STATEMENT
by Ms. Angela E. V. King
Assistant Secretary-General, Special Advisor on Gender Issues and Advancement of Women, and Director, Division for the Advancement of Women, United Nations

I am delighted to have the opportunity to speak at this important luncheon on health for all women in the 21st century. As I speak on the theme of "United Nations and Women's Health", I am particularly conscious that our hosts, the Global Alliance for Women's Health and the International Council of Women, both non-governmental organizations in special status with the Economic and Social Council, have long advocated in the United Nations the importance of women's health throughout the life span.

I am also delighted to share this occasion with my colleague Dr. Gro Harlem Brundtland, Director-General of the World Health Organization, and I welcome her strong statement on the importance of gender sensitive health care. I am also very pleased to share this venue with Dr. Wanda Jones, Deputy Secretary of Health of the US Government.

We are now in the countdown to a hard nosed review of what governments, UN system organizations and civil society have achieved to implement the Beijing Platform for Action (1995) and the Programme of Action of the International Conference on Population and Development (1994) in the critical areas of women's right to health and their enjoyment of reproductive health and sexual rights.

Beijing puts forward a broad view of a life-cycle approach to women's health. It follows women and girls from the cradle to those critical years before the grave. It sets tangible targets:

Every woman and girl in the world should have appropriate, affordable and quality health care services

The risk of maternal mortality should be reduced by at least 50 per cent of the 1990 levels and a further one half by the year 2015.

Reproductive health care should be accessible to all women no later than the year 2015.

The Secretary-General in his reform of the United Nations, emphasized that gender issues must be one of the cross-cutting issues in all sectors including health and as such must be mainstreamed into each sector, policy and decision made by governments, international organizations, NGOs or civil society.

In the area of health I wish to share with you some of the steps in which the United Nations entitles and the Division for the Advancement of Women and the United Nations Secretariat have taken to mainstream a gender perspective into the health care area at various levels, thus advancing the global agenda on women's issues.

The United Nations collaboration in this field is not new. Women's enjoyment of human rights, including the right to health has always been part of the work of the United Nations and the Division for the Advancement of Women, going back to the Charter and the Human Rights Covenants. The Division focuses on increasing Member States' awareness and advocating a woman's right to health. In its support for the Commission on the Status of Women and the Committee on the Elimination of Discrimination against Women it carries out research leading to new approaches to the advancement of women, and organizes seminars and expert group meetings dealing with various aspects of the advancement of women in many sectors, including health.

The reason why we are all here today is that health is the last of the 12 critical areas from Beijing to be reviewed by the Commission on the Status of Women before the five-year review of the platform at the Special Session of the General Assembly, to be held on 5 to 9 June 2000. Today we have a very interesting and provocative discussion with panelists regarding challenges that women face in the fields of health (reproductive health, prevention of HIV/AIDS epidemic, mental health and health sector reform).

Credit must be given to the UN as the Organization where on matters of health we can truly say, "We have come a long way, Baby." In Mexico and Copenhagen little was said specifically about the health issue. Today with the Nairobi and Beijing Conferences and the extremely useful inputs from the Vienna Human Rights and Cairo (ICPD) Population Conferences, women now can speak freely and openly in the UN fora of female genital mutilation, safe sex, female condoms, and the right of women as well as men to sexual enjoyment. Some of us who were here in the earlier days found a taboo on such matters. But women all over the world through the UN, through women's groups and NGOs' persistence can now talk freely of these issues. This empowerment places the issue squarely on the global agenda.

Second is the role of CEDAW. This year, we will celebrate the twentieth anniversary of the Convention on the Elimination of All Forms of Discrimination against Women which has been ratified by 163 States parties. The States parties report on progress and measures taken to address gender inequality in many areas, including health. For twenty years, the monitoring body under the convention, the Committee on the Elimination of Discrimination against Women (CEDAW) has reviewed States parties' yearly reports and made recommendations to Member parties on what they have to do to redress and eliminate discrimination against women in the area of health.

These have included suggestions for eliminating abortion as a birth control device, greater focus on the reduction of maternal mortality and dissemination of information on contraceptive methods, including the female condom. CEDAW has also made the critical link between the spread of HIV/AIDS and the use of contraception and sex education for girls and boys.

At its most recent session last month the Committee adopted its 24th general recommendation concerning Article 12 on Health. The recommendation sets out the Committee's understanding of the meaning of women's right to health. It affirms that access to general and reproductive health care is a basic right; and that States parties' compliance with Article 12 is central to the health and well being of women throughout their entire life span. The general recommendation will be available during the Commission on the Status of Women's current session and would be a useful guide for States parties. We hope that it will be endorsed.

Third, I am very pleased to see that the rights-based approach to health was discussed in depth in 1998, at a workshop organized in Rome by the Administrative Committee on Coordination (ACC) Inter-Agency Committee on Women and Gender Equality in cooperation with the OECD/DAC Gender Group. The workshop assessed the practical implications of a rights-based approach to gender equality, including implications for such sectors as humanitarian assistance, food, and health.

Another small step in the long march to women's equal access to health is the framework for designing national health policies with an integrated gender perspective for the 21st century. This came out of the Expert Group Meeting organized last September by the United Nations in collaboration with the World Health Organization, UNFPA, the Commonwealth Secretariat and the Government of Tunisia. Its title was "Women and Health - Mainstreaming the Gender Perspective Into the Health Sector", and the published report will shortly be available in the Commission's conference room.

One of the highlights of the meeting centered on mainstreaming a gender perspective into the structure and management of health system including health sector reform and health care financing; quality care; medical research and health service delivery. To this end, gender analysis needs to be applied to all reforms contemplated in the health sector to examine their potential differential impact on women and men. We also need to ensure that priorities are established in a gender sensitive way. Applying a comprehensive gender perspective would require that all health statistics be disaggregated by sex and age. These steps testify to the better understanding by Member States and civil society of the need to address the causes rather than symptoms of women's persistent inequalities. And this progress is very encouraging.

However, today I would also like to take a serious look at challenges facing us in this and the next millennium. They are unlikely to disappear without concerted efforts by Governments, NGOs and other actors in society.

On reproductive health, the situation is appalling and shows signs of further deterioration. Nearly 600,000 women die each year from pregnancy or childbirth. In Africa one woman in 23 dies from a pregnancy related risk. In countries in transition which were part of the former Soviet Union, maternity related mortality rates have climbed by 14 per cent in Poland and by 10 per cent in Russia. Several countries continue to have laws requiring that a wife obtain her husband's consent for sterilization or abortion. Lack of sufficient family planning information, particularly among rural women and adolescents, and costs related to contraception have been leading factors in the high levels of abortion. Criminalization of and restrictive laws governing abortion resulted in a high number of clandestine abortions in unsafe conditions leading to thousands of deaths annually.

The issue of the mental health of women remains much neglected. Generations of women all over the world have been and continue to be blamed individually for their mental disorders and are often qualified as hysterical. Little has been done to alleviate the symptoms of women's mental health and to recognize the extent of their suffering, even in developed countries. Depression, anxiety and stress are more prevalent in women: 30 per cent of mental disability in women is from depression as compared with 13 per cent in men.

Occupational and environmental health is increasingly recognized by Governments and civil society as a contributing factor to economic and social development. Women generally are employed in jobs that are repetitive and monotonous. They have little control over workspace and methods. Job insecurity leads to stress. Even in mechanical jobs, most tools, machines and workstations are designed for the average male and are unsuitable for women from an ergonomic point of view.

Women represent the majority of workers employed in the agricultural sector. Highly toxic pesticides are one of the major factors of women's morbidity and mortality, as well as a cause of complications in pregnancy and childbirth. Women working in textile and plastic industries are more vulnerable than men to exposure to absorption of chemicals through the skin used in dyeing. This can lead to acute poisoning.

Even housewives are not spared from health hazards such as indoor air pollution from domestic cooking. More than half of the world's households cook daily with unprocessed solid fuels that release 50 times more noxious pollutants than cooking gas. Women's occupational and environmental health is so neglected that little has been done to identify the underlying gender discrimination and search for remedies that would lead to its elimination.

Communicable diseases such as tuberculosis, malaria, and, to a growing extent, HIV and AIDS are diseases of poverty. Poor women are especially vulnerable because of their low nutritional status, restricted access to education and gainful employment, and heavy workloads. The stigma for women attached to many communicable diseases is greater than for men, particularly those involving disfigurement. This often leads to hiding the diseases and a decrease in life opportunities, including work and marriage. Gender bias begins at a young age: girl children are less likely to be brought to health services for immunization and early diagnosis and treatment of communicable diseases than boys are.

I salute and recognize non-governmental, grass root and women's organizations and associations like the Global Alliance for Women's Health, which act as advocates for the protection of women's right to health. You are closer than other actors to the real needs of women and are the first to come with assistance and strategies for resolving issues. You play an important role in attracting public attention to women's health issues and are instrumental in conveying the message that the underlying cause of many women's' problems in getting access to health care is rooted in systemic gender discrimination.

As important as NGOs can be, political will at the highest level is a condition sine qua non. Governments bear the primary responsibility for the implementation of the Beijing Platform for Action.

A key part of our strategy to reach the many actors in the health care area is to create knowledge of women's human right to health. To this end, we intend to expand our Women Watch website and strengthen our cooperative venture with UNIFEM and INSTRAW. We look forward to the day that WHO will join UNESCO and the World Bank, UNIFEM and INSTRAW on our website.

As we see it, the challenges for the 21st century for the international community are:

ACKNOWLEDGE openly that gender inequalities exist in medical research and government funding;

ADMIT that results of research on men are not always applicable to women;

GET the private sector to fund research on women's health needs, including not just breast and cervical cancers, but some of the neglected areas in occupational, environmental and mental health I mentioned earlier;

REVOLUTIONIZE the way doctors treat female patients;

GET the information about health rights, need and care facilities to women at the grass roots and other levels in all countries;

PROMOTE a gender perspective in health budgeting;

ENCOURAGE ratification of CEDAW by the U.S.

There is a great role for advocates such as the Global Alliance for Women's Health. We look to you to give strong input into the policy recommendations coming from the CSW and support for the Special Session in 2000.

My best wishes to you and for our strong partnership with Governments and UN agencies. Let us together make the 1st decade of the 21st Century the Decade for Global Women's Health!

Thank you.