11/07/2014 05:30 pm ET Updated Jan 07, 2015

David vs. Goliath?

By Betsy McCallon, WRA Executive Director and Brigid McConville, WRA Director of Media and Outreach

How does a group like ours - which represents mostly disadvantaged women and believes in change from the bottom up - speak truth to power at the UN and survive to tell the tale? Indeed, how do we even get heard?

Humor helps, as does courage, creativity and the conviction that it's high time.

Truth is over the last decade (at least) there has been growing frustration over the same people taking the stage at global health conferences. Last year, during the UN General Assembly in New York, this led colleagues to hold a drinking game for each time a 'Usual Suspect' spoke! We heard jokes that the speakers might as well charter a plane and go to all their meetings together. But it isn't really funny; not when you do the sums on how much these conferences cost and not when you realize that we're not assessing if these leaders do indeed warrant the platforms they are given. If they are so good, why haven't they solved the problem yet? Why haven't birthing women and their newborns stopped dying?

The problem, from our point of view, being the huge injustices in reproductive health, which means that girls and women around the world are still routinely married too young, denied family planning and left to die in pregnancy and childbirth for lack of life saving services. So we decided to rattle a few cages by printing a tabloid newspaper, the CITIZENS POST, demanding that the 'Usual Suspects' (as in the movie poster) move over and make way for those citizen leaders who are really making change happen in their own communities.

As with any challenge to authority, this was initially greeted by nervous comments from our peers such as "You're brave!", and while many backed it privately they were not so keen to go public. That began to change as soon as some of our 'usual suspects' responded positively - and within days leading figures on the UN stage (Ted Turner and Ray Chambers amongst them) were congratulating us and promising support.

We targeted particular leaders who are well known in global health (and more than just on the poster!) because they had already declared their belief in citizen engagement as crucial to sustainable change. Almost all of these individuals then demonstrated their leadership by actively commending the campaign and making space for citizen leaders. We look forward to continuing to work with them as we move forward. For example, Richard Horton, Kathy Calvin and Ted Turner all called themselves 'Usual Suspects' on their platforms before handing over to citizen leaders to speak in their place.

World Health Organization Director General Margaret Chan and her Deputy Flavia Bustreo enthusiastically commended the campaign as they recognize the important role citizens can - and must - play in accelerated progress and want to play their part to support these efforts.

Asking for space for these citizen leaders was not a token exercise to give voice to those on the 'frontlines' who conventionally are expected to tell sad and heart wrenching stories. Instead, we set out to show success, showcasing the evidence that progress can be greatly accelerated with strong citizen engagement. With less than 500 days remaining until the end of the Millennium Development Goals, we highlighted how much more can be done if citizen leaders are supported to lead the change in their own countries and to work with and push governments to deliver on their commitments.

Citizens do have an immense role to play in translating government commitments beyond New York and beyond the capital cities to ensure that they are delivered. This often means the rather unsexy work of identifying barriers to commitments being delivered and then systematically advocating for the changes required. It means bringing together communities, health care providers, district leaders, and elected officials to discuss what isn't working and coming up with practical solutions.

The barriers between these inspirational people and the corridors of power are legion - money, language, visa restrictions, entrenched hierarchies to name a few. The barriers are institutional too, but when we do hear them the impact is profound (think Malala).

White Ribbon Alliance is fortunate to be led by some of these citizens. For example, Rose Mlay is a midwife in Tanzania who has brought 4,000 organizations and individuals together to speak with one voice to persuade the government to end maternal deaths. She has brushed aside remarks from Ministers ('what's all the fuss, just a few women dying...') to build a powerful coalition that recently had a 90-minute meeting with the prime minister. Since then, and for the first time in Tanzania, specific budgets have been allocated to make sure that women will get the C-sections and blood banks needed to save their lives in obstetric emergencies.

Another such leader is Tonte Ibraye, a young Nigerian man whose sister died recently after trying to save money by giving birth at home. He has spearheaded a campaign that has won the first ever national government commitment to make respect for women's rights and dignity during birth the norm - and in one state, communities are now working with officials and health workers to put 'respectful maternity care' into practice. A help line for women to 'break the silence' about the shocking treatment they get has just been launched.

Similarly, Aparajita Gogoi has steadily built an alliance of many thousands in seven states of India to push the government to keep its promises in providing safe places for women to give birth. It is the relationships built over many years between the huge team of volunteers she leads and India's often defensive government hospital administrators which have enabled change to come via the constructive back and forth of suggestions and improvements, more suggestions and improvements.

Time and again we have seen how the actions of citizens, especially when funded and supported, really makes a lasting difference to the lives of women. The trouble is, these actions are rarely recognized, massively underfunded and often unsupported by the wealthy donors. The good news is that the numbers dying in childbirth have come down by half in recent years, but this is after decades of neglect and the death rate for mothers in many countries remains a global disgrace.

So what's next? As the global development dialogue focuses on the next round of goals that the world can get behind - as we work to solicit the support of celebrities and political leaders to make this round of goals 'famous', White Ribbon Alliance calls for the fanfare to celebrate citizens' rights. Let's make famous the call for greater democracy, in building the skills and the knowledge so citizens can demand the services that will keep their communities healthy and educated - and most importantly, so that citizens themselves can come together with the independent media and civil society organizations to hold their governments to account on promises made - to push for ALL governments to be transparent to those who elect them. If we allow the next set of global goals to develop without the robust accountability mechanism needed, we are doing a disservice to every single woman who is left to die in childbirth, every single young girl who gets married underage, and every single female who has no choice over her reproductive health.

We will keep championing the national campaigns we see making real changes - and we'll keep advocating to increase funding for citizens to push their own governments to invest more in what matters to them. If this work got the same funding as international conferences, the goal posts would change for good.

Over the course of the next year, White Ribbon Alliance and partners will be holding a series of national level dialogues to influence the so-called Sustainable Development Goals (which are set to replace the Millennium Development Goals which had a target date of 2015). We will work to make sure that momentum is not lost, existing commitments are not swept under the rug, and gaps are prioritized. We'll be advocating for civil society funding as a central part of the accountability strategy. We'll keep up the global drumbeat and amplify national successes.

Next time we are in New York (or London or Geneva) applauding new policy, financing and program commitments to women and children's health, we hope that we can all fully recognize and support the hard work by citizen and civil society leaders which is still very much needed to ensure these promises truly make a difference.