Last summer, UN Secretary-General Ban Ki-moon established the High-Level Panel (HLP), a group of 27 international government officials and civil society experts, to guide the development of the Post-2015 framework. The HLP recently convened in Bali for a meeting before they submit recommendations to Ban in May. Along with more than 100 youth delegates, I participated in a parallel youth multistakeholder meeting, which included an outreach event with key players such as High Level Panelist John Podesta of the Center for American Progress and Homi Kharas of the Brookings Institute.

In preparation for our meeting with the HLP, we were tasked with the impossible: to distill the vision and priorities of young people, all 3.5 billion of us, into a tidy presentation on what we hope to see in the next development framework. Compelled by this rare opportunity to provide direct inputs into what continues to be a frustratingly inaccessible process, we managed to catalog what matters most to young people, drawing on our own discussions as well as outcomes from prior and ongoing post-2015 youth meetings. Gender equality and sexual and reproductive health and rights (SRHR) emerged as areas of strong thematic consensus.

The Youth Communiqué, which documents the outcomes of the Bali youth meeting, calls for a transformative and transparent new development agenda, and includes strong language on inclusion and rights.  We also call for a number of commitments to gender equality and SRHR, including universal access to quality education (including Comprehensive Sexuality Education) and youth-friendly health services, a commitment to gender equality, the elimination of gender-based violence and the recognition of young people’s diverse sexual orientations and gender identities.

Inclusion was a striking theme of this meeting.  As we discussed the need for meaningful youth participation on the whole, we highlighted the challenge of ensuring that the most marginalized young people are included in the next development agenda.  Drawing heavily on commitments made during the 2012 Global Youth Forum, we demanded the recognition of young people with disabilities, sex workers, indigenous youth, and young people living with HIV/AIDS as valued stakeholders in the Post-2015 Development Agenda process.

Upcoming events throughout the summer (including another HLP meeting in mid-May and the ICPD Regional Reviews) present immediate opportunities for young people to mobilize yet again.  We must use these opportunities not only to further define our asks and non-negotiables, but also to continue challenging the limited and often superficial opportunities for meaningful youth participation. The fight is far from over. It’s crucial that we build on the momentum from Bali to claim this agenda as our own. 

But an equally important weakness of universal health coverage as a concept is that it fails to address the non-economic factors that play a significant role in determining whether women and young people can access and use the health services they need. These factors include:

• Laws and policies that restrict access, such as policies requiring parental or spousal consent or couples treatment, or laws that restrict the provision of and access to certain services, such as safe abortion.
• Social and cultural norms and practices that embody persistent gender inequalities. This can result in, for example, low immunization rates for girls or stigma and discrimination when unmarried women seek sexual health services. These norms and practices can keep women and girls from using services that are otherwise available.
• Lack of individual empowerment, information, and education, which impede women’s and adolescents’ knowledge about health and health-seeking behaviors.
• Weaknesses in health systems that may result in poor quality of care or inaccessible, inadequate, and inappropriate services. These range from resource issues such as the inequitable distribution of services between urban and rural areas and insufficient numbers of trained health care workers to systemic problems like discrimination and abuse of marginalized patients, including women, adolescents, and people who are lesbian, gay, bisexual, and transgender.
• Other social determinants of health, such as food and nutrition, security, water and sanitation, and other environmental and occupational factors that can have specific negative health consequences for women and girls, including for their sexual and reproductive health.

A draft discussion paper prepared for next week’s Global Leadership Meeting on Health acknowledges the critical gap of universal health coverage in addressing the social determinants of health and other barriers to health care. Indeed, this gap might even make universal health coverage something of a pipe dream when sexual and reproductive health is on the line. Without concomitant efforts to address these and the economic factors outlined in my previous blog, women and girls will continue to face challenges accessing and using sexual and reproductive and other critical health services and exercising their rights. The government and civil society leaders meeting next week would do well to discuss the full range of factors that can facilitate or impede people’s ability to achieve the highest attainable standard of health.

We at the International Women’s Health Coalition hope that global leaders agree to take a more holistic approach to improving health care by recommending development goals specifically for women and adolescents—two population groups who face the biggest barriers to care and whose health is critical for overall development. Such an approach would allow for focus on the particular health challenges faced by women and young people, the contextual factors that can jeopardize their health and erect barriers to care, and the specific interventions needed for both prevention and treatment of health conditions.

Universal health coverage is important, but it alone is not enough to guarantee access to health services and improve health. We need specific goals that address the diversity of barriers to care faced by women and adolescents, along with a dose of political will and resources adequate to meeting these goals.

Not only does VAWA protect women and girls in the United States from violence, but it also ensures that the U.S. is doing its part to protect girls from being forced into early marriages. Ending early and forced marriage is vital to the goal of ensuring that girls around the world are able to lead healthy, empowered, educated, and safe lives. As Senator Durbin, a champion on this issue, stated just after the vote, the bill’s “new mandate for a multisectoral strategy to end child marriage is an important step forward and now we must focus our efforts on ensuring it is developed without delay and its implementation is fully funded.”

The passage of this bill is a testament to how various communities that care about the health and safety of women and girls can come together to fight for what is necessary and what is right. It is also a testament to the hard work of steadfast leaders in the United States Congress on this issue, such as Senator Durbin (D-IL), Congresswoman McCollum (D-MN), Congressman Aaron Schock (R-IL), and former Senator Olympia Snowe (R-ME). We congratulate them on this accomplishment and thank them for their service to women and girls around the world.

For more reactions from communities and Congress, please see:

• Reps. McCollum and Schock Applaud House Passage of Child Marriage Prevention Strategy in Violence Against Women Act
• Interagency Working Group – “Congress Passes Violence Against Women Act”

As I reported previously, the ICPD Global Youth Forum in Bali earlier this month brought passionate engagement by young people committed to securing a healthy and just life for youth worldwide. The Forum closed on December 6 with a celebratory reading of the key recommendations from the various multi-stakeholder consultations that took place related to five themes: Staying Healthy, Education, Decent Work, Youth Leadership and Participation, and Families, Rights, and Sexuality.

The key recommendations are included in a public declaration. Please take a look and share your thoughts with us. We here at the International Women’s Health Coalition are thrilled that young people and adult allies from governments, civil society, the private sector, multilateral agencies, and other stakeholders from around the world spoke out in support of a bold and progressive vision for what the global community must do in partnership with youth to achieve the largest generation ever of educated, empowered, safe, and healthy young people.

Only by working together as a global community and as individuals can we realize this bold and achievable vision of what young people want, need, and deserve. UNFPA Executive Director Dr. Babatunde Osotimehin rightly 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.”

We look forward to working with and on behalf of young people to realize the key recommendations contained in the Bali Declaration, including with UNFPA which did an exemplary job ensuring that the process remained youth-led and youth-driven. We simply cannot progress as communities and nations without continuing to make these important leaps forward on our collective journey of 1,000 miles to secure an educated, empowered, safe, and healthy future for all.

Will you join us?

Researchers estimate that 35,000 pregnancies occur every year in Peru as a result of rape. Women and girls in this situation are faced with two options: seek an illegal abortion and risk going to jail or carry the pregnancy to term and suffer the psychological and physical trauma that go along with giving birth to your rapist’s child. Women who can prove that a pregnancy is the result of rape receive a “reduced” sentence of three months in jail (the standard prison sentence for illegal abortions in Peru is two years). Perversely, this reduced sentence does not apply to married women who are raped by their husbands, even though marital rape is a crime under Peruvian law. Doctors who perform abortions in cases of rape face up to six years in prison.

On September 28, 2012, a coalition of women’s rights groups launched a campaign to challenge this cruel violation of human rights. The campaign, Dejala Decidir (“Let her decide”), seeks to introduce a new law that decriminalizes abortion in cases of rape (currently, abortion is only permitted when the woman’s life or health is at risk). The groups, led by partners of the International Women’s Health Coalition—PROMSEX, Demus, Catholics for the Right to Decide-Peru, Manuela Ramos, CLADEM-Peru, and Flora Tristán—need to collect 60,000 valid signatures to petition Congress to consider the bill.

Photo courtesy of PROMSEX

This is no small challenge. The requirement for valid signatures means that people must be willing to provide their government ID numbers to verify their identities. This may be intimidating to many people in a country where the Catholic Church exerts a great deal of influence in the government and within communities. Consider also that many people in rural and indigenous communities—especially poor women who are disproportionately impacted by the abortion ban—do not have government IDs. Even if the campaign succeeds in obtaining 60,000 valid signatures, there is no guarantee that Congress members will risk controversy or the ire of the Catholic Church and support a change in the law.

The groups see the Dejala Decidir campaign as an opportunity to build a powerful and active movement on two important but neglected issues: abortion and rape. Every signature represents at least one more person informed about the harsh realities faced by rape victims in Peru, and mobilized to change the current abortion law.

George Liendo, Director of PROMSEX, says the time is ripe for a national dialogue. “It’s not always easy to build a coalition in Peru, but there is real energy for this campaign. People across the country want to put this on the political agenda.”

Peru is not the only country in the region rethinking its draconian approach to abortion. In October 2012, the Uruguayan congress voted to decriminalize abortion in the first twelve weeks of pregnancy.

Activists in Peru have until October 2013 to collect enough signatures to ask their own Congress to act. In the meantime, we can expect a rich and lively dialogue on rape and abortion. It’s about time.

This blog was cross-posted on RH Reality Check at http://www.rhrealitycheck.org/article/2012/12/19/double-jeopardy-rape-victims-in-peru.

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.

The numbers are staggering. Every year, 10 million girls under the age of 18 enter early and forced marriages, usually to men much older than they are. By becoming a child bride, a girl gets nearly every odd stacked against her.

This epidemic received much-needed attention last month during the first-ever International Day of the Girl Child. At events worldwide, government leaders and influentials acknowledged that early and forced marriage is a grave violation of girls’ human rights. Indeed, these girls are powerless within their families and societies, and experience strong disadvantages to their education and health.

But to end child marriage, we need more than one day. We need real action both at the international policy level and at the local level where it affects girls the most. We must prioritize the promotion of girls’ empowerment to give them a chance to succeed. As Archbishop Desmond Tutu said on the inaugural Day of the Girl Child, “we call on the international community to promise a different life to girls — a life of their choosing.”

Thankfully, local organizations around the world are working in developing communities to do just that.

One example of a community organization successfully working towards this goal is APAD – in English, the Association for the Promotion of the Independence and Rights of the Girl Child.

Led by survivors of child marriage, APAD works to make sure girls like them have a choice and a chance. APAD members are not only survivors; they are leaders in the fight for the elimination of early and forced marriage in the extreme north of Cameroun. By working within their own community, they have the unique knowledge and skills that enable them to effectively enact change. Learn more about the work of APAD by watching the video below:

Click here to view the embedded video.

Support grassroots groups working to end child marriage. Give to our partner APAD, directly through IWHC’s campaign on GlobalGiving.org – especially during the month of November, when APAD competes to win a featured spot on Nike’s Girl Effect campaign. Winners also receive a share of the Girl Effect Fund, which raised $375,000 last year.

To win, APAD needs as many people as possible to make donations this month. It’s not about how much you give, but about how many people give. Will you help support the fight against child marriage?

The fall is in full swing and so are we at the International Women’s Health Coalition!

We continue to push the U.S. Government to take greater, concerted, and strategic action to prevent the early and forced marriage of millions of girls in key countries and to support the more than 60 million girls who are already married. It goes without saying that global development goals will not be achieved without women and girls, and that women and girls cannot thrive when they are married off as children, against their will, and often to much older men. Yet in a number of countries around the globe today, more than 40% of girls are married before the age of 18. Our colleagues at the Ford Foundation put together a fascinating report on the situation around the world.

On October 11, 2012, the world marked the first International Day of the Girl with many events around the world, including Too Young to Wed, a haunting exhibition by photographer Stephanie Sinclair. IWHC, as co-chair of the U.S. chapter of Girls Not Brides: the Global Partnership to End Child Marriage, collaborated with organizations around the world to raise the profile of this issue.

A day before, on October 10, I participated in a small closed door meeting at the State Department in Washington, DC that included Secretary of State Hillary Clinton, Archbishop Desmond Tutu of the Elders, Dr. Babatunde Osotimehin, Executive Director of the UN Population Fund (UNFPA), and Luis Ubiñas, President of the Ford Foundation. It was a special thrill to meet Tutu – such a humble and inspiring man! Shortly thereafter, Secretary Clinton announced some welcomed steps, such as a USAID-funded project to get girls into schools in Bangladesh and a one-year program to keep girls in schools in the Democratic Republic of the Congo. Still, we had hoped for quicker and more decisive action from the U.S. Government – these girls should not and cannot wait! Other commitments were also announced on that day – $25 million from the Ford Foundation and $20 million from UNFPA to prevent child marriage, and $39 million from the MacArthur and Mastercard Foundation for girls’ education. There is still time for the U.S. government to do its part. We will keep pressing the Administration to provide the leadership and resources these girls needs to live healthy and just lives.

We’ve also received positive news from our partner and grantee MYSU – Mujer y Salud en Uruguay (Woman and Health in Uruguay). After a 12-year battle, the Uruguayan Congress passed a bill last week that will allow abortions on any ground in the first trimester of pregnancy, and President Mujica just signed it into law. True, the law continues to stigmatize abortion and contains odious provisions that will force women to “explain the circumstances that surrounded the conception…”(!) to their doctor, go before a hospital committee to hear about “alternatives to abortion,” and endure a five-day waiting period. Nevertheless, this is a very significant step in Latin America, where women still face severe legal restrictions to safe abortion except in Mexico City, Guyana, Cuba, and Puerto Rico. IWHC first gave a grant to MYSU for this work in 1999, and we have supported them steadfastly through the many twists and turns along the way. Two years ago, for example, a more liberal law passed the Uruguayan Senate, only to be vetoed at the last minute by then President Tabare. MYSU and their allies have their work cut out for them to make certain the new law is implemented in such a way that barriers to safe abortion are removed, not reinforced. Social and policy change does require patience and staying the course!

For more news, follow IWHC and me on Twitter at @IntlWomen and @francoisegirard, or go to our website www.iwhc.org

Best regards,