Beijing 18 October 2009
Dr. Gill Greer, Director General, International Planned Parenthood Federation.
Madam Chair, Honorable Minister, Li Bin, Ministers, Vice Minister Bhaige, Distinguished guests and representatives of donor governments and foundations, non-governmental organizations (NGOs), colleagues and friends.
It is a privilege to join you at the opening of this conference as a member of the International Steering Committee, and as Director General of the International Planned Parenthood Federation, working in 170 countries worldwide.
I would also like to thank the China Organizing Committee, the Chinese Government and our Chair, Vice Minister Bhaige, for hosting this conference on behalf of the International Steering Committee.
In September 1994, 179 governments, supported by NGOs and UN agencies, signed up to the ICPD Programme of Action.
15 years on the world has changed dramatically in many ways. The hosting of this conference on sexual and reproductive health in Beijing, a very ancient but modern city, is a powerful reminder in itself of how much change there has been in 15 years, in our beautiful and diverse region, and across the globe.
There has been much progress as you have heard. Yet too many people whether they live in the urban slums of our sprawling cities, in hill top villages on the small scattered islands of the Pacific, the gift of reproduction and sexuality continues too often to bring illness and death, not joy and celebration.
The facts speak for themselves.
- Globally a woman dies every minute from pregnancy or child birth related causes – a statistic that has barely changed in 15 years.
- 175,000 women die each year from cervical cancer – virtually all these deaths occur in developing countries and most could be prevented with better sex education, knowledge and sexual health services.
- Pregnancy related causes are the leading cause of death in the developing world for girls and young women aged 15 – 19 years – young women just beginning to enjoy their lives – a total injustice.
Too many of these pregnancies are the result of early or child marriage, violence, coercion or quite simply lack of knowledge, and too many of these deaths are as a result of unsafe abortion outside of the law.
As eminent Egyptian physician Professor Mahmoud Fathalla - recipient of the United Nations Population Award and IPPF’s first global award - has said 'women are not dying because of diseases we do not know how to treat...They are dying because societies have yet to make the decision that their lives are worth saving'.
The Asia Pacific NGO Forum held in September in Bangkok has highlighted issues within this region - persistently high levels of maternal mortality, and morbidity in some countries, unmet need for family planning for married and unmarried women, unmet need for comprehensive sexual and reproductive health services and information for young people and vulnerable groups.
Recent research ahs also shown 10 countries have reduced their health budgets in recent years.
So, 15 years after Cairo, those born in 1994 are now 15 and are part of the largest cohort of young people the world has ever seen.
Will their lives be any different? Will the visionary promises of Cairo be turned finally into reality, or will societies continue to turn a blind eye?
In this year of Cairo+15 we have seen encouraging events - and heard words that promise a better, brighter future for those 15 year olds.
These steps towards a better world began with the lifting of the Global Gag Rule by President Obama and the refunding of UNFPA; this was followed by the Commission on Population and Development in April – which delivered a powerful blueprint for a better world, if we will only grasp it and use it; the Human Rights Council’s recognition of maternal mortality and morbidity a denial of human rights; 2 weeks ago the United Nations Security Council recognized the critical importance of sexual and reproductive health and rights in post conflict situations in Resolution 1889; regional meetings in Bangkok and elsewhere have all called for action, and the NGO Forum in Berlin called for a renewed commitment to the spirit and Programme of Action of Cairo.
Nearly 400 NGOs from 130 countries, more than were represented at the ICPD in Cairo in 1994 or ICPD+5 in the Hague, were represented at the Berlin NGO Forum hosted by the German Government and UNFPA; they called for 5 quick wins to achieve the Cairo goals, and asked me as the Chair of that conference to bring their message to you together with their best wishes so that we may move forward in solidarity beyond Cairo, Berlin and Beijing.
In their quick wins they specified the urgent need:
1. To guarantee that sexual and reproductive rights are fully recognized and fulfilled.
2. To invest in comprehensive sexual and reproductive health (SRH) information and services as a priority in health systems strengthening....we all know NGOs providing community based care can reach those communities and individuals governments often cannot reach, and talk about issues governments cannot talk about. Listening to the participants in yesterday's Youth Forum was a powerful reminder of this.
3. Ensure the sexual and reproductive rights of all young people.
4. Create and implement formal mechanisms for meaningful civil society partnership in programmes, policy and budget decisions, monitoring and evaluation.
5. Ensure that national governments and donors allocate sufficient resources and budgets that meet the needs of all people's sexual and reproductive health and rights.
They said much more in their inspirational document - urging us all to go beyond Cairo and beyond Berlin, to finally break the cycle of poverty, support sustainable development and advance human rights.
As we were reminded by Eleanor Roosevelt many years before Cairo all human rights begin ‘in the small places close to home...the neighbourhood, the school, the factory, farm or office...where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination'.
But it is the last point from the Berlin Call to Action that I want to focus on for a moment: the urgent need to 'allocate sufficient resources and budgets that meet the needs of all people's sexual and reproductive health and rights'.
We must reprioritise sexual and reproductive health and end the continued decline of donor funding for population and reproductive health programmes, already down from 30 percent of health Overseas Development Aid (ODA) in 1994 to 12 percent in 2008. (World Bank 9 July 2009).
We must urge inclusion of comprehensive sexual and reproductive health – including the rights based provision of family planning, HIV/AIDS, maternal health and youth friendly services - into national health plans and budgets, and plans for strengthened health systems including primary care.
A failure to do so is unthinkable. Without it we cannot achieve the Millennium Development Goals.
201 million women already have an unmet need for family planning, but as the largest generation of young people the world has ever seen approaches sexual maturity, many are already sexually active, meeting their needs becomes critical.
As a result of both these factors demand for contraception alone is expected to increase by nearly 75 per cent by 2020.
As the Guttmacher Institute reported only last week, increases in global contraceptive use have contributed to a decrease in the number of unintended pregnancies and, in turn, contributed to a decline in the number of abortions, which fell from an estimated 45.5 million procedures in 1995 to 41.6 million in 2003.
Approximately half of all abortions are unsafe which causes an estimated 70,000 women’s deaths each year; an additional 5 million women treated annually for complications resulting from unsafe abortion.
Another 3 million women who experience serious complications from unsafe procedures go untreated.
People say it is contentious to speak of this but what is truly contentious is that women are dying needlessly or have their lives seriously affected or suffer illness and disability.
The world is at a crossroads - but if women have the right and power to say no to sex, or yes to safer sex, and they have the knowledge and means to choose the number and spacing of their children, they will choose more for their children, not more children.
This will contribute to individual health and wellbeing, healthier, more sustainable families and communities, greater social justice and equity in a time of diminishing resources, increasing environmental degradation and a healthier more sustainable planet.
So why despite some loyal donor governments and foundations is it so difficult to find the funding for this cost effective intervention?
We have heard of the H4 maternal health initiative (UNFPA, WHO, UNICEF, WORLD BANK) and the Consensus for maternal and child health and the possibility for new funding for this at the UN 2 weeks ago, but this is not enough.
There is no lack or energy - or commitment – on the part of Civil Society. A recent call by IPPF for small country-level advocacy grants resulted in over 300 applications for grants of 5 to 10 thousand dollars and we could give only 12.
That is the level of need at the community level where real difference can happen on a daily basis.
We need the funds to make Cairo a reality, yet against the backdrop of a global recession the funding environment is complex and competitive and we are already seeing the viability and sustainability of NGOs threatened.
There is no doubt that climate change has already changed our world for ever - as this region knows all too well - and development will never be the same.
Funds must be urgently invested in climate change, including the human health impact of climate change.
It is estimated that only 1 percent of gross national income (GNI) is needed, but it is vital that this is new money and does not diminish the scarce ODA resources, generally well under the agreed 0.7% of donor country gross domestic product (GDP), available for existing strategies to combat poverty, social justice and equity, and contribute to sustainable development.
To draw on existing funds for current work in order to fight the critical battle against climate change, will undermine our progress in health, education and development over these last 15 years.
If we are to secure the future envisaged at Cairo we cannot once again fall into the trap of polarised, siloed thinking and funding in a world that is interconnected as never before - and where issues of sexual and reproductive health, population dynamics, environmental degradation, rights, social justice and climate change are connected as never before.
2009 has brought us many fine words and renewed promises and much hope - but I urge all donors and national and local governments to invest now in the promise of Cairo so those 15 year olds and their children will truly have better lives.
That must be the reality of our legacy.
Our mandate to act for health, rights, justice and development did not begin or end in Cairo, the Hague or Berlin, and our mandate must not end in Beijing.
Rather it must be strengthened to meet the growing challenges.
We in civil society working on sexual and reproductive health are willing to intensify our efforts and build new partnerships with those working in other areas of development, including environment and climate change, just as we have built linkages between family planning and HIV and AIDS.
The next few days will demonstrate our commitment again, but we need the funding and the partnership with governments, parliamentarians, donors, UN agencies and each other to do so.
Realising the hopes of today’s 15 year olds will not be achieved by numerous conferences or by one organisation but can only be the result of united political will and unified effort.