Perspectives

Women Deliver 2013: taking a gender lens to the new global health and development agenda
Investment in women is central to future development

lobal health is entering a critical period as the international development agenda for the next 15 years is being negotiated. In 2000, 189 countries agreed on the Millennium Development Goals (MDGs) to improve the wellbeing of the worlds poorest people. The 2015 deadline for the MDGs is rapidly approaching, prompting intense global discussion about the next phase. May 2013 was a particularly significant month for womens health, with the third Women Deliver conference (WD2013) in Kuala Lumpur and the release of an eagerly awaited United Nations report outlining possible post2015 directions.1 There has been substantial progress in health outcomes since the adoption of the MDGs, including improvements in womens health, and development opportunities for women. Fewer women live in extreme poverty, maternal mortality has decreased by nearly 50%, we are close to reaching gender parity in primary education globally, women make up 40% of the global work force and more women now participate in government.2 Despite this progress, there are still more than 250 000 women and girls dying every year from potentially preventable complications of childbirth,3 primarily in low-income countries, with the coexisting tragedy of 3.1 million newborn deaths annually.4 There has been less progress in MDG5 (decreasing maternal mortality) than in the other development goals.5 Maternal mortality is an incomplete indicator: for every mother who dies, another 30 live with chronic disabling conditions due to complications of childbirth.6 The vast disability and loss of life associated with reproduction has been the concern of a growing movement that began with the Safe Motherhood Initiative more than 20 years ago and culminated in WD2013. Principally, the Women Deliver movement aims to reduce maternal mortality, recognising that gender equity and sexual and reproductive health rights are critical. Equity and rights are not only crucial to reducing maternal mortality but also important in their own right. Taking place on the eve of a new development agenda, WD2013 reflected on progress, highlighted ongoing challenges, considered solutions and, in looking to 2015, sought to establish a more transformative development agenda. The Medical Journal of Australia ISSN: 0025The overarching theme of WD2013 was that investing 16 December 2013 199 11 733-734 in women729X and girls is not only right but smart; that The Medical Journal ofrights, Australia gender equity, sexual and reproductive and 2013 www.mja.com.au maternal health are fundamental to economic and social Perspective progress for the whole community. Jeni Klugman from the World Bank presented evidence linking investment in reproductive health with economic progress. She argued that improving reproductive health increases female labour supply and productivity, increases

Catherine R Bateman-Steel
MB ChB, BSc, MSc, Lecturer

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW.

c.bateman-steel@ unsw.edu.au

doi: 10.5694/mja13.10890

the financial wellbeing of households by mitigating catastrophic expenditure from poor health outcomes, improves the economic prospects of the next generation due to the supportive environment of a healthy mother; and allows countries to benefit economically from declining fertility and improved population health (the demographic dividend).7 A key message from WD2013 was that realising these health and economic benefits requires more than effective interventions and strong responsive health systems; it requires a fundamental change in the status and empowerment of women. Currently, 222 million people globally have an unmet need for contraception.8 As many as one in nine girls worldwide are married by the age of 15, and one in three by the age of 18.9 Violence against women remains highly prevalent, with up to 71% of women in some countries reporting physical or sexual violence by an intimate partner.10 Despite gains in womens participation in political spheres, this still remains low, with women comprising only 16% of government ministers globally.11 If women and girls are not safe from violence, protected from child marriage, educated, able to control their fertility

Goals for gender equity (Goal 2) and health (Goal 4) proposed by the High-Level Panel on Post-2015 Development Agenda*

GOAL 2

EMPOWER GIRLS AND WOMEN AND ACHIEVE GENDER EQUALITY

a) Prevent and eliminate all forms of violence against girls and women b) End child marriage c) Ensure equal right of women to own and inherit property, sign a contract, register a business and open a bank account d) Eliminate discrimination against women in political, economic, and public life

GOAL 4

ENSURE HEALTHY LIVES

a) End preventable infant and under-5 deaths b) Increase by x% the proportion of children, adolescents, at-risk adults and older people that are fully vaccinated c) Decrease the maternal mortality ratio to no more than x per 100,000 d) Ensure universal sexual and reproductive health and rights e) Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases

* From A new global partnership: eradicate poverty and transform economies through sustainable development. The report of the High-Level Panel of Eminent Persons, by the United Nations, 2013 United Nations.1 Reproduced with the permission of the United Nations.

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Perspectives
and fully participating in all spheres of life, they are not able to adequately protect their own health or that of their families and communities. Creating the social, economic and political conditions that enable women and girls to participate fully in finding solutions to their health issues, and to contribute to strong productive societies, requires change at multiple levels. It requires political will manifested in effective laws and policy that protect sexual and reproductive health rights and promote gender equity. As WD2013 concluded, the UN High-Level Panel on Post-2015 Development Agenda released its report providing directions for the next development agenda.1 The panels recommendations drew on thousands of global consultations to propose a framework for the way forward, and reflected key points from the Women Deliver movement, including a gender equity goal (Box) among 12 overarching development goals. The proposed gender goal goes beyond the narrow focus on education in the current gender goal to include targets on violence, child marriage and economic rights. Sexual and reproductive rights are explicit targets in a general health goal (Box). Vigilance is needed to maintain these targets as the drafting of the goals continues. The health profession has a vital role to play in maintaining pressure to ensure that a commitment to promoting gender equity and gender rights, including sexual and reproductive rights, continues to be central to any post-2015 agenda.
Acknowledgements: My attendance at WD2013 was funded by the University of New South Wales Career Advancement Fund. Competing interests: No relevant disclosures. Provenance: Not commissioned; externally peer reviewed. 1 United Nations. A new global partnership: eradicate poverty and transform

Equity and rights are not only crucial to reducing maternal mortality but also important in their own right

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economies through sustainable development. The report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, 2013. New York: UN, 2013. http://sustainabledevelopment.un.org/content/documents/ 8932013-05%20-%20HLP%20Report%20-%20A% 20New%20Global% 20Partnership.pdf (accessed Oct2013). United Nations. The Millennium Development Goals Report. New York: United Nations, 2012. http://www.un.org/millenniumgoals/pdf/MDG%20Report% 202012.pdf (accessed Oct 2013). United Nations Population Fund, United Nations Childrens Fund, World Health Organization, World Bank. Trends in maternal mortality: 1990-2010. Geneva: WHO, 2012. http://www.unfpa.org/webdav/site/global/shared/documents/ publications/2012/Trends_in_maternal_mortality_A4-1.pdf (accessed Oct 2013). Cousens S, Blencowe H, Stanton C, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011; 377: 1319-1330. Islam M, Yoshida S. MDG 5: how close are we to success? BJOG 2009; 116 Suppl 1: 2-5. Ashford L. Hidden suffering: disabilities from pregancy and childbirth in less developed countries. Policy brief. Washington, DC: Population Reference Bureau, 2002. http://www.prb.org/pdf/HiddenSufferingEng.pdf (accessed Oct 2013). Grpin KA, Klugman J. Closing the deadly gap between what we know and we do. Investing in womens reproductive health. New York: The World Bank and Women Deliver, 2013. www.womendeliver.org/assets/WD_Background_ Paper_Full_Report.pdf (accessed Oct 2013). Singh S, Darroch JE. Adding it up: costs and benefits of contraceptive services estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund, 2012. http://www.guttmacher.org/pubs/AIU-2012estimates.pdf (accessed Oct 2013). United Nations Population Fund. Marrying too young: end child marriage. New York: UNFPA, 2012. http://www.unfpa.org/webdav/site/global/shared/ documents/publications/2012/MarryingTooYoung.pdf (accessed Oct 2013). Garcia-Moreno C, Jansen HA, Ellsberg M, et al. Prevalence of intimate partner violence: ndings from the WHO multi-country study on womens health and domestic violence. Lancet 2006; 368: 1260-1269. UN Women. Women in politics 2012. http://www.ipu.org/pdf/publications/ wmnmap12_en.pdf (accessed Nov 2013).

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