Transcriber: Virginie Labeye Reviewer: Jessika Malo
Thank you and a very good morning!
My topic, as all of us, is rebirth; rebirth which brings hope for the future.
But I'm going to talk about birth.
And believe me, I can tell you something about birth.
As a gynecologist, with 35 years of clinical work,
I have done or supervised about 18,000 deliveries.
18,000 babies born into this world,
and it's a great moment, it's really a moment of joy
where you can give a healthy, screaming, alive baby to patient parents
who are anxiously waiting for that.
These are the great moments.
But the delivery room
also has its dark sides.
And in the course of these 35 years, I also had, and I will never forget them,
72 girls and women who lost their lives,
who died while they were pregnant,
who died when they were trying to give life,
due to pregnancy and birth complications.
Most of these tragedies took place
in poor and middle-income countries,
in poor resource settings.
Most of these tragedies are preventable,
because women die of preventable causes.
And I will go a little bit more in detail.
This is one of the greatest places I had the honor to work in:
in Pumwani Maternity Hospital, in Nairobi, in Kenya,
where we had up to 100 deliveries every day.
Here you see the babies who were born within one hour.
It's a great place
where we were able to show that indeed,
with good policy, with commitment,
that there is a possibility to reduce maternal mortality,
because most of the deaths are preventable:
women die because of high blood pressure, infections, bleeding,
all things that you can prevent
with good care,
good skilled attendance,
drugs available, and so on...
Unfortunately, for many women, this is not the case.
In these 72 there were also a number of girls
who died because of abortion complications.
Typically, on Friday night, they go to find a solution,
because the stigma is too big, because they can't keep the child,
and they are looking for a solution in the backstreets of the big cities.
Invariably, you find them on Sunday afternoon or evening.
They are admitted at the hospital
because of serious complications -- bleeding, infections --, and they die.
In the maternal deaths, and there are too many maternal deaths,
it's still a silent tragedy
with over 250,000 women dying every year in the world,
13% of them are due to unsafe abortions.
Those pregnancies could be prevented.
Those girls could still be alive
if they had access to family planning, to contraception.
47,000 deaths every year
due to unsafe abortion,
47,000 preventable deaths.
1 out of 3 could be avoided
if all women had access
to family planning, to contraceptives,
something that is taken for granted for this part of the world,
but in many parts of the world, it's not like that.
The unmet need for contraception is huge:
222 million women in the world
are looking to limit the number of children
or to space the number of children,
and they don't have access to contraception.
Why? Many, many reasons.
There is no choice.
The supplies are supposed to be there but there are just not there.
There is no access.
Even if there are clinics available,
very often, women have no access, due to many reasons.
They have fear, there are misconceptions
about the side-effects of contraceptives,
a lot of stories, because of malinformation.
The quality of the health care services is often poor,
not providing the service, the quality that we are looking for.
And there are gender barriers.
And the numbers are staggering: 220 million women.
Of those, 162 million live in poor countries.
63 million unplanned, unintended pregnancies every year,
19 million abortions, unsafe abortions, most of them,
82,000 women dying.
But contraception is not all about maternal death,
it is also improving life and well-being.
It's about less worry about unplanned pregnancies.
It's also about self-esteem.
When women do have access to family planning,
when they can choose,
they can better plan their education,
they can have more access to the labour market,
they can join economic processes.
It's also about parental care.
It's also about employment opportunities,
about participation of women into the workforce.
It's about better health, better nutrition, better education
for the children that you want,
and it's about fewer orphans.
Contraception is also about higher productivity:
smaller burden for the family, smaller burden for the community
because you have less sick children, less children who need care.
It's about reduced public expenditures
for social services, for health services and others.
Contraception is also about higher savings and investments.
I remember -- maybe you know Professor Karan Singh.
He is an Indian philosopher, politician, professor at the university and minister,
who said in 1972:
"Development will lead to contraceptives."
If the society is developing, women will have access.
The same philosopher said 20 years later, in 1994:
" Contraceptives will lead to development."
It's the key factor to lead to better development of the society.
But contraception is also a human right.
It's a right of a society,
a right of all people, couples, individuals
to choose freely
the number, the spacing and the timing of their children.
It's the right to decide for yourself.
It's a human right, and we should look at it as a human right.
That implies also that users, people,
adolescent girls, married couples,
also the vulnerable, those who are marginalized,
those who have less access to the health care sector,
all people should have access and free choice.
Free choice means that at least there are enough methods available,
such as female and male condoms,
oral contraceptives,
emergency contraceptives,
long-acting methods such as injectables,
implants and intra-uterine devices,
because not all methods are suited for everyone,
so people should have good information, good counseling and free choice.
I'm heading the Department of Reproductive Health
at the WHO, the World Health Organization,
where, earlier this year,
we published a guideline
"Ensuring human rights in the provision of contraceptive information and services".
This is actually a guideline
for governments, for managers, for health care providers,
to help them to ensure the basic concepts of human rights,
which are: accessibility, availability, affordability, quality, but also
non-discrimination,
also non-coercion,
also choice free of fear, good information
and no force nor violence.
These guidelines can help the world,
but reproductive rights are human rights.
If we really want to move the field forward, we have to work towards
the way people are thinking about reproductive rights
as a basic human right.
Already in the sixties,
there were civil rights and women rights activists and leaders
who were saying,
"Family planning, contraception, it is really one of the key methods
that can help to ensure the reproductive rights as human rights."
As I said before, reproductive rights ensure the choice of couples,
individuals, adolescents, everyone,
to have access to the contraceptive methods they need.
But did we hear -- how come,
if you're also convinced that contraceptives
are good for your health, good for the individual,
for the family, for the society, for the world,
how come that it is not a priority
in our national and international programs, in the global community?
Well, as John Cleland from the London School, rightfully said,
we have now faced 18 years of horrendous neglect
in the field of family planning,
because even the word "family planning" was out of fashion,
because it was kind of connected
with population control and forced procreation,
so there was global silence.
Until recently.
I think I'm here to talk about not only what is not done,
but we are here for rebirth.
Today, since the last years,
there is indeed hope for the future.
There are a number of agents, of factors that are now announcing
a change in paradigm,
that are leading to a different thinking, a different view
on rebirth in contraception and family planning.
I'm very proud to be here today
as the Chair of the Reproductive Health Supplies Coalition
with the secretariat here in Belgium, in Brussels.
It's the world's largest coalition, bringing 300 organisations together
who are willing to join forces,
to look at how we can bring the supplies
to those who need them,
how we can increase accessibility, how we can lower the costs,
how we can bring together all the partners around the table,
looking at supply chain issues,
looking at market dynamics,
looking at lowering the costs.
So this coalition brings together the brains of the world
and the technical people who can work very hard together.
The coalition is this year celebrating its 10th anniversary
and it's really the largest network
with the largest impact on supplying the commodities.
Another major event two years ago
was the Family Planning Summit.
And indeed, in London, in 2012,
the UK government, together with the Bill and Melinda Gates Foundation,
brought together 150 leaders
of developing countries,
developed nations, industry, private sector,
international community, civil society
in a family planning summit.
With -- calculating what the world needs
to reduce the unmet needs by 2020,
a huge amount of money has been promised,
over 4 billion dollars,
to reach these objectives.
The objectives are, by 2020,
to reduce by half those who are in need --
the women and girls who need contraception or family planning.
If these goals are met, then we will have
110 million fewer unintended pregnancies,
50 million fewer abortions,
220,000 fewer women dying
and 3 million fewer babies dying by 2020.
This is really hope and promise,
but rebirth takes years and efforts.
We have seen gains but also big losses.
It takes time.
Just imagine that it took 7 years
to add a second 5B Millennium Development Goal.
Number 5 is aiming at reducing maternal mortality.
But it took 7 years to add 5B,
access to universal reproductive health
and to family planning.
And now, we start seeing the benefits, the gains.
Rebirth takes time, but also continuous effort,
and that is our task as the reproductive health community.
We have to ensure that this topic remains on the agenda,
because there are many other competing urgent priorities,
competing for money, for time, for importance, for attention.
But we have to do that,
because we have to act
before the shelves are empty.
We can't afford the empty hands,
and if it is too late, the empty faces.
We have to act now.
And if there is one thought,
one key issue that we should take along,
it's that the ability to make the choice
of if, when and with whom to have children,
is not a luxury.
It's not an added extra.
The ability to make the choice
of if, when and with whom to have children
is a basic human right
and for that right, we should continue to fight.
This thought alone should fuel all the efforts and energy,
and this will be the rebirth of access,
the rebirth of choice,
the rebirth of freedom
for women and girls all over the world,
because we have to invest in them.
Women are not only half of the world,
they also make the other half.
Thank you.