The head of the U.N. population agency said Monday that the world must address why 8.7 million young women aged 15 to 24 resort to unsafe abortions each year.
Babatunde Osotimehin also called on governments to explore why more than 200 million women in developing countries who want to prevent pregnancies don't have access to contraception. And he said countries must answer why one in three girls in developing countries are married before they turn 18, despite near universal commitment to ending child marriages.
He spoke at the opening session of a week-long meeting of the U.N. Commission on Population and Development to review progress and tackle new challenges since the landmark U.N. population conference in Cairo in 1994.
The Cairo conference changed the U.N. Population Fund's focus from numerical targets to promoting choices for individual women and men, and supporting economic development and education for girls. Underlying the shift was research showing that educated women have smaller families.
The conference broke the taboo on discussing sexuality, adolescent sexual behavior and the real concerns of women and families.
At the heart of the action plan that 179 countries adopted in Cairo is a demand for equality of women through education, access to modern birth control, and a recognition that women have the right to control their reproductive and sexual health and choose if and when to become pregnant. The only reservation added at the conference was that this should be in accordance with national laws, religion and culture.
Osotimehin told the opening session that in the 20 years since Cairo there have been "great gains" in reducing poverty, improving girls' education, reducing maternal and child mortality, and providing access to sexual and reproductive health services, including family planning, and protecting reproductive rights.
But he said "discriminatory laws, practices and attitudes continue to keep women and young people, particularly adolescent girls, from accessing sexual and reproductive health services."
Osotemehin, the Population Fund's executive director, said this means it's okay for girls to marry, have sex and have children—but they're not old enough to have access to contraception and sex education, or to control their own bodies.
"This simply does not make sense," he said. "And we cannot shy away from these issues."
Osotemehin noted that up to 50 percent of sexual assaults are committed against girls under the age of 16, and that gender-based violence in schools is "a significant factor in girls' drop-out rates."
He urged the conference to ensure that an 11-year-old girl stays in school, is protected from violence and early marriage, has access to sex education so she can protect herself from motherhood in childhood, and is equipped with choices and opportunities for her future that will contribute to society.
Nafis Sadik, who was executive director of the Population Fund in 1994, told the commission that unsafe abortions kill an estimated 47,000 women every year and injures many more—and the problem has grown in the past 20 years.
"I believe that the conditions exist today for a renewed, extensive and enlightened discussion about reducing unsafe abortion and changing its legal status," she said. "It has to be done, of course, in and by each country."
Sadik stressed that contraception is not universal or perfect, that human beings are fallible, that pregnancy complications can make abortion necessary, and that "increases in gender-based violence, and especially rape, increases the need for intervention."
Fred Sai, a Ghanaian physician who chaired the committee that negotiated the Cairo action plan, asked: "What kind of religion will say that if you've been ... raped during war" you should carry through with a pregnancy. He answered that today while many countries give victims of crime support, "the victims of rape are crying out."
Sadik said people often cite "cultural values" for "abusive practices" such as child marriage, sexual assault in the home or female genital mutilation.
These are often "the means by which one group keeps another in subjugation," Sadik said to applause, and she urged the commission to "call prejudice and discrimination by their proper name."
She also urged men in leadership positions to speak out on sensitive subjects like abortion, so-called honor killings, girls' education, and a woman's right to make decisions about her sexuality and reproductive health and rights.