(This blog was first published on BMJ Blogs on 22 June 2015.)

This week in New York, the Zero Draft of the Outcome Document of the Post-2015 Development Agenda ‘Transforming Our World,’ will be negotiated at the United Nations (UN). The document provides the main framework for the Post-2015 Development Agenda that will be adopted during the UN Summit in September. A Post-2015 Women’s Coalition, coordinated by the Center for Women’s Global Leadership in the US (http://www.post2015women.com), has been contributing to the development of these frameworks in support of a comprehensive gender equality strategy which is inclusive, addresses inequalities, and is accountable to all. While the Outcome Document does highlight women’s rights and gender equality prominently, it is not a given that this focus will remain, since women’s rights are often used as a bargaining chip and dropped during negotiations.

Moreover, according to the Post-2015 Women’s Coalition, the Zero Draft of the Outcome Document falls short of ensuring the universal realisation of women’s and girls’ human rights as a core principle. Other important criticisms of it by Coalition members are that it creates only voluntary follow-up mechanisms, which are disconnected from existing human rights monitoring mechanisms, and its restricted targets and indicators fail to capture the ambition needed for transformative change (The Zero Draft for Post-2015 Development Agenda contains gaps on key feminist issues, 17 June 2015. http://www.awid.org/node/3574).

Equally problematic are omissions in the 2015  Zero Draft of the Global Strategy for Women’s, Children’s and Adolescents’ Health, which will feed into the final Outcome Document as regards women’s and children’s health. Its authors claim it is based on stakeholder consultations with over 4,500 participants, that subsequent drafts will reflect updated content from working papers and further consultations, and that a consensus process is underway to finalise its goals and targets (Global Strategy for Women’s, Children’s and Adolescents’ Health: Zero Draft for Consultation, 5 May 2015). But will it call for sexual and reproductive health and rights?

The UN Secretary-General, Ban Ki-moon, launched the first Global Strategy for Women’s and Children’s Health in 2010, in order to focus attention on the lack of progress towards Millennium Development Goals 4, 5 and 6 (to improve child and maternal health and combat HIV/AIDS, malaria and other diseases) and highlighted how these goals also play a role in the other MDGs. That first Global Strategy called for urgent increases in resources and coordinated efforts to accelerate progress for women and children, and it specifically identified safe abortion as an essential intervention for women. Yet in its 2015 iteration, no longer in the hands of Ban Ki-moon, the focus on women has been reduced to a focus on maternal health only, reverting back to the narrowness of MDG 5, anchoring the needs of women to childbearing.

I applaud the many people who put so much effort into documents like this, but a far greater commitment to democratic representation of women’s proven needs is called for. Women are far from just mothers, and neither adolescents’ health nor women’s health can be reduced to maternal health. Unless they are amended substantially, these documents will take us back several generations. Improving maternal health in isolation, and tying women’s health needs to those of infants and children, failed women during the 15 years of the MDGs, and will continue to do so.

The 2015 Global Strategy for Women’s, Children’s and Adolescents’ Health only mentions abortion once, referring briefly to unsafe abortions among adolescents and the potential for reducing unsafe abortion through the use of contraception. This is a major omission and is particularly disturbing given that the 2010 Strategy did call for abortion to be made safe. It is critical that the key stakeholders in this process demonstrate their support for explicit inclusion of women’s right to safe abortion in the strategy.

Along with the 20 prominent individuals and over 60 international and national NGOs who signed the “Joint statement on the importance of including safe and legal abortion as a key approach in Round 2 of the Global Strategy for Women’s, Children’s and Adolescents’ Health” on 1 June 2015, http://www.ipas.org/~/media/Files/Joint-Statement-on-Zero-Draft-Global-Strategy.ashx), initiated by Ipas, the International Campaign for Women’s Right to Safe Abortion is concerned that the Zero Drafts of the Outcome Document and the Global Strategy for Women’s, Children’s and Adolescents’ Health fail to address sexual and reproductive health and rights adequately, and in particular, fail to make any call for women’s right to safe abortion.

Fertility control is essential to the earth’s future and safe abortion is essential to fertility control. Abortion needs to be decriminalised globally as an integral part of sexual and reproductive rights. If documents purporting to be about gender and women’s rights do not reflect this, then, I’m sorry, they do not support women’s health.

Upwards of a million women have died from unsafe abortions internationally since the Programme of Action of the International Conference on Population and Development was approved in 1994. Although the death rate has fallen a lot since 1994, it is mainly because women have taken the law (and medical abortion) into their own hands. The Programme of Action was passed only with a fatally compromised position on safe abortion, but 20 years on, this compromise should not remain written in stone. The world has moved forward on this issue ‒ and so have women themselves. 42 million women have abortions every year, and half of them are still unsafe.

The International Campaign for Women’s Right to Safe Abortion has members in 21 African countries, 20 Asian countries, 6 Pacific countries, 11 Central and Eastern European countries, 19 Latin American and Caribbean countries, 8 Middle Eastern/Mediterranean countries, 14 Western European countries and both North American countries. These more than 900 organisations and individuals are the voice of women internationally on this issue. Maternal health demands that every mother should be a willing mother. The sustainable development goals need to call for women’s right to safe abortion ‒ to reduce maternal deaths from the complications of unsafe abortion, to ensure access to safe, legal abortion on request as a legitimate form of fertility control ‒ and as a public health, gender equity and human rights issue.