After 10 years at the helm, a controversial new UNICEF

"The problem over the last 10 years is that UNICEF has not provided sufficient leadership in child survival, with the consequence that there is insufficient advocacy and support for implementing the proven, low-cost interventions that can save more than 10 million children from dying each year," says Robert Black, chairman of international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md. "There is still the need to do the conceptual and programmatic work to support countries with high child mortality. This is an important responsibility of UNICEF that I hope will be taken more seriously in the future."

Dr. Black's research found that interventions could save the estimated 10 million children and concluded that six countries - India, Nigeria, China, Pakistan, Congo, and Ethiopia - accounted for the deaths of half the world's children under age 5.

Among Bellamy's more vociferous critics has been The Lancet, a British medical journal. In an editorial published last December, editor Richard Horton suggested that UNICEF's "preoccupation with rights" kept most children in the 42 countries that account for 90 percent of deaths of children under 5 from receiving needed care. "Child survival must sit at the core of UNICEF's advocacy and country work," he wrote. "Currently, and shamefully, it does not."

Bellamy's staff responds with statistics of its own: a 16 percent drop in child mortality worldwide since 1990, with progress everywhere except in AIDS-plagued sub-Saharan Africa; a 99 percent reduction in polio since 1988; a 40 percent reduction in measles since 1999; more children in school than ever before; and "the enactment of national laws and policies in dozens of countries to better protect and service children."

Bellamy defenders suggest the preoccupation with results for children under 5 ignores those ages 6 through 18, or the inequity between boys and girls around the world. "Whenever a family is short on resources, they invest in their sons," says Adrienne Germain, president of the International Women's Health Coalition.

Bellamy has also angered groups like the Catholic Family and Human Rights Institute by advocating access to abortion and "sexual health." For example, UNICEF material teaches the health and economic benefits of "birth spacing" - for women not to have more than one child every two years. And UNICEF and other UN agencies have also made available the "morning-after pill" to refugee women who are victims of rape.

Asked to explain the vitriol she has stirred up in her 10 years, Bellamy, who will soon become president of World Learning, a nonprofit group, wheels in her chair, pauses, and gazes out the window at midtown Manhattan from her perch on the 13th-floor of the UN building. "If I understood it, I would tell you," she says. "Women are scary sometimes - sometimes more scary than men."

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