On the whole, we gave the world's
most powerful leaders poor marks on a complex ten-point matrix of health
issue content and financing results. The only exception was in their
commitment to strengthening health systems worldwide and to following
up on health at subsequent conferences. Here are the highlights:
Content: B-
An A- on the follow-up
mechanism that puts global health on the permanent G-8 agenda is pulled
down by Ds for the lack of language about primary health care, universal
access to reproductive health care, and rights of HIV-positive people.
A couple of Bs for noting the importance of a continuum of care and
the urgency of acting if the MDGs are to be achieved.
Finance: D
Real commitments were lacking
everywhere, and the grade for maternal and child health was F: the genuine
need for an additional US$10.2 billion a year was ignored.
General: C-
The Bs and Cs for content (i.e., promises) were overwhelmed by the Ds and Fs for financing (i.e., reality) for a disappointing overall grade. The only A was for the (unfunded) commitment to keep talking every year about global health, especially maternal health, and to evaluate progress. We shall see if this actually happens.
To view the full report card, click here.
Further thoughts
The actual language
The best language on maternal health came from UN Secretary General Ban Ki-Moon in his opening statement to the conference: "Maternal health stands as the slowest-moving target of all the MDGs. US$10 billion would ensure coverage of basic services for maternal, newborn and children's health. More investment for training community health workers would be a strong step towards strengthening health systems."
The final paragraph of the
communiqué "recognizes that for progress to be made on maternal,
reproductive and child health, and emerging and neglected health priorities,
additional resources - from both domestic and international sources
- are needed if the health MDGs are to be achieved."
In the "Toyako Framework
for Action on Global Health: Report of the G-8 Health Experts Group"
maternal/newborn health was mentioned four times, including a full paragraph
on the need for a comprehensive approach to reducing maternal and newborn
mortality: the continuum of care, increased access to skilled birth
attendants, access to emergency obstetric care, and a recommendation
that reproductive health care should be made widely accessible.
Immediately after our group press conference, I had an interview with a reporter who was here for both the International Herald Tribune and Japan's largest newspaper, Asahi Shimbun. It was a great chance to elaborate on our rationale, answer questions, talk about conservative U.S. positions on sexual and reproductive health and rights, and to make some substantial points about the benefits of investing in women. Clearly the economic arguments are the winning ones.
In short, it was a good start
and amazing that we accomplished so much in our first year of work with
and about the G-8. The ground is prepared and change is happening.
All this takes enormous energy from many people in different places, contributing different pieces - British First Lady Sarah Brown and her warm, determined, consistent reminders at every opportunity; the agencies who worked with the Secretary-General to be sure he highlighted maternal health in his speech; the researchers who helped us with the facts and the journalists who crafted the concepts into ink. We thank everyone for the work well done and the work still to be done.
Opportunities ahead include the September special UN General Assembly session on the MDGs, and then it's on to the G-9 summit in 2009-in Italy.
The non-politics
All week the clouds hid the near-vertical green mountaintops that surround this resort, but on the final morning, as I was walking to the bus, the clouds lifted - and there was Mount Yado, known as the Mount Fuji of Hokkaido. It was glorious, towering over us in perfect symmetry.
The hour-long bus trips back and forth to the conference site were wonderful. The things of daily life are relatively small here: cars, of course, but also doorways, chairs, bus seats ...it took some getting used to! As did the security everywhere: police wearing amazing outfits, especially in this heat-full-body Kevlar protecting every joint, every vital part, even with flaps down the back of their hats. Rumor said the security measures cost US$248 million, and I believe it.
I never saw a single weed in
the gardens that seem to be everywhere in Japan. Every house has flowers,
even if it's just one marigold in a coffee can. Most are tidy and
geometric, but some homes are surrounded by chaotic riots of color.
The vegetable fields are in flower too -- and the melons are worth a
trip to Japan all by themselves. I learned that ordinary citizens planted
thousands of flowers to welcome us. We saw them everywhere in unexpected
places, and that made us all feel very welcome and comfortable. Some
villages chose eight flowers, one for each of the G-8 countries.
The countryside is dotted by
shallow rivers, with rafts and canoes. Not many cows, but they must
be somewhere because the cheeses are amazing. We passed one farm with
a sign saying "Happy Life Holsteins." I don't doubt it for a minute.
It really is spring here, very late this far north. The wheat fields are only starting to turn gold -- winters are long and harsh: special signs along the road tell people where the road is when it's covered in snow. That's the attention to detail we saw everywhere -- signs are very specific and the people incredibly helpful. They were always willing to help get us un-lost. They honor tradition and we honored that. It will take awhile to readjust to New York!
]]>
The big issues here were climate
change, the global food crisis and the political situation in Zimbabwe,
but the NGO Health Group press conference this morning was very well
attended. We're in the game, we made progress -- more than most expected,
less than some had hoped. Now to take things forward -- faster!
First the good news:
Now the not-so-good news:
As I said, now comes the adding-up. We'll be posting a scorecard that our NGO Health Group devised, a tally of G-8 achievements and failures that got major attention at our press conference this morning.
Overall, the conference was a good start for us. The groundwork has been laid and the door is open -- we just need to pick up the speed of our walk through it.
Check out the following related resources:
The Final G-8 Communiqué
on Development and Africa
Africa's problems were Monday's focus: Algeria, Ethiopia, Ghana, Nigeria, Senegal, South Africa and Tanzania took part in discussions on development assistance and soaring food prices. On Wednesday, the focus will be Australia, Brazil, China, India, Indonesia, South Korea, Mexico and South Africa, who will join the G-8 for talks at their island conference venue. In between, the main Group of Eight will confer, and most of their discussions will be broadcast live to us NGOs milling about here at a stunning ski resort about 45 minutes away.
The setting is breathtaking, amid steep
mountains that vanish into the clouds, with events spread out among
distant buildings. But it's all green now, the breadbasket of the
country, and it's early spring crop time: Lunch choices involved sugar
snap peas, asparagus, berries, lovely cheeses and 11 soft ice cream
flavors, including purple sweet potato. That's high on my list of
things to try. And of course there's riot squads and padded wagons
too numerous to count. Camouflage helicopters buzz in and out with VIPs,
limousines hover and police are visible everywhere.
Sarah Brown, the wife of UK Prime Minister Gordon Brown, and Kiyoko Fukuda, wife of the Japanese Prime Minister, had us to tea at the British embassy in Tokyo on Saturday afternoon: Japanese dignitaries, the health and population community, and other international visitors, some of whom were in Japan for the G-8 meetings. It was very hot and humid but we got cucumber sandwiches and enormously enthusiastic support for our health agenda from all present.
Mrs. Brown praised Family Care International, Oxfam and White Ribbon Alliance as the engines behind the success so far in landing maternal health high on the agenda, and said she would spend her entire time here working on the issue. Mrs. Fukuda focused more on MDG 4, children's health. It is really energizing to have their warmth and support.
There's a so-called People's Summit
2008 in Sapporo, about 50 km. west of here, where alternative views
are being aired by NGOs, anti-Iraq-war demonstrators, and anti-globalization
groups as well as farmers, students, and union activists. They had a
peaceful Peace Walk on Sunday, where Oxfam representatives dressed up
in kimonos as the G-8 leaders and did a karaoke rendition of Abba's
"Money, Money, Money."
Attention is being paid to all this -
nearly 3,000 journalists are covering the G-8 from a media center set
up at a ski resort in Rusutsu; 30 of them for every one of the 100 or
so NGO representatives. Pretty good odds, for once!
Hard work starts Tuesday
The draft final communiqué is expected to come out Tuesday, and the buzz is all about the new order in the health section: it usually starts with a discussion of infectious diseases, but this year Section A will focus on the need to strengthen health systems worldwide. This is very different and a major step forward (the hope is they'll call for 2.3 workers per 1,000 people and a global investment of $60 billion). Following this - Section B - focuses on maternal, newborn and child health; also a first and a real triumph in being spotlighted this way.
We hear that the United States delegation wanted to eliminate any reference to reproductive health services, in their usual opposition to the International Conference on Population and Development goals, and that the European countries, especially Germany, led the resistance, so that this critical language is still in the draft. I'll keep you posted.
Infectious disease is the focus of Section
C, which also emphasizes the need for a cross-sectoral approach, noting
the interrelationship of all the MDGs and the importance of gender issues.
So far, the communique's final paragraph
(#30) says the G-8 "also recognizes that for progress to be made on
maternal, reproductive and child health, and emerging and neglected
health priorities, additional resources-from both domestic and international
sources-are needed if the health MDGs are to be achieved..."
The NGO health group here has designed a clever scorecard to evaluate what happens on our global health issues in terms of numerical targets, financial commitments and plans, timelines and actions. We'll be giving out grades as soon as the conference ends Wednesday - so stay tuned.
]]>The Group of Eight, the world's largest economies, have added health -- and specifically maternal health -- to the agenda of this year's annual meeting, at the behest of this year's host, Prime Minister Yasuo Fukuda. In fact, the G-8 will consider every major global issue during this three-day gathering: world economy, the environment and climate change, development (especially in Africa), and the Millennium Development Goals (MDGs), particularly health, water and education. This year is special -- it marks the halfway point to the 2015 deadline for meeting the MDGs, and it's also the 60th anniversary of the Universal Declaration of Human Rights.
And 2008 is also the start of the First Commitment Period (i.e., the first steps) of the Kyoto Protocol on fighting global warming, and the start of negotiations for the next period. The G-8 leaders will talk about all that, and they are also considering major political issues like strengthening nuclear non-proliferation strategies and building world peace.
Reliable rumor has it that the working draft of the G-8 final communiqué refers favorably to the need for action on the maternal health and child survival but omits the $10 billion "ask" we recommended to the Sherpas -- the personal representatives of the heads of state who prepare for the G-8 each year -- which could save the lives of six million mothers and children each year. This illustrates one of the great G-8 problems: it announces many good intentions and makes sterling promises, but the leaders then consistently fail to deliver.
We hope the leaders will at least agree to make global health (and maternal health) a part of every G-8 agenda from now on, until they DO deliver; and that they will set up a system to evaluate and track progress on the promises and pledges that are made. That would be a good first step. We shall see. The meeting ends Wednesday night.
The Civil G-8
From April 23 to 24, civil society representatives from around the world convened in Kyoto, Japan and joined selected Japanese civil society groups as part of a series of preparatory sessions leading up to the G-8 Summit in July. Participants were chosen by the Japanese Ministry of Foreign Affairs; in Japan, there's regular dialogue between the foreign ministry and NGOs on global health, and this year the Japanese Organization for International Cooperation on Family Planning (JOICFP) played a significant role in setting up this Civil G-8 session.
That session, the third annual, was small and focused, with about 200 participants (including 50 journalists) organized by Japan's Global Call to Action Against Poverty (GCAP), funded by the foreign ministry and OSI. Its purpose is to come up with joint civil society positions to sell to the G-8, through their Sherpas, who hold their own pre-G-8 meeting every year on world economic issues. An EU representative chaired the session.
There was lots of talk about world financial trends, all downward. Not one of the G-8 has reached the recommended level of contributing 0.7 percent of GDP to overseas development assistance. The countries that are the most on track have commitment from their leaders, who have prioritized it in their budgets; more accountability and transparency, especially on delivery systems; and more media and public debate.
Some of us wanted to push harder on that and on abolishing conditions on aid. Two issues were over-arching: the number of health workers on hand versus the number needed to create global health; and the new food crisis.
After a lot of discussion among the dozen civil society groups focusing on health, we decided three speakers would make presentations to the Sherpas at the April meeting: one on MDGs 4 and 5 (improve maternal and child health - that was me); one on MDG 6 (combat HIV/AIDS, malaria and other diseases - that was Masaki Inaba, Programme Coordinator on HIV/AIDS, Africa Japan Forum); and one on MDG 3 (promote gender equality - Dorothy Shaw, President of the International Federation of Obstetrics and Gynaecology).
The basic message on maternal and child health then and now is: "We know what to do. We know how to do it. We know what it costs. We sadly know what it costs NOT to do it." The full statement from the health-focused groups called for fulfillment of the G-8 commitment made at last year's Summit to provide $60 billion for HIV/AIDS, TB and malaria, and to add an additional $10 billion for maternal and child health.
The Sherpas showed differing levels of interest in what we all had to say. Germany, Japan and the UK were receptive; the U.S. was focused on environment and climate change.
Afterward, nobody in our group was optimistic about getting much more money allocated since current trends in health funding have been downward. But this could change if the right people actually understand the truth of our arguments that investing in women's health is the best way to fight poverty. Again, we shall see.
]]>This is the last in a series of posts about maternal mortality written by Jill Sheffield leading up to the Women Deliver Conference, October 18-20th, in London. RH Reality Check will be covering the conference, with reports from our Global Perspective writer in England, Rupert Walder, as well as from youth attendees from Advocates for Youth. Also, stay tuned for Jill Sheffield's post-conference analysis at the end of October!
The Women Deliver conference is only a couple of weeks away, and momentum is building. We've seen a flurry of activity that shows our message is registering with world leaders: Invest in women-it pays!
Over the past couple of months, more headlines have appeared on maternal and child mortality than during most of the past year.
In late August, the Centers for Disease Control released the newest statistics on U.S. maternal mortality: Things are getting worse.
According to the CDC's August 21 National Vital Statistics Report, complications of pregnancy and childbirth killed 540 U.S. women in 2004. That's 45 more than in 2003, the highest total since 1977. And for every woman who dies, another 30 suffer long-term illness or disability.
The scandalous U.S. maternal death rate is now 13.1 deaths for every 100,000 live births, among the highest rates for any industrialized country. Translated into the lifetime risk for women of childbearing age, this means one in 2,500 American women will die from pregnancy-related complications. That puts the United States at number 36 in the world rankings of 181 countries, behind Poland and Korea and just ahead of Bulgaria.
The reasons: rising U.S. rates of obesity, diabetes and high blood pressure, along with better reporting. Poor health care for minority U.S. women is the underlying problem: the rate for black women is nearly four times that for white women - 34.7 deaths per 100,000 live births versus 9.3.
Then UNICEF released figures showing child deaths at a record low of 9.7 million per year -below 10 million for the first time since records have been kept. The level is still tragically high, and it's not coming down as fast as it did in the 1970s, but it shows what can happen when donor priorities target one area.
It's time to target maternal mortality. A recent Newsweek article points out the obvious: the cures are well known and cost-effective. They are: education for girls and women, to teach them about their bodies and give them options in life beyond childbearing; better access to comprehensive reproductive health services, including family planning and abortion-related services; skilled care during pregnancy and delivery; and access to emergency services.
That's the idea behind two new European initiatives to save women and children. Last month, British Prime Minister Gordon Brown and Germany's Chancellor Angela Merkel detailed the International Health Partnership (IHP), a major multi-government initiative to strengthen developing countries' health care systems to fight disease and reduce child and maternal mortality.
Then, Norway led a coalition of governments announcing a major advocacy drive called Deliver Now for Women and Children. That drive joined the IHP as one of several parts of a broader Global Campaign for the Health MDGs. Norway then pledged an additional $1 billion specifically for MDGs 4 (reduce child mortality) and 5 (improve maternal health). A glittering event launched Deliver Now in New York City to build momentum for all these efforts worldwide.
This welcome activity is perfectly timed to coincide with Women Deliver, the Oct. 18-20 conference of more than 1,500 world leaders at London's ExCel Centre. The World Bank will join the chorus at its annual meeting in Washington with a special Oct. 18 session on Women Deliver issues. The Lancet will devote its Oct. 13 edition to Women Deliver, and WHO, UNFPA and UNICEF will make public new maternal mortality statistics and country rankings for 2005, the latest in their series of five-year updates.
In short, Women Deliver is already helping to generate serious political will worldwide to save the lives and improve the health of women, mothers and newborn babies around the world. We expect the gathering to be a landmark moment as we join to make history on this stubborn issue. After all, we're halfway to 2015, the target for achieving the Millennium Development Goals - and this activity gives me hope we might actually get there.
It's time to deliver for women.
]]>But the stories are only part of the full picture: the country's women are disproportionately the victims of the destruction of Afghanistan's health infrastructure. Because the health care situation is so bad, Afghanistan's maternal mortality rate is tied with Sierra Leone's as the worst in the world: one in every six Afghan women will die from complications of pregnancy and childbirth, according to the World Health Organization. Compare that to the U.S. rate of one in every 2,500 women and the Swedish rate of one in 29,800
It doesn't have to be like this. We know what to do to save these lives. That's why Family Care International is coordinating Women Deliver, a landmark global conference in London next October that will focus on creating political will to save the lives and improve the health of women, mothers and newborn babies around the world.
In Afghanistan and many other places, news media and governments seem oblivious to the daily tragedy of maternal mortality, which kills one woman every single minute of every day. Worldwide, we lose ten million women in every generation needlessly this way - wives and mothers, aunts and sisters, neighbors and friends. We also lose four million newborns every year, also from causes that are mainly preventable.
From October 18-20 at London's ExCel Centre, some 2,000 world leaders will hear this message: "Invest in Women: It Pays!" With increased political will and adequate financial investment, most women and newborns can survive so that their families, communities and nations can thrive.
The proof is in places like Afghanistan. If U.S. aid and the Afghan government had decided to invest in keeping Afghan women alive, and not just in making war, the country would now have at least a bare-bones health care system that would serve not just pregnant women, but everyone! They would also have a generation of healthy women who deliver in many other ways: paychecks, creativity, energy for economic production, for teaching, for reducing poverty, for the thousand other things all development advocates want and that families and communities need.
Pregnant women survive where they have access to basic health care, skilled caregivers such as midwives, and emergency care facilities with equipment for safe blood transfusions and surgeries. Those are the same things that keep everyone else alive, in daily life and in emergencies.
At the Women Deliver conference, governments - including the U.S. government - will get the message: investing in women pays off, no matter what your other needs might be. Without healthy women, other investments won't be as effective, sustainable, or long-lasting. That is why Millennium Development Goal #5 - to improve maternal health - is sometimes called the heart of the MDGs: the things needed for its achievement have so many other benefits. And if it fails, all the other MDGs will fail too.
The New York Times on July 12 lamented the Taliban's targeting of Afghanistan's public schools and called on the U.S. government to invest much more in teachers, school construction and security for them. It noted that schools and thousands of new school-going girls are "one of the new government's proudest achievements and sources of hope."
That is certainly true, but it is a mystery to me why maternal and newborn health doesn't receive the same kind of consistent media attention. Pregnancies don't take time-outs to await solutions to political struggles, and meanwhile every generation loses ten million women worldwide. It's a real tragedy, and not just in Afghanistan.
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The seeds for Women Deliver were planted right there. We began to plot ways to bring some kind of major global attention to the continuing worldwide devastation of maternal and newborn deaths. Our timing was right: the Safe Motherhood Initiative started in Nairobi 20 years ago, in 1987.
Have we significantly reduced maternal mortality since then around the world? Will we reach Millennium Development Goal (MDG) 5, reducing maternal mortality by three-fourths by 2015? Not at the rate we are moving now. So can we stand by and just keep doing what we are doing? No way.
I am often asked some good questions about Women Deliver: Do we really need another international conference? How will Women Deliver be different from all previous efforts to move a reproductive health agenda?
Every minute of every day, a woman dies needlessly in pregnancy or childbirth, most in the developing world. We have all heard this before about HIV/AIDS and maternal mortality. Remember the Broadway play Rent and its lead song, "525,600 Minutes"? Hum along, please. But stop and think: that's ten million women lost in each generation.
The fact of life is that huge disparities exist between rich and poor countries, and between the rich and the poor in all countries.
We shared these numbers with a colleague in the U.K. recently and she emailed an urgent correction to "the typo in the U.S. numbers." She thought we were missing a zero. But one in 2,500 is correct. The U.S. maternal mortality rate is high, one of the highest among industrialized nations—and the rate for black U.S. women is four times higher than for white non-Hispanic women. For Hispanic women it's higher than that.
So ask yourself, if not now—when? And let's not put it off to an election year when we'd be competing for world press, as we did at Countdown 2015.
The experts agree: with increased political will and relatively modest financial investment, most women and infants can survive so that their families, communities and nations can thrive.
Think survive and thrive. And think about joining 2,000 world leaders in the health and development community and come to Women Deliver. Our theme is Invest in Women: It Pays!
In upcoming blogs, I will share with you news about speakers, plenary sessions and media outreach along with things you can do to make a difference.
Go to: www.womendeliver.org
]]>Mother's Day is bittersweet for those of us who work in the field of maternal health. On the one hand, we appreciate the earnest tributes to the importance of mothers. And it is gratifying to note the increased global focus on the preventable tragedy of women's pregnancy-related deaths: Nicholas Kristof writes heartbreaking stories about women's lives and deaths in developing countries; maternal health is now enshrined in the Millennium Development Goals; and NGOs and donors alike—notably Britain's Department for International Development (DfID)—are making significant commitments to combat maternal deaths.
On the other hand, the reality is still that pregnancy is terribly dangerous for women around the world. The fact that the numbers are so familiar to us—one in 16 women in developing countries still dies from a pregnancy-related cause—in no way lessens their horror.
Over 20 years ago, I was in Nairobi attending the conference marking the end of the UN Decade for Women for the Carnegie Corporation. A World Health Organization (WHO) spokesperson told us that new figures indicated that a woman dies every minute from pregnancy. I was shocked by this fact, by the injustice that it represented, and I resolved at that moment to do something about it. Family Care International (FCI), the organization I founded with my colleague Ann Starrs, grew out of our conviction that we needed to start focusing the world's attention on these unnecessary deaths, and developing strategies to combat this problem. The founding of FCI coincided with the launching of the Safe Motherhood Initiative; FCI served as the Secretariat of this effort for 17 years, until its expansion into The Partnership for Maternal, Newborn, and Child Health, now housed at WHO.
This year, FCI—and the Safe Motherhood Initiative—are celebrating their 20th Anniversaries. Despite 20 years of effort, we know that one in 16 women in developing countries still dies from pregnancy. The contrast with our own lives is painful. When I ride on a crowded subway in New York, I look at the women around me and estimate that if they lived in rural Africa, two, three, or more of them would die prematurely and painfully simply because they live in a place without access to care. Each death must mean so much to these women's children, parents, partners, and communities. Last fall, when I visited communities in rural Kenya where FCI implemented our Skilled Care Initiative, I met women who told me their health and their lives were saved by improved health care services. Why are women still dying to give birth? And, most importantly, what can we do?
We've learned a lot over the past 20 years. The evidence is now clear—a midwife or doctor, with proper training and the right environment (which includes basic equipment, infrastructure, supervision, and policies) can manage many of the complications that arise before, during, and after childbirth. When the health care system is strengthened and women use it, we have seen dramatic reductions in maternal deaths, even in relatively poor countries.
But, there are far too many settings around the world where women—particularly those who are poor, indigenous, and rural—cannot access the high quality care that can save their lives.
We know what we need to do; we need the funding and political support to do it. Clearly, women's lives have to matter—not just to their partners and their children, but to their communities' leaders, their politicians, their religious leaders. We need to advocate for these critical investments on multiple levels, using arguments that resonate with different audiences. Safe motherhood is a rights and equity issue and we need to focus on it as such. The economic argument—that countries simply cannot afford to lose so many young, productive people—is also very powerful with important decision-makers, including finance and planning ministers, and corporations.
To mark 20 years of the safe motherhood movement, and to provide direction and momentum for the next 20 years, FCI is serving as the organizing partner for a major conference. Women Deliver, which will take place in London in October, will bring together political leaders, parliamentarians, business leaders, technical experts, and other leaders to mobilize increased investment and commitment to maternal health. We know that the health sector alone cannot solve the complex problem of maternal deaths, so these experts and creative thinkers will come from a range of sectors: maternal health, and also human rights, gender, HIV and AIDS, education, micro-enterprise, sexual and reproductive health, including family planning, and more. (More information is available on the Women Deliver website.)
This Mother's Day it is time to make good on our promises, not just to our own mothers, but to the mothers of the world.
]]>Jill Sheffield is the Founder and President of Family Care International (FCI).
I just returned from Malaysia, where I attended the International Federation of Obstetrics and Gynecology (FIGO) triennial congress. I traveled with some of my colleagues from Family Care International (FCI) to present results from the final evaluation of FCI's Skilled Care Initiative, a three-country project to increase the proportion of women who deliver with a "skilled attendant" - a trained and properly supported health care provider - in rural Africa. I'll be writing more about this initiative in my next posting.
In Kuala Lumpur, thousands of obstetricians and gynecologists gathered to share data from new studies, learn about new surgical techniques, and vote on their leadership. Among so many dedicated doctors who have made a lifelong commitment to promoting the latest and greatest in women's health, one could be lulled into thinking that women's health must be in good shape.
Sadly, over the past 20 years, maternal mortality rates have barely budged in much of the world. In some African countries, as many as one in 10 women will die of a pregnancy-related cause. Nicholas Kristoff's two columns in the New York Times (published in September) about the death of Prudence Lemokouno described the factors that contribute to maternal mortality. Ms. Lemokouno had a pregnancy complication which could have easily been dealt with had she received prompt obstetrical care, and when she and her family sought care, they encountered a range of barriers - financial, geographic, and cultural - that resulted in unacceptable delays, poor service, and ultimately, her death.
]]>Jill Sheffield is the Founder and President of Family Care International (FCI).
I just returned from Malaysia, where I attended the International Federation of Obstetrics and Gynecology (FIGO) triennial congress. I traveled with some of my colleagues from Family Care International (FCI) to present results from the final evaluation of FCI's Skilled Care Initiative, a three-country project to increase the proportion of women who deliver with a "skilled attendant" - a trained and properly supported health care provider - in rural Africa. I'll be writing more about this initiative in my next posting.
In Kuala Lumpur, thousands of obstetricians and gynecologists gathered to share data from new studies, learn about new surgical techniques, and vote on their leadership. Among so many dedicated doctors who have made a lifelong commitment to promoting the latest and greatest in women's health, one could be lulled into thinking that women's health must be in good shape.
Sadly, over the past 20 years, maternal mortality rates have barely budged in much of the world. In some African countries, as many as one in 10 women will die of a pregnancy-related cause. Nicholas Kristoff's two columns in the New York Times (published in September) about the death of Prudence Lemokouno described the factors that contribute to maternal mortality. Ms. Lemokouno had a pregnancy complication which could have easily been dealt with had she received prompt obstetrical care, and when she and her family sought care, they encountered a range of barriers - financial, geographic, and cultural - that resulted in unacceptable delays, poor service, and ultimately, her death.
Any one of the wonderful doctors who met in Kuala Lumpur could have saved this woman's life, and they do save women's lives in their daily work. But they rarely work in the areas of highest need - among poor, rural communities - and the barriers between the life-saving care that these highly trained professionals can provide and the women who need them, can be high indeed. The "enabling environment" for health care providers - equipment, operating theaters, surgical supplies, efficient management and adequate salaries - simply does not exist in much of the world. A multi-sectoral approach is needed to reduce all the barriers to care that result in the deaths of over half a million women each year.
Malaysia provides us with a useful example of such an approach. After independence, Malaysia invested heavily in community-based midwives - well-trained health professionals, working as part of a team with doctors. These midwives now conduct most deliveries. Traditional birth attendants, who had previously attended women undergoing home births, were integrated into the health care system, tapping in to their special knowledge of the communities where they live. Significant national investment went to health care generally (for more on Malaysia's approach to reduce maternal deaths, see FCI's profile). The result is that now maternal deaths are extremely rare in Malaysia, where fully 97% of births are attended by a trained health care worker (my figures come from the latest Human Development Report, which was released this week). In contrast, in Cameroon where Ms. Lemokouno lived, just 62% of women receive such care. And Cameroon has one of the highest rates of skilled attendance at birth in Sub-Saharan Africa - Niger and Chad are at 16%, and in Ethiopia, a mere 6% of women receive medical care during child birth. In Malaysia, only 41 out of every 100,000 births results in the death of the mother; in Cameroon, this ratio is more than 10 times higher, with 730 women dying for every 100,000 births.
By the middle of next year, we will be halfway through the timeframe set by the Millennium Development Goals. Do we have any chance of meeting MDG 5 - reducing maternal mortality by three quarters by the year 2015? After returning from Malaysia, I am allowing myself to be optimistic.
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