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Hillary Rodham Clinton - Participation in [VII Conference of Wives of Heads of State and Government of the Americas] Panama, [October 8-9, 1997] [2]
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Hillary Rodham Clinton - Participation in [VII Conference of Wives of Heads of State and Government of the Americas] Panama, [October 8-9, 1997] [2]
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Previous
Conference Declarations
Update on
Conference related issues
UNCLASSIFIED
LATIN AMERICA:
MEASLES ELIMINATION INITIATIVE
The Pan American Health Organization (PAHO), with support from
USAID's Bureau for Latin America and the Caribbean, assists
countries to implement an immunization program which includes the
elimination of the measles virus from the Western Hemisphere by
the year 2000. The vaccination strategies recommended by PAHO in
the Americas are being considered by several countries in Africa
and Asia, where measles continues to be a considerable health
burden.
Measles transmission has been interrupted in major
portions of the Americas. In 1996, twenty-seven
countries in the Americas reported zero cases of
measles - this includes all countries in Central
America and the Caribbean.
Substantial progress has been made towards achieving
the goal of measles elimination in the Americas.
During 1996, there were only 2,109 confirmed cases of
measles, a record low in the region and a 67% decrease
from 1995 when there were 6,489 cases.
In the eight countries where USAID provides support to the
vaccination program, the number of cases of measles was
reduced from 2,997 in 1994 to only 160 in 1996, a dramatic
95% reduction.
However, in 1997, there was an increase in circulation
of the measles virus. This started with an outbreak in
Sao Paulo, Brazil (4,000 confirmed cases) which then
spread to Paraguay, Chile and Peru including four
importations to the U.S. This illustrates the
importance and need for continued partnership
development and coordination to implement the
strategies for elimination of measles from the region.
The diversity of organizations, in both the private and
public sectors, which are now involved in supporting
the measles elimination program requires heightened
collaboration and coordination. This may be through
new or existing mechanisms such as the National Inter-
agency Coordinating Committees.
UNCLASSIFIED
Talking Points on Measles Elimination
Although substantial progress has been made towards
achieving the goal of measles elimination in the
Americas, this preventable disease continues to be one
of the leading causes of morbidity among childhood
vaccine-preventable diseases.
The Pan American Health Organizations' vaccination
strategy, where fully implemented, has proven to be
highly effective in interrupting measles transmission
in many countries of the region. 1996 was a notable
year for the program with only 2109 confirmed cases of
measles in the hemisphere.
Recently, epidemic measles occurred in the region,
quickly spreading through several countries. This
illustrates not only the high communicability of the
measles virus but also points to the importance of
coordinated national and international efforts to
achieve the goal of measles elimination.
16:38
'0'9 974 3635
PAHO SVI
002/002
Pan American Health Organization
Measles Update
1996-1997
In 1996, a record low number of measles cases was reported in the
Americas. However, in 1997, there has been increased circulation of
measles virus in the Region. Collaboration is needed
among all who are working to eliminate measles,
SO we can make this goal a reality!
I
n 1996. the Americas reported 2,109
C
ounrries in the Region of the Americas
measles cases-a record low in the Re-
should remain alert to the risk of impor-
gion. This represents a 67% decrease from
tation. as the measles virus can travel rap-
the 6.489 cases reported in 1995. The United
idly across national borders. There have been
States. Canada and Brazil accounted for 66%
four confirmed Importations of measles from
of these cases. Twenty-seven countries in the
Brazil into the United States. These are the
Americas reported
first importations of
zero cases of measles
measles from Latin
in 1996.
America into the Uni-
Reported Measles Cases
ted States since 1994.
A
S of September
Region of the Americas, 1970-1997"
Several other coun-
13. 1997. there
have been 5.332 con-
Reported measies cases
tries have experien-
1,000.000
Catch-up
ced smaller outbreaks
firmed measles cases
111
this year. where. simi-
in the Region, of which
EPI
lar TO Brazil. circula-
4.491 (84%) occurred
100.000
tion is focused among
in Brazil. Brazil has
young adults. It is ber-
also reported six meas-
ter TO prevent an out-
les-related deaths. The
10,000
break than to control
outbreak in Brazil be-
one. and countries
gan in late 1996 and is
should work to main-
focused in the Greater
1,000
70 72 74 70 78 as 12 84 as 00 90 92 94 9807
tain high measles vac-
São Paulo area. It is
Year
cine coverage among
primarily affecting sus-
Source: PAHO/SVI
susceptible popula-
ceptible adults. with
Date as of 13 September 1997
tions. especially chil-
over 50% of the cases
dren and those adults
in people 20-29 years of age. This group con-
working or residing in high-risk environments
sists of people who were either bom too early
such as secondary schools. colleges and
for routine measles vaccination. yet too late
health-care settings.
to have been exposed to measles. Contribut-
T
he current initlative to eliminate measles
ing factors to the Brazilian outbreak include:
requires that countries take a proactive
many susceptible preschool-aged children
approach. not only in maintaining high levels
due to low coverage with the two-dose vac-
of Immunity. but also by enhancing the ca-
cination schedule and the lack of a follow-up
pacity of surveillance systems to detect all
campaign: a large number of susceptible
suspected cases. PAHO recommends identi-
adults: and high population density. Investi-
fying and incorporating new reporting
garlon is currently taking place to determine
sources. such as non-governmental organi-
whether the virus is indigenous or imported.
zations. private physicians and community
Brazil will be conducting a follow-up campaign
groups. and strengthening the dissemination
targeting children 9 months to 5 years of age
of information to rapidly alen health workers
later this year.
to suspected cases and outbreaks.
Together we will eliminate measles from the Americas
For information a Special Program for Vaccines and Immunization, Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037.
Visit us on the World Wide Web at
Fact Sheet 2 SVI/EPI October 1997
OCT-01-1997 16:49
9 974 3635
97%
P.02
UNCLASSIFIED
UPDATE:MEASLES ELIMINATION INITIATIVE
The Pan American Health Organization (PAHO), with support from USAID's Bureau for
Latin America and the Caribbean, assists countries to implement an immunization program
which includes the elimination of the measles virus from the Western Hemisphere by the
year 2000. The vaccination strategies recommended by PAHO in the Americas are being
considered by several countries in Africa and Asia, where measles continues to be a
considerable health burden.
Measles transmission has been interrupted in major portions of the Americas.
In 1996, twenty-seven countries in the Americas reported zero cases of
measles - this includes all countries in Central America and the Caribbean.
Substantial progress has been made towards achieving the goal of measles
elimination in the Americas. During 1996, there were only 2,109 confirmed
cases of measles, a record low in the region and a 67% decrease from 1995
when there were 6,489 cases.
In the eight countries where USAID provides support to the vaccination program, the
number of cases of measles was reduced from 2,997 in 1994 to only 160 in 1996, a
dramatic 95% reduction.
However, in 1997, there was an increase in circulation of the measles virus.
This started with an outbreak in Sao Paulo, Brazil (4,000 confirmed cases)
which then spread to Paraguay, Chile and Peru including four importations to
the U.S. This illustrates the importance and need for continued partnership
development and coordination to implement the strategies for elimination of
measles from the region.
The diversity of organizations, in both the private and public sectors, which
are now involved in supporting the measles elimination program requires
heightened collaboration and coordination. This may be through new or
existing mechanisms such as the National Inter-agency Coordinating
Committees.
UNCLASSIFIED
El 002
PLAN OF ACTION FOR THE HEMISPHERIC SUMMIT
ON SUSTAINABLE DEVELOPMENT
Progress Report :
Immunization and Measles Elimination by the year 2000
1
Measles Elimination by the Year 2000
The Region of the Americas continued to make progress in the implementation of
the Plan of Action for Measles Elimination in the Americas by the Year 2000, approved
during the XXXVIII Directing Council in 1994 and endorsed by the 1st Summit of the
Americas (Figure 1). The English-speaking Caribbean and Suriname hold the longest
record in the Western Hemisphere (five years without measles). Similarly. there have
been no laboratory-confirmed cases of measles for over three years in Cuba and for over
two years in Chile.
Figure 1. Measles cases and vaccination coverage,
The Americas, 1960-1996*
No. of cases (thousers)
% Coverage
&
Compap -
100
8
-
1
an
-
8
200
20
0
a
Year
-Cass imCoverage
Source: PAHO/SVI
Vaccipation coverage in children . 1 year = age
- 1996 Date are provisionsi
I
During 1996, a provisional total of 2,109 cases were confirmed (Table 1),
compared to 6,489 cases in 1995, an overall reduction of approximately 77% and a 99%
reduction when compared to 1990.
E 003
Table 1. Measles Surveillance in the Americas, 1996
Final 1996 Data
Total
Suspected
Total Confirmed
Cases
Confirmed Cases
Region
Country
Notified
Discarded
Clinically
Laboratory#
Total
Casas 1995
Andean Region
Bokvia
100
93
7
0
7
76
Colombia
1.172
1,012
156
4
160
410
Ecuador
321
279
40
2
42
919
Peru
1,102
997
103
2
105
353
Venezuela
581
592
B5
4
89
172
Brazil
Brazil
3.233
2,853
519
61
580
793
Central America
Belize
53
53
0
0
0
4
Costa Rica
147
123
18
6
24
35
8 Salvador
350
349
0
1
1
0
Guatamaia
128
127
1
0
1
23
Honduras
55
51
3
1
4
0
Nicaragua
301
301
0
O
0
5
Panama
211
211
0
0
0
19
English-speaking
Anguille
6
6
0
0
0
0
Antigue & Barbuda
3
3
0
0
0
0
Caribbean
Bahamas
11
11
0
0
0
0
Barbados
74
74
0
0
0
0
Cayman Islands
0
0
0
0
0
0
Dominica
1
1
0
0
0
0
Granada
23
23
0
0
0
3
Guyana
83
83
0
0
0
0
Jameica
67
63
4
0
4
15
Montserrat
0
0
0
0
0
0
Netherlands Antilles
0
0
0
0
0
St Kitts & Nevis
11
11
0
O
0
1
St. Lucia
7
7
O
0
0
2
St. Vincent &
Grenadines
6
5
0
0
0
0
Suriname
15
15
O
0
0
0
Trinidad 6 Tobago
110
110
0
0
0
0
Turks & Caicos
0
0
0
0
0
&
British Virgin Islands
1
1
0
0
0
0
U.S. Virgin Islands
0
0
0
0
0
0
Laon Caribbeen
Cuba
120
120
0
0
0
1
Dominican Republic
38
38
0
0
0
0
French Guiana
0
0
0
0
0
-
Guadeloups
23
10
1
12
13
0
Hairi
3
2
1
0
1
Martinique
0
0
0
0
0
-
Puerto Rico
8
0
0
8
6
11
Mexico
Mexico
1,739
1,559
178
2
180
244
North America
Bermuda
0
0
0
O
0
0
Canada
327
0
0
327
327
2357
United States
489
0
0
489
489
309
Southern Cone
Argendina
1,037
978
59
0
59
655
Chile
129
129
0
0
0
0
Paraguay
64
51
9
4
13
73
Uruguay
4
2
0
2
2
5
Total
12,253
10.144
1,184
925
2.109
6,489
No information provided
Clinical suspicion of measies without laboratory investigation
#
Includes epidemiologically linked cases
Source: Country reports to PAHO
2
The overall reduction in measles cases in the Region is a direct result of PAHO's
recommended three-step vaccination strategy, which includes a one-time catch-up
vaccination campaign, high coverage through routine vaccination of children at 12
months of age (keep-up), and periodic complementary follow-up campaigns to reduce the
accumulation of susceptible infants and children 1-4 years of age. The spacing between
the follow-up campaigns is determined by the vaccination coverage obtained through
routine immunization programs. Based on this approach. it is estimated that Bolivia,
Brazil, Ecuador, Guatemala, Haiti, Trinidad and Tobago, and Venezuela will require
follow-up campaigns within the time frame of the next one to three years.
A major component of surveillance activities continues to be the laboratory testing
of suspected measles cases. The timely notification and investigation of suspected
measles cases will play a critical role in the successful completion of the measles
initiative, since it allows determination with certainty whether or not a suspected case is
due to measles. The Regional Measles Diagnostic Laboratory Network supported by
PAHO is collaborating with national laboratories in conducting trials that will determine
the most effective measles confirmation test.
During 1996 and 1997, evaluations were carried out in El Salvador, Mexico,
Nicaragua, Brazil, and Venezuela. Only the latter two countries showed evidence of
measles virus circulation.
Over the period covered by this report there have been 27 outbreaks in the
Western Hemisphere (3 in Latin America and the Caribbean, 1 in Canada, and 23 in the
United States) which offer some important lessons to Member States. In Latin America
and the Caribbean, the first outbreak took place in the State of Santa Catarina, Brazil,
with 24 confirmed cases (23 laboratory confirmed and I confirmed by epidemiologic
linkage). Prior to this outbreak, the last case in Santa Catarina had occurred in 1993.
Measles vaccination through routine health services between 1992 and 1995 reached 90%
of the children under 1 year of age, and 94% in 1992 among children 1 to 14 years of age.
Virus isolated from patients in this outbreak indicate the strong possibility of an
importation from Europe. Also in Brazil, an ongoing outbreak in São Paulo which started
at the end of 1996 is affecting mostly unvaccinated young adults, health care workers, and
migrants from rural areas. Isolation of virus from the São Paulo outbreak is now under
way.
The measles outbreak in Guadeloupe needs to be considered separately since this
French overseas department has not followed PAHO's recommended vaccination
strategy. The source of this outbreak was an importation from France, and it has affected
primarily young adolescents.
Two-thirds of the outbreaks reported by the United States were related to foreign
importations, none of which were from Latin America or the Caribbean.
3
These events and the results of recent evaluations of measles surveillance systems
in the Region have identified the major obstacles to impede the adequate performance of
the measles surveillance system: (a) weak managerial skills in epidemiological
surveillance and inadequate supervision of the surveillance system; (b) the untimely
identification of pockets of under-immunized individuals which does not allow national
programs to target intensified measles vaccination and reduce the number of susceptibles;
(c) insufficient logistical support for investigating suspected measles cases; (d) limited
involvement of the private sector and NGOs in reporting suspected measles cases: and (e)
insufficient dissemination and promotion of the Plan of Action for Measles Elimination at
the national level.
Member States are urged to overcome these obstacles and to allocate the
necessary financial and human resources to strengthen surveillance and laboratory testing
of suspected measles cases. Immediate measures should also be taken to vaccinate young
adults who lack measles vaccination or a history of measles disease and people who work
in health care settings.
2
Maintenance of Polio-free Status in the Americas
August 23, 1996 marked the fifth anniversary of the last case of indigenous wild
poliovirus in the Americas. The global eradication program is progressing well and the
number of cases continues to decline, but the disease still occurs in all other regions.
Importations constitute the greatest threat to the polio-free status in the Americas and a
signal of alert to the countries in the Region. In March 1996, an importation of wild
poliovirus from India was detected in Canada. This marked the second time that an
importation of wild poliovirus has been identified in the Americas since the last case of
indigenous polio occurred in August 1991, and the first time since the Region was
certified as polio-free in September 1994.
The latest importation is of great concern to PAHO, given the deteriorating
attention to the four acute flaccid paralysis (AFP) surveillance indicators, which are used
to detect possible circulation of poliovirus. Based on the data shown by the AFP
indicators, an increasing number of countries have not been conducting complete
investigations in 80% of cases, with at least one adequate stool sample taken, and the
AFP rate has been falling close to or below the expected rate of 1:100,000 for children
<15 years of age in several countries. Vaccination coverage has also declined in some
countries. It would be a tragedy if the Region loses one of its greatest public health
achievements and permits wild poliovirus to re-establish itself. Countries are reminded of
the danger of falling into a state of complacency, and it is strongly recommended that
AFP surveillance and the use of mass vaccination campaigns be strengthened.
we strongly
grefer high
levels of routine
vaccination
4
3
Vaccination Coverage
Table 2. Vaccination Coverage for Children Under One Year of Age
in the Americas, 1995-1996
(%)
CPT-3
OPV-3
Measles
BCG
Region
Country
1996
1995
1995
1995
1996
1995
1996
1995
Andean
Bolivia
81.66
87.87
82.14
89.48
98.00
82.61
98.02
86.56
Colombia
98.73
88.51
96.34
94.24
94.00
94.24
99.24
99.32
Ecuador
87.53
73.63
89.21
68.93
78.88
72.93
100.00
100.00
Peru
100.00
94.89
100.00
92.99
86.76
98.93
100.00
96.26
Venezuela
56.57
67.45
72.71
84.89
63.81
66.49
88.67
91.36
Brazil
Brazil
73.66
8269
97.35
82.94
76 98
88.30
98.56
100.00
Central American
Belize
85.00
82.81
85.00
83.23
80 00
8337
90 00
92 08
Costa Rica
64.12
64.97
83.88
84.06
86.00
94.10
91.23
99.04
a Salvador
97.51
99.94
96.21
94.20
96.02
93.45
100.00
100.00
Guatemale
72.56
79.68
73.34
80.45
89.50
83.34
76.50
79.00
Honduras
94.80
93.82
94.84
93.53
90.80
88.90
97.97
97.06
Niceragua
90.67
84.76
99.27
96.08
89.98
81.16
100.00
100.00
Panama
91.57
86.03
9234
86.23
90.13
64.09
100.00
100.00
English-/Dutch-
Anguilla
100.00
97.24
100.00
98.90
100.00
92.27
96.39
100.00
speaking Caribbean
Antigua 6 Berbuda
100.00
100.00
-
100.00
-
-
...
Bahamas
85.00
87.02
85.00
86.01
92.00
90.01
MA
Barbados
85.38
92.75
84.63
92.92
100.00
92.13
-
...
Cayman Islands
96.05
97.99
95.10
97.99
89.08
95.07
83.05
75.91
Dominica
100.00
100.00
100.00
100.00
Grenade
60.04
95.01
80.04
77.01
85.00
88.04
.
Guyane
83.00
86.00
83.00
87.00
91.00
77 00
88.00
93.00
Jamaica
92.00
90.17
92.00
90.22
96.00
8931
98.31
9763
Montserrat
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
St. Kitts & Nevis
100.00
99.04
98.01
99.04
100.00
99.04
--
--
SL Lucia
68.01
98.02
88.01
98.02
95.01
94.01
89.01
98.02
SL Vincent/Grened.
100.00
97.02
100.00
97.02
100.00
100.00
100.00
99.01
Suriname
80.00
84.00
79.00
81.00
78.00
79.00
i
---
Trinidad & Tobago
89.00
89.00
90.00
90.00
88.00
90.00
-
...
Turks & Caicos
100.00
100.00
100.00
100.00
100.00
99.08
100.00
100.00
British Virgin Islands
100.00
100.00
100.00
100.00
100.00
100.00
100.00
Latin Caribbean
Cuba
96.74
100.00
95.00
95.08
97.64
100.00
99.45
99.56
Dominican Republic
85.20
83.40
84.12
60.00
85.08
85.30
72.36
75.50
Haiti
-
...
...
...
...
Puerto Rico
Maxico
Maxico
99.65
91.50
94.78
91.90
93.00
89.90
99.10
97.90
North America
Bermuda
88.02
86.03
88.98
92.10
83.95
86.03
Canada
United States
Southern Cone
Argentine
8277
84.95
89.70
90.09
100.00
99.00
100.00
100.00
Chile
90.89
93.59
90.89
93.59
93.10
96.70
90.59
94.48
Paraguay
80.10
79.29
80.80
79.42
81.20
74.74
89.04
96.92
Uruguay
85.83
90.60
85.87
90.58
81.65
89.68
100.00
98.76
Total
85.50
85.86
92.58
87.46
85.42
68.65
96.69
97.03
Data not available
Source: Country reports to PAHO
5
this
From 1990 through 1995, the Region of the Americas has maintained, Ifacl todis-
vaccination coverage rates for DPT, polio, measles, and BCG at levels abc through btwn
children under 1 year of age. However, there is considerable variation betwee & fr Reg
as can be seen in Table2 which shows the data by country for 1995 and 1996. at one CO.
actions
4
Funding Issues
Efail to
exclude $
Overall costs associated with regional immunization programs for the period
1997-2001 in Latin America and the Caribbean, including the activities aimed at measles donated
elimination, have been estimated at US$ 710 million. Of this amount, approximately $53 CO.
t
million (7.5%) is expected to come from external resources and approximately $657
USAID, prop UN.
million (92.5%) from national resources.
etc.
The Special Program for Vaccines and Immunization has received a five-year
grant from the United States Government through its Agency for International
Development (AID) in the amount of $8 million to support the measles elimination
initiative and the expansion of immunization services. The Government of Spain has
approved grants amounting to $1,370,000 for the period 1996-1997, as well as one
associate expert to support the strengthening of national capabilities in the areas of
measles surveillance, laboratory diagnosis, training, and supervision. The Government of
the Netherlands has recently approved a grant in the amount of $500,000 to strengthen
measles surveillance. Negotiations with the Inter-American Development Bank (IDB)
were renewed for the redesign of an already approved $2.3 million, three-year grant. The
Canadian International Development Agency (CIDA) has been the major donor for
research and development activities, followed by the Global Program for Vaccines and
Immunization of WHO. Initial contacts have been established with the World Bank for
the possibility of supporting specific research and development activities.
A major impediment faced by the Program is still the availability of adequate
resources to play a more effective catalytic role in shaping policies and programs in the
areas of immunization services delivery and vaccine development. It is unlikely that
PAHO will obtain the estimated $53 million required between now and the year 2000 to
complete the measles elimination initiative. Including funds already secured, should the
negotiations with IDB be successful the Program can count on only approximately $20
million. Member States must place a high priority on coordinating the mobilization of
resources from the public and private sectors to support overall immunization programs
and to prevent the re-establishment of imported measles and polio virus in the Americas.
Only through this strong commitment of governments will the benefits of vaccination be
reaped equitably by all children of the Americas.
6
UNCLASSIFIED
UPDATE: MATERNAL MORTALITY INITIATIVE
Maternal mortality continues to be a critical problem in the Americas. Although data collection
and reporting are often unreliable in many countries, it is estimated that Latin American women
have a moderate Total Fertility Rate (TFR) of 3.1 and a Maternal Mortality Ration (MMR)
median ranging between 140-190 which translates into approximately 23,000 women dying
annually from pregnancy related causes. However, these aggregate figures mask wide variations.
The World Health Organization and UNICEF estimate a low MMR of 55 in Panama juxtaposed
to Haiti which has the highest MMR in the region with 1,000 women dying for every 100,000
live births. (Argentina's MMR is estimated at 100, Brazil at 220, and Venezuela at 120.)
Particularly at risk are indigenous women, women living in rural areas, and adolescents.
The major causes of maternal mortality include hemorrhage, hypertension related to pregnancy,
sepsis, and obstructed or prolonged labor. These conditions can largely be prevented or
controlled by increasing use of family planning, prenatal care, clean delivery, and postpartum
services, and improving care for obstetric emergencies.
During the Sixth Conference of First Ladies held in La Paz, Bolivia, Mrs. Clinton witnessed the
signing of a USAID/PAHO grant to support the Regional Maternal Mortality Reduction Initiative
in the Americas. USAID support is designed to provide more effective delivery of essential
obstetric care. This will be accomplished by generating community demand for services and
improving the quality of services within a supportive policy environment.
USAID's regional initiative is targeted in 11 countries which have MMR above the average in the
region: Bolivia, Brazil, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti,
Honduras, Nicaragua, Paraguay, and Peru. PAHO is working in these same target countries to
improve the policy environment. Three of these countries--Bolivia, Ecuador, and Honduras--
have been selected as demonstration sites to test out field interventions at the district level. The
MotherCare Project is working on improving the community's response to essential obstetric
care. The Quality Assurance Project is based at the clinic/hospital level working to ameliorate
the quality of care pregnant women receive during their deliveries. The conceptual model, which
encompasses a three tiered approach for reducing maternal mortality--at community, facility, and
policy levels,--will be crystallized through the lessons learned from these three-pilot sites.
Two events help illustrate the important work that this maternal mortality reduction initiative is
advancing. In May, in coordination with the Guatemalan Center for Reproductive Health,
USAID, the Centers for Disease Control, and with the support of PAHO, a meeting was held in
Central America on Guidelines for the Surveillance of Maternal Deaths. Representatives of
Central American countries discussed their experiences with the surveillance system and were
assisted in adapting the system to their country needs. In November, PAHO is sponsoring a
regional Senior Technical Advisory Group (STAG) meeting in the Dominican Republic which
will focus on Emergency Obstetric Care. STAG is composed of a core of eight experts in the
area of reproductive health with representation from UNFPA, UNICEF, International Plan
Parenthood Federation, CDC, and Family Health International.
UNCLASSIFIED
Talking Points on Maternal Mortality
Maternal Mortality is a topic that is important to all women
regardless of nationality, social status or ethnic group and
its reduction should be the common objective of us all. The
death of any mother is a tragedy because we have the power
to prevent maternal mortality.
Important steps have been taken to reduce maternal
mortality in the Americas during the past year,
including increased commitments of governments to
support and implement National Plans for the Reduction
of Maternal Mortality.
Maternal deaths are often the end result of a process
directly related to the nutritional and health status of
girls as they mature to adulthood and motherhood.
To reduce maternal mortality it will take more than just
rhetoric. There is a need to speak out on the following
items:
-
To insure that every maternal death is accurately
recorded, investigated and used to inform health
workers and communities -- without fear of
repercussions for the women or her doctor -- so
that deaths can be averted in the future
-
To overcome barriers to talking about women's
health problems more openly and raise awareness
about the need for birth spacing and family
planning, prenatal and postpartum care, safe
delivery and good nutrition
-
To provide access to information for women before
they become sexually active and throughout their
lives so that they can make informed decisions
about what happens to them and their bodies
Specifically in developing countries we need to:
-
Increase recognition of the warning signs of an
obstetrical emergency and seek care immediately
-
Praise communities that mobilize transportation
for women to a facility capable of responding to
the emergency
-
Support and acknowledge facilities that meet
minimum standards of quality of care.
U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT
USAID
PRESS RELEASE
THE USAID PRESS OFFICE
WASHINGTON, DC 20523
http://www.info.usaid.gov
ph: (202) 647-4274
# 96 - 88
Contact: Vicky Jaffe
FOR IMMEDIATE RELEASE
or Ann Kittlaus
December 2, 1996
USAID-Funded Initiative Will Save Mothers' Lives
On December 4 in La Paz, Bolivia, at the Sixth Conference of Wives of Heads of States
and Governments, First Lady Hillary Rodham Clinton will announce a U.S.-funded hemispheric
partnership to reduce maternal mortality. The Maternal Mortality Reduction Initiative is designed
to improve emergency obstetric care across the western hemisphere and contribute to the goal of
reducing maternal mortality by 50 percent of 1990 levels by the year 2000.
The U.S. Agency for International Development (USAID) will fund this initiative to be
implemented by the Pan American Health Organization (PAHO) and the USAID-funded
MotherCare and Quality Assurance projects. USAID will provide a grant to PAHO for $2.25
million, of a $4.5 million dollar effort, for regional activities of the Maternal Mortality Reduction
initiative. This is in addition to support for the MotherCare project and the Quality Assurance
project as part of the same initiative.
Mark Schneider, USAID assistant administrator for Latin America and the Caribbean and
PAHO Director George Alleyne will sign the agreement, which will foster an improved health
policy environment for emergency obstetric care.
Maternal mortality is a critical problem in the western hemisphere, with an average
maternal mortality ratio of 140 deaths per 100,000 live births. (In the United States, the ratio is
12 deaths per 100,000 births.) Major causes of mortality include hemorrhage, hypertension related
to pregnancy, sepsis and obstructed or prolonged labor. These conditions can largely be prevented
or controlled by increasing use of family planning, prenatal care, clean delivery, postpartum
services and better care for obstetric emergencies.
In addition to the support for the $4.5 million regional Maternal Mortality Reduction
Initiative, USAID also sponsors regional initiatives in Latin America and the Caribbean on
vaccinations, care of sick children and other health care services. These programs are directed, for
the most part, to women in rural areas where health care services are less than optimal.
USAID is the U.S. government agency that administers economic and humanitarian
assistance worldwide.
###
FACT SHEET ON MATERNAL MORTALITY GRANT
Background:
It is estimated that 23,000 women die from
pregnancy-related causes each year in Latin America. From
community-based studies in developing countries, it has been
shown that 80% of maternal deaths can be attributed to
hemorrhage, sepsis, hypertensive disorders of pregnancy,
obstructed/prolonged labor and ruptured uterus, and septic
abortion. These conditions are treatable with available
technology. But in environment where resources are scarce and
poorly organized, women continue to die. Some of the barriers to
safe motherhood in the Americas include: the lack of complication
recognition, the inability of women to seek care due to low
status in society, the dearth of accessible and affordable health
care, poorly trained and/or culturally insensitive health care
workers, shortages of medical supplies, and a lack of reliable
transportation.
The reduction of maternal mortality and the improvement of
maternal health care in the Americas have become major issues in
the past few years, with new initiatives being launched at the
Summit of the Americas' Symposium on Children and at the Summit
itself. To address the problem of maternal mortality, USAID has
developed a Regional Maternal Mortality Initiative to support and
advance a strategic approach for more effective delivery of
selected health services. The regional initiative takes a three-
pronged approach, aimed at improving service delivery through
improved community response, better quality of care at the first
referral, and policy reform aimed at improving the overall policy
environment which encourages these types of analysis and
promotion of legislation and policies to reduce maternal
mortality.
Description of Maternal Mortality Grant:
The Regional
Maternal Mortality Initiative will be implemented by a
partnership between two USAID-funded projects, the MotherCare
Project at John Snow International and the Quality Assurance
Project at the University Research Corporation, and the Pan
American Health Organization (PAHO). The Initiative represents
the regional program portion of US Government support to the
countries of the Americas in their effort to achieve the Summit
of the Americas' goal of reducing maternal mortality by one-half
of 1990 levels by the year 2000. PAHO will take the lead on
advising countries on the policy changes needed for the intensive
implementation of the Basic Emergency Care aspects of the
Regional Plan for the Reduction of Maternal Mortality. PAHO's
work will include revising and reaffirming the 1990 Regional
Plan; strengthening the regional and country Interagency
Coordinating Committee which brings together relevant ministries
at a country level and all interested parties at a regional
level; analysis and promotion of legislation and policies to
reduce maternal mortality; and building high-level political
support for reduction of maternal mortality, including support
for developing follow-up action by the First Ladies of the
region.
The MotherCare Project will focus on community response to
increase the capability of selected PVO networks and Ministries
of Health to identify and respond to community efforts to reduce
maternal and neonatal mortality, including training and
educational campaigns. The Quality Assurance Project will take
the lead in the area of quality of care at the first level of
referral -- developing, testing, evaluating and disseminating
approaches to enhance use of protocols, standards and guidelines
at the first level of referral.
The Initiative will be implemented from December 1996 through
December 2001. It has a working budget of $4.5 million, of which
$2.5 million will be granted to PAHO.
7TH SUMMIT OF
THE FIRST LADIES
OF THE AMERICAS
MATERNAL MORTALITY
REDUCTION PROGRAM
FOLLOW-UP REPORT
Pan American Health Organization
: INONA PRO SALUTE MUNOI BE
Maternal Mortality Reduction Program
Republic of Panama, Panama
October 1997
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Contents:
I
Background
1
II
Objectives of the Program
1
III.
Progress
2
i.
Regional Information
2
ii.
Country Information
3
IV.
Successful Experiences
3
V.
Constraints
3
VI
Plans and Follow up
4
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I. BACKGROUND
The history of the commitment of the First Ladies with the important task of reducing maternal
mortality in the countries of the American continent started in Costa Rica, at the Third Conference of the First
Ladies in 1993. A recommendation was made regarding the necessity to support actions in favor of the
health of women, children and adolescents. They identified the prevention of maternal morality as a priority
action.
It is estimated that 35,000 maternal deabs occur each year in the Americas. The majority of these
deaths could be prevented by simple, well known and inexpensive interventions. The death of a woman by
pregnancy or delivery related causes is always a tragedy. In addition, it has serious repercussions for the
affected families.
The magnitude of this problem varies from country to country, and within the same country
significant differences exist between urban and rural areas, different regions and social groups. The
importance of this situation for women in general and specifically for women's health issues, is a challenge
for sustainable buman development and therefore deserves to be considered within the sociopolitical context
of the countries.
At the Fifth Conference of First Ladies of the Americas in Paraguay in 1995, the First Ladies,
conscious of these issues, formally consolidated their support to dynamically promote all actions that
contribute to the accelerated reduction of maternal mortality in the Americas. Along these lines, the proposal
Regional Initiative of the First Ladies to Support the Plans of Maternal Mortality Reduction" is presented
At the Sixth Conference of First Ladies in Bolivia in December 1996, in the "Declaration of La Paz,
Bolivia, 1996" the First Ladies declared: "we cherate our support for the implementation of programs to
reduce maternal mortality, including access to prenaral care and delivery by trained personnel, the
development of services with capacity to resolve cbsteric emergencies, sexual and reproductive health
education, and the development of voluntary, accessible and high quality family planning services available to
couples. Likewise, we reaffum our comminent to Improve the quality of women's health care at all levels of
the health care system and throughout all stages of their lives."
In Plan of Action of the Sixth Conference, the First Ladies enunciated two principal strategies to
support the maternal and perinaral mortality pregrams:
a) to promote the formulation, revision, surengthering and follow-up of national policies, and
b) to foster mobilization of institutions and differ.s sectors of society
II. OBJECTIVES OF THE PROGRAM OF THE REGIONAL INITIATIVE OF
THE FIRST LADIES TO SUPPORT THE PLANS FOR THE
REDUCTION OF MATERNAL MORTALITY
General Objective
Contribute to the Accelerated Reduction of Maternal Mortality in the Americas through decisive support for
specific regional and national plans.
Specific Objectives
-Promote the formulation or strengthening of specific national policies, plans and programs for the
Accelerated Reduction of Maternal Mortality.
1
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The area of health communication is fundamental in achieving behavioral changes and to this end
projects in the initial phase of negotiation with the Spanish Government have been designed to
carry out activities in reproductive health including prevention of maternal mortality in six
countries.
By First Ladies or governmental initiative, Mass Media Communication campaigns have been
developed to contribute to the maternal mortality reduction programs in several countries.
Within this context, resources and active participation have been mobilized from different sectors
of the society.
The active and organized participation of women's groups and civil sector organizations has
generated increased awareness of the problem of maternal mortality. There are many more
organized groups that are active in political advocacy and lobbying in order to accelerate
legislative processes in favor of women's rights. These groups constitute a force that demands,
facilitates, and participates in the implementation of women's health programs, specifically
actions to prevent maternal mortality.
IV. SUCCESSFUL EXPERIENCES
Although the initiative for the reduction of maternal mortality is very young, there were some
important achievements during this year. Among the most successful and interesting experiences was when
Ecuador's First Lady called a meeting of different sectors of the society to ask for support and commitment
for the Plan for the Reduction of Maternal Mortality. As a consequence of that meeting, the Plan was
reaffirmed as a priority objective by the government, cooperating agencies and donor organizations. This
reaffirmation was reflected through an increased allocation of financial resources by different sectors to
respond to this problem.
The First Lady of Bolivia, President of the National Committee for Safe Motherhood, promoted the
implementation of a national Information, Education and Communication strategy for Safe Motherhood,
directed towards rural and marginal-urban areas of the highlands and valleys of Bolivia. The "Seguro de
Maternidad y Niñez" (Maternal and child health insurance) established in July 1996 has increased coverage
of institutional births in all Bolivia, and is expected to reach a greater coverage since it is growing strongly.
In the Dominican Republic, a Plan of National Mobilization for the Reduction of Maternal and Infant
Mortality was developed. This is a multisectorial and multi-institutional effort which operationalizes the
strategy of social development It is an expression of the political will of the national government.
In some countries, governments, technical cooperating agencies, donor organizations and
development banks have reassigned and acquired more funds and technical assistance for the Plan.
V. CONSTRAINTS
The tendency in many of the countries to reduce public spending, especially in social sector
investments such as health and education, has weakened the physical, material and human infrastructure of
the services for the most needy sectors of the society. The process of structural adjustment and the
consequent sector reforms present a changing and challenging context. This context influences the ability of
the countries to mobilize for a rapid response from the system towards concrete and accelerated plans, such as
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the Plan to decrease Maternal Mortality. Therefore, a search for and implementation of new suracgies and
alliances is required to mobilize resources for the Reduction of Maternal Mortality.
Another notable constraint specifically at the local levels which has been identified is the lack of
appropriate planning, follow-up and evaluation with due feedback to communities and health services. This
is due in part to the lack of reliable information and weaknesses in the collection and processing of
information.
VL PLANS AND FOLLOW-UP
Important progress has been made with the Accelerated Plan to Reduce Maternal Mortality in the
Americas. In order to continue to achieve the goals and objectives proposed in the First Ladies Initiative,
continued support and personal commitment of the First Ladies and the other participaring sectors involved in
this Plan are essential.
1. Lobbying and advocacy by the First Ladies in the different publicara are critical components in
order to insure continuous monitoring of resources received for the Plan, the operationalization of the
objectives and the achievement of its impact
2. The high visibility of the public persona of the First Ladies in the countries of the Americas and their
actions in favor of the well-being of wamen and families, represent an important model for all
women of the nations. The actions of the First Ladies constitute an example that influences,
stimulares and motivates many sectors of our societies, which in their current democratic
environment work to improve the quality of life of all the elements of society, especially the most
vulnerable and unprotected Thus, the public attention will continue to be focused on this
unnecessary tragedy, and will provide the recognition of the importance of this issue for the progress
of nations.
3. The role of the First Ladies in backing and supporting legislation in favor of women's rights, is an
action that in the short or the long run has irreversible benefits for the women of today and all future
generations of women and their families.
Following the Evaluation of the Accelerated Regional Plan for Reduction of Maternal Mortality in 1995 and
the previously mentioned PAHO/AID project, PAHO continues to support the countries with a number of
activities. Amongst them are:
1. The revision and development of National Plans for the Reduction of Maternal Mortality with an
emphasis on emergency obstetrics is being sumilated in all the countries.
2. Support for the formation of an interagency coordinating committee with the purpose of
concentrating efforts, avoiding duplication of activities and attending to priorities in such a way as to
have a greater impact
3. Regional and Sub-regional meetings to share experiences, obstacles and achievements.
4. The improvement of the basic data, epidemiological surveillance system and the use of information
necessary to improve the quality of the services, and better target interventions.
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5. Two key instruments which could be useful in mobilizing the legislative and normative components
which have an essential role to play in contributing to health changes are: a) a matrix of all the
sectors which at the same time contribute to the reduction of maternal morbidity and mortality and b)
a proposal of a legislative model which could be adapted by the countries. (Available early 1998)
The topic of "World Health Day" (April 7 1997) will be Safe Motherhood. This extremely important topic
can be placed by the First Ladies on the national public agenda. PAHO is preparing several resources which
could facilitate this implementation. For example, a resource "Kit" on information and dissemination and a
workshop for social sector management on planning, strategies and development of policies for Safe
Motherhood (These will be available at the end of 1997).
5
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-Promote national information, education and communication campaigns to raise awareness of the importance
and consequences of maternal mortality and 5 promote greatenctions to prevent it
-Foster the mobilization of public and private institutions, non-governmental organizations, grassroots
organizations and others, so that they contribute, from their areas of expertise, to the development of national
and local plans, and to the implementation of measures with the greatest impact aimed at the accelerated
reduction of maternal mortality.
-Facilitate the exchange of operations research and successful experiences among the countries, that will
permit the identification of the causes that impede appropriate access and utilization of the health services or
that prevent women's health programs from having a greater impact
. Foster programs to improve information systems, to conduct follow-up and monitoring of the maternal
mortality epidemiological surveillance indicators at the country and regional levels, and to maintain a
dynamic system of epidemiological surveillance at the community and institutional levels.
III. PROGRESS
The activities described here are the ones considered the most significant for the Americas Region
which have occurred since the last meeting of the First Ladies in December 1996 through September 1997.
These activities have already contributed to the Programs for the Reduction of Maternal Mortality.
Particularly notable are the following:
Six new governments of the Americas have clearly confirmed their commitment to the National
Plans for the Reduction of Maternal Mortality, thereby recognizing the importance of this issue
for the development of their nations.
Seven countries recently updated and revised (between 1996 and 1997) their National Plans for
the Reduction of Maternal Mortality.
During the last meeting of the First Ladies an agreement was signed between USAID and PAHO,
for a new regional project in which the MotherCare and Quality Assurance Project of University
Research Cooprporation (URC) will participate. Its goal is to improve emergency obstetric care
in eleven countries. The project includes political components, improvement of quality of services
and community mobilization. The countries involved are: Bolivia, Brazil, Dominican Republic, El
Salvador, Ecuador, Gustemals, Haiti, Hondurss, Nicaragua, Paraguay and Peru.
In order to contribute to the continuation and growth of the adolescent pregnancy prevention
project, among many other activities, support from other technical cooperating agencies and
donors is being sought. A new regional project for Adolescent Reproductive Health in 14
countries is currently being developed between PAHO and UNFPA.
A recent increase in investment from several development banks (IDB, World Bank) and other
donors in maternal health components and specific maternal mortality activities has been
observed in their projects in Paraguay, Venezuela and Nicaragua. These institutions have agreed
to take the issue into consideration in the development of new projects.
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UNCLASSIFIED
PARTNERSHIP FOR EDUCATION REVITALIZATION IN THE AMERICAS
In September 1996, USAID approved a cooperative agreement
allocating six million dollars to help establish the Partnership
for Educational Revitalization in the Americas. The Partnership
(in Spanish, Programa para la Promoción de la Reforma Educativa
en la America Latina y el Caribe, PREAL) is implemented through a
Secretariat at the Inter-American Dialogue, a Washington-based
NGO dedicated to promoting hemispheric cooperation. Drawing on a
diverse membership of institutions, networks, and individuals
throughout the Americas, the Partnership's objectives center on
improving finance, quality, equity, and decentralization of
public primary education.
Recently, the Partnership collaborated with the Ministry of
Education in Colombia to hold a regionwide conference on
education finance. It is also working with the Chilean Ministry
of Education to organize a MERCOSUR workshop on educational
statistics, to be held in Santiago, Chile, in late 1997. Also in
Chile, the Partnership is developing joint activities with the
UNESCO regional education office, and will co-sponsor, with the
Chilean NGO PARTICIPA, a conference on "Education, Democracy and
Sustainable Development in the Framework of the Second Summit of
the Americas". Other Summit-related activities include follow-up
on progress by various countries on the education initiatives
from the Miami Summit and planning of meetings to be held in
Washington and Santiago on the theme of education and trade. The
Partnership is also working with business groups in a number of
countries to increase business leaders' involvement in education.
The Partnership's biggest challenge is to sustain the current
unprecedented level of attention to educational reform among top
policy makers in the region. Moreover, policy debate must be
transformed into concrete programs with visible and measurable
results. To be successful, improving finance of public primary
schooling, decentralization and increased community participation
in school management, the application of national standards and
achievement testing, ensuring equity of rural and indigenous
students with their urban counterparts, and other education
reforms will need support from national governments as well as
local advocacy organizations and the private sector.
Because of its high profile in top policy circles, the
Partnership can play a vital role in keeping up the pace of
education reform throughout the region. Progress is by no means
assured and much remains to be done. The political moment,
moreover, is conducive to education reform. The proposed
bilateral US-Brazil Partnership for Education will stimulate
greater cooperation between the two countries in that area, and
education is a major topic at the upcoming Santiago Summit.
UNCLASSIFIED
Remarks from
Conference related events
7th Conference of Wives of Heads of State
and Government of the Americas
Panama City, Panama
Background on First Lady Hillary Rodham Clinton's Involvement
On October 8-9, 1997 First Lady Hillary Rodham Clinton will participate in the 7th
Conference of Wives of Heads of State and Government of the Americas, building on over four
years of her involvement in issues relating to children and women in the Western Hemisphere.
On December 10, 1994, as President Clinton hosted the Summit of the Americas in
Miami, Mrs. Clinton invited all the First Ladies attending the Summit to join her at a parallel
convening focused on children's issues. The Symposium on Children of the Americas examined
how the Summit of the Americas agenda and plan of action addressed the health and education
needs of children. There, the First Ladies committed themselves to working toward the Summit
health and education goals.
The Conference of Wives of Heads of State and Government of the Americas is an annual
meeting, which brings together First Ladies or designated representatives of the countries of
North, South, and Central America, as well as the Caribbean, to focus on critical social topics --
particularly affecting women and children -- and to share information on effective programs and
strategies. After the Miami Summit, Mrs. Clinton accepted the invitation of the First Lady of
Paraguay to participate in the 5th of these annual Conferences, marking the first time that a First
Lady from North America would join in this convening. On March 24, 1995 Mrs. Clinton wrote
a letter to each First Lady of the Western Hemisphere, recommending participation in the
Paraguay Conference and suggesting that three critical topics discussed at the Miami Symposium
be added to the agenda -- measles elimination, maternal mortality reduction, and education
reform.
In her letter, Mrs. Clinton urged the First Ladies of the region to be involved in the
measles elimination program coordinated by the Pan American Health Organization (PAHO),
and specifically, to participate in the launch of PAHO measles elimination campaigns in their
own countries. On April 7, 1995, at the national PAHO headquarters in Washington, D.C., Mrs.
Clinton gave the keynote address at the national launch of this effort, and there announced new
U.S. assistance to the campaign.
On October 16, 1995, Mrs. Clinton traveled to Asuncion, Paraguay and gave a keynote
address at the 5th Conference of Wives of Heads of State and Government of the Americas.
There, she announced the formation of the Partnership for Education Revitalization in the
Americas known by its Spanish acronym (PREAL), a project called for at the Miami Summit of
the Americas to provide assistance for the sharing of education reform best practices in the
region.
1
On December 3, 1996, Mrs. Clinton traveled to La Paz, Bolivia, to participate in the 6th
Conference of Wives of Heads of State and Government of the Americas, again giving a keynote
address and urging the First Ladies of the Americas to continue their work on behalf of women
and children in the region. At the Bolivia Conference, Mrs. Clinton announced a U.S.-funded
hemispheric partnership to reduce maternal mortality. There, she and Bolivia's First Lady, Mrs.
Sanchez de Lozada, witnessed the signing of a $2.25 million USAID grant to PAHO, for regional
activities of the Maternal Mortality Reduction Initiative.
This year, at the Panama Conference, the 7th Conference of Wives of Heads of State and
Government of the Americas, Mrs. Clinton will focus on promotion of women's political
participation and human rights, which Panama's First Lady, Mrs. Perez de Balladares, added to
the agenda following a private meeting of the two First Ladies at the White House. Her speech
at the Panama Conference is entitled, "A Vibrant Democracy Depends on Women's
Empowerment and Full Participation."
In Panama, Mrs. Clinton and Mrs. Perez Balladares will witness the signing of a USAID
grant of $4.5 million over 3 years, to the Inter-American Institute on Human Rights (IIHR), a
Latin American organization dedicated to promoting respect for human rights and the
consolidation of democracy throughout the Americas through research, education, training and
technical assistance to government, regional organizations and non-governmental organizations
(see separate USAID press release on the grant signing). Mrs. Clinton's involvement with the
IIHR has included a visit to IIHR headquarters in Costa Rica on May 8, 1997. There, she and
Secretary of State Madeleine Albright participated in roundtable discussion with IIHR leadership
and women who are human rights leaders from Central America to discuss the status of human
rights in the region.
2
FIRST LADY HILLARY RODHAM CLINTON
REMARKS FOR THE FIRST LADIES' SYMPOSIUM ON
CHILDREN OF THE AMERICAS
MIAMI, FLORIDA
DECEMBER 10, 1994
Welcome to all of my colleagues and friends from across the
Americas, and to all of our distinguished guests.
It is an honor and privilege for me to host this wonderful
symposium here in Miami. Let me begin by expressing my gratitude
to the First Ladies of Latin America, the Caribbean, and Canada
for your help and guidance in preparing for this session. Your
extraordinary efforts in previous First Ladies' meetings in
Colombia, Costa Rica, and most recently in St. Lucia, have
provided a foundation for all of our work -- today and into the
future.
I hope that in the course of our gathering here, and in the
weeks and months ahead, we will learn much from each other and
find new inspiration to address the needs of children, families,
and women across our hemisphere.
Today, we live in an age of great promise -- and great peril
-- for the 130 million children of the Americas. Great promise
because our children are our lifeline to prosperity and democracy
in the decades ahead. And we all take pleasure in knowing that
there are millions of happy, healthy children across the Americas
whose futures are filled with hope.
But there are perils too, because from the Queen Elizabeth
Islands to Tierra del Fuego, our children are shouldering burdens
rarely encountered by older generations.
Children suffering from hunger, poverty, homelessness,
inadequate health care, disease, illiteracy, violence, and abuse
are not confined to a single nation or a single continent. The
cries of desperate children are sadly heard in every nation
represented here. And it is the plight of those children that
brings us together today, not just as the spouses of heads of
state or as representatives of our governments, but as mothers,
sisters, daughters, grandmothers, aunts, neighbors and friends
who believe that every child in every country deserves a fair
chance in life.
The political leaders convening at this historic summit have
set forth an agenda to promote prosperity and democracy
throughout the hemisphere through trade initiatives, sustainable
development, and more effective government.
1
Today, summit leaders are outlining goals to ensure the
economic, social and physical well-being of children, which Dr.
Alleyne will outline later in greater detail:
The proposed Summit Plan of Action calls for universal
access to education so that all children, regardless of economic
or social status, racial or ethnic origin, or gender, will
receive the basic tools necessary to become full members of
society. The goal of requiring children to attend and complete
primary school is also under discussion. If this goal is
achieved, it will help eradicate child labor and give children a
greater hope of acquiring the skills and knowledge needed in a
modern global economy.
Beyond the important issue of school attendance, the Summit
initiative on education also addresses the nutritional needs of
children so they can learn more effectively.
The proposed Summit Plan of Action calls for equitable
access to basic health services, which will be particularly
beneficial to children, who are most vulnerable to illnesses and
unhealthy living conditions.
Specific programs being recommended will address child,
infant, and maternal mortality rates, as well as increasing
immunization efforts to eradicate childhood diseases, such as
measles, that still afflict too many children. We need only look
to the disappearance of new polio cases in the Western hemisphere
to know the success of these immunization programs.
We all know that the role of caregiver is crucial to the
development of healthy and secure children. And we all know that
the primary caregivers in society most often are women. The
Summit proposal to strengthen the role of women will increase
opportunities for women to participate in all spheres of life --
political, social, and economic.
Empowering women with economic self-reliance, access to
quality health care and education is not only a valuable step
forward in itself. It's an important step forward for children.
While we recognize that our political leaders are
responsible for devising policies and programs to meet these
important goals, we also know that, as First Ladies, we have a
significant role to play.
Just as advocacy organizations, social institutions, and
dedicated individuals are critical to progress, we, too, can help
push the agenda forward in our respective countries.
When it comes to children's issues, women have a special
calling. And that's why we have a duty to raise our voices for
2
the voiceless -- our children, the youngest and most vulnerable
among us.
This week I've had particular reason to think about the
difference one woman alone can make on behalf of children, even
against extraordinary odds. My friend, Elizabeth Glaeser, died
last weekend after losing a long battle with AIDS.
Elizabeth contracted HIV through a blood transfusion while
hemorrhaging during the delivery of her first child, Ariel.
Unbeknownst to her, her daughter, and then a son born later, also
contracted the virus.
When Elizabeth learned that she and her children had been
infected with HIV, she dedicated herself to raising awareness
about AIDS. From a small office in Los Angeles, she created the
Pediatric AIDS Foundation, which has raised over $30 million
since its founding in 1988.
Elizabeth often said she was motivated and strengthened by
the memory of her daughter, who died four years ago at the age of
seven. Her son, now 10, lives with HIV every day.
If Elizabeth could continue to contribute so much on behalf
of children throughout her own illness, I know we can make our
own contributions too. of course, we will not all be involved in
the same ways, or even on precisely the same issues. I know, for
example, that AIDS is not as prevalent in many of your countries
as it is in mine. That's why each of us must find a venue
appropriate to our own situation as First Lady or government
representative. But whatever role we choose represents a rare
opportunity to make a difference in the lives of tens of millions
of children -- and in the future of all of the Americas.
There is an urgency to our mission. More than half of our
population in this hemisphere is under age 23. Ushering children
into the world is, of course, the province of families. But
building safe and nurturing communities for them to grow up in
.
making sure they have access to schools that teach them to
read and write
protecting them from avoidable diseases
training them for productive adulthoods.
and honoring their
rights in the face of violence and abuse -- these are our
collective responsibilities.
This concept was eloquently expressed in a pastoral letter
issued in the United States several years ago by the National
Conference of Catholic Bishops. In that letter, entitled Putting
Children and Families First, the bishops said:
"No government can love a child, and no policy can
substitute for a family's care. But, government can either
support or undermine families. There has been an unfortunate,
3
unnecessary and unreal polarization in [the] discussion [of] how
best to help families. The undeniable fact is that our children's
future is shaped both by the values of their parents and the
policies of our nation.
As adults, we must take responsibility for our children so
that they can learn to take responsibility for themselves. And we
must insist that society's most vital institutions -- family,
school, and church -- create the conditions necessary for our
children to fulfill all their God-given potential.
To be sure, our challenges differ from country to country,
and our recipes for progress may require different ingredients.
The purpose of this gathering is not to prescribe one solution,
but to share ideas and opinions and learn from each other's
experiences.
Here in the United States, for example, we are not doing
enough to ensure that women receive adequate pre- and post-natal
health care, particularly poor women and teenagers. In 1992, 22
percent of pregnant women in this country received no pre-natal
care.
As the rest of the world knows all too well, my nation faces
significant challenges in stopping an epidemic of gun violence
that daily claims the lives of children in our cities and towns.
Today, homicide is the leading cause of death for African
American youth in the United States and violence is the second
leading cause of death for youngsters between the ages of 10 and
14.
Combined with violence is an equally disturbing scourge of
narcotics use among our young people. Illegal drugs are readily
available in too many communities in the United States, and even
in some of our schools. Studies show that as many as seven
million children abuse alcohol and drugs to some extent
At the same time, we are making progress on behalf of some
of our children -- progress that is visible right here in Miami.
Just yesterday I had the opportunity to visit Jackson Memorial
Hospital and Drew Elementary School -- two institutions that have
achieved remarkable successes in disadvantaged communities.
Jackson Memorial Medical Center, which is affiliated with
the University of Miami, has the difficult task of caring for
some of the poorest and neediest residents of this city. The
newborn intensive care unit that I visited yesterday serves the
highest risk population in Dade County -- but the hospital has
achieved the lowest infant mortality rates in the state.
The hospital also has devised innovative ways of serving its
community. A mobile van brings doctors and nurses to those who
4
might otherwise go without necessary treatment and care.
Drew Elementary School is located in a predominantly
African-American neighborhood. Community leaders devised a
cultural exchange program in which students from Drew and a
predominantly Hispanic school called Seminole Elementary come
together for a variety of activities that promote tolerance and
understanding. To enhance communication across cultures, students
at Drew take Spanish from the second grade on.
The positive educational climate at Drew is reflected in the
student attendance rate: 95 percent of the school's students come
to class every day.
Drew has succeeded because parents, teachers, the school
principal and community leaders have worked hard to create an
environment where children feel safe, secure, and confident that
they will thrive. The adults have taken responsibility; and the
children are learning to take responsibility as well.
In every one of our nations, dedicated, energetic, and
caring people are battling on the front lines to solve some of
society's most vexing problems. The purpose of this gathering is
to educate each other about our challenges and our successes --
and to make our efforts more cooperative by sharing the knowledge
and experience each of us holds within us.
When we return to our capitals, I hope we will not be guided
solely by documents, policy papers, and official pronouncements,
but also by the desire in our hearts to see that all children
have the gift of hope in their lives.
In the words of Gabriela Mistral [Mee-strall], the visionary
Chilean educator, poet, and Nobel prize winner for literature:
"Let me be more maternal than a mother; able to love and defend
with all of a mother's fervor the child that is not flesh of my
flesh.
"
As she once said: "Many things we need can wait. The child
cannot
To him, we cannot say tomorrow. His name is today."
Thank you for coming to Miami, and for joining together in
this important cause.
And now, let us go from words to deeds.
[Introduce UNICEF video]
###
5
THE WHITE HOUSE
WASHINGTON
March 24, 1995
Mrs. Alicia Pietri Caldera
Venezuela
Dear Mrs. Caldera,
Mrs. Wasmosy joins me in sending this letter.
As you know, this past December many of the Wives of Heads
of State and Government met during the Summit of the Americas to
discuss some of the most critical challenges facing children on
our Hemisphere. We were sorry you could not join us. Through
the contibutions of so many present, we identified three areas of
critical need which are of common concern and enormous importance
for the well being of our children.
The First Ladies' Symposium agreed that investment in the
human capital of the Americas is vital to the broader goal of
eradicating poverty and discrimination. In order to follow up on
the important health and education issues that were raised, we
would like to propose that we, as First Ladies of the Hemisphere,
engage the citizens of our nations in an active three-point
agenda to advance the goals in health and education adopted by
the leaders at the Summit of the Americas.
The first initiative we propose for follow-up is the
elimination of the transmission of measles in the Americas by the
year 2000. To start this effort, I will participate in the
launching of the Measles Elimination Campaign at the Pan American
Health Organization (PAHO) headquarters in Washington, D.C. on
April 7. Mrs. Wasmosy will lead a parallel effort in Asunción.
We understand that local PAHO representatives have been in
contact with you and the other First Ladies to encourage you to
sponsor similar events in your countries. Our participation in
this important initiative will provide the campaign with higher
visibility both at the national and the regional level. To
attack this problem, PAHO has formulated a regional project for
the elimination of the transmission of measles in the Americas
for the years 1995-2000. Strong partnerships with all sectors of
society can garner the political and financial support needed to
eliminate this killer disease.
The second critical initiative is the reduction of maternal
mortality in the Americas. Every year, 20,000 women die in the
hemisphere and at least 3 million are hospitalized from
complications relating to childbirth -- many of which are
preventable. We all agree that we need to promote the
implementation across the region of comprehensive health care
policies focused on women and the prevention of maternal
mortality and morbidity.
During the XXIII Pan American Sanitary Conference in 1990,
the Hemispheric Ministers of Health of the countries of the
region approved a Regional Plan for the Reduction of Maternal
Mortality in the Americas. Progress has been slow. Involving
ourselves in this initiative can help save lives of countless
women in all of our countries. We propose to include the issue
of maternal mortality and morbidity as an item for discussion at
the meeting of the Association of First Ladies that will be
hosted by Mrs. Wasmosy in Paraguay in October 1995. We are
convinced that we can generate renewed interest in an issue that
concerns the health and lives of women across the Americas. The
meeting in Paraguay will give us each an opportunity to review
the national plans, to learn what have been the most successful
strategies and projects to reduce maternal mortality and to learn
from each other.
The third area of interest is girls' and women's education,
which is also likely to be underscored at the 4th United Nations
World Conference on Women in Beijing. The rate of girls'
enrollment varies from country to country. We do know, however,
through extensive research in the field, that investments in the
education of girls yield a higher return than any other
investment in a country's development. As you know, when
countries focus their resources on the education of girls, they
achieve a wide range of benefits, including significant
improvements in health, domestic, agricultural and industrial
productivity, democratic participation and family wellbeing. We
propose to seek ways as First Ladies to be engaged in this issue
and increase the awareness in our nations of the importance of
girls' education. I was pleased to announce earlier this month
at the UN Summit on Social Development in Copenhagen that the
United States has made a commitment to financially support
efforts to enhance educational opportunities for hundreds of
thousands of poor girls and women around the world.
We hope that the above three areas and the suggested
initiatives adequately reflect the consensus reached at the
Summit Symposium in Miami and reflect the issues you believe are
most important for us in following up on that meeting.
Mrs. Wasmosy is also preparing additional items for the agenda to
reflect follow up to the First Ladies Meeting in st. Lucia.
Sincerely yours,
Hillary Rozlbam Clinton
Hillary Rodham Clinton
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April 7, 1995
FOR IMMEDIATE RELEASE
World Health Day 1995
Remarks by Hillary Rodham Clinton
First Lady of the United States
Thank you very much, Dr. Alleyne, and all of you who are gathered here today.
I know that you've already had an excellent program. I know some of the speakers who've
already addressed you and the work they have done over decades on behalf of children and, in
particular, on behalf of immunization.
I am pleased to be here with all of you on World Health Day. This marks a historic
opportunity for all nations to come together to work to improve the health of our global family.
I also want to thank all of you here at PAHO who are on the frontlines every day promoting
better health throughout our hemisphere.
I agree completely with Dr. Alleyne that you are the real champions of children and it
is your work every single day, your persistence in many instances- your begging, your
challenging, your promoting the idea that every child, every person is entitled to health care,
that really makes what we are now celebrating with the eradication of polio in this hemipshere
a reality.
Nothing is more important to our shared future than the well-being of children and for
that reason I am especially pleased that children are the focus of this year's World Health Day.
As you may know, I just returned yesterday from a 10-day trip to South Asia, where I saw
firsthand some of the world's greatest health challenges and also some of the most innovative,
thoughtful methods of bringing better health care to children and women in poor and remote
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areas. For me, that trip was an inspiring reminder of how much progress can be made when the
will and commitment are there to help those in need.
Today's world is one of great promise for the 130 million children of our own
hemisphere. Great promise, because our children are obviously our lifeline to prosperity and
progress in the exciting and unpredictable century that lies ahead.
Great promise because there are millions of healthy children across the Americas, whose
future are filled with hope and great promises because of historic commitments born at the the
Summit of the Americas las December, commitments that will translate into greater opportunity
and justice for all children.
Among other initiatives, government leaders endorsed the goal of making basic health
services available to all citizens. That will be extremely beneficial to children, who are the most
vulnerable to illnesses and unhealthy living conditions. I also want to commend the first ladies
who participated in this symposium on children in Miami and worked with Dr. Alleyne to clarify
our common vision and goals.
Today these women across the Americas are turning rhetoric into reality by helping
launch PAHO's historic campaign to eliminate measles from our hemisphere by the year 2000.
Later this year many of these women will convene in Paraguay to review our efforts and share
our experiences in working to meet this goal. The campaign to eliminate measles is vital to all
of our futures. It will save the lives of countless children in every country and will bring
primary health care to every single village in our hemisphere.
I say this with confidence because we know from past experience that it can be done. The
Pan American Health Organization already has led the world in getting rid of the polio virus.
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Since the World Health Organization resolved to fight polio in 1988, the number of polio cases
around the world has declined by 82%. Today, 145 countries are polio free and last year, as we
already heard, the Americas became the first region in the world to be declared formally free
of polio and not a single case has been detected in the region since August of 1991.
All of you here should take great pride in that achievement. You succeeded in getting
many nations and private and public institutions involved and that is no small achievement.
Now the work must continue in other parts of the world and in our region we must turn
our attention to another major health threat to children: measles. My husband often talks about
children as the greatest resource of every nation and one of the best ways to build on that
resource is to invest in children, especially their health.
And I would add and echo Dr. Alleyne's comments. When we talk about health and
education for children, we're not talking about a soft issue, about a marginal issue. We are not
talking about an issue that is the province of women. We are talking about a core issue that will
determine the future of every one of our nations and this is an urgent mission, that we
understand fully how significant the health of our children is to the future of all of us.
Because just as we live in a time of great promise for children, we also live in a time of
great peril. More than 1/2 of the population in this hemisphere is under the age of 23 and too
many of our young people in every one of our countries suffer from poverty, hunger, illiteracy
and inadequate health care.
But the statistics need not be so grim. While ushering children into the world is the
province of families, protecting them from avoidable diseases must be viewed as the shared
responsibility of our larger human family. We all know that a sick child has much less chance
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of learning, growing and fulfilling his or her potential than a child who is healthy.
A sick child has much less reason to be hopeful and optimistic about the future, less likely to
develop into a healthy, productive citizen. That is why it is our responsibility as a community
of nations to insist that all children receive the health care they need. We have the technology.
Vaccinations exist for most of the major childhood diseases and they are far cheaper than long
term treatments or the disabilities that result when children become seriously ill.
All we need now is the commitment to make these immunization campaigns succeed. the
United States has been a proud partner of past efforts to eliminate major childhood diseases in
this hemisphere. Nearly half of all external donor funding for the polio campaign came from the
United States Agency for International Development. The United States currently is providing
nearly US$7 million as part of our child survival programs in the countries of the Americas.
Today I am pleased to announce that the United States will join in partnership with
PAHO in the campaign to eliminate measles across the hemisphere. PAHO has estimated that
an additional US$46 million is needed for immunization programs between now and the end of
the century. Through USAID, the United States plans to extend a five-year, US$20 million grant
to PAHO to advance hemispheric health care priorities.
Although the United States, like many other nations, is operating under budget
constraints, our government hopes to allocate US$8 million directly to the Regional Expanded
Program on Immunization, which includes support to the measles campaign. At the same time,
we have every expectation that just as with the polio effort, USAID programs and technical
support across the Americas will help boost the campaign to eliminate measles.
During the polio campaign those programs more than doubled our regional commitment. One
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51.
of the most important aspects of PAHO's campaign to eliminate measles is that it will advance
all of our immunization efforts.
Perhaps equally important, it does reflect a larger vision of health reform that extends
a basic package of integrated health services throughout the region and in that way carries
forward the Summit of the Americas plan of action.
It also provides us through this measles campaign continuing opportunities for
surveillance throughout the region so that we do remain very much focused on how effective we
are in delivering immunization services. We have succeeded with respect to polio, but we must
remain vigilant as to that disease and all others. Although our specific health challenges may
differ from country to country, and our recipes for progress may require different ingredientes,
we share a common future and a common cause: we must not work in isolation to solve our
problems, whether we are health organizations, NGOs, government leaders, private citizens we
must join together as partners who appreciate the value of sharing our knowledge and experience
and we must remember that when it comes to helping our children words alone are not enough,
policy papers are not enough, press releases are not enough, documents and studies are not
enough. We have had more than our share of each.
Instead, we must translate into action what we can do and then get on with the business
of doing it.
Ultimately, we must be guided by a desire in our hearts to see that all children have the
gift of hope in their lives. As the wonderful Chilean poet Gabriela Mistral once wrote "Many
things we need can wait, the child cannot." And so today, as we celebrate this very important
effort, I hope each of us will remember that the child cannot wait and we can do something to
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ensure that the child throughout this hemisphere has the opportunity to live up to his or her God-
given potential.
Thank you very much.
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
October 16, 1995
REMARKS BY FIRST LADY HILLARY RODHAM CLINTON
AT THE FIFTH CONFERENCE OF WIVES OF HEADS OF STATE AND OF
GOVERNMENTS OF THE AMERICAS
ASUNCION, PARAGUAY
MRS. CLINTON: I am privileged to have the opportunity to
represent my country, the United States, for the first time at this
Fifth Conference of First Ladies from the Western Hemisphere. It is
also a great honor for me to be here in Paraguay with all of you.
We have gathered together to discuss the futures of women and
children in all of our countries. Whether we live in North,
Central, or South America or the Caribbean region, we are united in
our belief that women everywhere share common aspirations and
concerns.
Yet, as we meet here in this beautiful hall this evening, we
also know that a vast reservoir of human potential is now being
wasted across the Americas.
No nation in our hemisphere can say that all of its children
are fed, clothed, housed, schooled, and raised by loving parents.
No nation in our hemisphere can say that all of its women are
treated with dignity, respect, and given the chance to fulfill
their God-given potentials. And no nation can say that each and
every family within its borders is healthy, strong, and stable.
Our world, as we know, is far from perfect. But even though
enormous challenges remain, we have come here hopeful about our
future. Hopeful because, somewhere in our hemisphere right now, a
baby in a local health clinic is being immunized against a serious
disease.
a little girl is going to school and is learning to
read and write
a woman is taking out a small loan from a
neighborhood bank that will enable her to start her own business in
her home. We know that every problem we face in our hemisphere is
being solved somewhere in our region at this very moment.
We are also hopeful because of the progress made at last
year's Summit of the Americas in Miami, at the United Nations
Conference on Social Development in Copenhagen earlier this year,
and more recently at the United Nations Fourth World Conference on
1
Women in Beijing. I think it is very fitting that we meet after
those three historic gatherings, which drew world attention to the
plight of women and children and, in so doing, to the plight of
families as well.
Since Miami, we have seen cooperation grow among our nations,
and our political leaders. The Summit not only recognized every
nation's duty to invest in its people, but also the special role
that girls and women play in the economic and social development of
the Western Hemisphere.
That theme was reiterated again in Copenhagen, which focused
on the alleviation of poverty as an essential factor in political,
social and economic progress.
Many of us also attended last month's women's conference in
Beijing, where it was again made clear that democracy and
prosperity cannot be attained or sustained in countries that do not
value women as full and equal partners in society.
The conferences in Miami, Copenhagen and Beijing showed the
world that issues involving children and women are not secondary
issues. They are keys to building democratic institutions,
strengthening market economies, and achieving social justice.
They are also among the hardest issues we face.
That is why the agreement reached in Miami last year was an
historic first for countries of this hemisphere. For the first
time, there was universal recognition that no nation can compete in
the global economy if half its population cannot read or write,
cannot find a job, or cannot rise out of poverty.
And that is why it is also heartening that, despite assurances
from skeptics that nothing would be accomplished in Beijing, more
than 180 nations endorsed a platform for action that lays out
specific ways to expand the rights and opportunities of women
around the world.
This is particularly critical today, given the growing gap
between the rich and the poor, the educated and the uneducated, the
skilled and the unskilled.
Those among us who enjoy the opportunities of education,
health care, jobs, credit, legal and political rights are
flourishing in the new global economy. Those without such
opportunities are lagging farther and farther behind. And more
often than not, those lagging behind are women and poor children.
This trend, if it continues, threatens to undermine the very
institutions we are seeking to uphold: strong families, strong
economies, and strong democracies. All will be in jeopardy if women
2
continue to be denied the opportunities they need to thrive and
compete in the new century.
So, what must change?
First, values and attitudes.
In our everyday lives, we must begin to respect the dignity of
each person, no matter where that person lives or what he or she
looks like. To do that, we must be willing to overcome many
assumptions, presumptions, prejudices and prejudgments.
Because, to truly respect a child means to respect every child
in every family, boy or girl. To respect a child means to give that
child the love, attention, and discipline he or she needs to grow
up with confidence and competence. To respect a child means to
nurture that child with the health care and schooling that he or
she needs to get the right start in life.
Every time we dismiss the potential of a child because of skin
color, parental income, or family background, we betray our own
futures.
We must also appreciate the contributions of every woman,
instead of pigeon-holing and categorizing women in ways that limit
their potential. To truly respect a woman means to respect and
protect her human rights; it means to respect the choices she makes
for herself and her family; and it means to value the experience
she brings to all facets of life.
Second, institutions must change, and so must the ways we go
about our everyday business.
If programs and policies have outlived their usefulness, we
should admit that they no longer solve the problems they were meant
to solve. We must fix programs that don't work with reforms that
are efficient and inexpensive. And we must insist that institutions
-- whether government, schools, or health care systems -- overcome
bureaucratic intransigence and put people first.
We must also take advantage of the many innovative programs
that do exist throughout our hemisphere. Prior to arriving in
Paraguay today, I was in Brasilia, where President and Mrs. Cardoso
told me about Brazil's efforts to improve the quality of primary
education.
I then traveled on to Salvador da Bahia, where an
extraordinary effort is underway to channel the potential and
energy of thousands of street children. One program I saw was a
circus in which the performers were children, some as young as
eight, who had been recruited off the streets where they lived.
3
They were not being trained for circus jobs; their
performances were merely a vehicle for learning the value of
discipline, teamwork, and hard work. Along the way, these children
develop confidence, self-esteem, and pride in their
accomplishments. Part of a program called Project Axe, they also
receive schooling and vocational training, as well as counseling to
reunite them with their families.
I asked one 15-year-old boy, who had been with the project
since it began five years ago, whether it had made a difference in
his life. If not for the project, he said, "I would be dead or in
prison now."
Programs like this one, which receive support from the public
and private sectors and some international organizations, can be
replicated widely. But that requires us to share information,
exchange ideas, discuss honestly our successes and failures, and
learn as much as we can from each other.
Government has a vital role in all of this. But government is
only effective if it listens to the voices of the people it serves,
instead of making decisions based on political convenience or whim.
And government must be held accountable for meeting human needs.
At the same time, government cannot address every problem
alone. We must not look on government as a panacea, but as an able
partner of business, non-governmental organizations, and other
private institutions committed to investing in the promise of every
person, including those who are poor, disadvantaged, and
politically powerless. And one of the best things government can do
is to make it easier for outside groups, non-governmental groups,
to do the work they are willing to do.
Finally, as societies, we must be willing to move beyond
inertia to action. And all of us -- individuals and institutions --
must heed that call to action. We must start by taking
responsibility within our own families and then spreading that
responsibility to the communities in which we live.
Every segment of society has a stake in this issue. And every
segment of society can affect positive change.
Schools, for example, can be more flexible in responding to
the needs of their students, young and old.
A few days ago, in Santiago, Mrs. Frei took me to a school
that embodies the Chilean commitment to building an educational
system for the future. I saw boys and girls busy working on
computers hooked up to the Internet.
I learned from the Minister of Education that schools may
begin to keep their doors open on Saturdays and Sundays to
4
accommodate the children of working parents who have no
alternatives for child care, and for children who wish to acquire
new skills for themselves.
I saw that Chile has not been content to stick with old
methods that do not work. The government and people of that country
are devising new ways of training teachers, involving parents and
communities. All of this is happening now in many countries
throughout the Americas and more can happen if we are willing to
learn from each other's experiences.
Heeding the call to action also means that financial
institutions must serve all people, even if they are poor, live in
remote areas, or are women. How much more evidence do we need that
women are a good credit risk? I have seen the proof myself at the
Grameen Bank in Bangladesh, where the poorest of the poor in the
world have transformed entire villages by taking out small loans
for cows, rickshaws, and other items they use to earn an income.
I have even seen it in my own country, where poor women at a
project called Mi Casa, in Denver, Colorado, have banded together
to take out small loans to help themselves. And they told me
very, very directly how difficult it is for women even in the United
States to have access to credit. One woman said: "Too many great
ideas die in the parking lots of banks. "
But all over this hemisphere, women are overcoming these
obstacles. In Nicaragua, which I visited at the beginning of my
trip, I saw how hard President Chamorro has worked to strengthen
democratic institutions and promote a market economy. And I met
thirty women from a very poor barrio in Managua who run a bank in
their neighborhood, borrowing small sums of money to start their
own businesses, to start a bakery, to make mosquito netting, to be
a seamstress.
Not only had these women organized themselves to improve
their own circumstances, they were also improving the circumstances
of their families and communities.
Furthermore, they have, like every bank I have ever visited,
a high loan repayment rate. In that particular neighborhood bank,
the repayment rate was 100 percent. And from what I know about
banking, that would be the envy of many commercial lenders.
Individual men and women need to change attitudes and then
act, just as every branch of society.
Businesses can initiate policies, such as flexible work
schedules, child care,
and the use of modern technology, that enable employees to perform
well on the job and continue to fulfill their family obligations.
Businesses also can value women by paying women equal salaries for
5
equal work with their men employees.
The media can assume greater responsibility for the values it
transmits by avoiding negative advertising and television
programming that sensationalizes violence and glorifies the
exploitation and degradation of women and children.
At this conference, we will examine these issues, and we will
focus specifically on what can be done to address the pressing
health and education of women and children.
We will discuss initiatives to ensure the elimination of
diseases that primarily affect women and children, reduce maternal
mortality and provide comprehensive health care to women throughout
their lifetimes, including family planning. We will talk about what
every nation must do to ensure that girls are guaranteed the right
to an education and that all citiz
ens acquire the knowledge and skills they will all need in the new
global economy.
And we will explore ways to end the problem of domestic
violence, which has destroyed the lives of too many women and their
families in every country represented here.
I would like to make one final point about our agenda.
Because we are talking about the issues that matter most in the
lives of women and children does not mean we are not talking about
the lives of men and boys.
When I was in Nicaragua, I noticed billboards along the side
of the road. They showed the face of a crying child with the
caption: "My father has left the home." The problem of the absent
father is as tragic as the problem of the undervalued mother and
wife. It is a problem that, in the United States, we are urgently
trying to address.
If, as a hemisphere, we truly care about strong families,
strong communities, and strong societies, we have to recognize that
men and women can and must complement each other inside and outside
of the home. We should not be at opposite poles; we should be
partners in a common enterprise for the good of all of us, and
particularly our children.
Because of the roles that the women here and many of you in
this hall have, we know we can help initiate the changes that must
take place if we ever want to realize the great potential of this
hemisphere.
Like the women I have met all over this hemisphere in Canada,
in my country, in Mexico, in Nicaragua, in Chile, in Brazil and
here in Paraguay, we come together to pool our experiences and
6
ideas to improve conditions for our individual families as well as
our national family and the family of nations.
I was not present at the earlier conferences, but I want to
thank and applaud all of the women who took part in those
conferences and who have moved this agenda forward. I was
privileged to host our meeting in Miami and I look forward to the
work ahead of us. It is the most exciting and challenging work any
of us can imagine or be engaged in. And it is work in which we can
make a difference.
Thank you very much.
###
7
FIRST LADY HILLARY RODHAM CLINTON
WORKING SESSION ON CHILDREN'S HEALTH AND EDUCATION
ASUNCION, PARAGUAY
OCTOBER 17, 1995
Thank you, Mrs. Wasmosy. I think I speak for all of us in thanking
you for such an inspiring opening to our gathering last evening.
As we begin our working session on children's health and education, I
want to reiterate what I said last night. During this conference, we will learn
from each other and find new inspiration as we work on behalf of women
and children throughout the hemisphere
At the Summit of the Americas, our leaders committed our nations to
ongoing collaboration and open economic and democratic development. The
Summit recognized the central role of investing in human resources in all
dimensions of social, democratic, political and economic development. This
historic Summit set forth an agenda to promote prosperity and democracy
throughout the region by implementing trade initiatives, sustainable
development and more effective government. The declaration our leaders
signed included specific commitments in the areas of health and education.
At the same time, we came together for a one-day symposium to
review the status of health and education of children in the Hemisphere,
shared ideas of how we were addressing the major issues facing our
children, and reached a general understanding of future challenges. We
recognized that we have common needs in the region but we also recognized
that progress has been made. We agreed that investment in human capital is
vital to the broader goal of eradicating poverty and discrimination.
As a follow-up to the Summit, Mrs. Wasmosy and I sent each of you
a letter earlier this year in which we proposed a three-point agenda to
advance the health and education goals adopted by the leaders at the Summit
of the Americas.
1
Elimination of Measles
The first initiative we proposed is the elimination of measles in the
Americas by the year 2000.
I was very proud to be invited by Dr. George Alleyne, director of the
Pan American Health Organization, to launch the measles elimination
campaign in the Americas. Many of you have joined in launching measles
initiatives in your own countries. And today we will join Mrs. Wasmosy as
she begins a measles campaign here in Paraguay.
A regional plan of action that outlines the strategies and technical
components to achieve elimination of measles has been prepared and
funding is being sought to complement support already received. While
some countries are still waiting for international support, they have already
demonstrated their commitment to that effort. This has translated into
further control of the disease, which was at its lowest level ever in the
period between 1994 and 1995.
The United States has been a proud partner of past efforts to eliminate
major childhood diseases in the hemisphere. Through the United States
Agency for International Development, the United States plans to enter into
a grant with PAHO to advance hemispheric health care priorities. Although
the United States, like many other countries, is operating under severe
budget constraints, our government is hoping to allocate $8 million under
this new agreement. The funding would go directly to the Regional
Expanded Program on Immunization, which includes support for the
measles elimination campaign in our region.
Reduction of maternal mortality
The second critical initiative that we proposed for follow-up was the
reduction of maternal mortality in the Americas, an issue we cannot
separate from the well-being of our children.
One hundred million women cannot obtain or are not using family
2
services because they are poor, uneducated or lack access to care. Twenty
million of these women will seek unsafe abortions -- some will die, some
will be disabled for life. A growing number of unwanted pregnancies are
occurring among young women, barely beyond childhood themselves.
Most of these maternal deaths could have been prevented with basic
primary, reproductive and emergency obstetric health care. In some cases,
there are 175,000 motherless children for every one million families. Many
of these children don't survive. Of those who do, many are recruited into a
life of exploitation on the streets of our world's cities, subjected daily to
abuse, indignity, disease, and the specter of early death.
There must be a renewed commitment to improving maternal health.
The World Health Organization launched in 1987 a Safe Motherhood
Initiative to halve maternal mortality by the year 2000. In Miami, the
leaders of our hemisphere committed their governments to this same goal.
To reach these important goals, more attention must be paid to emergency
medical care, as well as primary pre-natal care. Providing emergency
obstetric care is a relatively cheap way of saving lives -- and along with
family planning services is among the most cost-effective interventions in
even the poorest of countries.
There has been progress, but many deficiencies exist. Maternal
mortality rates in the Americas are still unacceptably high and progress in
meeting the set targets has been extremely slow. We have the technologies
and the national plans in place to end the conditions under which women
continue to die from preventable diseases. There is no justification for the
wide differences that we find country by country in the hemisphere in
maternal mortality indicators. We need to encourage each other to give the
necessary priority to reduce the disparities and assign necessary resources to
implement national plans for maternal mortality reduction.
Education Reform
The third area we called to your attention in our letter is investing in
3
girls education in the context of improving overall quality of education.
Nothing is more important to the region's future economic and social
development than the education of its children. One of the Summit goals is
to achieve a primary education completion rate of 100% and a secondary
enrollment rate by the year 2010.
Over the past three decades, Latin America and the Caribbean have
had a remarkable record of achievement in human development. A great
distance still exists between our current knowledge and the quality of
education services provided.
Because of the critical nature of education, an initiative was created at
the Summit of the Americas to provide an ongoing consultative forum for
governments, nongovernmental organizations, the business community, and
international organizations of the Hemisphere to share experiences in
education reform and showcase innovations in the hemisphere.
Today, I am pleased to formally launch the Partnership for Education
Revitalization in the Americas (PERA) by pledging a commitment by the
United States of 3.7 million dollars over 5 years which constitutes initial
funding. As called for by the Plan of Action of the Summit of the
Americas, PERA was created as a sustainable hemispheric partnership to
promote the adoption and implementation of effective education policies.
This initiative will institutionalize across the hemisphere the capacity to
support and facilitate collaborative efforts to improve basic education
opportunities for all children, including special emphasis on increased
access to girls and women in those countries where this is still an issue.
Through PERA, countries will increase their knowledge of policy
alternatives and successful practices for improving educational quality,
efficiency and equity throughout the region leading to improved policies on
human resources. It will create a broad membership representative of the
key stakeholders in policy formulation and implementation and build a
consensus on critical educational policy issues.
4
We have a unique opportunity to impact on the Summit targets.
Because of our roles in our societies, we are in a privileged position to bring
attention to these issues and help build upon approaches that are working.
We can forge partnerships among governmental and nongovernmental
organizations all aimed at meeting the same goals.
5
As delivered
FIRST LADY HILLARY RODHAM CLINTON
REMARKS TO THE SIXTH CONFERENCE OF
WIVES OF HEADS OF STATE AND OF GOVERNMENTS OF THE AMERICAS
LA PAZ, BOLIVIA
DECEMBER 3, 1996
President and Mrs. Sanchez de Lozada, First Ladies and
special envoys representing the nations of the Western
Hemisphere, and distinguished guests:
It is a great pleasure for me to be in La Paz and to join
you for this annual conference. I particularly want to thank
Mrs. Sanchez de Lozada for her leadership on behalf of women
especially her work to promote safe motherhood, education, and to
reduce domestic violence - - and for extending to all of us a warm
welcome this week.
I know that, as in the past, this gathering will provide new
insights and fresh inspiration as we work to expand opportunities
for women, children, and families in North, Central, South
America and the Caribbean region. I am also pleased to note that
Vice President Gore will be in Santa Cruz in a few days
representing the United States government at what promises to be
a significant hemispheric meeting on sustainable development.
This is my first trip to Bolivia, but I have long felt a
special connection to this country. Little Rock, the capital of
my home state of Arkansas, is a sister city of Santa Cruz in what
is called the Eastern Bolivia-Arkansas partnership. This
partnership has initiated cultural, professional and health
exchanges that have benefitted the people in both of our
countries. So I am especially delighted finally to be in Bolivia
after all these years.
Many Bolivians have made their mark on my country. I am
proud to say that President Clinton named a woman who was born
and raised here in La Paz, Maria Otero, to be the Chair of the
1
Board of the Inter-American Foundation. That foundation funds
grassroots development in the region, and Maria is with me today.
I'm also pleased to be here at a time of such hope and
promise for women, children and families across the Americas and
around the world. A few days ago, I returned from a trip with my
husband to Australia, the Philippines and Thailand, and at each
stop I had the chance to talk to diverse groups of women from
government leaders to grassroots activists to teenage school
girls. And I was reminded once again, no matter where we find
ourselves in the world today, our aspirations and concerns are
fundamentally the same.
Thanks in part to the agenda set at the United Nations Fourth
World Conference on Women in Beijing, as well as the conferences
of this group in Miami, and Asuncion and elsewhere, the status of
women is improving in many countries.
In the Philippines last week, I had the opportunity along
with Mrs. Frei to speak to 15,000 women and girls in Manila.
Some had traveled for days by boat and car to celebrate the
Beijing Agenda and just as we are doing today, they came together
to renew their commitment to women's rights - - and to ensure that
every woman and girl has access to the tools of opportunity:
health care, education, jobs and credit, legal protections and
the right to participate fully in the political life of their
countries.
In the 15 months since Beijing, we have seen advances on
every continent. In country after country, governments, non-
governmental organizations, businesses and corporations, and
individual citizens are beginning to recognize that elevating the
status of women and girls in society is essential to progress and
prosperity. That is the same whether we are talking about the
East, the West, the North or the South; there is a growing
appreciation of women's contributions inside and outside of the
home - and a greater understanding that everyone in society
benefits when women are allowed to claim the political, economic,
social, and civic power they are due.
The Western Hemisphere is no exception. In Panama, the
family code has been reformed, giving women more say in alimony,
child support and child custody cases. The country's new Law 27
2
on Intra-Family Violence criminalizes certain forms of domestic
violence. In Colombia, men and women now have equal weight in
determining divorce. In El Salvador and Peru, new institutions
have been established to address issues relating to women's
development. In Guatemala, a national university has created
scholarships for indigenous women to study political science.
Jamaica's Gold Street Program, which addresses teen violence
and adolescent pregnancy, has become a model that the United
States is using to confront the same issues in the city of
Baltimore. In Brazil, women are now entitled to free breast and
uterine exams. And in Chile, the government has committed itself
to tackling AIDS and adolescent pregnancies and to expanding
educational opportunities for girls. And here in Bolivia, as
part of the President's plans, the Plan de Todos, special efforts
are being made to reach out to the indigenous population.
From the northernmost reaches of Canada to the southern tip
of South America, women are pushing governments to lift the veil
of secrecy that for too long has concealed the tragic crime of
domestic violence. I mentioned the legal advances in Panama.
Another ground-breaking domestic violence law was passed in
Ecuador, creating Family Courts that are empowered to separate an
abusive spouse from the home. In Costa Rica, police officers
receive special training on how to handle domestic violence
cases. In my own country we recently launched a national hotline
for victims of domestic violence which has already received
50,000 calls.
Looking across our region, we also see progress on the goals
that this group outlined at our previous meetings. Those goals
to eliminate measles from the hemisphere, reduce maternal
mortality, and promote education reform are making progress.
Since 1995, our region has witnessed a 63 percent decline in
measles. We have seen the Partnership for the Revitalization of
Education in the Americas launch new efforts to expand
educational opportunities in six countries. And while the tragic
problem of maternal mortality continues to haunt us, we know that
progress will come if we focus more energy and resources on this
issue.
It is clear that pioneering efforts are underway across the
Americas to improve conditions for women and girls. Earlier
3
today in La Paz, I visited with Ximena, Banco Sol, the only
commercial bank in the world and the largest that specializes in
microenterprise right here. I spoke to women whose lives had
been transformed because they had received a modest loan to start
selling vegetables in the market, to start making skirts. Not
only had they become economically self-sufficient, they had begun
to lift their families out of poverty and improve the economies
of their communities. We met one woman in the market who is
caring for her six orphan grandchildren because of the loans that
she had received. I have seen the same encouraging results at
FINCA, a micro-lending enterprise that I visited in Managua,
Nicaragua. I've visited a comparable enterprise in Santiago and
I have seen it in my own country.
In La Paz today I also visited new and expectant mothers at
a primary health care center run by an NGO, PROSALUD. The 28
PROSALUD clinics offer prenatal care and family planning services
that have resulted in safer pregnancies and deliveries and, in
some cases, have saved lives.
This is but one piece of the nationwide effort here in
Bolivia to promote safe motherhood and family planning SO that
women and girls are educated about their own health and their own
reproductive options.
Although the rate is far too high, Bolivia's success over the
past five years at reducing maternal mortality offers a model for
the world of how one nation has responded to a serious health
crisis and galvanized the government, non-governmental
organizations, and the medical communities. I wish to commend
the President and the Vice President for their leadership in
this very important effort.
It is worth noting that Bolivia undertook this campaign not
only as a way to reduce maternal mortality, but also to reduce
the increasing rate of abortion. Without access to family
planning, women often turn in desperation to illegal, unsafe
abortion procedures that account for half of all maternal deaths
in this country. Deaths from abortion complications are
responsible for from 30 to 70 percent of maternal mortality in
our hemisphere, depending on the country.
4
Here, in Brazil, and in other places around the globe, I have
seen examples of how investments in family planning improve
maternal health and the well-being of families as well as reduce
the number of abortions. The United States has supported family
planning efforts, including Bolivia's. However, as you may know,
some members of the United States Congress have voted to limit
American support for family planning initiatives. My husband's
Administration remains committed to encouraging a continuation of
these investments, which represent a sensible, cost-effective and
long-range strategy for improving women's health and for lowering
the rate of abortion. And for my part, I will certainly remember
and share the powerful stories I have heard around the world to
explain why these programs are critical.
Education is also critical. It is inextricably tied to how
women and children achieve progress. Children of illiterate
mothers are twice as likely to die as those with mothers who are
educated. So our efforts across the Western Hemisphere to
educate girls and mothers will have a profound and concrete
effect on women's health. The better educated a girl or woman
is, the healthier she is. The healthier she is, the healthier
her family is. And all of society stands to gain.
While some may dismiss the achievements of this conference
and the conferences before or of the Beijing Agenda as merely
"women's issues" that have no place on the front-burner of global
politics, I believe that you here in Bolivia, and certainly your
President and Vice President understand how they are part of
sustainable development and progress. They represent a balancing
of power that is just as crucial to the endurance of democracy as
issues like trade, diplomacy and national security. Democracy,
after all, requires the full participation of all citizens,
including women.
And today, we can take heart knowing that democracy has
replaced dictatorship around the world and virtually throughout
our own hemisphere. Building and sustaining democracy has always
required a balance of power, a balance of public power, private
economic power, and the power of civic society, those formal and
informal networks that bring people together. It is the balance
of power that Bolivia has incorporated into its Popular
Participation Law, and by doing so, insured the further success
of democracy. Whether we succeed at achieving the balance of
5
power is particularly important for women who despite the strides
we have made, still find their voices silenced and their
potential stymied in too many parts of the world. In country
after country from the most advanced democracies to those
newly emerging, from the most dynamic free market economies to
those struggling in the face of rapid global change women are
still striving to define and attain their rightful place in
government, the economy, the civil society and throughout their
lives.
Women are seeking balance in their lives and in their
societies, and I am heartened that civic education is on the
agenda of this conference. Teaching people about democratic
values and the importance of their participation in the political
process is critical to sustaining democracy. When we look at
what is happening in our hemisphere, when I look at what is
happening in my own country, I see that the voices and votes of
women can make a difference. If all of us believe in the God-
given potential of each human being, then all of us should do
what we can in our own ways and our own roles to further those
voices and that potential.
For all of the challenges that confront us on the eve of
this new century I am optimistic about our future. I am
optimistic about our hemisphere and about our capacity to meet
those challenges. And certainly, if there is one vision that
should guide us, it is that of the young people who rely on us to
leave them a world that encourages their dreams, nurtures their
talents and respects their choices. That is really why we are
gathered today most of us in this auditorium have made most of
the choices we will make that will determine the course of our
lives. It is up to us to determine how we provide the same
opportunities for all of our sons and daughters.
Building a better future for children, women, men, and
families in the Western Hemisphere is not just the opportunity of
government, it is the responsibility of all of us. And I thank
you very much for being part of meeting that responsibility and
challenge.
6
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PHOTOCOPY
HRC HANDWRITING
CLINTON LIBRARY PHOTOCOPY
October 9, 1997
7th Annual First Ladies of the Americas
Atlapa Conference Center
NO GREETERS ON ARRIVAL
MAIN SCHEDULE:
9:00 to 9:45 A.M.
Speeches in the Main Hall
9:45 to 10:00 A.M.
HRC gives remarks
10:00 to 10:45 A.M.
Speeches Continue
10:45 to 11:15 A.M. HRC witnesses USAID grant signing
11:15 A.M. to 1:00 P.M.
Speeches continue, Main Hall
1:00 P.M. to 2:00 P.M.
Lunch for First Ladies
October 9, 1997
7th Annual First Ladies of the Americas
Contadora Room, First Floor
Program
-HRC will be seated at main table 8 feet from the podium.
-HRC's delegation will be sitting behind HRC's chair or in
the front rows of the audience.
-HRC is sitting between First Ladies:
Josette Altmann de Figueres, Costa Rica (Left)
Ivonne Hinds, Guyana (Right)
-At 9:45 A.M., HRC will proceed to podium and make
remarks.
NOTE: SPEECH BOX WILL NOT FIT ON PODIUM
-After remarks, HRC will return to her seat for the rest of the
morning program
VII CONFERENCE OF WIVES OF HEADS OF STATE AND
GOVERNMENT OF THE AMERICAS
CEJEG/PANAMA
PLAN 1
English
October 6th
ACTION PLAN
PANAMA, OCTOBER 8ᵀᴴ AND 9ᵀᴴ
ACTION PLAN
GUIDANCE
The Action Plan is the document containing the main agreements and commitments adopted during the VI Conference of
Wives of Heads of State and Government of the Americas. The objective of this guidance is to assist in the complete
presentation of the Action plan and to act as the follow up proposal to the same.
1.
Topic or Project :
Refers to the title or name of the Project or Program.
2.
Objectives:
Refers to the goals to be achieved.
3.
Target Population:
Refers to the population assisted and benefited by the project.
4.
Possible Actions:
Refers to the activities we intend to promote and support.
5.
Responsible Entities:
The Governmental or non - governmental institutions who will develop the project.
6.
Achievements:
Refers to the final results obtained after implementing the project.
7.
Date of Follow up Report: The responsible entity will present a report the First Lady's Office. Each country will
establish the periodicity of said report.
i
FOLLOW UP ACTIONS
Topics of
Objectives
Target
Possible Actions
Responsible
Achievements
Date of
Projects
Popula-
Entity
Follow-
tion
up
Report
1. Health of
-Promote the
-Amplify and follow-up on the
- Ministry of
See Follow-up
women and
formulation,
Teenage Pregnancy Prevention
Health
Report
Children.
revision,
Project, incorporate strategies
- First Lady's
reinforcement and
such as sex education,
Office
follow-up of the
fortification of self esteem and
national policies,
others, with multidisciplinary
plans and programs
and intersectorial activities and
for the accelerated
with ample participation of
reduction of
youth and adolescents.
maternal mortality
and morbidity and
- Adhere to and further program
stillbirth in the
for the prevention and control
Americas.
of malnutrition due to the lack
of micronutrients (iron, calcium,
-Promote the
zinc, vitamin A and fluorine)
mobilization of
through the supplement of risk
public and private
groups, diet fortification and
institutions, non-
education on nutritional foods.
governmental and
social
- Promote, nutritional plans and
organizations, as
programs as well as local projects
well as others, in
in the countries aimed at
order to
increasing the covering in the
contribute, in their
prevention and control of
1
respective areas
gynecological cancer, especially
with the
of cervical cancer.
development of
- Continue to support the
national and local
program "Latin America against
plans for the
cancer", which is executed in
execution of
the region and supported by the
measures of greater
wives of Heads of State and
impact aimed at the
Government of the Americas
acceleration of the
and ALICC.
reduction of
maternal death.
- Continue to support and
follow-up on the action plan for
the elimination of the measles by
the year 2000 and support the
improvement of the surveillance
system.
-Further the development of
anoth
support mechanisms for the
other
reduction of maternal and infant
Things
death due to anemia caused by
lack of iron and other micro-
nutrients and support an
investigation project to evaluate
of the level of trace element
deficiency in pregnant women
and children under the age of 6.
2
2. Education
- Offer a better
-Motivate the summoning
- First Lady's
See Follow-up
and Training
quality of life to
capacity that the wives of Heads
Office.
Report
of Women and
women and girls
of State and Government of the
- Ministry of
Girls.
and their offspring.
Americas have shown to impulse
Education
the implementation of specific
-Women
projects in benefit of the
organizations
referred population.
- Increase the role as
communicators of the wives of
Heads of State and Government
of the Americas to broaden and
strengthen the promotion of the
adopted objectives.
- Promote the management of
the technical and financial
resources within the
international cooperation
organizations which allow the
promotion of the execution of
special programs in favor of
women and children.
-Promote the role of the wives of
Heads of State and Government
of the Americas facilitators for
the joint labor between the civil
society and governments aimed
3
at reaching the necessary
consensus that will allow the
realization of effective projects
programs.
-Promote the exchange of
innovative educational and
training experiences in order to
contribute to the search of
solutions to the common
problems that affect American
countries.
3. Prevention
Prevent all forms
-Implement the "Regional
- First Lady's
See Follow-up
and Control of
of violence within
Initiative to support the
Office.
Report
all forms of
the family
Prevention, Sanction and
-Family
domestic
Elimination of the Domestic
Counsel.
violence
Violence".
-Ministry of
Health.
-Work with all sectors of society
-Ministry of
to develop integral models
Education.
against domestic violence.
- Support the development and
promulgation of appropriate
laws that guarantee legal
protection to those affected by
domestic violence.
el prient of
Proneste the yes purshe polcy aimed
atthe prom elimination:
- Promote the consideration of
the ratification of the Inter
American Convention to
Prevent, Sanction and Eradicate
violence towards Women" in
countries that have not done it
yet and promote its fulfillment
throughout the region.
- Propose prevention strategies
to prevent domestic violence and
promote non violent life styles
through formal and non formal
education.
-Request international organisms
to continue supporting the
initiatives on this subject.
- Spread the commmitment of
the wives of Heads of State and
Government of the Americas to
support the prevention,
sanction and elimination of
Domestic Violence at a national
and international level
4. Participation
- Develop public
- Implement the "Regional
First Lady's
See Follow-up
of Women in
policies to
Initiative to support the fair
Office.
Report
spaces of power
strengthen the
participation of men and women
5
and the
political leadership
in spaces of power and the
- Women
decision
of women.
decision making process".
Institutions
making
or Offices.
process.
- Adopt measures to promote the
participation of women in spaces
of power through temporal of
mechanisms affirmative action.
-Contribute and support the
development of women training
programs for their participation
in power and decision making.
- Actively participate in
information, sensitization and
social mobilization campaigns,
to achieve the increase of women
participation in spaces of power
and the decision making process.
- Survey and evaluate the
progress made by women in
different levels.
- Promote the inclusion of
political participation and the
practice of active citizenship for
women in all the related
programs.
Complain
5. Rights of
Promote the
- Support activities child abuse to
First Lady's
See Follow-up
Children and
quality of life of
prevent child abuse in all its
Office.
Report
Youth
children from a
forms (physical, psychological,
physical,
sexual and in labour).
- Ministry of
psychological ans
Health.
social point of
- Further the implementation of
- Ministry of
view
the ILO's
Education
proposal related to the
eradication of child labor in
- Family
girls and boys under 12 year of
Institutions
age.
Counsels.
- Promote the exchange of
experiences between the
countries of the Americas and
with the International
Cooperation agencies to
strengthen systematization
mechanisms of health,
education and in general human
development indicators within
the
"Santiago Agreement".
- Promote and strengthen
surveillance systems on the
enforcement of children and
adolescent's rights (for example,
child protection, legal attention,
recreation and the
Comphanierl
CRC
implementation of the "Friend
of the Family" hot line.)
- Urge the governments to
continue the analysis of the legal
contents of minor protection
and to consider the appropriate
treatment to the transgressors
children according to their
conditions.
6. Latin
- Contribute to the
-Seminars for communication
First Lady's
See Follow-up
America
reduction of cancer
media.
Office.
Report
against Cancer
deaths and its
-ALICC
incidence.
- Preparation courses for the
-CNCC
education of citotechnologists.
(National
- Promote national
Coordination
plans and programs
- Celebration of the Smoke-Free
Committee
and local projects
World Day on May 31st.
against
to increase the
- Revision of the Cancer
Cancer)
reach of cancer
Registers.
prevention in the
countries.
- Foster Voluntary Enlistment.
- Implementation of equipment.
8
NEW PROJECTS
Topics or
Objectives
Target
Possible
Responsible
Achieveme
Date of
Projects
Population
Actions
Entity
nts
Follow-up
Report
a. Eradication
-Prevent the
- Groups of boys
- To promote
of child
premature association
and girls from 5
and support
Labour
with labour of girls
to 13 years old
initiatives in
and boys under 14
and 14 to 17
favor of
years old under
years old.
educational and
conditions of
legislative
economic exploitation
reforms aimed at
and subject to hard
the conciliation
and dangerous labour
of codes for the
and/or are prevented
eradication of
from attaining an
child labour.
adequate physical,
mental, spiritual and
- To promote
moral development.
and increase
awareness
- Review, amend and
campaigns for
supplement the
the eradication
legislation pertaining
of child labour
to girls and boys and
through media.
ensure its compliance.
- To promote
- Protect and safeguard
recreational and
9
higher interests of the
cultural activities
child by promoting
for the children.
and publishing the
Children's
- To unite efforts
Human Rights in
to promote
accordance with the
programs for
convention on the
universal and
Rights of the Child.
mandatory pre
school
education.
- To further and
strengthen
scholarship
programs.
- To promote
programs for
school supplies
- To further and
strengthen
feeding and
nourishment
programs for
school children
and adolescents.
10
b. Century XXI
- To eliminate from
- School
- To support the
School:
the children and
population from
fitting and
Educating for
adolescents hazardous
primary and
application of
Life
conducts and activities
secondary levels
the judicial
such as drug abuse,
frameworks
sexually transmitted
concerning the
diseases, teen age
rights of the
pregnancies, labour
children and
exploitation among
adolescents.
children, inter-school,
inter- family and social
- To support the
violence, through a
fitting and
model developed by
updating of the
inter -agency effort
curricular
and maximized by
contents of
international inter-
formal and
agency cooperation.
informal
education.
-Further
Human Rights
and foment
solidary
coexistence.
.To create
diagnostic
indicators on
risk and life
conditions of
11
children and
adolescents.
To further the
offering of care
and counseling
services in
integral health
including sexual
and reproductive
health.
c.
d. Education
-To contribute to
- Support the
for Human
strengthen human
production of
Rights and
rights and culture of
training material
Culture of
Peace through
for educational
Peace.
educational and
and cultural
culture actions in the
events of
countries of the
Human rights
Americas.
and Peace
Culture but in
- To further actions
formal and non-
me
aimed at achieving the
formal
equality of the sexes
education
of
by promoting
maximum
- Within each
recogn promotm of
country's
The UN Human
RB doc
development of
women, children,
possibilities,
youngsters and the
public radio
CEDAW and all
elderly with the
campaign will be
other human
12
its instruments
frameworks of
organized and
Human rights and the
produced on the
Culture of Peace.
projects related
topics.
- Support national
experiences pertaining
- Exchange of
to the projects fields of
information,
action through all
communications
possible means of
, as agreed to .
communications.
- Publish
collectively a
work to include
the thoughts and
contributions of
each country on
its present status
and perspectives
on Human
Rights and Peace
Culture.
d.Strengthenin
i) Support institution
160,000
-Create
g of the
and organizations
organized
awareness,
integration of
from the private and
women in the
promote and
rural women.
public sector, as well
rural sector from
create
Economic and
as from the civilian
Latin American
government
Social
community that
and the
positions(slots)
democratizatio
provide services to the
Caribbean.
to allow rural
n into
rural sectors so that
women to
13
productive
they will improve the
become
activities and
service they provide
integrated part
commercializati
both to women and
of the economic,
on
men, by crating
political and
conscience and
social arena.
incorporating
women's perspectives.
- Train rural
woman in
ii) To further and
organizational
create the necessary
technical aspects,
conditions so that
and management
women will acess and
techniques to
in fact participate in
negotiate and
the activities of the
participate in
productive chain.
managing their
own
organizations
and further
women's
leadership.
BUSINESS
- Further the
creation of funds
iii) Create financial
for the rural
mechanism to allow
enterprise
rural women to
FERURAL that
materialize effectively
is viewed as an
the business initiatives
operational
articulated by them.
financial
14
instruments.
- Coordinate
with institutions
an organization
committed to
equal rights for
women so they
will allow to
complement
each other with
new and/or
current
programs and/or
projects.
15
As prepared
FIRST LADY HILLARY RODHAM CLINTON
STATEMENT FOR SIGNING USAID GRANT
PANAMA CITY, PANAMA
OCTOBER 9, 1997
It gives me great pleasure to be here with the First Lady of Panama to announce a new
cooperative agreement between the United States Agency for International Development and the
Inter-American Institute of Human Rights.
I can think of no more fitting moment to put this agreement in place than today, for this
morning's session of the First Ladies' Conference has focused on the obstacles that continue to
prevent millions of women in the Americas from fully exercising their most fundamental rights.
I can also think of no more fitting organization to receive our support. Since its founding
in Costa Rica in 1980, the Inter-American Institute of Human Rights has been this hemisphere's
pre-eminent human rights organization. During the years when dictatorships darkened the region,
the institute stood as a beacon of hope. The Institute trained lawyers, judges, government
officials, and private citizens from every country in the Americas to recognize, observe and fight
for basic human rights.
It also offered crucial support to the brave individuals throughout the region who formed
non-governmental human rights groups. These men and women spoke out against torture and
repression at a time when such acts often meant risking one's job, one's home even one's life.
Individuals from every country of the Americas came to the Institute's courses, to its
seminars, and to its conferences. They learned the substance of human rights law, the
mechanisms for advocacy and the avenues to bring international human rights instruments to
bear on national human rights violations. In so doing, they helped bring about the democratic
changes that have fundamentally altered the political profile of the hemisphere.
It is no exaggeration to say that the Institute and its staff have played an indispensable
role in rekindling democracy and human rights in the Americas.
Since 1990, the Institute has opened an entire new frontier of human rights advocacy: It
has established a formal program on gender and human rights. In May, I had the privilege of
visiting the institute in San Jose along with the First Lady of Costa Rica and Secretary of State
Albright. We had the opportunity to meet and speak with women who are in the forefront of
women's rights issues throughout Central America.
We also had the opportunity to hear about how the institute is working to bring us closer
to the day when women's rights are finally seen as human rights. Indeed, the goals of this
conference mirror those of the Institute: to ensure that women are full participants in the political
lives of their countries to address the problems of domestic and sexual violence to repair
inequities within the law to find ways to rebuild the lives of refugees, many of whom are
women and children to see to it that women and girls have access to the same tools of
opportunity -- education, health care, credit -- as men.
All of us have a responsibility to help the Institute continue its efforts to promote freedom
and human rights throughout the America's. That is why USAID, through the agreement to be
signed today, will make available to the institute a grant of $4.8 million for the next three years.
These resources will go toward a wide range of important initiatives -- from supporting free
elections to assuring legal redress through the courts and through ombudsmen's offices to
enabling the institute to expand its Gender and Human Rights program.
To those who work to advance the cause of liberty and democracy for all the citizens of
the world -- the United States will always be your partner.
I would now like to invite Mark Schneider, Assistant Administrator of USAID for Latin
America and the Caribbean, and Dr. Juan Mendez, Executive Director of the Inter-American
Institute of Human Rights, to sign this cooperative agreement on behalf of their respective
organizations.
As Prepared
FIRST LADY HILLARY RODHAM CLINTON
REMARKS FOR SEVENTH CONFERENCE OF SPOUSES OF
HEADS OF STATE AND GOVERNMENT OF THE AMERICAS
PANAMA CITY, PANAMA
OCTOBER 9, 1997
Mrs. Perez Balladeres, First Ladies, representatives of the nations of the Western
Hemisphere, Distinguished Guests: I am honored to be a part of this Seventh Conference of the
Wives of Heads of State and Government of the Americas and to join you for a third year at this
important meeting.
I would like first of all to thank the government and the people of Panama, especially
Mrs. Perez Balladeres for organizing this conference and for welcoming us with the hospitality
we have come to associate with your country. The United States and Panama enjoy a rich and
enduring friendship -- one that will only grow stronger in the new millennium. For even as our
century-old partnership at the canal comes to a historic moment of transition, we will always be
bound by mutual respect and a shared commitment to securing the blessings of democracy for all
of our people.
And I think it is fitting that we gather in Panama for our annual conference. Panama is
truly the crossroads of the Americas -- a nation that literally brings our hemisphere together. The
very diversity of this country ecological, cultural and ethnic -- is a microcosm of all the
Americas.
We have come together from all across our hemisphere in hopes of building a better
1
world and better lives for all women, children and families. In many ways, our task is more
difficult and more complex than those of the canal builders of a century ago. Instead of
mountains, we seek to move hearts, to change old attitudes, to banish hunger and disease, to
educate all our children -- and most of all -- to empower the women of our hemisphere to
participate fully in the life of our nations.
We are pursuing our goals at a moment in history that is full of hope, a time ripe for
social change of the most positive kind. Across the Americas, military dictatorships have given
way to freely-elected democracies. For the first time in decades, or perhaps for the first time
ever, millions of people are enjoying the right to choose their own leaders, to form opinions
based on information gathered by a free press, to speak frankly and to meet in support or
opposition to a cause.
We all know that every democracy, whether newly formed or centuries old, is fragile.
The process of building and tending a democracy is never-ending. Democracy can only take root
when its principles are internalized in the hearts and minds of all people. Democracy can only
thrive when no one fears the consequences of standing up or speaking out for justice. And
democracy can only achieve its fullest potential when women are not barred by law, by
ignorance, by tradition, or by intimidation from making their voices heard at the ballot box, from
pursuing their most cherished dreams.
This is why I believe this "rights and participation" portion of our conference is so
2
important. Empowering more women to seek and claim their rights as citizens and as human
beings is the only way we can ensure that our democracies -- old and new -- survive and thrive
into the 21 st century.
The word "empowerment," I am told, does not translate well. But I am sure that every
woman in this room knows its meaning very well. Empowerment means the right to participate
in the political and economic life of our countries. Empowerment means being able to lead lives
free of sexual and domestic violence. And it means access to justice under law, to education, to
health care, to credit and property ownership.
In short, empowering women means making sure they are treated as full citizens in their
countries. No nation can hope to succeed in our global economy if half its population lack the
opportunity and the right to make the most of their God-given potentials. And as we can all
attest, in too many countries, my own as well, too many rights are denied and too many doors of
opportunity remain tightly closed.
Too many women live in fear of violence at the hands of family members. For them,
home provides no refuge, the law no protection, and public opinion no sympathy. Domestic and
sexual violence against women remains one of the most serious and under-reported human rights
violations in our region. For too long, too many women have suffered in silence. We must all
work to instill new attitudes and new protections against domestic violence. As Secretary of
State Madeleine Albright -- my country's first female foreign minister -- has said, domestic
3
violence can never be excused as cultural. It is criminal.
Too many women, especially those who are poor and less educated, are unaware of their
legal rights in the workplace, of their rights to own and inherit property, of their rights to vote
and choose their leaders. While these laws may exist on the books, they have failed come alive
for too many women.
Too many women and children are trapped in an endless cycle of poverty -- a cycle
perpetuated by inadequate health care, poor access to family planning and limited education.
But let us not forget that we already know many of the solutions to these problems. We
already know what works to change and improve lives. Next week, I will be traveling to South
America with my husband. There, I will be visiting microcredit, family planning and education
programs -- programs that I have worked to support all around the world. These efforts have
long, successful records of empowering women to lift their children, families and communities
out of poverty. We must continue to support them.
And there is also encouraging news to report on the three priorities -- the elimination of
measles in the Americas by the year 2000, the reduction of maternal mortality, and education
reform -- we set following our meeting at the Miami Summit of the Americas in 1994. Last year,
not a single case of measles was reported in 27 countries of the Americas. And while we may
have experienced a setback with an outbreak of the disease in Brazil, as well as in my own
4
country, we can stay on track to meet our goal by the end of the century. Every country in the
hemisphere has joined in the Pan American Health Organization's efforts to improve prenatal
and obstetric care and reduce maternal mortality, and many of you in this room have contributed
greatly to that effort. We have brought institutions and individuals together through the
Partnership for Educational Revitalization in the Americas to boost public primary education. In
Honduras, El Salvador and many other countries, more children are staying in school longer and
graduating from primary school. And we have helped elevate education reform and revitalization
to the top of our respective countries' national agendas.
But the topic we are focusing on this morning -- the promotion and expansion of
women's legal and political rights is perhaps the most difficult challenge we face. Slowly, but
surely, we are indeed witnessing legal reforms to raise the status of women in the home and in
society. In Costa Rica, women have pushed through a law against domestic violence and
worked to incorporate domestic abuse issues in police training. Many countries now have human
rights ombudsmen with special offices dedicated to protecting the rights of women. In El
Salvador, legislators have modernized rape laws, forcing perpetrators to face prosecution.
They've also passed laws forcing politicians to prove that they have paid child support before
running for office. Here in Panama, legislators have reformed the Family Code to better regulate
such matters as alimony, child support and child custody. Throughout Latin America, new laws
are encouraging more women to run for office. And in my own country, we have introduced
comprehensive Violence Against Women plans that provide counseling for victims, training for
officers, and prosecution of offenders in all 50 states. We need to share more of these ideas and
5
actions with each other so that all women throughout our hemisphere can experience the same
improvements in their lives.
None of this progress would have happened if women themselves had not spoken out,
demanded change and forced their governments to respond to their needs. We must encourage
more women to make their voices heard, to join together in both grassroots and national
organizations to press political change beneficial to all women, to encourage them to vote in
local and national elections, and send more women to office.
Only women can make democracy work for ourselves and our families. It is message that
is coming alive in countries all around the world. Last summer at a conference in Vienna, I met
with a group of women from the newly-democratic countries of Eastern and Central Europe.
They had just begun to recognize the power of independent citizen action to address challenges
as diverse as the trafficking of women and health care. And they had gathered to share ideas, to
renew and strengthen their faith in democratic values and freedoms. This kind of convening
might be beneficial for our hemisphere as well. As our countries continue to expand our
political, economic and strategic alliances, the women of this hemisphere can lead the way in
building an alliance of democratic values that will strengthen our democracies into the next
millennium.
In May, Secretary of State Madeleine Albright and I visited the Inter-American Institute
for Human Rights in San Jose, Costa Rica. The organization was founded to defend and foster
6
respect for human rights at a time when repressive regimes controlled the lives of many of the
peoples of the Americas. Over the last decade, it has helped guide those countries along the
difficult path toward democracy by advising leaders, educating citizens, and monitoring critical
transitional elections. Today, the Institute's new mission is to help the new constitutional
governments, their police forces, their citizens and children to understand and live by the
principles of democracy -- to create a true human rights culture in the Americas. Secretary
Albright and I met with women activists and officials who told us that even though the
governments have changed, the task of safeguarding and deepening respect for human rights
remains as challenging as ever. A few years ago, the Institute began a Gender and Human Rights
Program designed to educate women about their rights and promote the principle that women's
rights are indeed human rights. Later this morning, Mrs. Perez Balladeres and I will host a
ceremony announcing a $4.8 million USAID grant to help the Institute continue with its
important work.
Like the Institute, our work as individuals and as First Ladies of the Americas is far from
done. We must continue struggling to make democracy mean justice for everyone, to encourage
and empower all women to take their rightful places in government, to use their talents to start
businesses and pay back loans, to use their voices and votes to elect presidents and build peace.
And we cannot rest until we have repealed the laws, swept away the webs of tradition, stared
down the forces of intimidation that stifle the potential of women and children, that keep nations
from being truly democratic and fully free.
7
Last year, I participated in a call-in radio show for Voice-Of-America. One male caller
asked me very earnestly what I really meant when I said "Women's rights are human rights and
human rights are women's rights" at the Beijing Conference on Women. I told the caller to close
his eyes and think of all the rights and privileges he enjoyed as a man. Then I asked him to
imagine a world where every woman enjoyed those very same rights.
I know that if we all continue to work together, we can make that world reality.
###
8
Lista de Oradoras Definitiva - Jueves 9 de octubre de 1997
10:00 a 10:45 a.m.
- Honorable Señora Marta Larraechea de Frei, Primera Dama de
Chile.
- Honorable Señora Jacquin Strouss de Samper, Primera Dama de
Colombia.
- Honorable Señora Josette Altmann de Figueres, Primera Dama de
Costa Rica.
- Honorable Señora Lucia Peña de Alarcòn, Primera Dama de
-
Ecuador.
- Honorable Señora Patricia Bird, Primera Dama de Antigua y
Barbuda.
- Honorable Señora Ivone Hinds, Primera Dama de Guyana.
- Honorable Señora Virginia Gaylle de Quiroga, Delegada
Gubernamental de Bolivia
- Honorable Señora Abigail Castro de Pèrez, Delegada
Gubernamental de El Salvador.
- Honorable Señora Zelmira Regazzoli, Delegada Gubernamental
de Argentina.
11:45 a 12:45 p.m.
- Honorable Señora Géri Benóit-Preval, Primera Dama de Haitì.
- Honorable Señora Lady Ivy Silvia Watson Cooke, Primera Dama
de Jamaica.
- Honorable Señora Marìa Dolores Alemàn, Primera Dama de
Nicaragua.
Honorable Señora Ruth Cardoso, Primera Dama de Brasil.
- Honorable Señora Verònica Liburd, Delegada Gubernamental de
Saint Kitts.
Honorable Señora Sonia Beretervide Dopico, Delegada
Gubernamental de Cuba.
- Honorable Señora Beatriz Ramacciotti, Delegada Gubernamental
de Perù.
SCOTT DALTON / AP
CLINTON LIBRARY PHOTOCOPY
PHOTOCOPY
PRESERVATION
FIRST LADIES MEET
Hillary Rodham Clinton chats with Dora Boyd de Perez Balla-
dares of Panama at a conference of First Ladies of the Ameri-
cas in Panama Thursday. Mrs. Clinton stressed protecting the
rights of women. Story, Page 3A.
[Miami Herald, 10/10/97]
First lady says time to change attitudes toward women
By NANCY BENAC
attitudes, to banish hunger and
lence, encourage political partici-
greater legal and political oppor-
Associated Press
disease and ignorance, to educate
pation and reduce poverty.
tunity for women.
PANAMA - In a region
all our children
to
empower
"Democracy can only achieve
Mrs. Clinton cited signs of
where dictatorships have given
the women of our hemisphere to
its fullest potential when women
progress throughout Latin Amer-
way to democracies, Hillary Rod-
participate fully in the life of our
are not barred by law, by igno-
ica. In Costa Rica, for example,
ham Clinton urged nations of the
nations," Mrs. Clinton said.
rance, by tradition or custom, or
women pushed through a law
Americas Thursday to go a step
The first lady, speaking at the
intimidation from making their
against domestic violence and
further to protect the rights of
annual Conference of Wives of
voices heard at the ballot box and
worked to train police about the
women.
Heads of State and Government
from pursuing their most cher-
problem. In El Salvador, she
The only way for democracies
of the Americas, included the
ished dreams," she said.
said, legislators have modernized
to "survive and thrive," she said,
United States among the coun-
Mrs. Clinton underscored her
rape laws and required politi-
is to give women more power "to
tries where women need greater
message by witnessing the sign-
cians to pay child support before
seek and claim their rights as citi-
opportunity.
ing of a $4.8 million grant from
running for office.
zens and as human beings."
"In too many countries, my
the Agency for International
After returning home today,
Speaking at a conference of
own as well, too many rights are
Development to the Inter-Ameri-
Latin American first ladies, Mrs.
the first lady returns to Latin
denied and too many doors of
can Institute on Human Rights,
America on Sunday with Presi-
Clinton suggested the challenge
opportunity remain tightly
the region's pre-eminent human
dent Clinton for a visit to Brazil,
could be more difficult than the
closed," Mrs. Clinton said.
rights organization.
Argentina and Venezuela. She
giant undertaking of building the
Without being specific, she
Where once the institute's
plans to use the trip to see success
Panama Canal, whose Pacific
called for changes in both law
focus was repressive regimes that
stories local programs that
entrance was just blocks away.
and attitude to protect women's
engaged in torture and execution,
ensure women have access to
"Instead of mountains, we seek
property and employment rights,
now its Gender and Human
credit, family. planning, educa-
to move hearts, to change old
combat sexual and domestic vio-
Rights program pushes for
tion and other needs.