Published on Voices

Women Deliver: Investing in Reproductive Health

Mother and newborn baby in a clinicThis week I had the pleasure of attending Women Deliver 2013 in Kuala Lumpur, Malaysia — the largest global gathering of the decade to focus on the health and well-being of girls and women. The conference convened several thousand people from 140 countries — including many ministers and parliamentarians — to generate momentum and political commitment for girls’ and women’s rights and reproductive health.

We heard the voices of the wealthy and powerful — like Melinda Gates and Chelsea Clinton — as well as the voices that too often go unheard — including young people, sexual minorities, widows, women with disabilities, and women living with HIV and AIDS. I was really inspired by the passion of all the participants — of whom, by the way, 40% were male, quite a high proportion for gender events — and was reminded that the safe and healthy experience I had having my own kids is so far from the reality of many millions of women around the world. 

The World Bank was asked to prepare the background paper for the conference, which I presented in the opening plenary. I highlighted four key messages:

  • We can celebrate the gains we have made toward gender equality over the past three decades, but there is still more to do, particularly when it comes to maternal health.
  • Investing in women’s health has intrinsic value, but it is also smart economics. Substantial benefits accrue to individuals, households, and even nations.
  • Women’s lack of agency, alongside weak accountability, are key factors driving poor reproductive health outcomes.
  • And finally, where there is evidence, we need to act on what we know is working; and where knowledge gaps limit our understanding and accountability for results, we must fill these gaps. 
In the paper we show that agency — or a person’s capability to advance goals that he or she values — is a very important part of the story. In Bangladesh, for example, women who had more decision-making power were more likely to access prenatal services and have skilled deliveries compared to women with less power at home.
The graph below depicts Demographic and Health Survey (DHS) data across 54 low- and middle-income countries (latest year available), and shows that nearly 4 in 10 married women have no say in their own health care. And for young women the constraints on agency may be more severe.  Globally more than one-third of girls are married before their 18th birthday, and we know that young brides are less likely to finish school, more likely to have earlier riskier pregnancies, and more likely to experience violence.
Demographic and Health Survey (DHS) data across 54 low- and middle-income countries
These messages went over well at the conference and in the media, with coverage from Thomson Reuters Foundation and PBS, as well as news sources in Asia and Africa. Highlights from our paper were also published as a comment in a special Women Deliver edition of The Lancet. Continuing the momentum well-established by the WDR 2012, it seems that the conference participants and the broader public very much welcomed the authoritative voice that the Bank brings on women’s rights and health.

Looking forward, we need to help ensure that the post-2015 agenda ushers a vision for the kind of future we want to see — one where women participate fully in decision-making, in all contexts and at all levels — in households, communities, and countries. To make this a reality, the challenge of girls’ and women’s agency requires special attention.  On this front, our group is working with folks in the regions and other networks to break new ground on voice and agency, to help equip staff, policy-makers, and practitioners to address and measure these issues in operations. I hope that many of you will join with us and help us truly deliver for women and girls. 


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