First Ladies Session
26 July 2010

Firstly, my very warm thanks to the Hon. Janet Museveni, and the African Union for the invitation to join you here this afternoon for this important meeting at a critical time in the history of this great continent. Thank you too to PPD for facilitating this event. I would also like to thank the Hon Janet Museveni for her leadership on the maternal mortality road map in Uganda, and her inclusion of the importance of repositioning of family planning.

I had the privilege of meeting some of you last February and would like to acknowledge again your role as leaders and advocates. Each of you individually has so much to contribute, together your strength and commitment make you a formidable force for development, and the drivers of a better, brighter future.

I am privileged too to be here as a representative of civil society, the third part of the partnership of governments, UN agencies and civil society-although it is such a diverse group I cannot claim to speak for its richness and diversity.

In particular I represent a federation of 151 independent community based national NGOs which together provide 69 million health services, comprehensive education and advocate for health, human rights and development.

You will very probably know one of these organisations as a non-governmental organization (NGO) in your own country, but may not recognise that they are part of a global movement as well as leading providers of services in communities where people live and work; services including paediatric care, family planning, HIV prevention, counselling and testing, and often fully integrated programmes providing reproductive health and HIV treatment and care, as in Swaziland where the Family Life Association has been described as a model of integration, a one stop shop.

Each of these organisations has grown up in its community, is community owned, staffed and governed, many work with UN agencies like UNFPA, UNAIDS and WHO and as partners of governments, reaching those whom governments often cannot easily reach: young people, street children, sex workers, drug users. Others carry out community education, or train health workers, as in Ethiopia. Many are on government advisory committees or CCMs for the Global Fund, and some are Global Fund recipients. In these ways they are part of the health systems of your countries, and contribute to the achievement of the MDGs, especially MDGs 3,4,5, and 6.

The MDGs have been described as the world's 'biggest promise', but the world's biggest promise has failed women and girls, and their children, particularly in Africa, where women have a 1 in 16 risk of dying in pregnancy or childbirth, compared with 1 in 7,000 in high income donor countries, and girls have the highest rate of HIV infection.

This injustice cannot and must not be allowed to continue. All people, without exception, are entitled to universal human rights as agreed in international treaties and conventions, including the right to the highest attainable standard of health.

No-one should die because of sex, but millions have. No-one should die because they lack the basic information that could save their lives, but they do. No-one should be the victim of violence and coercion. Pregnancy anywhere in the world should be a reason for celebration, not fear, despair, disability and death. 

Research shows the young women and men of Africa generally want fewer children than their parents' generation, but in spite of this, young married women in the region have very low rates of modern contraception, although they wish to avoid pregnancy - often because of cultural and social reasons. Those who are unmarried are often refused services, or unwilling to access them because society believes they are not sexually active. Although rates of contraception are higher in central and East Africa than in other regions, unplanned pregnancies are therefore common, 40 percent in some countries, and up to 60 percent of adolescent pregnancies in one country are unplanned.

As a result 60 percent of unsafe, illegal abortions occur among women 25 or younger, and 70 percent of those hospitalised for treatment of complications following unsafe abortions are under 20.

In spite of the risks of unsafe abortion many young women choose this in desperation rather than tell their families that they are pregnant, because they feel afraid or guilty, such is the stigma surrounding unplanned pregnancy among unmarried young women. Globally, unsafe abortion is responsible for 13 per cent of maternal deaths, but in some African countries the percentage is far higher. And the price of shame, disability or death is, of course, paid only by young women, not by their partners. The liberalisation of the law in South Africa has resulted in a dramatic decrease in maternal mortality, and it is essential that all countries at least ensure the provision of quality post abortion care.

Like many of you, I am a mother and a grandmother, and like you, I want the best for them and their children, for present and future generations. But this cannot be achieved in Africa unless we prevent maternal mortality, and morbidity, because,  for every woman who dies, another 30 will be injured or disabled, as a result of fistula, or other complications.

This is a public health issue, and a human rights priority. It is a gender issue and it is also an economic issue. Increased investment in women and young people, especially girls, in their education, health and empowerment, so that they have both voice and choice, and can access contraception, will reduce maternal mortality and morbidity and transform nations. Having the ability to choose the number and spacing of their children is the freedom from which other freedoms flow, and a woman who is free to be employed, because she has fewer children, will reinvest 90 percent of her earnings in her family, compared with men's 30 to 40 percent.

Comprehensive reproductive health services with voluntary family planning at their centre, integrated with HIV prevention, voluntary counselling, treatment and care will prevent mother to child transmission of HIV, while ensuring those living with HIV can have children, as is their right.

Your governments in Africa have already recognised the critical importance of these issues to individual health and well being and to development. They were among the 179 member states that committed to reducing maternal mortality, and the right of all couples to plan the number and spacing of their children at the international conference on Population and Development in 1994. Then they committed to the Abuja declaration, the Maputo plan of Action, and now to CARMMA. These bold visionary strategies are Africa owned and Africa driven, and deserve the full support of Donors and of UN agencies, of Heads of State and Finance Ministers.

The rate of maternal mortality is almost the same in Africa as 20 years ago, these are not new issues, and governments, civil society and UN agencies are all accountable for playing our part in  implementing the promises that have been made. That message of accountability is one of the key messages from last week's world AIDS conference, and the women and girls, men and boys of this continent expect no less. Unless we carry out the responsibilities with which we have been entrusted young women, just on the brink of their adult lives, will continue to needlessly die, surrounded by silence and stigma.

As Professor Mahmoud Fathallah, an obstetrician and advocate from Egypt, a country that has prioritised these issues, has said, “women are dying not because we don't know how to save them, but because societies have yet to decide that their lives are worth saving”; it is indifference that kills.

If instead of indifference governments invest, like Egypt in family planning, together with investment in maternal and newborn health, they can reduce maternal deaths by 70 percent, the burden of illness which hampers women's lives by 60 percent, and children’s deaths by some 40 percent. All this can be done by investing less than $5 a year for every woman of reproductive age in the developing world. Is this too much to ask to save the lives of girls and women in a world that spent $1.5 trillion on arms last year?

Together, donors, country governments, UN agencies and civil society must ramp up the implementation of these visionary promises and plans or today’s children and their children have little chance of a better, brighter, future.

They will have even less chance of resilience in managing the impact of climate change, for which Africa is not responsible, they will have less chance of defeating poverty and achieving sustainable development and economic growth.

When women are free to work they can drive economic growth. Imagine an African country where the per capita income in 1957 was the same as South Korea: $490. By the 1980s, that had fallen to $400 for the African nation, but risen to $2,000 for South Korea. Today the GDP of the African country remains at $400 while South Korea's is over $6,000 and it is now a donor country.

This was achieved by a comprehensive set of strategies, central to which was a focus on girls' education and voluntary family planning. The economic benefits of this investment can be seen in another way, it has been estimated that $50 million spent on family planning in Bangladesh will save $327million on achieving other MDGs.

But ultimately these are issues of human rights and social justice. If we reduce the vulnerability of girls and women we ensure greater resilience for them as individuals for their families and communities in the face of food and fuel crises, the economic crisis, and climate change. If a woman has the understanding, and access to modern contraceptives she is more likely to choose more for her children, not more children. She is likely to have her first child later, have fewer children more widely spaced, and is more likely to be healthy. Her children too are more likely to be healthy, have better nutrition and be better educated. As Liberia's Head of State said at TICAD in 2008, you cannot have economic growth without development and you cannot have development without health, education and women's rights.

As part of addressing these urgent issues, we must learn not to be afraid to talk about them, to talk about the importance of comprehensive sexuality education in and out of school, which combines education about HIV, gender equity, sexuality, human rights and relationship skills. This is also one way in which we can change traditional gender stereotypes, and reduce violence, coercion, discrimination and stigma.

So what else can we do to reduce maternal mortality and morbidity, and reposition family planning?

We can encourage policies that are based on the realities of life, not life as we might like it to be.

We can ensure these issues, including contraceptives and other supplies are policy and budget priorities and are included in health plans.

We can talk about the need for sexuality education, for services that are accessible, including those which are youth friendly and those which meet the needs of those living with HIV so ensuring all have the right to health, and preventing mother-to-child-transmission.

We can work to eliminate stigma associated with unplanned pregnancy, abortion and HIV.

We can encourage donors to live up to their promises, and country governments to do the same.

We can encourage men to be champions of these issues, and continue to be leaders ourselves.

And to inspire us to do so, there are real examples of progress and innovation here in Africa:

• in Ghana 8 contraceptives are on the essential medicines list, and rural outreach work has resulted in  couples choosing to reduce the size of their families
• Uganda has a budget line and allocated funds for contraceptives
• Rwanda has tripled the use of modern contraceptives and incorporated family planning into its 2008-2012 poverty reduction strategy, and included relevant indicators in its finance strategy
• UNAIDS has recently shown that young people in 16 countries are leading a reduction in HIV infection, as a result of education leading to increased condom use, Namibia has trained youth educators so 64 per cent of 15 to 19 year olds use condoms in their first sexual intercourse.

These interventions and many more recognise that family planning save lives, and the value of universal access to reproductive health - MDG 5B.

But there is still so much more to do. In Africa 50 percent of the population are young people, their decisions, and the investment in services and commodities which enable them to carry out those decisions will be critical to their health and wellbeing, and to their families and communities, and critical to managing climate change and slowing down the impact of population dynamics on natural resources increasingly eroded by climate change.

Without this they have no chance of preventing even greater inequity, injustice and poverty. There is no hope for resilience, and sustainability, or a better brighter world, unless countries around the world, and here in Africa make investment in their young people, in their education and health an urgent priority now.

Only when girls are seen as equal to their brothers, and have the same chances and choices will women be free from maternal mortality and morbidity and be free 'to hold up half the sky' alongside their brothers, partners and husbands, as is their right.