MDGs and Maternal Health

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• MDGs and Maternal Health
• Delia Barcelona, UNFPA
• Junior Chamber International Programme
• July 9, 2004

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UNFPA Who we are

• Worlds 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 health
• Target 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

• UNFPAs 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 growth
• MDG 2 Higher pupil-teacher ratios, lower
  retention rates
• MDG 3 Lower status of girls and women
• MDG 4 Higher malnutrition, stunted growth of
  children
• MDG 5 Lack of contaceptive choice, births
  delivered by unskilled persons, more death and
  pregnancy related complications
• MDG 6 Increase in STIs and HIV infections
• MDG 7 Migration to crowded urban slums,
  environmental deterioration
• MDG 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
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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 of
• Maternal 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
Gender
BCC
Maternal Health
Family Planning
HIV/AIDS and STIs
Harmful practices, Cancers, infertility
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

• Between 25-50 of teen girls from developing
  countries marry and have a child before they turn
  18.
• Half of all new infections, 6000 daily (14 every
  second) occur among youth
• More adolescent girls die from pregnancy related
  complications than from any other cause
• Girls aged 15-19 are twice as likely to die in
  childbirth than women in their twenties
• Five million girls aged 15-19 undergo unsafe
  abortions each year
• 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

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• 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.