When the International Conference on Population and Development (ICPD) took place in Cairo, Egypt in 1994, I was just a schoolgirl in Bangladesh, too young to even begin to comprehend the importance of the gathering which was taking place. It is the fifteenth anniversary of Cairo this year, and it never fails to astonish me how despite having formulated a framework more than a decade ago, it seems as though we are moving farther away from the revolutionary and feminist agenda that was set forth at that UN conference.
Cairo marked a huge victory for feminists. It was when population policies shifted from being about controlling population growth and started being about empowering women. Feminists had long advocated the point that women’s fertility and empowerment went hand in hand: Unless women were in control of their reproduction, they could not really be empowered. If women had access to education and high salaried jobs, they would choose to have smaller families, and fertility rates would lower, thus slowing population growth. Population stability would occur naturally instead of through coercion. The idea was described as a real breakthrough moment in Cairo. This was a major win for feminists who had long urged policy makers to focus on the role women’s empowerment played in population growth.
Objectives were set in order to achieve universal access to reproductive health care by 2015, and donors committed to provide $18.5 billion annually by 2005. As we can all see, that has not happened. Donors have fallen so short of what was promised at Cairo that it is estimated that less than a quarter of what was set out at the ICPD is currently being spent on international family planning assistance. One also of course should factor in the massive damage committed under the Bush Administration to women’s health. Aside from the reimplementation of the Global Gag Rule (the Mexico City Policy), the de-funding of the United Nations Population Fund (UNFPA), US assistance to international family planning programs declined approximately 40% under the past Administration according to Population Action International (PAI). In his first 100 days, Obama has made major strides to reverse many horrifying Bush era policies. But there is still tremendous work to be done and it goes beyond elaborate policies and billions of dollars.
The World Health Organization (WHO) identifies maternal mortality as a major indicator of women’s overall position in society. The Safe Motherhood Initiative articulates that maternal health is “ultimately related to whether societies invest in and realize the potential of women- not only as mothers, but as critical contributors to sustaining families and transforming nations.”
Indeed the numbers from Women Deliver speak for themselves. It is estimated that one in eight women die in childbirth in Afghanistan. That number in the US? One in 4,800. That number in Sweden? One in 20,000. What can we gather from these numbers? What do they tell us? That these deaths are preventable. We are not looking for a cure to save women’s lives in childbirth or the complications that may arise from them. It is a question of priority and acknowledgment, plain and simple. It is a question of how much we value the lives of the women in our country, the lives of 50% of our population.
It is 2009 and despite all the advances the world has made in science and medicine, statistics for maternal and newborn deaths are not going down. In the past two past decades, maternal and infant mortality ratios have actually increased in regions such as South Asia and Sub-Saharan Africa. In fact, PAI reports that 99% of pregnancy related deaths occur in the developing world where giving birth can be paramount to getting a death sentence.
Imagine this: Every minute of every day, a woman dies from pregnancy related complications. The Guttmacher Institute states that currently there are about 200 million women in the world who wish to either delay or prevent pregnancy, but do not have access to contraceptives. It is estimated that approximately 530,000 women and girls die worldwide due to complications related to pregnancy, including as many as 70,000 women and girls who die every year from botched abortions.
Even though these statistics are widely used by family planning groups, it is important to remember that these numbers are just estimates. Actual numbers of women dying are much higher when you consider how many deaths go unreported. Child marriage, a common practice across South Asia , is a major but often silent contributor to maternal mortality rates: The risk of dying from complications increases five times for girls under the age of 15 years.
Frustratingly, most people do not even understand the importance of maternal health, or recognize the links between the health of a woman and that of her family, her community, and her country . Children whose mothers are in poor health are less likely to receive education or healthcare. Children who have lost their mothers are more likely to die themselves. Often even these very obvious links between infant mortality and maternal mortality are not made by the average person.
Recently there was huge outrage in Washington over President Obama's Stimulus Package including $200 million for domestic family planning programs. The provision ended up being taken out of the bill and turned out that it never existed in the first place. But the outrage speaks for itself. Imagine, the worst economic crisis in living memory is unfolding before our very eyes, and American lawmakers did not understand why birth control should be made affordable for low-income women? People need to control the size of their families so they can feed them, and right now people don’t have money. It is a recession. What is so difficult to understand about that? This is what happens when in 2009 men are still making and writing the majority of laws. Yes, even in America , the battle over who controls women’s reproduction continues.
As a Bangladeshi working and living in Washington, a large component of my work is advocacy and lobbying on international family planning. It’s a tricky position to be in and often I find myself in two worlds at once. It just fascinates me how most Americans are unaware of the far reaching effects of the policies created in Washington . So much power, concentrated in one tiny city that is not even a State, but a District and a District that can’t even vote. It makes me think of how much advocacy work is being done here by women’s and family planning groups to once again make the US the leader on global reproductive health after eight years of Bush. US leadership on global health is without a doubt an invaluable and critical asset, but securing women’s access to reproductive health care services goes beyond authoring language in legislation in the fancy marble halls of Congress.
I am sure I have no revolutionary solutions to offer, but I think that dictation on population policies must come from countries like Bangladesh where our maternal mortality ratios rival those of Afghanistan . We should be the authority. Bangladesh is in an excellent position to offer the solutions on population because we are the ones living with the problem at an unimaginable scale.
The Bangladeshi civil society and the non-governmental organization (NGO) sector need to be applauded for their work. I think it is fair to say they have single-handedly taken up the responsibility of prioritizing family planning in the country. Try to imagine where would Bangladesh be today without organizations like the Bangladesh Rural Advancement Committee (BRAC), the Nobel Prize winning Grameen Bank, or the countless NGOs on the ground? Where would we be without the healthcare workers who travel door to door in our villages distributing birth control? Still there needs to be more work done to make the case for maternal health and women’s health.
In Washington, I always hear family planning advocates throw around the word education. It is always education this and education that. I try to make them understand that an illiterate woman in Barisal pregnant with six kids understands that she needs better family planning. She can see she cannot feed her kids and she watches them die. Yes, education is a huge factor but it is not where all our solutions lie.
I think the solution lies within the women’s movement, both in Bangladesh and around the world. I think that this is an issue we must take up and advocate on endlessly and tirelessly until the world gets the point and understands why women’s health should be a global priority. Saving women’s lives is not up for negotiation. The right investments need to be made now in women’s health because we already know what to do and how to do it. We already have the cure. There is no search for a cure like there is for cancer. It is an issue of access . Simple things like increasing the number of skilled birth attendants, increasing their training, making sure clinics are well stocked with the most basic of supplies. It always astounds me that in the “Developed World” if a woman has even the slightest threat of an obstruction in labor, a caesarean section is performed. In countries like Bangladesh , women usually end up with obstetric fistula. Disparities like that should not exist in this day and age. It is needless and it is preventable .
Unless women determine the laws and the policies which will ultimately shape their reproduction, all other women’s rights causes will be lost. Just think if men could get pregnant, how different the world would be. Birth control would probably be available free for all, and abortion would be a birthright.
This year in commemorating Cairo , let us really reflect and uphold the frameworks that were articulated at the ICPD almost two decades ago. It all goes back to what feminists advocated for then and now: Women cannot be empowered until they are in control of their reproduction.
What better time to really win this fight once and for all than on the 15th anniversary of Cairo? We owe to ourselves. We owe it to women and their families everywhere.
Anushay Hossain is the Global Programs Coordinator at the Feminist Majority Foundation. She is a graduate of the University of Virginia and completed her Master's in Gender and Development from the Institute of Development Studies (IDS) at the University of Sussex. Ms. Hossain is a native of Bangladesh.
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I love this post. My only misgivings has to do with the praising of C-section. Do you really want the rest of the world to get to the point where the U.S. is? The point where the two surgeries that are most commonly done unnecessarily are C-section and removal of the uterus? (In fact estimates are that 75% of "hysterectomies" are unnecessary.) These unnecessary surgeries also put women at risk. I have been the victim of a doctor who tried to pressure me into having my uterus cut out at the age of 37. I didn't want more children, so it was useless, right? Good thing I did my research, got second opinions and found out that he'd misdiagnosed me.
I agree that women around the world need access to proper healthcare. Just don't assume that the way it's done in the "developed world" is always the right way. Especially not when it comes to OB/GYNs. They should be viewed with plenty of suspicion.
I totally agree with your comment. I am in no way advocating c-sections, and am aware of the alarming rate they are being performed in the US. But that is another issue. I was trying to make a point about the quality of healthcare available to women depending on where you live- why and how the "developed world" has all but eradicated fitsula while it is all too common of a condition in poorer countries.
Thanks for your comment and I am so glad you liked the post :) Thank you!
Thank you so much for writing this. It's really well written and poignant on the issues. This article led me to the Feminist Job Listing on your group's site, and now I'm looking at legal advocacy jobs and other ways to get involved. Seriously, really inspiring. Thank you.
Rachel, thank you so much for your comment. It really means a lot to me. I am so excited you checked out FMF's feminist career center! Feel free to email me if you have any questions ahossain@feminist.org Many thanks again for your words and support!
I was trying to make a point about the quality of healthcare available to women depending on where you live- why and how the "developed world" has all but eradicated fitsula while it is all too common of a condition in poorer countries.GED Program | High School Diploma | High School
we definitely need good healthcare for women. they definitely need to reform it. This is not good to see. The government needs to step in.
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really means a lot to me. I am so excited you checked out FMF's feminist career center! Feel free to email me if you have any questions ahossain@feminist.org Many thanks again for your words and support!Psychology Degree | mechanical engineering degree
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