In 1996, when I was living in Poumayassi in the Central African Republic, a woman came to my door in the middle of the night carrying a bloody piece of firewood. The blood was hers; her husband had used the wood to hit her on the head. She knew that, as a Peace Corps volunteer, I had sterile bandages and would help her. But the irony for me was that she had likely carried that very piece of wood on her head for miles to bring it back for the family fire.
The movement for women’s access to quality sexual and reproductive health services can and must become an indispensable force to end poverty, improve global health and build strong democratic institutions.
I also knew Tikoro and Fersinome, two young girls there who were so concerned by my attempts to cook, clean and adjust to life without running water or electricity that they took my daily care upon themselves. Together, the girls made sure I ate the right things and dressed and behaved properly. Probably about 10 and 13 years old, they had been kept out of school to care for their siblings, sweep the yard and fetch wood and water. But they still wanted to know about the wider world that had sent a naïve 22-year-old American woman to live in their village.
Seeing their strength and creativity despite their difficult lives made me resolve then and there to spend my life working on behalf of women. And it is these women—Tikoro and Fersinome and the millions like them in developing countries—who should be shaping the discussions of the policies and programs that will best meet their needs.
Those of us involved in the global movement for women's sexual and reproductive health and rights think we tell the stories of women and girls like Tikoro and Fersinome, but too often we choose aspects of their lives that fit our own agendas. Our funding tends to deal with things separately—HIV/AIDS OR maternal mortality, obstetric fistula OR family planning, child marriage OR genital cutting, domestic violence OR keeping girls in school.
We collect data and issue reports on the 222 million women who need contraceptives, or the one in three women who will be assaulted or raped during her lifetime, or the numbers of books we distribute, the midwives we train, the clinics we equip. We are not so blind as to think the tail or trunk we grasp describes the entire elephant, but we still do not address the whole lumbering beast that is women's worldwide second-class status.
While working at the Wallace Global Fund, I learned that partnerships and coalitions had the most impact in the field because they touched more facets of women's complex lives, more aspects of the elephant.
This is where our movement must go now. If a village woman opts for an IUD and then later changes her mind and wants it removed, we need to understand why and ensure she gets the care she needs, but we also need to understand whether the woman's partner favors its use, whether there is violence in the home, how much education both partners have, how many other mouths are they feeding. We need to see the whole picture of their lives. We need to more specifically identify where we are losing ground, where we are gaining it, and what has worked to change minds. We need, in short, to develop a new standard of evidence that enables our projects to meet women where they are rather than where our theories say they should be. And to do this, we need the women themselves at the tables where decisions are made.
Not many are investing in this holistic approach that puts real women's lives at the center. Yet promoting women's sexual and reproductive health and rights is one of the best bets in development. Every dollar invested in family planning returns up to nine dollars in better health, higher income and overall social stability and well-being. It's one part of the picture that can help change how the entire thing looks.
It's strange, given the evidence that fringe voices now want to end international development spending altogether. Its costs pale in comparison to what it buys—lives saved, national stability, growing markets.
The movement for women's access to quality sexual and reproductive health services can and must become an indispensable force to end poverty, improve global health and build strong democratic institutions. All of those goals become easier to tackle when women are equal players in the efforts to achieve them. It is our job to make that equality a reality.
Suzanne Ehlers is president of Population Action International.