NB Health Care

Tuesday
January 27
2015

Adam Lewis

Peaks Unclimbed: Former Malawi President Joyce Banda discusses how the Millennium Development Goals have failed to deliver for girls and women

Well, we made it. We’ve reached 2015. The countdown to the most monumental milestone in the history of international development has reached its final stretch as the deadline for the Millennium Development Goals quickly approaches. There has been no greater force for good in the fight against poverty and disease than the MDGs, having improved the lives of billions of people (yes, with a “b”) in one fell swoop of eight goals, thousands of committed partners and communities, and billions of dollars in support.

But if the MDGs are Mount Everest, we’re currently sitting on a plateau somewhere halfway up: Progress is as undeniable as it is unprecedented, yet most of the goals remain unfulfilled. We are the climbers alternating glances at the outstanding summits and the path ascended. And as tempting as it may be to marvel at how far we’ve climbed, Forbes’ “most powerful woman in Africa in 2014” believes that we will be judged by the peaks we couldn’t reach, and the millions of girls and women hanging in the balance.

“We’ve reached 2015 and it’s clear that great progress is being made,” former President of Malawi Joyce Banda recently told me (in a rare and eminently generous conversation). “But when we take stock of the MDGs, we will find that we’ve come up short for our girls and women.”

According the United Nations’ official MDG Progress Chart, two of the goals lagging furthest behind are MDG 3 – which aims to promote gender equality and empower women – and MDG 5 – which aims to improve maternal health. Neither goal will be met; and in the eyes of Banda, it’s because we didn’t pay enough attention.

“I don’t know how we can face the women of the world and say ‘the MDGs are up and we achieved some, but we failed on 3 and 5.’ How can we tell them that their health and equality simply wasn’t a priority?”

(The UN Millennium Development Goals, via Facebook.)

This joint failure – or perhaps mitigated success, to those with half-full glasses – should come as no surprise to a global development community steeped in evidence linking women’s equality and empowerment to their health. Women dying in childbirth are rarely those who are educated, earning a fair wage or in a position of leadership. Instead, the nearly 300,000 women who still die each year as they give life are the ones who aren’t able or allowed to attend school. The ones who get married off as teenagers. The ones who need permission from their husbands to seek health care outside their homes. The ones who have no say in whether they have one child, or two, or five, or 10 – despite often being children themselves.

This empirical connection between social standing, economic status and health among women is arguably the most important yet elusive hurdle in the push to end poverty and disease. And like many development experts immersed in the reality of these issues, Banda maintains that overcoming this challenge requires a trident, not a sword – a multipronged effort versus a unilateral solution. In her words, “We must take a holistic approach to improving women’s lives, one that accounts for all the social factors affecting women.”

Evidence from a fellow East African country corroborates Malawi’s former leader’s counsel. Rwanda, one of the MDGs’ biggest success stories following its horrific genocide, has demonstrated the far-reaching impact of this holistic approach toward women’s health and rights. Since the declaration of the MDGs, it has implemented policies and programs that have grown its female representation in parliament to a world-leading 64 percent; propelled it to No. 7 in the world in gender equality (trailing only the Nordic countries and Nicaragua); and achieved equal attendance among girls and boys in primary and secondary school. It’s no wonder that its maternal mortality ratio has plummeted by more than three-quarters since 1990, one of the most impressive advancements in the world.

These parallel trends underscore exactly what Banda emphasized during our conversation. As she explained, women’s progress hinges on five mutually reinforcing “pillars” that have become the focus of her work and that of her foundation:

1. Income: “When poor households begin to earn income, they can afford to send children to school (particularly girls), and they stop looking upon children as wealth, as many families do. And for women, economic empowerment means respect; it means they can contribute to household decisions.”

2. Education: “In most developing countries, secondary education is not free, so girls are sent off to be married when they’re very young. Sadly, childbirth is a leading cause of death for teenage girls around the world. Many more girls suffer fistula, and the social stigma that comes along with it. Ensuring those extra years of education can protect girls from early marriage and pregnancy, also giving them the skills and knowledge to earn income later in life.”

3. Maternal health: “I refuse to accept that women still die giving life. In the West, pregnancy and childbirth is a time of joy and celebration; in Africa, it is a time of anxiety. We don’t plan for the birth of a baby because we don’t know if we will come back. In the West, pregnant women are ‘expectant mothers.’ In Malawi, we call them ‘sick mothers.’ Safe motherhood must be a priority in all countries.”

4. Leadership: “I have found that leaders at the grassroots level who are sensitized and prepared to fight are the ones who can create change. In Malawi, if a village chief says, ‘Go to school,’ families will send their children to school. If he says, ‘Deliver in a facility,’ women will give birth in a facility. But we also need women leaders in the village, in the boardroom and in the statehouse. Women’s leadership plays a role in ensuring that all women can have a better life, especially when men in power refuse to make this their concern.”

5. Rights: “This pillar is the thread that ties the other four together. Without rights, women will have no chance of earning income, receiving education, ensuring quality maternal health care and pursuing leadership positions. We must stand up against traditional beliefs holding us back and ignite a cultural shift in how we approach human rights.”

As Banda shared this bold vision with me, I couldn’t help but think of the Mount Everest analogy and our own unfinished climb. Twelve months from now, the development community will rightfully applaud its ascent, and all the tremendous feats of the MDGs. But, with summits still in sight, we’ll soon turn to the Sustainable Development Goals, a new and ambitious mountain presenting similar challenges and loftier targets.

I find myself inclined to join the former president as she takes in the view from our current plateau, eyes gazing upward at the peaks unclimbed, the girls and women unreached. Unless we learn how to scale those final summits, we run the risk of repeating our failures. And until we do, the world’s most vulnerable girls and women – like those Everest peaks – will be left high and dry.

Adam Lewis is a senior associate at Rabin Martin, a global health strategy firm in New York.

Categories
Education, Health Care
Tags
education, government, health care, leadership, reproductive health, Women