When Natalia Kanem reflects on her eight-year tenure at the helm of the UN reproductive health agency, she doesn’t begin with global statistics, boardroom breakthroughs, or even memories of her visits to refugee camps.
She returns, over and over, to a single image: that of a ten-year-old girl – standing on the edge of adolescence, her future uncertain, and her rights still in grave doubt.
“Will she be able to stay in school, graduate, and make her way through the world?” Dr. Kanem wonders. “Or is she going to be derailed by things like child marriage, female genital mutilation, or abject poverty?”
That seismic question and that girl – not one child in particular, but an emblem of the millions worldwide whose future is at risk – have become the touchstone of Dr. Kanem’s nearly eight-year tenure as Executive Director of the UN’s sexual and reproductive health agency, formally known as the UN Population Fund (UNFPA).
From her early days working on the frontlines in East Africa to overseeing a $1.7 billion agency with operations in more than 150 countries, Dr. Kanem has shepherded UNFPA through global shifts, political headwinds, and ideological pushback.
Most of all, she has led a fierce revolution in the lives of millions of women and girls.
This month, she is stepping down from her post ahead of schedule. “It’s time to pass on the baton,” the 70-year-old told her staff – a 5,000-strong workforce – in a videotaped address earlier this year. “I have pledged to do everything in my capacity to keep positioning UNFPA to continue to do great things.”
Roots and ascent
Born in Panama and trained as a medical doctor, Dr. Kanem joined UNFPA in 2014 after a career in philanthropy. Her decision to serve “the noble purpose of the United Nations” first led her to East Africa and Tanzania, where she was struck by the quiet heroism of field staff. “It’s really at the country level where we prove our worth,” she told UN News.
But the job was not easy. In 2017, when she took the reins of the agency, Dr. Kanem inherited an organization grappling with waning visibility, unstable funding, and persistent pushback from conservative viewpoints. Still, UNFPA grew – not just in budget, but in stature.
“When I came, the narrative was, ‘We’re a small organization, beleaguered, nobody understands what we do,”‘ she said. “Now, I think it’s clearer.”
That clarity came, in part, from what Dr. Kanem calls “thought leadership.”
Whether challenging misconceptions about fertility or confronting gender-based violence enabled by technology, she pushed UNFPA to the frontlines of global discourse. “We exist in a marketplace of ideas,” she explained. “And we have to tell the truth in a way that’s compelling enough so we can garner the allies this movement requires.”
Under her leadership, the agency trained hundreds of thousands of midwives, distributed billions of contraceptives, and expanded humanitarian operations to reach women and girls in the most fragile settings – from the Rohingya camps in Bangladesh’s Cox’s Bazar to war-scarred Ukraine and cholera-stricken Haiti.
UNFPA’s presence in crisis zones was not only logistical, but symbolic. In Sudan, Syria, and Gaza, a simple tent stocked with menstrual pads, a blanket, and a bar of soap could serve as sanctuary. “It represents the respite that a woman needs in a time of crisis,” she said. “You know, we call our kits ‘dignity kits’ for that reason.”
Shifting the conversation
Beyond delivering services, Dr. Kanem elevated UNFPA’s role as a thought leader in a polarised world. She steered the agency into difficult public conversations – about teen pregnancy, climate anxiety, fertility rates, and online harassment – with an unflinching insistence on rights.
“The 10-year-old girl exists,” she said. “What her parents and her religious leaders and her community think is vital for her to be well prepared, for her to know what to do when she’s challenged by coercive practices.”
That leadership extended to data. Under Dr. Kanem, UNFPA invested heavily in supporting national censuses and building dashboards to help lawmakers shape reproductive health policy with real-time insight.
This year’s State of World Population report, the agency’s annual deep dive into demographic trends, reframed conventional narratives around so-called “population collapse” – noting that many women and men delay having children not out of ideology, but because they cannot afford to raise them.
Dr. Kanem praised the altruism of young people who say they’re choosing not to have children for fear of worsening the climate crisis. But that’s not what the data shows.
“The world replacement fertility rate is not endangering the planet,” she explained. “The facts really say: you can have as many children as you can afford.”
A rights-based compass in turbulent times
Dr. Kanem’s tenure coincided with mounting attacks on reproductive rights, rising nationalism, and growing scepticism of multilateral institutions. She faced years of US funding cuts – including under the current administration – even as demand for UNFPA’s services surged.
“UNFPA has more money than we’ve ever had,” she noted. “But it’s never going to be enough to stop the flow of need.”
Resources alone won’t secure the agency’s future – credibility and persistence are just as vital. “The multilateral system itself has come under question at a time when it is needed now more than ever,” she warned. “We do have to prove ourselves each and every day. And when we make mistakes, we’ve got to get up and rectify them and find partners who are going to be allies.”
One such partner has been the private sector. In 2023, UNFPA teamed up with tech firms to launch a development impact bond in Kenya, delivering mobile-based sexual health services to prevent teenage pregnancy and new HIV infections among adolescent girls.
Changing mindsets
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UNFPA has long worked to end harmful practices such as female genital mutilation (FGM) and child marriage. Under Dr. Kanem, that work became as much about shifting mindsets as changing laws.
“Yes, absolutely,” she said when asked if progress was real. “It’s been very important to see religious leaders and traditional leaders standing against certain practices… and to work with school systems so that the girls themselves will understand the risks and be able to take better decisions about their options.”
The _HREF=https://www.un.org/coronavirus“>COVID-19 pandemic, she admitted, was a setback. With schools closed, some communities increased the number of weddings and FGM ceremonies. But in many countries – including populous Indonesia – UNFPA has seen the practice decline, in part thanks to youth advocates speaking out from within their own communities.
New generation, next chapter
Looking ahead, Dr. Kanem didn’t dwell on uncertainty. She spoke instead of possibility. “We’ve transformed ourselves, modernized ourselves,” she said. “There’s just unlimited possibility for UNFPA.”
Her own future includes what she calls a “mini-sabbatical” – more time for music, her family, and, finally, herself. But she won’t stay silent for long. “I know that my passion for issues of women and girls is not going to recede,” she said. “It’s been a labour of love.”
Her parting thought? One final return to the girl at the centre of it all.
“When that 10-year-old girl succeeds, everyone succeeds,” she said. “It is a better world.”
