Around the world, young people are change makers who dream of a better, brighter future. Sooner than we think, they will be the ones shaping policy and driving progress, and we need their input now to best understand what to strive for in the future. Last spring, Women Deliver worked with The Lancet and Deutsche Stiftung Weltbevoelkerung (DSW) to compile essays written by young people about their hopes and goals. In this publication, titled We Have a Dream, some dreams are very concrete and specific, such as Raquel Revuelta from Argentina’s wish for access to sexual and reproductive information and services. Others are much more abstract, like Kwa Gaston from Cameroon’s dream of “…a world in which every human being has the right not only to life, but to a life worth living.”
Dreams such as these can be both inspiring and daunting. Throughout history, dreams that seemed impossible have forced people to grasp far beyond what they ever thought they could reach. Hope and human ingenuity have always been our driving force.
We are now less than two years away from the end of one development framework and the beginning of another. For the past two decades, the International Conference on Population and Development’s (ICPD) Plan of Action, and later the Millennium Development Goals (MDGs), have guided global development efforts, shaping how we measure progress towards a future in which all people have access to the resources they need to need to live long, healthy lives.
Looking back, it is incredible to think of all that has been achieved in recent years. More women are surviving pregnancy and childbirth than ever before, and the number of children under five dying each year fell from 12.6 million in 1990 to 6.6 million in 2012. New HIV infections have declined 33 percent from 2001 to 2012. Female representation in politics is growing — more than 50 countries have been led by a female head of state or head of government.
So many other accomplishments cannot be quantified in numbers. Increasingly, more men are advocating for girls and women’s access to sexual and reproductive health services. At Women Deliver 2013, the Prime Minister of Malaysia told a crowd of more than 4,500 in-person attendees and 50,000 webcast viewers that access to reproductive health services is a human right. His words were, above all else, a statement of progress-one that we hope will lead other global leaders to voice their support for the health and rights of girls and women.
This support is needed now more than ever. The progress we have made is heartening, but does not diminish the challenges that remain. MDG 5 — reducing maternal deaths and achieving universal access to reproductive health — has not made sufficient progress and is the most underfunded of all the health MDGs. Although nearly all maternal deaths are entirely preventable, 800 women continue to die every day because they lack access to quality care and services. Family planning has been recognized as a proven, life-saving solution, yet 222 million women in the developing world still are not able to obtain modern contraceptives.
In many parts of the world, even if a pregnant woman can convince her husband or family that she needs medical care, she faces difficulties in getting to the hospital. Once she gets there, there may not be electricity, essential supplies, or trained health workers. More than a third of women in developing countries are not assisted by skilled health workers while giving birth. Young women are especially at risk: adolescents 15-19 are twice as likely to die in childbirth as women in their twenties, and pregnancy and childbirth-related deaths are one of the leading causes of death for adolescent girls.
We need leaders across all sectors and around the globe to take action now to improve maternal and reproductive health. This entails ensuring that all girls and women have access to affordable, quality care, that health workers are adequately trained and compensated, and that health facilities have the resources they need. Private sector partners can help by ensuring that hospitals and clinics have access to essential medicines and supplies. Governments and donors can provide sustainable funding. Young people and civil society can give critical input into how policies and programs could be improved to better reach people in need.
When we all work together in tandem, there is tremendous potential for positive change. Investing in girls and women leads to more lives saved and more robust economies. With every step we take in this direction, we paint a brighter future.
The actions we take now to promote the health of girls and women can also help make the world more sustainable. The MDGs will soon be replaced by new goals that will build on lessons learned while also working towards a more environmentally and economically sustainable world. This means ensuring that already scarce resources are used wisely and to their full potential.
With each passing day, the world’s population grows larger while food, water and power supplies diminish. The global population is expected to reach eight billion by 2030, and the world will need to produce an estimated 50% more food and energy to meet this demand. Women can play a crucial role: their unpaid labor contributes up to one-third of global GDP, and they operate the majority of small farms in the developing world.
This is only the beginning. If women’s employment rates were raised to the same level as men’s, GDP would rise 9 percent in the US and 16 percent in Japan, and per capita income in 15 developing countries would rise 14 percent by 2020 and 20 percent by 2030. Providing women with equal access to agricultural resources would reduce the number of undernourished people by as many as 150 million. Women also invest more of their income in their families and communities than men, increasing access to education and health services, which, in turn, reduces poverty.
Girls and women are instrumental to the achievement of sustainable development goals. In a speech at the U.S. Green Building Council in November 2013, Former US Secretary of State Hillary Clinton told the crowd, “… there’s growing evidence that corporations with women in leadership positions, as corporate executives, and in the board, are actually more focused on sustainability.” Women are also uniquely affected by environmental issues such as access to clean water and clean cookstoves, and their insight into product development and outreach is invaluable in developing successful interventions.
Investing in girls and women, particularly their access to maternal and reproductive health services, education, nutrition, employment and political representation, is an investment in a more productive, equitable and sustainable world. Now is the time is to work together across genders, generations, borders and sectors to make sure that the new development framework is able to achieve what the MDGs did not. This requires recognizing that girls and women are central to development and sustainable growth and that we each need to do our part to close the gaps between girls, women and the resources they need. Together, we can reach the shared dream that 29-year old Souleymane Konate from Mali summed up in just one word: “Progress.” GHD
We are in the midst of a mobile revolution, with the number of mobile subscriptions expected to surpass the number of humans on the planet this year. Mobile phones not only connect people to each other,
but to vital health information, commercial markets, and financial services like savings and payment accounts. And these are just early uses, mobile innovation is flourishing in communities around the world.
With just over 700 days to achieve the Millennium Development Goals (MDGs) – eight goals embraced by the United Nations and governments to improve the lives of the world’s most vulnerable by 2015 – mobile technologies are playing an increasingly important role in accelerating development efforts.
The field of mobile health (mHealth) has shown tremendous promise in recent years to advance, in particular, child and maternal health (MDGs 4 and 5). At this moment, pregnant women – many of whom don’t have easy access to a health worker or facility – are receiving health information through their mobile phones to promote safe pregnancies. Mobile phones are tracking disease outbreaks, speeding up diagnoses, educating citizens on how to stay healthy, and reminding families to vaccinate their children. They are helping frontline health workers provide better care and more effective treatment for their patients, enhancing efforts to eliminate the transmission of HIV from pregnant women to their newborns, promoting the distribution and correct use of bed nets for malaria prevention, and more.
Many of these mHealth projects complement and support the United Nations (UN) Secretary-General’s movement, which brings together governments, companies, multilateral organizations, and civil society to save the lives of women and children. For example, FHI 360 is working on a project to expand access to family planning information for communities in Kenya and Tanzania – one of the international community’s most important requirements to improve maternal and child health and protect the rights of women and girls.
Mobile health efforts are also helping drive progress on other important global challenges beyond maternal and child health. For instance, many mHealth programs are becoming increasingly integrated with financial transactions and mobile money, helping to fight poverty (MDG 1). Mobile technologies are also helping to empower women and promote gender equality (MDG 3) by providing autonomy and access to health and other information and services.
Throughout the world, more than one billion women in developing countries have access to a mobile phone, and nine out of 10 women who use mobile phones say they feel safer and more connected with friends and family. While a mobile gender gap stubbornly persists (a report from GSMA found that women in developing countries are 21 percent less likely to own a phone than men), mobile has begun to have a significant impact on empowering women and giving them greater economic independence and control over their own health. Given these benefits, the UN’s Broadband Commission for Digital Development and other organizations are working to close the information and communication technology (ICT) gender gap. And increasingly, implementers of mobile technology are working to ensure that women and girls, often the beneficiaries of ICT for development projects, are also equal participants in the creation of these interventions and the policies that govern access and use.
Our challenge – and our opportunity – is to maximize the use of mobile technologies to make progress toward the MDGs, especially the goals to reduce child and maternal mortality, which require stronger action. We need to grow the body of research in the use of mobile for development, scale up projects that have been proven successful, and develop new and innovative technologies and programs.
At the same time, we need to make sure that mHealth and the broader field of mobile technology are included in the discussion around the post-2015 development agenda. Right now, the international community, under a process led by the United Nations, is planning for what comes after the Millennium Development Goals in 2015. This new agenda will provide shared global goals and a roadmap to get us to a more sustainable, fair, and equitable world by 2030. Mobile technologies and services can and must play an important role in achieving this brighter future.
Last spring, the UN Secretary-General’s High-Level Panel on the Post-2015 Development Agenda released a report that discussed the mobile opportunity, writing, “The number of mobile phone subscriptions has risen from fewer than a billion to more than six billion, and with it many mobile (m-) applications – m-banking, m-health, m-learning, m-taxes – that can radically change economies and service delivery in sustainable way.” To realize the promise of this technology, we must make sure that mobile is a key part of the development dialogue in the years to come.
We have only begun to scratch the surface of the power of mobile. Its potential to drive development both now and post-2015 is enormous: From alleviating poverty to expanding educational opportunities to improving health, mobile technologies can help transform the lives of billions, and particularly the lives of women and girls. Now we must seize this opportunity. GHD
It is a harsh reality that, in the 21st century, although a woman’s life expectancy at birth in more than 35 countries around the world is in upwards of 80 years, in the African region it is only 54 years according to recent World Health Organisation statistics. In addition, 99 percent of all maternal
deaths that happen each year, almost half a million in total occur in developing countries, many on the African continent, in fact 66 percent of maternal deaths happen in sub-Saharan Africa. There are many reasons for this challenging statistic, not least of which is the prevalence of poverty, combined with such factors as economic dependence amongst women in certain African societies, lack of power and decision-making in the home and in communities, and control over sexual and reproductive lives. Many women in Africa continue to face and experience many different forms of discrimination and marginalization in their day-to-day lives, simply because of their gender. Each of these individual factors have the potential to negatively impact on women’s physical, emotional and intellectual health and wellbeing, not to mention their ability to be able to build economic independence.
This last month, on March 8th, the United Nations marked International Women’s Day, an event designated to not just honour the important role played by women in society, but also to highlight areas of grave concern that require the world to sit up, take notice and importantly take action. This year, the focus of attention was on the Gender Agenda: “Gaining Momentum,” an issue of particular interest and concern to Africa where health challenges such as improving reproductive health, putting an end to gender-based violence and discrimination, addressing the issue of female genital mutilation, and reducing the incidence of maternal deaths are all too prevalent. If the ambitious aspirations of the United Nations in meeting Millennium Development Goals are to be fully realised, then it is essential that more work is done to improve the health and wellbeing of women in Africa, as the two sets of challenges are inextricably linked.
On the African continent, one of the biggest health challenges facing women is the need to improve maternal health. Despite being one of the Millennium Development Goals, it is still chronically short of achieving its targets of reducing the maternal mortality rate by 75 percent before 2015. It is a sad fact that in Africa, if radical health and education interventions are not put in place to address this issue, these ambitious goals will not be realised until at least 2165, such is the severity of the situation. Yet ironically, most maternal deaths are preventable, particularly if the overall health and wellbeing of women is improved. The number of deaths incurred as a result of complications suffered due to the lack of obstetric care services, unsafe abortions, bleeding, high blood pressure and obstructed labour, could be reduced and prevented. This is critical, particularly in the case of teenage mothers on the African continent who experience complications and premature deaths as a result of young bodies having to go through the physical and emotional trauma of childbirth whilst still developing themselves. This prevalent issue that teenage pregnancy raises needs to be at the top of the education agenda in Africa amongst young girls if they are going to be empowered to take control of their bodies, their futures, and critically their health.
The most recent report published by the United Nations on Trends in Maternal Mortality (1990 to 2010) indicates that although sub-Saharan Africa has witnessed a decline in maternal mortality of 41 percent in the past 10 years, the figures are still unacceptable. One in 42 African women still die during childbirth, as opposed to 1 in 2900 in Europe. On the African continent, mothers should expect to be able to stay alive after the birth of their children and to see them grow up to have children of their own, instead of simply hoping that their personal and family ambitions will be realised in this regard. Initiatives such as the Campaign for the Accelerated Reduction of Maternal Mortality in Africa (CARMMA), introduced in partnership with the African Union, are already providing much needed support on the ground at grass roots level in Africa to improve maternal health programmes. Yet, at a practical level, we must recognise that more needs to be done to provide improved access to basic health facilities and health workers for women.
On the general health front for women in African countries, things are also bleak. The latest World Health Organisation report “Addressing the Challenges of Women’s Health in Africa,” published to coincide with International Women’s Day in March, highlights that the rate of cervical cancer amongst African women is twice the global average. In addition, the challenge of female genital mutilation is still a major health and societal issue in Africa. It requires vigorous debate and action if the lives of over two million young girls aged between 4 and 12 who are subjected to this brutal practice are to be changed for good. Recognising that many of the health and wellbeing challenges experienced by women in African society occur as a result of socio economic and socio cultural factors and pressures, it is essential to improve women’s empowerment overall. Solutions to positively addressing women’s health and wellbeing can be found by improving literacy levels and overall access to education, improving the economic status of women, and addressing cultural and long-standing traditional challenges in African society that impact negatively on women’s health.
There is no doubt that women living in today’s Africa continue to face an ever increasing number of health and wellbeing challenges and this is tangibly reflected in the unacceptably high levels of female and particularly maternal mortality rates in sub-Saharan Africa. Society as a whole needs to rethink its approach to improving women’s health by getting to the heart of the problem and addressing the need to improve the social status of women on the continent, while empowering and supporting them to make the change needed. This empowerment needs to come from education and inclusive participation in all aspects of society and decision-making. This calls for political will, cultural debate, and undoubtedly large-scale investment in sustainable women’s health programmes that can be successfully rolled out across the African continent. The challenging women’s health and wellbeing situation to date has been caused by a failure on the part of key stakeholders and society as a whole to unite and work together to advance the socio-economic standing of women in Africa and, as a result, address the challenge of investing in women’s health and education. Continued failure to find the necessary solutions will increase the vulnerability of women in our society, while at the same time, limit the positive contribution they will be able to make to the socio economic wellbeing of the African continent as a whole. It is time that, as a united people of Africa, we take a stand in addressing the cultural and socio economic factors that are sustaining inequality in advancing women’s health. Policy makers need to come to the table and commit more resources to women and girls’ education, health and maternal wellbeing. Legislation needs to be developed and enforced across the African continent safeguarding the rights of women to control and safeguard their health and wellbeing in the home and in the community. Africa must take a stand to improve the efficiency of health care delivery and access systems for all women and young girls and to take a multidisciplinary approach to addressing the medical, socio-cultural and economic factors that have the potential to adversely affect women’s health and limit their lifespans. It is high time that Africa starts implementing the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa and it’s plan of Action. It is time for Africa to stop needless deaths of it’s women from preventable and potentially treatable causes. The time has come to take a stand. GHD
Improving women’s and children’s health is critically important to almost every area of human development and progress. Healthy women and children help build healthy societies which are the foundation of successful economies, prosperity, political stability and social harmony.
Unsurprisingly, the condition of children and women is a good indicator of progress on other development issues such as governance and equity.
Yet, across the globe, progress in improving reproductive health and reducing child and maternal mortality is uneven and must be accelerated if we are to achieve the Millennium Development Goals (MDGs). Every year, around 6.9 million children die of preventable causes, and more than 287,000 women die from complications of pregnancy or childbirth. In the developing world some 222 million women who want to avoid pregnancy are not using a modern method of contraception.
Global momentum is building to pursue bold and inspiring endgames. In his 2013 State of the Union Address, President Obama recently set forth a vision for realizing the greatest contributions to human progress in history — ending extreme poverty, creating an AIDS-free generation and ending preventable child deaths.
A steady drumbeat is already underway. The Global Strategy for Women’s and Children’s Health was launched by United Nations secretary-general Ban Ki-moon. The Every Woman, Every Child initiative, a campaign accompanying the Global Strategy, continues to galvanize new commitments and, more importantly, focus on concrete action in this area.
Last June, the governments of the US, Ethiopia and India, in close cooperation with UNICEF, held a Child Survival Call to Action in Washington D.C. World leaders in attendance embraced the strategic shifts necessary to speed up progress in reducing preventable child deaths. Such efforts included increasing progress in the countries where most deaths occur; focusing on vulnerable populations like the very poor and investing in high impact solutions to address the main causes of mortality; investing in education and empowerment of women; and creating accountability including through the use of scorecards.
The Call to Action and the follow up work in Committing to Child Survival: A Promise Renewed demonstrate, global alignment around the vision of ending preventable child deaths in a generation. The goal of the Call to Action for all countries was to reduce child deaths by under 20 deaths per 1000 live births by 2035. Planning on a similar approach to ending preventable maternal deaths is underway since maternal mortality is linked so closely to under-five deaths and especially newborn mortality. A specific global effort is being made to address the problem of newborn survival —even in countries that make progress generally in addressing under-five mortality; neonatal progress often lags and so deserves particular attention.
We are less than 1,000 days to the 2015 goal post. Work to frame the post-2015 development agenda has surfaced, many good approaches, frameworks and considerations. Many see the wisdom of a new high-order vision for “wellness along the arc of life”. However life expectancy as an integrator is difficult to measure and communicate and is very sensitive to under-five mortality.
Structuring the agenda through a unifying framework of universal health coverage (UHC) provides a good mechanism for reaching our goals. It also will help prevent people from slipping back into poverty, as medical bills are often a major cause of going back into poverty.
As the world moves toward increasing health coverage and financial protection for more and more people through collaboration between the public and private sectors, work on health systems is a way to make a dramatic difference in health and development and to achieve universal health coverage. We must increase local capacity to reorganize and manage growing domestic resources.
Also, focused investments in “game-changing” innovations can dramatically improve health for the poorest by increasing their access to life-saving interventions and care, particularly at the community level. Low-cost innovations and scale up of effective and cost-effective commodities that are more easily administered by less-skilled health workers; point-of-care diagnostics; and approaches that use mobile phone technologies to provide services, information and monitor patient outcomes have the potential to vastly expand the reach of health-care workers and reduce some of the transportation, time and cost barriers that often prevent people from seeking care.
The past decade has been a period of learning for us. We have learned that there are lost-cost feasible solutions. We have learned how to deliver those solutions. We are committed to finding solutions to global health problems; for understanding the bottlenecks and barriers to quality care. Opportunities for market shaping and leveraging local leadership commitment are great ways to translate science into sustainable implementation at scale.
If we can find the courage to do things differently, and quickly deliver breakthroughs to the field, we will advance human progress—helping families escape devastating cycles of poverty and disease that drain vital health and economic resources, hold back communities and nations, and prevent young children from living up to their potential. GHD