Maternal Mortality at the World Health Assembly

The 62nd session of the World Health Assembly took place in Geneva, from 18 May- 22 May. Although the recent flu pandemic dominated the discussions, monitoring the achievements of the health-related Millennium Development Goals was also on the agenda. Secretary General of the United Nations, Ban Ki-moon, and Sarah Brown, the wife of British prime Minister Gordon Brown, delivered passionate speeches that emphasized the necessity of dealing with global progress toward MDG 5, reducing maternal mortality.

Ban Ki-moon's speech "slammed the world's progress on lowering the maternal mortality rate" stating that of all the Millennium Development Goals, this is the slowest moving. He continued on to say that "maternal health is a key barometer of a functioning health system," and without making significant strides to reduce maternal mortality, hope for other health related progress, such as fighting HIV/AIDS, is limited. In the final moments of his passionate speech Ki-moon stated that, "In the 21st century, no woman should have to give her life to give life," maternal mortality must be quickly prioritized in order to stop the magnitude of avoidable deaths. Even in the face of one of the worlds worst financial crisis, we cannot scale back or stop our efforts in such an important area of health.

Sarah Brown addressed the World Health Assembly with an equally passionate speech. Speaking not as a researcher or a scientist, but rather as a mother, Sarah Brown was quick to point out that "there is no excuse for the fact that pregnancy and childbirth worldwide kill 529,000 women and leave one million children without a mother each year." With an emphasis on the incredibly high statistics of sub-Saharan Africa, Mrs. Brown made it clear that something must be done to save these women's lives, "We have the science, the technology, the medicine, the knowledge, the cultural understanding, the means to educate and inform and if we are moved to act, then let us show we have not only the compassion but the moral commitment and the political will too." Sarah Brown also pointed out the consequences of not acting for the children of these mothers. "When one mother survives a lot survives with her. A mother’s survival is the key to her baby’s welfare and often her baby’s life." With that in mind, it appears that not addressing maternal mortality hurts not only the 529,000 mothers who die each year, but also their children. By promoting effective reproductive health, a child's life will begin positively, and by having a mother to look to for advice and guidance, it is PPD's belief that combating maternal mortality will lead to a better life, and a better role in society for both mother and child.

In conjunction with the World Health Assembly, IRIN, a humanitarian news and analysis project released updates on maternal health in Chad, Zimbabwe and Ghana. In Chad, one of the world's most dangerous places to give birth, UNICEFS efforts to step up obstetric care are examined, in order to better prepare for emergencies. IRIN's report on Zimbabwe shows an increasing trend of maternal deaths, due to understaffed clinics, equipment shortages, and poverty. In regards to Ghana, attention to family planning, skilled attendance, comprehensive abortion care, as well as adolescent health care are necessary in order to combat the increasing rate of maternal mortality present.

The Millennium Development Goals were instituted in 2000, but without much progress since then, recent meetings and events have seen more passionate speeches and dire requests than ever before. Prominent leaders such as Ban Ki-moon and Sarah Brown are instrumental in raising awareness of MDG 5, but without government cooperation and implementation of effective programmes, the target goals will never be met. We have the means, now we must show we have the political commitment and the compassion for women around the world.

To Watch Ban Ki-moons speech, visit: http://video.who.int/streaming/wha62/wha62_unsg_speech.wmv

Or, to read the text version, of his WHA address, visit: http://www.who.int/mediacentre/events/2009/wha62/secretary_general_speech_20090519/en/index.html

To watch Sarah Brown's speech, visit: http://video.who.int/streaming/wha62/wha62_brown_speech.wmv

Or, to read the text version of her WHA address, visit: http://www.who.int/mediacentre/events/2009/wha62/sarah_brown_speech_20090519/en/index.html

Also on the subject of maternal mortality, the NY Times recently published an article focused on maternal mortality. Entitled, "Where Life's Start is a Deadly Risk," the article provides some interesting insights and an even more fascinating image portfolio of childbirth in Tanzania. To check it out, visit: http://www.nytimes.com/2009/05/24/health/24birth.html?_r=1

Achieving the Millennium Development Goals: The Contribution of Family Planning

The Millennium Development Goals are quickly approaching their target date of 2015, and in order to ensure that progression is being made in a positive direction, the USAID Health Policy Initiative has specifically focused on the considerable and noteworthy contributions that family planning has thus far made to achieving the goals. Updated analysis for more than 30 countries demonstrates how family planning can help accomplish MDG's by reducing costs for meeting the goals and improving health outcomes.

MDG Briefs for Bangladesh, Bolivia, Burkina Faso, Cameroon, Chad, Democratic Republic of Congo, Dominican Republic, El Salvador, Ethiopia, Ghana, Guatemala, Guinea, Honduras, India, Indonesia, Kenya, Madagascar, Malawi, Mali, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Peru, Rwanda, Senegal, Tanzania, Uganda, Yemen and Zambia can be accessed in English (and often French or Spanish) at: http://www.healthpolicyinitiative.com/index.cfm?id=publications&get=Type&documentTypeID=15

Access to Female Condoms (FC)

What is the status of your country’s access to female condoms (FC)?
Female condoms only comprise about 0.2% of the world’s condom supply. In 2007, 25.9 million Female Condoms were available worldwide (almost doubling the 2005 supply) and about 11 billion male condoms were distributed.

PPD member and collaborating African countries with FC country programs include:
1. Ghana
Another resource from Ghana
In Ghana, the Society of Women against AIDS in Africa (SWAA) in Ghana, launched a programme to improve women’s health rights through the introduction of the female condom. They successfully raised awareness of FC in two high incidence areas and tackled obstacles to FC use. While these activities still need to be extended into more districts, regions and communities, a total of 127,500 female condoms have been distributed to date through sales, community meetings and free distribution by SWAA/Ghana and collaborating organizations. Over 10,000 people have been directly reached through female condom training programmes.

2. Kenya

3. Mali

4. Nigeria

5. Rwanda

6. Senegal

7. South Africa

8. Tanzania

9. Uganda
Uganda's Ministry of Health to Reintroduce Female Condoms. Uganda's Ministry of Health will reintroduce female condoms as part of its HIV/AIDS prevention program in response to increased demand, IRIN/PlusNews reports. The Uganda government in 2007 halted distribution of the female condom because of insufficient demand and complaints that the condoms were not user-friendly. However, a recent health ministry analysis determined that women in the country sought an HIV prevention method that allowed them control over preventing sexually transmitted infections, including HIV, and unintended pregnancies. (Source: Kaiser Daily HIV/AIDS Report - Tuesday, February 17, 2009)

10. Zimbabwe
In Zimbabwe, where distribution of female condoms has expanded rapidly in 2008, women’s groups collected more than 30,000 signatures from women demanding access to the female condom. As a result, the government initiated importation of the female condom.

How to improve female condom availability and programming in your country
Strong advocacy for the female condom is needed to stimulate demand and increase access and availability. You can:

1. Develop an integrated advocacy campaign to support the effective introduction of female condoms within and across HIV prevention and reproductive health programs.

2. Advocate for the inclusion of female condoms in your country’s
• commodities purchasing plans.
• national strategic plan submitted for PEPFAR funding.
• Country Operational Plan submitted to Global Fund to Fight AIDS,TB and Malaria.
• Ask that your government request to be included in UNFPA’s Female Condon Initiative and Comprehensive Condom Programming Initiative. UNFPA’s Global Female Condom Initiative scales up female condom programming. For example, in Nigeria, UNFPA began collaboration in 2005 with the Federal Ministry of Health in Nigeria to implement a UNFPA Female Condom Initiative. Over 30 registered national RH and HIV/AIDS NGOs were trained in FC counselling and distribution and linked to sustainable supplies of stock for their programmes. These NGOs are now distributing 76% of the FCs used in Nigeria. The social marketing organizations currently engaged in distributing most (about 80%) of all male condoms used in Nigeria are planning to launch marketing of FCs as well. African countries enrolled in the UNFPA Condom Initiative in 2006-07: Zambia, Zimbabwe. Malawi, DRC, Cote d’Ivoire, Senegal, Nigeria, Sierra Leone, Liberia, Ethiopia and Eritrea. African countries targeted for enrollment in 2008-09: Benin, Cameroon, Chad, Niger, Mauritânia, Burkina Faso, Rwanda, Mauritius, Botswana, Madagascar, Swaziland, Comoros, Seychelles, Mauritius, Lesotho, Mozambique, Ghana, Gabon and Congo-Brazzaville.

3. Contact the United States Agency for International Development (USAID) mission in your country and demand that they help you gain access to the female condom (Tanzania is currently receiving female condoms from USAID; Rwanda, Uganda and Kenya are not.).

Resources:
Global Campaign for Microbicides: http://www.global-campaign.org/africa.htm
UNFPA: http://www.unfpa.org/hiv/female.htm
PATH: http://www.path.org/projects/womans_condom.php
http://www.path.org/projects/womans_condom_gcfc2005.php
WHO guide for FC use and programming: http://www.who.int/reproductive-health/publications/RHR_00_8/index.html

Additional Contacts and Organizations:
Prevention Now! Campaign. One of the goals of Prevention Now! is to link with existing female condom campaigns, such as those in Argentina, Ghana, Zambia and Zimbabwe, in order to support and catalyze efforts to increase FC access. For more information, see www.preventionnow.net.

Female Health Foundation Team Leader, Katy Pepper at katypepper@femalehealthfoundation.org. FHF works in partnership with UNFPA and provides technical assistance to governments, INGOs, NGOs and other agencies. They provide assistance, guidance and support with advocacy including linkage to others working in the same field/area; updated information on FC promotion and use; technical information on female condoms and guides on programming with the female condom.

For countries in East Africa, the Global Campaign for Microbicides’ Eastern Africa coordinator, Pauline Irungu, at pirungu@path.org. PATH, A.C.S Plaza, Lenana Road, P.O Box 76634 Nairobi, 00508. Phone: +254 (020) 3877177/80/89 Fax: +254 (020) 3877172. The Global Campaign’s goal has always been to amplify demand for more and better HIV prevention options, particularly for women They are now increasing our efforts to mobilize advocacy for access to the female condom, especially in countries hardest hit by the HIV pandemic. For more information, please see the Global Campaign website at www.global-campaign.org.