It is an honor to be here on this the 20th anniversary of one of the great milestones in the history of global development. The International Conference on Population and Development held in Cairo changed the whole conversation. Instead of just counting people we recognized how each person counts, has rights, and should be empowered to make his or her own choices.
This had profound consequences. 179 governments pledged to make access to reproductive healthcare and family planning services a basic right, to fight infant, child, and maternal mortality and to do a better job of educating women and girls.
Civil society deserves a lot of credit for this. Non-governmental organizations were there in force. Not just outside, or as adversaries, but as full participants. This was unprecedented. You had a master plan, common messaging, and even a daily bulletin that delegates themselves used to stay on top of the conference and to find out what was going on.
Two decades later you continue to drive progress. When political will ebbs, and back sliding is a real possibility, civil society holds the line. Universal access to reproductive health became a target under the Millennium Development Goals, only after you pushed hard and long for this. During the recent UN Open Working Group meetings on post-2015 Sustainable Development Goals, sexual and reproductive health was a low priority for some. You leapt in, alerted friendly governments and helped us get sexual and reproductive health into the health goal and reproductive rights into the gender goal, linked to women’s empowerment and equality. We believe these could be some of the most transformative goals in the Post-2015 Development Agenda.
We also count on you at the annual meeting of the UN Commission on Population and Development, as it carries out its responsibility to review our progress in implementing the ICPD Program of Action. There, you and non-governmental organizations from the global south remind us, again and again that enlightened policies and effective programs are a matter of life and death. Your work has been instrumental in coaxing governments to make the additional commitments needed to keep the promises made in Cairo.
You were right to argue, as you have for years, that clinics treating pregnant women for HIV/AIDS should also offer contraceptive services, and that family planning services tailored only for married couples may put young, single people at risk. The CPD resolutions reflect these realities.
Civil society helps us inside the U.S. government as well. One reason the State Department’s annual Human Rights Report now covers reproductive rights is because advocates and service providers convinced top officials that this was needed.
Your research is as essential as your advocacy. The Guttmacher Institute demonstrated that access to modern contraception does not just save lives, empower women, and reduce poverty. It also saves money! Guttmacher’s research found that the $4 billion spent annually on contraceptive care in developing countries actually saves $5.6 billion on the cost of medical care for mothers and newborns. This makes not just health ministries, but influential finance ministries sit up and take notice. Another widely accepted figure that came from Guttmacher is that an estimated 222 million women in the developing world want to avoid or delay pregnancy but still lack the means to do this.
The barriers are geographic, economic, practical and cultural. And we need civil society’s help to overcome them. You are in the field, figuring out what women need and how they can get it.
Take the case of injectable contraceptives. These once had to be administered by doctors and nurses. With USAID’s support, FHI360 conducted research in Uganda and Madagascar showing that community health workers with minimal education could provide them safely. As a result, thirteen African countries now permit this practice.
Civil society groups figure out how to help at-risk, underserved populations including youth. In Liberia, Population Services International developed tools and provided training for family planning and reproductive clinics. Participating clinics were able to serve 15 times more young people and distribute 36 times more contraceptives to youth than they had before.
You also reach the hardest-to-reach places. Marie Stopes International brings family planning services to women and men in 30,000 isolated urban shanty towns and remote rural locations in 26 countries. It has even transported supplies by mule and camel train. MSI offers temporary “Saturday” family planning clinics advertised in local markets and by word of mouth. Women stream in, voluntarily seeking everything from short term methods, to sterilization.
Marie Stopes also helps poor communities set up their own high quality clinics and pharmacies, by explaining what’s needed, training local staff, and offering discounted contraceptives and medical supplies. Last year, while I was in Ethiopia for the International Family Planning Conference, I learned more about this when I visited the Alemu Blue Star Clinic.
On an earlier trip to Burkina Faso, I visited a Rama Foundation recovery center for women and girls ravaged by obstetric fistula. I heard their heartbreaking stories, and met women who had suffered for decades, abandoned by their husbands and families. The Rama Foundation arranges surgery, and gives women a place to stay, learn a trade and rebuild their lives.
As you know, many girls develop obstetric fistula because they give birth before their bodies are ready. Every year, two million girls under age 14 become mothers and most of these girls are married.
NGOs and civil society groups do more than offer medical treatment and contraceptive services. You work to change the attitudes that imperil girls’ bodies, their dreams, and their rights.
Civil society groups know that you cannot end centuries old traditions like child, early and forced marriage by just showing up and saying “don’t do that.” In eight countries across West Africa, an award winning NGO called Tostan sends locally based facilitators who stay in communities for three years. They help people speak openly about what happens when very young girls are forced to marry. Communities discuss the reasons for this practice, like the fear that unmarried girls will be raped or bring dishonor to their families. And together they think of other solutions.
Tostan and other NGOs figure out how to educate and communicate in ways that respect local cultures and make sense to people who cannot read and know little of the wider world. They work with community gatekeepers – traditional and religious leaders – who can empower communities to use family planning, just by signaling their approval.
We need your extraordinary reach, your patience, your passion, your grass-roots connections and experience to make the vision of Cairo real. We promised empowerment and that is not so simple. Enabling people to decide if and when to have children is just part of it. Empowerment happens not in conference rooms but out in the real world in the communities where you work.
On behalf of our government, I want to thank you for being such formidable allies and valued partners now and in the years ahead.