Reaching the Unreachable, Securing Sustainable Development’s Promises Can Reverse Maternal Mortality Trends, Integrate Women in Green Economy, Commission Told
Reaching the Unreachable, Securing Sustainable Development’s Promises Can Reverse Maternal Mortality Trends, Integrate Women in Green Economy, Commission Told
|Department of Public Information • News and Media Division • New York|
Commission on the Status of Women
11th & 12th Meetings (AM & PM)
Reaching the Unreachable, Securing Sustainable Development’s Promises Can Reverse
Maternal Mortality Trends, Integrate Women in Green Economy, Commission Told
Expert Panels in Women’s Commission — on Gender Equality,
Sustainable Development — Prompt Lively Exchange with UN Women’s Chief
Amid the ongoing tragedy of maternal mortality and morbidity, reaching the unreachable must be the goal of strategies to improve maternal health care, while securing the promises of sustainable development required that poor women be “dealt in” to a green economy, the Commission on the Status of Women heard today.
During the first of two expert panels today, on gender equality and sustainable development, two of the four presentations focused on raising the profile of the women’s agenda in the run-up to next year’s “Rio+20” summit, which would review the United Nations Conference on Environment and Development (UNCED) held in Rio de Janeiro in 1992.
The consultative process that had led to the landmark 1992 “Earth Summit” had opened the door to women’s voices and provided the means for their direct participation, the Interim Executive Director of the Women’s Environment and Development Organization (WEDO) said. Identifying the principle of gender equality and rights-based development as the most inclusive element in development policy, she stressed its place as an entry point for women’s empowerment and equality on the road back to Rio.
“It is impossible to achieve sustainable development anywhere unless the world is prepared to develop, protect and empower women everywhere,” she said. While it was not necessary to remake that agenda for every conference, it must be borne in mind that paper rights did not translate into freedom to act, she said. As they prepared for Rio+20, women must once again ensure that the new lexicon of the green economy — including terms that had become household words like eco, carbon neutral and global commons — reflected their values and aspirations.
Also making the case for women’s place at Rio+20, the Conference’s Executive Coordinator said the groundwork should be laid now for projects and programmes to capitalize on renewed political commitment coming out of Rio. Because the summit would be shaped by the dictates of Member States, she encouraged all delegations to work to influence the contributions of their States now. She cited gender-sensitive language and the creation of sustainable development indicators with a built-in gender dimension as potential inputs.
Providing a real-world example of how women’s economic situation could be transformed through engagement in sustainable activities, the founder and President of Peru’s Grupo Cuidad Saludable (Healthy Cities Group) described how people living in garbage dumps and making between $1 and $2 a day had been trained as recyclers. When organized into an association, they were able to earn between $8 and $10 a day. The programme’s impact was not limited to an individual family’s bottom line, since the creation of dignified work also meant access to social safety nets, education and, importantly, loan programmes.
Focusing on energy’s role in empowering women and reducing poverty, the Executive Director of the Solar Electric Light Fund (SELF) underscored energy as a “huge accelerator” to all development goals, from those related to health to those that focused on water. Expressing disappointment that “energy poverty” had not been counted among the Millennium Development Goals, he said modern energy must still be brought to those lacking it. In the developing world, solar energy stood as the least costly option for doing so, while also providing the opportunity for whole societies to leapfrog the carbon-fuel economies.
Moderated by the Executive Director of the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women), Michelle Bachelet, the afternoon panel addressed the links between women’s empowerment and the elimination of preventable maternal mortality and morbidity. Posing a number of questions to her seven panellists during a truly interactive session, she sought to flesh out the root causes of that tragic scourge to women’s health and to assemble a snapshot of global efforts to eliminate it, particularly since the launch of the Global Strategy for Women’s and Children’s Health by Secretary-General Ban Ki-moon last year.
Responding to questions from Ms. Bachelet, as well as representatives of Member States, non-governmental organizations and civil society, the panellists named the education of the girl child as the most effective area of investment to improve maternal health care. They also underlined the links between the health-related Millennium Development Goals, describing how, for example, interventions aimed at preventing the transmission of HIV/AIDS raised the levels of prenatal care. In closing, Ms. Bachelet said leadership must be exercised to abolish what was, in the twenty-first century, a tragedy.
The Commission on the Status of Women will reconvene at 10 a.m. on Thursday, 3 March to continue its general debate.
Interactive Expert Panel 1
The morning panel on “emerging issues, trends and new approaches to issues affecting the situation of women or equality between women and men” was moderated by Commission Vice-Chair Leysa Sow of Senegal and focused on “gender equality and sustainable development”. Panellists included Henrietta Elizabeth Thompson, Executive Coordinator of the United Nations Conference on Sustainable Development; Monique Essed-Fernandes, Interim Executive Director, Women’s Environment and Development Organization (WEDO); Robert Freling, Executive Director of the Solar Electric Light Fund (SELF); and Albina Ruiz, Founder and President of Grupo Cuidad Saludable (Health Cities Group).
Launching the discussion, Ms. THOMPSON said the forthcoming 20-year review of the United Nations Conference on Environment and Development (UNCED) to be held in Rio de Janeiro (Rio+20) should be used to raise the profile of the women’s agenda within the context of sustainable development. The upcoming conference had three objectives, two of which included renewing political commitment to sustainable development and evaluating and addressing the gaps in policy implementation. In that context, she asked “What was the role of women in achieving sustainable development?”
Zeroing in on the links between women’s advancement and economic development, she said there was no doubt that the face of poverty was female. The majority of the unemployed were women. When they were employed, women were paid an average of 17 per cent less than their male counterparts. Women also had little control over reproductive health, on one extreme, and few national assets, on another. They were also disproportionately absent from boardrooms and executive offices. Yet, if the question of women’s roles were cast in business terms, women could not be ignored. Indeed, no Chief Executive Officer in the world would choose to alienate half of the resources available to his or her company. The same was true in the realm of development policy.
In that vein, she stressed that investments were needed in human resources, including women, to achieve sustainable development. According to research from the Organisation for Economic Cooperation and Development (OECD), women were more likely to buy recycled and recyclable products and to pursue green opportunities. The global consulting firm McKinsey showed in a recent report on the economy and the environment that a green economy was not just possible, but cost-effective. Together, findings like those made the case for women’s place at Rio, she said.
The work to renew political commitment and assess gaps and implementation at “Rio+20” must recognize that one critical gap was how women were being used to further sustainable development, she continued. Stressing the importance of the language used in the texts, she encouraged all delegations to influence the input of their States to include gender-sensitive language. Groundwork should also be put in place now so projects and programmes could seize the political commitment coming out of Rio.
Outlining the story of a Chinese woman, Zhang Yin, who was called the “queen of trash” and had built a multibillion dollar business by recycling paper into containers, she underlined the significant economic opportunities for women in a green economy. Moreover, more women like Zhang Yin should be identified as success stories and their best practices shared around the world. Soliciting recommendations from the Commission on how the women’s agenda could be strengthened in the sustainable development context, she concluded that efforts to ensure that women were healthy and educated and had access to goods, services and businesses would be part of creating societies that were both sustainable and successful.
Speaking next, Ms. ESSED-FERNANDES said she would address the historical context of governance issues and the possible entry points for the road to Rio+20. Looking back at the process that had lead to the United Nations Conference on Environment and Development, she said women from the South had historically been excluded from discussions on both development and the environment. But the UNCED consultative process had opened the door to women’s voices and provided the means for their direct participation. Moving forward, she said the preparation for the 20-year review conference must be inclusive, adding that “we do not have to redefine and remake that agenda every time we have a conference”.
However, paper rights did not translate into freedom to act, she warned, emphasizing that women were still struggling to gain basic rights to livelihood, health and education services, among others. Women must once again make sure that the new lexicon of the green economy — including terms that had become household words like eco, carbon neutral and global commons — reflected their values and aspirations. It should be asked “what is green, and green for whom?”
In that regard, she highlighted three main challenges in putting a green economy into practice. First, the focus of the present-day economy on growth was measured mostly in gross domestic product (GDP), while largely ignoring the fact that economic growth in and of itself had not automatically led to solving poverty or even a more equitable distribution of production. Second, most countries had huge imbalances within and among the pillars of the commonly accepted paradigm of well-being — employment, education and health. Finally, most economic systems lacked participatory processes, and it was not clear how a green economy guaranteed them. On the last point, she pointed to the experience of indigenous women.
Turning to entry points on the road to Rio, she identified the principle of gender equality and rights-based development as the most inclusive element in development policy. The adoption of a holistic perspective on development — namely one that integrated socio-cultural, economic, environmental and political dimensions — was a prerequisite for green governance. The effective participation of players and citizens in development processes required women’s voices, participation and decision-making. In addition, considerable investments by the State were required.
Next, Mr. FRELING, focusing on energy’s role in empowering women and reducing poverty, said: “I’ve taken electricity for granted my entire life.” In many parts of Africa that were not connected to a power grid, people retreated into houses that were dimly lit by smoky kerosene candles. Virtually every aspect of their lives was affected by “energy poverty”, especially women’s, who spent their days collecting water and wood. Today, 1.6 billion people lacked access to electricity, and he was disappointed that the issue had not been counted among the Millennium Development Goals. Solutions still must be found to bring modern energy to those lacking it. In most cases, extending the grid was not a viable option for rural, isolated villages. Diesel generators also were unsustainable, as they were expensive, vulnerable to supply chain disruptions and polluting.
Describing the Solar Electric Light Fund (SELF), he said that, in the 1990s, it had set about using the sun to light rural areas, mainly by installing 50-watt systems into rural households. Without cash, the vast majority of those families had no way to purchase the electricity, so SELF had extended micro-credit, which proved a success, as many families were already spending $5 per month on kerosene candles.
In 2000, SELF had expanded into electrification projects for communities, lighting schools and small businesses, and bringing Internet access to rural villages. By way of example, he said that in South Africa, the Fund had equipped a rural school with a 4.5-kilowatt “solar array” to power a computer lab, which, in turn, improved the pass rate among students. In Rwanda, the project had installed solar photovoltaic systems in all health clinics run by Partners in Health, supplying electricity for state-of-the-art laboratories in a cheaper, more environmentally sustainable way than using diesel. In Haiti, it was installing the same systems in all 10 clinics it ran in the Central Plateau. In Benin, it provided clean drinking water in several villages, freeing girls to now attend school.
Rounding out the panel, Ms. RUIZ said the focus of Healthy Cities was on creating dignified jobs for women and their families. “Often, we look at people but we don’t see them,” she said, explaining that 2 million people in Peru — and 20 million people worldwide — lived in trash and garbage. Born in the Peruvian Amazon, she had attended university in the capital city, Lima, where, unlike the jungle, she had found “mountains” of trash. When she had inquired as to why it was not removed, she was told: “poor people like to be dirty”, which clearly was not true.
She said that experience had spurred her to create a programme to train people living in the dumps and making between $1 and $2 a day, to become recyclers, who, when organized into an association, would make between $8 and $10 a day. She had partnered with a training institution that would certify people as recyclers, and developed a post-graduate programme to train professionals in municipalities and ministries of health about recycling. Without those services, she reasoned, large companies offering their own programmes defined how municipalities operated. Healthy Cities also trained volunteers to teach families about separating waste, so they no longer dumped it in the streets.
“Political will is very important,” she said, adding that if authorities did not make decisions, “we cannot move forward”. Taking the lead on the issue, Peru had devised the first law in the world for recyclers, outlining measures for socio-economic inclusion. Indeed, the creation of dignified work meant access to social safety nets, education and, importantly, loan programmes. As loans were almost always the most expensive for the poor, she had designed a programme whereby Healthy Cities guaranteed loans — normally offered by banks at a 16.5 per cent interest rate — to recyclers. “We have zero default on the loans,” she said.
Looking ahead, she stressed the need to invest in education, saying: “If we don’t raise awareness so people take on their social responsibilities, there’s not much we can change”. She also hoped to partner with a university in North America or Europe to offer post-graduate programmes. “We do know that together we can change the world. We will create dignified jobs and fight poverty.”
Kick-starting the panel’s interactive portion and keying off the presentation by Mr. Freling, the representative of Jordan said it was high time to have a special rapporteur on the right to energy, just as there was a special rapporteur on sanitation. Marshalling his arguments, he noted that having an advocate for toilets had resulted in concrete changes as policymakers were made aware that absence of separate sanitation facilities affected girls’ school-retention rates. He stressed that an expert on energy could also effect real change.
Several interventions suggested that the bulk of Governmental environmental programmes were largely motivated and organized at the municipal level. Switzerland’s representative highlighted her country’s recycling programmes, which were organized at the municipal level. What was missing, however, was a focus on integrating women in such actions. Portugal’s delegate said her country was currently in the process of evaluating gender and environment at the “territory” level.
Several speakers seized on the waste dimension of sustainable development. One speaker warned of the dangers of environmental exploitation, suggesting that the concept of “green” was sometimes used by large corporations to further their interests, rather than those of the community, the poor or women. The consumption side of the environmental equation could not be ignored, others said.
A number of speakers called for better understanding and valuation of global public goods, stressing that they must be included in development and economic growth models. Another speaker asked if African solar energy initiatives like those highlighted by Mr. Freling could be transferred to the developed world.
Responding, Ms. THOMPSON agreed that a green economy had to include the concept of green energy and that a definition of what “green economy” actually meant did not yet exist. The United Nations Environment Programme (UNEP) had recently attempted to produce a definition, and she believed an economy could reasonably be defined as “green” if it grew while also protecting its human and natural resources. She further stressed that it was impossible to achieve sustainable development anywhere unless the world was prepared to develop, protect and empower women everywhere. She urged delegations to provide definitions on green economy in the run-up to Rio+20, which would inevitably reaffirm the principles of the original conference.
Mr. FRELING said a special rapporteur for energy access was an excellent idea. The cost of solar energy had decreased dramatically, and “a new renaissance” in energy generation was emerging in the developed world. He particularly noted its growing use in the countries of Europe, led by Germany. As for the developing world, there was no technology that could effectively compete with solar energy, stressing that kerosene was not really an attractive alternative. As the least costly option for power generation, solar energy also provided the opportunity for whole societies to leapfrog the carbon-fuel economies. However, the upfront costs posed the biggest obstacles to that development and financing was a critical component in advancing that agenda. “These systems will pay for themselves over time,” he said, adding that energy was a huge accelerator to all development goals, from those related to health to those that focused on water.
Suggesting that Suriname provided some examples of how municipalities could be motivated to move towards sustainable development programmes, Ms. ESSED-FERNANDES said the Government had developed a vision for green economic development, and civil society and non-governmental organizations had played animating roles in that process. However, it had taken time. While Government should be in the driver’s seat, policymakers must have the ability to make informed choices. For that, they had to be fed information from civil society and the private sector. Financing was also critical in bringing that process to fruition, and should not just come from public coffers.
Holding up her purse, Ms. RUIZ said it was made by women from recycled newspapers. The woman who made it had been combing the streets looking for food for her pigs when she had stumbled on a business idea. “Give women an opportunity and they take off,” Ms. Ruiz said.
Continuing, she said her efforts in Peru demonstrated that the process of working with the Government could be lengthy and repetitive because ministers did not always talk to one another and even sometimes competed with each other. She underlined the role of the press to develop responsible consumers, further stressing that the consumption dimension was indeed a central component in sustainable development. Instead of marginalizing poor women, they should be “dealt in” to the green economy, she said, underscoring education as the key means of doing so. Indeed, the sanitation engineers that developed systems in which raw manufacturing waste was dumped into rivers had clearly learned the wrong thing and should return to school to learn better methods.
Speaking once again, Ms. THOMPSON said that as sustainable development indicators were created to modernize GDP measurements, they should be designed to include a gender dimension. A stable set of indicators with a built-in gender dimension was one contribution the Commission could make on the road to Rio.
In a second round of questions and comments, a number of speakers discussed national initiatives to achieve sustainable development in a way that took into account the unique needs of women and girls, especially by broadly integrating environmental issues — including waste disposal — into school curriculums throughout the education lifecycle. Some inquired about training women to repair and maintain solar systems. Every day, South Africa’s delegate said, women worked with water and used energy, and needed training in recycling, solar energy and renewable energy technologies.
Other delegates underscored their strong commitment to gender equality as a means to contribute to equitable sustainable development, with one speaker pointing out that progress on Millennium Development Goal 5 (maternal health) lagged more than that of all other Goals. Failure to account for women’s rights in development plans meant that countries were underinvesting in their human capital. In that context, the European Union’s representative asked how local authorities and the private sector could contribute to gender equality as a driver for sustainable development, and further, how women’s role in the free economy could be strengthened.
Other comments centred on the design and implementation of gender-sensitive policies for climate change and natural disaster risk reduction, with a representative of the United Nations International Strategy for Disaster Reductions (UNISDR) noting that such events could reverse in an instant gains made by women over decades. Women’s unequal access to knowledge and power deprived them of the ability to protect themselves, their children and their assets in such cases. Gender and disaster reduction were cross-cutting issues that impacted every aspect of development and must be addressed by a multistakeholder approach.
Other questions focused on ways to empower women as managers and decision-makers, and further, to strengthen the presence of the Convention on the Elimination of All Forms of Discrimination against Women in the Commission on the Status of Women, and processes in which the Commission was involved, such as the Rio+20 summit in 2012.
Replying, Ms. THOMPSON said the secretariat for the Rio summit would respond to what Member States wanted. “We are going to be driven by the dictates of Member States,” she stressed. “We will respond if you are able to influence your countries, particularly in relation to the issue of mainstreaming gender into national and international policy”, and on whether gender-sensitive text should be included in Rio.
To questions about training, Mr. FRELING said the Fund trained men and women to install solar systems and was looking to expand those programmes. It had started devising more ambitious concepts for training programmes, which had been well received in Rwanda. He also hoped to create a training programme that would teach the next generation of solar entrepreneurs. “The last thing we want to do is install the technology and run away,” he said, stressing that know-how must be transferred. While photovoltaics (solar energy) was a sophisticated technology, it was simple in its application and lent itself to training. He encouraged all States to promote training in photovoltaics and other renewable energy technologies.
Ms. ESSED-FERNANDES, addressing a question on the Women’s Anti-Discrimination Convention, said that with 186 States parties, the Convention could wield important power over Member Governments. In the context of Rio+20, she urged creating better national and international monitoring mechanisms, as those bodies often grew weak at the lowest levels. To a query about representation, she said it made sense for women to combine forces to wield more influence and impact. By way of example, she said that in Suriname, a platform of women’s organizations represented all sectors and included grass-roots women’s organizations and indigenous women. It used a democratic system of operation, regularly rotating the Chair and representing women in the places they needed to be.
On the private sector’s role in financing microcredit, she said “the private sector can be an ally”, particularly in pushing for democratic mechanisms and those for ensuring women’s participation. Microcredit must be a system that encompassed a road to growth, as it made no sense to set up those services without a “step-up” system, whereby finance could reach the next level. Existing funding mechanisms created in the context of sustainable development must be better monitored and include a gender dimension.
Finally, Ms. RUIZ said sustainable development required the involvement of the public, private and social sectors in order to help the most people. Healthy Cities had a presence in 100 towns and cities across Peru, including in Lima, where 8 million people lived. The benefits of being involved in the organization transcended the financial advantages. The confidence of women who had been abused or worked as prostitutes often improved when given a decent job. Children who had been ashamed of their mothers who rifled through trash felt a new sense of pride when their mothers work — and in a business that promoted the environment.
Also participating in the morning discussion were representatives of Iceland (also on behalf of Denmark, Finland, Norway and Sweden), Israel, Cuba, Philippines, Greece, Japan, Paraguay, Mexico, Azerbaijan, South Africa, Guinea, Ghana, Dominican Republic, Armenia and Gabon.
Representatives of the Network Women in Development Europe and the International Alliance of Women also spoke.
Interactive Expert Panel II
Moderated by Michelle Bachelet, Executive Director of the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women), the afternoon panel on “elimination of preventable maternal mortality and morbidity and the empowerment of women” featured seven panellists: Babatunde Osotimehin, Executive Director of United Nations Population Fund (UNFPA); Kyung-wha Kang, Deputy High Commissioner for Human Rights; Christoph Benn, Director of External Relations and Partnerships of the Global Fund to Fight AIDS, Malaria and Tuberculosis; Mayra Buvinic, Sector Director in the Gender and Development Group at the World Bank; Werner Obermeyer, Executive Director ad interim of the World Health Organization (WHO) New York Office; Julia Kim, Cluster Leader for Mainstreaming HIV & Health and the Millennium Development Goals at the United Nations Development Programme (UNDP); and Diane Summers, Senior Specialist at the Global Alliance on Vaccines and Immunizations.
Responding to a question raised by Ms. BACHELET about earlier concern over the lack of progress in achieving Goal 5 (maternal health), and later data showing some progress, Mr. OSOTIMEHIN said that each year, more than 350,000 women died from complications of pregnancy and childbirth — almost 99 per cent of them in the developing world. Globally, maternal mortality had fallen by one third since 1990, but the pace of decline was slow, despite that the vast majority of those deaths were preventable. In sub-Saharan Africa, 1 in 30 women died from such causes, versus 1 in 6,500 in the developed world. Each year, more than 1 million children were left motherless, and they were 10 times more likely to die prematurely than those who had not lost their mother.
He said that through the “Health-4 Plus” initiative, which also involved the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank, $40 billion had been pledged by 45 countries to address maternal health. The challenges concerned women’s status; a lack of respect for their rights and space. Further, the International Conference on Population and Development agenda — which empowered women to exercise their rights, not only to services, but also in the economic and political spheres — had not been fully implemented. Health systems posed another challenge. Resources had been poured into social issues, but “we have not built health systems”, and without that, there would be no forward movement.
He proposed devising an integrated package of sexual and reproductive health services to address Goal 5. Also, countries had not come up with required resources to build systems or provide for basic health commodities and human resources. It was true that donors had not met their pledges, but countries in the global South had not allocated resources. The Abuja agreement, for example, outlined that 15 per cent of any federal budget should go towards health; however, only a handful of countries had actually done that.
Asked by Ms. BACHELET how WHO addressed maternal mortality in the larger context of improving health systems, Mr. OBERMEYER said women died from severe bleeding during and after childbirth. Functioning health-care systems must help women plan their pregnancies. With that in mind, WHO worked to improve the base for applying knowledge in health-care delivery systems, including in the provision of funds, trained staff, primary health care and quality care facilities that were accessible to rural areas.
Asked to share best practices, Mr. OSOTIMEHIN underscored the importance of “education, education, education” for girls. The priority should be on ensuring that girls stayed in school, and he highlighted a programme in Bangladesh that did so through a cash programme. Generally speaking, girls in school developed emotionally and psychologically, so that when they married and had children, they made informed choices. They were less likely to contract HIV and more likely to seek protection and insist that partners use condoms. Girls’ empowerment was the major intervention to make that happen.
Asked to provide further information on the efforts of UNDP to ensure women’s access to health services, Ms. KIM said UNDP was largely using partnerships with local organizations. In India, it was supporting a public-private partnership to assist Lifespring Hospitals, which had committed to provide 82,000 women and their families with health care. UNDP was working in areas that might be considered on the margins of women’s health, including, for example, to reduce gender-based violence. Its work to improve infrastructure, such as roads, helped expand the ways in which women could access health care. UNDP was taking a wider perspective to harness development initiatives in order to bolster their collective impact on maternal health.
Asked how the Population Fund, as a member of the so-called “H4+”, as the health partnership between WHO, UNFPA, UNICEF and the World Bank was called, was working to implement the Secretary-General’s Global Strategy for Women’s and Children’s Health, Mr. OSOTIMEHIN said that roughly two dozen countries working to improve children’s and women’s health had been identified for support. The aim was to ensure they had access to a range of interventions, and when the Global Strategy had been launched, $40 billion was pledged by both the global North and South. UNFPA had led consultations with the international community and that work would continue throughout 2011. Outreach opportunities included an event on the applications of information and communications technology in June and a one-year review event for the Global Strategy in September.
Underlining the nexus between the public and private sector in accelerating progress in reducing maternal mortality, Ms. BACHELET asked Mr. OBERMEYER how accountability could be improved. Responding, Mr. OBERMEYER recalled that the Strategy aimed to help countries monitor the flow of resources and which interventions were most effective. Two working groups had been set up to fill out the accountability framework by identifying data gaps both in terms of resources and effectiveness. A draft framework would be in place by May, with a final version completed by the Global Strategy’s one-year review in September. That work could be followed on www.everywomaneverychild.org.
Asked where the variety of resources pledged to the Global Strategy were being disbursed, Mr. OBERMEYER said the $40 billion promised so far was not “cash on hand” and would come over the next few years. The short answer on where the fund stood was that that the amount calculated covered the total volume of pledges, including in-kind services. Tracking programmes and mechanisms to make those commitments as effective as possible were still forthcoming, he added.
Mr. BENN said the Global Fund’s core mandate was combating HIV/AIDS, tuberculosis and malaria, but it was increasingly clear that the health-related Millennium Development Goals were interrelated and the Fund was impacting Goal 5. Integration was the key word in achieving efficiency across the health-related Goals. In Ethiopia, where the Fund had made a particularly large investment, health-care workers who were trained in the Fund’s key diseases were also providing maternal care. Tanzanian clinics that aimed to prevent the transmission of HIV from mothers to children also provided general pre- and neonatal care.
Ms. BUVINIC, stressing that health services must be “acceptable, accessible and affordable”, said health was more than health-sector reform. The determinants in that field were important to explain women’s health and ensure that gains translated into creating an empowered female health-services user. She must be old enough to give birth without complications, be able to plan her family, be educated and be economically empowered. Ultimately, the value that families and societies placed on girls and women must be changed, mainly because it was “smart economics” and affected societies from cradle to grave. The World Bank was uniquely placed to deliver that message to planning and finance ministries.
Describing two important new tools that would soon be available, she said the International Development Agency, the “soft loan” window of the Bank, would soon see its sixteenth replenishment — the largest ever, at $49.3 billion. For the first time, gender equality would be among the main four themes of the window, with a special emphasis on reproductive health and decreasing maternal mortality. As the Agency was country-driven, Governments must request the funding for gender equality.
The second tool to help Governments see that investing in gender equality was smart economics was the 2012 World Development Report, the Bank’s flagship publication, which for the first time ever would focus on gender equality and development. She hoped it would stimulate finance ministries to see that putting the Agency’s resources to work on behalf of women meant they would be put to work on behalf of development.
As for how a global strategy could expand existing partnerships to reduce maternal mortality, Mr. OSOTIMEHIN said the “Health 8” initiative, a group of eight health-related organizations that included the Global Fund and the Gates Foundation, had created a “ground swell” of stakeholders. The goal was to provide assistance to national systems by producing plans and advocating for resources. Communities must be involved in implementing plans, and it was important to bring on board religious and other leaders to join efforts.
Asked by Ms. BACHELET about instances in which the World Bank had led global health partnerships, Ms. BUVINIC described a partnership with Norway and the United Kingdom by which a $500 million fund had been created to support results-based financing, an umbrella term which included performance-based financing and provision of incentives. Results showed that in Afghanistan, child health services and antenatal care had increased from 5 to 30 per cent in four years.
In another partnership, which involved several Governments and the Nike Foundation, she said a pilot project had been carried out to aid the transition of adolescent girls from school to work. In Malawi, for example, the Bank provided conditional and unconditional cash transfers, but rather than giving the entire transfer to the girls’ mothers, half of it was given to the adolescent girl. In some cases, it was provided on condition that she attended school; in other cases, it was provided unconditionally.
“The results have been amazing,” she said, noting that after two years, adolescent girls who received the transfer had reduced their pregnancy rate by 38 per cent, early marriage rate by 48 per cent and HIV infection by 60 per cent. “This may be the most effective tool to prevent HIV in adolescent girls,” she said. The Bank now hoped to replicate the experiment in other countries and other situations.
Asking to explain how the Global Alliance on Vaccines and Immunizations was helping to improve women’s access to maternal health services, Ms. SUMMERS focused on access, stressing the need to strengthen health services in a way that responded to women’s needs. Maternal health required skilled attendants, among other high-cost services, which helped to explain why maternal mortality was decreasing at a slower rate than children’s mortality. “Getting this right means investments,” she observed.
Addressing barriers to access, she cited a WHO study showing that, while overall immunization rates between girls and boys were equal, immunization services were not reaching poor women, who faced a double barrier of poverty and gender discrimination. Barriers must be overcome by working in partnership. There was also a need to work together on women’s health, especially in addressing the link between maternal deaths and non-communicable diseases, outlined in a 2009 WHO report on women and health. Finally, she said that a quarter of a million women died each year of cervical cancer, most of them in poor countries and in the prime of their lives. Prevention was of critical importance. The Global Alliance on Vaccines and Immunizations was working to reduce the high $300 price tag for the human papillomavirus (HPV) vaccine, which was required in three doses.
Turning to a number of unaddressed issues, Mr. OSOTIMEHIN said it was critical to identify the non-negotiable aspects of the health-care package — namely the community health workers. He suggested that in trying to access the hard-to-reach individuals, the strategy should aim to support millions of health-care workers. They must be trained in, among other things, family planning and the care of pregnant women. With that range of services, it would in large part be possible to prevent HIV transmission and unsafe abortions, which, he argued, was a big part of maternal mortality.
He further emphasized that to ensure the sustainability of health-care initiatives they should be built with community involvement. Finally, and critically, Governments must commit resources. Indeed, it was easy to build a hospital with a thousand beds in the capital to showcase a country’s progress in health care. But what mattered was reaching the unreachable.
Asked for examples of UNDP’s local partnerships, Ms. KIM cited the Programme’s work in Tunisia, Uganda and Ghana to locate and target specific bottlenecks on Goal 5 in each country’s health services. In Tunisia, UNDP had worked with its international partners to prepare a sub-national report, which became an important advocacy tool for the Government and the United Nations team to scale up services in regions with the highest rates of maternal death. While its more health-oriented partners were taking the lead in further medical action, UNDP was mobilizing greater awareness and working to include Goal 5 in broader development strategies.
Asked to elaborate on the unique value-added of the Office of the United Nations High Commissioner for Human Rights (OHCHR) in maternal health care, Ms. KANG said the Office did not add value per se, but human rights thinking did. “Human rights force you to look at the individual at the centre of the dynamics,” she said, referring to the pregnant woman who faced death or life-long disability as a result of her pregnancy.
Human rights thinking also forced Governments to face up to the obligations that they had voluntarily signed up to implement, she said, noting their accession to the various human rights conventions. The accountability framework provided by those conventions was the basis on which specific actions in the area of maternal health could be asked of Governments. The root causes of the problem of maternal mortality and morbidity were, of course, deep-seated stereotypes, and the first two articles of the Universal Declaration of Human Rights provided the basis for discrediting and dispelling those.
Referring to a recent rights-based evaluation of maternal health care, she said a wide range of rights had been identified as relevant. For example, the right to life was engaged when a preventable death was not. Among other relevant factors were the right to education, the right to freedom from discrimination, the right to the highest attainable standard of health and the right to privacy and effective remedy. Concluding, she stressed that maternal health care was not simply a question of medical care, but fundamentally a question of justice.
Asked for concrete examples on how better immunization had improved maternal health, Ms. SUMMERS said she had been in a village on immunization day, and family planning providers had been equally busy as those who had been administering immunizations. She had been told that the mothers bringing their children to be immunized were availing themselves of injectable contraception without the knowledge of their husbands or mothers-in-law, and the family planning and immunization services were deliberately provided in tandem. Her point was that if the cultural barriers to women’s access to health services were not overcome, progress in reducing maternal death would be slow. To redress that, women should be put at the centre of services that were responsive to their needs.
Asked for evidence on how the Global Fund’s work to further Goal 6 had affected Goal 5, Mr. BENN said that, together, HIV, tuberculosis and malaria directly caused over 1 million deaths per year among women. HIV remained the leading cause of death for women in Africa. Sixty-thousand pregnant women still died from HIV-related diseases. Thus, investments in reducing those diseases directly affected maternal mortality rates. The Fund also supported antiretroviral treatment for 3 million people, of which 50 per cent were women. Without that treatment, they would die. Similarly, the Global Fund provided intermittent treatment to pregnant women highly susceptible to malaria. Together, those examples provided direct evidence of the Fund’s impact on Goal 5.
Asked for lessons learned on how national human rights mechanisms affected maternal-health initiatives, Ms. KANG suggested that the notion of “acceleration” should be avoided in favour of gradual increases over time. Short-term, high-impact projects risked leaving out the most vulnerable and marginalized women. She added that the human rights treaty monitoring bodies periodically reviewed country performance, with rights-reviews touching on women’s rights, including maternal health.
When the floor was opened to questions and comments, delegates stressed that the birth day was still most dangerous in some countries for the mother and baby alike. Despite many interventions to improve the situation, maternal mortality remained high in several countries, with efforts to promote modern contraceptive use, especially that of the female condom, unsuccessful, some speakers said, in part because of social perceptions and high costs. Maternal mortality was symptomatic of women’s low status and entrenched gender inequalities, others said, which was especially true for women and girls with little or no education.
Moreover, scarce national resources, especially in times of economic crisis or weakness, often flowed to sectors other than health care, delegates noted, leaving women’s priorities unrecognized and unmet. Knowledge was not lacking, but rather an ability to implement programmes that Governments knew were effective.
A broad range of rights must be advocated, other speakers stressed, including the right to safe abortion. “Let’s not underestimate women’s own agency,” Norway’s representative asserted. Being serious about maternal health required a seriousness about the right to safe abortion and the quality of abortion-related laws. Access to comprehensive sexual reproductive health services was also needed.
Not so, said Chile’s delegate, who argued that her country’s experience showed that respect for human life was essential for any country wishing to reduce maternal mortality. Abortion was illegal in Chile, a country which boasted the lowest rate of maternal mortality in Latin America. Safe pregnancies, rather than abortion, should be promoted.
Questions focused on the fact that, along with multiple resource constraints, developing countries also had to fight a “brain drain” of skilled health personnel who migrated to countries where “the grass is greener”. Given that backdrop, Zimbabwe’s representative asked about the viability of a maternal mortality levy, to be implemented on a sliding scale, against countries that sent trained health-care personnel to developed nations. For example, in her country, 3 per cent of all employee income was taken by the Government as an AIDS levy, which had helped to reduce HIV prevalence.
Other speakers asked for panellists’ views on effective strategies for building capacity in the health sector, and specifically on whether women’s status as health workers affected maternal mortality in any way. Still others asked about any examples of health outcomes that had been linked to interventions to improve women’s education and nutrition. Some wondered whether the initiatives and strategies discussed by the panellists’ were aligned with national priorities, and further, how the Secretary-General’s recently announced Global Strategy on Women’s and Children’s Health could be implemented at the national and local levels.
“Even one woman dying from preventable causes in childbirth means we still have work to do,” said a representative of the Youth Coalition for Sexual and Reproductive Rights. She asked panellists about any mechanisms that included young women in their organizations.
Responding, Ms. BUVINIC said reaching remote areas of South Sudan embodied the most critical aspects of the current session. Providing basic infrastructure, including roads, was paramount. To Zimbabwe’s question, she said more accountability was needed, particularly in terms of how national budgets were allocated. She also stressed that empowered women and girl customers would, in the long run, be the ones who made the difference in terms of the success of maternal health care. Responding to Norway’s comments, she said the amazing thing was that cash made a difference. She added that any innovative way of financing the health sector, as well as women’s empowerment more generally, was important, and the World Bank and the international community must be aware of them.
Mr. OSOTIMEHIN said the most important intervention in improving maternal health was the education of the girl child. It improved skills sets, advanced maturity to make healthy decisions, including marrying when a woman wanted to marry and the spacing of children. Studies demonstrated that the issue of access was related to the proximity of services, the ability to pay and the quality of health services. Those aspects must be integrated. Given the mobility of health-care professionals, it was important to integrate them into the community.
Mr. BENN said that while female condoms could be distributed for free, there were other social and cultural barriers to their use. The Global Fund had adopted a gender-equality strategy, which meant to educate and provide guidelines on a country-level basis.
Ms. KANG agreed entirely with Mr. Osotimehin that, given limited resources and the goal of improving maternal health care in the long term, investments should target education of the girl child. She referred delegations to the compilation by the Centre for Reproductive Rights entitled “Bringing Rights to Bear: Preventing Maternal Mortality and Ensuring Safe Pregnancy” for more information on a rights-based approach. Her office was preparing an analytical compilation of a human-rights approach to the issue of maternal health care for an upcoming session of the Human Rights Council.
Concluding the panel, Ms. BACHELET underlined the impact of free health services. She was on the HIV/AIDS Commission and she had seen female condoms, but she believed that better female condoms were needed. Their manufacturers should be encouraged to come up with an improved design. The empowerment of women and girls was essential so they could make the best decisions for themselves. Education was key in that effort, as was community input and support. Finally, leadership must be exercised to abolish what was, in the twenty-first century, a tragedy.
Also taking part in the afternoon panel discussion were representatives of Sudan, Greece, Ghana, United States, Mali, Canada, China, France, Ireland, New Zealand, South Africa, Portugal, Switzerland and Japan.
A representative of the European Union also spoke.
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