TWN Info Service on Health Issues (December 06/04)

7 December 2006

Reducing maternal mortality stymied by lack of funds and absence of national laws

Among all reproductive health indicators, the least progress has been made in reducing maternal mortality. This means that the fifth Millennium Development Goal to reduce by three quarters the maternal mortality ratio, given that over half a million women die every year during pregnancy or childbirth will not be reached in many countries.

Lack of funds and the slow progress to implement laws that protect maternal healthcare and reproductive health rights are undermining this goal.

The report below is reproduced with the permission of South-North Development Monitor (SUNS) # 6149, 27 November 2006.

With best wishes
Evelyne Hong

Development: Maternal mortality goals hit by funds crunch

By Marwaan Macan-Markar, IPS, Bangkok, 23 November 2006

A scarcity of funds and a failure to translate national laws into action are undermining hopes of the world meeting a key development goal in 2015 that aims to help women, says a ranking UN official.

The fifth Millennium Development Goal (MDG) ''will not be reached in many countries because of a lack of implementation of national laws and a lack of resources to fund programmes the laws call for,'' Thoraya Obaid, head of the United Nations Population Fund (UNFPA), said in an IPS interview.

This goal - to reduce by three-quarters the maternal mortality ratio, given the estimates that over half a million women die every year during pregnancy or childbirth - is one of eight targets that the world's nations pledged to meet at a UN summit in 2000.

The other goals, set with the 2015 deadline in mind, include eradicating poverty by halving the number of people living on less than one US dollar a day, eliminating gender disparities, reducing child mortality by two-thirds and halting the spread of killer diseases, like HIV/AIDS.

As significant to the looming failure of the fifth MDG was the slow progress among developing countries to implement laws that guarantee maternal health care and reproductive health rights, said Obaid, on the sidelines of a conference here on population and development goals attended by 180 parliamentarians from 103 countries.

''If there were laws, we can hold governments accountable. But if there were no laws, you cannot hold them to anything.''

The findings of a global survey released during the meeting, which ran from November 20-22, revealed that 250 laws addressing concerns such as gender-based violence, empowerment of women and support for reproductive health had been passed in 77 countries, a figure well below half the number of nations at the UN - 192.

Obaid also faulted the developed nations for failing to meet their share of the commitment made at a major population conference in the mid-1990s to fund sexual and reproductive health programmes in the developing world through their overseas development aid (ODA) programmes.

''Within ODA, the commitment for sexual reproductive health from the donors' side has not reached the one-third level that was supposed to be met,'' she said.

Such limited funding of maternal health care programmes was not lost on the participants at the Bangkok event, the 2006 International Parliamentarians' Conference, the third such global event since 2002, to review the progress since the 1994 International Conference of Population and Development (ICPD), held in Cairo.

''Funding for family planning, the first line of defence against maternal mortality, has dropped from 55% of total population funding in 1995 to 9% today,'' noted the 'Bangkok Statement of Commitment,' released at the end of the conference. ''And funds for reproductive health commodities remain in short supply.''

One reason behind that, participants at the conference conceded, was the shift in funding to deal with the killer disease HIV/AIDS over the past decade. ''Funds for the treatment of AIDS has grown exponentially, while funds for its prevention remain scarce,'' adds the final declaration.

''As a result, statistics on maternal mortality and morbidity remain virtually unchanged in some regions of the world, while statistics on HIV and AIDS reflect only slow change.''

''No one should die as a result of sex, denial of accurate information or the lack of a condom, or a single birthing kit,'' Gill Greer, director-general of the International Planned Parenthood Federation, said in her keynote speech to the conference, which shed light on the alarming death rates due to inadequate maternal health care, unsafe abortion and the absence of HIV prevention services.

''In Niger, the lifetime risk of dying from complications in pregnancy or childbirth is one in seven, in Sweden, one in 29,800,'' she added. ''However, we do not know the actual survival status of some 36 million women who give birth each year in countries which do not officially count maternal deaths.''

World Bank estimates show that 74% of maternal deaths could be prevented if ''all women had access to interventions to address complications of pregnancy and childbirth,'' she revealed. ''Yet some 200 million women a year are not accessing the contraception they desire or need in order to space or prevent pregnancies.''

The countries in the Asia-Pacific region offer a window into this problem, noted a publication released this week by the Economic and Social Commission for Asia and the Pacific (ESCAP), a regional UN-body based in Bangkok.

''Among all reproductive health indicators, perhaps the least progress has been made in reducing levels of maternal mortality,'' writes Philip Guest in the 'Asia-Pacific Population Journal.'

According to World Health Organisation (WHO) estimates in 2004, there were close to 253,000 maternal deaths a year across Asia, of which South-central Asia had the highest rates, 207,000 annual deaths.

''A significant contributor to maternal mortality is unsafe abortion,'' adds Guest of the Population Council, an international public health non-governmental group.

''Of the total estimated number of unsafe abortions (10.5 million in Asia in 2000), over seven million occurred in South-central Asia.''

As a key Thai participant at the conference admitted, getting governments interested in population and maternal health issues are not as easy as seeking political support for more visible development initiatives.

''This issue is difficult to convince governments, unlike telling them about the need to build a road,'' says Malinee Sukavejworakit, secretary-general of the Asian Forum of Parliamentarians on Population and Development, a Bangkok-based body lobbying the region's legislatures on development issues.

And even after governments agree to accept the challenge of reducing maternal mortality in their countries, no universal model will provide a solution, adds Yasuo Fukuda, a Japanese parliamentarian and a leading figure in this campaign.

''The solutions have to be diverse, taking into consideration the different needs of every country,'' he said. ''But we have to overcome two common obstacles - legislative action and getting the budget to implement the actions.''