MDGs and Maternal Health

Delia Barcelona, UNFPAJunior Chamber International Programme

July 9, 2004

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UNFPA: Who we are

World’s largest source of funding for population programmes

Since 1969, has provided nearly $6 billion in assistance to developing countries

Works with governments and NGOs in over 140 countries

Programmes in RH, HIV/AIDS, gender, population and development

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MDGs

Goal 1: Eliminate extreme poverty and hunger Goal 2: Achieve universal primary education Goal 3: Promote gender equity and empower women Goal 4: Reduce child mortality

Goal 5: Improve maternal healthTarget 6: Reduce MMR by ¾, between 1990-2015

Indicators: 16. Maternal mortality ratio 17. Proportion of births attended by skilled health personnel Goal 6: Combat HIV/AIDS, malaria, and other diseases Goal 7: Ensure Environmental Sustainability Goal 8: Develop Global Partnership for Development

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ICPD and MDGs

• UNFPA’s work is guided by the Programme of Action adopted by more than 170 countries during the International Conference on Population and Development (ICPD) held in Cairo in 1994;

• The ICPD Programme of Action set out priority issues, including population and devt, gender equality and equity, reproductive health and rights, and adolescents and youth

• MDG targets update and reinforce ICPD targets especially in the context of global development agenda addressed by several international conferences since the Millenium Declaration in 2000

• ICPD RH goal, universal access to quality RH services by 2015, essential for meeting MDG targets by 2015, especially on poverty, child and maternal mortality, HIV/AIDS, gender and education

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MDGs and Reproductive Health

Reproductive Health central to the achievement of all MDGs; Below are probable consequences of lack of recognition of reproductive rights and lack of access to RH information and services

MDG 1: More poverty resulting from higher population growthMDG 2: Higher pupil-teacher ratios, lower retention ratesMDG 3: Lower status of girls and womenMDG 4: Higher malnutrition, stunted growth of childrenMDG 5: Lack of contaceptive choice, births delivered by unskilled

persons, more death and pregnancy related complications MDG 6: Increase in STIs and HIV infectionsMDG 7: Migration to crowded urban slums, environmental deteriorationMDG 8: Lack of access to services, medicines, technologies

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Poverty and Poor health are interrelated

Disease leads to•Inability to earn a living•Lower productivity at national level

Poverty leads to •Malnutrition•Bad environment•Lack of access to healthcare

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Mortality and Morbidity by income level

0 50 100 150 200

Underweight children (percent)

Under-Five deaths/1,000 livebirths

Maternal deaths/10,000 live births

AIDS deaths/100,000 pop

TB deaths/100,000 pop

Rate/RatioPoorest 25% 2nd poorest 25%

2nd richest 25% Richest 25%

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Maternal Health Status in Sub-Saharan Africa

•The average maternal mortality ratio is 400 per 1000,000 live births• MMR is highest in Africa at 830, followed by Asia (330), LAC (190) and Developed countries (20)•Women in Africa face 1 in 16 chance ofMaternal death; in developing countries this chance is 1 in 2800

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Addressing Disparities

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What do we mean by RH?

Reproductive Health

Maternal Health

Family Planning

HIV/AIDS and STIs

Harmful practices, Cancers, infertility

BCCGender

Adolescents and Youth

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Causes of Maternal Mortality

Maternal mortality: Death of a woman while pregnant or within 42 days of termination of pregnancy

5 major causes of MM: bleeding, infection, high blood pressure, obstructed labour, and complications arising from miscarriages

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Dimensions of Maternal Mortality and Morbidity

Each year, 529,000 deaths Estimated 40 times more disease and disability, ie

obstetric fistula 95% of deaths occur in Africa (251,000 deaths) and Asia

(253,000 deaths) Average MM Ratio is 400 per 100,000 LB Africa MMR highest at 830, followed by Asia (330),

Oceania (240), LAC (190) and the developed countries (20)

Women in Africa face 1 in 16 chance of maternal death; in developing countries this chance is 1 in 2800.

Growing role of indirect causes of MM: HIV/AIDS, malaria, TB

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Source: World Bank Development Group

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MDGs and Young People

In 2004 – Four Years after the Millennium Declaration

Millions of young people live in poverty Almost half of the world's youth (15-24) live in

low-income countries One in four of all youth (15-24) live on less than $1

a day Poor young people have the least access to health

care and other social services Poverty, underdevelopment, gender inequities and

illiteracy are principal contributing factors to the spread of HIV/AIDS

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MDG Targets related to Young People

Goal 1: Halve the proportion of people whose income is less than $1 a day

Goal 2: Ensure that boys and girls alike will be able to complete primary schooling

Goal 3: Eliminate gender disparity in primary and secondary education

Goal 5: Reduce by three-quarters the maternal mortality ratio

Goal 6: Have halted and begun to reverse the spread of HIV/AIDS

Goal 8: Develop and implement strategies for decent and productive work for youth

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Maternal health and young people

o Between 25%-50% of teen girls from developing countries marry and have a child before they turn 18.

o Half of all new infections, 6000 daily (14 every second) occur among youth

o More adolescent girls die from pregnancy related complications than from any other cause

o Girls aged 15-19 are twice as likely to die in childbirth than women in their twenties

o Five million girls aged 15-19 undergo unsafe abortions each yearo Young women are also most vulnerable to obstetric fistula, a

devastating morbidity of pregnancy

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The UNFPA Vision and Strategy for Reduction of Maternal Mortality and

Morbidity

3-pronged approach:

Family Planning Skilled Attendance at (all) births Emergency Obstetric Care

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Family Planning

Strongest component of MM reduction remains prevention of unwanted + potentially dangerous pregnancies

High Unmet Need (lack of services for those who most need them)

Focus on particular needs of adolescents

Provision of commodities

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Skilled attendance at birth

A skilled attendant is capable of performing at least the 6 basic delivery functions, in a (non-surgical) facility with infrastructure, equipment, and supplies

Also capable of referring severe cases to comprehensive facilities, and managing them during transport

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What is Emergency Obstetric Care

EOC may be basic or comprehensive. Generally, this service is

Based in a health center or hospital Requires an operating theater or facility Requires drugs (e.g. antibiotics, anti

convulsants) Includes safe blood transfusion Includes ceasarian section

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UNFPA: Programming in Maternal Mortality

Reduction

MM Reduction Projects in all programme countries (Promising experiences in Sri Lanka, Malaysia, China, Jamaica, Egypt of improved skilled care at birth; shift from home to a health facility)

4 MM Reduction pilot projects: Morocco, State of Rajasthan in India, Mozambique, and Nicaragua specifically focused on improving provision of emergency obstetric care

Overall Goal: improve quality, availability, and use of emergency obstetric care services

Also addresses issues related to infrastructure, management, monitoring and evaluation, partnerships, human resources, policy and sustainability, and community involvement

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Challenges in Promoting Maternal Health

Need to address issues related to gender, sexual and reproductive health and rights, in overall context of poverty reduction and sustainable development

Political commitment: integrating maternal health into national health policy/strategy

Human Resources: equitable and sustainable deployment of skilled providers, addressing brain drain

Securing resources: financial support, equipment and supplies; technology

Developing partnerships with all sectors, going beyond health

UN Secretary-General Kofi Annan

« Population issues are at the heart of these challenges.

The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women's rights, and

greater investment in education and health,

including reproductive health and family planning. »