She decides on her health, her future

Dr Flavia Bustreo,
Assistant Director-General of the World Health Organization and Vice-Chair of GAVI,
the Vaccine Alliance
Commentary
8 March 2017

Last week, I attended the 'She Decides' conference in Brussels, where Ministers and other high-level
participants reaffirmed their support for women’s and girls’ ability to make decisions about their own lives.
This gathering comes at a time when the sexual and reproductive health and rights of women and girls are
facing a stark challenge, and we risk losing important hard-won recent advances. Reduced funding for
women’s sexual and reproductive health is a loss not only to these women, but also to their communities and
society as a whole.

Flavia Bustreo, Assistant Director-General, Family, Women's and Children's Health, WHO
WHO

However, this is about more than sexual and reproductive health and rights. It is about women's and girls'
ability to make decisions about their own bodies and their environment so they can improve their health,
their futures and their lives.
Strong evidence
Clear evidence shows that investing in contraception saves lives, contributes to gender equality and boosts
economic development. If all women who want to avoid a pregnancy used modern contraceptives – and all
pregnant women and newborns received care at the standards recommended by WHO – unintended
pregnancies would reduce by an estimated 70%, abortions by 67%, maternal deaths by 67% and newborn
deaths by 77% (compared to 2014). Every US$1 invested in modern contraception and good quality care for
pregnant women and newborns returns an estimated US$120 (1) (2).
She decides on her health, her future
Women must be able to decide about their health and the things that influence it, including their sexual and
reproductive health and environment – not least because it can lead to other life-changing decisions.
If an adolescent girl does not get pregnant too young, she can stay in school longer, opening up better
economic opportunities and a more independent, fulfilling future. Every additional year of schooling for a
girl increases her future earnings by 10% to 20% (3)
"On International Women’s Day, we must all unequivocally reaffirm our commitment to
gender equality and women's and girls' fundamental rights."
 Dr Flavia Bustreo, Assistant Director-General of WHO and Vice-Chair of GAVI, the Vaccine Alliance

If a woman can decide to limit or space the number of children she has, she can invest more in nutrition and
care for herself and her children, contributing to their cognitive development and ability to thrive. The
likelihood of a child reaching the age of five increases by more than one third when its mother is able to
space her pregnancies by three or more years.
If an adolescent girl can decide to have the HPV vaccine, she can drastically reduce her chances of getting
cervical cancer, averting illness and potentially catastrophic health expenditures in the future.
She has a voice in policies that affect her
To control their lives in this way, women must be able to participate and have a voice in the design of
policies and programmes that impact them. All too often, their personal decisions are infringed upon by
regressive policies and harmful gender norms that prohibit them from exercising their rights.
For example, women and adolescent girls may have, in theory, access to contraception, but norms around
their gender or age may cause providers to deny access without the consent of a spouse or parent. Women
and girls are most impacted by their immediate environment – for example by indoor air pollution and lack
of clean fuels. When young women are tasked with fetching the wood and the water, they are deprived of
time which they could use to get an education.
In contrast, when women are involved in decision-making they can shape and influence policies for their
benefit. Women’s social, political and economic participation is strongly associated with better health
outcomes for women and children. Some studies point at the fact that countries which have made the most
progress in reducing maternal and child deaths all have a high number of women parliamentarians (4)
Having more women in politics is one important way to ensure that women’s health and rights are protected
and advanced – but with women making up only 22.8% of national parliamentarians worldwide, (5) there is
still a long way to go.
United for women and girls
The past few decades have seen impressive advances in women’s health, including their sexual and
reproductive health and rights. At this critical juncture, we must do all that we can to ensure that we continue
to move forwards, not backwards.
WHO is resolutely committed to playing its part by providing the standards and scientific evidence that
underpins advances in women’s and girls’ health, data and estimates on the scale of the challenges, and
innovative ideas on how to overcome them.
On International Women’s Day, we must all unequivocally reaffirm our commitment to gender equality and
women’s and girls’ fundamental rights. Quite simply, we must all do what we can to ensure that women
across the globe are able to make decisions about their bodies and their environment, which will have a
positive impact on their health and their futures.

(1) Singh S, Darroch JE, Ashford L. Adding it up : The costs and benefits of investing in sexual and
reproductive health. New York : Guttmacher Institute and UNFPA, 2014.
(2) The High-Level Task Force for the International Conference on Population and Development (ICPD).
Smart investments for financing the post-2015 development agenda. Policy brief, 2015.
http://icpdtaskforce.org/wp-content/uploads/2015/01/FinancingBriefSmartInvestments2015.pdf
(3) "Accelerating Secondary Education for Girls: Focusing on Access and Retention." Discussion Paper.
New York: UNGEI, 2014. Web. 28 Feb 2017.
(4) Kuruvilla S, et al. Success factors for reducing maternal and child mortality. Bulletin of the World
Health Organization, 2014.
(5) Single House or Lower House. Inter-Parliamentary Union. "Women in national parliaments, as of 1 June
2016".