Ministers, Excellencies, Ladies and gentlemen,
Thank you for that kind introduction, and my thanks to the organizers of the Third International Family Planning Conference – including the Bill and Melinda Gates Foundation and the Federal Ministry of Health of Ethiopia – for inviting me to speak with you here today.
The issues that you’ve discussed and advanced this week, issues related to human rights, access to life-saving health services, and equity in the provision of development assistance, are critical to the health and well-being of millions of women and girls around the world.
This has been true for some time, is true today, and is even more important when we look at the stakes for future generations.
A Look Back
Looking back on the years since the new millennium began when we challenged ourselves as a global community to achieve the Millennium Development Goals, we can see that we have made progress.
Indeed, the reviews of global efforts to reach the MDGs are a testament to that – including achievements in reducing poverty, providing increased access to drinking water, and improving the lives of slum-dwellers.
But the goal where the least progress has been made is the one that strikes at the heart of issues related to equity and equality for women, and that’s MDG 5, reducing maternal mortality and providing universal access to reproductive health, including family planning.
We all know five key facts:
1) First, that there can be no development without a focus on women and girls.
2) Second, women cannot fully participate in development unless their reproductive health needs are met and their reproductive rights are respected, protected and fulfilled.
3) Third, the right of women to decide if, when, and how often to have children is crucial to their ability to take control of many other aspects of their lives.
4) Fourth, the most effective way for women to have autonomy over their fertility is through access to safe and effective modern forms of contraception.
5) Fifth and finally, those least likely to have access to reproductive health care are the world’s poorest and most marginalized people. They include those living in rural or remote areas, those displaced by humanitarian crises, the disabled, indigenous people, and, importantly for my remarks today – young people.
So, in taking stock of where we’ve come in advancing the world’s development agenda, and measuring progress on the Millennium Development Goals, we must recognize that specific obstacles continue to stymie our efforts to reach women and accomplish MDG 5.
If future efforts at sustainable development are to be effective, we must do more to break through these barriers and reach those most in need.
Let’s look at what has been achieved right here in Ethiopia. The Government of Ethiopia has emphasized the importance of providing sexual and reproductive health services to women throughout the country.
The United States is proud to be a partner in support of these efforts, including increasing the percentage of married women using modern contraceptives from 15 to 29 percent in a few short years.
Ethiopia has also achieved impressive reductions in child marriage. And most impressive, Ethiopia recently achieved MDG 4, which called for the under-five mortality rate to be reduced by two-thirds.
The United States is also working in partnership with other key donors and governments to reach women in underserved areas across Africa.
USAID is a founding member of the Ouagadougou Partnership along with the French Government, Gates Foundation, and the William and Flora Hewlett Foundation.
This effort supports nine Francophone West African countries to accelerate the achievement of their national family planning goals and reach at least an additional one million women in the region by 2015.
With these local and regional efforts in mind, let’s imagine now the life of a mother in a developing country somewhere in the world. Let’s say she was married in her early adolescence and gave birth to a daughter.
The mother may have left school, had additional children, and remained somewhat poor and under-educated.
But thanks to recent efforts, the mother may be dissuaded from having her daughter marry at an equally young age and may support her daughter’s desire to stay in school longer than she had been allowed. Imagine all that this girl could achieve if our efforts are successful!
The focus of her childhood could be on family, friends, and school, and she wouldn’t be married at 12 and a mother at 13, facing severe health risks, like her mother was.
Instead, she would attend primary and secondary school, and be better able to lift her family out of poverty.
Ethiopia has shown that efforts to keep girls in school can make a lasting impact, as healthy educated girls raise healthy educated children, creating a virtuous cycle that is essential to eradicating poverty and ensuring human rights, including the right to education and the right to the highest attainable standard of health.
It hasn’t been easy, but your efforts are a testament to what can be achieved in challenging circumstances when governments focus on the rights and needs of women and girls.
So let’s switch gears and talk about what is happening right now. We live in a world of seven billion people.
Many countries have larger populations of young people than ever before, and this is especially true among developing or middle-income countries.
Today, almost half the world’s population is under the age of 25, with two billion under 18. The majority of these young people live in developing countries.
Just two weeks ago UNFPA released its 2013 State of World Population Report. The topic this year is adolescent pregnancy.
UNFPA reports that two million girls between the ages of 10 and 14 give birth every year. That figure is astounding, and haunting.
Just to clarify, this isn’t that two million girls get pregnant every year; it’s that two million girls give birth, so the actual pregnancy figure can be assumed to be higher.
And 9 in 10 of these births occur within an early or forced marriage. An additional 5.3 million adolescent girls under the age of 18 also give birth annually.
These early pregnancies put girls and their children at great risk of death and disability.
Together, we must do more to ensure girls reach their full potential and are protected from early or forced marriages, as well as other forms of gender-based violence.
This conference is taking place at the same time as many global review processes are currently under way to help us reassess, realign, and rededicate ourselves as a global community to a core set of development priorities. These include:
1) The International Conference on Population and Development (or ICPD) Beyond 2014 process;
2) The 20-year review of the Beijing Declaration and Platform for Action;
3) UN-led discussions on the post-2015 development framework;
4) And given the theme of this conference, I would also add to this list the London Summit on Family Planning held in July 2012 and the Family Planning 2020 goals.
The next two years will see us through a critical juncture when governments will reflect on what is important for global development, and decisions will be made that will influence priorities for the design of aid programs and the allocation of resources.
I would argue that the lessons of the past few years and the facts with which we are presented today – facts like the information shared in the 2013 UNFPA State of World Population Report – should inform all of these various processes.
Young people – and particularly girls – must be educated and prepared with the right skills to participate in our interconnected global market of ideas and opportunity.
One element of this is secondary education, and supporting adolescents to stay in school. Another critical element is comprehensive sexuality education, which empowers young people to make healthy and informed decisions as they navigate through adolescence into adulthood.
The reproductive health and fertility decisions that the current generation of youth makes will determine their prospects as adults, and set the course for a healthy global population and economic growth for years to come.
Lessons from the ICPD Program of Action and the MDGs tell us that it is the role of governments to address the conditions that compromise a woman’s ability to exercise her reproductive rights, including the right to attain the highest standard of reproductive health. Providing services is essential, but it is not enough.
We need supportive policy and legal frameworks, as well as innovative, country-owned programs that address the needs and desires of the people they serve.
This also includes effective programming to address violence against women and children.
We know that violence seriously jeopardizes physical and mental health, often including sexual and reproductive health.
Recent research by the Together for Girls partnership shows that in many African countries as many as one in three girls and one in seven boys report experiencing sexual violence; and, one in four girls report that their first sexual experience happened unwillingly.
Those are astounding statistics, especially because we know that the consequences of such violence are devastating.
For example, about one in three young women who experience pressured or forced sex gets pregnant as a result.
And because those who witness or experience violence as children have a higher risk of perpetrating or experiencing violence as adults, we must continue our work to ensure that girls and boys are protected and that we stop this cycle of violence.
Strong public policy dictates that public health programs – which are designed to improve the health of populations – should also be designed with a human rights focus.
What does this mean? It means that public health programs should focus on the individual while serving the many.
For example, in working to meet our shared commitment to the Family Planning 2020 goal of enabling an additional 120 million women and adolescent girls in the world’s poorest countries to access and use voluntary family planning, we should ensure our programs incorporate public health approaches and goals as well as an emphasis on human rights.
I appreciate that through FP2020 additional research and efforts are under way to improve our understanding of why some women stop using particular contraceptive methods, and investments in the development of new contraceptive technologies are expanding options.
These efforts will help us to better provide the family planning methods individual women want, including by empowering them to ask for and receive specific products, with the goal of respecting and fulfilling their family planning needs and wishes.
With that in mind, let’s return to our adolescent girl who has NOT gotten married and is supported by her family to stay in school.
She likes a classmate and they are thinking about a possible future together.
But where does our girl-turned-student get the information she needs to understand her emerging sexuality and all the challenges of staying healthy as she transitions from adolescence to adulthood?
You and I know that with a little bit of help, she could be tomorrow's active community leader, lawyer or school teacher. And her children would not be destined to live a life of poverty but a life of opportunity.
Yet for many young people, particularly girls, critical decisions that shape the course of their lives are often made for them before they ever have a chance to discover who they want to be in the world or have the chance to nurture their own potential.
Every effort must be made to raise the value of girls in society, and to address the underlying conditions and beliefs that lead to early and forced marriage, as well as physical and sexual violence, which is the reality for too many young women around the world.
I applaud UNFPA for leading the way in highlighting this critical issue.
At this point, let’s turn and look to the future. Even if we reach all these shared goals that we will be discussing in the coming months, experts predict that world population is likely to reach 9 billion by 2050. The policies and programs of the coming years will have a huge impact on the world's development in the coming decades.
These factors will form the backdrop of our efforts to advance the post-2015 development agenda, and we must think carefully about them.
Our future agenda must be relevant to a changing world – we are interconnected in ways that were unimaginable even a generation ago and our policies and actions must reflect this.
Focusing on the notion of shared responsibility and collective action is the most effective way to address global inequality and inequity. The United States envisions one post-2015 agenda that addresses poverty, inclusive growth, and sustainability.
Ultimately, we want a set of goals that is ambitious, measurable, limited in number, and that can be easily explained to the general public.
Addressing the fundamental needs and development of individuals must be at the heart of the post-2015 framework.
For women, this means careful consideration of reproductive rights. For – ultimately – whether we succeed or fail, will depend on our ability to empower people, particularly women and girls, to make informed decisions for themselves.
What does that mean here in Ethiopia? We pledge to supporting Ethiopia to meet its goal of raising the contraceptive prevalence rate to 66 percent by 2015.
It’s these types of ambitious goals, coupled with committed political leadership and a large dedicated community-based workforce that can transform the lives of individuals and the development path of a country.
Civil society and NGOs are also essential to these efforts. For example, supported by funding from USAID, Marie Stopes Ethiopia is working to reduce maternal mortality by meeting the family planning needs of over 17,000 women last year alone through their MSI Blue Star social franchise network.
Another USAID partnership with Pathfinder International and John Snow, Inc. is using innovative task-sharing programs to expand access to long-acting contraceptives in rural areas through community-based provision of implants.
In the near future, our adolescent girl will consider whether she wants to go to university or not.
At some point, with brighter prospects for her future than her mother had, she may contemplate starting a family. But she will not have been rushed into motherhood by a lack of information and a lack of options.
Looking ahead, I want to assure you that the United States will continue to promote sexual and reproductive health and reproductive rights in development discussions.
When it comes to the empowerment of women and girls though, it's not enough that we simply reaffirm the goals and policies outlined almost 20 years ago.
We believe one of the positive outcomes of the ICPD, Beijing, and MDG review processes will be an opportunity for the world to take note of the progress we have made together.
After all the hard work of advocates, the private sector, governments and international and nongovernmental organizations over the past 20 years, there has been tangible progress in integrating a rights-based perspective into a wide range of policies and programs.
We have to publicize this fact and build on that momentum every which way we can.
Across the board, it’s clear we need strong global leadership and enhanced understanding of these challenges in order to continue to make progress.
On this front, we look again to civil society – including the organizations that many of you in the room today represent – to hold us accountable and ensure that our policies and programs are of the highest quality, based on facts about what is needed and what works, and meet standards of accessibility, availability, and acceptability.
It is a United States priority that women and girls everywhere achieve the freedom to decide for themselves on matters of their own sexuality so that they may enjoy strong healthy families and live in thriving communities and nations.
Together, so much has already been achieved, and the incredibly positive spirit expressed during this conference convinces me that we can do so much more.
Our efforts have the potential to transform the lives of women and girls around the world, as the life of my imaginary girl could be.
Let’s keep the world’s girls in mind as we renew our commitment to work in partnership and achieve these goals.