"Saving Women’s Lives", Smith College Lecture

Good evening.

I am delighted to have this opportunity to address you tonight at Smith College, on my second visit. I always enjoy visiting women’s colleges, not only because I myself attended one – Mills College in Oakland, California – but also because they are special. Their education is of the highest quality and they provide an empowering environment for women who often go on to distinguished careers.

I would like to thank Anita King, the Chairperson of the Massachusetts Chapter of the Sierra Club, for organizing tonight’s event and for inviting me to participate.

Tonight, I will talk about “Saving Women’s Lives”.

Professors, students and friends,

Tonight in Afghanistan, a woman will give birth. If she survives, she will hold and feed her baby, comfort her and care for her—just as any mother would anywhere in the world. In these most basic acts of human nature, humanity knows no divisions. However, to give birth today in Afghanistan is to give birth in conditions that are far away from the prosperity that one small part of humanity has achieved. It is to give birth under conditions that many of us in this hall would consider inhuman. Truly, it is as if it were a tale of two planets. I speak of a mother in Afghanistan, but I might equally well have mentioned a mother in Sierra Leone, or a mother in war-torn Iraq.

No one today is unaware of this divide between the world’s rich and poor, of the great divide between the powerful and the powerless. Moreover, perhaps, nowhere is this divide more evident and more tragic than in the area of reproductive health and reproductive rights. In many poor countries, including those caught in conflict or recovering from war, women are suffering and the rates of maternal mortality remain unacceptably high.

Of all health indicators, it is maternal mortality that shows the greatest gap between rich and poor. Today, half a million women die each year during pregnancy and childbirth, with 99 per cent of these occurring in the developing world. These women die because they do not have access to basic health services and because they have little or no say in the decisions that affect their lives.

The fact is that many of them may not have wanted to get pregnant in the first place. We estimate that one quarter to one third of the 200 million pregnancies each year are unwanted or ill-timed. In addition, while here in the United States, pregnancy and birth are not considered likely to end in death or disability, this is not the case in many other parts of the world.

Overall, women in the developing world face a risk of dying during pregnancy and birth that is 80 to 600 times higher than for women in the wealthier parts of the world. Each and every minute, one woman dies, almost all of them needlessly.

In Africa, a woman’s lifetime risk of dying of maternal causes is 1 in 16. In Asia, it is 1 in 110, while in Latin America and the Caribbean the risk is 1 in 160. In Afghanistan, a woman’s lifetime risk of maternal death is 1 in 15. Here in the United States and in Western Europe, it is 1 in 3,500 and in 4,000, respectively.

This tremendous disparity in health and well being, and the awful loss of life that is represented in each of these statistics, represents far more than a failure of public health. It represents the low status of women and the low priority that is accorded to their health and the full realization of their human rights.

The 1948 Universal Declaration of Human Rights states that everyone is entitled to the right to life, liberty and security of person. Yet, this most basic right is violated each and every minute for women who are giving birth. What should be a time of joy and celebration becomes, instead, a time of tragedy and mourning for the husbands and families of women who do not survive.

It is ironic that women are honoured as mothers and the givers of life in all cultures worldwide. Yet, when it comes time to protect them and ensure their safety, too many are sacrificed to premature death and life-long disability. In other words, they are denied their right to life.

One of the most severe and saddest forms of disability that results from trauma during birth is a condition called obstetric fistula. In places where there is inadequate health care and where women and girls have few choices and opportunities, a young woman may be in obstructed labour for days on end without any medical help. Her baby usually dies and the woman herself is left ruptured and terribly damaged, unable to control her bodily functions. And to make matters worse, she is usually abandoned by her husband and family and left alone to suffer in silence and shame.

Obstetric fistula is not well known here in the United States because it was eliminated here and in other wealthy countries over a century ago. Yet, fistula continues to strike an estimated 200,000 poor women in poor countries each and every year. This hidden and silent condition is a powerful symbol of the neglect and discrimination that many women continue to confront.

Last year, UNFPA, the United Nations Population Fund, initiated a global campaign to end fistula. We have started the campaign in sub-Saharan Africa, where we are working with international and local partners to prevent fistula and surgically repair survivors. The surgery itself costs about $350 dollars and is over 90 per cent effective. Yet, despite its low cost and effectiveness, there are thousands and thousands of women who are on waiting lists, literally waiting to be surgically repaired.

These women, many of whom are teenagers, are usually from very impoverished communities. Often, they live miles away from health clinics and transportation is very bad. Even if they do get to a clinic or hospital, they do not have the money to pay for services. And oftentimes, the medical facilities themselves are poorly equipped and short-staffed. There may be no gauze, no antibiotics, no sutures, no safe blood supply, no operating table, no anaesthesiologist and no doctor who knows how to perform the surgery. In some cases, the care that is given actually leads to fistula. Sometimes women are mistakenly told to drink water to expel the baby, which only increases pressure making it more difficult for the baby to exit the womb.

As part of the global campaign to end fistula, UNFPA is working with partners to train doctors, nurses, midwives and traditional birth attendants on the warning signs and causes of fistula and the necessary interventions. We are funding efforts to equip health centres and hospitals for emergency obstetric care and to ensure safe blood supplies. A crucial part of the campaign focuses on advocacy, so that policy makers and communities can and do take action to prevent fistula.

I began my statement this evening by talking about maternal mortality and disability because I have chosen the theme, “Saving Women’s Lives”. And the point that I would like to stress is that almost all of these women’s lives could be saved and improved if governments, policymakers and the international community made the health and well-being of women and girls a top priority.

It is necessary to economically empower women, to respect their rights, to give them the opportunity to take charge of their own lives, and to make these issues central to national and international development policies. Yet, even though world leaders have pledged to increase gender equality, to provide universal access to reproductive health services and to reduce maternal mortality within the next 12 years, we will not meet these goals unless far greater commitment is demonstrated, stronger action is taken and greater resources are devoted to these critical issues.

In September 2000, world leaders, meeting at the United Nations Millennium Summit, agreed to launch a global assault on poverty, hunger, disease and gender discrimination. They agreed to work with the United Nations to achieve eight goals, called the Millennium Development Goals. Among these international targets are the goals to cut extreme poverty and hunger in half, to reduce the spread of AIDS, and to reduce infant and maternal mortality by the year 2015. But it is painfully clear that these goals will not be achieved unless greater progress is made for women and girls.

This is not to say or infer that we have not made progress. We have. Women today are moving forward and taking control over their lives as never before. We see this clearly in the case of international family planning.

Today, women are choosing to have half as many children as they did 50 years ago. They are making their own choices about pregnancy and childbearing. And this is not only a victory for women and human rights; it is also an achievement that has literally changed the world.

Because so many women have access to contraception and are able to determine the number, timing and spacing of their children, global population growth is slowing. In the developing world, the average woman has three children today, down from six a half century ago. The Population Division of the United Nations Secretariat now projects that global population will rise from 6.3 billion today to 8.9 billion in the year 2050, down nearly half a billion from the earlier projection of 9.3 billion people by mid-century. This slower growth is based on the assumption that all women who are in their reproductive age will have access to quality reproductive health services that are voluntary, available and affordable.

However, while population growth is slowing, our numbers continue to grow by 77 million people a year. We must recognize that the bulk of growth in the coming decades will occur in the least developed countries—nations least-equipped to meet the growing needs of increasing numbers of citizens and are already hard-pressed for adequate food and clean water.

And this situation is made even more urgent with the spread of HIV/AIDS. The United Nations anticipates a more serious and prolonged impact of the HIV/AIDS epidemic in the most affected countries than was previously envisioned. In fact, the spread of HIV/AIDS and the increase in deaths, along with a reduction in births, are the two factors that caused the United Nations to revise its population projections downward.

Let me put the demographic impact of HIV/AIDS into focus. The United Nations estimates that there will be half a billion fewer people in the world by mid-century partly because of AIDS. This statistic is startling, in its own right. During this century, there will be an estimated 278 million excess deaths due to AIDS. This is more people than those who died from all the conflicts during the 20th century. Whereas a few years ago, it was thought that population would continue to grow or remain stable in the most severely affected countries due to moderate or high fertility levels, the new data shows that four countries will actually experience a population decline due to AIDS by mid-century. They are: Botswana, Lesotho, South Africa and Swaziland.

In Botswana, the country with the highest HIV prevalence, where over one out of every three adults is HIV-positive, population growth has already been significantly reduced, and population decline is projected to begin in the next few years. It is projected that Botswana's population will be 20 per cent lower in 2050 than it was in 2000.

By 2015, the population of the most highly affected countries in Africa is projected to be 10 per cent lower than it would have been without AIDS, with an estimated 14.8 million excess deaths from AIDS during the first five years of this new century. In Asia, an estimated 3.3 million excess deaths will occur from AIDS during the first five years of this century, compared to 0.7 million in Latin America and the Caribbean. India alone is expected to experience 2.2 million excess deaths during this period because of the AIDS epidemic. In Russia, the HIV infection rate is fastest growing in the world and it certainly will affect an already declining population.

Of course, the demographic impact is just one of the many devastating effects of HIV/AIDS. The social, economic and political impacts cannot be overstated. Families, communities and entire nations are coming unravelled. The epidemic is eliminating the most productive members of society—the parents, the teachers and health workers, the doctors and the nurses and the farmers, and leaving behind a generation of orphans and elderly with little social support.

At the end of last year, women for the first time comprised 50 per cent of the 42 million people living with AIDS worldwide. In sub-Saharan Africa, 58 per cent of those infected are women. Around the world, women have been calling for 50/50 representation in government and responsibility in the home. And it is a sad reality that the first place where women have been able to achieve this equality is among those infected with HIV/AIDS.

Ladies and gentlemen,

At the heart of the global AIDS epidemic lies gender inequality. Women bear the main burden of care, and women are the last in line for treatment. Women are often blamed for spreading the disease and suffer tremendously from the stigma and discrimination associated with the disease. Women and girls are denied information and education. A recent UNICEF survey found that up to 50 per cent of young women in high-prevalence countries did not know even the basic facts about HIV/AIDS. And in many cases, what they do know is nothing more than myth. In some hard-hit African countries, teenage girls face HIV infection rates that are five to six times that of boys their age. The Special Envoy of the Secretary-General to Africa on HIV/AIDS, Stephen Lewis, has said that HIV in Africa has a woman’s face.

The point is that women and teenage girls are often unable to say ‘no’ to unwanted or unsafe sexual relations because they lack the power and the means to do so.

UNFPA is a strong advocate for gender equality, women’s empowerment and the elimination of violence against women and girls. It is clear that widespread discrimination and violence must be fought with a level of outrage and corrective action that is proportionate to the scope of the problem. We know very well that gender discrimination and violence do a great deal of harm and block progress on many fronts. And it is clear that we will not be able to reverse the spread of AIDS, and expand economic development and social justice, unless women are free and economically empowered to play a vital role in the solutions.

The challenge is to mobilize the political will and resources to duplicate successes around the world. Uganda, Thailand, Senegal and other countries have been able to reduce HIV infection rates. We must learn from these countries and expand effective prevention, treatment and care programmes. We must also use the inroads that have been built for family planning and maternal health, to provide services.

UNFPA is working to integrate HIV prevention into reproductive health services. Such services include voluntary family planning, care during pregnancy and birth to ensure safe motherhood, and prevention of sexually transmitted infections.

We know that women need access to family planning so that they can better plan and space their births. Having pregnancies too close together, or too early or too late in life increase the risks to both mother and child. We also know that women need prenatal care during pregnancy and skilled attendants at birth, and also emergency obstetric care, if complications arise.

Yet, today, just over one half of the women in Asia, Africa, the Middle East, Latin America and the Caribbean, give birth with trained medical assistance. Worldwide, 350 million women lack access to a range of safe and effective family planning services. As a result, each year, nearly 80 million pregnancies are unwanted or ill-timed, and countless women die. And this is especially true for the poorest women, who have the least access to education and health services. This translates into less opportunity for poor women and families and increased difficulties for them to break out of poverty.

Throughout the world, reproductive health and family planning remain urgent issues—issues that are directly linked to security, poverty reduction and environmental sustainability.

UNFPA provides support to 150 countries, at their request, to address reproductive health and population issues. We have three main areas of work: to help ensure universal access to reproductive health, including family planning, to all couples on or before the year 2015; to support population and development strategies to ensure human well-being and environmental sustainability; and to promote awareness and mobilize the resources and political will necessary to accomplish these areas of work.

UNFPA is committed to reproductive rights, gender equality and male responsibility and to the empowerment of women everywhere. We believe that safeguarding and promoting these rights and promoting the well-being of children, especially girls, are development goals in themselves. We are convinced that meeting these goals will contribute to improving the quality of life and to the universally accepted aim of stabilizing population growth and ensuring sustainable development.

I am happy to report that this framework and these goals enjoy universal support. World leaders agreed on these principles and goals at the historic 1994 International Conference on Population and Development that was held in Cairo. This Conference represented a breakthrough for international population policy. It moved policy away from a narrow focus on numbers and demographic targets to a focus on respecting human rights and meeting individual human needs. It placed the focus squarely on respecting individual choice and freedom.

Ladies and gentlemen,

When we look at the global picture, we see a tale of two planets, not only when it comes to health services, but also when it comes to consumption.

Vast numbers of people have been left out of the 20th century consumption boom, resulting in "a huge consumption gap" between those who live in industrialized States and those living in developing countries, especially the very poor. In the worst cases, the poor are not consuming enough to sustain themselves—some 800 million people are chronically malnourished—while the rich are over-consuming, squandering vital resources and creating vast amounts of waste in the process.

Of the 6.3 billion people sharing the planet, the 20 per cent who live in high-income regions, including Western Europe, Japan, North America and Australia, account for 86 per cent of total private consumption. The poorest 20 per cent of people account for a little over 1 per cent. On an individual level, a child born today in an industrialized country will add more to consumption and pollution over his or her lifetime than 30 to 50 children born in developing nations.

The burning of fossil fuels has quadrupled during the past half century, consumption of water has nearly doubled since 1960, and the use of wood, both for industry and households, is now 40 per cent higher than it was 25 years ago. The United States alone, with only 4 per cent of the world's people, emits nearly one quarter of global greenhouse gases. Over the past 70 years, global population has tripled, from 2 billion to over 6 billion, and water use has grown sixfold. Overall, it is clear that future population growth and rising consumption levels will test the links between population and the environment as never before.

Here, I would like to return to the mother in Afghanistan, or the mother in war-torn Iraq. The health care that women here take for granted is beyond the wildest dreams of most women in the developing world. This presents far more than a threat to individual women and their families. The great gaps that we see in our world today are a threat to world stability and security.

In response to this growing gap, we find many different responses. But, I would like to talk about the power of one idea and one dollar. It is a great opportunity that I can personally thank the Sierra Club for taking the challenge to contribute to the 34 Million Friends Campaign. I thank you today for demonstrating your support to the people of the developing countries, especially women, who are unable to fulfil their basic human right – to live free of fear and free of want, as world leaders declared at the Millennium Summit held at the United Nations in 2000.

This campaign started with a great awareness that we are all living on one globe and that what touches me in the South affects you in the North and that we are just one human chain, interlinked and connected by a common vision and aspirations for the highest level of human rights.

It all began with Jane Roberts of Redlands, California, and Lois Abraham of Taos, New Mexico, who each independently began the campaign without knowing that they were working on the same idea. Our thanks go to both of them for their vision, commitment, and very hard work. But, I must also thank the technology and the communication possibilities provided by the Internet that made their effort bloom into a full-scale campaign here in the United States and Canada.

As of 18 March, we had received $ 811,930.63. We still have many letters to open and we will have a press conference once we reach the first million – which will take place by late April.

The money is important for UNFPA, for sure. However, just as important are the letters and messages of strong support that accompany contributions. One of them says: “As a 77-year-old retiree, I have little income to spare, but I want to help in my small way.” Such a message makes a difference in the way we all look at the world and it reaffirms that we are all partners on this globe.

You can also go to web site www.unfpa.org to find out about the 34 Million Friends Campaign and meet Jane and Lois.

Before I end my remarks tonight, I cannot but make a reference to the situation in Iraq. Despite all efforts to find a peaceful solution, the world is now faced with a very ravaging war, which will only lead to increased suffering for civilians, and for women and children in particular. There are international laws to protect civilians in times of war and these are the Geneva Conventions. All United Nations officials, myself included, have been urging all parties to respect these provisions.

In preparation for the tragic humanitarian situation in Iraq, the United Nations Population Fund has placed equipment and supplies in Iraq and neighbouring countries in an effort to ensure that pregnant women can receive basic care. As you all know, the many years of sanctions before the war has taken its toll on women and children. Maternal and infant mortality rates have risen substantially in Iraq in recent years. In the past 15 years, maternal mortality rates have more than doubled and mortality rates for infants and young children have also increased dramatically.

Before the war began, pregnant women were reportedly rushing to hospitals in Baghdad, pleading with doctors to deliver their babies -- even if it meant having Caesarean sections or giving birth extremely prematurely. During the war in 1991, many maternal and infant deaths occurred because patients were unable to reach hospitals.

UNFPA has placed basic reproductive health supplies inside Iraq, as well as in Jordan, Syria, Iran and Türkiye, in case there are refugees, to assist mothers and ensure safe pregnancy and childbirth.

Ladies and gentlemen,

All these efforts are important to save lives. But, there is one ingredient that is so very essential – and that is real and just peace. Without peace, the 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.

These are dangerous and challenging times for our world. And I firmly believe that, at this time, when grave decisions are being taken, we must keep the broader and longer-term social, human rights agenda as a priority. We must keep up efforts for universal health and education and respect for human rights.

The United Nations was founded on the principle that saving future generations from the scourge of war is closely linked to promoting social progress and better standards of life in larger freedom. That is why we must increase efforts to close the great gaps that divide us, and to create a world where peace, prosperity, and justice are shared by all. The greatest challenge is protecting the human rights of all people and ensuring that women’s rights are well respected as human rights.

Thank you.