Investing in Women: Building Political Leadership

Statement by Thoraya Ahmed Obaid, Executive Director, UNFPA

I have been asked to speak about women's rights and women's health and the power of political leadership. And I would like to start by paying tribute to the leaders at this symposium. You have done so much to position women's health and rights as political priorities.

Tonight, I will focus on three priority issues: promoting leadership at the global level, at the country and community levels, and ensuring there are adequate resources that are well spent to reach women.

I just returned a little over a week ago from Chad and Benin. I continue to be struck by the challenges that Africa faces. The possibilities for a girl born here, near Washington, D.C., or in New York are worlds away from those for a girl born in Chad. Although world leaders have been talking about women’s rights and health for some time, there is an urgent need for 'quick wins' to rapidly change the quality of women’s daily lives.

We are here because we know that political leadership at all levels can make a difference. And I strongly believe that our job is to make sure that it does.

Vision

We are here in the hope that a woman in Chad or Benin or Bangladesh will not die on a donkey cart on the way to a health clinic or suffer the devastating condition of fistula due to obstructed labour.

We are here in the hope that a young mother in Papua New Guinea can live free of domestic violence.

We are here in the hope that a woman in southern Africa or South Asia can protect herself and her children from HIV/AIDS.

We are here in the hope that health systems can be upgraded to meet women's needs, and health care providers can be trained and maintained to provide quality care, care that millions of women so desperately need.

We have a unifying vision.

And certainly you have been focusing on this vision since yesterday evening.

Leaders must work to translate this vision into action. Providing an environment for changing women’s lives cannot be achieved unless it is considered within a human rights context.

This evening, allow me to outline three specific areas we should focus on.

First, it is high time we put women's health and women's rights at the top of the international development agenda. And we must use the review of the Millennium Declaration as one of such opportunities, and the Millennium Development Goals (MDGs) as an entry point.

Political leadership fostered the creation of the MDGs and while not perfect, and not sufficient, they do provide an unprecedented unifying framework and focus for international development efforts and for national execution.

The specific goals on improving maternal and child health, combating HIV/AIDS, and promoting gender equality—and the reports of the Millennium Project Task Forces—point the way forward.

We know that improving sexual and reproductive health is essential for achieving the MDGs and ensuring the health and rights of women.

The United Nations Millennium Project stresses that expanding access to sexual and reproductive health information and services is a “quick win,” a cost-effective action that can put countries on the road towards achieving the MDGs. A quick win that can produce real results in fighting poverty and improving the quality of women’s lives in the short and long term.

We must build on this unprecedented consensus to galvanize stronger leadership at both the global level and the national level.

Global Level

At the global level, we are getting there. The recent session of the World Health Assembly agreed on the need to accelerate the achievement of the internationally agreed health-related development goals, including the MDGs and the Cairo goal of universal access to reproductive health by 2015.

It is also encouraging to note that, through political negotiations, we do have in the current draft outcome document for the September Millennium summit a commitment to universal access to reproductive health. The draft text reads: "Achieving universal access to reproductive health by 2015 as set out at the ICPD, integrating this goal in strategies to attain the international development goals, including those contained in the Millennium Declaration aiming at improving maternal health, reducing child mortality, promoting gender equality, combating HIV/AIDS and eradicating poverty".

Continued leadership is needed to galvanize political support, specifically for a new target under MDG5 on improving maternal health, on universal access to reproductive health, in line with the recommendation of the Millennium Project Task Force. This will allow us to monitor progress and hold governments accountable for achieving this target.

National Leadership

But greater political leadership at the global level means little without greater leadership at the country level.

This brings me to my second point.

It is at the country and the community levels that policies and programmes are implemented and budgets allocated. It is at the country and community levels that a difference is made.

Leadership is needed so that national and subnational development plans and budgets are designed to improve women’s health and increase respect for their rights. This requires national targets for coverage, including for skilled health personnel and reproductive health commodities. And these need to be ensured within national development frameworks, particularly poverty reduction strategies (PRS), sector-wide approaches (SWAps), budget support, and national economic and social agendas.

It is also important that we promote comprehensive and integrated women's health initiatives that build local capacity.

With more and more women becoming infected with HIV and AIDS, we must focus on more fully linking sexual and reproductive health and HIV/AIDS interventions, as called for in the New York Call to Commitment. We must ensure that sexual and reproductive health programmes are part of every country's national AIDS plan and that reproductive health programmes and services serve as effective entry points for HIV prevention, care and support. This will be the only way we can possibly hope to combat HIV/AIDS and reduce maternal death. By fully linking sexual and reproductive health and HIV and AIDS, we will ensure more cost-effective programmes that help women access integrated and more relevant services.

Greater political leadership is also needed for advocacy and public awareness-raising.

The UNFPA-supported global survey on progress towards the implementation of the Programme of Action of the International Conference on Population and Development (ICPD) recognized that a great deal of progress had been made in the last decade, since the Cairo and Beijing Conferences, in passing legislation and devising policies for women’s reproductive health and rights. However, it also recognized a big gap in implementing and monitoring these laws and policies, including as they relate to engaging societies in dialogue to change harmful traditional practices and to end discrimination and violence against women.

We know that poverty is not just about lack of money; it is also about lack of choice. This is particularly true for women. Today, many women cannot make their own choices about pregnancy and childbearing; they cannot make their own choices about seeking medical care. These choices are made for them and, in the worst cases, there simply are no choices. That is why political leadership is critical. Political leaders must speak out for equality and equity, for the empowerment of women, for women’s rights and for women’s health. These issues go together.

We know that addressing the high levels of maternal death and illness and HIV/AIDS in low-income countries requires stronger health systems.

We must ensure there is adequate capacity to implement integrated and good-quality programmes. This means doing everything possible to ensure that health professionals, who form the backbone of the health system, do not feel the necessity to migrate to developed countries in search of 'greener pastures'. The pastures need to be made green in developing countries. Therefore, investment in the required kind of capacity-building and work environment, which will allow retention of national health personnel, is a critical political decision.

It is also only fair that developed countries that receive the quality workforce from developing nations should find ways and means to make work in the health-care systems of developing countries, attractive. This includes support for the development and implementation of effective human resource strategies that motivate and retain staff, including better job conditions and remuneration packages, better managerial capacity and human resource plans, and increased money for learning and continuous education.

Furthermore, a lack of 'managerial capacity' at all levels of health systems is increasingly cited as a barrier to scaling up services and achieving the MDGs. Transforming political commitment into action depends on the ways resources and services are managed. This is assuming that there are financial resources.

This brings me to my third point.

We must be strong advocates for increased official development assistance in line with the Monterrey Consensus, and stronger debt relief and cancellation, and fairer terms of trade. This will free resources for women.

Increased spending is required, particularly in the poorest countries, which often have the lowest health spending. We must call for increased spending to support human rights, gender equality and reproductive health, and to close existing funding gaps on reproductive health commodities and logistics. This was agreed upon by ministers of developed and developing countries alike, along with members of civil society in the Stockholm Call to Action, which was recently adopted.

Today, we are at a crossroads and we must be bold and ambitious.

A global health partnership involving governments, civil society, the United Nations system and the private sector should scale up collectively our response to achieve the MDGs and improve women’s health and rights. When national programmes are effectively scaled up, efforts monitored and leadership kept accountable, we will ensure that resources really reach women and really make a difference.

In conclusion, while I have focused on three specific aspects, these fail to be important if the fundamental issue of equity is not addressed. This must be the prerequisite for what we do to ensure women's health and rights. For millions of women today, life or death is an issue of equity. And political leadership is and should be a lifesaver.

Thank you.