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8 Questions for Nafis Sadik

Nafis Sadik, MD, is accustomed to great challenges. A former executive director of the United Nations Population Fund (UNFPA), Sadik was the first woman in UN history to head one of its major programs. She is perhaps best known for leading the 1994 International Conference on Population and Development. Held in Cairo, the conference changed the paradigm of population policy and emphasized the individual woman's reproductive health rights. "When the essential needs of the individual are addressed, those of larger groups—the family, the community, the nation and indeed the planet—are more likely to be kept in the right perspective," Sadik has said. A Pakistani obstetrician-gynecologist, Sadik retired from UNFPA in 2000 only to take on new roles as special advisor to the UN secretary-general and special envoy for HIV/AIDS in Asia. Sadik earned a Certificate of Graduate Studies in International Health in 1964 from the School and is a member of the School's Honorary Committee. On January 18, she met in New York with a group of the School's Sommer Scholars. Afterward, she spoke with Sadaf Khan, MBBS, MPH '03, a Sommer Scholar and a DrPH candidate in Population, Family and Reproductive Health, and Brian W. Simpson, editor of Johns Hopkins Public Health.

What hasn't been achieved since the Cairo conference in 1994?
I wanted every country to have a very strong reproductive health program linked with gender issues and women's involvement. That has not happened. ... In fact in many African countries, the programs are really going quite slowly because of the attention to HIV/AIDS. ... I think we need to refocus the attention on family planning and reproductive health.

Is it personally frustrating for you to see the lack of progress since Cairo?
Not particularly. You know, I don't take it personally. I think that it's the environment and the politics of it, and I'm quite used to it. ... It's always been an uphill fight because the values and cultures of many societies want to control the sexuality and fertility of women. Men want to control fertility. All the rules and regulations and the laws are how women cannot do this or that. I mean, women have never been given autonomy. It's only in the Western countries not too long ago that women got autonomy in the areas of reproductive decisions.

Is family planning funding better utilized when directed through NGOs or through government programs?
I think it has to be through both. ... The countries that have done well have all used their NGOs, but the major infrastructure in [any] country is the government, so you need the government programs also. And you need the NGOs also to bring attention to policies that need to be addressed and to be changed.

To what would you attribute the stalls that we're seeing globally in reducing the total fertility rate [the average number of children born per woman]?
I think [it is] because of the lack of attention to family planning programs. That's basically what is happening. That's why there's a great interest now at reviving [commitment] at the policy level from all donors.

What do many of us not understand about women and reproductive health in developing countries?
I think most young people don't realize that what we have as rights in the developed world are not rights in the developing world. What they take for granted like education, access to health care, etc., these are not norms in many developing countries. Especially not for girls and for women. The right of who to marry and if to marry and all that, those are not norms in developing countries. The status of women in many of our societies is quite low compared to the status of boys.

You once wrote that "leaders cannot find the courage even to discuss sexual behavior, let alone how to protect women's sexual and reproductive health." Is that still true?
In the HIV/AIDS context, this is very true. Yes. Still. They have great difficulty in, you know, mouthing the word "sex." In our society, sex is something that is to be discussed only in the bedroom, not in public, and that it's a taboo, so, how can you talk about HIV/AIDS if you're never going to say anything about sex? So they talk about it as a disease when in fact it's also behavior. ... I think, of course, the way to do it is to keep talking about it, and it becomes familiar. As in the case of family planning in the '60s, nobody talked about contraceptives or condoms at dinner parties. But now, people just toss out these words in a very matter-of-fact way. I suppose the more you talk about it, the more familiar people become with the terms, and the less inhibited they are.

It's almost a linguistic barrier?
It's a mental barrier, you see?

As you've shifted at this point in your career toward focusing on HIV/AIDS, are there things that have really surprised you?
Not really. When I first started, I thought, this law should be changed, this should happen, [and] it's so self-evident. ... Things are not so self-evident to other people or to the leaders as they seem to be to you [Laughs]. It needs a lot more persuasion than you thought would be required.

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