New York - As the 2015 deadline for the United Nations Millennium Development Goals (MDGs) approaches, world leaders will face a choice: move the goal posts back another decade or two, or hold accountable those who have failed to deliver on their commitments. For women, the choice is clear.

We have been here before. In 1978, at the International Conference on Primary Health Care in Alma-Ata, 134 states signed a declaration calling for adequate health care for all by the year 2000. Sixteen years later, in 1994, in Cairo, 179 governments embraced reproductive rights as a basic human right and adopted resolutions to ensure the provision of universal access to a full range of reproductive health services, including family planning.

Yet those deadlines had come and gone when, in September 2000, during the 55th UN General Assembly, leaders of 189 nations adopted the MDGs. And several other commitments and resolutions were undertaken by world leaders before and after the MDG declaration.

So, where are we now?

We know that several MDG targets have already been met. Extreme poverty has been more than halved since 2000, to about 22% in 2010 – taking almost 700 million people out of the ranks of the world’s poorest. We have seen positive results in the fight against HIV/AIDS, malaria, and tuberculosis. Billions of people have access to improved drinking water; and many have gained access to sanitation (though a billion people still have to resort to open defecation – a major health risk).

There has also been progress on gender equality. Girls and boys attend school in equal numbers, and women are increasingly making themselves heard in the political arena.

But the picture quickly becomes cloudy. Though chronic under-nutrition among young children has declined, one in four children – 162 million children, according to the World Health Organization – are still affected by stunting. Indeed, maternal and child mortality has decreased by millions, but many of these preventable deaths are still claiming the lives of hundreds of thousands of women and children each year.

Moreover, the UN Foundation reports that 222 million women still cannot access the most basic information, products, and services that would enable them to decide how many children to have and to time their pregnancies in ways that preserve their health, enable them to pursue an education, and improve their lives. The same report notes that more than 300,000 girls and women aged 15-19 die every year from pregnancy-related complications, while many more are left to deal with debilitating disabilities.

The UN secretary-general’s 2013 report "A Life of Dignity for All” calls for a universal agenda to ensure that no one is left behind. But millions of people – and particularly women – already are being left behind. And, because world leaders and their development partners have failed to meet women’s basic reproductive-health needs once again, it will be more difficult to achieve concrete progress toward realizing the agenda for sustainable development.

The UN’s own calls to accelerate momentum at the launch of the 500-day countdown to the MDGs’ expiry highlight the fact that inequality, maternal mortality from childbirth, lack of universal education, and environmental degradation remain serious challenges.

To truly affect change – and not only for women – we need global support for access to family planning, women’s and children’s health services, and support for empowerment initiatives. An educated woman is better able to take care of herself, make informed choices, and broaden her contribution to her community. When we leave women behind, we leave their communities behind, too.

No one disputes that development must be inclusive and equitable. What is missing from the diplomatic discourse is a strong framework to hold governments and development partners accountable for translating lofty ideals like human rights – particularly the right to access basic health and social services – into practical solutions.

As the post-2015 sustainable development agenda is drafted, world leaders and their development partners need to think beyond setting new goals or targets that fade with time, and move toward establishing accountability mechanisms, processes, and systems to ensure that we meet the goals that we have already set.

We must break away from the current unwritten code of "zero accountability” for leaders who fail to honor their own commitments to internationally agreed goals. In short, our governments must begin to do what they have promised. Without strong accountability mechanisms, ending preventable maternal deaths and fostering sustainable and equitable development will continue to elude us as we move into increasingly perilous times.

Yetnayet Asfaw (@yetnayetasfaw) is Vice President of Strategy and Impact at EngenderHealth and an Aspen New Voices Fellow.

Copyright: Project Syndicate.