Population and Development

Toespraak | 27-10-2009

Ladies and gentlemen,

It’s great to see that so many of you have come to Addis Ababa to talk about implementing the Cairo Programme of Action, which was adopted by the entire international community fifteen years ago. This agenda is close to our heart. We are concerned about MDG5. You, like me, are deeply committed to achieving sexual and reproductive health and rights. But we are making too little progress.

MDG5 is the mother of all the MDGs. Investing in MDG5 has a positive effect on all the others. Yet MDG5 is lagging behind. The paradox seems to be that is has not a natural constituency, like the environment or education. How can that be? We are all fathers, mothers, children, daughters and sons, and in all parts of the globe culture and religion share the importance of motherhood. Here we are and we should find common ground and today I see there is a constituency! You are representing 115 countries and parliaments in the world. So, a constituency clearly exists.

I am grateful to UNFPA and the FAAPPD for organising this conference, and to Chantal Gill’ard, the Dutch MP who has done more than anyone else to put MDG5 on the map in my country, the Netherlands, and elsewhere. She took the initiative to submit a motion in the Dutch parliament calling for MDG5 to be given more priority on the international agenda. I welcomed this initiative, since MDG5 is one of my policy priorities as Minister for Development Cooperation. We agreed with UNFPA to organise the High Level Meeting on Maternal Health, which was held here yesterday. It was attended by representatives of governments, members of parliament, NGOs, youth organisations, the business community, and many other actors. I’ll come back to the outcome of this meeting later in my speech.

I regard it as a privilege to be giving this speech to you. Of course, as a former MP I feel at home in this company. In my ten years in parliament I gained first-hand experience of the importance of international networks of parliamentarians. As Chair of the Parliamentary Network on the World Bank and President of the NATO Parliamentary Assembly, I saw what could be achieved if MPs from different countries worked together. By working together you can make things happen that would otherwise be impossible. Don’t underestimate your power and your responsibility! This conference and the inter-parliamentary conference on MDG5 held in The Hague in November last year are clear evidence of this. It is possible for parliamentary diplomacy to go to the heart of the matter, to be more direct and less cautious than diplomacy between governments. It can forge links between North and South, and help answer basic questions. Is the money being spent well? Is there enough budget tracking? Are the governments of North and South transparent enough? And how can we take the lead in our constituencies for action on MDG5? How can we help to openly discuss sensitive issues as sex, safe abortion, violence against women? In no culture this is easy, but MP’s have to take the lead.

A highly inspiring and very recent example of what parliamentarians can achieve if they work together is the joint effort of four MPs who organised a regional inter-parliamentary conference on MDG5 in Nicaragua last week. These four MPs, members of different political parties in Nicaragua, decided to take cross-party action. I have already heard that the MPs and experts from various Central and South American countries who attended the conference were very enthusiastic, and became aware of the need to forge alliances. The conference, with MPs taking a very public stance, fuelled the debate on MDG5 in Nicaragua and hopefully in many parts of Latin America.

When I took office as Minister for Development Cooperation in February 2007, I was shocked at the statistics on MDG5. Above all, I was astounded at how little progress had been made in the previous 20 years. None at all had been made since 2000, when the MDGs were first drafted. Every year 536,000 women – most of them in developing countries – die from complications during pregnancy. I am talking about half a million preventable deaths. That is more than the entire population of The Hague, the third-largest city in the Netherlands.

I’m not saying that we’ve all been sitting idle in the past few years. On the contrary, important lessons have been learned about what works and what doesn’t, and innovative ideas have been developed, for instance on stopping postpartum bleeding. Major studies have been carried out, and reports published – very recently by the Center for Global Development and two weeks ago by the Guttmacher Institute. The Guttmacher Institute’s report comes to the conclusion that a ban on abortions, while it has no effect on the number actually performed, does affect the circumstances under which women undergo them. Reliable research and statistics are badly needed, so that decisions can be reached on the basis of facts rather than ideology.

Yesterday we shared the very needed practices and operations of Ministers of Health of many countries. They are working hard to achieve MDG5. I see progress there, including in countries in conflict. In this connection, I would like to stress the importance of universal access to reproductive health – I will return to this point in a moment. Some countries are taking serious action and achieving results, but don’t have any data. Tanzania, for example, has no reliable information on maternal mortality, but the general impression is that progress has been made. There is evidence that child mortality is declining. All existing health centres have the standard equipment and medicines to provide mothers and babies with the care they need. There are 139 training centres for doctors and other healthcare personnel, which will be receiving more funding from donors like the Netherlands to train more people and reduce staff shortages. Action is also being taken to improve access to health care, raise awareness and provide information. The aim is for every village to have a medical centre. Waiting homes are already in use.

Unfortunately, the overall global picture is not as encouraging. Some countries have made a little progress on MDG5, but in others the situation is getting worse. MDG5 is furthest beyond reach in fragile states, conflict and post-conflict areas and emergency situations, for instance after natural disasters. That is why the Dutch government is focusing its development policies on fragile states. We are investing where it is most needed, for instance in Afghanistan. Yesterday, Dr Sayed Mohammed Amin Fatemi, Afghanistan’s Minister of Public Health, gave a forceful presentation on the status of MDG5 in his country. And he showed that even in difficult circumstances major progress is possible.

In some parts of Afghanistan, pregnancy and childbirth are literally a matter of life and death. This is due to a combination of factors. Women have only limited access to health care. Only ten per cent of the population have a health clinic in their village. Cultural factors also play a very important role. What is more, too few healthcare workers are women. It is therefore an essential step forward that midwives are now being trained in Afghanistan, under the great leadership of UNFPA.

As I said before, I want to draw your attention to sexual and reproductive health and rights, the second MDG5 target. Though added later, I believe that this target – universal access to reproductive health – is just as important as reducing maternal mortality. However, I also believe that it receives far too little priority. That is wrong, but in some cases it is understandable.

Sexual and reproductive health and rights are sensitive or even taboo issues in many countries and cultures, because they are about very personal decisions on family planning, relationships and sexuality. But these sensitive issues have to be addressed if we are to make any progress towards achieving MDG5.

Research shows that more than 200 million women all over the world would not have become pregnant, or would have done so later, if they had had access to contraceptives. So 200 million women want to use contraceptives, but have no access to them.

This worldwide unmet need for contraception must be dealt with. It is in the interests not only of the women themselves, but of their children, their partners and society as a whole.

And it is important to invest in educating women and girls. Studies show that educated women choose to have fewer children, and to have them later. Children from small families are more likely to receive an education, and have access to health care and enough food. It is easier for small families to find a route out of poverty. And the mothers often have a paid job, giving the family a better income.

In times of economic crisis, rising food and fuel prices, and negative scenarios about the impact of climate change, it is becoming increasingly important to consider demographic trends at national level. These are global problems. Especially in countries with a high birth rate – which is the case in many developing countries – it will be difficult, if not impossible, to ensure enough food, water, schools, houses and jobs for a growing, mainly young population.

My own country, The Netherlands has built consensus around these issues in a long struggle during the past 100 years. It was also the birthplace of the very first advocate of contraception: Aletta Jacobs, the nation’s first woman doctor. Practising medicine in Amsterdam more than a hundred years ago, she treated poor women free of charge, gave courses in family planning and popularised the diaphragm as a contraceptive. Make no mistake about it, more than a hundred years ago, these issues were highly sensitive in the Netherlands too. Aletta Jacobs not only helped many women, she was also a source of inspiration to people in the Netherlands and beyond to campaign for women’s rights, and what we now call sexual and reproductive health and rights.

To this end, cooperation at national and international level is essential. Only by working together and seeking new alliances can we make real progress.

We work together with my government colleagues, various MPs and many other partners, UNFPA in particular. To achieve MDG5, for example, we have concluded Millennium Agreements, and we organised a special event on the evening before Mothers’ Day to draw attention to maternal mortality. This event – Mothers’ Night – has now gone international, and was held last May in Tanzania, Malta and Pakistan.

One of these Millennium Agreements led in Sierra Leone to the development of a national health plan, in which mother and child care and reproductive health occupy a prominent place. The same agreement also forms the basis of a partnership between midwifery trainers in the Netherlands and Sierra Leone. The knowledge gained in the Netherlands, with its long tradition of midwives and obstetric care, is being passed on to colleagues in Sierra Leone.

Yesterday, a broad range of actors – from ministers to youth representatives and businesspeople – met here in this conference centre. This diversity was vital because, as I pointed out earlier, I see cooperation as the key to success. We need broad coalitions if we are to make real improvements in relation to MDG5. This is no isolated aim. If we make no progress on MDG5, we will not achieve the other MDGs either.

And we are going to need everyone: finance ministers to approve budgets and fight for them within governments; companies we can work with that will invest in innovative solutions.

The group we should focus on most is young people. About one half of the world’s population is under 25, and that proportion is growing. We are talking about their choices and their opportunities. They are, quite literally, our future. Young men and women must be able to choose, they must be able to enter into safe sexual relationships, and to have children in safety. They must decide for themselves how many children they will have, and when. Young people themselves must say how the agenda should be filled. And they must take the lead. That is why young people, girls as well as boys, play an active part in this debate. And this debate will be about sensitive subjects, like sexuality, family planning and the balance of power in relationships. But above all, young people must have access to sexual and reproductive health information, services and commodities. This is a universal right, and there are no exceptions.

And, of course, we need you: MPs from all over the world. Some of you came to the High Level Meeting yesterday, and I want to thank you for that. You form the link between what we discussed there and the plans you will be drafting today. I think that you will agree with me that the people at the meeting yesterday were all convinced of the need to take urgent action. We committed to action and agreed that we will:

• Prioritize family planning, one of the most cost-effective development investments. If we ensure access to modern contraception, we can prevent up to 40% of maternal deaths.
• Make adolescents a priority. If we invest in adolescent health, education and livelihoods, we will accelerate progress.
• Strengthen health systems with sexual and reproductive health as a priority. If a health system can deliver for women, it is a strong health system that benefits all.

No leader, no parliamentarian, no organization, no nation can meet these challenges alone. We need to act jointly. Each of us with a focus on his or her own mandate and responsibilities. By joining forces we will be able to achieve more and better results. In the Addis Call to Action we identified a number of key actions for important groups of actors. I am not going to read out the entire list of actions. Let me highlight some of the actions we identified.

As Presidents and Ministers we have to ensure that comprehensive sexual and reproductive health education, services and supplies are provided. A strong focus on young people and their involvement is crucial. Closely linked to this is the need to address urgently the high number of deaths from unsafe abortion, and ensure access to safe abortion. As political leaders, we have to speak out and openly discuss sensitive issues.

You parliamentarians in my view could be the lead players here to achieving MDG5, through the influence you exert on policymaking and legislation. You can ensure that laws are adopted in your country banning child marriages. You can ensure that legislation in your country safeguards ‘the right to the highest sustainable standard of health’, for women as well as men. You can oversee the enforcement of laws, and couple budgets to legislation. You can influence your country’s political agenda, and together you can determine the international agenda and ensure that the subject of sexual and reproductive health and rights maintains its prominent place. Only then can MDG5 be achieved.

I wish you a very successful conference, with many new ideas that will help you to work in your own countries on the further implementation of the Cairo Programme for Action, the Addis Call to urgent action, and on securing access to sexual and reproductive health for all. Because that is the way to achieve MDG5.

Thank you.