On March 14, 2019 In Statements and Speeches

President of the Royal College of Obstetricians and Gynaecologists Professor Lesley Regan’s Distinguished Congress participants, Ladies and Gentlemen It is a joy and honour to be in the company of so many eminent academics, esteemed colleagues and faithful partners in the struggle to advance the health of women and girls globally. I am told there are an astounding 2000 participants hailing from 77 countries including 22 African countries. That is a remarkable number, and the diversity represented here is truly a testament to the incredible work going on around the world to reduce maternal and child mortality, to address women and girls health issues, and to mainstream conversation and action on their issues. I want to thank the University of Leicester and, specifically, the Royal College of Obstetricians and Gynaecologists, for inviting me to take part in this unique and timely conference, and to share my reflections as an African woman, mother, citizen advocate and First Lady who is both deeply concerned about the health challenges facing women and girls on the continent, and deeply optimistic about the direction our continent is taking in dealing with those challenges. My special thanks go to the President of the RCOG, Professor Lesley Regan; to Dr. Ann Kihara for her generous and gracious introduction, and to RCOG team for the impeccable hospitality we have received during our time here.   Finally, I must of course register my profound gratitude to RCOG for the recognition you have extended to me. Today, I am proud to be received as a “Fellow Ad Eundeum” of your illustrious institution. I am especially honoured because at the heart of this award is an implicit recognition of Beyond Zero Initiative. The Initiative begun four years ago as an effort to reduce maternal and child mortality, as well as HIV prevalence, through awareness raising, advocacy and expansion of access to basic medical services. Last year, we met our three year target of delivering 47 fully equipped medical clinics to 47 counties in Kenya. This year, we have turned our sights towards building a fully-fledged national referral hospital with a special focus on neonatal care and mothers, wellness, research and training. We have also broadened the scope of our work to target cervical and breast cancer, that are—sadly—gaining prominence in our society. Beyond Zero is committed to this trajectory of growth because we recognise that there is a great deal of work to be done to support women and children, and the world needs more heads, hands and hearts devoted to doing it. Fortunately, those critically needed specialised human resources are available—as this forum today indicates. While Beyond Zero is widely associated with me personally, the reality is that for four years I have had the very great fortune of being a highly visible face for a vast and invisible movement that has encompassed hundreds of thousands of people including citizens, activists, educators, health professionals, volunteers, civil servants, philanthropists and many many other groups of people who have—in one way or another—expressed their commitment to ending maternal and child mortality. I have been reminded of that time and time again. I would be remiss not to recognize the Beyond Zero Secretariat, the tens of thousands of individuals and institutions who have partnered with Beyond Zero over the last four years, and the millions of champions for women and girls whose passion is fuelling the push to attain Sustainable Development Goals 3 and 5. Today, I honour and thank these individuals. Ladies and gentlemen. Over the last couple of days, there has been robust dialogue around the question of women and girls health. We have outlined the issues, identified gaps and opportunities in healthcare systems, elaborated on targeted interventions and renewed our shared commitment to addressing the myriad of complex issues related to women and girls health. I am sure that the conversation has been enlightening, provocative and challenging for all of us—even with the significant expertise represented here. And I know that these conversations will continue to catalyse diverse action on the part of numerous stakeholders.   But as we continue to consider the issues, I think there are several ideas and principles that should guide our effort, engagement and successes. Allow me to elaborate on three of them.   Firstly, based on my experiences, I think it is exceedingly important for us to remember that there is no homogeneity in women and girls health issues.  Our health issues go beyond medicine. The health challenges facing women are as diverse as women themselves. They are not limited to scientific and biological components, but are informed by socio-economic, political and cultural realities which differ across communities and regions. Which means that standardised medical and scientific responses to women and girls health issues must account for nuance, and be adapted for cultural contexts—or they risk failure.   In this day and age, as we deal with the issue of maternal mortality—which remains prevalent in Africa—HIV, female genital mutilation, breast and cervical cancer and the other issues. Sensitivity to the needs, desires, beliefs and orientations of affected groups and communities is critical to successful intervention and engagement. World views must not be imposed. Solutions must be co-owned by communities.   The second thing that I think we need to consider is that -  As we strive to create interventions to support the health of women and girls, we should not overlook the simple for the spectacular. We are exceedingly fortunate to live in a day when rapid changes in technology afford us more options and advanced medical tools for dealing with diseases. We are in an era, for instance, where cancers can be identified and treated with a higher degree of precision than ever before and using a wide range of methods. Medical miracles have proliferated. Medical options and outcomes have been enhanced and I applaud the wealth of medical research being pioneered across the world, by many of you professionals and experts in this room. But, even as we leverage these new tools, we must not forget that that sometimes a few simple conversations and advocacy interventions that can go a long way in advancing our shared goals. Circulating information about self-screening for breast cancer, for example, or fostering public dialogue around HIV or catalysing community conversations about FGM or advocating for lifestyle changes — these relatively simpler and sometimes less costly remedial actions must not be marginalised in the 21st century.  None of us can afford to see single–component interventions. Instead, we must create integrated holistic approaches for dealing with the myriad of health issues facing girls and women. Related to that thought, the third principle that I believe must guide all stakeholders in the battle for women and girls health in the developing world, is that it must be fought on all fronts. I mean this in two main ways. Today, non-communicable diseases pose an increasingly serious threat in the developing world. Cancer is chief among them. An estimated 85 per cent of the annual incidence of cervical cancer, and 88 per cent of cervical cancer related deaths, occur in low and middle income countries. There is no doubt that we need to significantly compound the amount of time, capital and human resources dedicated to addressing non-communicable diseases. And we are beginning to see that happen more. In my own country, Kenya, we launched the National Cancer Institute in 2015, and a National Cancer Program in 2016, to lead the fight against cancer. Several multilateral agencies have raised the flag on non-communicable diseases and their growing impact—especially in low and middle-income countries. However, as we turn our attention towards fighting along this newer frontier, we must be careful to safeguard the gains we have made in dealing with communicable diseases such as TB, HIV, Cholera, Hepatitis and to continue our progress in this arena.   As I have alluded to already, women and girls health issues involve complex and divergent problems: some systemic, some political, some cultural. And to engage effectively, we must fight on all the relevant fronts. We must address the fundamental issues that have led to the historic marginalisation of women and girls issues. Which means action cannot be limited to one arena alone, but must be comprehensive and include lobbying for political and policy action as well as enhancing grassroots engagement. I want to close by recognising the critical role obstetricians and gynaecologists play in advancing girls and women’s health. The role you play is often sometimes not well understood or appreciated in low and middle income countries. Yet you are on the front lines of duty every day supporting maternal and child health, fighting reproductive organ cancers and addressing a host of other issues that affect women and girls across the continent. There is no doubt that in Africa, there is a great need to train more obstetricians and gynaecologists and ensure their services are more accessible to more women. So, I applaud the incredible work of the RCOG and of all the obstetricians and gynaecologists here. I personally hope to see more partnerships emerge between you, as members of the medical community, and other stakeholders—including Governments, Civil Societies and Judiciaries, to create more effective interventions for women and girls. I know, through my involvement with Beyond Zero, that your contribution to interventions is invaluable and I look forward to seeing those contributions being registered on a larger scale in my country, on our continent. Once again, thank RCOG for awarding me with an honorary fellowship. I hope we will continue to live up to the honour you have accorded us. And I look forward to engaging further, to find areas where we can collaborate towards the shared vision of a healthier world for all people—including women and children. Allow me to close with those remarks, and invite you to watch a short video of the Beyond Zero story.

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