Women, Health, and Development

Speech by Michelle Bachelet Executive Director of UN Women, at the “Women, Health and Development conference in Asunción, Paraguay, 12 December 2011.

[Check against delivery]

Greetings to you all,

For me it is a great pleasure to have this opportunity to visit Paraguay in my capacity as Executive Director of UN Women and to have the additional opportunity to discuss with you an issue of particular importance — namely, the relationship between health, women and development.

I would like to express my appreciation for the invitation that has been extended to me by the Paraguayan government through Dr. Esperanza Martínez, the Health Minister, who has also expressed the interest shown by other women Ministers in embarking upon this dialogue.

And it gives me considerable pleasure to know that my first activity in Paraguay is precisely to talk about an issue that is widely ignored: that relating to Health, Women and Development.

I would also like to thank the Ministers Esperanza Martínez, Gloria Rubín, Lilian Soto and Liz Torres, all of whom have taken time out of their extremely busy schedules to support this initiative through their presence at this event, and indeed their work.

Until some years ago the relationship between health, women and development was invisible.

Health was considered only to be a drain on expenditure and the contributions made by women to human development were simply glossed over.

However, it is very much the case that the evidence, the pressure of social movements, international agreements and the commitment expressed by many governments have been factors that have as a whole led to health not being considered purely as a drain on expenditure but rather as what it really is: an investment that can but enhance productivity and the development of societies.

But we can see that the field of women's health has lagged far behind, both in terms of the treatment of illnesses and in professional prevention and attention, a situation that is obvious in many countries in the world. Women's health and consequently the health of boys and girls is a critical factor and a strategy that is central in terms of human development.

It is in light of this that we at UN Women do our utmost to ensure that global, regional and national debates give primacy to the links that exist between gender inequality and human development, and in which women invariably lag behind, including women who are poor and indigenous.

If we are capable of recognizing and facing these inequalities faced by women we will be in a position to know how best to carry forward the design, investment and implementation of public policies and programmes that promote gender equality and the empowerment of women so as to guarantee their rights and thereby to ensure that the whole of their human development potential is brought into play.

My friends:

Health is one of the most important areas in which women encounter risks that are different from those faced by men, and they have a central role both in health services as well as in their communities and families.

Although there are many important aspects of women's health that have an impact on development, I wish to refer to two in particular because they are fundamental and of extreme urgency not only in Paraguay but also throughout the region and indeed the world: 1) maternal mortality and adolescent pregnancy and 2) Access to sexual and reproductive health.

I have chosen these examples because countries have defined maternal health as an issue that is central to their development agendas — a commitment embraced by 189 countries through the Millennium Development Goals — and because MDG 5 is one of the goals that is still behind schedule in both global and regional terms.

This situation of lagging behind is not a product of our not knowing what to do or how to treat complications such as pregnancy or prevent it, but because we have not done enough to end gender inequalities or promote the meaningful empowerment of women in order to guarantee the exercise of all human rights, including sexual and reproductive rights.

Maternal mortality is determined by a combination of biological, sociocultural, economic and institutional factors that reflect the social inequality that affects women and both its causes and consequences have their roots in the cycle of poverty and the persistence of marginality.

In order to be successful in reducing the rate of maternal mortality to 75 percent and achieving universal access to sexual and reproductive health services, we need not only a technical focus but a political focus as well.

This comprehensive perspective calls for alliances in which national and international social stakeholders commit themselves to increasing resources in order to ensure the right of women not to die due to causes that could have been avoided; to strengthen health services so as to guarantee access and quality; and to encourage the participation of women in positions of leadership both within and outside of the health sector.

It is certainly the case that countries in Latin America and the Caribbean have made efforts and important progress in terms of reducing maternal mortality. Nonetheless, we can see that in 2008, 9200 women died on account of causes associated with pregnancy, childbirth and puerperium.

Maternal mortality during the period 1990-2008 went down from 140 to 85 for every 100,000 live births; a reduction of 41 percent that is equivalent to an annual reduction of 2.9, less than the 5.5 percent required in order to reach the goal established by the MDGs [1].

Moreover, we should not forget that these figures — in which Latin American and Caribbean women are almost 9 times more likely to die than European women due to reasons related to maternity — are only averages.

We are aware that bad sexual and reproductive health affects disproportionately specific groups or subsets of women such as young women, poor women, indigenous women and illiterate women who live in rural or marginal areas. Indigenous women in Mexico, Guatemala, Panama and Paraguay all evidence rates of maternal mortality that are three times those of their non-indigenous countrywomen.

We are concerned about the rates of adolescent pregnancy in the region because these are the second highest in the world, after Sub-Saharan Africa.

Studies bear out that a third of young women have a first sexual relationship that is non-consensual in nature, and that approximately 40 percent of pregnancies are not planned, a significant number of these being the product of rape or incest [2].

We are also aware that the risk of young women between 15-19 dying during pregnancy and childbirth is double the rate of those who are more than 20 years old [3].

In the area of sexual and reproductive services we have seen important progress with regard to access, in which we find that it is the case that three quarters of women in Latin America and two thirds in the Caribbean use contraceptives.

However, contraceptives are still not available on a universal level: more than 3 million pregnant women do not have access to modern methods of family planning and approximately 40 percent of women face unmet demand for modern contraceptives with an over-representation of young, indigenous and rural women [4].

In the case of Paraguay, we have seen that there is a tendency towards the reduction of maternal mortality with a reduction from 164 to 100.8 per 100,000 childbirths in the period 2000 to 2010 [5] . Here we can see that the first cause of death is abortion (27 percent) followed by haemorrhage and toxemia[6].

20 percent of the poorest women account for 27 percent of deaths, and among these are to be found indigenous women. The percentage of adolescent pregnancies is at least 10%. Despite efforts, the current rate of reduction is not sufficient to achieve the objectives set by the Millennium Development Goals.

We have noted that there has been an increase in Paraguay in the use of contraceptive methods in recent years, reaching 79.4 percent in the case of married women or women in relationships, and 32 percent among single women. National studies have identified the need to strengthen actions in order to bring services closer to female and male adolescents and to promote a comprehensive sexual education.

I have been engaged in conversations with my fellow women Ministers and I am cautiously confident because inexperience indicates that the development of comprehensive public policies, based on human rights that conceptualize health as an important component of social development with equity, have the potential to expedite the process.

And this is what is precisely posed in “Public policies for quality of life and health with equality, which is being introduced here in Paraguay, in order to quicken the pace of change in an effort to avoid preventable deaths, to keep on increasing investment and commitment to ensure the implementation of programmes such as those that have been outlined by the current administration, and which seek the universal application of primary care offering free services and a national medicines policy.

These programmes clearly anticipate the social determinants for health associated with gender inequality and make it possible to combine economic, political and technical efforts so as to transform the social and cultural structures that determine social and gender inequality and which manifest themselves, inter alia, in maternal mortality.

With regard to health services, it is necessary to strengthen these services in terms of their institutional development and increase training programmes for professional and administrative personnel.

In this regard, continuity in the implementation, monitoring and evaluation of current free-of-charge primary care programmes is extremely important, ensuring that the necessary financial and human resources are in place.

Together with its sister agencies UNFPA, OPS (Organización Panamericana de la Salud) and UNICEF, UN Women will support national efforts to improve quality of services in order to mainstream gender and intercultural perspectives in primary care services and assistance for victims and survivors of violence, promoting readily approachable services for adolescents and young people — essential if we are to reduce the rates of adolescent pregnancy, unsafe abortions and HIV infection-and supporting efforts relating to political advocacy so as to ensure that the facilities in question have in place the infrastructure, equipment and supplies that are necessary to provide quality services, including consciousness-raising and training of health personnel in order to prevent discrimination [7].

Finally, in the individual sphere, we see how the subordination of women, their level of education, their low economic level, are all factors that interconnect, reinforce each other and impact on their ability to make decisions with regard to their own health.

The work of serving the cause of women that is pursued by our agency, by furthering policies and programmes that increase women's physical, economic and political autonomy, are central in terms of the empowerment of women, the relationship between their bodies and sexuality and their relationships as part of couples, which undoubtedly will have a positive effect on health and civic participation.

And this issue points to the international commitments acquired by States: The Convention on the Elimination of all Forms of Violence against Women (CEDAW), other human rights treaties, the Action programme of the International Conference on Population and Development (ICPD), the Action Platform of the Fourth World Conference on Women and the Millennium Declaration, to all of which Paraguay is a signatory, and which will enable us to have a national consensus that will provide us with the opportunity to take action and to promote the exercise of the human rights of all women.

And while it is the case that progress has been made in the region in order to consolidate this progress, we have to keep on working, to galvanize and double our efforts, and train and empower women in our region so as to demand and exercise their rights. Each woman should be capable of making her own decisions with regard to sexual and reproductive health, supplied with adequate information, without coercion, discrimination or violence.

In Paraguay we can witness progress made in the area of budget funding, in the design and implementation of public policies for honoring these commitments. This progress is paying dividends by increasing access to health services and reducing maternal mortality but, considering the scope of the problem, more rapid progress in this area calls for a pact between all stakeholders at the national level, including the support of the international community and donor countries.

We are talking here about guaranteeing the exercise of civic responsibilities of women and deepening democracy and, as a result, it is salutary to coordinate the efforts made by all women and all men.

We need more women to participate actively in politics, in social organizations, parliaments and at the municipal level, in order to ensure that these issues are tackled, that they are made visible, that discussion takes place about these issues, that citizens, both men and women can demand that the authorities address these questions as key components of the country's development.

Finally, you can rest assured that at UN Women we will be working forcefully and with conviction. We are doing this by promoting a greater participation by women in decision-making environments that are on a par with men, so as to guarantee that problems and solutions are treated impartially, no matter whether one is female or male.

We will work to seek alliances, in constructing better programmes and projects, in defending at the highest level the urgent and just demand for equality of rights and opportunities between women and men.

There is no better investment that a country can make to extend democracy, justice and economic growth than investing in girls and women.

Thank you so much.

[1] WHO, UNICEF, UNFPA, The World Bank (2010). Trends in Maternal Mortality: 1990 to 2008. pp 40-41.

[2] WHO. Forthcoming study of 12 countries.

[3] Regional Working Group for reducing Maternal Mortality. Prevention of Adolescent Pregnancy, a challenge for the GTR. Draft 2011.

[4] Data of Michelle Bachelet's speech to the OPS.

[5] MDG National report, November 2011

[6] Ibid, page 30

[7] Indirect discrimination in which there exist policies, laws or institutional arrangements that are apparently indifferent to differences between men and women, and which impact negatively on the lives of women and girls. These policies can contribute to reproducing and perpetuating inequalities and discrimination that is based on gender.