Successful Strategies for Women’s Health and Rights: Achieving MDG5

Excellencies,

Distinguished colleagues,

Ladies and Gentlemen,

Thank you very much Anders for the kind introduction and for inviting me to Stockholm to deliver this keynote address. All of us at the United Nations Population Fund (UNFPA) value our strong partnership with the Swedish International Development Agency (Sida) and we look forward to continued collaboration.

I would like to thank Her Excellency, Gunilla Carlsson, Minister for Development Cooperation, and the Government and people of Sweden, for your unwavering support to the global effort to advance women’s health and women’s rights.

As usual, it is a special pleasure for me to be in Stockholm and with you today.

Just last week it was announced that Sweden is the best place in the world for mothers and children.

As many of you know, this was announced by the organization, Save the Children, in their ninth annual State of the World’s Mothers 2008 report. Because of your forward-looking policies, programmes and investments, Sweden tops the list of 146 countries in mothers’ and children’s health, education and economic status.

At the bottom of the list is the poor African nation of Niger. There is a distance of some 5,000 kilometres between this beautiful city of Stockholm and Niamey, the capital of Niger, but in reality the distance can seem further because we have two different stories of two different cities and their peoples.

While here in Sweden, nearly every birth is attended by skilled health personnel, only 33 per cent of births are attended in Niger.

While here in Sweden, a typical woman has nearly 17 years of formal education and will live to be 83 years old, a typical woman in Niger has less than 3 years of schooling and will live to be only 45.

While here in Sweden, 72 per cent of women are using some modern method of contraception, only 4 per cent of women in Niger are using modern contraceptives. And one child in four dies before the fifth birthday.

At this rate, every mother in Niger is likely to suffer the loss of a child. And I can assure you that even though it is far more common in Niger than it is here in Sweden to lose a mother or child, it is no less painful for the loved ones left behind.

As human beings, we share common emotions and aspirations. And these aspirations are articulated in part in a declaration that marks its 60th anniversary this year—the Universal Declaration of Human Rights. It remains a light in the darkness for individuals and groups around the world who are fighting for better lives and freedom.

The Declaration is the first international bill of rights elaborating human rights standards for all individuals. It has been translated into more than 300 languages and dialects—from Akhaz to Swedish to Zulu. And it gave birth to the international human rights movement.

Throughout the past 60 years, this movement has had many champions. One was the great Swedish leader and former Secretary-General of the United Nations, Dag Hammarskjold. He died in the name of freedom in 1961 and was awarded the Nobel Peace Prize.

He once said: Freedom from fear could be said to sum up the whole philosophy of human rights.

Yet, as we all know, freedom from fear remains out of reach for too many people. For millions of women and girls, living with widespread gender discrimination and violence, fear is a constant companion.

While loving human relationships provide happiness and security for many of us, for too many women and girls, relationships built on love, equity and mutual respect remain out of reach.

Also out of reach is basic information about their bodies, their health and their sexuality, and access to sexual and reproductive health services.

As a result, millions of women and girls live in fear, afraid of getting pregnant.

If they have an unwanted pregnancy, many are afraid to have an abortion.

Millions of girls and women are afraid of being abused. They are afraid of being raped.

Millions of women are afraid of being beaten by their partners or their husbands. They are afraid of walking outside alone.

Today, too many women are afraid of getting infected with HIV because they cannot insist on their partner using a condom.

And in too many countries, women are afraid of having a baby because they might not live through the experience.

Today, millions of women and girls wouldn’t know what it would be like to live in freedom from fear, as Dag Hammarskjold and others envisioned. They only know fear and are accustomed to insecurity.

And what is even more troubling is that many leaders are also afraid. They are afraid of speaking out about the right to sexual and reproductive health. They are afraid of talking about adolescent sexuality and sexuality education. They are afraid of talking about abortion though it is legal under some conditions in their countries. They are even afraid of speaking about the consequences of unsafe abortion.

All of these issues have become highly politicized and this stigmatizes the concept and the words of sexual and reproductive health services. And yet, it is only through dialogue that we will make greater progress for women’s health and human rights.

And I say, if a woman like me from Saudi Arabia can talk openly about sexual and reproductive health and reproductive rights, then other leaders can, too.

We have to speak out and we have to continue to do so. The right to sexual and reproductive health is essential to human development, to equitable growth and to women’s empowerment and gender equality.

When it comes to women’s health and Millennium Development Goal 5 (MDG 5), to improve maternal health, I say, No woman should die giving life. And I say, no woman should die from unsafe abortion.

We have to be strong and keep pushing ahead. I believe that we now have a solid foundation on which to build and accelerate progress.

I say this because there is clear agreement on the way forward.

There is increasing global spending on health—it is not enough, but it is a positive trend.

There are new dynamic partnerships to achieve the health-related MDGs, with a focus on aid effectiveness, increased coordination and harmonization, and national leadership.

There is increased engagement by the public and private sectors. There is so much that the private sector can do to improve the health of women, in their own operations, for the communities in which they operate and beyond. Their expertise and ability to subsidize drugs and supplies offer opportunities for greater progress.

Today, there is a welcome and absolutely vital focus on health system strengthening. And there is growing awareness and political will.

This confluence of forces is unprecedented, and it bodes well for our efforts to achieve MDG 5, to improve maternal health, and to achieve universal access to reproductive health by 2015.

However, we must be realistic. As I visit maternal wards in public hospitals and community-based service delivery points in the countries to which I travel, I find very sad conditions, reminding me that we still have a very long way to go to reach the most vulnerable.

As we focus on strengthening the health system, we must support comprehensive primary health care that addresses women’s health, in general, and maternal health, in particular, and is available, affordable and sustainable. Here, I would like to say that Margaret Chan, the World Health Organization (WHO) Director-General; Ann Venemen, the United Nations Children’s Fund (UNICEF) Executive Director; and I are committed to improving community–based services provided through primary health care.

Today, I call for a special push, on multiple fronts, across sectors to reach MDG 5, to improve maternal health. We need a broad global movement to accelerate efforts and increase investments because at the current pace, MDG 5 is the least likely of all the eight Millennium Development Goals to be met.

We need high-level visibility for the plight of women in conflict zones, where maternal deaths are among the highest.

And we need a massive push to strengthen health systems, so they can deliver life-saving reproductive health services and supplies. The evidence is now overwhelming: the number of maternal deaths will not go down until more women have access to contraceptives, to skilled attendants at birth and to emergency obstetric care. Maternal health should be part and parcel of the integrated provision of reproductive health services through the primary health care system.

The new target on universal access to reproductive health by 2015 under MDG 5 in the monitoring framework paves the way for greater progress. And we have the four corresponding indicators on contraceptive prevalence, adolescent birth rate, antenatal care coverage and unmet need for family planning.

Overall, our challenge is to support governments to build health systems that can deliver to women, when women are ready to deliver. This is essential because to reduce maternal death, all critical elements of a well-functioning health system – from trained staff, to facilities close to homes, to drugs, equipment and supplies – must be in place. There must be a continuum of care that stretches across the lifespan and from the community to the hospital. We need to support community engagement.

It is estimated that access to family planning services alone could reduce maternal death by about one third. Yet, today an estimated 200 million women who want to limit their births are not using effective contraception. As a tragic consequence of this unmet need, unsafe abortions are responsible for 13 per cent of all maternal deaths.

To improve the uninterrupted availability of contraceptives in countries, UNFPA is working with many partners through the Global Programme on Reproductive Health Commodity Security to bolster supply systems as part of health system strengthening.

While the provision of contraceptive methods does not require highly skilled staff, it does depend on trained health workers who have a supportive attitude for all clients, especially unmarried adolescents. Today, there are high rates of adolescent pregnancy in many countries. And while young women under the age of 20 face much higher risks of maternal death, they have the least access to reproductive health information and services.

In response to this situation, UNFPA has developed a global strategy that cuts across sectors to enhance the education, health, and livelihoods of adolescent girls. Such interventions empower young women, help keep them in school and help them avoid child marriage and early pregnancy. Efforts are also underway to involve men and boys as partners for equality and women’s rights.

Worldwide, there is growing awareness of the benefits of investing in women and girls. When women are educated and healthy, their children are, too. There are more women leaders. Productivity and savings increase and there is a rise in economic growth.

Together, we must address the economics of empowering women and saving women’s lives. We must come out of our comfort zones of the ministries of health and extend our dialogue with the Ministers of Finance, so that they can understand the economic benefits of investing in the empowerment and health of women.

Studies also show that poor maternal health drags down an economy. The global economic impact of maternal and newborn deaths in lost productivity amounts to an estimated $15 billion each year.

One of the major challenges to improving women’s health in many countries is the shortage of health-care workers. As I said, we need to focus on increasing access to skilled attendants at birth, at the primary-care level, combined with prompt referral in case of complications. This has been the cornerstone of success in many countries that have reduced maternal death.

There is an immediate need for more midwives in communities and I thank Sweden for its support in this effort. We also have to scale up emergency obstetric care as a life-saving priority. There are good practices worth replicating in Mozambique, Tanzania and Malawi, where non-physicians are being trained to provide obstetric care and other life-saving procedures.

We also need better integration of health services to meet people’s needs. We need stronger links between HIV/AIDS and reproductive health, to prevent HIV infection in women, to empower women to negotiate safer sex, to address the unmet for family planning in women living with HIV/AIDS, and to expand antiretroviral therapy to pregnant women. And here we still have a very long way to go and we need to speed up action at the operational level.

Many women learn their HIV status only when they are in a maternal health care facility, pregnant, or giving birth. Therefore, we need to integrate services to create better health outcomes.

We also need stronger links between malaria and maternal health. In malaria-endemic countries, 5 to 25 per cent of maternal deaths are attributed to malaria during pregnancy. However, this impact of malaria is not receiving adequate attention and has to be addressed.

I would like to stress that in all of our efforts, we have to focus on reaching the poor and the marginalized. The problem of maternal death is overwhelmingly concentrated in poor rural areas, which are often beyond the reach of the formal health system. Obstacles include lack of transport and roads and even when women do reach a facility, they often die due to lack of surgeons, lack of drugs and lack of safe blood supplies. These factors help explain the discrepancy in maternal deaths between rich and poor countries, which is the starkest statistic in public health. In Niger, the chances of dying during pregnancy and childbirth are one in seven; here in Sweden the chances are 1 in 17,400.

I believe that, at this point, we need a combination of more money, a sense of urgency and better coordination to accelerate progress and achieve MDG 5. This is why I am calling on governments and partners to make this a priority.

With all the various partnerships and initiatives underway, we really have to make sure that efforts are better coordinated and less fragmented. All development agencies and partners need to collaborate according to national plans that are country-led and country-owned, and align with national needs and capacities. As a United Nations agency, UNFPA is also committed to working with our United Nations system partners to deliver as one in support of nationally owned and led development. And we have good experiences in Tanzania and Malawi, where we support health-sector reforms through the sector-wide approach. In Malawi, there has been an increase in resources to reproductive health within the health budget and a reduction in maternal mortality. And in Tanzania, there has been a dramatic increase in national funding for contraceptives to meet unmet need. These are concrete achievements on which we can build.

I am also pleased to report that 74 countries now have their own budget lines for contraceptives.

We are making progress. Several countries, such as Mozambique, Tanzania, Malawi, India, Bangladesh, Sri Lanka, Thailand, Malaysia, Egypt and Honduras have reduced maternal mortality. Some have cut death rates in half in less than a decade. It can be done. Our challenge now is to scale up effective interventions where they are needed the most. And to do so, increased resources are urgently needed.

Today’s spending of $530 million is far below what is required. To save the lives of women and newborns, and guarantee reproductive health, about $13 billion is needed each year, rising to $24 billion by 2015. While this sounds like a lot of money, it amounts to about three days of global military spending. The resources are available; it is a matter of priorities.

I would like to take this opportunity to commend Sweden for meeting and surpassing the commitment to official development assistance of 0.7 per cent of gross national income. Now, we need to encourage other Organization for Economic Cooperation and Development (OECD) countries to meet and beat this commitment. And we need to utilize the forthcoming Group of Eight (G8) and Doha Financing for Development meetings to urge the international community to honour commitments made to the health-related MDGs, with the aim of increasing the absolute amount, predictability and resources from official development assistance. All countries should increase investments in women’s health and human rights and finance ministers should champion this cause, in line with the Stockholm Call to Action.

To generate greater progress, UNFPA has created a Thematic Fund for Maternal Health to rapidly scale up effective interventions, to develop national capacity, to address the health workforce crisis, and to ensure increasing and predictable funding.

The Maternal Health Fund is created to support national health plans. And I encourage European countries to contribute to it. To reach our goals, we need catalytic funding.

I would like to stress that it can be done. We can reduce high rates of maternal death and disability. We can improve the health of women and this in turn will lead to stronger economic growth and national development.

Just last week, I attended a meeting in Atlanta of a group called the Elders, with United Nations Secretary-General Ban Ki-moon, former United States President Jimmy Carter, and the leaders of a number of global public health organizations, research centres, and academia. I am pleased to report that we agreed to make women’s health and health system strengthening political priorities. I am very excited about this development and am sure it will accelerate progress.

Ladies and Gentlemen, Yes, we need to work from the top down to improve women’s health and human rights and strengthen health systems. And we also need to work from the bottom up within communities

The quest for human rights begins within each of us. It begins in our homes and in our families and relationships, in our schools, workplaces, communities and places of worship.

Under my leadership, UNFPA has institutionalized a programming approach grounded in culture, gender and human rights. We know that greater progress for women’s health and human rights depends not only on government leadership, the creation of an enabling legal and policy environment and the provision of services, which are essential. Progress also depends on changes in discriminatory attitudes and mindsets.

To carry this work forward, we have to engage with communities and local leaders and faith-based organizations. UNFPA has long-standing partnerships with governments, civil society, the media and parliamentarians. And now we are building a global inter-faith network to advance women’s empowerment, gender equality and the right to sexual and reproductive health. We believe in fostering change from within.

As Dag Hammarskjold said, The longest journey of any person is the journey inward.

Just as there is a need for mutual respect and responsibility within human relationships, there is also a need for mutual respect in development relationships. This fundamental awareness and approach can make all the difference.

We have found this to be true in our work to address violence against women, to accelerate the abandonment of harmful traditional practices, such as female genital mutilation/cutting and child marriage. And we have found it to be true in our work to improve sexual and reproductive health and eradicate the devastating childbirth injury of obstetric fistula. This condition was eliminated in wealthy nations like Sweden over a century ago. But it persists in poor countries where there is no access to maternal health care. There are more than 2 million girls and women living with this disability and they are often shunned by their families and made to feel shame. The real shame belongs to our world, with its wealth and technology, that allows such conditions to persist.

In closing, I would like to stress the power of partnership. Five years ago, few people had heard of fistula. Now, since we began the international campaign to end it, fistula has appeared on the front pages of leading newspapers, and it has been talked about in TV and radio newscasts worldwide. More than 8,000 women have received treatment. This partnership, which is supporting the prevention and treatment of fistula and the reintegration of fistula survivors into communities in 45 countries, has benefited from the commitment of governments, and not-for-profit organizations and foundations, and also from the active engagement of the private sector. I can tell you from experience that there are few happier sights than seeing a young woman after a successful treatment operation in a what can only be described as a journey from dark despair to hope. And I thank Sweden for having provided financial support to this work and hope we will receive additional funding.

My friends,

They say that a society can be judged by how it treats its women and children. By this measure, Sweden has been ranked number one, although I am certain you have your challenges, too. Our challenge, as development partners, and our responsibility is to support other countries to do the same—to improve the education, health and economic status of women, so they, too, can enjoy the many benefits this brings.

I thank you.