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Global Health Policy Blog


[caption id="attachment_1534" align="aligncenter" width="420" caption="Courtesy U.S. State Department"]Courtesy U.S. State Department[/caption]

When it comes to Secretary of State Hillary Clinton, no sliver of the international development community is more enamored than the sexual and reproductive health and rights (SRHR) crowd (yes, that’s their self-designation). Last Friday, Hillary returned the love. In a speech (see the full text here) in the regal Benjamin Franklin reception room at the State Department, Secretary of State Clinton and many of her top staff brought the international dimension of reproductive health and family planning in from the cold. It’s been a long winter.

The occasion of the speech was the 15th anniversary of the “Cairo Conference” – officially the International Conference on Population and Development (ICPD) – in 1994, at which then-first lady Clinton was a very prominent and passionate leader of the U.S. delegation. Last Friday she said,

There is no doubt in my mind that the work that was done and the commitments that were made in Cairo are still really the bulwark of what we intend to be doing and are expected to do on behalf of women and girls.

The ICPD was particularly ill-timed. Several months later, Republicans took control in the U.S. Congress and anything having to do with sex, rights, or Hillary became a political cudgel. The conditions for advancing the Cairo Plan of Action on SRHR became worse in 2000 when George W. Bush took office, the Mexico City policy (known by some as the global gag rule) first imposed by Ronald Reagan was reinstated, U.S. funding was pulled from the UN Population Fund (UNFPA)and replaced by Nordic and other European countries and the U.S. became a pariah in international circles concerned about women and their rights.

The SRHR crowd in the U.S. went into exile. They’ve been there for almost half the time that has elapsed since Cairo. As Margaret Pollack (newly appointed Senior Advisor on Population Issues at the U.S. State Department) said at a UN Foundation luncheon to celebrate Friday’s speech, a lot of time has been lost that could have been spent achieving the Cairo Plan of Action – and not incidentally, getting much closer to achieving MDG 5, the maternal health goal.

Secretary Clinton seems to be in a hurry to make up for lost time. She used the full arsenal of her top staff and emboldened them with strong words. Eric Schwartz, assistant secretary of state responsible for population issues, opened the event saying, “We recommit to the principles of ICPD and its Plan of Action.” Ambassador-at-Large for Global Women’s Issues, Melanne Verveer, in introducing the Secretary, called her a woman who has not wavered on the issues of SRHR and applauded the focus on girls and women in the Secretary’s “groundbreaking speech on development” two days earlier at CGD. (For those who missed it, you can read the text of the prepared remarks here – note the very nice reference to Start with a Girl in her sixth point.)

Maria Otero, the undersecretary of state for democracy and global affairs, drove home the point that the Secretary is dead serious about putting the needs and condition of girls and women at the center of U.S. foreign policy. And completing the all-star line-up, USAID Administrator Raj Shah, sworn in just the day before, assured the crowd that a newly energized and excited USAID is ready to live up to the core principles of SRHR and the full vision that the Secretary articulated in last Wednesday’s speech – a speech he called “the most important statement on development by a secretary of state in decades.”

So what did Secretary Clinton deliver in her tidings of comfort and joy? (this speech was originally scheduled to happen right before Christmas but a Washington DC blizzard delayed it.) Four points that pretty much capture the essence of what’s needed:

  1. Girls and Women: The Secretary not only “Started with a Girl,” but she put girls in the center and at the end of her speech as well. After reciting some of the brutal statistics that describe the sorry state of women’s and girls’ health – including a woman dying every minute of every day from pregnancy and childbirth and 70 million women and girls worldwide with their genitals carved up – she declared the situation intolerable. (For a discussion of the available statistics on girls, see Ruth Levine’s blog here.) In addition to reinforcing on-going U.S. programs to prevent maternal mortality and female genital cutting, the Secretary is asking every program in the State Department and USAID to determine what its contribution is for the well-being of girls and women. That will require some careful searching, but it is the soul-searching that will accompany it that could most change the State Department.
  2. U.S. as a global leader: I felt an undercurrent of last year’s inaugural mood in the Benjamin Franklin room as the Secretary and her cadre spoke of the future. They were wiping away 8 years of U.S. blockage and manipulation of international family planning programs and policy negotiations. There was a sense of pride and almost disbelief in the audience that the reversal could be so complete. The members of the diplomatic corps that I spoke with afterwards were perhaps the most gratified. One ambassador said to me, “Now, when the U.S. speaks, people will listen again.”
  3. More money: Getting down to the important details, Secretary Clinton said, “We’ve pledged new funding, new programs, and new commitments to MDG5.” The Obama Administration has already renewed funding to UNFPA and “more is on the way,” according to the Secretary. She said there will be in increase in population funding within the U.S. budget (as we’ve seen already, by almost one-third), and reproductive health and family planning , in addition to maternal and child health, will be central to the Global Health Initiative being constructed by a constellation of USG agencies in time for the President’s budget speech in February.
  4. Centrality of SRHR to development: Perhaps most challenging but key to it all is the connection between SRHR and so many other development goals. Secretary Clinton gets it in spades, and so she said, “We understand there is a direct line between a woman’s reproductive health and her ability to lead a productive, fulfilling life. And therefore, we believe investing in the potential of women and girls is the best investment we can make.” And some concrete actions: “We are integrating women, adolescents and girls into our Global Health Initiative and our Food Security Initiative. We will make sure the integration of family planning happens…all health programs will be designed to take into account women and girls.”

I daresay that not just the SRHR crowd – stalwarts all—were pleased when she said off-script,

“I know it can sometimes be hard to take, we might grow weary of the ups and downs in these things that seem so self-evident to the rest of us that this must be done. But work with us, and let’s create structural and institutional change that does not get wiped away with the political winds.”

For those of us in the development community who are immersed in questions of how to achieve better health in the developing world and/or issues of the empowerment of women, the renewed attention to the health of girls and women is very welcome. At the same time, it’s hard to quiet the inner questions about how to reconcile enthusiasm for SRHR within the “international community” with the much less positive view in many of the governments of developing countries. While it is certainly the case that in some countries receiving U.S. development assistance (for example, Ethiopia and Egypt) there appears to be genuine high-level support for family planning and good reproductive health care, this is far from a universal position. At best, countries that are not actively supportive will permit family planning services to be provided when donors pay – which is why there is a dramatic ebb and flow of access to services depending on the party affiliation of the President of the United States. At worst, the policies and practices of governments with which we do development business are retrograde with respect to the health-related rights of girls and women.

This puts us in a little bit of a bind when it comes to simultaneously insisting on the value of a women-centered approach in health and the principle of “country ownership” and engagement in true partnerships – a priority for development policy that Secretary Clinton articulated in her address earlier in the week. One way to manage that conundrum is to invoke the fact that the vast majority of the world’s nations are signatories to the Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child, which include provisions that cover almost all of actions that SRHR advocates promote. Therefore, as signatories they have already endorsed access to quality health services, protection from gender-based violence, and many other important objectives. But, sadly, the bind becomes tighter if we attempt to use this rationale because the U.S. is among the very few countries that has ratified neither of those conventions – along with Iran and Sudan in the case of CEDAW, and Somalia in the case of the CRC. In this domain, we fall far short of being able to serve as a model or inspiration – and are significantly challenged even to highlight the disconnect between other countries’ rhetoric and practices.

In spite of these significant reasons for caution, we can all bask for a moment in the reflected warmth from the end of the SRHR community’s long winter in exile.

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.