In a global health report that speaks as much to the powerlessness of women as it does to the diseases that are killing them, the World Health Organization said this week that the leading cause of death for girls and women aged 15 to 44 is now AIDS. The report also found that in poor countries, unsafe sex and lack of contraception is the single leading risk factor for death and disability, resulting in unsafe abortion and range of infections including HIV. Domestic violence poses an additional risk to sexual and reproductive health.

Studies like the WHO report highlight the critical intersections between women’s disempowerment and health outcomes–issues the United Nations desperately needs to focus on. But for more than five years, the UN has been dancing around a proposal to create a high-powered, well-financed agency for the world’s women. In a last-minute decision in September, before the start of a new UN year, the final session of last year’s General Assembly approved the step in principle. But nothing concrete has happened since, and there are plenty of UN members willing to stall implementation, at least into next year.

Progressives may well ask, Didn’t the idea of ghettoizing women’s issues go out with newspapers’ women’s pages? That was also the theory around the United Nations, where for decades the buzzword was “mainstreaming,” meaning that women would be factored into all the work of the organization. As it turned out, a majority of nations among the UN’s 192 members never took seriously the concept of mainstreaming female sexual and reproductive health and rights in development, though the status of women is widely acknowledged to be critical to progress on many fronts from the economy to the environment.

No mention of reproductive rights, aside from maternal health, appears in the Millennium Development Goals, the eight-point plan for reducing poverty and disease worldwide. Ever since the 1994 UN Conference on Population and Development in Cairo, a relentless Vatican campaign aligned with a claque of nations–among them some in which women most need good reproductive healthcare and rights of all kinds–continues to scaremonger. In its sloganeering, gender equality and sexual/reproductive rights become code words for abortion, feminism and lesbianism.

The debate over gender rights exposes deep fissures in the UN system. One of them is the divide between the expert UN agencies, bodies staffed largely by professionals, and the majority-rules General Assembly, which can box in the international civil servants of the Secretariat and constrain even a secretary general. In the weeks before he resigned in 2006, Kofi Annan tried to jump-start the creation of the new women’s agency and was slapped down by member governments. (Among the opponents at the time were large and important nations such as the United States and India.)

Annan’s successor, Ban Ki-moon, got the message and shied away from action when he took office at the beginning of 2007, turning the issue over to the Assembly, a surefire way to stall something innovative. Does this sound like the American healthcare debate?

On the other side of this UN divide are the autonomous or semiautonomous UN agencies where policies are set and decisions made with less political pressure. When Margaret Chan, a former director of health in Hong Kong, took over as director-general of WHO in 2007, she vowed that women’s health would be a priority, and she has been active on that front. So, to varying degrees, have the leaders of the UN Development Fund for Women (UNIFEM), the Population Fund (UNFPA) and UNICEF, the children’s fund.

UNICEF? Yes, because teens and even younger girls barely beyond puberty are dying by the thousands in unwanted pregnancies when their small bodies are not developed enough to give birth. Pregnancy-related complications are a leading cause of death among 15-to-19-year-old girls in the developing world. Globally, girls are also victims of sexual abuse at a rate three times that of boys, WHO found.

When Chan released the new report, Women and Health: Today’s Evidence, Tomorrow’s Agenda, on November 9, she explained why she commissioned it: “I did so based on my conviction that the health of women has been neglected, that this neglect is a major impediment to development, and that the situation needs to improve. I did so based on my conviction that women matter in ways far beyond their role as mothers.”

Another fissure that can impede concerted action in the United Nations on women’s health and sexual rights yawns between the health and rights of women in the industrial countries and the global South. Those in Europe or North America who may be surprised to learn that, numerically, HIV/AIDS kills the most women worldwide may also be those in the developed world who do not see the lack of access to contraception (and thus control over their bodies) that poor women endure.

Where women’s health is concerned, there are clearly two worlds. The new WHO report, for example, finds that while unwanted pregnancies and unsafe abortion are major killers of young women in poorer countries, the leading cause of death among girls 10 to 19 in rich countries is traffic accidents.

Among adult women, mostly between the ages of 20 and 59, cervical cancer among the poor account for 80 percent of world cases, and most of the deaths. Ninety-nine percent of the more than half a million maternal deaths annually occur in low-income nations, where societal pressures may also contribute to the powerlessness of women. Leading causes of death among the poor include respiratory infections and diarrheal diseases. For women in rich nations, heart disease, stroke and Alzheimer’s or other dementias are at the top of the mortality list.

The proposed new UN women’s agency or department, which doesn’t have a profile or a name yet, will combine four existing women’s offices or organizations. Its role will not, of course, be primarily in matters of health. But the WHO report, and Chan’s own comments, stress that the broader deficiencies–legal, political, economic and social–in the lives women lead need serious attention if women, particularly in low-income countries, are to enjoy the benefits of better health.

A coalition of more than 300 organizations in eighty countries called GEAR–for Gender Equality Architecture Reform–is now demanding that Secretary General Ban start an open international search for a strong leader of the new agency, which is expected to have an under secretary general at its head. Waiting for the General Assembly to cobble together an entity with lowest-common-denominator powers would be a waste of time and purpose. A staff with muscle must be assembled and significant money raised. Women’s departments and agencies at the United Nations have been notoriously underfunded.

This step at the UN is going to need a push from the Obama administration, and support in Congress when US contributions are considered. The secretary general should not be allowed to get away with a “safe” appointment to this crucial post as so often happens at the United Nations. The lives of several billion women are potentially at stake.