Deadly Serious
Sarah Boseley
The Guardian (UK), June 30, 1999

Millions of women's lives could be at stake if the UN fails today to safeguard progress made on a global sexual health. As Sarah Boseley finds out, Clare Short is more than ready to do battle with reactionary forces in New York

Clare Short, the international development secretary, is not going to be sidetracked. She is in forthright and determined mood for today's United Nations meeting in New York. Short cares passionately about the agenda - and so should everybody on the planet - because its success or failure is critical for all of us. This is what has become known as Cairo+5, a special session of the UN general assembly to assess how far we have come in population control, maternal mortality and reproductive health since the watershed conference in Egypt in 1994.

Cairo was an extraordinary breakthrough on global sexual health. Many targets were agreed and hard-fought principles were eventually laid down: women have the right to control their own fertility, to decide the number and timing of their pregnancies; they should have access to contraceptive advice and education and safe abortion where it is not against the law; young people, the biggest risk group for HIV, should get sex education and contraceptive help. The Vatican lobbied loudly and aggressively against the principles, and some Catholic and Islamic countries registered objections, but the deal was done.

But throughout this year, in the run-up to today's meeting, the Holy See and its allies have been working ceaselessly behind the scenes to unstitch all that progress. Their aim appears to be to block the report of what has been achieved from ever seeing the light of day and to force re-negotiation of the Cairo agreement.

It profoundly angers Short. "The Holy See is in an unholy alliance with reactionary forces deeply unholy, and I speak as a fully signed-up ethnic Catholic, as I learned to call myself in Bosnia," she says.

"My church is playing a deeply obstructive role where, if it had its way, a million people would get the HIV virus, there would be more and more unwanted pregnancies, more and more illegal abortions, more and more mothers dying as a result of illegal abortions. That is the position they are trying to work for. And it's a morally destructive course.

"There's this alliance trying to find governments which, for one reason or another, they can bully into adopting a position to obstruct this growing, informed international consensus.

"We have to have it out and argue and defeat those arguments. And while the office of the Holy See is putting that position, I know that Catholics worldwide, the overwhelming majority of them, do not agree with it."

Emergency contraception is one of the most fraught issues now muddying the Cairo waters. The morning-after pill, which the Vatican insists is an abortifacient because it prevents a fertilised egg implanting in the womb, was not widely available five years ago. But in what was interpreted as a shot across the UN bows prior to New York, the Vatican opposed delivery of the pills to refugee camps in Kosovo for women who had been raped.

"The whole of international opinion just does not agree and thinks that is a profoundly disgusting position," says Short.

In the pre-New York meetings that have been going on since January to try to agree the progress document, the Holy See's lobbyists have been operating in a more subtle and sophisticated fashion than they did at Cairo, according to Frances Kissling, of Catholics for a Free Choice, who oppose the Vatican stance. She says they have a two-pronged approach, working with countries such as Argentina and Guatemala, which support their views, and mobilising conservative organisations within the US which are not necessarily Catholic to lobby delegates.

"They planed and bussed in over 100 young people - mainly from Utah, which is heavily conservative and Mormon," Kissling claims.

Kissling accuses the lobbyists of using intimidating tactics and putting out misinformation. "They say condoms do not prevent Aids," she explains. "It is a kind of convoluted logic." The argument goes that condoms break and will let down some who might have chosen to abstain from sex if condoms had not been available. She herself, at a public meeting, was told she was "the Salman Rushdie of the Catholic church and they needed to take out a contract on me". She fears that the New York meeting may be dragged out to an anticlimax, with no document produced.

Clare Short is determined that will not happen. She has gone down a storm at the UN in the past - the heads of agencies, the delegates and the NGOs love her straight-talking. There will be hopes that she can help stop the drift, if anyone can.

There are lives at stake. In Britain, women have one chance in 5,000 of dying in childbirth; in Nepal, it is one in 10; of the number of deaths globally, 15% are due to unsafe abortion.

Short also wants to stop the tragedy of HIV infection that is on the horizon for so many young people. She says: "We've got the biggest generation of young people the world has ever seen - a billion of them - and half the HIV infections are young people, most of them girls now."

Yet one of the main sticking points is whether young, unmarried women should get contraceptive advice. "We're saying that those rights extend to all people, including young people, who all over the world are sexually active at a younger age," she argues. "The only way to protect them and to make sure they don't have unwanted pregnancies and then abortions - and in some countries that means dying of the consequences - is to give them proper sexual education and access to reproductive health care."

She recognises that it has been ever thus. "In all societies, people have wanted to control women by denying them control over their fertility." But a new economic awareness is fighting the cause for the reformers. Women living longer and having fewer and healthier children means they are less of a drain on budgets and help economic prosperity. "That means girls being educated, women having more authority and access to information and the opportunity to make a living and access to reproductive health care and control over their fertility," Short says. "That's one reason why we are winning the argument. Reluctant traditionalists are having to give in because you can't have economic development and obstruct this."

It was not until the late 1980s that HIV appeared. Now there are 40m people infected and millions more at risk. South Africa and Zimbabwe are badly affected, and there is the prospect of further spread throughout Asia.

But if Aids could be said to have a positive fall-out, it has been to focus attention on the need for sex education. "You can't deal with HIV properly without proper reproductive health care," Short says. "It becomes seamless." There was total denial of HIV in many African countries, she says, but now they are looking towards Uganda, which has become a beacon.

Could the UN agencies do more? They could do a lot more, she acknowledges. But their effectiveness is rapidly increasing, she says, with the use of internationally agreed targets to measure progress and with the arrival of the new breed of reformers - such as the World Health Organisation's Gro Harlem Brundtland,who is "a fantastic breath of fresh air".

"She's a good woman, she's got a very clear agenda, and she's making fantastic progress," Short says. "She'd like to go faster - wouldn't we all? - but there's no doubt, objectively, that we're making progress."

Fundamental to that progress are sound basic health care systems, which the WHO is pushing for in the developing world, because, says Short, individual top-down programmes - whether on sexual health or rolling back malaria - will not deliver protection to whole populations.

There have been accusations that donor countries have dragged their feet on providing the funds they promised to help the developing world - which is supposed to foot two-thirds of the bill itself - to provide sexual health services. Short is robust. The funding argument "is a game that is played in New York. We're trying to get the argument around to being about backing effective reformers and guaranteeing an increase in resources for those that do what's necessary, because donor funding can't make up for governments that won't put in place the structures that will deliver to their people."

So money is another side issue. And Short's mission over the next few days is to cut through the side issues, the delaying tactics and back-tracking. It matters to millions of people that she should succeed.