Malawian President Joyce Banda (AFP/AFP); Liberian President Ellen Johnson Sirleaf (Stan Honda/AFP)

(The Root) — The woman in the bright-pink traditional African dress spoke firmly: "It is unacceptable that a mother should die while giving birth because the nearest health center is far away." President Joyce Banda of Malawi was speaking at the 67th Session of the United Nations General Assembly last month, before the same audience that listened to Iranian President Mahmoud Ahmadinejad, President Michel Joseph Martelly of Haiti and President Barack Obama.

Ellen Johnson Sirleaf, president of Liberia, also talked about women's issues in her speech to the group of 193 heads of state: "We have made strong strides in gender equality, but much more must be done for girls' education and women's empowerment."

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Both Banda and Sirleaf escaped violent marriages and struggled through single motherhood to overcome poverty and eventually make history as the only two female leaders in the modern history of Africa. And both women have placed the issues of reproductive health and family planning at the center of their national agendas.

As a clear indication of where her interests lie, Banda, soon after taking office, sold the presidential jet and the fleet of Mercedes limousines and launched the Presidential Initiative for Maternal Health and Safe Motherhood. In Liberia, where nearly 1 in 1,000 women dies in childbirth (in the United States, it is 1 in 2,400), Sirleaf established the Reach Every Pregnant Woman program to ensure that all pregnant women get the medical attention they need. Both leaders are fighting entrenched cultural and religious ideas about family planning.

In so doing, they have brought these issues into the center of the global development discussion. (Meanwhile, in the U.S., the terms "reproductive rights" and "family planning" are often co-opted and shrunken in scope to mean "the abortion debate.")

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Much of this shift rests in the international focus on the Millennium Development Goals, eight goals that were officially established at the U.N. in 2000 to concentrate the global community on achieving "significant, measurable improvements in people's lives." The mission of the fifth MDG is to improve maternal health, reducing the world maternal-mortality rate by three quarters between 1990 and 2015, and to achieve universal access to reproductive health, including family planning.

Nigerian President Goodluck Jonathan co-chairs the U.N. Commission on Life-Saving Commodities for Women and Children, dedicated to increasing access to medicine, medical devices and other supplies to women and children. Like Sirleaf and Banda, Jonathan has affirmed his country's commitment to the issue of reproductive health, even tweeting during the General Assembly gathering in September: "Government has adopted measures to reverse maternal death."

These African leaders see clearly the wide umbrella that is reproductive health, an umbrella that not only covers abortion, contraception and the tragedies of child marriage and maternal and infant mortality but also reaches beyond. As Secretary of State Hillary Clinton said in 2010 at an international population conference, "Reproductive health care is critical to the health of women, and … women's health is essential to the prosperity and opportunity of all, to the stability of families and communities and [to] the sustainability and development of nations."

In Somalia, for example, which has one of the world's highest fertility rates, the connection between family planning and food security is clear: Somali women — who, on average, have seven children each — must travel great distances to find food and water. At some point in the terrible trek, they are often forced to choose which child to abandon for the sake of the others.

Family planning has a direct bearing on population growth, which in turn affects sanitation, finite resources and the degradation of the environment. And in terms of economic empowerment — on a micro and macro level — the link is unmistakable.

In the book Why We Care: Global Leaders Council for Reproductive Health, Banda describes her best friend growing up: "Chrissie went [to school] one term, but she couldn't return — her school fees cost $6, and her parents couldn't raise the money. My parents could, and I went on and finished my schooling, and today I am the president of Malawi. Chrissie went back to the village, got married early, ended up with half a dozen children or more, and she is still there, locked in poverty."

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But this is not just "an African problem." In the U.S., the teen-pregnancy rate is the highest in the developed world. And although the U.S. spends $98 billion annually on hospitalization for pregnancy and childbirth, the maternal-mortality rate has doubled in the past 25 years.

Although such statistics are grim, it's possible to envision an entirely different scenario. The far-reaching positive repercussions of having access to reproductive health and family planning are depicted in a highly engaging video made by the Nike Foundation called "The Girl Effect," which shows how changing the life of one girl by providing her with access to reproductive health and education can drive positive global consequences.

Presidents Banda and Sirleaf are examples of such a "girl effect," and they bring their own experiences as women to bear on their leadership. In her autobiography, This Child Will Be Great, Sirleaf describes the traumatic consequences of a society torn by poverty and war, in which women are utterly disempowered. She describes meeting one such woman, the victim of a rape at the hands of soldiers for whom such vicious behavior is as common as it is horrible.

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In Why We Care, Banda explains how she suffered a postpartum hemorrhage after the birth of her fourth child. She survived only because she could afford the kind of special care not available to most women in Malawi, where the rate of maternal mortality is devastatingly high: 58 times that of the U.S. These personal experiences drive these leaders' commitment to push for change — and attention — on a global scale.

The world is listening: Oct. 11 was International Day of the Girl, and the U.N. joined millions in celebrating the strength of women and girls. Yet in the U.S., a war on women wages on. Rape is defined as "legitimate" or not, and in the recent vice presidential debate, reproductive health was mentioned briefly, and only in the context of religion and abortion.

In the second presidential debate, on Oct. 16, most of the talk about women concerned binders (apparently full of women), although President Obama did mention funding for Planned Parenthood — along with Big Bird. None of the questions posed during the debate concerned reproductive health.

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But the international community is focusing on other, wider-reaching women's reproductive-health issues. And two African women — once girls themselves — are demanding that these issues be part of the global agenda.

Ann Clark Espuelas is a copy editor at The Root and co-editor of the book Why We Care: Global Leaders Council for Reproductive Health.