"The UNtold Story: Child Survival Success Stories", Statement on UNA-USA Members Day at the United Nations

29 March 2003
Author: UNFPA

Good afternoon.

I would like to thank Ambassador Bill Luers, the President of the United Nations Association of the United States, for inviting me to participate in today’s meeting. It is wonderful to be here, along with my friends and colleagueuall of us in this room can agree that the United Nations is more relevant today than ever before. Your applause for Eveline Herfkens, the Secretary-General’s Executive Coordinator for the Millennium Development Goals Campaign, and advocacy for the United Nations, speaks loudly of your support. All of you work to raise awareness and support in this country for the United Nations. On behalf of my colleagues here in New York and around the world, I would like to say, thank you.

I have been asked to speak about child survival success stories and I do so with great pleasure.

Ladies and gentlemen,

When we think of the welfare of the world’s children, we usually think about UNICEF, the United Nations Children’s Fund. And rightly so, UNICEF has been saving children’s lives for the past 56 years.

One of the greatest success stories is vaccination. Each year, immunization against preventable diseases saves the lives of two-and-a-half million children under the age of 5. Another great lifesaver is oral rehydration. During the last decade alone, diarrhoea-related deaths around the world declined by half, saving more than one million children each year. And UNICEF has always been in the front line doing a most visibly successful work to save children’s lives.

However, as we all know, healthy children require healthy mothers. And UNFPA, the United Nations Population Fund, is working with many partners, including UNICEF, the World Health Organization and the World Bank to improve maternal health. One of the greatest success stories for both children and mothers is the global spread of reproductive health services. These services include care during pregnancy and childbirth, voluntary family planning as well as the prevention of HIV/AIDS and other sexually transmitted infections.

Today, these life-saving services are reaching more women and couples than ever before. We see this clearly in the case of family planning. The use of contraceptives in the developing world has jumped from 10 per cent fifty years ago to 65 per cent today. This is a tremendous achievement that has given women greater freedom, saved millions of lives especially of children and mothers, and literally changed the world.

Because women are taking control of their lives, and choosing to have fewer children, population growth is slowing. And this allows countries to increase their savings and economic growth and better pursue a course of sustainable development. Women in less developed parts of the world are now having an average of three children compared to six a half century ago.

We know that smaller families are better able, at the household level, to increase their savings and to provide better education and health care for their children. So, the benefits of family planning are quite tremendous—resulting in saved lives, higher standards of living, and lower levels of poverty.

This is important because when we look closely at the issue of child survival, we see that high death rates are closely related to high levels of poverty. Poverty creates conditions that are, quite frankly, often deadly. Poor families have to cope with a lack of clean water, poor sanitation, malnutrition, endemic infections, and poor or non-existent health facilities. In these conditions, babies who are not strong and robust at birth do not receive the health care they need to survive.

So, it is clear that reducing poverty and making needed changes to improve living conditions are high priorities. And here I want to come back to the issue of reproductive health services, including family planning, because two other factors that affect the likelihood of babies’ dying during their first year are more immediately amenable to change. These are the age at which women give birth and the length of time between births. And these two factors are strongly affected by women’s access to reproductive health services.

Overall, babies who have an increased risk of dying before their first birthday fall into three broad categories: those born to very young mothers, those born to women past their prime childbearing years and those born too soon after a previous birth. That is, too early, too late and too soon.

Improved access to and use of reproductive health services enables women to reduce closely spaced births and to choose when to have children, thereby reducing their chances of having a baby who dies in infancy.

Studies clearly show that in nations where contraceptive use is moderate to high, twice as many babies survive their first year as in countries where family planning use is below 10 per cent.

The positive impact of contraceptive use is particularly strong when it helps women to avoid closely spaced births. When births are separated by less than two years, the infant mortality rate is 45 per cent higher than when births are two to three years apart.

We see the benefits clearly in Costa Rica, where the Government's commitment to family planning services has helped lower the infant mortality rate by 80 per cent.

Studies also show that women around the world are waiting longer before they get married and are delaying their first births, which also saves lives because giving birth too young in life greatly increases health risks for both mother and child. In Bangladesh, for instance, teenage girls face double the risk of dying in childbirth than the national rate.

Babies born to teenage mothers also face tremendous risks. Studies show that they face death rates that are 30 per cent higher than babies born to women who are in their 20s and 30s. This is because teenage mothers are physically immature, which increases their risk of suffering from obstetric complications. Teenage mothers are also more likely to give birth to infants who are premature or have low-birth-weight—conditions that reduce the resilience and stamina babies need to overcome infection or trauma early in life. Also, pregnant teenagers are less likely than older women to receive good prenatal care and skilled medical care at delivery, and to provide adequate care for their babies.

Yet, despite the increased risks, every year, some 82 million 10-to-17 year-old girls and young women get married, many by force. Deprived of education and social opportunities, the young bride enters adulthood with few skills and few opportunities to improve her situation. This reinforces low self-esteem, social isolation and the cycle of poverty and ill health.

The United Nations Population Fund is working around the world to promote the benefits of delaying pregnancy and marriage, and to provide universal access to reproductive health services. Our strategy to reduce maternal and infant mortality revolves around three interventions. Number one is reproductive health, family life education and voluntary family planning to prevent unwanted pregnancies and ensure adequate spacing between births. Number two is skilled care by a health professional to ensure that every pregnant woman gets adequate care during pregnancy and childbirth. This includes information and services to prevent HIV infection. Number three is emergency obstetric care to ensure that women who experience complications during birth survive, along with their babies.

Today, young people and women are among the most vulnerable to HIV infection, which in turn affects the health of the infant and child. In countries with high HIV prevalence rates, young people and especially young women are at particular risk of contracting the virus. In recent years, over one half of all new HIV infections – approximately 7,000 every day – are among youth aged 15 to 24. This is the same age group with the highest rates of sexually transmitted infections.

Young people are particularly vulnerable to HIV infection because they lack access to sexual and reproductive health information, education and services. Gender inequalities and practices like early marriage, sexual violence and the search by older men for younger ‘HIV-free’ partners, create added risks for young women. In some countries in sub-Saharan Africa, teenage girls are now five to six times more likely to be infected with HIV than boys their age.

The rapid spread of HIV infection among women is alarming. Today, half of all HIV-positive adults are women, and in sub-Saharan Africa, the figure is 58 per cent. Roughly 47 per cent of the 14,000 new infections each day are in women of childbearing age and this has a direct impact on child survival rates. Women are biologically more vulnerable to HIV infection and often socially disenfranchized. Therefore, they often lack the means and power to say no to unwanted or unsafe sexual relations.

The pandemic is, therefore, taking a severe toll on women and children. Historically, efforts – including collaboration among United Nations agencies –

have largely concentrated on the prevention of HIV transmission from mother to child. While this is a necessary intervention, it is also necessary to prevent HIV infection in mothers in the first place. UNFPA is focusing on the mothers in “mother-to-child-transmission plus” because we have found that very few examples of interventions exist that focus on pregnant women in their own right.

While, in a few countries, alarming infection rates exist among pregnant women, in most others the great majority of pregnant women are HIV-negative. An estimated 200 million women become pregnant each year, of which about 1.8 million are HIV-positive. Thus, 99 per cent of pregnant women worldwide are HIV-negative. UNFPA is working with partners worldwide to ensure they remain so.

By preventing HIV infection in pregnant women, transmission to children is avoided. Concentrating efforts on the majority – that is uninfected women and young people– in the face of limited resources has been the rationale for UNFPA’s strategic focus.

Pregnancy is known to be one of the few occasions where women go to clinics and hospitals. Therefore, it is a natural entry point and opportunity to provide information on HIV prevention to help ensure that HIV-negative women remain free of infection. It is also an opportunity to provide HIV-positive women with the support and care they need to ensure a better chance of safe pregnancy and delivery.

Since there is no vaccine for HIV/AIDS, prevention remains key to any response. An effective strategy has been demonstrated in Uganda, which has been able to slow the spread of AIDS. The strategy is called the ABC approach: abstain, be faithful and condom use. UNFPA funds programmes that focus on all three messages, which taken together, form a comprehensive and effective approach.

All over the world, women and girls in many countries need increased support to meet their basic needs and protect their basic rights. Access to education and health care, including reproductive health care, is absolutely critical. Also important are legal rights, and increased access to resources, opportunities and greater participation in decision-making.

The support of individual men and women like you can make an invaluable contribution. Here in the United States, two women have made a great difference. After the United States withdrew its funding from UNFPA last year, Lois Abraham of New Mexico and Jane Roberts of California started a grass-roots campaign to replace the missing funds. The 34 Million Friends Campaign started out as a trickle of support over six months ago and has now turned into a downpour. We are now closing in on the $1-million mark.

I would like to encourage you, as members of the United Nations Association, to become friends of UNFPA and spread the word about the 34 million friends campaign. Some UNA chapters in the United States have taken the challenge already, as has UNA/Canada. For this, we are truly grateful. The money will be spent to prevent unwanted pregnancies and HIV infection, and to ensure more child and mother survival success stories in the future.

You can get more information about this grass-roots movement and meet Lois and Jane at There are also brochures about this initiative in the back of the room, which I encourage you to pick up and use.

In closing, I would like to stress that, although the challenges we face may seem daunting, we have made much progress together. And together, we will make even more. The United Nations is founded on the principle of the equal worth and dignity of every human being. And, if we increase our collective efforts to meet the needs and human rights of every woman, man and child, we will create a century like none before.

I am not going to talk about the Millennium Development Goals (MDGs) because Ms. Herfkens, who spoke earlier to you, did so with great passion. I will only add that the Secretary-General, Kofi Annan, has indicated that, unless we take issues of population and reproductive health into consideration as the underpinning for the MDGs, we will not be able to achieve the goals set for 2015. He is absolutely right. We cannot reduce poverty, slow the spread of HIV/AIDS, decrease maternal and infant mortality, and empower women without taking into account population dynamics, such as growth, age structure and distribution, and without ensuring universal access to reproductive health services.

During these difficult days, one cannot forget that there is a war going on that is ravaging a country, Iraq. But there is also another war that is long-standing and just as ravaging and that is the Israeli-Palestinian conflict. I am singling out these two wars because they are not localized; they are conflicts that have a global dimension and global impact. These two volatile issues will occupy the attention of the United Nations and I am sure the United Nations is THE organization for dealing with them.

Regretfully, despite all efforts to find a peaceful solution, we are now faced with the reality of war in Iraq and increased suffering. During the past 12 years of sanctions, as documented by UNICEF, the health situation of Iraqi children, mothers and families has suffered. With war, the situation will only get worse. Also well-documented are the suffering of Palestinian families, especially women and children. The United Nations is working hard to provide support. All these efforts are important to ensure child survival and decrease maternal mortality. But there is one ingredient that is so very essential – and that is peace. Without just and lasting peace, human rights of all people cannot be protected and enjoyed. Without peace, the most basic right – that is the right to life – will invariably be denied.

Thank you.

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