Keys to Improving Maternal Health: Education, Resources and Community Partnerships

As Michelle Bachelet, Executive Director of the new agency, UNWomen, opened a panel on maternal mortality and morbidity and the empowerment of women during the Commission on the Status of Women yesterday, she stressed the importance of the work of all UN agencies to achieve MDG 5, the Millennium Development Goal to improve maternal health.

“Today’s discussion will be an opportunity for CSW to assess progress in addressing maternal mortality, identify good practices and successful interventions, as well as ways and means for further accelerating action with the aim of measurably reducing and eliminating maternal mortality, and achieving MDG 5,” Ms. Bachelet said.

Although new data released during the MDG Summit in September 2011 indicated progress in reducing maternal mortality around the world, much concern was voiced about the lack of progress towards achieving MDG 5.

The panelists discussed the remaining challenges, especially regarding the engagement of civil society to work with the United Nations and its partners on the ground.

Three major challenges

“As I see it, there are three major challenges,” said the UNFPA Executive Director, Dr. Babatunde Osotimehin. “Lack of respect for women’s and girls’ rights is one of them. Women are not empowered to make their own choices and decisions about their health. So we need to empower them to claim their rights, including the right to sexual and reproductive health,” he said.

“In addition, many health systems that should be providing care are weak and or crumbling apart,” Dr. Osotimehin added. “We need to strengthen health systems to deliver an integrated package of sexual and reproductive health services to achieve MDG 5.”

The third challenge, he said, is to ensure adequate financing. “In the last decade, funding for global health has increased dramatically, while funding for reproductive health, including maternal health and family planning, has remained stagnant. We need to increase both international and national funding for reproductive health so we can achieve MDG 5.”

Government commitment and ‘smart economics’ needed

Mentioning the Secretary-General’s Global Strategy for Women’s and Children’s health, launched in 2010, Dr. Osotimehin pointed out that, in order to make a real impact in the countries with the highest maternal death burden, it’s necessary that local governments make a commitment, both politically and economically, to improve maternal health.

“Take the case of Africa. Only a few countries responded to the pledge to commit the necessary resources to reduce maternal deaths. Domestic resources have to be mobilized, so that we can also develop the health systems,” he said.

According to the World Bank Gender and Development Group Sector Director, Ms. Mayra Buvinic, some programmes recently carried out in developing countries were able to help significantly reduce sexual and reproductive health problems using ‘smart economics’.

For instance, results from a pilot cash transfer scheme directly benefiting young women in a controlled two-year experiment in Malawi demonstrated that the adolescent girls who received the resources were less prone to get pregnant (38 percent reduction), early marriage (48 percent reduction) and HIV infection (50 percent reduction). The program will be tested for replication in other countries.

Change must come from within

Dr. Osotimehin said that even with political and financial commitment, changes cannot be imposed vertically. “Changes should come from within the society. We have to make sure that girls are educated enough so that they can make their own choices. Educated girls are also more likely to escape the cycle of poverty, fight for their rights, protect themselves and resist detrimental traditional practices.”

According to him, the status of women in general is a cause and consequence of the lack of support women receive from their communities, leading to the lack of education and sexuality education, early marriage, violence, unplanned and unwanted pregnancies, greater vulnerability to HIV and other infections, lack of access to sexual and reproductive services. All these situations also reinforce the poverty cycle in which women are usually trapped.

When asked how it would be possible to reach the poorest of the poor, the most marginalized women, Dr. Osotimehin stressed that certain groups, such as indigenous women and women with disabilities, are doubly affected by inequality, requiring more attention and specific solutions.

Reaching the most marginalized

“Reduction of maternal mortality will not be achieved and will not be sustainable without protecting the sexual and reproductive health rights and addressing the needs of all groups of the population, including the most marginalized. It is no longer possible to design strategies looking only to the low hanging fruits.”

Dr. Osotimehin emphasized that all interventions are interlinked. “I think the most important intervention to avoid maternal deaths is the education of the girl-child,” he said. “When you educate the girl-child, you improve her skills; you give her an opportunity to mature. She will marry if she wants to marry, when and with whom she wants to marry. She will also be able to take care of her children.”

He also emphasized that integration of services is essential. "If we have maternal health services that deliver, with skilled and motivated professionals, we can ensure that the work can be done, in partnership with the communities.” Integrated services should include health education, health information, family planning, commodities and HIV prevention, according to Dr. Osotimehin. “If we have that, we will be able to reduce maternal mortality as a consequence, especially if all this happens in countries that are also mobilized and have the financial resources allocated for this.”

Other participants in the panel included the UN Deputy High Commissioner for Human Rights, Ms. Kyung-wha Kang; the Director of External Relations and Partnerships, Global Fund to Fight AIDS, Malaria and Tuberculosis, Mr. Christoph Benn; and the UNICEF Policy and Practice Director, Mr. Richard Morgan.