How long is five seconds? Long enough for a woman in Nairobi or Atlanta to hear that she is HIV-positive. How long is 30 seconds? Long enough for a girl in Toronto or Sao Paulo to take her first puff of a cigarette. How long is five minutes? Long enough for a woman in Bangkok or New York City to be sexually assaulted. How long is nine months? Long enough for an adolescent in Tokyo or Amsterdam to have a baby she does not want.

How long is five years? Long enough for the world community to respond to the agenda set at the International Conference on Population and Development, which we have come to know as "Cairo."

In 1994, more than 180 nations from all parts of the globe gathered in Cairo to rethink the way we approach women's health. The question at hand was: How do we move women's health beyond the narrow focus on population control and reproductive health, and instead empower women of the world to take control of all spheres of their lives -- academically, economically, socially, and politically?

Cairo challenged the world to live up to the affirmation that women's rights are human rights. Cairo supported the view that a woman's value exists far beyond her reproductive organs; that her fate does not exist in a vacuum.

There are vast cultural differences in our world, but there is one common truth: when a woman dies, becomes disabled, is abused or goes hungry, it can profoundly affect each of her children, her extended family, a whole neighborhood, and an entire community.

The United States has responded to this affirmation with vigor. In the past five years, we have reached beyond our traditional concept of "women's" initiatives, and are creating programs that allow women to not only stay healthier and more economically successful throughout their lifespan, but will also strengthen and support the broad circle of people around them.

We began our response to Cairo by recognizing that every day American women are faced with threats to their well-being simply because they are women. But we also recognized that when given knowledge, education, opportunity, and power, women can be heroines and move mountains to help themselves and others they are destined to nurture. To create an environment that will support these heroic acts, the United States Department of Health and Human Services (DHHS) has implemented numerous programs that target women throughout all phases of their lives.

We hope that other nations see our initiatives as demonstration models, just as we have benefited and learned from innovative programs around the world.

Starting young, our Girl Power! campaign focuses on girls aged 9-14, the age when they begin their often complex and confusing transformation into women. Studies show that girls encounter different social, cultural, physiological, and psychological challenges than do boys. For example, the National Longitudinal Study on Adolescent Health reported that one in 20 girls has attempted suicide, double the rate for boys, and "The Girls Report: What We Know and Need to Know About Growing Up Female" found that 90 percent of cases of eating disorders occur among girls and young women.

Drug use is also on the rise. Girls today are 15 times more likely than their mothers to have begun using illegal drugs by age 15, according to the National Center on Addiction and Substance Abuse at Columbia University.

"Girl Power!" is designed to help girls through the critical period of pre-adolescence by building their self-confidence in academics, sports, art, and other activities and developing their interpersonal and social skills. In addition, they also receive health messages about drug use, sexual activity, nutrition, and mental health.

As their transition into womanhood continues, our National Strategy to Prevent Teen Pregnancy helps them through the next phase. This strategy promotes education to encourage abstinence, conducts evaluations, and funds pilot projects. Teen pregnancy rates and births have declined in the United States in recent years, but the teen birth rate is still two to seven times higher than that of other industrialized countries.

We recognize that teen pregnancy is more than just a short-term health issue. These pregnancies can interrupt and even stop a woman's education, which can affect her economic independence for the rest of her life. Of women who give birth during high school, 62 percent drop out of school, and they are less likely to go to college as compared to women who delay their pregnancy.

As women get older, they face the threat of chronic and deadly diseases. In their lifetime, American women face a one in eight chance of developing breast cancer. So in 1993, in response to a 2.6-million signature petition calling for a coordinated national strategy to combat breast cancer, President Clinton initiated the National Action Plan on Breast Cancer, a public/private partnership that better focuses our resources to fight this horrible disease. In addition, the Center for Disease Control and Prevention (CDC) has expanded its Breast and Cervical Cancer Screening Program, which is now protecting the health of low income women in each of our 50 states.

Much as we all fear breast cancer though, heart disease remains the number one killer of women. We are learning more about the heart health of women in the Women's Health Initiative at the National Institutes of Health (NIH), the largest clinical trial in U.S. history. This research has brought thousands of women into important clinical studies and is increasing our knowledge about hormone replacement therapy, dietary patterns, and exercise. This important study is just one example of the greatly expanded women's health research agenda at NIH.

As a nation we cannot meet the Cairo mandate without looking far beyond diseases to other societal threats to women's health and well-being. According to the DHHS Office of Women's Health, domestic abuse is the leading cause of injury to women in the United States. More than 50 percent of women murdered in the United States are killed by current or former male partners, and it is estimated that one in four women in the United States will be assaulted by a domestic partner in her lifetime.

Violence and victimization also greatly impact young girls and adolescents. It has been estimated that between one in three or one in four girls has been sexually victimized by the time she reaches 18 years of age. The United States has responded by enacting tougher laws, establishing better training curriculums for health providers, and increasing funding for battered women's shelters.

In addition, a national 24-hour toll-free Violence Against Women hotline (1-800-799-SAFE) has been created to refer thousands of women to safety. Since its inception 18 months ago, more than 200,000 women have called the hotline for help and advice in their most pressing time of need.

The Department of Health and Human Services is also working to stop the increasing threat of HIV/AIDS. In 1997, women comprised 22 percent of all reported AIDS cases; this compares with only 7 percent in 1995. Heterosexual contact is now the fastest growing mode of transmission. In the United States, the threat is even greater for women of color. African American and Hispanic women made up 76 percent of the female AIDS cases reported to date.

So we have moved quickly to create an agenda centered around women and HIV. Community organizations and medical providers are working with the Department of Health and Human Services to develop programs that meet women's needs for prevention and care of HIV. The NIH and CDC are leading an integrated research strategy for HIV and AIDS, funding studies to develop improved behavioral and biomedical interventions to give women effective tools to reduce their risk of HIV infection.

Cairo also encouraged us to take a more global view of issues affecting the health of women. We now realize that the international issue of female genital mutilation has become a domestic issue. The prevalence of female genital mutilation in the United States is still largely unknown, but CDC, using U.S. Census data and female genital mutilation rates for African countries, has estimated that more than 150,000 women and girls in the United States had or are at risk for female genital mutilation. We are now working on methods to determine the true prevalence of the practice in the United States, working with communities to better understand the cultural influences that may be involved, and educating health care providers about female genital mutilation.

We recognized at Cairo that improving women's health cannot occur without fully integrating it into communities' priorities. Our efforts require the full support of the American public, women and men. We have developed programs to encourage men to become more involved in family planning by having them work in family planning clinics, learn about reproductive health, and receive assistance with career planning and job training.

Also, we know that involving males in parenthood is beneficial for children. Non-custodial fathers who have a sense of parenthood maintain strong emotional ties with their children and voluntarily pay child support. To that end, the Department of Health and Human Services has established a Fatherhood Initiative. It will fund responsible fatherhood demonstration programs, increase funding for access and visitation services, include pregnancy prevention activities for boys and young men in the National Strategy to Prevent Teen Pregnancy, and work with women's groups to reduce violence against women and children.

DHHS has done much in five years. But, the road from Cairo has not been and will not be easy. The United States still has a long way to go in dealing with interconnecting issues of race, ethnicity, and poverty. Increasing numbers of aging women will dictate different health needs. Much more still needs to be done to give women a fuller sense of responsibility about their own health and lives and to hold men responsible for their actions that affect family life.

As the five-year anniversary of Cairo approaches, let us all celebrate our successes, acknowledge our shortcomings, and vigorously explore future directions for the human rights of women everywhere. Time waits for no one.

Global Issues USIA Electronic Journal, Vol. 3, No. 2, September 1998