Dr. Musinguzi on World Population Day 2009

Fulfilling Our Promises to Women
Saturday, 11 July 2009

In these times of global economic crisis, our families, communities and nation face increasingly difficult decisions about how to spend scarce financial resources. We hear dismal statistics repeated in the newspapers and online: the economy of developed countries (measured by GDP) is predicted to fall 4.5% in 2009 and world trade will fall nearly 10% (The World Bank’s annual Global Development Finance (GDF) report: http://www.worldbank.org/gdf2009).

For example, in Uganda, remittances are down 47%, from $504.04 million to $267.32 million (http://news.id.msn.com/business/article.aspx?cp-documentid=3398635 and http://af.reuters.com/article/ugandaNews/idAFLM14443220090622?feedType=RSS&feedName=ugandaNews). USh2.5trn of Uganda’s budget this year (33%) is to come from donor support. Yet it is widely known that donor countries’ official development aid (ODA) is reduced when their economies face turmoil (http://ideas.repec.org/p/frd/wpaper/dp2009-01.html and Roodam, D. (2008). ‘History says Financial Crisis Will Suppress Aid’. Centre for Global Development Website, http://blogs.cgdev.org/globaldevelopment/2008/10/history_says_financial_crisis.php).

What started as a financial issue of the US and Europe is now clearly a global crisis that is hitting Africa hard. It is already affecting our progress toward reducing poverty. Uganda and other developing countries are negatively impacted in the economic crisis because of our reliance on remittances from family overseas and official development aid (ODA) for national budget support.

We know that women and children in developing countries will bear the brunt of the impact of the global financial crisis. Yet we must face this harsh reality with the knowledge we have on what works in development. We must invest in critical services to mitigate the impact on women and allow them to contribute to the economic productivity of their families, communities, and our country.

Funding for reproductive health, prevention of HIV, and preventative health care in general can be viewed by both families and policy makers as non-essential services. Yet dropping these critical services leads to increases in maternal and infant death and disability.
Investing in family planning and reproductive health services not only is good for women’s health and rights (UN resolution on "Preventable maternal mortality and morbidity and human rights", June 17, 2009), it makes economic sense—each $1 invested in contraceptive services will avoid between $1.7 and $4 in expenditures on maternal and newborn health, in addition to cost-savings in education, water sanitation, and immunization. Investing in family planning services reduces maternal mortality, improves child survival, promotes women's empowerment and contributes to poverty reduction.

On 11 July 2009, people around the world will observe the 20th World Population Day. Over the past 20 years, we have seen investments in health and education for women and girls leading to increases in productivity, agricultural yields, and national incomes in developing countries.
Yet, there is still much to be achieved. For example, at the 2009 Commission on Population and Development, the Government of Uganda recognized the high population growth rate of 3.2%, “unacceptably high levels of illiteracy (30%), high infant mortality rate (76/1000 live births), high maternal mortality ratio (435/100,000 live births); low life expectancy (average of 51 years); and a high rate of HIV/AIDS (6.4%).” Yet while a number of these indices have improved over the last 10 years, Uganda has not made a significant positive step in terms of the population growth rate, fertility rate and contraceptive usage (http://www.un.org/esa/population/cpd/cpd2009/comm2009.htm.

Every year, 265,000 mothers in sub-Saharan Africa die in childbirth from preventable causes. In Uganda alone, approximately 6,000 women die every year due to pregnancy complications. Women bleed to death, they do not have access to antibiotics to prevent simple infections; they often do not have the option of a caesarean section when it is necessary. We can prevent these tragedies by providing women with prenatal care, skilled attendance at births, and emergency obstetric care.

Maternal mortality has significant impact on women, families and our country--in terms of lost lives, rights, and national productivity (GDP) (Maternal mortality has a statistically significant negative effect on GDP http://ajol.info/index.php/ajhs/article/viewFile/30801/23132).

We have a blueprint for what we need to do, in Africa and globally—we must fund and implement the 2006 Maputo Plan of Action of the African Union Conference of Ministers of Health (later ratified by African Heads of State). This plan of action aligns with global frameworks and agreements such as the global commitment to universal access to reproductive health services by 2015 of the International Conference on Population and Development Programme of Action (ICPD PoA) agreed to by 179 countries in 1994 and the Millennium Development Goals (MDGs).

In order to fulfill our commitments, we must use our resources wisely. This can best be done in developing countries by sharing our experiences and good practices through South-South cooperation and learning from the successes of our brothers and sisters in other developing countries. We need to look to the example set by other countries like Egypt, Malaysia, Thailand, South Africa and Sri Lanka, who have successfully lowered their rates of maternal ill-health through sustained financial and political commitment. Between 1992-93 and 2000, Egypt reduced its maternal mortality ratio (MMR) over 50% due to the focused efforts of the Ministry of Health and Population to improve access to, and quality of maternal and reproductive health services, reduce fertility rates, and improve antenatal care utilization and skilled attendance at delivery (http://www.jsi.com/JSIInternet/Projects/ListProjects.cfm?Select=Region&ID=2&ProjectStatus=Active). With concentrated efforts, significant improvements in reducing maternal mortality are achievable.

South-South cooperation is a tool that we must take advantage of to both share our knowledge with other developing countries and to learn from their experiences, as well. Developed countries will be increasingly focused on their own problems, leaving us as developing countries to partner and learn from each other as we all strive towards the attainment of the common ICPD goals and MDGs. We must take advantage of our knowledge of local conditions and solutions.

We have the shared knowledge to implement effective, low-cost strategies to improve the health of mothers and children. What we now need is the commitment of community and political leaders to support health progammes that work and to fund the policies and commitments they have made.

We must commit ourselves to ending the tragedy of maternal mortality. No woman should lose her life while giving life.

by Dr. Jotham Musinguzi, M.D., M.P.H.
The writer is the Regional Director of Partners in Population and Development Africa Regional Office (www.ppdafrica.org).