The Test of Political Leadership: Valuing Maternal Health

World leaders are finally paying attention to a long under-prioritized global challenge - protecting women's health.

In June, G8 leaders meeting in Canada committed significant new resources for improving maternal and child health in the poorest nations. In July, the African Union Heads of State Summit in Kampala was dedicated to Maternal and Child Health. Plans for the launch by the UN Secretary General of a new Global Strategy on Women's and Children's Health are underway. And at the upcoming UN summit on the Millennium Development Goals, perhaps the largest ever gathering of heads of state will recommit to dramatically reducing the number of maternal deaths and increasing access to reproductive health services by 2015.

These are all welcome developments but the true test of political leadership lies not in global summits and strategies. Improving women's health requires leadership closer to home.

As heads of state - one sitting, one former - we have experienced the ups and downs of political leadership. We know what it takes to build political capital and make it count in women's lives. When we met in Sierra Leone last month, we compared our own stories of how we have used our different positions as presidents to advance women's health and equal rights.

In Sierra Leone, presidential visibility, attention to clear goals and a hard deadline helped galvanize action on the launch earlier this year of an initiative called Free Care for Pregnant Women, Lactating Mothers and Children Under Five. At a 2009 meeting of donors in London, a presidential statement announcing that the Free Care program would launch on April 27, 2010--the 49th anniversary of Sierra Leone's independence - proved to be key in showing resolve and strengthening support for the plan.

But the decision wasn't easy. Detractors said Sierra Leone wasn't ready to offer free care. They cited examples of wealthier countries that were still not offering similar services and urged the government to hold off on such a major financial and programmatic commitment. But holding off wasn't an option. No nation can secure its survival when its mothers and children are brought down by illness and death. In Sierra Leone it was simply that: the very survival of a nation. This could not be held off. Though the challenges were huge, they had to be met. Only through leadership from the top would it be possible to keep the key players from government and the donor community working toward this goal and working together to address the challenge of turning the policy into practice. Today, despite remaining obstacles, the Free Care program is operating and strengthening the entire health system and empowering the women of Sierra Leone.

In Ireland, over several decades, a similar set of challenges arose on issues related to the health of women. The legalization of family planning centers and proposals for overturning a longstanding legal ban on condoms and contraceptive devices for unmarried women were on the table. Powerful religious and conservative elements mobilized forces to sway public opinion and politicians against these reforms.

Having been a strong proponent of these reforms as a lawyer and senator, the election of the first woman president of Ireland in 1990 helped to bring issues of women's rights and gender equality to the forefront of the political debate. It provided the opportunity as non-executive president, to advocate for women's leadership and women's rights in a way that helped to shape the modern Ireland.

We're convinced that presidential leadership can make the difference between success and failure for policy reforms aimed at improving the health of women - a subject that all too often takes a back seat to "more pressing concerns."

The evidence for what works is overwhelming. Delivering a quality package of interventions through effective health systems, including comprehensive family planning; removing barriers to access such as abolishing fees for maternity related health services; ensuring that skilled and motivated health workers are in the right place at the right time; and demanding accountability for results, all backed by strong political leadership and community engagement add up to an effective strategy for improving women's health. Now we must make the case to national leaders that addressing these issues in their full complexity at the UN and within their countries can make all the difference.

We know from our own experience as presidents that progress on women's health and rights does not happen without political leaders who are willing to take risks. We call on all leaders to take such a risk now. Use your political capital on an investment that will not only produce great rewards for your societies but will also be a symbol of leadership for generations to come.

Ernest Bai Koroma is the president of Sierra Leone. Mary Robinson is a former president of Ireland and currently president of Realizing Rights.