You only need to read the headlines every morning to know that immigration is a big issue, so the theme of this year’s session, “New Trends in Migration,” was especially timely. Today, more women are migrating than ever before, representing nearly half of the total international migrant population, and in some countries, as much as 70 to 80 percent.

During the process of migration, women and girls tend to be more vulnerable to human rights violations, particularly breaches of their sexual and reproductive health and rights including violence and sexual coercion.

In recognition of these realities, the Resolution urges governments to “incorporate a gender perspective into all policies and programs on international migration,” and to “strengthen actions to prevent and eliminate all forms of violence, coercion, discrimination, trafficking in persons, and exploitation and abuse of women and girls.”

The Resolution also calls upon governments to provide migrants with access to sexual and reproductive health services, information and education, and implement measures to prevent violence. These services include emergency contraception, safe abortion where permitted by law, and HIV/AIDS prevention, treatment, care and support.

Françoise Girard, President of IWHC, welcomed the final Resolution:

“We are pleased that governments have committed to respecting the rights and meeting the needs of migrant women and girls, given the large numbers of women who migrate for work around the world today. This agreement makes clear that health services for migrant women must include sexual and reproductive health services, including vital services for migrants who have suffered violence such as emergency contraception and safe abortion.”

The negotiations during the weeklong Commission reached tense levels over issues of whether and to what extent migrants should have access to services. The European Union and Canada, in particular, strongly opposed extending services to all migrants regardless of migration status. For its part, the Vatican once again argued against sexual and reproductive health and rights and claimed not to see any connection between sexual and reproductive health and migration—turning a blind eye to the clear needs of migrant women and girls. The Vatican was joined by conservative governments such as Nigeria, Egypt, and Qatar. In the end, however, they were unable to thwart consensus.

As my colleague Sarah explained in this post, the UN established eight international development goals, called the Millennium Development Goals (or “the MDGs”) in 2000. The MDGs were a diverse set of objectives—from eradicating extreme poverty to improving maternal health—the UN wanted to reach by 2015. Now that this MDG deadline is only a few years away, the international community is looking ahead to define what’s come to be known as the Post-2015 Development Agenda, or “post-2015.”

The United States is helping develop the post-2015 agenda. John Podesta, the founder of the Center for American Progress, is a member of the High-Level Panel, a group of 27 international government officials and civil society experts who are guiding the development of the Post-2015 framework. This agenda can go a long way in transforming the lives of women and girls worldwide, so we’re directing many of our messages to him this week. Putting gender equality at the center of a post-2015 framework can lead to greater social, ecological, and economic justice for all. A few of the issues we’d like Podesta to draw attention to are:

• Treating women and girls’ reproductive rights—including access to contraception,  safe abortion and maternal health care—as fundamental human rights
• Guaranteeing women’s rights to participate in leadership, decision-making and political participation, and enabling this by providing girls with basic skills and a quality education
• Measuring our progress towards ending early and forced marriage
• Addressing violence against women

We hope you’ll join us in asking John Podesta to make sure these issues, which will affect the lives and futures of all the world’s women, are central in the post-2015 agenda. Join the conversation on Twitter.

In his opening remarks, Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA), emphasized the rights of female migrants among the issues most important to UNFPA’s work. Osotimehin noted women and girls make up nearly half of all the estimated 214 million migrants worldwide. He continued:

Building a life in a new country can foster greater independence and  self-confidence, and create opportunities for the empowerment of women. However, breaking down established values and practices also creates tension and vulnerability. Moreover, all too often, female migration is accompanied by exploitation and abuse and trafficking across borders, especially in unregulated and informal sectors of the economy where women predominate. These women typically have limited or no access at all to health insurance and public services, including much needed reproductive health services.

This week, IWHC and other women’s rights groups will be focusing on several key issues as government delegations negotiate a resolution.

• Since a large percentage of the migrant population is of reproductive age, the CPD should ensure that women, men, and young people who migrate have access to sexual and reproductive health services, including contraception, evidence-based comprehensive sexuality education, safe abortion, and prevention, testing and treatment of sexually transmitted infections. Migrants often experience barriers to sexual and reproductive health services.
• Migration can empower women and girls and offer them economic opportunities, but it can also be a process fraught with risk. Women and girls can experience exploitation and abuse while migrating, and in the host country. It’s critical the CPD make special provisions for the protection of female migrants against abusive labor conditions, and against sexual violence and exploitation.
• Women and girls may be migrating to leave an abusive marriage, or escape gender-based violence. Current conflicts in Syria and Congo, for example, have brought about fresh crises of rape being used as a weapon of war. For that reason, migration policies must pay particular attention to the situation of women and girls fleeing violence.
• Many migrants leave their homes to escape persecution because of real or perceived sexual orientation or gender identity. States must put in place mechanisms to ensure these persons can seek refuge in a new country.
• Finally, we’ll be watching to make sure that governments respect and promote the human rights of all and provide health and social services to all, regardless of migration or national status.

IWHC staff will be at the UN this week, so watch the #CPD46 hashtag on Twitter for our live updates.

After two weeks of fierce negotiations at the United Nations’ annual Commission on the Status of Women, on March 15 more than 130 governments committed to ending violence against women and girls, and reached strong agreements to promote gender equality and ensure access to sexual and reproductive health services.

The International Women’s Health Coalition and our amazing partners from around the world came out in force to the UN for the negotiations. Our agenda was clear: push governments to commit to concrete strategies to empower women and girls and end gender-based violence.

We met with instant opposition from conservative governments. Countries such as Iran, Russia, Egypt, and Syria joined with the Vatican in what The New York Times called “an unholy alliance.” IWHC staff and our women’s rights caucus of more than 100 activists worked around the clock to support progressive delegations to stand strong and not to cave in to pressure. We would not let a small but vocal minority use culture and religion as excuses to deny women their rights.

Our efforts prevailed and consensus was finally reached to loud applause from supportive governments such as Argentina, Brazil, Denmark, Mexico, Norway, the Philippines, South Africa, Switzerland, Turkey, United States, Uruguay, and even the small island of Tonga! As the “agreed conclusions” document was adopted, hundreds of women’s rights activists streamed into the negotiating room to join in the cheers.

For the first time at the UN, governments reached consensus that survivors of rape are entitled to emergency contraception to prevent unwanted pregnancy, and to timely and respectful forensic exams to support prosecution. They called for an end to child marriages. They agreed women’s right to control their sexuality is essential to preventing further violence. And they recognized the role that evidence-based sexuality education can play in reducing the harmful gender stereotypes that lead to violence.

In a sign of just how much was at stake, this year’s meeting received an unprecedented amount of media coverage after the Muslim Brotherhood condemned (and mischaracterized) the negotiations. IWHC featured prominently in many news articles, including in The Washington Post, The Guardian, Associated Press, ABC News, The Globe and Mail, Radio Free Europe, O Estado de S. Paulo, and Reuters.

Once again, we women have shown we’re an irresistible force. But our work is far from over. Now we must be vigilant to ensure that the agreements made at the UN are put into practice in local communities worldwide.

For that to happen, we must continue to support women’s groups to hold their own leaders to account.

Best regards,

One proposal on the table would group all these concerns under the objective of “universal health coverage.” In my two-part blog series, I will discuss why this proposal falls short when it comes to women and adolescents.

Universal health coverage is defined in the draft discussion paper for Botswana as “two inter-related components: coverage with needed health services (prevention, promotion, treatment, and rehabilitation) and coverage with financial risk protection, for everyone.” Universal health insurance is considered critical to achieving universal health coverage because of the protection it can provide against catastrophic health costs and its contribution to sustainable financing. But is it enough?

Economic barriers (“financial risk”) certainly pose formidable obstacles to women and adolescents seeking sexual and reproductive health care; universal health insurance can help to address this.  But alone, it is not sufficient. In fact, health insurance schemes may contain their own barriers to care, particularly for marginalized women and adolescents.

For example, core sexual and reproductive health services, such as family planning counseling and contraceptives and maternity care, are often excluded from benefits packages that determine what is and is not covered by insurance schemes.

Abortion services are largely excluded from coverage, despite the fact that abortion is legal (on one or more grounds) in a majority of countries worldwide. Coverage of contraceptives and sexual health services for adolescents may be likewise constrained due to political sensitivities.

The level of financial protection provided by health insurance can also vary and may not be sufficient to insulate women against economic hardship.  Women consistently experience a higher burden of out-of-pocket costs for health care services than men who have similar levels of insurance coverage, largely due to non-coverage or limits on coverage for sexual and reproductive health services. Even nominal co-pays, common in many insurance programs, may pose a significant barrier if women do not have access to or control over cash.

Concerns about confidentiality and privacy may also impede access for adolescents and women when their own insurance coverage is tied to their parents’ or spouse’s coverage.  In the United States, adolescents and young women and men enrolled as dependents under their parents’ health insurance policies often choose not to use their insurance coverage to pay for sexual and reproductive health services, for fear that their parents will receive notification that they sought such care. Women covered as dependents under their husbands’ insurance policies may likewise be hesitant to seek much-needed care, such as contraceptives or treatment for violence.

Finally, the most marginalized women often fall through the cracks of so-called “universal” health insurance schemes for a number of reasons including lack of autonomy and decision-making power, or lack of information.  Women who are employed in the informal sector, women living in poverty, adolescent girls, and older women are often those least able to obtain good quality health insurance.

How do we make sure what is recommended at the Botswana meeting addresses these concerns?

I suggest a way forward in my next post.

Despite the highly gendered nature of the HIV/AIDS pandemic (women represent well over half of all people living with HIV worldwide), most prevention and treatment programming fails to account for the social determinants—violence against women, limited access to sexual and reproductive health (SRH) services, early and forced marriage, etc.—which make women and girls particularly vulnerable to the virus.

The International Women’s Health Coalition believes that effectively curbing the spread of HIV/AIDS relies fundamentally on the integration of sexual and reproductive health and rights (SRHR) with HIV/AIDS programming. The post-2015 development agenda must address the particular susceptibility of women and girls to HIV as well as the fundamental role that gender inequality plays in the spread of the virus.

Integrating SRH and HIV/AIDS services is a proven strategy for reducing new infections.   When men and women have access to HIV testing and treatment in the same spaces they seek out family planning and maternal health services, they are more likely to find out their status, learn about prevention methods, and explore treatment options.

Research has also shown that the availability of HIV services alongside other SRH services can reduce the stigma typically associated with HIV-specific programs.  Because the availability of treatment services for other STIs has been proven to reduce new HIV infections, expanding access to all forms of contraception and sexual health services through voluntary, rights-based, client-centered, and cost-effective programming is imperative.

Comprehensive Sexuality Education (CSE) should equip young people with protective sexual behaviors, the skills to effectively use condoms and other contraceptive methods, and should address gender and power, human rights and healthy relationships.  While male and female condom use is proven to reduce new HIV infections, the distribution of condoms alone is not a sufficient prevention method.  CSE should ensure that young people know how to use condoms correctly and should equip girls in particular with the tools to negotiate condom use and refuse unwanted sex.

In addition to equipping young people with scientifically sound and culturally appropriate information about sexuality, health, and rights, CSE should introduce empowering life skills to help young people navigate healthy and rewarding relationships, influence leaders in their community, and exercise their rights.

It is critical to invest in prevention efforts that target the most at-risk and overlooked populations of women and girls—adolescent girls, married girls and women, sex workers and women who use drugs. We must also ensure that treatment options are available and accessible to those living with HIV/AIDS, and that prevention and treatment efforts do not infringe on the rights of women living with the virus.

Women living with HIV/AIDS have a number of unique needs, and are particularly vulnerable to coercive sterilization practices, violence and discrimination.  They still often provide the bulk of care and support for their families, they face unmet need for contraception, and they need support to prevent vertical transmission.

Prevention of Mother to Child Transmission efforts play an important role in reducing new HIV infections, but these programs tend to focus far more attention on the infant than the mother.  The rights of HIV positive mothers must be fully protected and realized, including the right to informed consent and to choose the treatment regimens that best meet their needs.

The post-2015 development agenda must commit to addressing HIV/AIDS through targeted evidence-based prevention and treatment methods that account for the unique needs of women and girls.  Curbing the spread of HIV hinges on the transformation of discriminatory gender norms and practices, and the expansion of SRHR programming and policies. When women are able to refuse sex, live free from violence, insist on condom use, and avoid early marriage, they are able to reduce their risk of HIV infection (not to mention attend school, participate in civic affairs, and engage in healthy and respectful relationships).

Like so many of our development priorities, addressing the HIV/AIDS pandemic is inherently linked to issues of gender equality.  We must focus not only on the direct determinants of HIV infection, but also the profound gender inequalities and resulting discriminatory practices which make women more vulnerable to the virus and which stand squarely in the way of addressing its spread.

Young people all over the world face a range of unique challenges to exercising their rights.  Barriers to age-appropriate health services, meaningful education, and viable livelihoods opportunities are among the most pressing impediments to youth empowerment.

The International Women’s Health Coalition is centrally concerned with the sexual and reproductive health and rights of young people.  We believe that working with both young men and women is critical to ensuring that the rights of all young people, particularly girls, are universally protected and realized. The following contribution focuses specifically on the challenges facing girls, who continue to experience systematic social, economic and political marginalization in every part of the world.

Given the global persistence of gender inequality, many of the issues disproportionately affecting young people also tend to disproportionately affect girls. In 1997, UNAIDS reported that 60% of new HIV infections in sub-Saharan Africa were among young people (aged 15-24), with a 2:1 ratio of infected girls to infected boys.  This ratio continues to grow increasingly lopsided, with girls representing 74% of new infections among young people in 2009.

Additionally, girls face extraordinarily high rates of violence.  The experience of violence, the perceived threat of violence, or the stigma associated with being a victim of violence hinder access to entitlements, opportunities for social participation, and employment.

In developing countries, 40% of girls have their first child before the age of twenty, many before the age of 18. Not only does this mean that more girls are dropping out of school, but girls are also more likely than adults to die, experience complications, or suffer chronic injuries related to childbirth. Because they have less access to contraceptives and are less sexually experienced, adolescents are more likely than adults to seek out unsafe (often late-term) abortions.  Each year, it is estimated that 2 million to 4.4 million adolescents in developing countries have abortions, 70,000 unsafe abortions are carried out, and 13% of all maternal deaths occur as a result of unsafe abortion.

Early pregnancy is often associated with child marriage, a practice which also puts girls at increased risk of HIV infection.  Female genital mutilation, infanticide, nutritional bias—these and other harmful traditional practices disproportionately affect girls, infringing on their fundamental rights and opportunities for development.

The short answer to why these inequalities exist is that girls, especially the most vulnerable girls, continue to remain invisible. Despite the aforementioned figures, policymakers have consistently masked the specific needs of girls within “male-focused and male-dominated community-based activities and generic ‘youth’ prevention initiatives, all of which widely miss the mark” (Bruce, Temin, & Hallman, 2012).  This generic youth programming disproportionately benefits boys over girls overall, but it also favors unmarried to married girls, well-connected to socially marginalized girls, urban to rural girls, girls belonging to an ethnic majority to migrant or indigenous girls, and so on.

Girls also remain invisible because of how we measure progress.  Primary education enrollment figures, for example, are based on one day of the school year; even if there were genuine parity on this particular day, these figures fail to account for the reality that girls often miss multiple days of school each week because their domestic and reproductive responsibilities take priority.  Moreover, data on young people is rarely disaggregated, resulting in measures of participation which fail to report gender, age, marital status, and other critical factors.

The disproportionate burden that girls share for maternal morbidity and mortality, the time burdens that girls shoulder, the staggering inequalities in girls’ educational outcomes—these are all reversible realities. To tackle these disparities, we need to begin by making girls visible.  We must call for the post-2015 agenda to pay particular attention to girls and the challenges that they face.  The risks facing girls are well documented and the next step is to match the research with the necessary resources.

We need to make girls visible.

Making girls visible begins with how we count them.  By properly counting girls and disaggregating data by age and gender, we can target youth programming at specific subsets of youth—like adolescent girls.  We can also measure whether programs are actually reaching the girls who are most at risk.

We need to invest in girls.

We must invest in programming aimed specifically at girls, with an emphasis on the most at-risk populations of girls—those who engage in transactional sex, those who are forced into early marriage, those who fluently speak their native language but cannot communicate in their national language, and so on.  These programs must include the following features.

• Comprehensive Sexuality Education (CSE) must be thorough, scientifically sound, and culturally appropriate.  It should take place in a safe and healthy learning environment and it should explicitly address gender norms and gender equality.  When young people are educated about human rights, gender equality, and the role of power in relationships, they are not only equipped with the tools to negotiate their own health relationships, but they are also able to educate and influence power-brokers in their communities.
• Comprehensive services must be universally available and accessible.  This means, access to high quality sexual and reproductive health care, all forms of safe and effective contraception, safe abortion and post abortion care, maternity care, and prevention and treatment of sexually transmitted infections including HIV.
• Education is foundational to girls’ empowerment. We must ensure that all girls, no matter how poor, isolated or disadvantaged, are able to attend school regularly and without the interruption of early pregnancy, forced marriage, etc.  Education—for both girls and boys—must go beyond academics and equip young people with life skills so that they are prepared to think critically and challenge discriminatory and repressive policies and practices.
• Empowering spaces ensure girls have the opportunity to feel secure, be themselves, and plan for their safety and development.  Even if only for a few hours a week, accessing safe spaces allows girls to frame their own agendas, receive training on sexual and reproductive health and rights, and develop their social and economic capital. These participatory social spaces also foster opportunities for community-building and networking, mitigating the isolation that many girls experience.

We need to support young leaders.

We must continue to support both young women and young men to be advocates for change. Ensuring that reproductive rights are protected and promoted rests in the hands of young women and men, particularly young people throughout the global South.  Young people should be involved in all types of decision making on sexual and reproductive health and rights.  Seasoned advocates must be willing to pass the torch, share best practices, and work alongside—sometimes even be led by—a new generation of SRHR leaders.

As advocates, we can listen to one another and work in tandem to repeal legislation that legitimizes discrimination against girls and press for new protections that ensure equality of access to health services, jobs and earnings, education, property and all the rest.  Addressing the profoundly complex root causes of gender inequality (and accordingly the inequalities experienced by girls) is not a simple challenge.

As we begin to develop a tangible action plan for the post-2015 development framework, we must remain mindful that shifting the social and cultural norms that permit and promote discrimination against girls is not a simple box-ticking task. We cannot continue to view gender equality as a singular aim, but rather as both an explicit goal and an issue that needs to be mainstreamed throughout the post-2015 development agenda.

The last couple of days of the ICPD Global Youth Forum in Bali, Indonesia, have seen a flurry of around-the-clock activity by nearly 1,000 young people, adult allies, NGO representatives, academics, government officials, and other stakeholders from around the world. Their hard work is already paying off.

Yesterday, forum participants developed a number of “Staying Healthy” recommendations to ensure that governments prioritize programs that empower vulnerable young populations, including young women and adolescent girls, LGBTQI individuals, persons with disabilities, and young people living with HIV and AIDS. These recommendations are progressive, measurable, and based on evidence.

The journey has not always been easy. A small, but vocal, opposition made up of non-youth participants have attempted to intimidate and censor young people during this forum. Many people could easily have been intimidated into silence by this group, but thankfully the youth at the Global Forum refused to back down. There is too much at stake.

The “Staying Healthy” recommendations were developed as part of a consultative process following a lively plenary. In his speech, UNFPA Executive Director Dr. Babatunde Osotimehin encouraged young people to continue questioning the status quo, stating that young people are not only the present but the future. He discussed a number of issues impacting the sexual and reproductive health and rights of young people, including meaningful participation, gender equality, ending early and forced marriage, unintended pregnancy, maternal mortality, and the needs of both married and unmarried adolescents. Osotimehin described the process of meeting the sexual and reproductive health and human rights of young people as “A journey of 1,000 miles [that] starts with the first step.”

Indonesian Health Minister Nafsiah Mboi also spoke at the plenary and was met with rousing applause when she stated that, “We have the responsibility to fulfill and promote the health and human rights of young people,” that, “Young people need to be empowered in all aspects of their life,” and that, “It is a fundamental human right of adolescents and youth to access comprehensive sexual and reproductive health education and services.” In Indonesia, there are more than 65 million young people aged between 15 and 24 years old and only 21 percent of them have comprehensive knowledge regarding HIV/AIDS. Sexual transmission of HIV accounts for the vast proportion of new HIV infections among young people and unmarried girls cannot access contraception. Despite these facts, Mboi stated she believes that “The government has an obligation to provide education and services on sexual and reproductive health that are equitable, affordable, and accessible.” For the tens of millions of Indonesian young people in need of information, services, and protection of their human rights, we are optimistic when she says that “You can count on me, I won’t let you down.”

I am thrilled that the final consolidated “Staying Healthy” recommendations articulate a clear, comprehensive, and human-rights based vision as to where the global community needs to focus attention and resources to secure the health and human rights of all young people, and in particular the most marginalized and vulnerable which include adolescent girls and LGBTQI individuals.

These young forum participants deserve our applause for remaining steadfast that this must remain a youth-led and youth-driven process. They stood strong as did UNFPA, which made it clear in various ways that this is indeed intended to be a youth-led and youth-driven process. Displeased with the final consensus recommendations consolidated from the 15 Staying Healthy breakout sessions, the vocal minority of non-youth unconstructively confronted forum participants, after the recommendations were presented during the plenary. During my own breakout session, this same minority consistently opposed suggestions concerning individual rights, and access to safe abortion and contraception.

In contrast to this small group, many other government and non-youth forum participants from around the world stood out as great allies to the youth participants in support of this set of recommendations. The final “Staying Healthy” recommendations will be released as part of a consolidated set of recommendations including the other forum themes: “Decent Work,” “Sexuality, Family and Rights,” “Education,” and “Leadership and Meaningful Participation.” We at the International Women’s Health Coalition look forward to sharing the final recommendations with you when they are released. Stay tuned!

The discussions at the Global Youth Forum are intended to feed into the review of the ICPD Programme of Action, or the “ICPD Beyond 2014,” review process. The outcome document and recommendations that emerge from this forum have the potential to influence larger discussions among world leaders about global development priorities beginning in 2015, after the current Millennium Development Goals expire. The International Women’s Health Coalition and our partners are working to ensure that the new development agenda includes targets to help young people achieve a healthy, safe, educated, and empowered future.

In preparation for the meeting, I am participating in a two-day expert workshop facilitated by UNFPA along with approximately 70 young people, representatives from non-governmental organizations, and other stakeholders. Together, we will be the backbone of the meeting in terms of facilitating, rapporteuring, and ensuring that the outcome document developed captures the various recommendations gleaned from the more than 75 small group or “World Café” breakout sessions that will take place throughout the December 3 – 6 meeting on five different themes (Staying Healthy, Comprehensive Education, Sexuality, Family and Rights, Transition to Decent Work, and Leadership and Meaningful Participation).

I am consistently impressed with the level of expertise, poise, and passion of the youth leaders from around the world who are driving this process, and I look forward to finding as many ways as possible to support them in their leadership roles throughout the forum so that specific, meaningful, and visionary recommendations are developed during the breakout sessions.

If you are not one of the 1,000 participants at the forum in Bali, Indonesia, this week, fret not, there are still many ways in which you can articulate your ideas and opportunities to make progress on a range of issues impacting young people in your community. Go here to find out more and make sure you follow and take part in the conversations taking place on Twitter through #icpdyouth.