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).

Recent gains in eradicating hunger and poverty endangered by economic and food crises

The Millennium Development Goals Report 2009 was released on 6 July 2009.

The report finds that more than halfway to the 2015 deadline to achieve the Millennium Development Goals (MDGs), major advances in the fight against poverty and hunger have begun to slow or even reverse as a result of the global economic and food crises.

The assessment also warns that, despite many successes, overall progress has been too slow for most of the targets to be met by 2015.

Progress Needs to be Accelerated in Africa
The proportion of the population in sub-Saharan Africa living below the World Bank’s new international poverty line of $1.25 a day decreased from 55.7 per cent in 1990 to 50.3 per cent in 2005 – showing some progress, but far from the pace needed to reach the over-arching Millennium Development Goal of halving the rate of poverty by 2015, according to a just-released UN report.

Because of population growth, the number of people in sub-Saharan Africa living in extreme poverty actually grew by 100 million over this period.

The Millennium Development Goals Report 2008 provides statistical evidence of the progress that sub-Saharan Africa has made in addressing the multiple dimensions and causes of this extensive poverty.

As a sign of potentially better prospects in the future, the region’s total net enrolment ratio in primary education increased from 54 to 58 per cent between 1991 and 2000, and then accelerated to 71 per cent in 2006. Girls account for an increasing share of this total, with the gender parity index rising from 83 per cent in 1991 to 85 per cent in 2000 and 89 per cent in 2006. Despite these improvements, the region will have to intensify its efforts if it is to achieve the Goal of universal primary education by 2015 and the target of primary school gender equality, originally set for 2005. At the secondary level, there has been a slight deterioration in the gender parity ratio, with the number of girls enrolled falling from 82 per cent of the number of boys in 2000 to 80 per cent in 2006.

The UN report also points to accelerated, but narrow and insufficient improvements on the health front. Most notably, primarily thanks to the increasing availability of anti-retroviral drugs, the number of deaths from AIDS has halted its seemingly inexorable increase. The corollary is that, because infected people now survive longer, the number of those living with the disease continues to increase. Among these, the majority are women, who now account for almost 60 per cent of those with the disease in the region.

The proportion of people living with HIV who need treatment and are receiving antiretroviral therapy rose from 21 to 30 per cent between 2006 and 2007, mostly thanks to the substantial amount of public and private external funding provided for this purpose. Here again, despite the progress, there remain some 5 million people in the region who do not have access to the therapy they require.

The lack of health care services is among the factors that contribute to the high number of deaths of children under five years of age. From 184 deaths per 1000 births in 1990, infant mortality fell to 157 in 2007, but this remains almost twice the figure for Southern Asia, the region with the second highest rate.

There was almost no improvement in the region’s very high rate of maternal mortality between 1990 and 2005. A woman in sub-Saharan Africa has a 0.9 per cent chance of dying as a result of pregnancy or childbirth, again roughly more than twice the rate of the second-highest region, Southern Asia. A major reason is that, in 2006, less than half of all mothers-to-be were attended to by skilled health care personnel when giving birth. The intolerably high maternal mortality rate highlights the need for expanded and improved basic health services throughout the region, particularly in the rural areas.

The extent to which women are able to contribute to and benefit from development in the region has been increasing. Women accounted for 31 per cent of non-agricultural wage employment in 2006, compared to 25 per cent in 1990. But women are confined to the more unstable and insecure jobs: more than 80 per cent of women who work are self-employed or unpaid family workers. In terms of political participation, female representation in parliaments has more than doubled since 1990 and, at 17.3 per cent, is higher than the overall average in the developing world.

Full text of the Report (English) : http://www.un.org/millenniumgoals/pdf/MDG%20Report%202009%20ENG.pdf
Press Release (English) : http://www.un.org/millenniumgoals/news.shtml
Data used to prepare the report: http://mdgs.un.org.

Rapport 2009 sur les objectifs du Millénaire
Les crises économiques et alimentaires mettent en péril les récentes avancées dans le domaine de l’éradication de la faim et de la pauvreté, révèle un rapport de l’ONU. Le Secrétaire général de l'ONU appellent les pays richent et pauvres à intensifier leurs efforts et à respecter les engagements en matière d'aide.

Alors qu’il reste moins de la moitié du chemin à parcourir avant la date butoir de 2015 pour la réalisation des objectifs du Millénaire pour le développement, les grands progrès dans la lutte contre la pauvreté et la faim commencent à ralentir, voire à s’inverser à cause des crises économiques et alimentaires mondiales, révèle un rapport sur le sujet publié par les Nations Unies.

Cette évaluation, que le Secrétaire général de l’ONU Ban Ki-moon a rendue publique à Genève, prévient qu’en dépit de nombreux succès, les progrès ont été trop lents dans l’ensemble pour atteindre la plupart des cibles fixées pour 2015.

Rapport 2009 - texte complet: http://www.un.org/french/millenniumgoals/pdf/MDG%20Report%202009%20FR.pdf

Private-public partnerships: Can an additional $75 billion in aid be raised?

A fashion heiress and a Nobel Prize-winning economist make seem like an unlikely duo when it comes to addressing global aid funding, but Renu Mehta and James Mirrlees are ready with a plan based on a renewed partnership between the private and public sector. Renu Mehta is the daughter of an Indian textile magnate, and her socialite status has allowed her to gain the support of billionaires, supermodels and pop stars in initiating her global aid plan. Mehta's partner, James Mirrlees, is a Scottish economist who won the Nobel Prize for Economics in 1996 for his fundamental contribution to the economic theory of incentives under asymmetric information. Together, these two plan to launch the Mehta-Mirrlees plan at a meeting of the 8 industrialized nations in Italy this July.

Each year, governments are committed to donate 0.7% of their gross national income to help meet the 8 Millennium Development Goals. However, in 2007 only Denmark, Luxembourg, the Netherlands, Norway and Sweden were able to meet this commitment. Other countries' contributions were significantly behind. Collectively, all members of the United Nations were only able to deliver 0.3% of their gross national incomes (approximately $103.7 billion). The Mehta-Mirrlees plan aims to bolster U.N. donations by calling on the 8 industrialized nations to match private donations with state aid. That would mean, that for every $100 pledged by the private sector, the government of the donor country would agree to add a matching $100 from existing state budgets. Speaking of her and Mirrlees intentions, Mehta states that the best way to address meeting MDG targets " is [to] come up with a new model, find a new way to meet these targets, on the one hand. On the other hand, we need to make sure that the money is deployed to the maximum effectiveness."

Despite the global economic crisis, if the plan is put into action, Mirrlees and Mehta estimate that it could raise more than $75 billion in funding, as the plan provides a greater incentive for donors as they know that their donation will be matched. Funds generated would be dealt with by a newly created private-public organization that would oversee how donations were spent and ensure spending met the private sector's performance expectations.

While the Mehta-Mirrlees plan has drawn support from the U.N. Secretary General Ban Ki-moon, many others are skeptical about giving too much power and influence to the wealthy private sector. Richard Murphy, director of Tax Research LLP speaks on the issue of ethics, stating that, "Just because you're rich and you give to charity doesn't mean you necessarily make better decisions." If we allow private donations, these individuals are going to want a voice in how their money is spent, and their views may often conflict with what is best for a countries personal foreign policy. For example, if a private company that specializes in antiretroviral drugs dictates that their donations must only be spend on HIV/AIDS programmes, the other 7 Millennium Goals will fall behind due to agendas dictated by wealthy donors. Another problem that skeptics of the plan point out is the problem with offshore banking. When governments match donations, the funds would be generated from assets held in offshore tax havens, and due to the recent crackdown on such accounts, many are skeptical of whether aid agencies would be willing to even accept this money. Instead, if officials forced the shifting of funds in offshore accounts into taxed accounts back home, $250 billion could be raised annually, which is more than five times the money needed by governments to meet the United Nations' Millennium Development Goals.

While their innovation is applauded by many, the Mehta-Mirrlees plan still has a few problems that need to be smoothed out before being presented at the G8 Summit this July. If accepted, this plan could be a huge contribution to the Millennium Development Goals, and would hopefully put the world back on track for achieving all target goals by 2015.

To read the original AP article, "Fashion heiress, economist push foreign aid plan," please visit: http://www.google.com/hostednews/ap/article/ALeqM5gFBOWimtt_06Cdt6tT_bD8f_wHRwD98CAQ8O0

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

A Proposal for a Global Health Fund

A recent article published in The Lancet calls for "bold action to streamline the global aid architecture for health" through the creation of a global fund for the Health MDG's. In May and June of this year, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance will hold their annual board meetings. These meetings provide an occasion to propose recommendations for an expansion of the Global Fund and the GAVI Alliance toward becoming a broader global health fund to address the lack of progress toward the MDG's.

Maternal mortality has remained stagnant for far too long, child mortality is declining at too slow a pace, HIV/AIDS remains a huge problem throughout the world, and inequalities are continuing to widen. In order to address these problems and work toward reaching Millennium Development Goals in time, radical action must be taken immediately. Increased funding and efficient spending are the two most imperative reforms that must be addressed.

In the past 10 years funding for global health has been unable to meet the demands of modern societies. Attention to HIV/AIDS has lead to increased funding, yet it is still inadequate in addressing the multitude of new infections occurring every day. Resources for other health needs have remained stagnant, or in some cases, have declined. In the past, developing countries heavily relied on international funding to combat health problems in society, but lately there has been a shift toward national financial autonomy. Such a concept requires that nations receiving assistance should eventually be able to finance their own health services through a reliance on their domestic revenues. Such a model has thus far proven to be ineffective, and serves as a major constraint to "scaling up service provisions in countries where public services rely heavily on international resources."

Increasing prevalence of diseases and other health related problems, such as maternal mortality, combined with the lack of commitment to a national financial autonomy based approach, has shifted reliance back to the international community. More specifically, the GAVI Alliance and the Global Fund, who have themselves admitted that “It is time to take a comprehensive approach with the necessary support from key donors to refocus on all of the health-related MDGs."

Health systems in many countries lack the capacity to implement many of the programmes or assistance plans provided for them, Unable to take full advantage of funding provided is a complete waste and unravels the entire global health funding process. It is thus essential that health systems themselves be strengthened before any further funding in doled out to communities unable to reap the benefits in their entirety. By overcoming structural challenges to service delivery the results will be much more effective, and progress toward the MDG's will in theory speed up.

The Lancet article recommends that the Global Fund should sustain successful programmes while expanding the effective approaches already put in place by the Global Fund and the GAVI Alliance. Eventually, the hope is that such a fund would allow for the prevention and treatment of specific diseases through revamped health services as well as a reduction in costs and a streamlining of the global health architecture.

Radical action must immediately be undertaken in order to achieve the Millennium Development Goals by 2015, and more importantly to save millions of lives that are lost to treatable and often preventable health problems.

You can access the entire article that appeared in The Lancet and learn more about the recommendations for the Global Fund and the GAVI Alliance at: http://www.familycareintl.org/UserFiles/File/Lancet_Global%20Fund%20Health%20MDGs_web.pdf

After Accra: Delivering on the Agenda for Action

Jeffrey Gutman of the World Bank Institute recently put together a special report entitled After Accra: Delivering on the Agenda for Action, which attempts to assess the progress made toward the Paris Declaration (2005) and the recent Accra Agenda for Action (2008). The report looks at overall progress and the effectiveness of programmes in specific countries, as well as outlines the next major steps that need to be taken by donors, developing countries, and the World Bank.

In 2005, the Paris Declaration on Aid Effectiveness was implemented as a "roadmap to improve the quality of aid and its impact on development." An agreement between donor and recipient countries, the Paris Declaration attempted to reform the delivery and management of aid funding to strengthen its impact and effectiveness. Five principles (ownership, alignment, harmonization, managing for development results, and mutual accountability) outline the goals of the Paris Declaration and can be read in their entirety here. 122 donor and recipient countries and 26 international organizations adhered to the agreement and are currently attempting to improve the effectiveness of aid funding by 2010.

Three years later, a High Level Forum (HLF) was held in Accra, Ghana, to assess progress on the implementation of the Paris Declaration on Aid Effectiveness, and to set out an agenda for action. The result of this meeting was the Accra Agenda for Action (AAA) which recommitted the international community to achieving progress toward the Paris Declaration, as well as the Millennium Development Goals. The AAA lists actions that developing countries and donors should take in order to accelerate implementation of the Paris Declaration, and improve aid effectiveness.

The HLF in Accra was especially significant in that it took steps to increase the developing countries role in the process. At the event, "developing countries’ concerns determined the agenda, developing countries’ representatives were part of all decisions relating to the HLF, and developing countries were full partners in the negotiations leading to the final communiqué, the Accra Agenda for Action." By allowing developing countries a voice in such a forum, concerns and issues can be addressed, making the implementation of such an agreement much smoother and feasible. Developing country participants at Accra are not only necessary as a voice at such meetings, but also as a way to "take the message of Accra back to their communities and institutions and put them into practice."

The AAA not only provides a platform to improve aid effectiveness, but also adds a new dimensions to the discourse as a whole. Recognizing the role of Parliaments, local governments, civil society institutions, research institutes, media, and the private sector, as well as middle-income countries and global funds, the agreement has a plethora of partners in its development efforts and is able to achieve significant progress throughout the country toward set goals. South-South cooperation is highlighted, with an emphasis on sharing good practices and experiences among others trying to reach the same goals. Specifically, Gutman's article highlights Madagascar and Sri Lanka, which have taken noteworthy steps to reduce poverty and improve the quality of life for their citizens. Furthermore, the AAA is unique in that is emphasizes a true partnership between donors and developing countries, rather than a dictated agenda.

In order to achieve considerable progress by 2010, the international community must constantly work toward meeting the goals set out by the Paris Agreements and the Accra Agenda for Action. Checks on the effectiveness and implementation of such practices are essential in order to highlight those countries that are leading the way, and encourage others to follow in their footsteps.

To read more about Gutman's take on progress since Accra, and to see his suggestion for what developing countries, donors, and the World Bank now need to do, see his article, After Accra: Delivering on the Agenda for Action at http://www1.worldbank.org/devoutreach/articleid521.html

You can learn more about the Accra Agenda for Action (AAA) by reading the policy briefs produced by the Partners in Population and Development Africa Regional Office (PPD ARO) shortly after the Accra meeting in 2008:

In English: http://www.ppdafrica.org/docs/accra.pdf

In French: http://www.ppdafrica.org/docs/accraf.pdf

Governments Declare Maternal Mortality a Human Rights Violation

In March this year, 83 Governments issued a joint statement to the United Nations Human Rights Council. Expressing concern over the unacceptably high number of women who die each year due to pregnancy related complications, the delegation urged the Human Rights Council to declare maternal mortality a human rights violation.

Each year more than 500,000 women die from pregnancy or childbirth. Most of these deaths could be prevented, and by not doing so, such inaction clearly constitutes a human rights violation. A women's right to health, life, education, dignity, access to information and appropriate healthcare are violated each and every time a preventable death occurs, and this is completely unacceptable. Reaffirming the importance of The Convention on the Elimination of All Forms of Discrimination Against Women, The International Covenant on Economic, Social and Cultural Rights, Millennium Development Goal 5, The Beijing Declaration and The International Conference on Population and Development, the delegation demanded a recommitment to such global obligations.

MDG 5 aims to reduce the maternal mortality ratio by three quarters, however, between 1990 and 2005 the global rate decreased by less than 1%. Governments and international organizations must recommit themselves to decreasing maternal mortality by 5.5% annually in order to meet set targets. Maternal mortality is an issue that affects women worldwide, and must not be looked at as a concentrated regional problem, but rather a sector of health in which continuous improvement is required.

The delegation laid out 4 keys actions that the Human Rights Council should undertake to contribute to existing efforts. Identifying the human rights dimensions of preventable maternal mortality and morbidity, reviewing and considering information on discrimination in the provision of and access to healthcare for women and discrimination against women in respect of their right to decide freely and responsibly on the number and spacing of their children, talking about the human rights implications of maternal mortality and morbidity in the universal periodic review and in treaty body dialogues, including the exchange of programmes and policies that have successfully reversed the trend of maternal deaths and injuries, and finally, requesting states to include women in decision-making about maternal health, including decisions on the design of local health care mechanisms, and to recognize women’s right to skilled professional care before, during and after pregnancy and childbirth. Goal 3 highlights the importance of South-South cooperation and sharing of good practices as an excellent tool of progression.

The Council will meet next in June of this year and it is PPD's hope that the suggestions provided by one of the largest joint-intergovernmental statements delivered to the Council will have taken effect, and that maternal mortality will be declared a human rights violation. Urgent action is needed in order to meet Millennium Development Goal 5 and to prevent thousands of unnecessary deaths, and the Human Rights Council has the ability to spur such action.

You can view the entire joint statement issued to the Human Rights Council at http://www.womendeliver.org/news/pdf/NewZealand.pdf

Waiting Houses in Mozambique Aim to Decrease Maternal Mortality

Waiting houses, or Casas de Espera, as they are referred to in Mozambique, allow at-risk pregnant women to reside in a home near the local hospital in order to provide immediate care when labor begins. As many of Mozambique's citizens live in rural areas, far from a reliable hospital, these waiting houses are crucial to prevent pregnancy related complications and maternal death from occurring. The Mozambique government has recently decided to revamp its waiting house programme in order to combat maternal mortality and progress toward achieving MDG5.

At the African First Ladies Health Summit last week Maria de Luz Guebuza, the First Lady of Mozambique, explained how 75% of Mozambique's 128 districts now have waiting houses for mothers-to-be. By providing such accommodations, pregnant women are able to travel before their labor begins and remain in the vicinity of well trained professional health care workers, should a complication arise. Women in the community at risk for complicated deliveries, such as pre-eclampsia, history of cesarean section or severe bleeding, malpresentation, or cases of multiple births, are often advised to travel to a casas de espera anywhere from 2 to 4 weeks before their pregnancy. Once there, the women are often able to learn from midwifes on pregnancy-related topics such as development of the fetus, labour and delivery, breast-feeding, immunization and family planning. In some cases the women use their spare time to make crafts and dresses, in order to sell their products to the local community and generate funds for maintenance. Since most of these houses are free of charge, any extra revenue is especially helpful in maintaining the facilities.

Mozambique is not alone in providing such waiting houses. Many other countries throughout Africa and Asia have instituted similar programmes and are moving toward achieving MDG5. In 1987, a study was conducted in Zimbabwe that found that women who stayed in these antenatal accommodations experienced better pregnancy outcomes than those women who entered the hospital directly from the community. Since then, improvements have been made and the effectiveness of such a program is remarkable. In addition to maternal mortality decreasing, infant survival rates are also being positively affected.

It is crucial that governments provide funding for such initiatives and that South-South cooperation continues to be emphasized at international conferences, such as the African First Ladies Health Summit. By sharing the effectiveness of such a program with other regional leaders and policy makers, it is PPD's hope that maternal mortality can be significantly reduced in the next few years.

You can read about other country case studies at http://who.int/reproductive-health/publications/MSM_96_21/MSM_96_21.chap4.en.html

African First Ladies Health Summit Meets in Los Angeles

"You as First Ladies are powerful champions for the causes you support. Powerful role models, motivators and catalysts for action. Your work is formidable. If we can also harness the efforts of civil society and clinicians to support you, you will be unstoppable."

- Sarah Brown

On April 20th and 21st, 14 First Ladies from across Africa met in Los Angeles, California to discuss and publicize prominent health issues in Africa. Organized by U.S. Doctors for Africa (USDFA) and African Synergy, the two day summit focused on maternal health, malaria, gender inequalities in education, and HIV/AIDS related issues.

Although the meeting tackled a wide range of topics, the focus was unquestionably on women's health and the likelihood of achieving Millennium Development Goal #5, reducing maternal mortality by 75% by 2015. Sarah Brown, wife of British Prime Minister Gordon Brown, spoke at the event and emphasized the importance of maternal health care, stating that "a health system that works for mothers, works also for early infant care, for vaccinations, for infection control, for blood transfusions, for emergency surgery for every member of the community. Build for mothers and you build for everyone." The 14 First Ladies that met in L.A. emphasized the importance of South-South cooperation and finding answers to complicated African problems through dialogue. By sharing both their own countries policy and programmes, as well as holding one another accountable for achieving Millennium Development Goals, the First Ladies summit looks promising as a catalyst for action.

Los Angeles may seem an unlikely venue for a summit promoting African health, but the high celebrity turnout and the First Ladies fashion choices drew a horde of media attention and helped to spread the importance of addressing African health issues worldwide. Agreeing to strengthen their leadership roles in their respective nations and work with U.S. based health experts, the First Ladies departed with a commitment to launch new efforts in health care. USDFA Chairman, Ted Alemayhu explained how "empowering Africa's First Ladies is an innovative approach to bettering the lives of Millions of Africans." South-South cooperation and the pairing of African First Ladies with U.S. experts and organizations creates ongoing partnerships and the potential to achieve change.

You can read Sarah Brown's entire keynote address online, at http://www.huffingtonpost.com/sarah-brown/build-for-mothers-and-you_b_189527.html

Pictures from the First Ladies Health Summit can be viewed at http://www.huffingtonpost.com/sarah-brown/build-for-mothers-and-you_b_189527.html

http://www.unicef.org/specialsession/about/sgreport-pdf/09_MaternalMortality_D7341Insert_English.pdf provides more information on maternal mortality and progress toward achieving MDG5

Film on Abortion in Ethiopia: Not Yet Rain

In 2004, Ethiopia enacted one of the most progressive abortion laws in Africa. A woman may now seek an abortion if her life or health is threatened. Abortion is also permitted in cases of rape, incest, fetal impairment, or if the woman is a minor or physically or mentally injured or disabled. Before 2004, abortion abortion was permitted only to save a woman’s life and protect her health and in cases of rape.

However, many women still continue to perform self-induced abortions for multiple reasons: the stigma of sex outside of marriage, the cost of abortion, an inability to travel to safe clinics, and late term abortion restrictions. The new film Not Yet Rain examines the topic of abortion in Ethiopia through the voices of women who have faced the challenge of accessing safe abortion care within their communities.

Each year, 68,000 women around the world die from unsafe abortions. After hearing some of the techniques described in the twenty-three minute documentary Not Yet Rain, this comes as no surprise. One woman describes how a catheter and an umbrella were used to terminate her daughter's pregnancy, ultimately resulting in her death. Others resort to using sticks, plastic objects, and roots to attempt self-induced abortions. Whatever the reason behind being unable to access safe abortion services, the decision to turn to self-remedies is an extremely unsafe option, and it is vital that education is improved in the most remote communities, in order to ensure that women know their options and rights.

As a result of Ethiopia's revised law and 2006 guidelines for safe abortion services, abortion services are some of the safest in all of Africa. At a clinic in the documentary, the midwife/nurse explains that abortion services are now free, allowing women of all economic levels to receive proper care. Furthermore, the use of a manual vacuum aspirator (MVA) to perform the procedure is extremely safe and does not require the use of anesthesia, thus allowing clinics in the poorest and more remote areas of the community to provide such services. Regardless, the system is still full of problems. Due to a lack of education about reproductive health in Ethiopia, late term abortions are still one of the biggest factors leading to self inducement or use of traditional medicines.

Unintended pregnancy is a root cause of induced abortion and maternal mortality. An estimated 108 million married women in developing countries have an unmet need for contraception. Thus, meeting the need for contraception is a critical step toward reducing the incidence of unintended pregnancy.

In light of the mandates of intergovernmental agreements (ICPD, MDGs, Maputo) the prevention of unsafe abortion and death in all countries is an imperative goal for women’s health and rights.

To view the entire film Not Yet Rain online, visit http://www.notyetrain.org/

For useful resources on maternal mortality and MDG 5, check out the Women Deliver Resources at: http://www.womendeliver.org/resources/womendeliver.htm

For more information on the legal status of abortion, read the Center for Reproductive Rights 2007 briefing, “Abortion Worldwide: Twelve Years of Reform” http://reproductiverights.org/sites/default/files/documents/pub_bp_abortionlaws10.pdf

Related articles from The Lancet on global abortion rates and trends are available online at:

• David A Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E Okonofua, Iqbal H Shah. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006: http://wwwlive.who.ch/reproductive-health/publications/articles/article4.pdf
• Gilda Sedgh, Stanley Henshaw, Susheela Singh, Elisabeth Åhman, Iqbal H Shah. Induced abortion: estimated rates and trends worldwide. The Lancet 2007; 370: 1338–45: http://media.mcclatchydc.com/smedia/2007/10/17/13/Chang-Guttmacher_Institute_abortion_report.source.prod_affiliate.91.pdf
  

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

Commission on Population and Development to Focus on Contribution of ICPD to MDGs

This week (30 March- 3 April) the forty-second session of the Commission on Population and Development will meet at the United Nation's headquarters in New York. The theme this year is "The contribution of the Programme of Action of the International Conference on Population and Development to the internationally agreed development goals, including the Millennium Development Goals."

Founded by the Economic and Social Council in 1946, the Commission is most recently involved in monitoring and assessing the implementation of the International Conference on Population and Development (ICPD 1994). This year's session will focus on lowering population growth, and effective family planning in the least developed nations of the world, in order to reduce overall poverty and remove the barrier to achieving Millennium Development Goals (MDGs).

Since the 1960's, the least developed nations, many in sub-Saharan Africa, have been unable to reduce their overall fertility rates, leading to rampant population growth. On average, these countries have fertility rates of 4.6 children per woman, which is significantly higher than the estimated goal of 2.17 births per woman to achieve "near-replacement-level fertility." Hindered by their inability to reduce population growth, the Commission will emphasize the necessity for these least developed nations to ensure a quicker decline in fertility, in order to "reduce maternal mortality, improve child survival, promote women's empowerment and contribute to poverty reduction." The Commission on Population and Development's second focus this year is on effective family planning, helping to contribute to poverty reduction. By reducing the number of births within a family, the ability to save money becomes more easily attainable and a greater investment in the health and education of each individual child born into the family can be achieved. Furthermore, improved access to efficient family planning contributes to enhanced maternal health and a greater survival rate of young children.

Although efforts are underway to improve the implementation of both population reduction and family planning, the forty-second session this week will express the need for a stronger political commitment and increased funding, in order to achieve significant progress on the ICPD PoA. In addition, the Commission recommends continued implementation of successful programs, an emphasis on national leadership and ownership, the development of effective health systems, and an investment in pro-poor policies.

The Commission explicitly points to South-South cooperation as vital in order to identify what programs are working, and what policies are most efficient, stating that "South-South cooperation is valuable, especially for the identification of best practices and the exchange of lessons learned." A continuous exchange of information between countries will help to improve the overall trend in reaching the MGDs.

Population growth and family planning are crucial topics that must quickly be addressed, and it is the PPD ARO's hope that the this year's session of the Commission on Population and Development will be able to bring to light this year's crucial issues and further encourage South-South cooperation in population and development. Keynote speakers this year include David Canning (Harvard School of Public Health), Jean-Pierre Guengant (Representative from Institut de Recherche pour le Développement, Burkina Faso), and Zeba Sather (Country Director of the Population Council in Pakistan).

To learn more about the Commission on Population and Development, you can access a summary of the session at http://www.un.org/News/Press/docs//2009/pop970.doc.htm

You can also read the keynote address, official statements, and agenda items in English and French for the Forty-second session at: http://www.un.org/esa/population/cpd/cpd2009/comm2009.htm

International Women’s Day: The Status of Women’s Health and Rights

Of the 8 Millennium Development Goals (MDGs), Goal 3 explicitly calls for empowering women and promoting gender equality, specifically setting targets to eliminate gender disparity in all levels of education by 2015, with additional indicators on employment of women and the proportion of women in parliaments. However, gender equality is an essential cross-cutting component for meeting all the targets. According to Kofi Annan, Former Secretary-General of the United Nations, "In our work to reach those objectives, as the Millennium Declaration made clear, gender equality is not only a goal in its own right; it is critical to our ability to reach all the others . . . Study after study has shown that there is no effective development strategy in which women do not play a central role".

Gender gaps in access to and control of resources, in economic opportunities and in power and political voices are widespread. To date, only four countries (Sweden, Denmark, Finland, and Norway) have achieved a combination of approximate gender equality in secondary school enrolment, at least a 30 per cent share for women of seats in parliaments or legislatures, and an approximate 50 per cent share of paid employment in non-agricultural activities for women. In most countries, women continue to have less access to social services and productive resources than men. While the last two decades have seen some progress in many parts of the world in gender inequalities in schooling (as of 2006, the world was on track to meet the primary target of MDG 3: Gender Parity in School). Yet, women remain vastly under-represented in national and local assemblies, on average accounting for only 14 per cent of the seats in national parliaments.

And of particular concern to women’s health and rights is maternal mortality, MDG target 5. Pregnancy should be full of hope and joy--yet for so many women in Africa, pregnancy come with unnecessary danger. As a result, women in sub-Saharan Africa have a 1 in 16 chance of dying from complications of pregnancy or childbirth during their lives; comparatively, the lifetime risk to women in developed countries is 1 in 3,800.

Unfortunately, despite global progress on many of the MDGs illustrated in the Figure: Progress Against Targets to Meet the MDGs, less than 1/10th of the distance to be covered to meet the MDG 5 of reducing maternal mortality has been made. The chart shows how far behind the world is on MDG 5. The MDG target for maternal mortality will unlikely be met globally, and particularly in sub-Saharan Africa, without concerted efforts. The Maputo Plan of Action (PoA) for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights 2007- 2010 states that that “African countries are not likely to achieve the Millennium Development Goals (MDGs) without significant improvements in the sexual and reproductive health of the people of Africa.”

On International Women’s Day, PPD encourages its member and collaborating countries to support implementation of MDG 5 by advocating for improved reproductive health services. Universal access to reproductive health (as called for by the ICPD PoA) is essential to achieve gender equality, combat HIV/AIDS, and reduce maternal and child mortality.

Find out more information (including what you can do) by reading PPD ARO’s policy brief on RH in the MDGs:
In English: http://ppdafrica.org/docs/RH-MDGs.pdf
In French: http://ppdafrica.org/docs/RH-MDGsf.pdf

More information on the MDGs is online at:
UN: http://www.un.org/millenniumgoals/
MDG Indicators: http://mdgs.un.org/