductive health per se was the missing link in the MDGs, and now it is back on the agenda. This is good news. Thanks to all of you, we did it! The Cairo goal was reaffirmed at the highest level. Guaranteeing reproductive health was linked to achieving the MDGs to reduce maternal mortality, improve maternal health, reduce child mortality, promote gender equality, combat HIV/AIDS and eradicate poverty.

And world leaders also agreed that this goal should be integrated into national development and poverty reduction strategies.

I can assure you that UNFPA is working with countries in every region to make sure that the reproductive health goal is integrated into national plans, strategies and budgets. This is a top priority for us right now.

The other priority is getting the reproductive health target added to MDG 5 on improving maternal health. We are hopeful, and have every reason to believe, that the target will come. That is why I am being cautious in certain areas in the lead-up to September when the target will be introduced. The point is that we have to be strategic and keep our eyes on the prize.

Family Planning: The Unfinished Agenda

The second priority is family planning. It seems we are somewhat victims of our own success. But there is still great unmet need, which needs to be addressed urgently. Today, 200 million women want to plan or space their births, but do not have access to family planning services. This is causing the numbers of unwanted pregnancies and abortions to climb, putting the lives of women and children at risk.

The need is particularly acute in sub-Saharan Africa, where one in four married women wants to use family planning, but has no access.

Overall it is clear that, while resources for population assistance are increasing, the majority of resources are mobilized by a few major donors, and there has been a pronounced shift towards funding for HIV/AIDS at the expense of other vital population activities. During the past decade, funding for international family planning has dropped from more than half of all spending on population assistance to less than 10 per cent.

And there is another issue—the contra-contraception movement that is evolving in the culture wars alongside the movement against abortion. You probably saw the cover story on this in The New York Times magazine a couple of weeks ago. The point is that here in the United States, there is a small, but motivated group of people who are working to deny access to contraceptives—through pharmacists and political policies—arguing that contraception equals abortion. So, this is something that we have to monitor and address with strong advocacy.

In the article, a senior public-policy associate at the Guttmacher Institute said: “Ten years ago, the fight was about abortion. Increasingly, they have moved to attack and denigrate contraception. For those of us who work in the public health field, and respect longstanding public health principles—that condoms reduce sexually transmitted diseases (STDs), that contraception is the most effective way to help people avoid unintended pregnancy—it’s extremely disheartening to think we may be set back decades.”

Clearly, we have to continue to argue that being able to plan one’s family is a human right, as is the right to make use of scientific advances, and that access to family planning improves the health of women and babies, and reduces recourse to abortion. We also have to ensure that information and services reach women so that unmet need is addressed.

We have to remind people that family planning is one of the three interventions scientifically proven to reduce maternal and infant death. And we have to argue with evidence that family planning services need to be linked to services for HIV/AIDS, which brings me to my third point, which is better linking sexual and reproductive health and HIV/AIDS.

Linking Sexual and Reproductive Health and HIV/AIDS

We know that the vast majority of new HIV infections are transmitted through sexual contact, childbirth or breastfeeding. We also know that women are at increasing risk. The feminization of the epidemic has been apparent for many years and it is only getting worse. Clearly, we need to do more in this area and there needs to be much more commitment at the highest levels. For many women in Africa, the first time they find out they are HIV-positive is when they are in a maternal health clinic, pregnant.

So, clearly there is a need to better link sexual and reproductive health policies and interventions with those dealing with HIV/AIDS. While we have made some progress in this area, we need to do more.

In partnership with others, UNFPA has produced a framework for priority linkages and we will soon issue a report based on case studies in four countries (Haiti, India, Thailand, Kenya, and Serbia and Montenegro) where work has been done to link the two. We do have commitment from UNAIDS’ governing board; linkage is considered an essential policy action to intensify HIV prevention. These linkages are also in the current draft declaration being negotiated for the 2006 High-Level Review on AIDS next week at the United Nations. We hope it will remain in the text.

So, while we are moving forward, challenges remain. They arise when it comes to working with youth because these issues remain sensitive. So, it is necessary to continue to mobilize young people and ensure that they are engaged in policy dialogue. It is also important to mobilize adults, through an intergenerational forum, in support of young people and their right to know. As one young person told me: “Adults say we are too young to know and we, the young people say, we are too young to die.”

I know that many of you are engaged in advocacy on linking sexual and reproductive health with HIV/AIDS. We at UNFPA applaud your work and encourage you to continue to do so, so that we can have greater impact and reduce the spread of HIV infection.

I should like to inform you that some delegations are now working to delete reference to condoms from the draft declaration of the HIV/AIDS review meeting of next weeks so, we also have to keep up our efforts on this front. We have to use evidence to show the effectiveness of condoms, as the only technology presently available for HIV prevention.

The next issue I would like to address is scaling up efforts for safe motherhood and saving women’s lives 

Saving women’s lives

In this day and age, no woman should die while giving birth. Yet, as we all know too well, more than half a million do every year. We know that, in order to save women’s lives, we need to address gender inequality. Two of the key manifestations of gender inequality are discrimination and violence against women and girls. There is still not enough high-level political commitment in this area of concern. So, this remains a challenge and a focus for mobilization and urgent action.

We know how to prevent these preventable maternal deaths. I have already addressed family planning and would like now to address the two other proven interventions: skilled attendance at birth and emergency obstetric care.

Today, 700,000 more midwives are needed to provide universal access to skilled care at birth. UNFPA held a meeting recently with the International Confederation of Midwives, with whom we are working to improve national midwifery standards and help countries scale up community-based midwifery practice.

The New Partnership for Maternal, Newborn and Child Health, with which we are working, helps to support countries in developing national roadmaps for action. We are very active in this area, especially in Africa, where dozens of roadmaps have already been prepared or are currently being prepared to guide nations in reducing maternal, infant and child mortality.

I would also like to talk briefly about our Global Campaign to End Fistula because it is here, and in other places, that we are strengthening efforts for emergency obstetric care. If women had this care, they would never suffer from the devastating condition of fistula.

Today, efforts are underway in 30 countries in Africa, the Arab world and South Asia and progress is being made in raising awareness and treating those afflicted with the condition.

Last week, I was in Bangladesh, where I visited the Fistula Centre in the Dhaka Medical College Hospital. Since 2003, when the Centre was established, more than 500 women have been treated through corrective surgery, and 50 doctors and 36 nurses have been trained to treat others. The facility is still small and requires much more development, but it is a step in the right direction.

Overall, there is a need to scale up interventions and to ensure that reproductive health is not only made a policy priority, but also a programming priority, with an adequate budget. This is a challenge, given the new aid environment of direct budget support, health-sector reforms and sector-wide approaches. We have had some success in these areas in pushing reproductive health through, and we are monitoring very closely what is happening in countries so that we can learn as we go along and ensure greater success in the future.

Finally, the last issue:

Reproductive Health Commodities

Unless people have access to contraceptives, condoms and the drugs and equipment that are needed for maternal health, HIV prevention test kits and other reproductive health supplies, the right to sexual and reproductive health will not be realized.

Therefore, reproductive health commodity security is essential.

UNFPA is on the verge of launching the Global Programme to Enhance Reproductive Health Commodity Security, which we have prepared in consultation with many partners and which belongs to all of us who work in this critical area. We are working with a wide range of partners, including the Reproductive Health Supplies Coalition. We are confident that we will make greater progress in this area.

We have registered success in some countries, where there are national coordinating bodies for reproductive health commodities, where there are budget lines for commodities as well as where procurement and supply systems are being established and owned by governments. I am repeating old news when I tell you that last year, the Ministers of Health of the Economic Community of West African States (ECOWAS) decided to introduce budget lines for reproductive health commodities in their respective ministries. This was very encouraging and we should work with them to ensure that they will eventually be self-sustaining.

Yet, we all realize that there is a lot of work that remains to be done.

In conclusion, I would like to stress that we must stay strong and focused. The work we do for sexual and reproductive health and reproductive rights is extremely important for both the lives of women, men and children and for the economic development of their communities and nations.

We should all be proud of what we have achieved so far, while we strengthen our resolve to make greater progress in the years to come. I believe that if we focus on youth, and particularly younger adolescents, we will make greater progress because they are an underserved group that deserves greater attention and resources.

I thank you and look forward to our discussions.