Sex is a dangerous word for politicians. It makes them uncomfortable and, as we see all too often in the political arena, poses risks of all kinds. So it's easier to ignore it, or pretend it exists only in certain narrowly delineated ways.

However, those of us in the sphere of public health have to deal with the realities and consequences of sex without pretence. We recognize it as a fundamental driver of human behavior and a key determinant of the health of entire populations. After all, among humankind the act of sex takes place an estimated quarter of a billion times a day, resulting in more than half a million new pregnancies—every day.

This is an enormous part of the global health picture. Three and a half million people will die this year as a consequence of unsafe, and often unwanted, sex resulting in pregnancy or HIV infection, or both. And, of course, most often the victims will be poor women living in the world's poorest countries.

Twenty years ago, the world community met to address this vast challenge at a meeting in Nairobi—the first-ever global conference to focus on Safe Motherhood. Health providers, NGOs, researchers, women's groups as well as representatives of governments and UN agencies met to discuss how to put women's health and women's rights at the center of the global agenda.

The alarm was raised: 600,000 maternal deaths a year was a terrible price for the world's women to pay, both unnecessary and profoundly inequitable. After all, a girl entering adolescence in many parts of sub-Saharan Africa faces a one-in-sixteen lifetime risk of dying as a consequence of pregnancy or childbirth, while her more fortunate cousin in Europe faces a risk 250 times smaller. This is neither biologically nor theologically ordained; rather, it is a consequence of just how little these women are valued and how limited their access is to the most fundamental of health services: decent care for pregnancy and labor.

In Nairobi, and in Cairo seven years later, a set of fundamental principles were laid out reinforcing the central importance of sexual and reproductive health and rights. These principles said to women around the world: You are not chattel.

"Why rights?" some have asked. "Why not just stick to health?"

It's quite simple: If something is not a right, then it's simply a commodity, and entirely acceptable for some to get it—usually the rich and well-connected—and others not. But history has shown that, over time, those things considered to be human rights grow to encompass everyone.

Women bear 100% of the risk of childbearing, and therefore are at the heart of this discussion of sexual and reproductive rights. The essential reproductive right is the right of each woman to decide whether, when and how many children she will bear. The essential sexual right is the right to say no, to make the act of sex voluntary and willing. Too many women still lack these rights and too many men, in countries both poor and rich, are threatened by them. So it's up to concerned global citizens and the public health community to work on keeping attention on these issues that directly affect the lives of millions of women worldwide.

Twenty years after the first Safe Motherhood conference, progress has been shamefully slow. From 600,000 deaths two decades ago, today's estimate indicates a decline of less than 15%. Almost all those dying needlessly are poor women in Africa, Asia and Latin America. Even today, after all the promises, many will die from pregnancies that they did not wish, and would have avoided if they could. And global investments have been pitifully low.

At this week's annual Global Health Council international conference in Washington, DC, two thousand of us will convene to celebrate the achievements in healthcare for the world's poorest two billion and to show the strength of partnership in sharing our knowledge, experience and evidence about what has worked in the real world that these people inhabit. We are also in Washington to recommit to the unfinished business of the 20^th century: making the world healthier and more equitable for women and children. Assuring that all pregnancies are wanted and safe is at the core of a healthy world on both these counts, which is why we will kick off our weeklong program with a focus on Safe Motherhood as the central theme of our welcome celebration on the evening of May 29.

The Global Health Council has called on the U.S. Congress to increase funding for essential maternal and child health programs, including family planning, by hundreds of millions of dollars. As I testified last month before the Senate, each $100 million invested in maternal health will result in 12,000 fewer maternal deaths and 15,000 fewer newborn deaths, and provide basic and essential care for 4 million women.

How can we afford not to finally do what we promised 20 years ago? We have the knowledge and the will; let us finally have the means to finish what we started.