|The United Nations, Civil Society, and Global Development: Interview with Adrienne Germain|
The United Nations, Civil Society, and Global Development: Interview with Adrienne Germain
The Current (The Public Policy Journal of the Cornell Institute for Public Affairs), Vol. 10, No. 1, Fall 2006
>>Available in PDF
The Current (TC): Will you tell us a little about IWHC, how the organization began and what its mission is?
Ms. Germain: Believe it or not, President Ronald Reagan is to thank, in part, for the early work of the International Women’s Health Coalition (IWHC). In 1984, his “Mexico City Policy,” also called the “Global Gag Rule,” denied U.S. funds to private organizations that support safe, legal abortion for poor women throughout the world. (This policy was rescinded by President Bill Clinton in 1993, but was reinstated by President George W. Bush in 2001). It represented a huge step backward for reproductive health and rights, but few women living in developing countries had the money or means to argue against it in international arenas or even in their own countries. Drawing on our combined 25 years of work on population and women’s rights, Joan Dunlop and I picked up the gauntlet in 1984. Through IWHC and the financial resources we leveraged, we identified and funded local leaders in Africa,
Working with women enables us to speak with authority on issues often shrouded in silence: the epidemic of undiagnosed and untreated reproductive tract infections, persistent high numbers of deaths and injuries related to pregnancy, limitations of contraceptive technology, and a pandemic of violence against women. Together with our colleagues, we transform international population and health policy in international
TC: In spite of continuing technological innovation and economic growth, women’s health outcomes in many parts of the developing world are either stagnating or getting worse. What makes this inequity possible, and what stands in the way of changing it?
Ms. Germain: More than half a million women still die from complications of pregnancy or childbirth every year—all but 1 percent of them in developing countries. Approximately 80 million unintended pregnancies occur annually,1 about 19 million of which result in unsafe abortion, and ultimately 70,000 women die as a result.2 Up to three quarters of women globally report experiencing physical or sexual abuse by their intimate partner. And every day, 7,000 girls and women are infected with HIV/AIDS.3
We know what to do and we have known for a long time. The World Bank, for example, has estimated that 74 percent of maternal deaths could be averted by simply providing basic health interventions,4 but willful neglect of women’s and girls’ realities still persists at the policy table. The obstacle is not knowledge, but failure of policymakers to allocate funds, pass necessary laws, and implement appropriate policies and programs. Why?
In a word: sexism. While I’ve seen important progress in education and employment in 36 years of professional work in the health arena, the models that guide policy do not value women’s health. Data systems are especially weak on gender differentials and even high-priority research is not very interesting to many scientists. Sadly and simply, girls’ and women’s lives are still not valued by families, communities, and societies, all of which fail to invest in their daughters and young women—one of their greatest resources. When I traveled to Bangladesh earlier this year, over and over again, I met girls who had been married by their parents at age 12 or 13, when they should have been completing their education. Their dreams are stopped before they start.
Women’s health and rights are too often political pawns. In Nicaragua, Catholic and evangelical leaders recently pressured parliamentarians to vote on restrictive abortion legislation right before national elections, a blatantly political move. On October 26, the Nicaraguan National Assembly banned abortion for any reason, even to save the life of the pregnant woman. Only three other countries in the world have such a policy.
TC: A great deal of talk about fair and sustainable development can be boiled down to one phrase: political will. What are the necessary ingredients for building political will to take action on issues of women’s rights?
Ms. Germain: Our work to win and sustain political will aims for change in three arenas: international policymaking, national prioritysetting, and galvanizing key leaders.
First, we repeatedly mobilize the critical mass of women and youth leaders needed to ensure positive decisions from international deliberations and by global institutions. An essential element is support for non-governmental organization (NGO) leaders from all over the world to make their views known, lobby their governments and strategize effectively with other key actors. Collectively, women and youth leaders have honed the political savvy needed to secure positions on negotiating teams, be appointed to government delegations, and be consulted as essential advisors. This work is not glamorous and can be painfully slow, but it has resulted in real successes, including at ICPD in 1994, and more recently at the UN High-Level Meeting on HIV/AIDS in June
We also work at the national level—in Africa, Asia and Latin America—to finance and leverage the work of women and youth organizations. We now have a cadre of effective organizations poised to drive policy change in their countries and internationally. With these colleagues, IWHC advocates for governments to make multisectoral investments in women’s health and rights across ministries (e.g., health, judiciary, education, information/media, labor/youth). Such work requires longterm
Finally, we engage and mobilize key leaders and influential individuals. We will, as in the past, seek to influence new global leaders, including the UN Secretary-General, the Director-General of the World Health Organization and the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. It is critical to get on their agenda early and stay there, by applying political pressure through governments and NGO allies who sit on the governing bodies of these agencies. Another emerging type of leader we aim to influence, increasingly prominent in the field of global health, is private donors sufficient to wield significant influence in the corridors of power.
TC: What is the connection between the spread of HIV/AIDS and women’s rights? Do you believe the international community will be able to achieve its goal of stopping HIV/AIDS without taking action to promote the rights of women, especially in the developing world?
Ms. Germain: HIV/AIDS and women’s rights are inextricably linked. The practices which impair women’s health and violate their rights also make them vulnerable to HIV/AIDS and fuel the spread of the pandemic overall: widespread sexual coercion and violence; marriage of young girls to much older men; lack of access to health information, sexuality education, and reproductive health services; and imbalances of power in sexual and marital relationships, to name a few. These are universal problems. For example, a WHO study just concluded that physical and sexual partner violence against women is widespread across the globe. In the United States, and worldwide, the current U.S. government is depriving young people of comprehensive sexuality education that they need to protect themselves and each other against HIV, unwanted pregnancy, and sexually transmitted infections.
The consequences are universal. In sub-Saharan Africa, 76% of HIV positive young people (ages 15–24) are female. In the U.S., the number of women living with AIDS increased 15% between 1999 and 2003, compared with 1% in men,5 and AIDS is now the leading cause of death in African American women aged 25 to 34.6
The With Women Worldwide Compact outlines the priority actions needed. First, HIV/AIDS policies and budgets must be used to expand access to sexual and reproductive health services to all women and young people. These services are accepted by families and communities, and have critical core capacities that we can build on to provide the full range needed to empower women and girls against HIV/AIDS, including quality pregnancy care, STD diagnosis and treatment, subsidized female and male condoms, and, eventually, microbicides, as well as HIV/AIDS counseling, testing and treatment.
Second, increasing women’s control over their sexual lives and reducing their vulnerability to HIV/AIDS requires changing how men and women relate to each other, and that means starting early. It means investing in comprehensive sexuality and gender education, not simply providing full and accurate information about HIV/AIDS. Comprehensive programs also build skills to establish equality in relationships; respect the right to consent in both sex and marriage; and end violence and sexual coercion. These programs need far more money and higher priority than global policymakers are currently giving them.
TC: In your comments at the 59th Annual DPI/NGO conference, you stressed that the international community has been unable to prioritize women’s social and reproductive health in part because it has focused too much on medical and technical intervention without doing enough to promote gender equity. Can you give an example, perhaps on a small scale, of how equity and empowerment can help women get healthy and stay that way?
Ms. Germain: The Girls’ Power Initiative, GPI for short, in Nigeria, is a strong example of the progress that can be achieved by focusing on equity and empowerment. Bene Madunagu and Grace Osakue founded GPI in 1994 to build girls’ confidence, knowledge, skills, and self-esteem. Working with parents and community leaders, and learning from the girls themselves, they are helping the girls, school principals and teachers, and parents to understand that early marriage is a danger
IWHC has worked closely with and supported GPI since its beginning
In Cross River, a state where GPI works, where HIV prevalence has reached 12% among sexually active individuals, GPI girls have knowl- edge and show initiative when it comes to protecting their sexual and reproductive health. In addition to the 1,500 girls directly involved in the program, GPI’s message of empowerment now reaches another 25,000 girls in 28 schools. GPI’s example, and the example of others
IWHC funds many more organizations like GPI throughout the world. For more information, visit www.iwhc.org/programs/index.cfm.
TC: What role is the United States playing in the global campaign against HIV/AIDS? Is it what it should be, or does it fall short?
Ms. Germain: The United States government plays a critical role through the President’s Emergency Plan for AIDS Relief (PEPFAR), which is slated to provide $15 billion over five years (2003–2008) and makes it the largest single donor to global HIV/AIDS programs. As important as the financial commitment is, the policy that goes with it is flawed in some important ways.
The U.S. government has repeatedly failed to grasp the key linkages between HIV/AIDS and sexual and reproductive health. For example, at a recent briefing for U.S.-based NGOs, officials were asked whether any PEPFAR-funded programs would provide the new vaccine for human papilloma virus (HPV) to adolescents, given that this would also build capacity for rolling out future HIV/AIDS vaccines and further reduce risk for HIV. Ambassador Jimmy Kolker (Assistant Coordinator and Director
Second, guided by ideology, rather than evidence, the PEPFAR program overemphasizes abstinence-only over comprehensive approaches to HIV prevention, leaving the majority of women and girls without the information or tools to protect themselves from HIV. The “ABC” approach overall is ineffectual and irrelevant for women and girls in developing countries who are married and cannot choose whether or when to have sex. In Mozambique, a PEPFAR country, 57% of girls are married by age 18.8 In a survey of adolescent girls in 31 developing countries, 80% of unprotected sexual encounters occurred in marriage.9 In South Africa, 30% of girls say their first intercourse was forced, and 71% have experienced sex against their will.10
The new Congress following November 2006 elections has a strong foundation for making change. Representative Barbara Lee (D-CA) and several co-sponsors have introduced the Prevention Against Transmission of HIV for Women and Youth Act (PATHWAY Act) in the House of Representatives, which aims to reduce women and girls’ vulnerability through a truly comprehensive approach. For more information, visit
TC: A number of women have recently risen to positions of power in international politics. I’m thinking here of Ellen Johnson-Sirleaf in Liberia, Michelle Bachelet in Chile, and Angela Merkel in Germany. Is politics still a sexist realm? In order for women’s rights to become a global priority, do
Ms. Germain: Sexism and gender inequality are still alive and well despite progress in some areas, as I noted above. Politics is one of the most intransigent arenas—consider the severely imbalanced, though improving, gender makeup of the U.S. Congress. But we cannot wait until gender inequalities in the political sphere end to tackle the many other inequalities. Rather, we must continue to attack inequalities wherever we find them, including by engaging more men in the struggle.
What is virtually unique and most powerful about Presidents Johnson-Sirleaf and Bachelet’s leadership so far is their identification as womenand with women as they seek to strengthen their countries and move toward more just societies. Few other women at the pinnacles of power do this—we also need more of them.
Reprinted with permission from The Current.