Target 1: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

Target 2: Achieve universal access to reproductive health by 2015

Geoffrey Dennis, Chief Executive.Geoffrey Dennis, CARE International UK chief executive examines progress on MDG5:

“Of all the MDGs, the world has made the least progress in achieving the targets set for MDGs 4 and 5: Reducing maternal and child mortality and helping women access reproductive healthcare. “A recent study released in the medical journal The Lancet suggests that global maternal deaths are declining.

While this news is encouraging, the truth is that the number of women who will die this year in pregnancy or childbirth - whether it’s 350,000 or 450,000 or 550,000 - is still far too high. In fact, many countries, particularly in sub-Saharan Africa and Southern Asia, have made little or no progress at all in reducing maternal mortality.

“These statistics are particularly devastating when you consider that a majority of these deaths can be prevented if women have access and are able to utilize proven, cost-effective, life-saving interventions. Urgent and decisive action is needed to accelerate progress on MDG 5, the MDG that has consistently been the most off-track. What is needed now are the financial resources and political will to make progress to save women’s lives.”

How Do We Achieve Success?

During the MDG Summit, global leaders have an opportunity to tackle one of the most basic human challenges the world faces – assuring the survival of women and newborns. UN leaders must adopt and take decisive action to implement a bold plan on maternal and newborn health, building on the G8 Muskoka Initiative on women, newborns and children’s health and linking closely with the financial, political and  programmatic commitments being made as part of the UN Secretary General’s Global Strategy for Women’s and Children’s Health.

CARE believes any strategy to make progress on MDG 5 requires focusing on the following priorities:

• Be comprehensive, cover the full ‘continuum of care’ and integrate/link with other health and development issues. Any plan must cover the broad spectrum of healthcare services that connects home to community, to clinic, to hospital and back again and across the lifecycle. It must also support community-based approaches that integrate or link maternal and newborn health with child survival, sexual and reproductive health and family planning, nutrition, micro-finance, education and HIV/AIDS in a coordinated manner.
• Focus on ensuring access for poor people and the most vulnerable people, in the world’s poorest regions. Interventions must address the extreme inequity in receipt of quality health services by focusing on the most vulnerable and by removing barriers to women accessing services, including cost, transportation, discrimination and cultural beliefs. The UN must give special attention to responding to the needs in Africa and support the commitments and ongoing efforts of African countries.
• Focus on empowering women and girls. Women and girls are often the most vulnerable to poverty, poor health and social marginalization due to their social position and existing gender inequalities, yet do not have the resources, nor power needed to change their situation. Evidence has shown that by empowering women, you can increase their use of health and other services; improve their lives, the well-being of their children and the economic stability of their communities; and make governments more accountable to their needs.
• Commit to accountability and tracking results. A comprehensive approach needs to provide for regular reports on the progress made in implementing financial, programmatic and policy commitments, including measurable results/impacts and any needed midcourse corrections.
• Invest in strategies focused on promoting civil society participation and mobilization.
• Even when measures are taken to improve health care facilities and services, poor women still face additional barriers such as cost, discriminatory behaviors of health workers, and lack of understanding of their health rights that often prevent women from seeking or utilizing health services. An active and informed civil society can overcome these barriers by educating women and the broader community about their health rights, demanding improvements in policies and services, monitoring and reporting on the quality of health services and holding governments and decision-makers accountable to their commitments.
• Engage communities as core partners in program design, implementation and evaluation.
• Communities understand the barriers, including structural barriers, social norms and gender related inequities, to improving health in their specific country context. It is through working in conjunction with the people on the ground that real and lasting change can be made.

Maternal Health… The Facts!

• One woman dies nearly every minute of every day during pregnancy or childbirth—and millions more are left with life-altering disabilities. The vast majority of these deaths are preventable.
• One in four women in developing countries continue to give birth alone or with only a relative or neighbor to assist them.
• In many countries where CARE works, a girl is more likely to die during pregnancy than attend school.

Maternal Health Success Stories

A few examples of CARE’s recent success stories include:

• In Tanzania, Rwanda and Ethiopia, CARE increased access to emergency obstetric care and cut fatality rates in emergency obstetric care facilities by 30 percent to 50 percent.
• In Peru, CARE strengthened community capacity to address maternal health risks resulting in a 50 percent reduction in maternal mortality in the remote project area and a doubling of women accessing health services and treatment for obstetric complications in health centers. The Peruvian Minister of Health established new national clinical guidelines for obstetrical emergencies based on those developed through CARE’s project.
• In India, CARE advanced a 10-year program in nine states - one of the largest non-governmental organization (NGO) public health programs in the world - to strengthen the quality and coverage of maternal and child health services, and to improve maternal and child survival in more than 90,000 villages.

And if world leaders needed more reasons to take action….

• Healthy women mean huge economic returns. Each year an estimated US$15.5 billion in potential productivity is lost when mothers and newborns die. Poor maternal health is associated with reduced labor market participation, decreased wages and increased welfare dependency.
• Illness and loss, particularly of a mother, can be a major cost to a family or community and accelerate the cycle of poverty, a cost which is picked up by government spending to manage the widespread effects of poverty.  One serious malarial infection can pull a family into poverty due to the cost of care.
• Money spent on preventing illness and promoting good health reduces the healthcare costs of curing people when they get sick. For child survival alone, US$700 million globally per year could be saved in healthcare spending (e.g. the costs of infant illness and death.)
• 30-50% of Asia's economic growth between 1965 and 1990 can be attributed to favorable demographic and health changes, which were largely a result of reductions in infant and child mortality and subsequently in fertility rates and also improvements in reproductive health.
• 60 percent of all farmers in Africa are women - making them major contributors to Africa’s agriculture-based economy.
• A woman’s earning power increases 10-30 percent every year of education she receives - which means more money to invest in her family and community.
• For every year a woman is educated, the mortality rate of her young children is reduced 5-10 percent - her children are better fed, better cared for, and more likely to be vaccinated.
• Girls in school are six times less likely to be married off to older men - preventing forced pregnancies, abuse and HIV infection.

Comment from the expert:

Gaia Gozzo, Governance Advisor for Latin America and the Carribean.Gaia Gozzo is CARE International UK’s Governance advisor for Latin America and Caribbean region:

“The world leaders at the MDG conference have every reason to step up their commitment to MDG 1. There is proof that efficient programming on maternal health can and does work. A recent Government survey in Peru found that maternal mortality fell by 44 per cent from 2000 to 2009.

“This fantastic achievement puts Peru up there with the countries that have been most successful in recent years in reducing maternal mortality, and on track to reach the MDG target.

“CARE has contributed to this remarkable achievement by encouraging women’s involvement in community organisations, providing technical assistance that benefits those living in poverty and by training citizens from traditionally marginalised groups to monitor heath services. This work led to the development of a set of national neo-natal guidelines for health workers.

“CARE has also been providing support on maternal health to the Peruvian Ministry of Health, to scale up the model for emergency obstetric care developed by CARE in the Ayacucho region. That project cut maternal mortality by 49 per cent over five years and boosted newborn health after a successful advocacy process highlighting the importance and magnitude of this neglected health issue.”