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Why Gender Matters for UHC

Flachsbarth calls for greater attention to girls’ and women’s needs on the road to Universal Health Coverage

Conference participants

The promise of universal access to health services remains unrealized – especially for many women and girls. On the sidelines of the High-Level meeting on UHC on 23 September in New York, SheDecides, BMZ and the Netherlands invited decision-makers to discuss how women and girls can gain access to the health services they so urgently need.

Discussion with a bite

There was no doubt among the panelists from government, civil society, development partners and youth who gathered on 23 September in New York: Gender does not just matter for UHC. It is essential. Powerful speeches and contributions full of vigour and personal commitment filled the one and a half hour lunch. ‘I might look like a nice girl, but when you touch on these issues, I am a pit bull in disguise,’ Kitty van der Heijden, Vice-Minister for International Cooperation, Ministry of Foreign Affairs of the Kingdom of the Netherlands declared. Among these issues is the fact that more than 200 million girls and women want to prevent unwanted pregnancy - but have no access to reliable contraceptives. Equally, every day hundreds of girls and young women die of heavy bleeding, infections, complications in childbirth or abortions because health services before and during pregnancy and birth remain unavailable, unaffordable, unacceptable or unsafe. Panel participants wanted to discuss what needs to be done to make sure that the situation and needs of girls and women receives full attention as more and more countries move towards Universal Health Coverage.

Because every child and every woman matter

The event was co-hosted by Germany and the Kingdom of the Netherlands in support of SheDecides, a global advocacy network for women’s and girls’ sexual and reproductive rights.

Initiated on the backdrop of the reintroduction of the Global Gag Rule, SheDecides has succeeded in mobilizing lacking funding for sexual and reproductive health and winning many prominent and influential champions. Since the beginning of the year, Parliamentary Secretary of State, Dr. Maria Flachsbarth is also champion of SheDecides and has through this set a strong sign for her personal commitment in supporting women’s and girls’ rights. During her powerful opening speech Dr. Flachsbarth stressed the importance of taking into account the health needs of all women and girls. She made a powerful plea for not forgetting those who are left behind due to lack of money, discrimination or marginalization.

Financial barriers remain high for women and girls

Financial barriers to health services tend to disproportionally affect women and girls. Almost two thirds of costs for sexual and reproductive health services are covered by out-of-pocket payments. Girls and women often have less money to pay for them. Aruba’s Prime-Minister Evelyn Wever-Croes explained that this is why her country’s general health insurance now covers the whole population making maternal health services accessible for all. Yet, Wever-Croes acknowledged, teenage pregnancy rates remain high: As many believe – or refuse to believe – that adolescents are sexually active, their sexual and reproductive health needs are often not considered. Comprehensive Sexuality Education is crucial to inform girls from a young age on their rights and choices. At the same time, UHC reforms need to ensure that adolescents are not only fully covered, but that the services also respond to their needs. 

Money is not the only challenge

First lady from Chad in conversation with SheDecides guiding group

Mereseini Vuniwaqa, Minister for Women, Children and Poverty Alleviation in the Fijian Government spoke of the many additional factors that drive inequality and hinder women from embracing the health services they so urgently require. Social stigma is one. Nutrition is another. Why should a woman decide to deliver in a hospital where she has to put herself in the hands of an unknown - and possibly unskilled - birth attendant? Where food supplies are short and a friendly word rare? Other social determinants are education and political participation of women and girls. There is definitely a need for not only urgent action, but also more intersectional action. Jane Ellison, WHO Executive Director, External Relations and Governance introduced the WHO barriers assessment tool to look at the bottlenecks within health systems. Identifying these barriers is a first step. Multi-sector cooperation to address these barriers is the next.

Not costs, but investments

Making essential health services available to all requires appropriate funding – which currently is not available. Julia Bunting from the Population Council reminded the audience of the importance of framing funding for sexual and reproductive health as investments, not costs: ‘Investing in women and girls is not only the right thing to do, but the smart thing.’ South African young leader Levi Singh expanded that investments in the reproductive health and empowerment of women and girls can also bring about economic growth and promote women’s share in this growth, fostering a country’s gender dividend. Finally, as Dr. Flachsbarth emphasized ‘Healthy, empowered girls and women who can make their own decisions are key to development and prosperity.’

Delivering on SRHR 

Standing up for the right – and the smart thing – remains more necessary than ever. This was also evident in the concurrent proceedings in the adjacent UN General Assembly where – after long negotiations – the political declaration on UHC was agreed upon with only cautious references to sexual and reproductive health and rights. Kitty van der Heijden reminded the audience of not losing track of the ultimate goal: ‘We need not only to ensure that SRHR remains on the agenda and in the text, we need to ensure that the services are delivered on the ground.’ Katja Iversen, CEO of Women deliver supported her from the floor: ‘How are we going to use our power to change?’ The answers from the panelists came swiftly: Work together, not in silos. Think of the people you want to reach. Consider whom you are speaking to. And: Don’t leave anyone behind.

Laura Bleckmann
October 2019


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