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© 2011 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2011;19(38):35–41 0968-8080/11 $ – see front matter DOI: 10.1016/S0968-8080(11)38575-8

Perpetuating power: a response Adriana Ortiz Ortega Academic Advisor, Universidad Nacional Autónoma de México, Secretaría General, Mexico City, Mexico. E-mail:

ERIT Austveg's paper1 explores the power dimensions revealed in two prevalent human rights approaches: feminist notions of sexual and reproductive rights versus those posited in the Millennium Development Goals (MDGs). This divergence requires an exploration of who the actors were who replaced the agreements about the global development agenda made in the International Conference on Population and Development (ICPD) in Cairo 1994 and the 4th UN World Women's Conference in Beijing in 1995 with the MDGs, as well as an exploration of the processes which shape and affect the exercise of power, which can lead to such a radical change. It is in this context that the renewed call by feminist activists for the implementation of strategic actions envisaged in the Cairo Programme of Action and the Beijing Platform for Action gains salience and acquires meaning. Referring specifically to maternal mortality, we find that this has become a sensitive problem, in that deaths from complications of unsafe abortion have apparently been dropped from the measurement of maternal mortality, or at least mention of them and attention to them has been dropped.


the future, developed through international dialogue and subscribed to by almost all the governments in the world. As Naila Kabeer wrote about Beijing in 2005:

Some history

“[Beijing]… was not just another UN conference… It was a conference that represented an international movement whose members were present, not only in the NGO Forum held alongside the official conference and actively seeking to influence it but were also playing an active role within the official conference itself, as civil society representatives on government delegations and, occasionally, as the government delegates themselves. Nor could the conference be seen as a one-off event. It was a moment in a process that had begun over two decades ago when Women in Development advocates had been able to persuade the UN to declare 1975 the International Year of Women and then to declare 1975–85 the First International Decade of Women. In one sense, Beijing represented the culmination of this process, which had begun so many years ago. In another sense, however, the Platform for Action with which it concluded represented another moment in that process, the beginning of a new phase in the history of the international women's movement and its attempts to influence the course of development.” 2

The Cairo Programme of Action and the Beijing Platform for Action contain the consensus recommendations agreed at the 1994 and 1995 conferences, respectively, which marked a milestone for the international women's health movement as they contained a comprehensive, holistic and transformative vision for

Symptomatically, however, that same year, several other international meetings had been initiated at the United Nations (UN) to create a different direction for development, mostly influenced by financial considerations. Those meetings, attended by top development leaders, began in 1995 and lasted until 35

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2000.* They got a lot of media attention when it became clear that they would culminate in a new development agenda, which had not happened in previous UN meetings. It was during the Dawn of a New Millennium Meeting that the Millennium Declaration was adopted by the UN General Assembly. Although the 12 areas of concern of the Beijing Platform for Action were integrated into the Millennium Development Goals, it was done in a way that reduced their critical edge and left out the holistic approach of the Platform for Action.2† Essential elements of a gender agenda certainly remained, and equal rights and opportunities for women and men and their freedom from hunger and from fear of violence, oppression and injustice were stated. Nonetheless, the strategic objectives and actions from Beijing were transformed into thinner recommendations in the six relevant Millennium Development Goals. Moreover, a different constellation of actors and a diminished role for feminists led, for example, to the technical representation of reduction of maternal mortality only through the proxy indicator of “births attended by skilled attendants”.1 The result was that more than two decades of worldwide discussion among women and the combined cross-fertilization of a worldwide feminist dialogue with NGOs, political *The Millennium Declaration came about as a joint effort between the Organization for Economic Cooperation and Development, World Bank, International Monetary Fund and United Nations. The declaration evolved through a series of UN-led conferences in the 1990s focusing on issues such as children, nutrition, human rights, women and others. It is not possible to narrow down the specific conference in which the actual drafting of the MDGs began to materialize, but in 1995 the UN played a critical role, aware of a decrease in Official Development Assistance by major donors, as did the World Bank and International Monetary Fund. The 50th anniversary of the UN was considered an historical opportunity to encourage international debate about the role of the UN. These UN meetings led to the report entitled We the Peoples: The Role of the United Nations in the 21st Century, which in turn led to the Millennium Declaration. By this time, the OECD had already formed its International Development Goals (IDGs), which were combined with the UN's efforts at the World Bank's 2001 meeting, which formed the MDGs.


parties, international institutions and governments, got lost. Historical accounts of how this happened remain to be written, yet the few articles on the matter state that the MDGs have served to reduce the vision and aspirations of the feminist movement to a series of narrow and technically conceived targets.1,3,4 Furthermore, the adoption of the MDGs signalled a shift of resources and priorities away from civil society to governments for policy development that eroded the holistic human rights perspective embraced in the Cairo and Beijing conferences and the World Conference on Human Rights (Vienna, 1993).3 Thus, the capacity of civil society actors to hold governments responsible and accountable for the promises made has become reduced to attempts to influence from the outside – as it was before the Cairo and Beijing conferences – losing the space for interaction and reducing the ability of women's movement advocates to place conditions on the terms upon which governments become recipients of external funds. A key element in this process, which deserves special attention, is that the change of priorities and content of the development agenda emerged †

The 12 critical areas of concern in the Beijing Platform for Action were based in a gender perspective and in principles of equality, indivisibility of human rights and recognition of poverty and inequality: 1) the persistent and increasing burden of poverty for women; 2) inequalities and inadequacies in, and unequal access to, education and training; 3) inequalities and inadequacies in, and unequal access to, health care and related services; 4) violence against women; 5) the effects of armed or other kinds of conflict on women, including those living under foreign occupation; 6) inequality in economic structures and policies, in all forms of productive activities and in access to resources; 7) inequality between women and men in the sharing of power and decision-making at all levels; 8) insufficient mechanisms at all levels to promote the advancement of women; 9) lack of respect for and inadequate promotion and protection of the human rights of women; 10) stereotyping of women and inequality in women's access and participation in all communication systems, especially the media; 11) gender inequality in the management of natural resources and in the safeguarding of the environment; and 12) persistent discrimination against and violation of the rights of the girl child.2

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after only limited interaction between governments, civil society and international agencies. It was not just that women's movement activists were left out. Instead, the global agenda – covering issues that ranged from population and sustainable development to human rights and gender – was taken over by the World Bank and the International Monetary Fund. This new leadership diluted the multilateral approach to global problems and privileged a corporate vision. This “coup” was a by-product of the consolidation of power by these new stakeholders, who asserted their leadership at the expense of the United Nations, whose leadership was previously responsible for global governance. In the new scenario, public policy was transformed into services for “consumers” or “clients” – as opposed to policies for citizens – and was handed over to private companies to provide instead of being functions of the state. Some argue that in this process, governance has become the missing link in the development agenda.5 In this new global scenario, governments of the South find themselves in a fragile position, relying often on external funds to carry out the MDG agenda, especially in places where there is war, conflict and increased social violence. Scepticism about this process has led some authors to state that although the MDGs are promoted by the UN as being the result of a global consensus, in fact, a top-down approach was used, which represents a kind of privatisation of the global agenda.6 If this observation is true, it is perhaps one reason why the previous consensus, achieved in conjunction with civil society, was replaced not only with different goals, but also different strategies and mechanisms.5 In any case, the MDGs represent a less critical approach to development in a changing world where, at the same time as the fall of the Berlin Wall and the end of the Cold War were taking place, there were also diminishing funds for development through bilateral cooperation. In this context, donors have privileged channelling funds through governments. And as stated before, the most problematic aspect of the shift of agenda has been the decrease in the inclusion in decision-making of civil society, a key source of influence aimed at changing mentalities, e.g. in relation to the need for safe, legal abortion, a subject about which few governments feel able to take action in a manner supportive of women.

A perverse effect of this process has been not only greater limitations on resources available for implementing the Platform for Action, but the conditionality placed on resources available to NGOs, who have again been reduced to the status of observers. As Austveg explains: “The influence of power has increasingly been ignored in the MDG agenda, with the effect that existing power structures, which create obstacles to change on the ground, are not being challenged.”1 In the midst of adverse circumstances, feminists have responded by engaging in multiple strategies. First, they have aimed at engaging in dialogue with UN agencies so as not to miss an opportunity to influence the MDGs. The original dismay with which the MDGs were met by women's groups in different parts of the world has been followed by a growing awareness of the change of scenario that has required women to pay greater attention to macroeconomics; for example, the understanding that increased access to education for girls does not necessarily translate into secure and well-paid employment for women. And, that reaching a critical mass of women in the labour market does not necessarily translate into access to political office or decisionmaking positions in the private or public domain. Second, feminists have made sustained efforts to continue to make the importance of the Cairo and Beijing recommendations visible.* This was exemplified during follow-up global and regional meetings for ICPD +5 (1999), Beijing+5 (2000), ICPD+10 and World Health Assembly in 2004, and Beijing+10 in 2005, during all of which leaders reaffirmed their commitment to the agreements made. The ICPD follow-up is important in that its Programme of Action calls for *The Women's Watch is a UN gateway to global information about women's concerns and progress in achieving equality, put together in 1999 by online global working groups to gather information on implementation of the 12 critical areas of concern of the Beijing Platform for Action. The members of the working groups represented more than 120 countries and included NGOs, government representatives, inter-governmental organisations and researchers. This effort aimed to collect lessons learned, assess progress made identify continuing obstacles and share good practices across the 12 critical areas of concern.7


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the strengthening of health systems capacity, legislative change, monitoring and evaluation of policy and programme implementation, and mobilisation of political will in favour of sexual and reproductive health to be guided by a human rights framework.8 Third, feminists have worked on promoting and showcasing successful examples at the local and national level of reproductive health interventions; what has been done in Nigeria in terms of promoting girls' education as a means to improve sexual and reproductive health stands out as an example of such interventions.9 The Girls' Power Initiative was begun in southeast Nigeria and has become an internationally recognized organization running a comprehensive educational and empowerment programme designed to achieve gender equality in four Nigerian states, as well as to engage in lobbying. In a context where female genital mutilation is common, offering information about health and rights seems highly important. This action has been remarkable in creating an inter-generational dialogue that has helped girls to develop skills to protect themselves and to challenge pervasive inequalities. Similarly, in Asia, ARROW has developed models of intervention that have allowed NGOs to influence state policies in education and sexual and reproductive rights. Each one of these expressions of feminist engagement illustrates how feminists have remained committed to making sure that Cairo and Beijing retain their critical influence. Fifteen years later it is possible to state that even though feminist efforts have not been able to stop the reproductive health agenda from being pushed aside, it is also true that in the Millennium Development Goals the targets of gender equality and women's empowerment are present and the elimination of gender disparities remains a goal. In the case of maternal mortality, however, the goal established in MDG5 has a far more limited scope, as it is associated only with the measurement of the capacity of primary health services to attend deliveries than to a commitment to integrated sexual and reproductive health services, including abortion, which women need for all the years they are not pregnant. In this context, making the case for political analysis and constant revision of strategies seems timely, due not only to the changing 38

scenario and the risk of gender being ignored, but also to neoliberal macroeconomic and financial decisions and new permutations in the relationship between conservatism and corporate development. In short, new forms of conservative leadership are also eroding gains made through progressive North-South alliances that were manifested during the Cairo and Beijing conferences. As Barton argues happened in Beijing: “Moral conservative groups that oppose an agenda for women's rights have systematically attempted to emerge as champions of the South', including the Vatican and a small group of southern nations. This has created a sharp divide in UN negotiations between Northern nations arguing for a certain limited definition of ‘women's rights’ while strengthening the neoliberal stranglehold on the South, and some southern nations undermining those ‘women's rights’ while leading the battle against Northern economic control.” 4 Barton was referring specifically to the ways in which the Bush administration dealt with women's rights, and although a different scenario has opened up with the Obama administration, the influence of conservative coalitions persists. Thus, continued examination of the reconfiguration of alliances between the forces involved and the nature of the backlash is still called for, in which religious opposition and fundamentalism require particular attention. According to Antrobus, four trends have changed the context for women's organizing in the past 12 years: the spread of political neoconservatism, the spread of religious fundamentalism, Bush's “war on terrorism” and – on the plus side – the emergence of an expanding transnational social movement against the spread of neo-liberal globalization.10 The growing number of spaces in which the transnationalization of feminist activism is taking place has been recognized as an important site of resistance. In these spaces, the discussion is about both the need for conceptual understanding of gender subordination and the different forms it takes, and the multiplication of spaces of struggle. The work includes movement building, debate and reflection. Some examples are the Feminist Dialogues, the AWID conferences, the Feminist Task Force of the Global Call against Poverty,

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and Countdown 2015.* These networking efforts aim to explore and monitor policy-making, preserve gains and counterbalance the effects of backlashes when they occur. After 15 years of feminist engagement in building capacity to influence decisions, and to participate hand-inhand with governments and international agencies, feminist are recognizing more and more that: “[Their] engagements with the ‘larger’ social movements and global campaigns provide feminists with unique opportunities for negotiating and reframing social contracts around political unities and new forms of democratic mass politics.”10 As part of these tasks, feminists have broadened their conceptual understanding of the connections between sexual rights and violence, war and law reform. At the same time, they have coped with tensions that emanate from the effort at building a common agenda while respecting *The “Building Solidarities: Feminist Dialogues”, created in 2003, provided a space for feminist analysis and movement-building preceding the Fourth World Social Forum in Mumbai, India (< index.php?option=com_content&task=view&id=283& Itemid=167&date=2007-11-01>). The Global Call to Action against Poverty is a global citizens' campaign in support of poverty reduction as a priority in the MDGs (<>). While women's networks such as DAWN had concerns about being part of this campaign, due to its contradictions and public relations hype, they agreed that they could not exclude themselves from a global initiative that had poor peoples' movements in it and which was aimed at creating the broadest possible alliances against poverty. Hence, they formed a feminist task force within it, from which to operate.10 AWID (Association for Women's Rights in Development) is a Canadian feminist group which has been organizing global conferences for the past 12 years to discuss development from a feminist, transnational perspective and within a rights framework (<www.awid. org>). The Countdown to 2015 Initiative, involving a mix of UN and intergovernmental agencies, donors, large NGOs, and universities, tracks coverage levels for health interventions proven to reduce maternal, newborn and child mortality. To do so, it calls on governments and development partners to be accountable, identifies knowledge gaps and proposes new actions. Overall, the Countdown Initiative can be described as a supra-institutional collaborative effort (<>).11

diversity, different subjectivities and varying political priorities.4 For example, bridging the gap between gender justice and economic justice has required dialogue that has to be translated into strategies and actions. Given the scarcity of resources, movements of feminists, human rights activists, and those addressing sexuality and HIV/AIDS are carrying out strategic planning on how to advance goals and objectives while facing funding cuts, conservatism, and the weakening of the previously strong North-South coalition built during Cairo and Beijing in the 1990s. Yet there is no doubt about the continuing relevance of these agendas, evident in the high costs of sexual and reproductive ill-health. To give weight to the efforts described earlier, it is important to remember that the ICPD Programme of Action was the result of a fragile negotiation between diverse women's constituencies, governments and international institutions,12 while the relevance of the Beijing Platform for Action on reproductive health and rights remains. Indeed, the issues dominating the agenda have not changed dramatically, but have expanded, and some feminist and human rights groups have fought for the inclusion of the consequences of worldwide violence against women; recognition of sexual and reproductive rights; and attention to gender inequalities in the context of poverty and the structures that generate inequality. Yet, the difficulties faced by feminists are not limited to re-expanding the new, narrow development approach, but rather the strains that globalization and conservatism have placed on the already demanding agenda for sexual and reproductive rights, to make space for the inclusion of violence and environmental issues. In this context, if feminists are to engage in repoliticizing the sexual and reproductive health agenda, a broad discussion on how to build a people-centred development agenda continues to be at the top of the list, as well as seeking mechanisms and strategies to rebuild governance from a feminist perspective. This task requires continuous engagement in uncovering the ideology underlying the present development agenda and its narrow vision of democracy. Questioning the present global trade and finance regimes, and current global political governance, is an exercise to which different feminist groups are devoting energy. Among 39

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the challenges is the need to deconstruct, so to speak, the technocratic discourses.

Conclusions For all the above-mentioned reasons, feminists need, more than ever, to:

• identify and re-identify those who hold power and the discourses they use to justify power, as well as the connections, separations, transformations and fissures that prevail among them; and • analyze how they have managed to reshape the international scenario, and in some cases derail progress by inserting new (or old) ideas. With this understanding, feminists will have the evidence to show that the worldwide concentration of income among the powerful leads to increases in poverty levels, ecological destruction, the spread of violence and armed conflict, political instability and corruption. And to show that the failure of “structural adjustment” policies is due to the failure of state intervention based on the political administration of neoliberal economic policies. This in turn provides a window for feminists to invite those in the donor community who stand out from these other stakeholders to reconsider the route they have been supporting for the last 12 years. It is for these reasons that feminist critiques of power and empowerment need to be revisited in relation to contemporary events. In the past, feminist discourses and action pioneered an expansion of the notion of power to include sexual and gender differences and the false dichotomy between the private and the public spheres in matters related to gender, sexuality and reproduction.13 The novelty of present reflections is based in the need to ask ourselves again and again with fresh eyes:

• How effective have feminists been in setting, influencing and transforming agendas at the level of conception, design of actions, follow-up and in other ways? • What lessons can be learned from the successes of the 1990s? • What accounts for the present difficulty in preserving similar negotiating powers? Certainly, some of the answers come from the interconnection of our agenda with the agendas 40

of others, e.g. the macroeconomic and international dynamics described earlier but also the changes taking place in the international and national order. Second, we need to find a way to be effective in multiple arenas again. In both cases we need to maintain feminist efforts to view gender as cross-cutting: “Starting from the body has become a tool to engage from within or from outside in the multiplicity of democratic political and cultural struggles that not only women but other social movements are waging.”14 Third, we must recognize that corporate developments have been embraced by some feminists who, in their local context, benefit from the profit derived from having close connections with the status quo. In other words, although feminist have engaged in diverse transnational actions, opening new spaces within constituted democracies, or participated in the process of building democracies, we cannot idealize such dynamics. Rather we need to keep a critical eye on this process: “The SRHR [sexual and reproductive health and rights] field, like any other international health arenas, embodies creative tensions and contradictions that are delicately balanced in some places and fractured in others. Initially a coalition of activists, implementers, researchers and donors forged a political path to establish a field through UN Conferences and other forms of international mobilization. Today, we are a large, disparate group, with different funding bases and class trajectories. The organizations involved draw motivation from agendas ranging from women's human rights and social change to corporate and business models for commodity distribution and service delivery.”15 Finally, holistic answers will emerge as different inter-generational and inter-regional voices are included. One of these examples is the inclusion of Chinese views on sexual and reproductive rights at a time when these discussions are only beginning to take place in academic settings and are not yet part of the public debate in Asian countries.16 Commenting upon Chinese views seems important as Asian voices will begin to figure prominently in the international arena and it is important to take into account that beyond China being recognized as a leading economic country with vast influence in the world, civil

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and academic groups are increasingly articulating a critical and transformative view of dominant sexual norms and publicly voicing these concerns in the narrow spaces provided by their state. In short, we need to invest in continuous political analysis that can help us to understand better the places where we are able to have influence and those where we are unable to influence. Our different experiences and different analyses must be shared in virtual space across countries and regions, to contribute to constructing strategies to move sexual and reproductive health and rights forward, as con-

ceived by feminists, located within a rights and social justice framework. Without underestimating tensions, it is still possible to imagine that movements with scarce resources at a time of deep cultural and social transformation will be able to assert influence and move forward progressive agendas. Hopefully, while learning how to do more with less, we can also open doors for renewed and expansive change as we identify how to shift the gears of power once more in favour of the deep-seated change we have so comprehensively and carefully envisioned.

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