Dr Gill Greer, October 2009

On behalf of IPPF’s 147 Member Associations delivering the Cairo Programme of Action in their communities in 170 countries, it is a privilege to be with you today.

There is clear evidence that the ICPD Programme of Action is crucial to the achievement of all the Millennium Development Goals (MDGs), in particular for the health MDGs and MDG 3.

However, MDG 5, the closest to the spirit of Cairo is the furthest from realization.

Furthermore target 5B ‘universal access to reproductive health’, the centre of the vision of ICPD, and central to improving maternal health and realizing the MDGs is all too often overlooked, and under-funded.

The full implementation of the vision of Cairo is essential for the elimination of poverty, the achievement of sustainable social and economic development and for the achievement of equity, social justice and human rights.

As Members of Parliament in an interdependent world you have a unique and critical role to play. You are a voice for those who remain unheard, and the bridge between constituents and the legislature.

You decide policy, ensure civil society is at the table when policies, plans and budgets are discussed; you can ask parliamentary questions and monitor progress – progress not in words but in actions. 

And there has been much progress. Yet for too many people, whether they live in the rapidly spreading urban slums of sprawling cities, in hilltop villages, on small scattered islands or in vast deserts, the gift of reproduction and sexuality continues too often to bring illness and death, not joy and celebration. The facts speak for themselves.

• A woman dies every minute from pregnancy or childbirth related causes – a statistic that has barely changed globally in 15 years, a public health disaster and a denial of human rights that kills only women. Yet the World Bank estimates that increased investment to meet the unmet need for family planning could reduce those maternal deaths by 40 per cent.

• 175,000 women die each year from cervical cancer – virtually all these deaths occur in developing countries. Most could be prevented through accessible sexual health services, sexuality education and information.

• 32.9 million people are living with HIV/AIDS (UNAIDS 2009). Again, this can be largely prevented by improved access to comprehensive sexual and reproductive health services, including voluntary counselling and testing (VCT) and prevention of mother to child transmission (PMTCT), education and information, gender equity, a targeted attack on stigma and discrimination and ensuring access to treatment - yet some continue to insist on denying young people the information, services and access to condoms that could prevent infection and save lives. IPPF’s survey this year shows we are failing young people across the world.

• 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 live their lives – a denial of gender justice. Too many pregnancies are the result of early or child marriage, violence, coercion or quite simply lack of knowledge. Too many deaths are the result of unsafe abortion outside the restrictions of the law.

Why have we failed to address these issues as a priority?

As eminent Egyptian physician Professor Mahmoud Fathalla - recipient of the United Nations Population Award and winner of IPPF’s first global Award to be presented next month - 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'.

Those born in 1994 are now 15, part of the largest cohort of young people the world has ever seen.

Will their lives be 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 initiatives leading up to this important meeting, and heard words that promise a better brighter future for those 15 year olds.

These steps towards a better world began with President Obama lifting the Global Gag Rule and the refunding of UNFPA; the Commission on Population and Development delivered a powerful blueprint for a better world, if we will only grasp it and use it.

The Human Rights Council then recognized maternal health as a human right; 2 weeks ago the United Nations Security Council recognized the critical importance of sexual and reproductive health and reproductive rights in post conflict situations in Resolution 1889.

In addition, the African Union CARMMA initiative to reduce maternal mortality and achieve the Maputo Plan of Action, the G8 parliamentarians meeting in Rome, regional meetings around the globe, the Berlin non-governmental (NGO) Forum – Global Partners in Action, last week’s Asia Pacific conference on Reproductive and Sexual Health and Rights, and the most recent review here at the AU, have all urged a re-commitment to the spirit and agenda of Cairo.

Yet these events will only make a difference if there are strategies and resources to implement them.

Nearly 400 NGOs from 130 countries were represented at the Berlin NGO Forum hosted by the German government and UNFPA.

In their Call to Action the NGOs called for 5 quick wins to achieve the Cairo goals, and move beyond Cairo.

They have asked me, as the Chair of that conference, to bring their message to you so that we may move forward in partnership beyond Cairo, Berlin, Beijing, and Addis Ababa. In their quick wins they specified the urgent need:

• Firstly, to guarantee that sexual and reproductive rights are fully recognized and fulfilled.
• Second, 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 that governments often cannot reach, in particular the poor and most vulnerable living on the very margins of society, and can talk about issues governments cannot talk about. 
• The Berlin NGO’s third quick win is to ensure the sexual and reproductive rights of all young people.
• The fourth, to create and implement formal mechanisms for meaningful civil society partnership in programmes, policy and budget decisions, monitoring and evaluation.
• The last quick win is to 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.

We hope that these will be central to the Declaration you deliver tomorrow from the world’s parliamentarians.

The Berlin Call to Action said much more, (I have copies available) urging NGOs to work together with parliamentarians and decision makers to finally break the cycle of poverty, support sustainable development and advance human rights, including sexual rights.

To achieve all this, the partnership between NGOs and parliamentarians, other members of civil society including public private partnerships, is more important than ever.

Tanzania offers an example of such partnership. Our Member Association there has worked with members of parliament (MPs) to increase funding for reproductive health from US$ 2.65 to US$ 7.26 million for 2010.

Now the challenge is to monitor the implementation together.

Increased emphasis on country-ownership of development aid presents further opportunities for civil society and parliamentarians to call with one voice for increased funding and inclusion of sexual and reproductive health in health and development plans and budgets.

A comprehensive approach to MDG 3, 5 and 6, and the ICPD agenda will also ensure that the needs of the forgotten and marginalized, including refugees and internally displaced people (IDPs), and women and girls in conflict situations and environmental disasters, are recognized and addressed, including their maternal, reproductive and sexual health needs and their right to be free from sexual violence. 

Women are the drivers of development.

Yet violence against women, forced early marriage and denial of their sexual and reproductive rights, continues to rob women of their health, and their rightful place in society as equal partners in creating sustainable social and economic development.

201 million women already have an unmet need for family planning, many of them in the poorest countries.

Unless urgent action is taken now to provide services, information and contraceptives, this figure will be rapidly multiplied by the contraceptive needs of the largest generation of young people the world has ever seen, many of whom are already sexually active.

As a result, demand for contraception is expected to increase by up to 75 per cent by 2020 (UNFPA Fact Sheet Population growth and poverty 2009). This is a crisis linked to human rights, sustainable development and health.

As the Guttmacher Institute reported only 2 weeks ago, increases in global contraceptive use have contributed to a decrease in the number of unintended pregnancies and in the number of abortions.

Approximately half of all abortions are unsafe which causes an estimated 70,000 women’s deaths each year; an additional 5 million are 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 about abortion, but what is truly contentious is that women are dying needlessly or suffer avoidable debilitating 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 timing, number and spacing of their children, they will choose more for their children, not more children.

Their ability to exercise this most basic human right is vital for individual health and well-being, healthy sustainable and resilient families and communities, greater social justice and equity in a world of diminishing resources, and a healthier more sustainable planet.

Surely then, no-one can deny that the time has come to reinvigorate family planning, to ensure all women have this basic right.

This will require increased funding for comprehensive sexuality education, youth friendly services and access to a wide range of contraceptive methods, including male and female condoms.

But all too often, discussions about health systems strengthening, new aid compacts and budget support largely ignore the role of NGOs as community based providers and the ICPD agenda, including voluntary family planning, sexually transmitted infections (STIs) and young people’s development as part of a truly comprehensive approach to MDG 5.

Indeed evidence from Tanzania shows that funds specifically for family planning have actually declined under budget support.

The point from the Berlin Call to Action that I therefore want to focus on for a moment is the NGOs demand for donors and governments to 'allocate sufficient resources and budgets that meet the needs of all people's sexual and reproductive health and rights'.

Together we must re-prioritize sexual and reproductive health and end the continued decline of donor funding for population and reproductive health programmes, already down from 30 per cent of health ODA in 1994 to 12 per cent in 2008 (World Bank 9 July 2009). 

We must urge inclusion of sexual and reproductive health - including family planning, HIV/AIDS, maternal health and youth friendly services - into national health plans and budgets, and plans for strengthened health systems. The consequences of failure are unthinkable.

So why, given the need, the demand and the social and economic benefits, is it so difficult to find the funding for this cost effective intervention?

We have heard of the H4 maternal health initiative and the Consensus for Maternal and Child Health and the possibility of new innovative funding, but this is not enough.

There is no lack or energy - or commitment – at the community level where the difference is made and experienced daily.

A recent call by IPPF for small country-level advocacy grants resulted in over 300 applications for grants of 7 to 10 thousand dollars and yet we could give only 12 grants.

We need adequate funds to make Cairo a reality, yet against the backdrop of a global recession and climate change, the funding environment is increasingly complex and competitive.

But we cannot allow the critical issues that lie at the heart of Cairo and the MDGs to fall off the agenda once again.

There is no doubt that climate change has already changed our world for ever - as this continent knows all too well.

Funds must be urgently invested in climate change, including the impact of climate change on health, including sexual and reproductive health and on the poorest least responsible countries.

It is estimated that only a relatively small per cent of Gross World Product, is needed for mitigation, compared for example to expenditure on arms, but it is vital that this is ‘new’ money and does not diminish the scarce resources currently available for existing strategies to combat poverty, achieve social justice and equity and contribute to sustainable development.

To draw on these existing official development assistance funds, in most cases still well below the 0.7 per cent that was previously pledged by donor governments in order to fight the critical battle against climate change, will undermine our fragile progress in health, education and development over these last 15 years.

If we are to secure the future envisaged at Cairo we cannot again fall into the trap of polarized siloed thinking and funding in a world that is interconnected as never before - and where issues of sexual reproductive health and rights, population dynamics, environmental degradation, gender, equity, social justice and climate are connected as never before.

The opening pages of the ICPD Programme of Action declare “All human beings are born free and equal in dignity and rights... Human beings are the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature. People are the most valuable resource of any nation. Countries should ensure that all individuals are given the opportunity to make the most of their potential... Never before has the world community had so many resources, so much knowledge, and such powerful technologies at its disposal, which if suitably directed, would foster sustainable economic growth and sustainable development.” These words are as true and relevant today, here in Addis Ababa as they were 15 years ago in Cairo and even more urgent.

2009 has brought us many fine words and renewed promises and much hope - but words are not enough.

I call on you as parliamentarians from around the globe to ensure that donors and partner governments invest 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 must not end here. Rather it must be strengthened to meet new and existing challenges.

We in civil society are willing to intensify our efforts, strengthen our partnership with parliamentarians and governments and U.N. Agencies and to build new partnerships with those in other areas of development, including environment and climate change, just as we have built the linkages between family planning and HIV/AIDS.

Realizing the hopes and aspirations of today’s 15 year olds will not be achieved by words alone, or by any one organization or initiative, but can only be the result of united political will, clear funding decisions and a united effort.

I urge us all to work together to ensure that a comprehensive approach to sexual and reproductive health and rights with family planning and women’s health at its centre is a priority in policies and funding, in strengthening health systems and primary care, recognizing the vital role that can be played by NGOs in complementing the role of governments.

Only then can we truly make a difference so that all people can realize their full potential and aspirations.

We are in Africa, so it is appropriate to borrow from the wisdom of Africa “To go fast, go alone. To go far, take others with you”.

Only then can the vision of Cairo become a reality. We have no time to lose.