Global Gender Equality

Baroness Finlay of Llandaff Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I join other noble Lords in congratulating the Minister on the leadership she has shown, both in her speech opening this debate and in the way that she is taking these issues forward. The theme is rightly on Women Deliver: it is worth reflecting that we have already heard in the debate how women deliver not only children, but their upbringing; they deliver food and water to those who need them; where they receive education they then deliver education in spades; they deliver—and really are the route to—peace; and when older they deliver as grandmothers when a mother is ill or has died.

In March 2018, the Department for International Development published its strategic vision, stating its intention to,

“step up and deliver results for girls and women, pressing DfID and its partners to take action across the board to make gender equality a reality”.

Education and healthcare are of course key priorities in addressing gender inequality, particularly maternal, sexual and reproductive health rights. As has already been pointed out, every year more than 300,000 women die from complications related to pregnancy and childbirth; 99% of these deaths occur in developing countries and more than half in sub-Saharan Africa.

The vast majority of maternal deaths, injuries and illnesses could be prevented but, sadly, not all. Even when high-quality reproductive and maternal health services are in place, things sometimes go wrong. On my way here, in preparation for the debate, I had a communication from UNESCO’s Bioethics Group, of which I am a member, representing my department at Cardiff University. It concerned something that happened last week. Following the death in delivery of a patient, a mob attacked the intensive care unit at a hospital, assaulted the staff with rods, including the female gynaecologist, and left her severely injured. In Darjeeling, violence against medical professionals seems to be reaching new heights, as this recent case of assault shows. The incident took place at the Darjeeling Sadar district hospital on Saturday, when a pregnant woman with a history of cardiac illness, thus already at great risk, was brought there by her family. She collapsed in the ward and was rushed into coronary care but when the doctor conducted a ventouse—that is, a vacuum delivery—in difficult circumstances, sadly the baby was delivered dead. The patient was intubated immediately after delivery, but all resuscitation efforts failed and she died within a few minutes. The news of the patient’s death reached the family and an angry mob rushed in, attacking the staff and vandalising the ICU. I was sent photographs of this poor woman sitting on a bloodstained floor with her head bandaged, having been attacked when she had done all that she could to resuscitate the patient.

There are movements highlighting the problem of women delivering healthcare being attacked. In the eight months to the end of last year, 60 women doctors were beaten up in Kashmir. The result, sadly, has been that some women doctors are staying away from labour wards because they are just too frightened to deal with women with complications. There are movements such as “stop violence against doctors” and “doctors are also human”. In all our debates, we must remember that unless we protect women healthcare workers, we really will not be able to provide the services that women need, particularly because they often need them from other women. An interesting recent study from America showed that women providing front-line clinical care carry a much greater burden of the childcare and domestic duties than their partners do, even when they are working full-time or more than their partners are.

Maternal mortality rates are notably high in areas of conflict. In conflict, access to contraception is often one of the first things that women lose. Clinics close, doctors move on, medical supplies diminish and, as we have heard, women often become the victims of gender-based violence. That violence continues long after a peace agreement has been signed. UK development and peace and security strategies must ensure that there is a gender perspective to protect the human rights of women and girls and, as has been said, ensure their participation in conflict prevention and conflict resolution. As has been said, in war zones women and girls are often targeted for rape. Women and their children make up approximately 80% of all refugees, as stated by the State of World Population report. Emergency contraception can be critical, and it is also important for women who are unable to have their partners negotiate condom use.

Women who are affected by conflict often lose their homes and their income. They may be forced into prostitution and other exploitative relationships in order to feed themselves and their families. Despite the role of condoms in preventing sexually transmitted diseases, including HIV, if the partner refuses to use one, women have little power to persuade them. A recent report by Family Planning 2020, FP2020 Catalyzing Collaboration 2017-2018, found that the push to boost the number of women in the poorest countries using safe contraception seems to be slipping. Despite an increase of 46 million in the number of women accessing contraception in the last six years, reaching a total of 317 million, the report said:

“Looking at projected trends, the hill is simply too steep to climb in the two years remaining in this initiative”.


As we have heard, the impact of sexual violence lives on for decades. As the noble Baroness, Lady Goudie, has said, in Vietnam there is a major problem. The Lai Dai Han are the tens of thousands of children of Vietnamese women raped by some of the 320,000 South Korean soldiers deployed to fight alongside the US during the Vietnam War. The story of one woman is quite telling. She was a young nurse, a virgin at the time, who became pregnant and was then ostracised by her family. Her attempted abortion failed and she gave birth to a daughter. Suffering a life of shame, secrecy and prejudice, she was later brutally raped twice more by soldiers, giving birth to another girl and a boy. She has raised her children singlehandedly, but they have all experienced bullying and cruelty from the local community.

Some of those raped or subjected to sexual violence were as young as 12 or 13. There are more than 800 such victims alive and tens of thousands of young adults of mixed Vietnamese-Korean heritage living in the shadows in their own society. Many live in severe poverty, with no access to healthcare and education. Because many are illiterate, they cannot advocate for themselves.

Even in peacetime, affordable contraception can be an elusive goal. I recall an auntie who, in the 1960s, volunteered to provide family planning services when she was living in the West Indies. She said that even though they fitted women with diaphragms, she discovered that the diaphragms were being collected by men after sexual intercourse and held as trophies, so they were becoming single-use contraception only, rather than being for repeated use. It highlighted the problem for these women in avoiding pregnancies when they wanted to do so.

The recent report from the Independent Commission for Aid Impact, the watchdog scrutinising spending, highlighted that between 2011 and 2015,

“DFID did not pursue the strengthening of health systems to provide quality maternal care with the same intensity as it did for family planning, nor did it do enough to address the barriers that the poorest women face in accessing health services”.

Although Britain has been praised as,

“a vocal champion of family planning and safe abortion”,

I ask the Minister why DfID are not doing more to champion safe pregnancy and delivery. We know that,

“severe shortages of beds, trained personnel, equipment and supplies”,

mean that women are dying from “basic obstetric complications”, including obstructed labour, uterine rupture, eclampsia, haemorrhaging to death and dying of infection. This very high maternal mortality cannot be tolerated around the world. We should be making sure that, during birth, every woman is attended by somebody who knows what to do when the biggest emergencies arise.

Sierra Leone has the highest maternal mortality rate: one in 17 women there have a lifetime risk of death associated with childbirth. In the Pujehun district, for example, there is just one ambulance for a population of 340,000. In the fallout following Ebola, healthcare has become more difficult overall, and it is predicted that this mortality rate will rise further. In Sudan, the aid ban is exposing women to risky births; the story of one woman was covered in the Guardian in 2017.

In some countries, things are being done well. In some Middle Eastern countries, mosques are serving as more than just centres of faith and are being used for training people in the insertion of IUDs and so on. The WHO has launched a new tool on safe contraception for front-line care providers, which provides guidance on the who and how of delivery, including a checklist to confirm that a woman is not pregnant.

The UNFPA’s aim to achieve three zeros by 2030,

“zero unmet need for contraception; zero preventable maternal deaths; and zero gender-based violence and harmful practices, such as child marriage and female genital mutilation”,

is laudable. We must cling on to that. We must also follow the example already given and provide leadership across the world.