The Millennium Development....Guys?

Editor's note: This article was updated at 1:02 pm Wednesday, July 7, 2010 to fix typographical and grammatical errors and to insert a quote.

Consider these truths:

Men don't get pregnant.

Completely preventable complications of pregnancy, labor, unsafe abortion and AIDS-related illnesses remain the leading causes of death and disability among women in countries throughout the world due to lack of political will, lack of funding, and the politicization of sexual and reproductive health by fundamentalist religious and political actors. 

Women now make up the majority of those infected with HIV worldwide and over two-thirds of those infected in sub-Saharan Africa.

Women and girls continue to face profound discrimination in access to education, employment, and political power in virtually every country (yes, including the United States).  Women continue to experience high rates of sexual violence and coercion, high rates of child marriage, and low rates of access to basic reproductive and sexual health care, including safe abortion.

The health and well-being of newborns, infants, and children rests primarily on women.  In communities riven by poverty, violence and discrimination, the death of a mother too often results in the neglect, deteriorating health, abuse, or death of her child(ren).

Consider also that virtually all of these issues remained invisible--or just plain unimportant--to the largely male power structures in every country for the past several decades, until the global women's movement gained traction in their fight to put them on the global agenda.

Given these realities, it would seem that appointments to a recently convened United Nations High-level Advocacy Group focused on pushing for progress on the Millennium Development Goals would take pains to put high-level women in charge--at least in equal numbers to their male counterparts--of advocating for maternal health, child health, and HIV and AIDS, as well as those "other things" like economic development, in which women, as all the development literature has repeated ad nauseum for 40 years, are essential actors.  

Someone, somewhere, did not get the memo.

A "final" July 1 2010 list of prominent individuals circulated by the United Nations End Poverty 2015 Millennium Campaign comprising the "Global Advocacy Team" indicates that not one woman has been assigned to Millennium Development Goal (MDG) 4 (to reduce child mortality), MDG 5 (to improve maternal health), or MDG 6 (to combat HIV and AIDS and malaria). 

This is, quite simply, astounding. 

And yet, its not.  Because in the pattern of all things having to do with women's health--whether we are talking about Utah or Nebraska, Uganda or the United Nations--there are other truths.  Men continue to control the agenda and to decide how much or how little money and attention will be paid to ending the epidemic of pregnancy- and sexually-transmitted infection-related deaths and illnesses that robs millions of women of their lives and health every year worldwide.  Men continue to decide what priorities will be on the table when they do "pay attention" to these issues, and when they won't, for reasons of their own political or financial agendas or their own ideological or political affiliations or all of the above, address honestly one of the leading and most preventable causes of pregnancy-related death and illness, that being unsafe abortion. Men continue to decide  whether they will, for the sake of ideology cloaked as "common ground," push for abstinence-only-until-marriage programs that leave women disproportionately vulnerable to HIV and AIDS, leave the issue of safe abortion out of research and international documents, confront other issues like stoning as "adulterers" women who've been raped, or "accept" that ending the war in Afghanistan likely means leaving women to the "mercy" of the Taliban.  Men decide whether we can talk about women's health writ large, or even their sexual and reproductive health writ large, or only about the mommas and the babies.

So when I received from a colleague the PDF file containing the list, having been here and done this before, I knew to some extent I already knew the story. I also knew my obligations and therefore in an effort to find out more about this group yesterday, I called numerous colleagues in the advocacy and policy field as well as the UN Campaign office itself.  I also emailed a contact in the office of the UN Secretary General.  I did not hear back from any of the UN spokespersons as of this writing, but of those colleagues I reached they were, to a person, shocked at the composition of assignments on the list.  Most had not yet heard that this group had been convened, and a couple suggested that the role might largely be for public relations, as the September 2010 UN Summit on Millenium Development Goals in New York approaches.  In other words, every one of these colleagues had virtually the same reaction as I did on receiving this list: A combination of "How could this happen?" "Where are the women's advocacy leaders that have worked so hard on these issues the past 20 years?" and "Business as usual."

Let's be clear: Every one of the people on the list of UN MDG campaign "advocates" is a prominent person. The list includes Ted Turner, who provided the original funding a decade ago for the establishment of the UN Foundation, under the umbrella of which--in full disclosure--RH Reality Check now exists.  The list includes, but is not limited to well-respected men such as Jeffrey Sachs (all MDGs) director of the Earth Institute at Columbia University, Bill Gates (MDGs 1, 4, 5, and 6), founder of Microsoft, and of the Bill and Melinda Gates Foundation, Julio Frenk, Dean of the Harvard School of Public Health (MDGs 4,5,6, and 8), Akin Adesina, Vice President of the Alliance for a Green Revolution in Africa (AGRA) (MDG 1, extreme poverty and hunger), Muhammed Yunus, founder of the Grameen Bank (MDG 8 on poverty), Philippe Douste-Blazy (France) UN Special Advisor on innovative financing for development (MDGs 4, 5, 6 and 8), and Paul Kagame, President of Rwanda and a co-chair of the group. 

The women include, among others, Stine Bosse (Denmark), CEO of TrygVesta Group, Chairman of Børnefonden (The Childrens’ Fund) (MDG 3 on gender equality and the empowerment of women); Wangari Maathai (Kenya) Nobel Peace Prize Winner, environmental and political activist (MDG 7 on environmental sustainability); Dho Young-Shim (Republic of Korea) Chairperson of the UN World Tourism Organization’s Sustainable Tourism for Eliminating Poverty (ST-EP) Foundation (MDG 2 on universal primary education); HHS Sheikha Mozah Bint Nasser (Qatar) First Lady, Chairperson of the Qatar Foundation for Education, Science and Community Development (MDG 2) and Graça Machel (South Africa / Mozambique), former First Lady, advocate for women’s and children’s rights (MDG 3, gender equality and the empowerment of women).

So why is it that Bob Geldof, the Irish singer and political advocate is being assigned to advocate for "all MDGs"--including those addressing maternal and child health and HIV and AIDS, when Michelle Bachelet, the former president of Chile who grappled directly with high rates of unintended pregnancy and unsafe abortion in her own country, is assigned only to the MDG focused on gender equality and empowerment? (The MDG, by the way, which everyone agrees is the lowest priority in terms of funding and which also can't be separated from the others.) Geldof and his colleague Bono--no matter how well-intentioned--both are associated with the ONE campaign, which, while it advocates for ending poverty in Africa, has also advocated for abstinence-only-until marriage programs in PEPFAR, to deny HIV-positive women access to family planning services, and against efforts to address safe abortion as an integral aspect of women's health and rights.

Why is it that Sachs is covering all MDGs including all of those of greatest concern to women's health, but Graça Machel, Sheikha Mozah Bint Nasser, Bachelet and Young-Shim are not?  Machel and Maathai both actually live in and are from sub-Saharan Africa, the region in which pregnancy-related death and illness, complications of unsafe abortion, HIV infections and deaths among women from AIDS-related illnesses, violence and all the rest are perhaps more pervasive than anywhere else. To whom does this make sense?

Why is it that Bill Gates is covering all the MDGs of greatest concern to women, but real women leaders, including those who fought to put these issues on the global agenda and have studied, worked on, and staffed actual health facilities working to promote both prevention and treatment are not?  It is true that the Gates foundation is providing $1.5 billion for maternal and child health programs over the next five years, a laudable contribution. It is however one that will almost certainly fail to make real headway on reducing the toll on women, families, communities, and economies of pregnancy-related illness and death in part because the Gates Foundation will not--whether out of political or religious or other concerns--address or apparently even speak about unsafe abortion, which in some countries accounts for a third or a half of all maternal deaths.  Moreover, the representation of funders in this group creates an immediate conflict of interest, reducing the likelihood that any uncomfortable issues will be raised.  The Gates Foundation funds Sachs' Earth Institute, for example. The ONE Campaign and the Gates Foundation partner on the "Living Proof" Campaign to highlight successful global health initiatives; yet as a colleague pointed out the original materials made no mention of the role of increased access to voluntary family planning, recognized worldwide as one of the single most successful health interventions in the past four decades. And a recent study of maternal mortality funded by the Gates Foundation and published by the Lancet made no mention--not one--of the toll on women of unsafe abortion.  [The UN Foundation does not censor content of RH Reality Check in any way.]

The bottom line is this: We can not solve problems if we can not talk about real life.  And we can't continue to fool ourselves that we are just "following the lead of what country governments want," when so much of what they want is determined by the funding available to them, and so many of them remain pathologically undemocratic, especially when it comes to the representation of women and their rights.

Why is it that there are only six women in a group of 19? Where are the amazing female physicians, researchers, advocates, youth organizers who work, write, speak, and organize on these issues every day, often with few or no resources? Of the many who are prominently known and have deep legitimacy in the women's movement, could more of those not have been included?  What about someone representing the devastating disparities in maternal and infant health outcomes by race and ethnic status in the United States, the part of the "most powerful country" that most resembles a poverty-stricken nation?

What gives? Is someone concerned that a woman like say, Michelle Bachelet, will speak truth to power on issues of greatest concern to women that funders and politicians want otherwise to avoid?

It is clear to me that if women with legitimacy in the women's movement and as social justice and health advocates were leading this effort, many more salient issues would be on the table, including but not limited to safe abortion services and maternal mortality. But that would change the entire power dynamic.

I believe all these people have the best intentions.  I also believe the time has long passed when the UN, the U.S., and any and all other political bodies can continue to talk about the importance of women, and keep putting men in charge. It is long past time to confront the "advocacy" groups that continue to put more stock in the concerns of fundamentalist religious groups and far-right politicians than in the lives of real women. Does anyone see the gross irony in talking about "the empowerment of women" when we can't even get equitable distribution on a UN "high-level" advocacy group?

Does anyone else see the even greater irony, as Stephen Lewis, founder of AIDS-Free World and formerly the first UN Special Envoy on HIV/AIDS in Africa, underscored to me "that the better than two-to-one ratio of men to women advocates comes within one week of [the U.N.'s announcement] creating UN Women (the United Nations Entity for Gender Equality and the Empowerment of Women), the new international agency for women, while boasting about gender equality"?

Thomas Paine is said to have originated one of my favorite quotes often used by colleagues in the global AIDS movement: "Lead, follow or 'get out the way.'"  In other words, if you are not interested in the real problems and the real issues, let others lead.

It's time for women to take the reins on these issues and lead, without apology.  It is time for us to confront more directly the power structures that result in the discussion time and again of the same issues with relatively little progress made. And it is time to hold the leadership of the UN and others accountable for putting their own rhetoric into practice.

Follow Jodi Jacobson on Twitter, @jljacobson