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The electronic version of this document has been prepared at the Fourth
World Conference on Women by the United Nations Development Programme (UNDP)
in collaboration with the United Nations Fourth World Conference on Women
Secretariat.
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AS WRITTEN


THE FOURTH WORLD CONFERENCE ON WOMEN
Statement by Dr Hiroshi Nakajima,
Director-General, World Health Organisation,
Beijing, 4-15 September 1995


The Fourth World Conference on Women must make a difference to women’s
everyday lives, to their health and to their well-being. It must go down
in, history as having fostered the empowerment of women with concrete
means and opportunities to enhance their own status and that of their
daughters. In all countries of the world, it must promote equity and
partnership between women and men.

Beyond a general agreement on goals, principles and methodologies, it is
essential that all countries and participants here in Beijing should
reach for a commitment top provide and sustain the necessary resources
and infrastructure to translate our consensus into action once the
Conference is over. We will be held accountable for our words and judged
by our deeds and must commit ourselves clearly to achieving well-
identified and significant results—significant, that is, for the women
themselves. As in all programmes for social development, the first step
towards relevance and effectiveness is to learn from the people
concerned, and here this means from the women themselves, what their
priority needs are. In the voice of the people, ultimately, lie the
legitimacy and sustainability of any public action and policy.

One major contribution of the World Conferences on Women, since 1975, has
been to provide a global forum for women of all countries, from all
cultures and walks of life, to meet, share their experiences and
concerns, together work out their own agendas for development and make
their voices heard by all governments, institutions and public leaders.
For twenty years now, through the courage, determination and generosity
of innumerable women, and with the support of an increasing number of men
around the world, much has been achieved. Yet, a considerable task still
lies ahead before the gaps can be closed in terms of social justice
between women and men and between rich and poor.

At a time when so many countries are going through painful economic
transitions and profound social reappraisals, it is particularly
important that this Fourth World Conference on Women should ensure that
women's needs and expectations are not sacrificed to immediate
constraints but receive utmost attention and priority, as they rightly
deserve. Saving on women's health and education is unacceptable from an
ethical point of view. It is also a grave miscalculation from an economic
and social point of view. No country and society can afford to lay half
of their natural resources to waste, to neglect half of their human
potential.

Health is crucial to the overall social and economic development process,
for individuals and countries alike. Human development will take place
and become self-sustained only when health concerns and interventions are
integrated into all public policies, at the local, national and
international levels. To achieve this and foster integrated health,
social and economic development for all, the World Health Organisation
proposes that the Fourth World Conference on Women should endorse and
pro-mote the concept of health security within its Platform for Action
and strategic priorities.

WHO's focus on health security, as a means to achieving health for all—
including women, implies the recognition that health is a fundamental
right and that access to quality care and appropriate technology must be
ensured to all throughout the life cycle. Health security also includes
the right to work and live in peace within environments where known
health hazards are controlled.

As I stressed to the WHO's Global Commission on Women's Health, promoting
the health of women is the surest road to achieving health for all:
firstly, because women represent such a large share of humankind and
secondly because there is a strong intergeneration link between the
health of women and that of the children they bear and raise. Last but
not least, women can be our strongest allies in disseminating
information, raising awareness about health risks and opportunities and
introducing new skills and knowledge to improve care and foster health-
conducive environments and life styles within their families and
communities.

For too long, women's specific health needs and concerns have been
neglected or only partially addressed. The opportunities for bringing
significant improvements in women’s health are many and well within our
reach technically and financially. It is estimated that, out of
approximately 200 million pregnancies each year, about 23 million develop
serious complications. Half a million of the women concerned die—99% of
them in developing countries—and 20 million survive only to suffer severe
and long-term disabilities. At less than US$ 5 a year per capita in low-
income settings, ensuring information on and access to family planning,
prenatal and child-birth care is one of the most cost-effective health
interventions that can be made available world-wide. Another example is
that of cervical cancers, 75% of which occur in developing countries
where they are an important cause of deaths among women. With appropriate
health education, it would be possible to achieve a significant cure
rate, as demonstrated in India where literate women in Kerala were
successfully taught simple methods for examination and diagnosis.

Providing health education is essential for promoting women's health and
helping women to make their own free, informed and responsible choices
for health and prevention. But advocacy and information must always be
coupled with access to essential care and drugs, provided locally within
integrated primary health care services. It has been a major concern of
WHO to make safe and effective drugs, methods and products, available at
an affordable cost to the women who need them most, whether for the
prevention and treatment of locally prevalent diseases such as malaria
and tuberculosis or for reproductive health care including family
planning, obstetric care and control of sexually transmitted diseases and
HIV/AIDS.

People in general, and women especially, will make use of existing health
services when they can be sure about the quality of care available. And
they see "quality" as not only technical competence and effectiveness but
also personal respect and confidentiality in the delivery of care. One
essential way to improve quality is to ensure that primary health care
services have strong technical back-up with referral to district
hospitals for specialised care.

WHO is committed to implementing the Programme of Action adopted last
year in Cairo by the International Conference on Population and
Development. We are actively pursuing the integration of reproductive
health care in primary health care services, to monitor and meet the
specific needs of women, men, children and adolescents at all stages of
the life cycle. It is especially important that health education and
counselling be provided to the young to help them develop relationships
based on mutual respect and equality, to reduce risk-taking behaviour and
prevent or control such major health hazards as substance abuse,
depression, violence, unprotected sex and early and unwanted pregnancies.

Malnutrition is a telling example of how health problems can affect women
to a greater extent than men and differently. Statistics show anaemia to
be widely prevalent among women of all ages and all continents. In
developing countries 55% of pregnant women and 44% of all women suffer
from anaemia. Inequities in food intake and disregard for women's
nutritional needs start early in life when baby-girls are weaned too
early or when girls receive less food and of lesser quality than their
brothers. Malnutrition reduces the strength and resistance to infection
of girl children and affects their learning ability. Anaemia and micro-
nutrient deficiencies have a far-reaching impact on women and, across
generations, on their babies who are more likely to be under-weight, more
fragile and, in their turn, may suffer congenital diseases and mental
retardation. Interacting with infectious or parasitic diseases such as
malaria, malnutrition accounts for high morbidity and mortality rates
among women, including during pregnancies. The consequences of inadequate
diet extend into old age, facilitating the early onset of osteoporosis
and the development of serious conditions and disabilities related to
noncommunicable diseases.

Sexually transmitted diseases, including HIV/AIDS, are another striking
illustration of how socio-economic and physiological factors may combine
to create specific health risks and problems for women, including
increased poverty and stigmatisation. These issues must be recognised and
appropriately addressed.

WHO's inclusive approach to women's health extends to tropical diseases
such as malaria, leprosy, filariasis and schistosomiasis, which affect
millions of women in developing countries. WHO is helping to combat the
stigmatization which some of these diseases entail for women, such as
rejection by families and communities. To reduce the impact of tropical
diseases, WHO has been promoting women's involvement in early detection
and treatment, both for themselves and for their families.

We need more disaggregated data to elucidate women's specific health
needs and responses to various patterns of disease and at different
stages of the life cycle so that we can better adapt treatment and
prevention. Much remains to be learned, for ex-ample, about the
biological, emotional and mental health problems which women have to face
in their old age and in a changing society.

In all cases, women's perspectives must be represented and systematically
explored when carrying out basic and operational research, drug
development programmes and clinical trials as well as in the planning of
health services and delivery of care. This has been WHO's concern and
priority in defining and implementing its health policies and technical
co-operation programmes.

Gender, as a social and cultural construct, implies differences in
perceptions of, and approaches to, health needs and expectations. A
gender focus must apply to the legal, social and economic factors which
determine women's status, their multiple roles and identities, and which
also influence their access to health care, information and education.

Violence against women is present in all societies where it too often
goes unrecognised or is accepted as part of the order of things. While
relevant data started being collected only recently and are still scant
and fragmented, domestic violence against women has been documented in
all countries and socio-economic environments and would seem to reach
staggering proportions. Violence, in fact, is emerging as a major
societal and public health issue world-wide. Poverty itself perpetuates
violence.

Whether violence hits women at home or in situations of armed conflict,
as refugees or as migrant workers, they must be protected, offered
appropriate care and ensured legal redress. Strong political, legal and
educational action is required, which must be led from within the
countries themselves, to denounce, prevent and eliminate violence against
women. Women's lives, their health and security must be safeguarded.
Their dignity, rights and freedoms must be upheld.

We all stand to learn from other cultures, which all deserve that we
should respect them and try to understand them. But, in all cultures,
beliefs and practices evolve and change. Any practice that violates the
integrity and imperils the life and health of any human being must be
rejected by each and everyone of us individually and must be declared
unlawful by society as a whole. We cannot accept that modern health
technology and prenatal sex identification should be used to selectively
eliminate baby girls; and we must firmly discourage such painful and
harmful practices as female genital mutilation. Laws must be passed and
enforced. But if general and lasting changes in attitudes and practices
are to be effected, laws must be supported by consistent communication
and educational efforts in all sectors of society.

The challenge, if we want change to occur for all women and not just a
small elite, is to empower women without cutting them off from their
personal and social environments. A focus on health can help us do just
that. Education, including on health, must be recognised as a crucial
tool to enhance women's status, welfare and autonomy, empowering them
with improved access to information, knowledge and gainful employment.
Education on gender equality must not be directed to girls and women only
but must reach all groups and individuals alike in all societies.
Policies for improving women's status and quality of life must not be
marginalized as "women only” issues. They must be seen and implemented as
part and parcel of comprehensive and coherent public policies which,
within any community, should ensure a fair deal to all individuals,
irrespective of sex, income or ethnic group.

Governments have a prime responsibility to ensure the provision of
equitable access to health, education and employment for all women. At
both national and international levels, they must foster the development
of an economic, social and legal environment that is supportive of
women's rights, including their health and welfare, and gives women full
opportunity to realise their individual potential according to their own
free choices and as equal partners in all areas of activity. The World
Health Organisation is committed to this global endeavour jointly with
other United Nations Agencies and especially UNFPA. WHO pledges its
continued support through the achievement of equitable access to health
for all women, in a spirit of solidarity, respect and social justice.