A Right to Choose
Gelegenheid:A Right to Choose
Speech by Bert Koenders, Minister for Development Cooperation of the Kingdom of the Netherlands
‘Global Safe Abortion Conference 2007: Whose right? Whose choice? Who cares?’
London, 24 October 2007
Ladies and gentlemen,
I am very pleased to be here, at this Conference on Safe Abortion, four days after the closing of the “Women Deliver” conference, a landmark gathering - also in London - to mark 20 years “safe motherhood” and to chart the way forward how to deliver for the health of women.
Preventing unsafe abortions is part of our common agenda for women’s health and rights. An agenda that needs to be dealt with in our joint efforts to attain the Millennium Development Goals, MDG 5 and 3 in particular. Yet, the subject of unsafe abortion is so delicate that it also deserves to be spoken about specifically. It should not be silenced.
Women’s access to quality sexual and reproductive health care services is a universal issue. And a woman’s right to choose is a universal right. The right of men and women to freely and responsibly plan families is denied and the right to information, education and facilities is withheld.
[common ground]
Ladies and gentlemen,
This session is about finding ways forward; breaking from the past and looking to the future.
Our starting point should be to recognise that preventing maternal mortality and maternal ill-health is a goal we could and should aim for as a priority.
We want every child born around the world to be wanted and loved. The best way to achieve this is to do more to educate the public – men, women and young people alike - about sexual and reproductive health and rights and how to prevent unwanted pregnancies and unsafe abortions.
We have just heard about this from Laura Villa Torres, representing young people in this conference.
In the last twenty years, more than ten million women have died from comp l ications of pregnancy and childbirth. Around three hundred million women have developed post-natal conditions or long-term disabilities, such as obstetric fistula. “By any measure,” Obaid said in her address to the World Health Assembly in May of this year, “this situation is deplorable when we consider the fact that most of these deaths and disabilities could be prevented if every woman had access to reproductive health care. Family planning alone could save the lives of one hundred and fifty thousand women each year. Spacing births by at least two years could save more than one million children under five every year. ”
These are striking figures. This preventable mortality and morbidity of poor women –mainly women among ‘the Bottom Billion’- is a true violation of their right to life, to health, to well-being and to human dignity. It is unacceptable. I am not optimistic about the current trends. Over the past few years we have seen more restrictive legislation on abortion, for example in El Salvador and Nicaragua. This results in mothers being sent to prison, leaving their children unattended. Financing for family planning services is falling way short. Women who want to avoid the next pregnancy need access to family planning services. But less money has been invested in family planning. Also investments in health systems have been insufficient to meet the needs. The lack of well-trained health personnel to counsel for family planning is a major bottleneck.
We should act and we should act now. I would like to quote the Ministerial statement, brought forward last Saturday, at the closure of the Women Deliver conference: “Resources, political will and accountability are essential to the implementation of strategies that can quickly and effectively reduce maternal mortality, including family- and community-based interventions. These strategies include the following:
• Access to affordable family planning and reproductive health services to prevent and manage unintended pregnancies and unsafe abortions.
• Reduction of the stigma associated with abortion or adolescent pregnancy. That is why I want to speak out and work via public diplomacy.
• Provision of affordable, skilled care, including emergency care, during and after childbirth for all women and newborns.
• Efforts to address other factors that contribute to high maternal mortality, such as poor nutrition.
The Ministers also stated: “Now it is time to intensify our action”. We have to do more! You put this into action. You do it. I admire you!
I have made the position of women and their sexual and reproductive health and rights a major priority in my development co-operation policy. I felt urged to do so, due to the stagnating progress in reducing mortality rates among women and children –Millennium Development Goals number 4 and 5. Fighting gender inequality is about empowering women and enabling them to make their own choices. This is not just a matter of human rights and mortality rates. Gender equality also promotes economic development and a more equal distribution of security.
[International agreements]
Ladies and gentlemen,
Today, unsafe abortion is a major killer — an estimated 189 women die every day. That is eight women per hour. We will not meet goals to reduce maternal mortality until this crucial issue is addressed.
A broad package of good quality sexual and reproductive health services does include safe abortion services. Those are always needed – everywhere - for good quality care after miscarriages; for good care when complications arise from unsafe abortions.
Legalising abortion and making laws less restrictive is another route to go. Legalising abortion has proven to be one of the most effective ways of reducing maternal mortality rates, when it is flanked by setting up good health care facilities. Nations that have scaled up these services in the field of sexual a nd reproductive health are reaping the benefits, saving the lives of mothers a nd their children and ensuring their countries’ well-being. Since legalisation in South Africa, maternal mortality has dropped significantly.
You have been discussing these facts and figures over the past week, especially in the last one and a half day. Legal barriers do not reduce the demand for abortion. Nor do they reduce the number of abortions taking place. The publications issued in the lead up to the two Conferences this week in London, provide clear evidence. Legal barriers serve only to make women wait longer and force them to seek clandestine, sub-standard care. This results in unnecessary deaths of women: globally 13 % of maternal mortality is caused by unsafe abortions. In many more cases, it leads to temporary or permanent injuries or disabilities. The social and economic consequences of this are enormous. The solid data and research provided in the publications are highly useful: they help us focus the debate on facts, on public health aspects.
I am aware that the broader sexual and reproductive rights agenda is obscured by the controversial issue of abortion. I do not expect the pro-life – rather to be named anti-choice - and pro-choice movements to ever really find a middle ground.
But I believe we can work on the basis of documents we have been able to agree on.
[international agreements]
Ladies and gentlemen,
In 2000, we reached a new consensus on the Millennium Development Goals. The access of men and women to reproductive health services was once again emphasized. In that same year, UN Security Council Resolution 1325 on Women, Peace and Security, was adopted unanimously, also providing us with a framework for action. At this point, let me say a few words on sexual violence. When it comes to sexual and reproductive health trends, those relating to sexual violence are the most alarming. Especially in conflict zones, where over the last decade violence against women has become endemic. Only yesterday – exactly one day ago - I addressed the UN Security Council on this issue. We need a comprehensive approach to curb this trend. Violence against women is more than a violation of human rights. It is also a security issue.
At the World Summit in 2005 the international community agreed that sexual and reproductive health are central for the attainment of all MDG’s. I consider the recent inclusion, by the UN General Assembly, of the additional target under MDG 5 “universal access to reproductive health by 2015” a small but significant accomplishment in this respect. Bureaucratically and politically I am happy. The Netherlands, with others, in particular UNFPA, have worked hard to get it included. But this is not enough.
We are extremely pleased to see regional commitments growing in number and strengths, The Ministers of Health of the African Union adopted their ‘Plan of Action for Sexual and Reproductive Health and Rights’ in Maputo in September 2006. This is an encouraging development. In international discussions and in our partner countries in Africa we help governments to defend the Maputo Plan and turn it into reality.
[the international arena and the development perspective]
Ladies and gentlemen,
Despite our agreements in the 1990s, with the ICPD Program of Action as a high point, and the more recent Plans of Action, there now again seems to be growing disagreement in the international community on the issue of sexual and reproductive rights.
The US government’s reinstatement of the Global Gag Rule and the prostitution loyalty oath has had an enormous impact in the field. As discussed a while ago, in Afghanistan for example -a country with one of the highest rates of maternal mortality in the world- healthcare resources for women and girls are drying up. What’s more, new donors are becoming more prominent on the development scene. These new donors are not always supportive of the sexual and reproductive healt h and rights agenda, including the right to safe abortion.
This ideological shift is a new reality that we need to come to grips with. We have to find ways to curb this negative trend. I see three main areas for action. First, we should look for new coalitions of donors and receivers, and foster the coalitions already formed, to keep the momentum for combatting maternal mortality. The momentum once again forged last week at the “Women Deliver” conference, and the “Safe Abortion Conference” give confidence that it is possible.
The two hundred million women worldwide who want to prevent or postpone a new pregnancy must be heard. I intend to support and actively coordinate their position, along with like-minded governments and organisations. And I intend to seek discussions with those who are not yet convinced. Like-mindedness on this agenda is not a donor versus recipient issue. It is rather a matter of countries that put public health first versus countries that choose not to.
I think it is crucial that sexual and reproductive health and rights form an integral part of education and health plans. You are giving the example here.
Second, we should step up our investment in the provision and accessibility of the entire package of sexual and reproductive health rights and services. Safe abortion is a small but crucial element of this package, as is prevention and education, especially for young people, but also for men and young adolescents. The Netherlands is currently a large donor to UN organizations and NGO’s working in this field; and of the UN research programme on sexual and reproductive health and rights. Together with like-minded donors, we will monitor the UN institutions closely, making sure that they include gender equality and sexual and reproductive health and rights is included in their policies to the maximum, as the UN is better on paper than they act in reality. Furthermore, we will work closely with the finance and development ministers to bring their financing for development and health care up to the levels agreed in Monterrey and Cairo. But you, many excellent NGO’s, doctors, activists present here today: You can be the champions!
And last but not least, we should break the silence. Sexual and reproductive health and rights is a delicate matter, often surrounded by stigma and taboos. As a minister for development cooperation, I do not shy away from controversial issues in policy dialogues with recipient countries. We took up the Global Gag Rule in our discussions with the US Congress – very interesting! A few months ago, I visited Nicaragua. In my discussions with President Ortega, I tabled my concerns on the new legislation placing abortion on medical grounds under the Nicaraguan penal code. Now we are bringing it up in the Budget Support Group. Since the law came into force, girls and women have unnecessarily lost their lives.
[conclusion]
Ladies and gentlemen,
The simple fact of holding an event like this helps us break the silence. It was a great pleasure for me to speak here today. We can save the lives of women and girls around the world.
Thank you.