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First Lady

The ICPD Cairo Plus Five Forum
UN Population Forum Keynotem

Address by First Lady Hillary Rodham Clinton
The Hague, Netherlands
February 9, 1999


Thank you, Dr. Sadik, and thanks to the conference organizers for your kindness in permitting me to return to be able to address this forum. I appreciate that greatly. I want to say a word of special recognition to Dr. Sadik, however. I believe that the world owes her a debt of gratitude for all she has done over the years to place women at the very center of development, and I know that this work which carries on the commitment that you made at Cairo will continue to do what we know needs to be done in linking development, and human rights, and women's rights, and population issues together. It is also a pleasure for me to be here with ministers, excellencies, and senior officials from all over the world.

And I especially appreciate the government of the Netherlands for their leadership and support in hosting this forum. I am delighted that we meet here in this historic city. The Hague is a place where people have gathered on many occasions in the past to find common ground and to work toward a just and more peaceful world. It was here one hundred years ago that people gathered for an international exhibition on women, to talk about the importance of motherhood, education, and women's rights. It was also here in 1945 that the United Nations established the International Court of Justice. And, just this week, we gather again in The Hague to take up another global challenge: how to ensure that human and economic progress go hand in hand.

This dialogue that was begun in Cairo among representatives from one hundred and eighty nations came to a consensus for the first time: that women's reproductive health and empowerment are critical to a nation's sustainability and growth. The world agreed -- for the first time — that smaller families and slower population growth are created by choice and opportunity, not control or coercion. And the world agreed that respect for women's rights must be a part of our efforts to improve the quality of life for all the planet's citizens.

Now as you in this great auditorium know better than I, developing that historic consensus was not an easy task. Yet every nation and NGO agreed to work to implement the common goals laid in the Cairo Programme of Action: that by the year 2015 all governments will make access to reproductive health care and family planning services, a basic right; that all governments will reduce dramatically infant, child, and maternal mortality; and that all governments will open the doors of education to every citizen, most particularly to girls and women.

I wanted to come here today to reaffirm my government's commitment to carry out the ICPD Programme of Action, and my husband's administration's renewed determination to continue to work with other governments and NGOs to meet the goals we have set. Over the past five years since Cairo I have had the privilege of seeing first-hand some of the progress that is being made in many of the countries represented here. In Indonesia, I remember sitting under a tree in a small village, watching young mothers breast-feed their babies while at the same time learning how to care for the children they had. There are now thousands of village midwives in that country who have been trained in life-saving skills to keep both mothers and babies healthy. And every day despite the economic challenges confronting Indonesia, they have remained true to the commitments set in Cairo: to make reproductive health an integral part of the national health care system. At a small clinic in Nepal, I saw a Safe Home Delivery kit that is given to expectant mothers. You've seen them, I know. Inside is a bar of soap, twine, wax, a plastic sheet, and a razor blade. The purpose of this simple kit is to reduce the major causes of maternal and neonatal death, by promoting clean hands, clean surfaces, and clean cord care. Part of the safe motherhood initiative, these simple kits teach us that women do not have to die in childbirth. They don't have to bleed to death, or suffer from terrible infections. With these simple tools that could be available in every country, no matter how poor — they cost thirteen cents to make — motherhood can be a safe and healthy experience.

In Kazakhstan and Uzbekistan, an area where abortion rates have historically been high, I toured new clinics for women and visited with expectant mothers, physicians, and nurses. Today, thanks to clinics like these, women there have greater access to health and reproductive care, and the use of contraceptives has increased by anywhere from a third to a half. And the result of making family planning accessible and available — the results are that abortion rates have declined dramatically.

I also see progress in my own country. With new funding increases, our government has made family planning and reproductive care services available to more women and families nation-wide. We are also working to ensure that abortion is safe, legal, and rare. That is one of our top priorities. So I am particularly pleased that under this administration the number of unintended pregnancies in America is declining and abortions have fallen a full twelve per cent. Through our national campaign to prevent teen pregnancy we are also seeing how comprehensive, community-based health programs are bringing down both teen pregnancies and teen sexual activity.

Let me just give you one example. In 1990 a small town in New York state had one of the highest teen pregnancy rates in their area. That particular challenge spurred the local government to bring together stakeholders: a family planning clinic and a local NGO called Catholic Charities. Working together, Catholic Charities and the NGO made a clinic free, and enlisted teens to talk to teens. They created a place for young people to go every Saturday night with adult supervision. They brought in religious and business leaders to talk to parents about how to talk to their own children. Today, that community because they had a community response that involved every aspect of their community, is ahead of schedule in reaching their goal of reducing teenage pregnancy by one-third by the year 2000.

There are many more examples I could choose from to demonstrate clearly to all of us that we have made progress since Cairo. And I want to applaud and thank both the governmental and non-governmental leaders who are here once again, renewing our commitments and forging ahead with new developments, strategies, and a higher level of resources.

Yet as far as we have come, we have much further to go. When nearly 600,000 women around the world still die every year — that is one every minute — from pregnancy-related causes, this is no time to cut back on our commitments to family planning. When there are still 960 million illiterate adults in the world today, and two-thirds of them are women, this is no time to question our investments in education. It has been proven time and again by both research done through the World Bank or the United Nations or even independent private sector businesses, that nations thrive when all their people are educated.

And we now know that no nation can hope to succeed in the global economy of the 21st century if half of its people lack the opportunity and the right to make the most of their God-given potential. No nation can move forward when its women and children are trapped in endless cycles of poverty; when they have inadequate health care, poor access to family planning, limited education, or when they are constrained inside social or cultural customs that impoverish their spirits and limit their dreams.

If there is one achievement that I hope we can look back on standing in the year 2015, and gazing back into time, to this conference, I hope it will be that we have created an environment in which more children are wanted who come into our world in the next century, and where pregnancies are planned; where women are given their rightful place in all of their societies.

Now I fully recognize that there will never be full agreement on some of these issues, particularly reproductive rights, because they go to the heart of our personal, political, and religious beliefs. There are people of good faith on all sides of these issues. Yet I believe that there is more that unites us than divides us, and I think the genius of Cairo is that people of profound differences and varying backgrounds came together and made an agreement around some simple convictions.

So today I hope we can agree first and foremost that government has no place in the personal decisions a woman makes about whether to bring a child into the world. That is a decision that should be made freely and responsibly without government coercion. Every time I hear the calls of those who would do away with family planning or limit reproductive rights, I wish they could remember and even hear the voices of women who have suffered and died because governments were making decisions that women should have had the freedom to make. Human history is filled with such voices. We could hear the voices of the women in my own country who lined up around the block for hours in 1916, waiting for Margaret Sanger to open the nation's first family planning clinic in Brooklyn, New York. Before the police shut it down ten days later, the clinic managed to help hundreds of women. And they all had stories to tell: about miscarriages, and illegal abortions, and their desperate struggles to feed and clothe eight, nine, or ten children.

I hope they will hear the voices of the women from pre-democratic Romania. When I visited Romania a few years ago I spoke with women about what it was like before democracy came. How they were taken against their will once a month during their work hours to be physically examined to determine if they were pregnant. How they were stripped of their dignity and humanity. As part of that nation's campaign to increase it's population and to try and require every woman to produce five children, family planning, sex education and abortions were outlawed.

I hope also they will hear the voices, the old and the new voices, coming out of China. The new voices now include many who are working to ensure that their country's family planning practices are voluntary and respectful of individual rights.

When I was last there I heard about what the one child policy had meant for too many women forced to have sterilizations and abortions. And I'm very pleased that UNFPA and the Chinese government have recently developed a pilot program in 32 counties to address these concerns, to promote voluntary family planning and seek to remove all coercive actions by local officials.

While government has no place in such personal decisions, government can and must play a critical role in helping women and families lead full and productive lives, and that includes making available voluntary family planning. By giving individuals and couples the freedom to choose the spacing and number of their children, women not only gain more control over their lives, they also contribute more to their families and their communities. And through family planning, we not only lessen the number of unwanted pregnancies, we diminish the number of illegal and unsafe abortions that cause so many deaths and so much suffering.

I will always remember visiting a maternity hospital in Salvador di Bahia in Brazil where I saw women getting the information they needed to make wise choices about their families. I saw mothers cradling their new-borns in the hallways as they stood in line for their check-ups. I watched young people being educated on the most basic of reproductive facts. I saw pregnant women waiting for their pre-natal check-ups and parents being taught what nutritious food to feed their children. But I also saw a ward of women hospitalized because they didn't have access to family planning services and as a last desperate resort, had submitted to self-induced or illegal abortions.

When I met with the Minister of Health for that state, he told me that his goal was to give poor women what wealthy women have always had, access to family planning. And that must be our goal as well. In every country, even those where abortion and family planning are considered off-limits, or abortion is illegal and criminalized and where family planning is not available, we know that wealthy and well-connected women can find their way to the services they need. What we ask is that all women have the same right to do so on their own behalf.

In Cairo, the world made commitments to ensure that women had such greater access to such services. And I want to pay particular attention and applaud our host country, the Netherlands, for being one of the strongest donor nations in the world. Not just in relative terms, but in absolute terms, the Netherlands has led the way in showing what needs to be done to fulfill the priorities of Cairo.

I'm also pleased that there has been growing support in my country for population activities in both the government and the private sector. The U.S. government, through USAID, has spent more than three billion dollars on programs in population and reproductive help in developing countries. And two and a half billion dollars on programs that promote women's economic, social, legal, and political rights. Among the results, well over fifty million couples now have access to family planning. And tens of thousands of health workers are being trained in over sixty countries. And I'm pleased that in this budget for the year 2000 the President has proposed a $25 million voluntary contribution to UNFPA. And I hope that our Congress will support that request. Some of you, I know, understand that in our system the President proposes, but it's not a parliament, so the Congress has to make the decisions as to what is appropriated. The restoration of U.S. funding for UNFPA would send a strong signal that the United States continues to support the ICPD Programme of Action.

We've also seen private support for international population activities increase significantly, including approximately $150 million a year from foundations alone. Just a few months ago, I accompanied the heads of four major foundations from our country to one of the poorest neighborhoods in Port au Prince, Haiti. They are working there together to reduce teen pregnancy and AIDS. We watched young people perform a skit about how they were saying no to teen pregnancy and yes to school and sports, the things children should be saying yes to. So this kind of partnership between the public and the private sector is critical in my country to making it possible for us to fulfill our requirements under Cairo. And I want to recognize all of the Americans here and particularly the American foundations represented here for your investments in health and population and development issues.

Now, as important as it is that we continue to fulfill our commitments to family planning and reproductive health services we know that in reaching the goals of Cairo we are called upon to do more. We are called upon to make investments in the human and economic development of people, particularly girls and women. To understand that when we educate a woman, we educate a family and when we educate a family, we educate an entire society. We lower the risk with an educated woman that her infant will die and we increase the chances she will be able to feed, clothe, and educate her children. I have seen in many of the countries represented here a very important commitment made to increasing education and increasing girls' opportunities. Sometimes it comes at a great cost, after bad decisions have been made, after there's been too much trafficking of young girls into prostitution. And a country finally says enough, we will protect our young women and we will invest in their potential.

I was pleased to meet when I was here on Sunday with the Yemeni delegation. I want to commend them for tripling girls' enrolment in village schools since 1994. And now I know that the Yemen government has waived school fees for girls which I also very much appreciate.

When I spoke at the NGO forum, I was overwhelmed as I always am, by the passion, commitment and energy of the NGO community. Long before Cairo, NGOs and advocacy groups have been on the front-lines, working in health centers in small villages and poor urban areas. They have been trying to set up schools and encouraging parents to send their girls and boys to school. But it was not until Cairo that we really created the kind of partnership between governments and NGOs that is in the best interests of our common goals. And we need to continue to do so.

Because certainly Cairo requires sustained commitments from all of us: government leaders, NGOs, civil society groups, business, labor, foundation leaders, and most of all, young people themselves, young people like those who attended the Youth Forum. They are the ones who will bear the responsibility for what happens in the 21st century. They will have to determine where we will find the water, the food, the environmental resources, how we will manage the burgeoning explosion of population in urban areas that spread further and further out from a core. How we will deal with diseases, from tuberculosis to AIDS. They are the ones for whom really we meet today. One billion people on this globe are between the ages of 15 and 24. Just beginning or in the middle of their reproductive years.

Will they have the freedom, the information, the education, and the support to make wise choices about their lives and their families? Will they be able to fulfill their own dreams? Will they be able to be part of societies that respect and honor their human rights?

There are many individual stories of courage that I have heard and seen around the world. People who have stood up for their rights, women who have demanded an equal opportunity to go to school or send their daughters to school. Doctors and nurses who have labored under extraordinary circumstances, both to bring primary health care and important emergency obstetrical care to remote parts of the world. There are many, many heroes in this effort.

I want to end with the story of just one young woman. Hussum Singh, a young Indian girl, married at the age of 13 to an abusive, illiterate husband. At the age of 15 she said , “I decided I had no future.” She knew if she were to have any hope at all, she had to stand up for herself. When elections for community health workers were held, she stood for election and she won. But to work in the village, she had to take a courageous step, to walk out of her house. She said the biggest challenge in her health care work was to get other women out of their homes and become more active in the life of their community. “First two joined, then four, and before your eyes we became a group,” she explains. Now she says she has the capacity to “mobilize 250 women to walk with me toward a healthier life.”

It is now up to all of us to walk with those who are leading women in a direction of more hope, dignity, respect, and a better future for themselves and their children. We have come a long way since Cairo and Beijing. We used to come one by one, sometimes not daring to raise our own voices, to speak above a whisper. Now we can hear those voices, not just the voices of the past and not even just the voices of the present. But if we listen hard, we can hear the voices of the future. We can hear the voices of young boys and young girls who deserve better than what they currently have. Who look to us to give them the opportunities which they then will have to fulfill. Who look to us to give them the freedom so that they then can exercise responsibility on their own behalf. The hopes and dreams of these young people are being realized around our planet as never before.

And yet we still know there is much left for us to do. Those of us privileged enough to be here in The Hague today, have a great responsibility to make sure that all human rights are recognized and that all human beings are given the chance to fulfill their God-given promise.

Thank you for the work you have done to bring us to this day. Thank you for working together despite continuing differences and misunderstandings. Thank you for understanding that what we want to give to every boy and girl is what we do give to our own children if given the chance.

And with that as our hope, that all children will be wanted, will be given the love, the attention, and the discipline they need to grow into productive adulthood, then the promise of Cairo should guide us forward with confidence and resoluteness into that future that awaits.

Thank you very much.

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