Why We Care

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Why We Care Global Leaders Council for Reproductive Health Copyright © 2012 by The Aspen Institute All rights reserved.

The Aspen Institute One Dupont Circle, NW Suite 700 Washington, DC 20036-1193 USA www.aspeninstitute.org Published in the United States of America in July, 2012 By the Aspen Institute Publication number: 12-016

Editors: Ann Clark Espuelas and Peggy Clark Graphic designer: Silvia López Chavez Principal photographer: Dominic Chavez All photographs © Dominic Chavez unless otherwise noted.

Foreword: Photo of Musimbi Kanyoro by Elise Mann Page 44: Photo of Tarja Halonen by Max Taylor Photography Page 48: Photo of Ted Turner by Dado Galdieri

Printed in the United States of America by Kirkwood Printing, a Forest Stewardship Council (FSC) certified lithographer, and on FSC certified paper. FSC certification ensures that the paper used in this book contains fiber from well-managed and responsibly harvested forests that meet strict environmental and socioeconomic standards.

Table of Contents 06 08 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68

Foreword: Musimbi Kanyoro Chapter I: Fred Sai Chapter II: Mary Robinson Chapter III: Joyce Banda Chapter IV: Gro Harlem Brundtland Chapter V: Jan Eliasson Chapter VI: Helen Clark Chapter VII: Regina Benjamin Chapter VIII: Jenny Shipley Chapter IX: Annie Lennox Chapter X: Tarja Halonen Chapter XI: Ted Turner Chapter XII: Phumzile Mlambo-Ngcuka Chapter XIII: Vaira Vike-Freiberga Chapter XIV: Maria Otero Chapter XV: Joy Phumaphi Afterword: Peggy Clark

To Katie, and to all of our daughters

The Global Leaders Council for Reproductive Health is a group of eighteen sitting and former heads of state, high-level policymakers, and other leaders committed to advancing reproductive health for lasting development and prosperity. Chaired by former President of Ireland Mary Robinson, these leaders work to mobilize the political will and financial resources necessary to achieve universal access to reproductive health by 2015 â&#x20AC;&#x201C; a key target of the UN Millennium Development Goals.

The Global Leaders Council is an initiative of Aspen Global Health and Development, a policy program of the Aspen Institute that works to address persistent global health and development challenges by promoting breakthrough solutions to advance entire fields or systems. Aspen GHD promotes and accelerates these solutions by bringing political and thought leaders together to share and advance innovative practices and evidence-based solutions; working to replicate successful local practices at a global level; and strengthening the capacity of developing world leaders to champion and act on these solutions.

The Aspen Institute mission is twofold: to foster values-based leadership, encouraging individuals to reflect on the ideals and ideas that define a good society, and to provide a neutral and balanced venue for discussing and acting on critical issues. The Aspen Institute is based in Washington, D.C., Aspen, Colorado, and on the Wye River of Marylandâ&#x20AC;&#x2122;s Eastern Shore and has an international network of partners.

Support for the Global Leaders Council for Reproductive Health is provided by the David & Lucile Packard Foundation, the William and Flora Hewlett Foundation, the United Nations Foundation, and the United States Agency for International Development (USAID).

For more information on the Global Leaders Council for Reproductive Health and Aspen Global Health and Development, visit www.globalleaderscouncil.org and www.aspeninstitute.org.

FOREWORD

For the past thirty years I have had the privilege of being both part of grassroots movements and in spaces of power to advocate for women’s rights.

During this journey I have been able to affirm that women want to be safe and secure decision-makers of what happens in their own lives and in the lives of their children. I believe in the power of women’s voices – at all levels – and it is for that reason that I embraced the idea of the Global Leaders Council for Reproductive Health and was able to support its establishment through the David & Lucile Packard Foundation and with my partners at the William and Flora Hewlett Foundation and the United Nations Foundation. Since then, it has taken on a life and vitality of its own with the leadership of Mary Robinson and Peggy Clark and other funders and partners.

Photo by Elise Mann

The role of institutions such as the Aspen Institute in bringing people of various beliefs to a place of listening and reflection – and opening minds to hearing new ideas – is so important to this work and these issues. We must work with diligence and focus to convey what saving the life of a woman means. Some ideas about reproductive health are entrenched in outdated notions and fear, and inspiring and enacting true social change around this issue demands Herculean efforts.

Such a task requires a diverse group of leaders – and these are the members of the Global Leaders Council for Reproductive Health.

These leaders are trusted by people at the grassroots; their message is reaching far beyond politicians or reproductive health advocates.

8 | Why We Care | Global Leaders Council for Reproductive Health | Foreword

We must support leaders at all levels – local, national, regional, and global – to work for access to reproductive health services. Local leaders must labor to change attitudes in communities. National leaders must change policies and bring forward the ideas occurring on the ground to regional and global forums. For change to take root, it must spread to a regional level – it is easy for a political, economic, or natural disaster to undermine change in one country, but if activists can see change occurring and draw support from neighboring countries, they gain confidence and can continue fighting. Finally, respected world leaders like the members of the Global Leaders Council have the access and expertise to catalyze change at the highest levels and bring the voices of women on the ground to the world stage.

When I began heading the Women and Population Program at the Packard Foundation, we recognized that to really enable women to have access to reproductive health services, we had to enact social change on a fundamental level – changing the way people think about reproductive health and family planning. It’s not laws that make people change – it is shifts in attitude that foment behavior change.

All of the leaders who have contributed to this book share their stories in a powerful, personal way. From President Joyce Banda, who speaks movingly of her own experience as a wife, mother, and leader, to Dr. Fred Sai, known and beloved by so many as the “grandfather of maternal health,” these leaders speak from the heart.

They speak not as puppets or surrogates; they speak as people who have seen desperate mothers, dying children, helpless sisters. And they have also seen women empowered by choice, given voice by education, bestowed with strength by knowledge. They have seen the miracles wrought by access to reproductive health services – they have seen change.

I would like to thank each of these leaders for their perseverance, commitment, and strength. And most of all for sharing their stories, for sharing with the world – for women everywhere – why we care.

Musimbi Kanyoro President and CEO, Global Fund for Women June 2012

I asked Mary Robinson to lead this work because she travels the world and speaks to women on the ground – she really listens to them – and accurately brings their voices forward. She has the authority to speak to this issue, and the experience to approach it from a human rights perspective. It has been a privilege having Mary lead this effort.

9 | Why We Care | Global Leaders Council for Reproductive Health | Foreword

FRED SAI

Frederick Torgbor Sai has been recognized the world over for his important contributions to the field of family health. Now known by many as the “grandfather of maternal health,” Fred Sai has brought dedication, passion, wisdom, and patience to a field that has often been little understood or appreciated. Born in Osu, a suburb of Accra, the capital of Ghana, he went on to train in medicine at the Universities of London, Edinburgh, and Harvard. He has received many awards for his efforts, including in 1993 the United Nations Population Award and in 2006 one of his nation’s highest honors, Member of the Star of Ghana. Dr. Sai served as the chairman of the National Population Council of Ghana from 1992-1997. He was the president of International Planned Parenthood Federation and also a senior population advisor at the World Bank from 1985-1990. Dr. Sai is world-renowned for his chairing of various international conferences. He has published extensively, and his most recent book is With Heart and Voice: Fred Sai Remembers, a vivid account of his childhood, and his experiences in the world of reproductive health.

Photo by Dominic Chavez

I

am often asked why, as a man, I have been so involved and persistent in this field, a field that is often tied to “women’s issues.” My primary response is simple: I care because it is the right, humane, and human thing to do. This is what drives me. Also, I happen to have lived through some of the horrific circumstances that can surround the issue of family planning and reproductive rights.

My father died when I was very young – three or four years old. I was brought up mainly by my mother, and therefore I had to stay in the women’s compound in Osu, where I grew up, a lot longer than ordinary boys of my clan. I stayed there until I was about ten years old. So as a young, impressionable child, I was surrounded, always, by girls and my powerful aunties, and my mother.

Then a bit later, I worked in my first job as a stand-in teacher to a class of thirty girls, in Osu, and I learned even more about girls. It was during this time that I was waiting anxiously for the results of my Cambridge School Certificate exams, which had been delayed

by World War ll. Finally, I left my country at age 23, in 1947, and went overseas, having received by good fortune a British Colonial Government scholarship. I trained in medicine at the University of London, and in Edinburgh. In Britain in the 1940s and 1950s, not even the condom was available very readily. I saw the result of this restriction. There were girls, overseas students like us, who had gotten pregnant and could not face it and had gone to unskilled providers. A couple of them had died, and one had attempted suicide.

When I returned to Ghana as a doctor, one of my assignments was to conduct autopsies or post mortems and I was to see horrible things on those slabs as a result of botched abortions.

Early on, I was doing research for a paper I had to write and I began to read about nutrition. I read about the malnutrition levels in Africa, and I became engaged in this problem. Later, in the 1960s, when I was called on to help develop the family planning program in my country, I didn’t hesitate to join. It was around this time that I made the connection between nutrition and family planning. I was looking after these children who had “kwashiorkor,” as we call it, which is protein-energy malnutrition. Scientific papers had reported that quite a large proportion of the children found with this condition had mothers who’d had children very close together. So we began to advise people on how to space their children better.

Women are dying in childbirth by the hundreds – not because the technology for saving them is not available, but because the will, the support, the enthusiasm, the understanding that this is the humane thing to do, the human thing to do, is not there. When you see women dying from preventable and manageable causes, you must do something.

Worldwide, there is good news. A study in the Lancet from March 2010 found that the number of women who die every year in childbirth is dropping at an unprecedented rate. From 1980 to 2008, maternal deaths globally have fallen from 500,000 each year to 340,000.

The latest news from the United Nations is that the number of maternal deaths globally is now below 300,000, continuing the decline. Having spent some forty years working on women and children’s health in Ghana and across Africa, I welcomed this progress when I heard this news.

12 | Why We Care | Global Leaders Council for Reproductive Health | Fred Sai

But as the world celebrated, I also couldn’t help but wonder, “Where is Africa?” I am saddened and even ashamed at the poor progress my continent has made in maternal health.

of all goods that are moved and produce 60-80 percent of the food in the developing world. And maternal and infant deaths account for $15 billion in lost productivity.

It is an unfortunate truth that progress for the world at large does not necessarily mean progress for Africa. Maternal mortality in Africa is complex, and challenging. Our countries face increasing rates of HIV, entrenched and debilitating poverty, food shortages, weak education and health care systems, problematic governance, corruption, and civil conflict. These are huge issues in their own right, but they also have significant impact on maternal, newborn, and child health.

I believe that the success of African leadership in this decade should be judged first and foremost by the progress made in the lives of our girls and women. My credo is there should be no more unplanned pregnancies in Africa. There should be no more unsafe abortions in Africa. There should be no more preventable childbirth-related deaths in Africa.

It doesn’t need to be like this. I am confident that we can address this crisis if we shift our approach and start investing in women. We must increase women’s access to health services. We must promote business development and support women with grants and loans. We must ensure that girls have access to quality education. And we must work to convince our neighbors, be they relatives or countries, to prioritize women and girls in all that they do.

Reducing maternal deaths is not a simple battle, and the high ratios of maternal death in African countries will continue to shame and burn me until we see progress across the continent. I do, however, rest a little bit easier seeing some momentum around this issue. And I hope that when the next round of statistics are released, the story is about African progress – progress that was spearheaded by Africans.

Many African leaders understand the urgency of addressing the maternal health crisis, despite its complexity. They have a sister, a niece, or a daughter who has died – or if they do not, they certainly understand the broader impact maternal death has on their countries.

Women are the heart of African economies. They transport two-thirds

It is because of all of this that I remain in this field. Many people ask me, how is it that you have lived so long and you continue still to advocate these things with such passion?

I tell them that I think I’m afraid that when I die, I will be judged by how I have failed – what I was unable to do. And so I persevere.

I am happy to see progress being made when I am alive. I am old, but I still have a voice. To the extent that my little heart will keep ticking and supporting that voice, my voice and heart are with this cause.

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13 | Why We Care | Global Leaders Council for Reproductive Health | Fred Sai

MARY ROBINSON

Mary Robinson, the first female president of Ireland (1990-1997) and former United Nations high commissioner for Human Rights (1997-2002), has spent most of her life as a human rights advocate. Born in 1944 in Ballina, County Mayo, Ireland, she was educated at the University of Dublin (Trinity College) and Harvard Law School.

The recipient of numerous honors and awards throughout the world, including the Presidential Medal of Freedom from President Obama, Mary is a member of the Elders, former chair of the Council of Women World Leaders, and a member of the Club of Madrid. Currently she is president of the Mary Robinson Foundation â&#x20AC;&#x201C; Climate Justice.

Photo by Dominic Chavez

W

hen I was a little girl, my father, who was a doctor, would allow me to go along with him on house calls. He was taking care of very poor people, in a large rural area in the West of Ireland. I didn’t fully understand what was going on – why the patients were sick, how he was making them better – but as I sat in the back seat of his car, I was intrigued. The work was solemn, important, and serious. I noted how long it took my father to say goodbye at the door. He would stand listening, often leaning down a little if it was a woman or elderly person. I loved it – I felt a part of something very adult.

My grandfather, who lived down the road from us in Ballina, County Mayo, also made me feel this way. He was of the age and disposition where he had no idea how to talk to a child. So he talked to me as if I were an adult. I felt so important. He was a lawyer, and passionate about his work. He had a profound sense of being on the side of the little guy – the tenant against the landlord, David vs. Goliath – and he would talk to me about these cases. I was riveted. This, I think, sparked something in me that has never diminished: a sense of fairness, a belief in the possibility for social change.

I was twenty-five and elected to the Senate of Ireland on a platform that included the idea of dismantling a ban on contraception that was part of the 1935 Criminal Law Amendment Act. I wasn’t the first person to take this issue on, but I was the first who really tried to change the law, by introducing a bill in February 1971. At the time it was a criminal offense to buy or sell a condom, but it was not illegal to use one. Also, married women required a medical note that they had menstrual cycle problems in order to avail of a contraceptive pill.

I didn’t know it at the time, but this was the first step in a process that would take more than a decade to complete. When a vote was called, I had to request permission in the Senate for the bill to be officially printed and distributed. I thought of my grandfather and his trying to help “the little guy” – and now I was the little guy! I was in a tiny minority – it was David vs. Goliath – and Goliath had the Catholic Church behind him. I had to stand up and talk firmly about issues that embarrassed many senators. Sometimes it’s a matter of being able to say what others are too embarrassed to talk about. The bill was defeated by a large vote.

My mother was also a doctor, although she gave up medicine to have five children, all quickly, one after the other. I have said before that this caused my first real interest in “human rights” – being wedged between four boys! My mother never said she wanted it any other way, but her experience – when I reflected on it later in my own life – led me to understand that the real key is to have choices. There still is not, really, the necessary range of choices for women.

At the time I received a deluge of hate mail. Condoms were posted through my letterbox, and in my hometown the bishop denounced me from the pulpit. The Leader of the House in the Senate said that I was behaving in a “schoolgirlish, irresponsible manner.” People said that a change in the law would be a “curse upon our country.”

This experience – fighting very hard as a small David against an enormous, powerful Goliath – taught me so much, and inspired me greatly, to this day.

Holding my own amongst those four brothers did give me a competitive spirit, a willingness to jump right in to the rough-andtumble if that’s what it takes, and to think and dream big. And those attributes, I would soon come to see, would serve me very well.

In the summer of 2011 I visited Somalia. It had been almost twenty years since I’d been there as president of Ireland drawing attention to the food crisis in 1992. I have not been able to get the suffering of the people of Somalia out of my system since then. I was quite

16 | Why We Care | Global Leaders Council for Reproductive Health | Mary Robinson

discouraged to see that the situation had become much worse. It was devastating to see that so little had changed for the better. The drought was very serious, compounded by poor governance, climate change, and increasing food prices. The U.N. declared two regions of Somalia to be suffering from famine and that tens of thousands of Somalis – mostly children – had died.

The Horn of Africa had experienced the eight hottest years in succession ever, so that the drought was affecting about 13 million people spread over parts of Ethiopia and Kenya as well. I asked each of the women I met in Somalia, and later in the Dadaab camp in Kenya, how many children she had. Not one said fewer than six, and many had seven or eight. I realized that their sense of reality was that by having a number of children they had some hope that one or two might survive. That is not a position any woman should ever be in.

We are talking about some of the most vulnerable people on the planet. We must help to have their voices heard, and their basic rights protected.

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In many ways I am very different from that headstrong twenty-fiveyear-old impatient to change Irish law on family planning – I hope I am more humble, for one. But in many ways, I haven’t changed.

Family planning, maternal and child health, and reproductive rights are still issues that are of great importance to me. I hope I never forget those formative, inspiring days of my childhood, witnessing poverty and hardship from the back of my father’s car, watching as he tried to light a candle in the darkness, one house at a time, by having the patience to listen.

17 | Why We Care | Global Leaders Council for Reproductive Health | Mary Robinson

JOYCE BANDA

Joyce Banda is the president of Malawi. Previously, she served as Malawi’s first female vice president. She was a member of Parliament for the Zomba-Malosa constituency and was minister of Gender, Child Welfare and Community Services, and in 2006 President Bingu wa Mutharika appointed her Malawi’s minister of Foreign Affairs. She was appointed as Malawi’s Goodwill Ambassador for Safe Motherhood in 2009 by the African Union.

Photo by Dominic Chavez

W

hen I was growing up, my father wanted my sisters and me to have the same opportunities our brother had. This was not a traditional mindset in African families. My father instilled in us the belief that even if we were girls we could achieve whatever we wanted.

By the time I was twenty-one, I was in an abusive marriage. After ten years, I decided that I had to get out. Remember, I was an African woman in an African situation – you didn’t just walk out. Nothing was considered too much pain to endure. But I made my decision, I packed my bags, and with my three children I walked out.

There was a tug of war all the time between my father and my grandmother, who believed that African girls were supposed to simply be given the tools to grow up, get married, and have children.

My father was a policeman so we lived in town, where we went to school. But my grandmother insisted that every Saturday I go to her house in the village so that I could acquaint myself with village life.

And I am thankful for that, because I’ve spent most of my adult life trying to empower women because of the taste of village life that I had as a child.

I remarried later, this time to a fine man. Given my experience in my previous marriage, I realized that economic empowerment was crucial to women, and I started my own business. Gradually, I built a business that employed 100 people. I was empowered on many levels – in society, and in my family. I had a say about many things, including how many children I wanted to have.

In the village I had a very good friend. Her name is Chrissie Zamaere.

Chrissie went to the village school and I went to the town school.

Every Friday she would meet me by the roadside, waiting to hear about town life. And I would be excited to hear from her all the news of the village. She would teach me all about village life, from collecting wild fruits to getting crabs from the river.

Chrissie was the brightest in the village school – brighter than I. We were both selected to go to the best secondary girls’ school in Malawi. Chrissie went one term, but she couldn’t return – her school fees cost $6, and her parents couldn’t raise the money. My parents could, and I went on and finished my schooling, and today I am the president of Malawi. Chrissie went back to the village, got married early, ended up with half a dozen children or more, and she is still there, locked in poverty – and it makes me angry. It has made me angry all these years. As a young woman, I remember saying, “What can I do?” Today I keep Chrissie in mind each day as I work on behalf of women and girls.

Around this time I started to travel and interact with women’s organizations. With five other women I started a national organization supporting women – the National Association of Business Women (NABW). NABW grew to 50,000 women in two years – a revolutionary organization that grew to be the largest rural network of women in Malawi, all driven by the idea that there is no way women can succeed and participate if we are not empowered economically.

As I traveled across the country, going from village to village, I would meet women and girls who were stuck. Their brothers weren’t around – they were in school. Their husbands weren’t around – they were in town, working as doctors, teachers. The women had no say over how many children they had, and they had no power at all in the community. And they were hopeless. They told me to leave them alone, shaking their heads at me: “What do you mean we can change our situation here? Impossible.”

And eventually, these women began to understand. I can tell you thousands of stories of how women have come to me to say thank you, to say, “I am empowered.”

20 | Why We Care | Global Leaders Council for Reproductive Health | Joyce Banda

NABW was an opportunity to reach out to women with reproductive HIV and AIDS information and family planning information and health services. With support from United Nations Population Fund, supplies. We give small grants to groups, one of which is a group we could use the existing women’s groups as entry points for the of market women. These are women who have been working their provision of family planning devices, information, and motivation. whole lives in the market, and their situation is dismal. When I first Women began to have a say in their families because they were would visit them, my heart would break as I watched them sitting economically empowered, and eventually the women started there, children on their laps, no toilet facilities, no running water in negotiating with their husbands about family planning. The men the market, no crib for the child. We started a grant program for softened up, they appreciated these women, so they could begin the contribution the women to change their lives. ¸>VTLU ILNHU [V OH]L H ZH` PU [OLPY MHTPSPLZ were making to the household, ILJH\ZL [OL` ^LYL LJVUVTPJHSS` LTWV^LYLK When I was elected to Parliament they appreciated the need for the women to have more time to in 2004, the first thing I did was HUK L]LU[\HSS` [OL ^VTLU Z[HY[LK ULNV[PH[PUN engage in their businesses, and to evaluate the laws affecting ^P[O [OLPY O\ZIHUKZ HIV\[ MHTPS` WSHUUPUN ¹ negotiating for family planning women. In 2006, we passed the became much easier, and NABW Domestic Violence Bill, which supported the provision of family planning services took a situation that was previously viewed as a private matter and to meet the demand. subjected it to the law, thereby offering protection to women and children. This was especially poignant to me given what I’d gone Apart from the NABW experience, my passion for work in maternal through in my first marriage. Then the African Union asked me to health comes from a personal experience. When I was pregnant with serve as Goodwill Ambassador for Safe Motherhood, and I began my fourth child, I developed high blood pressure. After the baby was to look for community-based strategies to improve maternal health. born, I suffered a post-partum hemorrhage, and I almost died. The I went to the villages and I worked with village leaders making the only reason why I am still alive to tell my story is that I could afford connection between girls’ education and maternal health. skilled care. Malawi has one of the highest maternal mortality rates in Africa, and after what I went through, I became driven to work on Back when I was fifteen, I made up my mind that when I grew up, maternal health.

I would send as many girls as possible to school – especially those who find themselves in vulnerable situations like Chrissie did. These I use any opportunity I can to support the cause for women and girls now have choices about their lives, including when they will the underprivileged. With the Joyce Banda Foundation we provide begin to have children, and how many children they want in their education for both boys and girls, and orphan care centers – we family. And I am proud to say that I have been blessed to be able to have 10,000 children that we look after and feed every day. In the change the lives of many girls and many women, and that now there women’s program, we reach out to 70,000 women, and we provide is a school – an excellent, free school – right next to where Chrissie lives.

21 | Why We Care | Global Leaders Council for Reproductive Health | Joyce Banda

GRO HARLEM BRUNDTLAND

Gro Harlem Brundtland is a Norwegian politician, diplomat, and physician, and an international leader in sustainable development and public health. Born in Oslo, she was educated as a medical doctor at the University of Oslo, and received a Master of Public Health degree from Harvard University in 1965. She was Norwegian minister for Environmental Affairs from 1974-1979, and became Norwayâ&#x20AC;&#x2122;s first and only female prime minister in 1981, and then again for two terms from 1986 to 1996. In 1983, she was invited to establish and chair the World Commission on Environment and Development, widely referred to as the Brundtland Commission. Brundtland was elected director general of the World Health Organization in 1998. She has served as a special envoy on Climate Change for the UN, and on the UN Secretary Generalâ&#x20AC;&#x2122;s High Level Panel on Global Sustainability.

Photo by Dominic Chavez

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ong before I became prime minister of Norway, back to my earliest years, I was rooted in the ideals and attitudes of social activism. My mother, Inga, was a radical socialist who dreamed of a coming era of justice and equality. Her mother, Margareta, was a politically active radical who became the first female lawyer ever to hold public office in the city of Stockholm. The bookshelves at our home were lined with tomes about the workers’ movement and social democracy, Karl Evang’s Sexual Education alongside The Worker’s Lexicon. I was also very influenced by the political debate in our household, and the fact that my father, a member of the Labour Party, was appointed minister of health and social affairs, and later defense minister of the Norwegian government. Around the dinner table, getting ready for school, playing in the garden – there was always political chatter going on, which fascinated me.

I became the youngest and first female prime minister of Norway.

In that capacity, I appointed eight women out of a total of eighteen positions in my cabinet – a first in the world. And during these years, I learned all too well what it means to be a woman in a leadership position. I faced difficulties in terms of sexism and patronizing, and in efforts to demean me and weaken my impact.

I remember being told about the matchstick workers’ strike of 1887 in Christiana – the first working-class women to organize in Norway; learning of this event made a deep impression on me. All of these workers were women, exploited and suffering from terrible health problems – yet they had the courage and strength to make a difference.

I thought such a career would enable me to make a difference – and it did. Early on in my medical education, a woman was brought into the hospital where I was training. I examined her and found what I thought to be a tumor in her breast. But the resident doctor on duty had found nothing and wanted to discharge her. I had to muster my courage – as a female student, facing many older men – and speak up for what I knew to be right. Did I dare to challenge openly the doctor in charge? Deep silence – but our professor of surgery listened to my opinion and re-examined the woman. It turned out she did have cancer. I learned the powerful and sometimes vital importance of speaking up for myself – and for those who couldn’t speak for themselves, like that patient – even when I was afraid to.

And gender equality was simply the norm in many areas of my young life. My mom participated in heated political discussions, taught herself to drive the car, and thought it the most natural thing in the world to carry a yoke with a three-gallon bucket of water hanging off each end. I was taught that women can achieve the same things in the world as men.

These early years influenced me and created in me a fierce passion for justice, equity, health, and the greater world. The rights of women – and my own role as a woman in politics – played out when

My father was a doctor, and when I was an adolescent, I would use his medical textbooks in gynecology and obstetrics to explain to my friends how the whole business of making babies worked – I was quite the expert! Later, when I turned eighteen, I decided to make my “expertise” official and began training to become a doctor myself.

I wanted to be part of the search for new knowledge, to spread the sort of knowledge that everyone had a right to, and to ensure that everyone was free to exercise that right.

Elise Ottesen Jensen, a Norwegian-Swedish sexual educator, journalist, and agitator, was my heroine. She was a real pioneer, traveling through Sweden and Norway in the 1920s and 1930s,

24 | Why We Care | Global Leaders Council for Reproductive Health | Gro Harlem Brundtland

spreading the word about women’s rights and their need to protect themselves and to plan their reproductive lives. Even in the 1950s and 1960s, these things were by no means taken for granted. The political debate about sexual education was in full swing. In 1967, I became a part-time school doctor and I entered the fray, educating public health nurses, working together with the more enlightened teachers. The years following my time on hospital duty were completely devoted to being a doctor in public health. I was, as I’d been raised, living according to my principles and my passions.

I became increasingly engaged in issues of reproductive health and family planning. My experience when having my own children illustrated the fragility of childbirth – many things can go wrong.

My son Knut had a serious attack of jaundice soon after he was born.

After the birth of my son Ivar I had a terrible infection of the uterus; out of commission as a mother, I learned that being fit and well isn’t something women can take for granted. In my position as prime minister and with the World Health Organization, I could not ignore the struggles and pain that so many women in the world go through in having children.

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widespread. That is a positive. It’s important to see things this way, because there is a lot of pessimism in the world today.

As we look forward, let’s think about where we need to focus.

Health is key to the economy. More than ever before, there is a global understanding that long-term social, economic, and environmental development will be impossible without healthy families, communities, and countries. As director general of the World Health Organization, I worked to make this a driver behind all that we did. Health is a dimension of societal and political development that stretches beyond the bio-medical sphere right into the core of the global political agenda for development.

And in this equation, women are key – to health, and in every society.

Beyond the basic rights of equality that women deserve – beyond the morality or ethics of how women are treated in a society – there is the plain fact that it pays to invest in women. Statistics also now clearly demonstrate the considerable economic gain for societies through a high level of participation by women in the workforce.

We are, after all, half of the world’s population! It pays to protect the health and well-being of women. Woman power is a formidable force.

Women will not become empowered merely because we want them to be, but through legislative changes, increased information, and redirection of resources. It would be fatal to overlook this fact.

When I look back on my own work I see the long line of women who came before me, women inspiring and pushing me forward: the striking matchstick workers, brave and undaunted, my grandmother, my mom, Elise Ottesen Jensen – to name only a few.

My passion is renewed, the spark re-lit – we must keep working.

25 | Why We Care | Global Leaders Council for Reproductive Health | Gro Harlem Brundtland

JAN ELIASSON

Jan Eliasson is a veteran in the field of foreign relations. From 1980 to 1986, he was part of the United Nations mission mediating the Iran-Iraq War. From 1988 to 1992, he served as Sweden’s permanent representative to the UN in New York, where he also served as the secretary-general’s personal representative on Iran/Iraq. In 1992, he was appointed the first UN under-secretary-general for Humanitarian Affairs. From 1994 to 2000, Eliasson served as Swedish state secretary for Foreign Affairs. From August 2000 to 2005, he was Sweden’s ambassador to the United States. In 2005, he was elected president of the United Nations General Assembly. In 2006, he also served as the Swedish minister of Foreign Affairs. Also that year, he was appointed as UN special envoy to Darfur, Sudan. Eliasson has been a member of the UN Advocate Group for the Millennium Development Goals and Chair of WaterAid Sweden. On July 1, 2012, he took up the position of deputy secretary-general of the United Nations. By that date he also stepped down as a member of the Global Leaders Council for Reproductive Health, yet continues to support its mission.

Photo by Dominic Chavez

I

grew up in a working-class family in Gothenburg, Sweden.

Many people today look at Sweden and think it is one of the richest countries in the world, but seventy years ago, we were one of the poorest countries in Europe. I did not see my first indoor bathroom until age ten. My aunt died of tuberculosis. Life was not easy.

My mother had only four years of school, my father just seven, yet they instilled in me a deep respect for knowledge. My father was a labor union leader, and at the end of the day, around the kitchen table, my brother and I were part of the frank discussions my parents had about the issues they were fighting for.

As things in Sweden improved and my studies broadened, I got the opportunity to be an exchange student in the United States, in Indiana. I remember vividly the ten-day ocean crossing from Amsterdam to New York; there were twenty-two nationalities onboard, and my eyes were quickly opened to what a big world we live in. I remember listening to quarrelling Greeks and Turks, and I made suggestions to help them work out their problems. Someone said to me, “You should work at the United Nations!”

Over the years, I have worked as an emergency relief coordinator and mediator for the UN in several conflicts in Africa. In this capacity, I have had direct exposure to a reality of life and death that enforces my commitment to the cause of reproductive health and family planning for women. Most recently, I have been in Darfur, during drought and conflict.

On one trip, when we arrived in a village in Darfur, we were met by a group of women chanting: “Water, water, water.” The enemy militia had poisoned their well. They had to walk miles to get to water – not

poisoned but hardly drinkable. The children had grey skin, suffering terribly from dysentery, dehydration. Some were dying.

On another trip, I met girls who lived in terror of sexual violence on their way to gather water. They told me of friends who had been raped while carrying out this most mundane yet vital of tasks. And because of the lack of sanitation facilities in the village, they had missed still more school while they were menstruating.

And it was in the Horn of Africa that I saw young girls – around thirteen years old, still children – who were pregnant. I met married women dying from HIV/AIDS. I met women who had been raped, and who were desperate about giving birth to a child from a soldier from the opposing side. These were women and children for whom reproductive health care and family planning was a very distant reality.

After I got back from Darfur in 2008, I established WaterAid Sweden.

I began to focus my work on linking issues of water and sanitation with health as well as to conflict.

It is clear that a lack of family planning – and the resulting population growth – puts great pressures on resources and nature. Sixty percent of humanity will be living in cities in the next eight to ten years. Sanitation programs and family planning are in the enlightened self-interest of nations.

Yet the reality remains daunting. Despite the proven effectiveness of reproductive health services, they remain out of reach for far too many, like the chanting women I met in Darfur. Today, 99 percent of maternal deaths occur in poor countries. In Sweden, one in three hundred children die before their fifth birthday. In Sierra Leone, the figure is one in three.

28 | Why We Care | Global Leaders Council for Reproductive Health | Jan Eliasson

These issues intersect with a major political, economic, and moral imperative of our times – ensuring gender equality.

When women have choices they can change their lives and those of their communities.

In terms of family planning, it is more productive to focus on contraception programs. Abortion is a sensitive issue in most societies. Even in Sweden, one of the most liberal in the world, it is a difficult topic. It makes most sense to me to focus on family planning, which starts with education. Women who have education, and then employment, will be more likely to embrace family planning. Women who cannot plan their pregnancies cannot plan their lives.

I see progress on water issues, but I see great problems in sanitation.

Toilets are more of a taboo than clean drinking water. But if we expand access to clean drinking water, then maternal health will improve dramatically. A great number of women are dying in childbirth because of lack of clean water.

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It is imperative that we take the drama out of this debate.

The issue of reproductive health, unfortunately, is often surrounded by taboos or political tensions. But as I see it, the discussion of reproductive health should be hands-on and down-to-earth. We must see the issue for what it is – separate from taboos and politics.

I think back to the faces of the women in Darfur, the hungry children, the girls who fear sexual violence in the most basic of tasks, bringing water for their families. It is my job – our job – to show a light for these women and children. It is our job to stand up for reproductive health and place the human being in the center of our work.

29 | Why We Care | Global Leaders Council for Reproductive Health | Jan Eliasson

HELEN CLARK

Helen Clark, a New Zealand politician and administrator, is the head of the United Nations Development Programme (UNDP), the third-highest UN position. She is the first woman to lead the organization. She is also the chair of the United Nations Development Group, a committee consisting of heads of the UN funds, programs, and departments working on development issues. Clark was the thirty-seventh prime minister of New Zealand for three consecutive terms, from 1999 to 2008, and led the Labour Party from 1993 to 2008. Before resigning from Parliament in April 2009, Clark was Labourâ&#x20AC;&#x2122;s foreign affairs spokeswoman and member of Parliament for the Mount Albert electorate, a position that she had held since 1981.

Photo by Dominic Chavez

T

hroughout my life, women have been powerful, instructive, and inspirational. I am the eldest of four daughters, and we grew up on a farm in New Zealand, at Te Pahau in the Waikato region. My mother, Margaret, was a primary schoolteacher, and my father George ran the farm. My mother had a kind heart and an inquiring mind. Both of my parents loved visiting me at Premier House during my time as prime minister – they particularly loved watching “question time” and the pageantry of the official opening of Parliament.

I have tried to emulate my mother in my own life, and to bring her kindness and intellectual engagement to all I do, especially when I try to tackle difficult issues like family planning and reproductive health.

Adequate sexual and reproductive health services are an absolutely basic human right. Yet it is one that so many do not enjoy. It is critical for promoting gender equality and empowerment. It is critical for achieving the Millennium Development Goals (MDGs). And it is critical for development progress overall.

Having served as prime minister of my country for ten years, and as the first woman to lead the United Nations Development Programme (UNDP), I believe that achieving gender equality is not only morally right, but also catalytic to development as a whole, creating political, economic, and social opportunities for women, which benefit individuals, communities, countries, and the world.

MDG progress, as it currently stands, is uneven, and it is still too slow to meet the 2015 target date of all the goals. In no area is that more apparent than on MDG 5 on maternal health. As long as more than 200 million women in the world have an unmet need for family planning, their chances of finishing their education, engaging in paid work, and breaking out of poverty are reduced. I believe that women

have the right to make their own decisions about whether and when to have children, how many to have, and with whom – and then to receive the support and care to give birth safely.

UNDP is mandated to promote the empowerment of women and incorporate gender perspectives and women’s participation into its programming. We cannot hope to reach the MDGs if 50 percent of the world’s people are not afforded equal rights and opportunities.

Addressing the needs of women needs to be at the heart of the development agenda everywhere, and it is an issue that I keep at the forefront of my work.

Development progress is lagging where the needs and status of women and girls are given low priority. Women’s reproductive health needs remain hugely underserved. Hundreds of thousands of women die every year from complications related to pregnancy and childbirth. Moreover, twenty-five years into the HIV/AIDS epidemic, gender inequality and unequal power relationships expose women to great risk. About half of all people living with HIV/AIDS globally are female. In sub-Saharan Africa, approximately 60 percent are female, and in some areas girls are 2 to 4.5 times more likely than boys to become infected. Investing in women and girls will be critical for achieving the goals.

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32 | Why We Care | Global Leaders Council for Reproductive Health | Helen Clark

Achieving real progress on maternal health requires a broad approach toward empowering women, and a greater investment in achieving gender equality. Ensuring political and economic empowerment is crucial to speeding up development progress and improving women’s lives. A woman’s level of education impacts her economic and social empowerment, and her children’s nutrition and health. Meeting a woman’s need for sexual and reproductive services will increase her chances of finishing her education, and breaking out of poverty. I feel very fortunate that I have been able to do all that I’ve done with my life, and have not been limited by poor resources and no choices – as are so many women in the world.

The evidence is clear that there is a variety of proven ways to advance maternal health. Without question, meeting the current high level of unmet need for family planning services is high among them.

A woman who can plan and space her family will enjoy better health and more choice over her life. The impact will be beneficial to her family, too.

This matters enormously to me as a woman and as a former health minister and prime minister. Making major progress on maternal health will require much more than isolated interventions; it requires a broader approach toward empowering women and greater investments in achieving gender equality. I think often of my own experience growing up and making my way out into the wider world – with the loving support of my parents who made sure I knew what choices I had, and who made sure I felt empowered. So many girls in the world have no idea what empowerment is, much less live their lives by it.

able to protect themselves from HIV/AIDS and sexually transmitted infections generally. It also gives them the opportunity to lift their own status and that of their family, their community, and their country. I owe my own opportunities to work and be of service to my country to the fact that I had choices, education, and empowerment.

I know that when women’s basic needs for family planning go unmet, their chances of finishing their education, of being in productive work, or breaking out of poverty are sharply reduced.

Even with impressive development progress in many areas over the last decade, many people – especially women – have been left behind, experiencing a toxic mix of economic, social, and political exclusion. Yet those women, too, have dreams and aspirations, just as I did, growing up on that farm. Our dreams are not just for material progress, but also for the opportunity to realize our full potential, build a better future for the world’s children, and participate in shaping the decisions that impact their lives.

Those of us who have had the fortune to be able to access maternal health services have insights into what it would mean not to have been able to have that chance. And with that insight comes responsibility – a responsibility to speak for those who cannot give voice for themselves, to stand up for those who do not even know they are not fully standing. I hope I honor my mother and engage in this struggle with intelligence and compassion, and the courage to fight. To fight for reproductive health – a basic human right.

When women do have control over their health and sexuality, they’re better able to plan their futures and their pregnancies and are better

33 | Why We Care | Global Leaders Council for Reproductive Health | Helen Clark

REGINA BENJAMIN

Regina Benjamin is the eighteenth surgeon general of the United States Public Health Service. As “America’s Doctor,” she provides the public with the best scientific information available on how to improve their health and the health of the nation.

She is the founder and former CEO of the Bayou La Batre Rural Health Clinic in Alabama, former associate dean of the University of South Alabama College of Medicine in Mobile, and past chair of the Federation of State Medical Boards of the United States. She was the first physician under the age of forty and the first African-American woman to be elected to the American Medical Association Board of Trustees. In 1998, she was the United States recipient of the Nelson Mandela Award for Health and Human Rights.

Photo by Dominic Chavez

E

arly in my career, when I was an intern, having just finished medical school, I attended the Medical Association of Georgia’s annual meeting. One of the issues being debated was whether sexually transmitted diseases needed to be taught in medical school. I stood up in a room of maybe fifteen people and said I thought there was a need. The resolution passed and the Georgia delegation sent me to the American Medical Association convention to speak to the same issue – and the resolution again passed. Within six months every medical school in this country was encouraged to include sexually transmitted diseases as part of their core curriculum. I learned that one person can make a difference, whether it’s in medical policy, in medical practice, or in reproductive health.

We know that lack of access to reproductive and sexual health is a leading cause of morbidity and mortality in the world. In the United States, it is one of the key strategic priorities that we’re pursuing at the Department of Health and Human Services through our National Prevention Strategy. As we know in the international arena, these issues may differ in magnitude, but they are very similar around the world, from the small town in Alabama where I started out as a doctor to villages in Africa. We need better access to prenatal visits.

We need to increase the number of skilled healthcare workers, increase the number of cervical cancer screenings, and increase access to STD and AIDS screening throughout the world.

When I began to practice medicine, the National Health Service Corps sent me to Bayou La Batre, Alabama, a small fishing village of 2500 people along the Alabama Gulf Coast. It’s a pretty place, but it’s a poor place. I found a community of working poor, too poor to afford medical care, but too rich to qualify for Medicaid. I quickly

learned that my patients had problems my prescription pad alone could not cure.

I realized that in addition to providing my patients with information about basic health care such as diabetes, hypertension, and reproductive health, I needed to bring in programs to help some of them learn to read, find jobs, and to help keep our bayou clean.

This work continues as surgeon general as we recognize the social determinants of health in all our initiatives.

I learned from my grandmother that you can always make a difference in someone’s life. Our homestead is along a highway, and during the Depression of the 1930s, my grandmother would set out lemonade and sandwiches for the poor and hungry who would be passing by. The hobos, as some regulars were called, knew there would always be something there to eat and a cool drink. I learned it is important to be a part of your community and help others, whether you know them or not.

Often I think of my mother’s older sister, whom I never got to meet.

As the story goes, she was sixteen years old when she became pregnant, unknown to her family. She apparently got sick, because her baby had died, although no one knew this.

My aunt got sicker and sicker until she became septic and she, too, died. It was preventable. I often imagine the “what ifs” – what if she had access to family planning, a home pregnancy test for example, what if she had necessary prenatal care, what if she had a simple ultrasound, or just the information to know what to expect.

36 | Why We Care | Global Leaders Council for Reproductive Health | Regina Benjamin

Sometimes challenges can seem insurmountable. But it is often women – like my grandmother, my mother, and aunt – who inspire me and keep me going.

The day that President Obama held a press conference in the Rose Garden to announce my nomination as surgeon general, my immediate family was not there with me. My mother had died of lung cancer because she started smoking as a teenager. My father died from complications of a stroke, due to high-blood pressure, and my brother, my only sibling, died of HIV. All of these were preventable diseases, and I don’t want anyone else to suffer the loss of a loved one from a condition that could have been prevented.

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Prevention is the foundation of my work as surgeon general, especially in terms of women and reproductive health – from sexually transmitted diseases to smoking, to eliminating chronic diseases.

I am honored to chair the National Prevention Council, consisting of seventeen federal agencies. Our vision is to change our health care system from a system based on sickness and disease to one based on wellness and prevention. To make prevention and wellness a part of our everyday lives and everything we do.

37 | Why We Care | Global Leaders Council for Reproductive Health | Regina Benjamin

JENNY SHIPLEY

Jenny Shipley was the first female prime minister of New Zealand. Born in Southland, she trained as a teacher and joined her husband Burton Shipley in a large farming partnership before becoming involved in local government politics. She stood as a National Party candidate and was elected to the New Zealand Parliament in 1987.

During the 1990s, she served as minister of Women’s Affairs, Minister of Health, Social Welfare, State Services, State Owned Enterprises, Transport, and the Accident Compensation Commission, and was a driving force in the economic and social reforms during this period. Elected prime minister in 1997, she guided New Zealand through the “Asian crisis” and back to positive economic growth. She led the New Zealand delegation to the 1995 Beijing United Nations Conference on Women.

Since retiring from politics she continues her interest in governance and leadership, heading numerous companies in New Zealand and elsewhere, and is highly involved in women’s leadership, rights, and governance issues. She is vice president of the Club of Madrid, a group of former leaders who promote global democracy and transparent economic development, and is a member of the Council of Women World Leaders.

Photo by Dominic Chavez

I

am deeply honored to be part of this critical conversation about reproductive health and wish to bring a sense of urgency to it.

I was born in 1952 when there were about two and a half billion people on the planet. Today there are seven billion people, and the demographers project that in another forty years there will be nine billion plus. This is a daunting projection! It has serious implications for many issues we face, including the human footprint and its impact on climate. I was raised to face all issues with honesty and confidence. That’s what we must do today as we deal with reproductive health at the local and global level.

As always, women’s rights and global health are of utmost importance to me. Women make up the highest proportion of people living in extreme poverty. Women represent the highest percentage of refugees and displaced persons in the world. The persistence of rape, genital mutilation, and other forms of violence against women continues to be of critical concern globally, and progress is frustratingly slow. Women globally have continued to have insufficient access to the resources necessary to achieve economic independence. Whatever their situation, women need a sufficient income to break or avoid the cycle of poor health, educational disadvantage, and low status, and to do that well, they must be empowered to control their fertility.

By and large, women in New Zealand are fortunate compared with some other countries, including many in our own region. In my country, Maori people hold a special position in our society. Maori women, in particular, have led a renaissance of Maori culture. Every day Maori women are demonstrating resourcefulness, innovation, and leadership in the development of new programs, often through their community organizations, such as the Maori Women’s Welfare League. We must enable all women, regardless of their cultural background, to fully participate in aspects of economic and political

life and ensure they are able to be fully involved in the decisions that affect them. And while cultural practice can sometimes add complexity, it must not be used as an excuse to deny women the ability to have control over the timing of their babies’ births; this can be assured by access to family planning support.

People sometimes don’t wish to talk about things that embarrass them, but sexual and reproductive health, family planning issues and their consequences are the daily reality for most women under fifty.

These things must be talked about and acted on as the lives of all women, their families, their children, and the future of the community and the planet depend on it!

Every child deserves to be a wanted child. Every child deserves to be cared for. Every child deserves to live a full life. If these are clear goals – if the reproductive health strategy worldwide can seek to achieve that goal – we not only defend the rights of women and also ensure the rights of the next generation, but we will also have an impact on the issues of climate. When you talk about the future of the environment, it means nothing unless you are also talking about the future of our children. For me the carbon footprint is irrelevant if we’re not courageous enough to talk about the human footprint.

I want to put the issue of population and reproductive health in the forefront.

International institutions often avoid talking about the issue of reproductive health and family planning, yet they wring their hands about the changes we observe in our climate. These issues are directly connected! If governments funded the cost of family planning and made it available to all women who wish to have this voluntary choice, it would be the single most useful step global governments could make to sustaining the planet – so why wouldn’t we act now?

40 | Why We Care | Global Leaders Council for Reproductive Health | Jenny Shipley

Let us get the conversation going and the information flowing again, and let’s make sure the major players – women and children – are included, not simply the subject of the discussion.

Women from all corners of the globe are watching us closely. They demand we provide hope for their future. The work we do must be capable of improving women’s lives and be worthy of their hopes and aspirations, to bring about real change and real improvement in In my experience, when people have information, they are the lives and status of women globally. Governments and decisionempowered to take control, to make choices that then allow them makers at all levels must see that women are empowered politically to have control of their lives. Learning empowers. Let us convert and economically so that they themselves have the tools and the the conversation in a meaningful way so that children on the streets ability to make the decisions that will bring about real change in of New York, children on their own lives, and in the lives the streets of Asia and on of their children and families, ¸7LVWSL ZVTL[PTLZ KVU»[ ^PZO [V [HSR HIV\[ any continent feel that this through having access to family [OPUNZ [OH[ LTIHYYHZZ [OLT I\[ ZL_\HS HUK conversation is about them. planning when they need it.

Let’s use social media to YLWYVK\J[P]L OLHS[O MHTPS` WSHUUPUN PZZ\LZ HUK [OLPY spread the word, to fuel Men and women are responsible JVUZLX\LUJLZ HYL [OL KHPS` YLHSP[` MVY TVZ[ ^VTLU the debate. Technology is for developing those priorities changing lives – we can and strategies that will guide our \UKLY ÄM[` ¹ be at the forefront of that efforts toward a better future when working to promote for women in the twenty-first reproductive health if people will be upfront and open-minded century. Our daughters and sons, their children and grandchildren, about providing meaningful and affordable solutions to today’s have high expectations of us. We must confront the realities of great challenges. people’s lives and act to make a real difference. We must not let them down.

The serious problems facing the world today will only be solved if women have a seat at the table and are listened to as to what is required. These issues will never be solved until women are able to use their full potential on behalf of themselves, their families, and their global and local communities. The current structures tend to marginalize women’s issues and to mute women’s voices. This has to change.

41 | Why We Care | Global Leaders Council for Reproductive Health | Jenny Shipley

ANNIE LENNOX

Internationally renowned and award-winning singer-songwriter, performer, and recording artist, Scottish-born Annie Lennox, OBE, is also a social activist and campaigner. Dedicated to speaking out for women and girls affected by the HIV epidemic, she founded the SING campaign in 2007 as a vehicle to raise awareness and funds. As well as being a UNAIDS global ambassador, she is also a special envoy for the Scottish Commonwealth Parliamentary Association, HIV Ambassador for London, Goodwill Ambassador for Oxfam and the British Red Cross, among others.

Photo by Dominic Chavez

I

n November of 2003, I was invited to take part in a special concert held in Cape Town, South Africa, to celebrate and publicize the launch of Nelson Mandela’s HIV/AIDS Foundation, named after his former prison identity number, 46664.

It was an exceptional event, with performances by Bono, Peter Gabriel, Beyoncé, Queen, and Youssou N’Dour, among many other wonderful musicians. The following day, all the artists were invited to join Mandela for a press conference to be held in Robben Island prison, the place of his incarceration for almost twenty-seven years.

As we gathered together in the exercise yard in front of his former cell, facing a sizeable assemblage of international press and photographers, we were about to witness a speech that was to have such a personal impact and influence upon me that it would kickstart the journey of activism and advocacy I’ve been passionately dedicated to ever since.

Mandela spoke about the HIV/AIDS pandemic as it was affecting the entire nation of South Africa, especially with regard to women and children, describing the situation as a literal “genocide,” a term that carries such resonance and weight that it can never be used lightly.

People could not access treatment on the scale that was needed, and as a result, thousands of lives were being wiped out on a daily basis.

In 2003, 17 million people had already died of HIV-related causes.

Today the death toll stands at more than 30 million.

Since the mid-1980s, I had been very much aware of the ravages of AIDS and had supported several stalwart organizations, taking part in the Red Hot and Blue project, the first campaign of its kind to raise awareness and funds. A few years later, I performed with Queen and David Bowie for the Freddie Mercury Tribute concert.

But later on down the line, throughout the nineties, I had been far less aware as to how the virus was afflicting the lives of millions of women and children, most often leading them to painful and premature deaths. It was a horrifying and shameful situation.

Why wasn’t this monstrosity emblazoned across the headlines of newspapers, television, and radio everywhere?

Why did it seem to be virtually invisible?

While epidemics of bird flu and swine flu received massive coverage and media attention, why didn’t the African HIV/AIDS pandemic warrant a similar global response?

If Coca-Cola could be distributed to every corner of the earth, then why couldn’t life-saving treatment be made available to everyone who needed it? Baffled and outraged, I started asking questions in order to understand what was actually happening, recognizing the terrible irony in the fact that the post-apartheid citizens of South Africa had inherited a country that was faced with the highest rates of HIV infection in the world.

HIV/AIDS is the biggest global killer of women of reproductive age.

One in three pregnant women in South Africa is HIV positive. As a mother, I have something in common with billions of women around the planet. And no matter which culture, creed, or social/economic strata we emerge from, fundamentally, every mother wants the same thing. We want our children to be able to lead happy, healthy, and fulfilling lives, with access to resources and security. And as I began to meet women and girls faced with no choices, no resources, no access to reproductive healthcare or family planning support – indeed, with no hope – I knew I had to do something to try to make a difference.

Several of my own friends and associates had died. They were all gay men.

44 | Why We Care | Global Leaders Council for Reproductive Health | Annie Lennox

In 2005 I was invited to take part in the second 46664 event, held in the historic town of George in the Western Cape of South Africa.

There, poverty delineates a starkly striking contrast on the other side of affluence, while HIV/AIDS steadily destroys lives.

Saint Mary’s is a small hospital there. With 46664 as a calling card, we (a small group of artists) were invited to pay a visit. With Graca Machel graciously at the helm, we were welcomed by a lively ensemble of nurses and staff: “Thank you for coming here!” “We welcome you!” “Thank you!” “Thank you!”

Three years before, Saint Mary’s had been established to address the needs of the people of George who were infected by HIV/AIDS. At that point in time, the hospital was generally viewed with a high degree of suspicion, with people mistakenly believing that it would bring the virus directly into their midst – ignoring the fact that AIDS was already there, and the hospital was the best thing that could happen to address the situation. The township had been fearful and hostile.

Nurses, doctors, and patients had been regularly attacked with stones. Regarded as dangerous and untouchable, people stricken with full-blown AIDS were frequently abandoned by their families at the front gates.

However, three years after the establishment of the hospital, people’s attitudes had become more informed, and as a result, Saint Mary’s had now become accepted and appreciated.

We walked somewhat tentatively through the wards. I will never forget the sight of an emaciated man/skeleton, with vacant glassy eyes, and a tiny baby-bird-like, three-year-old girl, weighing less than a bag of sugar. These hauntingly disturbing images of illness and affliction were harrowing. But in extreme contrast, the spirit and dedication of the doctors and staff was absolutely inspirational.

Despite all the advancements of the post-industrialist and technological revolution, we appear to have lost our way in terms of a shared sense of global human rights, values, and responsibility.

As a result we have become impoverished in an entirely different kind of way.

Imagine living in a remote rural environment, where the health care clinic is several miles away. You have no means to afford transport, and can only get there by foot. If you’re desperately ill with AIDSrelated pneumonia, your life depends on making that journey. So people are lifted into wheelbarrows, or lifted up onto someone’s back, to be pushed or carried for miles under the blazing sun or heavy rainfall. When they finally make it to the clinic, they usually encounter the kind of queue that will take a full day to process, and most likely there will be no doctor in attendance to properly diagnose or prescribe medical treatment, so the long journey begins once more, to return back home, defeated by poverty all over again.

Broken down, overburdened public healthcare systems, the lack of trained doctors and nurses, lack of facilities, no access to medication – all these factors play into the HIV/AIDS pandemic with devastating consequences.

As an AIDS activist, I have to stay committed and focused on what can be done, particularly in regard to girls and women. Sometimes the challenges seem overwhelming but that doesn’t mean that you can simply step back and walk away. In my life I’ve had the benefits of good medical care, education, legal rights and security, clean running water, democracy, freedom of speech, among many others.

I want to see women and girls given the same basic human rights and resources that I’ve been privileged to take for granted for five decades.

45 | Why We Care | Global Leaders Council for Reproductive Health | Annie Lennox

TARJA HALONEN

Tarja Halonen was the eleventh president of Finland and finished her term in March of 2012. The first woman to hold the office, Halonen was previously a member of Parliament since 1979. In addition to her political career, she had a long and extensive career in trade unions and various non-governmental organizations. At the University of Helsinki, she studied law from 1963 to 1968 and was active in student politics.

In 1971, she joined the Social Democratic Party and worked as a lawyer in the Central Organization of Finnish Trade Unions until she was elected to Parliament in 1979. Halonen served in the Parliament of Finland for six terms, from 1979 to 2000, representing the constituency of Helsinki. She also had a long career in the city council of Helsinki, serving there from 1977 to 1996. Halonen is a member of the Council of Women World Leaders.

Photo by Max Taylor Photography

I

t’s very true that the conversation about reproductive rights is considered “sensitive.” People say, “We cannot say that, we cannot speak about that part of it, don’t use that word, don’t use this word” – we can’t speak about what is really going on! And this is a fundamental part of who we are, the way we give birth to our children. Such a basic, simple, beautiful thing – and it provokes such sensitivity.

we are in that lucky position that we have been able to practically eradicate infant and maternal mortality in Finland.

And when people refuse to talk about this issue, they ignore many of the problems that exist in this world. Basic human rights are not respected.

We have seen, over the years, that we have to go beyond the health sector – we have to look at the broad development agenda. We have to advance sustainable development that is equitable to girls and boys, women, and men. Poverty prevents access to basic services and deprives women of health choices in their everyday lives.

This causes premature deaths of women and infants. Access to reproductive health services is vital in improving maternal, newborn, and child health.

When I was much younger, in the 1960s and 1970s in Finland, the northern part of Europe, the issue of reproductive health was very much taboo, even more than it is today. As a people, we Finns are not too talkative in general, and it was especially so about the subject of reproductive health and sexuality. Mothers would say to their children, “Oh, you will find out about that later on, let’s not talk about it now.”

I was working as a young lawyer, and we had the idea of bringing together the reality of many issues surrounding reproductive health – especially concerning illegal abortions – and the theory that was behind the current legislation. We had the idea of making a book about all of these legal cases that we were seeing, so that people would know what was really going on. We wanted the women to tell what happened to them – before and afterwards – the reality of their situation. And then we started to campaign about this issue, and try to educate people.

We succeeded. After all of our hard work, we got much better legislation, legislation that supported family planning. And now

As in other countries, by investing in public health care, sexual and reproductive health services education, and women’s empowerment, we have been able to decrease both mortality and fertility rates. This, in turn, strengthens economic growth and decreases poverty.

In Finland, we are very fortunate to have maternal welfare clinics, which play an essential role in promoting health and well-being for families. A particularly Finnish form of support is the “maternal kit,” a starter kit for a new life, which is given to expectant parents in the form of goods or money as encouragement to participate in appropriate prenatal health care.

Reproductive health and human rights go hand in hand. Today more than ever before, the opportunities for doing good are enormous. We have the capacity and we have the knowledge and resources – we only lack delivery. We all are part of the same global community.

Women – especially minority and immigrant women – are still far too often the first to face the negative impacts of various crises and conflicts. We have to improve the status and rights of women and respect the rights of children. So far our efforts have not

48 | Why We Care | Global Leaders Council for Reproductive Health | Tarja Halonen

been sufficient. We all now share the responsibility for making the common goals come true.

Empowerment should be something normal and daily. It is fundamental in achieving a more just and safe world. At the global level, we need better coherence among different objectives and actions and a common understanding on how to achieve our goals.

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Investing in women’s sexual and reproductive health pays off. This has been proven time and time again. We should not tiptoe around this “sensitive” subject. I call on you to be brave. Be pragmatic.

When I was working as a lawyer and we made that book and changed family planning legislation all those years ago, many people predicted that from such change would arise many difficulties; such dire predictions did not come to pass at all. Finland has now a higher birth rate, healthier women. We have healthier children. We have healthier families. That’s why I always want to encourage you that things can change.

49 | Why We Care | Global Leaders Council for Reproductive Health | Tarja Halonen

TED TURNER

Throughout his career, Ted Turner has received recognition for his entrepreneurial acumen, sharp business skills, leadership qualities, and his unprecedented philanthropy.

In 1997, Turner announced his historic pledge of up to $1 billion to the United Nations Foundation. The organization supports the goals and objectives of the United Nations to promote a more peaceful, prosperous, and just world. UNF has identified four core priorities: women and population; children’s health; the environment; and peace and security. He is chairman of the United Nations Foundation, co-chairman of the Nuclear Threat Initiative, chairman of the Turner Foundation, and co-founder of Ted’s Montana Grill. Turner is also chairman of Turner Enterprises, which manages his business interests, land holdings, and investments, including the oversight of two million acres and 55,000 bison. He is the recipient of numerous honorary degrees, industry awards, and civic honors, including being named Time magazine’s 1991 Man of the Year and Broadcasting and Cable’s Man of the Century in 1999.

Photo by Dado Galdieri

W

hen I was born in 1938, I may well have been the twobillionth person born on the planet. It took only thirty years for the world’s population to grow by more than 50 percent to more than 3 billion. I started taking notice when Silent Spring was published, revealing the serious environmental concerns relating to this rapid population growth. Subsequently, many of us began reading and learning about the profound demographic and environmental challenges facing humanity.

I became convinced of the importance of this issue when I read The Population Bomb, by Paul and Anne Ehrlich. The Ehrlichs deserve credit for opening my eyes and capturing the public’s attention about the rapid pace of population growth. They also raised our collective awareness about the pressure that human needs and numbers put on the ecological systems we depend on for life – the oceans, freshwater, soils, and the atmosphere.

At about the same time, my dear friend Jacques Cousteau was emerging as one of the world’s most respected conservationists.

Captain Cousteau was a citizen of the world – a voice for the oceans and other planetary resources. He, too, cautioned that rapid population growth, pollution, and poverty were powerful forces that the nations of the world should work together to address. When I start to feel overwhelmed by the problems facing our global society, I’m reminded of Captain Cousteau’s sound advice. He once told me, “Ted, it could be that these problems can’t be solved, but what can people of good conscience do but keep trying until the very end?”

These influences and my own ongoing research led me to believe that population growth and preservation of the Earth’s environment deserved to be considered as one of the most significant threats to human survival.

I’ve been committed to women’s rights, maternal health, and population growth issues for a long time, and today, I am more concerned than ever about the huge unmet need for voluntary family planning. There are 215 million women around the world who wish to prevent pregnancy, but lack access to quality contraceptives, education, information, or services. This number has devastating implications – complications from pregnancy are the leading cause of death of women in their reproductive years, killing an average of 1,000 women per day. That number is just plain unacceptable in this day and age.

When I was chairman of Turner Broadcasting, we attempted to reflect these concerns as part of our effort to make the most important news and issues available to people all around the world twenty-four hours a day. Over the course of the 1980s and 1990s, Turner Broadcasting units created award-winning series like “Earth Matters,” “People Count,” and the animated adventure series “Captain Planet,” which was broadcast in more than 100 countries. Some questioned why we were airing programming on the environment, development, reproductive health, and population, but we were confident the issues warranted the coverage and the quality of the productions warranted airing.

We were especially proud of our coverage of the major UN conferences of the 1990s – on the environment, women, population, and social development. I have always believed in the United Nations as a platform for peace and global problem-solving, and those conferences represented the UN at its best – bringing together governments, business, and non-governmental organizations to address the great challenges facing humanity.

52 | Why We Care | Global Leaders Council for Reproductive Health | Ted Turner

At the Turner Foundation, where all of my children are Trustees, we strive to reflect a comprehensive approach in both our business endeavors and our philanthropic initiatives. In our work to help stabilize population, encourage development, and address our environmental challenges, we believe it is our job to do whatever we can to leave the Earth in a better state for future generations.

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We have worked with other foundations and the UN to address the needs of adolescent girls and women. UNF’s Universal Access Project works to help mobilize resources for international family planning and reproductive health efforts. We are committed to this work because we know that family planning benefits mothers, families, and communities, and helps children survive. Experience has taught us that coercive practices such as the one-child policy are a violation of human rights.

In addition to the implications for child health and survival, I believe that access to family planning is essential to achieving U.S. foreign policy goals. This includes healthier women and families, allowing women to pursue education and incomegenerating activities, food and resource security, and environmental sustainability.

In the years since I first read The Population Bomb, important progress has been made in understanding and responding to the world’s major demographic and development challenges. Fertility rates have declined, millions of people have been lifted from poverty, and women’s rights are expanding. So, we’re doing some things right, but much more remains to be done. We need to stabilize the population, encourage family planning, stop global warming and the decline of key ecosystems, and achieve a more just and equitable world for all the world’s people, including, and especially, the world’s women.

The scale and significance of the world’s challenges can seem overwhelming. But I am an optimist, inspired by the work of the United Nations, the United Nations Foundation, the Turner Foundation, and many others. The most precious gift we can give our world’s young people is to teach them how to sustain a healthy, safe, and prosperous planet. Their future is in our hands now, but soon, it will be in theirs.

53 | Why We Care | Global Leaders Council for Reproductive Health | Ted Turner

PHUMZILE MLAMBO-NGCUKA

A teacher by training, Phumzile Mlambo-Ngcuka has a long history of empowering women and ensuring their voices are heard. In 1983, she became the first president of the newly formed Natal Organization of Women (NOW), an affiliate of the leading anti-apartheid political movement in South Africa, the United Democratic Front (UDF).

She also had leadership roles in the YWCA and TEAM, a development organization based in Cape Town. In 1994, Phumzile Mlambo-Ngcuka served as a member of Parliament and chairperson of the Public Service and Administration Portfolio Committee. She became the deputy president of South Africa in 2005 until 2008.

She was the first woman to hold the position and was the highest ranking woman in the history of South Africa.

Photo by Dominic Chavez

I

was born in Clermont, Durban, in Natal (now KwaZuluNatal), in South Africa. My mother was a community health nurse, specializing in family planning, and my father was a schoolteacher. Our family was Catholic, and there was always much discussion about the way that the church looked at the issues my mother was facing in her work, issues of reproductive rights and family planning. My mother was determined to make a difference and express her opinion, and she was my first exposure to activism.

She has also been an inspiration to me my whole life. She is in her eighties now, and she still works running the St. Clement’s homebased Care Project, helping families of people with HIV/AIDS. Every day she is an angel of mercy to hundreds of indigent and sick people.

Each day, she and her small staff cook and distribute food parcels and meals to hundreds of needy victims of poverty and diseases.

From an early age, I was aware of the world far beyond the walls of our house – from the apartheid under which we struggled to the hunger and poverty I witnessed in my neighborhood. We were living in a country that had so much, yet when I went to school, as one of the children fortunate to be able to bring my lunch with me, I saw my schoolmates who did not have enough to eat, who were hungry.

I remember thinking to myself that this sort of thing shouldn’t happen in South Africa. I did not have the vocabulary to express the inequality that I saw, but I knew it was there. I recognized that I must share the food that I was lucky to have with my classmates – who had nothing. And the deprivation that I saw – in the context of the rich country that we lived in – angered me. It angered – and it inspired.

When I was a teenager, in the 1970s, I worked as a Youth Leader with the Young Women’s Christian Association (YWCA). It was there

that I became a student activist. I quickly learned how to articulate my opinions about issues and to take a stand.

It was there, surrounded by young women like myself, and most importantly, by older women from whom I learned so much, that I became socialized into politics and public discourse, involved in anti-apartheid marches and rallies. We were driven to bring down the state in its totality – to end apartheid. And it was within this context that I began to see women’s issues and to see how they fit into the greater picture of injustice. And I saw how South Africa was just one country – but that the upheaval we were going through was hugely relevant in the world.

And I have never looked back. As the years went by, I was fortunate to meet many women – in South Africa and beyond – through the work I was doing. I worked as a teacher, as my father had done, and I continued my work with the YWCA; in 1984 I worked as a youth director for the organization in Geneva. It was here that I began promoting the development of education in Africa, Asia, and the Middle East. I began to see the clear connection between the education of young people – especially young women – and the ability to create change.

The advances we have seen at the political, social, and economic level in South Africa have been gained through struggle and will also be defended through struggle – and a part of this is the continued struggle for women’s rights. Women’s rights are human rights. We have not done much to empower women who are on the margins of society. I saw this when I started out in politics. I recognized the importance of focusing on rural development in empowering women.

I saw how even a small act – like teaching a group of women how to sew clothes and to sell them, forming a crafts association, as we did in Gugulethu – made a huge impact on their lives.

56 | Why We Care | Global Leaders Council for Reproductive Health | Phumzile Mlambo-Ngcuka

The concept of home-based care and primary care is due to women.

Many poor countries in Africa, including mine, do not have the capacity to cope with chronic illnesses. So home-based care is needed. Therefore women in developing countries have invented a layer in the healthcare system born out of need and care. Such a service is based on caring leadership and resourcefulness and needs to be recognized as a critical extension of the healthcare system without over-formalizing it.

In my work today, my driving passion is ensuring access to information for young people. Many young people – especially young women – don’t get accurate information about reproductive health. They don’t always know where to go, where they can speak openly without fear because a particular issue is politicized and it’s a taboo. I’m amazed at the hunger for information – a hunger that we must satisfy. If we don’t fill this need – by opening channels of communication, by establishing ways that young people can learn and grow – then we lose a tremendous opportunity to effect real change.

The young people of today should be made to feel proud – and above all inspired to acquire education and use it for growth and development of themselves and their country. How can we empower young people to take control of their own lives and their own futures, and in so doing, change the course of their own lives and those of future generations? This is my driving question.

Following my passion, I established the Umlambo Foundation in 2008 to provide support to schools in impoverished areas through mentorship and coaching for teachers. The vision is to help people win against poverty through education – to help lead these schools to produce learners who escape poverty.

Poverty and hunger could derail the progress the developing world has made. We face exposing our women and young people to untold hardships. This calls for all of us to do much more. The solutions to our circumstances cannot be imported from elsewhere; the solutions are within ourselves.

As I was by my parents and all the older women who surrounded me and held me up in my early years, particularly at the YWCA, so many of us were nurtured by many other people, our peers and older women. We must create room for younger women and in all walks of life to allow them to lead and contribute.

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57 | Why We Care | Global Leaders Council for Reproductive Health | Phumzile Mlambo-Ngcuka

VAIRA VIKE-FREIBERGA

Vaira Vike-Freiberga was president of the Republic of Latvia from 1999 to 2007, the first female president in Eastern Europe. After fleeing her native country at the end of World War II, she spent her childhood in refugee camps in Germany, attended schools in French-administered Morocco, and in 1954 settled in Canada. After obtaining her Ph.D., she worked for many years as a professor of psychology at the University of Montreal and has gained recognition as an interdisciplinary scholar and expert on science policy. In 1998, she returned to Latvia to become the director of the newly founded Latvian Institute. As president of Latvia, she was instrumental in achieving membership in the European Union and NATO for her country. She is a founding member of the Club of Madrid, and has received many awards and medals for her continued work in the international arena in defense of liberty, equality, and social justice.

Photo by Dominic Chavez

I

have a black-and-white photograph of myself as a child in Riga, staring solemnly at the camera. I am wearing a blue coat trimmed with white rabbit fur. It was the early 1940s, a time of war and foreign occupation, and my grandmother had gone to all sorts of trouble to find the materials for this coat. I look at this photograph, at my serious, young face, and I am inspired by my grandmother’s act – to make something needed out of seemingly nothing!

My childhood was not an easy one, but I did survive. Having experienced one Stalinist Soviet occupation in 1940-1941, my parents were not ready to endure another one. Three days before the Red Army took Riga, in October of 1944, they fled, taking with them my baby sister, me, and only what they could carry in their hands.

They had a faint hope that they might possibly return, but deep in their hearts they sensed that they were leaving forever.

We kept moving West. Less than a month after leaving Latvia, my baby sister died in a German transit camp. A year later, in Lübeck, my mother gave birth to my brother at a Red Cross Hospital run by Latvian refugee nurses and doctors. In the bed next to her was an eighteen-year-old Latvian refugee girl who had just given birth as well. At the end of the war, her family had become caught in the wild rampages of the victorious Red Army in East Germany. Jadwiga had been brutally gang-raped by a band of Russian soldiers.

She endured the enforced pregnancy that followed, but when her newborn was brought to her in the hospital, she turned her face to the wall and refused to breastfeed that child of gang-rape or even to look at it. The nurses did their best to care for her, but within six weeks that child had pined away and died, as if understanding that

she was not wanted in this world. Babies just kept on dying, whether loved and wanted or not.

I saw all of this as a seven and eight year old: how vulnerable and unprotected were women and children, both during a war and in a post-war period. I had thought such things would come to an end when peace finally came to Europe. But they continue across the world to this day. There is always a new conflict somewhere and there are always new horrors. Soldiers die fighting with arms in their hands. Civilians, especially women and children, suffer and die unarmed and unprotected.

When the United Nations Relief and Rehabilitation Administration (UNRRA) closed down the refugee camps in Germany, my family moved to a building site in the bled (countryside) of then French Morocco. One day Dad came home telling how an Arab he was working with had made him an offer for his daughter – me! – in marriage: 10,000 francs, two donkeys, and a camel (or something to that effect). Dad was taken aback: “But she is still a child, only eleven years old!” I was so relieved to hear that Dad had not been tempted to take him up on his offer!

Decades later, hardly a day goes by without another so-called “honor-killing” on this democratic continent of Europe. I’m all for respecting cultural traditions and heritage, but not if they infringe on basic human rights. Enforced marriage of very young girls constitutes a disguised form of pedophilia. Enforced early pregnancies are a major cause of maternal mortality. Enforced marriage at any age is not to be condoned in civilized societies. Women and girls anywhere in the world should have the right of choice over their lives and command over the integrity of their bodies.

60 | Why We Care | Global Leaders Council for Reproductive Health | Vaira Vike-Freiberga

In my early years in the academic world, I experienced firsthand some of the difficulties women face in what traditionally had been all-male domains. When I got pregnant during my first year as a tenure-track assistant professor, there was no provision for maternity leave in Canada. I was so tired and overworked that my second child was born prematurely and died within two days of hyaline membrane disease. Instead of offering his sympathies, the director of my department called me in after my return from hospital, to complain that some of my colleagues had actually had to correct some exampapers in my place!

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into thinking that when their daughters marry, the bride should be “clean.” This perverse cultural custom is being perpetuated by the women themselves, who have become their own worst enemies.

In working to make change in any one of these areas, you need partners. You need determination to do it. I think of my grandmother, gathering what she needed to make me that coat, all those years ago. A button here, a bit of cloth there, a length of thread. And gradually, she brought it all together and made me a beautiful coat.

Together we can make change happen – for that frightened girl pledged in marriage, for that woman who thinks she has no choice, for the desperate worker in the village who cannot work and care for her newborn at the same time – and we can bring it all together. We can insure that all women and girls have the education, services, and supplies they need to lead healthy lives and have healthy children.

Since then, great strides have been made in improving working conditions, health care, and maternity leave rights for women, at least in the developed world, but there remains so much to be done before the same level is reached worldwide.

Since the end of my second term as president, I have been active in the Club of Madrid, in a variety of projects to empower women.

I went to Uganda to try to convince the government to give property rights to women and criminalize sexual violence; I went to Colombia to address the difficulties of women, especially in families driven off their lands by either drug lords or paramilitaries.

In countries where the rights of women are ignored, we are especially challenged. Some social customs run generations deep. One such custom is female genital mutilation, where women are brainwashed

61 | Why We Care | Global Leaders Council for Reproductive Health | Vaira Vike-Freiberga

MARIA OTERO

Maria Otero was sworn in as United States under secretary of state on August 10, 2009. She oversees and coordinates US foreign policy on a variety of civilian security issues, including democracy and human rights. Otero is currently the highest ranking Hispanic official at the State Department, and the first Latina under secretary in its history. She is the former president and CEO of ACCION International, a pioneer and leader in microfinance working in twenty-five countries. She also serves as the presidentâ&#x20AC;&#x2122;s special coordinator for Tibetan Issues. In June 2006, Otero was appointed

by UN Secretary General Kofi Annan to the UN Advisors Group on Inclusive Financial Sectors. She served on the board of the US Institute of Peace, a position to which she was originally appointed by President Bill Clinton. She is a member of the Council on Foreign Relations.

Photo by Dominic Chavez

I

was born in La Paz, Bolivia, and I’m one of nine children – I grew up in a Catholic, Latino family that believed that the more children, the better. So it’s slightly ironic that much of my work is in the area of family planning!

I have had the honor of working in family planning and in reproductive health going back to the 1970s. I think I was fourteen at the time, and I worked with the Center for Development of Population Activities (CEDPA). That opportunity exposed me, at a very young age, to the issues that we are trying to address now. And that opportunity imprinted on me a desire to make a difference.

Over the years, I have seen women all over – from Africa to Indonesia to Latin America – in need of family planning and access to contraceptives and also looking to improve their own lives.

I spent many years at ACCION International in the area of microenterprise, making capital available to women and men to create their own enterprises. I have spent many hours sitting with women, listening to the stories of their lives, and hearing how having a little bit of capital to be able to work and to be able to provide for their families really changed these women. They developed a sense of empowerment, of dignity – they had control of their own lives.

And it didn’t matter whether I was in Accra or Mumbai or Lima – even though all of their stories were different, when I asked these women what they wanted for their daughters, they all said they simply wanted their daughters to be able to have the education that they didn’t have.

There are 600 million young women in the developing world today, and so many pregnancies of girls under the age of twenty. The

mortality rate for those young women is twice as high as it is for older women. How, I ask so often, can we empower young women?

How can daughters have what was denied their mothers?

Clearly education is one piece of it, but there are many other ways in which we can take on that challenge of having young women become actors in their own lives. We must think about the issue of reproductive health not only as the delivery of contraceptives but as an issue that is interconnected to many other issues, including empowering young women.

We have made progress, no question about it. There has been a decrease in the number of maternal deaths in the world. But we still know that only 21 percent of women in developing countries have access to modern contraceptives. In my work as an undersecretary of state for civilian security, democracy, and human rights, this issue of reproductive health hits me between the eyes when I travel, when I meet people all over the world who suffer because of everything that has not been accomplished in this field – who suffer because despite how far we have come, we have a much longer way to go.

If I am in a refugee camp with Somalian refugees on the Kenyan border, what they want to talk to me about is reproductive health.

Can it be made available to them? These are vulnerable populations.

For them, access to reproductive health is one way to become less vulnerable. If I am in a place where security is the issue, this also becomes an enormously important issue. In Pakistan, I have been working – even before the floods – with the Pakistanis to help address the issue of water and to manage water in a more effective way, but when the Pakistanis project enormous population growth, their efforts to address water and its scarcity become far more complex.

64 | Why We Care | Global Leaders Council for Reproductive Health | Maria Otero

Reproductive health is an issue that fuels the spread of HIV. That’s true for low- and middle-income countries, and it is the leading cause of death for women during their reproductive years. Reproductive health is also an issue related to environment, which is another area in which I work. When I traveled to the Arctic Circle, and I recognized the degree to which that part of the world is being affected by climate change, I began to see that women in all of our communities are going to be on the frontlines of addressing these issues. So you can go from the Arctic Circle all the way to the tip of the continent where I was born, South America, or to Africa, and you will see that these are the problems that continue to prevail.

women in villages and small towns in the countryside is done – and will continue to be done – by those women who may have not had a great deal of education. For example, traditional birth attendants.

All those years ago, at CEDPA we trained women who were leaders in their countries. In Kenya one of the women that CEDPA provided training for was a woman who became a wonderful parliamentarian.

She was a woman who fought for women in Kenya.

Later, when I went to Kenya to train traditional birth attendants on issues related to delivering family planning services, we went to the countryside with this same woman – who wore her head piece, looking quite regal – and everyone Indeed, whether we seek to fight ¸/V^ 0 HZR ZV VM[LU JHU ^L LTWV^LY `V\UN was so delighted to see her. Here hunger, improve health practices, was a group of traditional birth ^VTLU& /V^ JHU KH\NO[LYZ OH]L ^OH[ ^HZ or create microenterprises, no actor attendants – older women, some proves more reliable or is more of them with no teeth, some of KLUPLK [OLPY TV[OLYZ&¹ determined than the mother, sister, them very slim – and as I stood daughter, or wife. In communities there with my friend, one woman around the world, it is the women who drive the family, who was very small and frail and elderly, with maybe two teeth and the community, and the society toward a better future. her chest wrapped, looked at my friend and she said, “I delivered you.” Our eyes widened. Beside me my friend grinned and clasped The scourges of our world, such as poverty, exclusion, repression, her hands over her heart. The older woman continued, “I was there and illness, impact women both first and worst. All too often, women when your mother gave you birth.” are the first victims of crisis. A disproportionate number of women are refugees, as I recently witnessed when visiting the Dadaab It is these women – my friend, the birth attendants, that old refugee camps in Northeastern Kenya near the Somali border. woman who remembered – it is these women who are delivering Across the globe women are victims of gender-based violence, reproductive health services. It is these women whom we are trying the most traumatic tool of war. And they are undereducated and to empower. And it is these women who drive me in my work. With disenfranchised compared to men in nearly every corner of the world. commitment, resources, and coordination, we can have an impact.

As we elevate the issue of women’s health, we need to remember that the “heavy lifting” of making reproductive health available to

65 | Why We Care | Global Leaders Council for Reproductive Health | Maria Otero

Photo by Dominic Chavez

JOY PHUMAPHI

Joy Phumaphi began public service in Botswana as a local government auditor.

From 1994 to 2003, she went on to serve in Parliament and then became minister for Health in the midst of the countryâ&#x20AC;&#x2122;s AIDS crisis. She later became the assistant director general for the Family and Community Health Department at the World Health Organization and the vice president of the Human Development Network at the World Bank.

I

was born in a rural village in Botswana. It was in October, and my grandmother was the midwife.

It was malaria season. And of those babies born during that plowing season, only 40 percent of us survived. I have carried that with me my whole life; I always felt I was fortunate – I survived.

When I was quite young, around four years old, my younger sister died of German measles; we had not been immunized. In my culture, when someone dies in the family, children are kept away. I hadn’t seen my mom for two days, and I decided to sneak in and see her.

I saw my sister in a coffin, a plain wooden coffin. My mother was on a mat, on the ground, weeping. That memory will never leave me.

When I started primary school, we were taught under a tree, writing on slates with chalk stone. There was an outbreak of German measles, almost two years after my sister had died, and that sad experience left a deep impression on me. My schoolmates and I had the idea that in Germany, there must be even more children dying of measles than in Botswana. We wrote letters to the German people, telling them how sorry we were their children were dying!

These experiences gradually made me realize how important skilled healthcare is – the importance of antenatal care services, protecting the health of newborns and children, whether through immunization or nutrition. I have also realized the importance of family planning – it is vital for a woman to have information about how to space her children.

When I was Minister of Health of my country, I received a letter written by a seven-year-old boy. He had a huge problem, he wrote.

He was living with his grandmother, his mother was dead, his father was dead, and he had HIV/AIDS. He was told that because he was HIV positive he didn’t have many years to live, but there were medicines to help him. He had already traveled a long distance with his grandmother to a healthcare facility, and they told him the

medicines were not available. “Can you help me?” he wrote in his neat, careful penmanship.

Some time after I received his letter, I visited him and his grandmother. He was a brilliant little boy. He received straight As in his classes. He told me he wanted to be a doctor; he knew he was very sick and he wanted to help others like him. My young friend did go on antiretroviral (ARV) medication, but it was too late for him. When he died at age thirteen, I was out of the country. When I returned, I went with his grandmother to his grave. To me, my young friend signified an important turning point in the fight against HIV/ AIDS. He represented the plight of a new generation of children who had no parents – all across the region. These are the children of mothers who had no access to services for family planning, maternal healthcare, and prevention of mother-to-child transmission of HIV. When I started my work as health minister, I didn’t have a budget allocation for AIDS drugs. So I went outside the country to look for money. This was a time when African governments had not introduced ARVs in the public sector; although they were widely available elsewhere. In fact, I had other health ministers in Africa who thought that the program would be unsustainable encouraging me not to introduce ARVs. They said it was too expensive, that we must wait until the price was low enough. That what I wanted was unrealistic.

I told them that we could not wait – we have children like my young friend. I wanted every single person in Botswana who needed treatment to get treatment. And so Botswana became the first country in Africa to introduce a comprehensive HIV/AIDS treatment program, in both the public and private sectors.

If my young friend’s family had had community healthcare workers, his parents would not have died. His parents would have learned about how to protect themselves from HIV early; they would have had access to and been coached on the consistent use of condoms

68 | Why We Care | Global Leaders Council for Reproductive Health | Joy Phumaphi

to avoid infection; his mother would have been given the reproductive and maternal healthcare she badly needed, so that even if she was infected, she would not infect her baby. He would not be orphaned, and he would not have died at age thirteen. The community healthcare worker would have educated the whole community about HIV/AIDS, and followed up with each household. The community healthcare worker would have made sure that if one parent was HIV-positive, they would be using condoms. But because at that time Botswana had just completed the exercise of phasing out family welfare educators (Botswana’s version of community healthcare workers) we didn’t educate people in villages about HIV until it was too late; we had children like my young friend.

Community healthcare workers can also educate about women, newborn and child health, and communities’ nutrition – an especially important issue in many developing countries. Poor nutrition can be disastrous for children, pregnant women, and in turn the health of the unborn baby. Poor nutrition can have terrible consequences on the cognitive development of the baby’s brain and future skills development – which has been proven to reduce their productivity and earning potential in later life. Healthcare workers can teach about drought preparedness and nutrition, and about breast-feeding.

Access to education about family planning can help a woman decide when and if she wants to have more children, especially in the context of poor countries where problems like drought are recurring.

We know how critical breast-feeding is for the development of the child, and yet there are many countries in Africa where exclusive breast-feeding can be lower than 10 percent, because families – without the right knowledge – start giving the baby supplements when breast milk alone during the first six months is recommended by the World Health Organization. In an alternative scenario, a community healthcare worker, armed with information about family planning and maternal, newborn and child health; actively participating in the community, can be very effective.

¸(JJLZZ [V LK\JH[PVU HIV\[ MHTPS` WSHUUPUN JHU OLSW H ^VTHU KLJPKL ^OLU HUK PM ZOL ^HU[Z [V OH]L TVYL JOPSKYLU LZWLJPHSS` PU [OL JVU[L_[ VM H JV\U[Y` SPRL )V[Z^HUH ^OLYL WYVISLTZ SPRL KYV\NO[ HYL LUVYTV\Z ¹ One example of such a success is a family I know of in which the teenage girl in this family had a baby, but her story – unlike so many stories of teen pregnancy – has a happy ending. A community healthcare worker connected that girl to maternal and newborn healthcare, and when the baby was born, she monitored that child and made sure the girl was educated about taking care of a newborn.

She made sure that the girl herself was able to go back to school and continue with her own skills development, realizing her own potential. The healthcare worker was engaged effectively with this family, with this community – it was her community, after all, and she felt a certain ownership of both the challenges they faced and the responsibility to identify and implement solutions.

One of our responsibilities as members of the Global Leaders Council is to make sure that we use whatever platform we can to effectively engage in our spheres of influence and help effect change. We don’t have to wait until the next meeting; we don’t have to wait until there is a conference. We don’t have to wait for the next death, disability, or sickness.

The fact of the matter is that we cannot wait. We must push and work for effective solutions – and there are many, chief among them access to family planning and reproductive healthcare – for all women, for all children. I think of my own experiences, multiplied again and again, generation after generation. I think of my young friend, always in my heart, who wrote me that beautiful letter. And I think back all those years to when I was born – and I survived, one of the privileged few. And I cannot wait. Life and good health cannot be a privilege; it is a human right.

69 | Why We Care | Global Leaders Council for Reproductive Health | Joy Phumaphi

AFTERWORD

While the issue of reproductive rights has become sensitive – even toxic – we know we cannot allow it to remain that way. Access to reproductive health is not a marginal issue; it is a mainstream issue.

The issues of food security, the environment, water, and economic development are all connected to and dependent on a family’s ability to choose when and how many children they will have.

The stories recorded here are testament to the commitment and engagement that is being asked of all of us. These stories demand universal access to reproductive health by 2015 – to address the unmet need of more than 200 million women the world over for reproductive health services.

Photo by Dominic Chavez

Rudyard Kipling said, “If history were taught in the form of stories, it would never be forgotten.” That is why we created this book – so the history and the commitment of the fifteen leaders profiled here will always be remembered. Their stories tell what lit the spark in them, what made them care about the centrality of reproductive health to development, dignity, and prosperity. Their stories inspire, motivate, unite. They are stories for change.

This book was born at the close of a series of meetings one day, in New York City at the time of the United Nations General Assembly in 2010. Speeches had been made, arguments and agreements had come in equal measure. But as the sun began to sink over the chilly autumn day, something was different. The leaders who are in these pages spoke, finally, not of facts and figures and statistics.

They spoke their stories. They told of that moment in time, or that event in their lives, during which the spark to work for change was lit for them. For some, it was highly personal: the birth of a child, the near-death of a child. For others it was having been witness to demoralizing sadness and tragedy. For all of them, such a moment was life-changing.

Why We Care would not have been possible without the support and generosity of the David & Lucile Packard Foundation, the William and Flora Hewlett Foundation, the United Nations Foundation, and the United States Agency for International Development. I am also grateful to Lyndon Haviland for her exceptional partnership on this project, and to the brilliant and tireless work of our editor and my sister Ann Espuelas, and to our special photographer Dominic Chavez and designer Silvia López Chavez. Thank you also to the dedicated and wonderful Aspen GHD staff members Marissa Mommaerts, Shannon Mills, Gwen Hopkins, Elise Mann, Katie Drasser, Rachel Feely-Kohl, and May Doherty. A huge thank you also to my beautiful and strong daughter Katie and my beloved husband Michael. It is their practical hopefulness for the future that guides and strengthens me every day. It is thanks to these individuals and institutions and to the remarkable Council members themselves that these stories are given voice and can create real, lasting change.

Peggy Clark Vice President, Policy Programs Executive Director, Aspen Global Health and Development The Aspen Institute June 2012

70 | Why We Care | Global Leaders Council for Reproductive Health | Afterword

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Publication number: 12-016