Transcript of keynote address by Natalia Kanem
August 4, 2023

Distinguished conveners, distinguished guests, dear young people, dear friends and dear team, it’s teamwork that makes the dream work. Salaam Alaikum, we meet in peace. Peace is the noble purpose of the United Nations, which was forged nearly 80 years ago in response to World War and Peace. This is the dearest wish of women, this world over peace in our homes, peace in our communities, peace in our hearts. And what memorable days we have had here at the fourth annual gathering of the continents’ homegrown philanthropy stakeholders. I want to thank you for inviting me. I love the bravery and the ‘can-do spirit’, and the ‘yes, we can’ determination of your sector. I thank Trust Africa, and the Wits Business School, CAPSI, and everyone for having us here. Ebrima in particular, I would like to thank you for your leadership and for your dedication, it really inspires me. I certainly would like to acknowledge my board chair and mentor Comba Toure who has joined us today. Coumba, thank you so much. Look, for everyone who is here, you as a participant, I have noted that you are leagues ahead when it comes to fashioning effective philanthropy, and it’s been an inspiration.


So, policy today, why is that important? I am here to recount the story of a great battle. As old as Methuselah. It is a battle that is raging right here, right now across this magnificent continent, and all across our world. As usual, the fight is about power. It is about control. It is the age-old question, who is the owner of the body of a woman? Who is in control of the life chances of a 10-year-old girl? In other words, what if every person on the planet, and it is now 8 billion of us? What if every woman and every girl in particular had true control over her body, her life, and her future? We at UNFPA, which is the United Nations sexual and reproductive health agency, believe that with control and bodily autonomy in the hands of a woman or a girl, the possibilities for individual, societal, and advancement in this world become infinite.


Bodily autonomy. That is the foundation for gender equality. That is essential for the prosperous, sustainable future that we all want, and that we all deserve. So, if we believe in human rights, and we want to see that better future, then we are called to step up and defend the sexual and reproductive health and rights of women and girls of everyone. To stand up for the full equality of everyone. I imagine a girl who is standing at a fork in the road, and education is going to make a difference. If she is able to stay in school, she is set on a lifelong path of health and well-being along with her children, and the next generation – all the evidence shows us this. However, as happens all too often, she is forced to drop out of school, married off as a child (which is the euphemism we have for child sexual exploitation and child labor). If she becomes pregnant while still a child, what she will face assuredly is a cascade of catastrophy, challenges over the course of her life, and the next generation, jeopardising her personal health and well-being, but also that of her children, and ultimately, societal prospects for prosperity.


At UNFPA, we know this girl very well. She is right here in fatigue, she is around the corner in Sudan, she is in Guatemala, and she is wondering what is going to happen to me. Someone called Aminata told me the story and it’s just fresh in my mind, in Niger. She said, my dream was to be a nurse and it ended when I was 15 years old, I became pregnant. Having a child at that age was a big mistake. Now, I don’t work, I am a school dropout, my peers are still in school and here I am at home nursing a baby. Such a story as Aminata is telling is, in fact, common. It is the commonness of it that is so tragic. A girl’s life is turned upside down because of ignorance, ignorance about her body, and about her rights. When you flip that script, then that’s the better path from the fork in the road. For vulnerable women and girls in particular, as a health professional, now I am on the education side. Education is that door opener, that is what will make her life better, and different. Better educated women are healthier, marry later, more likely to plan the number and spacing of their children more likely to use prenatal care, vaccinate their children, and seek health services when necessary. Also more likely, with education to participate in the formal labor market, which comes with benefits. Also, education will reduce the likelihood of harmful practices like child marriage, and female genital mutilation in the next generation.


Certainly, an educated woman with her own money is far less at risk from gender-based violence that is far too prevalent, and that is part of that age-old battle. Now, quality education is not just book learning ABC mathematics. It has to include comprehensive sexuality education, age-appropriate, and culturally sensitive, but take that girl and boy out of ignorance. The evidence is very clear that when women and adolescent girls have the information, that translates into power. Power to govern their own reproductive rights and choices, and to exercise their agency in other areas, with better opportunities throughout their lives. Societies, then as this magnifies and multiplies, will flourish.


But yes, there is a catch. Right now, sexual and reproductive health and rights, the phraseology of gender equality, sustainable development goal number five, and women’s rights more broadly, are facing relentless growing pushback in practically every single place around the globe. I have to be frank, the opposition to women’s rights is powerful, it is well-organised, and it is well financed. It is active at the national, regional, and global levels. Every time that UNFPA sits in the Commission on Population and Development, as we sit with UN women in the commission that deals with women’s rights, they’re in the front row ready to object to full equality for women and girls. Now, this anti-rights, anti-choice movement has a strategic agenda that was developed in 2017. Part of their strategic plan back then, which now we see being fulfilled, and is well financed – let me underline that again, is to demonise our LGBTQI+ transgender people. It is to erase issues of racial and ethnic majority concerns and I never use the term minority, racial and ethnic, indigenous peoples’ concerns from the multilateral system. It is an agenda that is aimed to systematically roll back rights and this type of anti-human dignity movement demands a response from philanthropy.


Will philanthropy stand up against such a well-organised, well-funded opposition? I repeat, will philanthropy stand up for human rights, because we need a philanthropic effort that is better organised not just as well organised as the opposition that is more adept, that is more combative, more visible, and just as unrelenting. The silent majority should not take for granted that you will win just on the morals of the occasion, and the stakes could not be higher for women and girls in societies. Today, 44%, almost half of women, cannot make their own choices about their reproductive health, about whether or not they can use contraception without the consent of a male, and whether or not to have sex is not under their decision-making power. Our research at UNFPA shows that nearly half of the world’s pregnancies were not intended, and many of these unintended pregnancies, of course, are a happy occasion for the family, but nearly half end in abortion and unsafe abortion, which is a concern for developing countries.

Now, as I look across Africa today, 550 Women are going to die due to complications of pregnancy and childbirth, every single day. Maternal mortality is a fight that is your fight, and unsafe abortion is part of that hemorrhage that the doctor is going to write on the certificate for fear of policy for fear of the law that keeps women and girls subjected to coerced sexual activity and then blames them for the consequences. This is a wretched situation, and it is one that each and every one of us has to pay attention to. When I think about these deaths, and the tears and the 550 families, for their daughter, for their sister, for their mother, for the other children that she leaves behind. I know that many of these deaths would have been entirely preventable if policy allowed transportation to take that woman from her Island community in the boat to where she could have a safe cesarean section. If policy allowed comprehensive sexuality education so that a girl could say no when the neighbor drops by when there are issues related to sexual and gender-based violence. So, I want to emphasise that when I say 550 women will die today. Many of these are not women, they are girls. They are girls who should never have been pregnant in the first place.


Now it is so troubling. Akwasi mentioned I have served in many countries on the continent. I remember being so startled the first time as a pediatric doctor when you approach a 13–14-year-old who is pregnant and ask what happened. Now I have heard it so much, but I just remember my disorientation and shock when she tells you, I don’t know! Teach a girl to be silent, teach a girl to be acquiescent, and teach her to subject herself to male dominance. She knows nothing about her biology, it is a stomach that is inside, that is it. Then, of course, force her out of school in shame, stigma, and discrimination. The complications that I mentioned of pregnancy and childbirth include fistula and how many of us have seen women stigmatised as they leak urine or feces because of a rupture of their womb, they are too small to carry a pregnancy. Luckily, UNFPA and others are able to help with surgical attention, and this can be very transforming for women and girls who have that condition.


My main point though is that ignorance is not innocence. Often ignorance is deadly and indeed with complications from pregnancy and childbirth being the leading cause of death among African adolescent girls, we all have to sit up and take notice. Until very recently, for example, the world did not even measure pregnancy in girls 14 and under, they were completely invisible. We found out that there are half a million births across the world, to girls who are in the age range 10 to 14. The battle rages on. I believe that the controversy around comprehensive sexuality education is a manufactured controversy because we know that it is protective for girls and boys. In far too many parts of Africa, the opposition is growing because of coordinated, disinformation campaigns that are propagated by those same well-organised well-funded global anti-gender anti-rights, anti-humanity, opposition people that I mentioned. So, my dear friends, sexual and reproductive health and rights are going to be a key variable for prosperity in Africa.


When I look around post-COVID conflict, I just heard from Dr. Naheed Tobia who is from Sudan that with the conflagration that we have in Africa, leading to movements and displacement of people, it is always women and girls who bear the brunt of whatever the disaster is. We have to add climate-related disasters to that list. It is setting back progress, and things are not going well in the neighborhood. Luckily, there are things that we can do to intervene that we should do to intervene, and I believe that as we see the dramatic effects of these trends, including hunger and malnutrition whether it is drought or flood. The newest Russian action to blockade Ukraine’s grain, which is so vital to the African food supply chain. All of this means that we have to work on concert better together.

For us at UNFPA, we have informed ourselves because we are a data shop. We confer with governments in developing countries about the census, for example, and that means constructing the question, it also means modernising the approach to information for prioritising those choices that we talked about yesterday. For us, the three priorities are to make sure that family planning is in the hands of every woman and adolescent girl who requests it, to prevent maternal deaths, and to zero gender-based violence. It is a question of rights and dignity, and harmful practices like child marriage, and certainly female genital mutilation will end in our lifetime. We use quality data to help us reach those who are in greatest need, leaving no one behind.


Speaking to stakeholders in philanthropy, your investments make a difference. They are catalytic, you do have a range of creativity, experimentation, and innovation, and right now, universal access to sexual and reproductive health and rights is an important investment for everyone throughout their lives. It has been wonderful to see a group of African heads of state, including here in Senegal, who under the leadership of Madame Former President Ellen Johnson, Sirleaf devised men against gender-based violence initiatives. Now, for every dollar that you invest in family planning, you can save a government $3 in the costs for pregnancy-related and newborn care. Over time, the total package that dollar leads to, if part of it is information and services including family planning. According to Guttmacher, and others, the yield is as much as $120 in health and economic benefits by helping girls to stay in school and boosting women’s lifetime earning potential. Today, more than 200 million women and adolescent girls still cannot readily access contraception. This is not just a logistical problem; it is a post-policy issue.


We have seen significant progress in maternal health in recent decades. Uneven, but the march is forward, and also with the lifetime pace of progress regarding the statistics for the continent. However, it is not really a big mystery what makes a difference, it is the policy and willing environment. One objective is to double the number of midwives, for example, because midwives are on the ground in the communities, the medical system has never embraced this. It is time now, to assure ourselves that young people see the excitement of a career as a midwife, or a nurse, as well as innovative low-cost solutions, like the new AI-powered ultrasound device that can be used by a community health worker to identify early warning signs during pregnancy and avoid complications.


Working with academia, UNFPA has estimated that more than 115 billion US dollars are needed over the course of the next 10 years to have a major impact on maternal death in the 120 priority countries, most of whom are right here. When you look at the bottom 10 countries for death during pregnancy and childbirth, except for Afghanistan, it is Africa. When you look at the bottom 20 except for Afghanistan, and Myanmar. This is something that we can join hands and do something about. I would like to say that African philanthropy is an important source of financing. However, you are also an important source of know-how, innovation, and what I would call HOPE.


The examples that were given to us during the course of our meeting are the type of social change that you are espousing is going to accelerate development. More and more foundations align what you are doing with government priorities and with the global sustainable development goals. This has a big influence on what happens in the international sphere. Generosity and informal philanthropy as we have also elucidated during this meeting, continue to play a significant role in African societies as they have for centuries. That spirit of generate of generosity really comes forward during times of crisis, and we saw this with Ebola. We saw it with the HIV pandemic and the role of grandmothers has been highlighted. Now as we see devastating floods and concomitantly devastating droughts, it is again these informal philanthropic efforts that make a difference. I would like to include the diaspora in this type of community because as Africa’s proud and powerful sixth region, we too have to play our role in the development of a continent that was ravaged by lack of bodily autonomy, by the enslavement of so many of our forebears. So, I think it has been important to stimulate that diaspora giving, funding, and time. I think there will be a lot of potential in that kind of dynamic. I have seen that the African Philanthropy Network here estimates the potential giving pool of wealthy individuals at 2.8 billion per year, possibly as high as 7 billion. This is something we can go after because you can imagine how fast and far we could move, especially the gender equality needle if we target those investments appropriately. If we particularly focus on reproductive health and rights and on girls’ education.


I would like to close by highlighting strategic partnerships that we are extremely grateful for. We have worked, for example, with African philanthropy, in the discussions on taxing and the financial flows, that so many of you have put on the map and been very vocal in visibilising. We have worked with foundations such as the Children’s Investment Fund Foundation, Bill and Melinda Gates Foundation, and Anonymous philanthropy, which provided 50 million US dollars to our UNFPA supplies program just a year ago. This funding is strengthening health systems to reduce the unmet need for family planning in the wake of the funding gap. As a result, the contraceptives provided through the UNFPA supplies partnership have helped to avert over 5 million unintended pregnancies, and 114,000 maternal and child deaths over the course of two years. This also translates to preventing unsafe abortions by more than a million and a half and reaching more than 13 million users with quality modern methods of contraception.


We have done everything possible to work with young people and to have their ideas incorporated into what their vision is for how sexual and reproductive health should be deployed, and working with the maternity foundation to launch a COVID module within their safe delivery app. This helped midwives and other healthcare personnel to protect themselves during COVID, as well as women and newborns from the virus. This is an app that has been downloaded hundreds of 1000s of times and is used in more than 40 countries, many of them here. Foundation Chanel has also been a strategic partner, we have also conceived a power-of-choice initiative with them, that aims to reach women and girls directly on the ground. With Sif, because of their interest in adolescent health, they have recently committed $5 million through a bond programme that is being tested in Kenya, and it looks very promising.


There are a whole host of other very important initiatives, including working with you on advocacy. I think that is how you can really help by continuing to advocate for increased attention to support sexual and reproductive health and rights, and more financial and human resources to strengthen national health systems, and the supply chains. We saw the collapse during COVID. Their critical dimensions beyond the health system as well, though, and I think use your influence and power on employment on the digital technology equation, and economic empowerment opportunities. With Ukraine on the map and so much else, official development assistance is on the decline, and that is affecting our programming. So, I think the ideas that you have had about stimulating domestic resources as a continuing, renewable potential source of funding and financing needs to emphasise maternal health and family planning, and young people’s services going forward. So now is the time when we should stand strong, we should stand shoulder to shoulder basing what we do on human decency and human rights. This applies to everyone whether a woman or a girl with a disability, an ethnic or religious majority-minority, people living in rural areas who are at higher risk, and every woman everywhere. The prevalence of gender-based violence is ubiquitous, and an end to child marriage and female genital mutilation and attention to survivors.


It is time for Mother Africa to claim all of her children, especially her girl children, and stand united in her favor, and stand united against xenophobia, racism, discrimination, and any patriarchal patterns. For us at UNFPA, we will stand with you, and we will stand for rights and choices wherever we may be. We need to stand together for the full dignity of LGBTQ+ people in all their sexual diversity which is their right. Full equality and accessibility for people who live with disabilities, that is their right. Ending FGM now in our lifetime, stopping child marriages now, and sexual exploitation of women and girls now, not 2030 or 50 years from now.


Now, and I think you could examine the medical apartheid as mentioned, that really shocked me during COVID, how we failed as a health system, and how Africa got pushed to the back of the line. The vaccine inequity, that my dear brother Dr. Tedros spoke about at the World Health Organisation is something that needs to be rectified, and you can help to end that now. Certainly, the United Nations will stand ready to partner with you. For us, we are helping to advance the effort of this and combat racism and discrimination. As we stand for the rights of indigenous people, we also provide technical support to the United Nations Permanent Forum on people of African descent, which is a new post-urban process. We are going to continue to push back against the push back, and to keep moving forward, which means hearing your voice among all the voices that speak for the most left-behind populations. None of us accomplishes anything solo.


I served on the Trust Africa board, and it has been my honor, along with our current chair. I learned so much from Madame Aisha, and other giants like Bishop Malusi, and Assefa Bacala. From the reception, when I walked in, to the operations, accounts, and programme people, I stood in awe of that staff willing, imaginative, and capable. I would like to thank all of you, who in whatever part of the world you are working, are promoting that sense of imagination and capacity, especially among your younger staff. I have to say that Turanga was alive and well, the whole time that I have been back in Senegal, and I would like to thank the hotel team and in particular, our wonderful interpreters. Thank you so much for what you have done.


To my own colleagues at the United Nations, my UNFPA colleagues are committed, they always say we are passionate, and that is true. I hope you have had a chance to chat with all of us here who are committed to rights and choices. Our image is of a world that is welcoming a life that is a whole lot better for a 10-year-old girl. Thank you, to my colleagues that every woman and girl owns her body, right? When she can exercise her rights and govern her own body, then that is the Africa we want. That is the future that we build. It is one of the rights and choices and full gender equality. So let us not keep that a secret. Let us move forward to greater peace and prosperity because peace and prosperity are what she wants for herself, for her family, for her community, and for our world. It is a battle, and we are going to win it. Aluta continua, thank you so much.