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Tag Archives: Maternal Health

Women’s Rights and Access to Maternal and Reproductive Healthcare

As someone who has worked on international development issues from my desk in Washington, I was excited to participate in the 2013 Women Deliver Conference last week in Kuala Lumpur, Malaysia.

The conference afforded me an amazing opportunity to listen and talk to a variety of people from 149 countries about their experiences and views related to the health and well-being of women and girls. A recurring theme that emerged from the week was the issue of women’s sexual and reproductive health. I have never written about reproductive health before, but I’ll credit that up to never spending a week at a conference focused on maternal and reproductive health before this experience.

Since returning home, I have spent a lot of time thinking about the issue of reproductive health and I firmly believe that we need to start thinking about this issue in a different way – through the lens of a woman or a young girl in a developing country, and with an eye on equality.

In the U.S., we all face the reality that a majority of young adults engage in sexual relations outside marriage, and we educate our kids to wait to have sexual relationships – preferably until marriage. But as parents, we also want to ensure that they know how to protect themselves when they decide to engage in such activities.

This was a key part of the international dialogue I participated in; however, on the international front, in many poor or developing countries, access to reproductive health includes a very different reality.

That reality is that girls and women’s rights are systematically violated in too many places around the world today. (I would encourage anyone reading this or interested in this issue to check out the trailer, and the movie called Girl Rising, an innovative new feature film that highlights the struggles of women and girls around the world). In some cultures, it is still considered acceptable for a husband to beat his wife for not having sex. In too many places, girls are forced into marriage at far too young an age. HIV disproportionately impacts women. In many cultures, when reproductive health options are available, a woman’s male partner often vetoes her decision to use those options.

Women and girls in developing nations are more likely to become mothers at a young age. We know that pregnancy during adolescence has serious health impacts for girls and their babies. There are complications from pregnancy and childbirth – which is the leading cause of death among girls, aged 15-19 in developing countries.

Approximately one in three women will experience gender-based violence in her lifetime. In some pacific countries, more than 60% of women and girls experienced violence at the hands of their partners.

I met a woman from the Congo at the conference. We were discussing access to female contraception and she explained to me that access to female condoms in her village have been transformative because women and girls are now using these resources when walking miles to the wells to get water. The incidence of rape is so great, that these women and girls have decided to use female condoms to avoid unwanted pregnancies.

In developing countries, desire for smaller families and the motivation for healthy spacing of births has steadily increased. Yet, 222 million women in developing countries do not have the ability to determine the size of their families, or have a say in the planning of their families.

MDG 5 — Improve Maternal Health — has two sub targets. Target 5A set a target of reducing maternal mortality by three-fourths by 2015, while Target 5B set a target of universal access to reproductive health.

The achievement of the MDGs is strongly underpinned by the progress that the world makes on sexual and reproductive health. It is a pillar for supporting the overall health of communities, in particular, that of women. Ill health from causes related to sexuality and reproduction remains a major cause of preventable death, disability, and suffering among women. Apart from the health consequences, poor sexual and reproductive health contributes significantly to poverty, inhibiting affected individuals’ full participation in their own social and economic development.

I was surprised to learn that the world has not made as much progress on this front as is needed to meet MDG5 by 2015. Many countries in sub-Saharan Africa and South Asia have shown little progress in recent years; some have even lost ground. Globally, the rate of death from pregnancy and childbirth declined between 1990 and 2005 by only 1% per year. In order to be on track to achieve MDG 5, a 5.5% annual rate of decline was needed from 2005 to 2015.

During my week at the conference, our group was fortunate enough to have a conversation with Melinda Gates. We were all enlightened and her comments during our conversation were extremely helpful to me. Mrs. Gates stated that when she talks about health with women from developing countries, they explain to her that their job is to feed the children. They explain that if they cannot space out their births, they cannot work or properly care for and feed the other children. In many places, Melinda explained that while condoms might be readily available, women – due to cultural perceptions – couldn’t even fathom negotiating the use of condoms because it means they are suggesting that their partner might have AIDs or that she is trying to say she has AIDs.

The Gates Foundation does not fund abortions, and has it right when they state that we need to put girls and women at the center of this debate. We need to start trusting one another and realize that “family planning” is not code for anything else in this debate.

As the week progressed, I became certain that the only way for the world to begin to correct this problem is for us to start trusting one another and to look at this issue as an equality rights one, not something else. Advancing equality among boys and girls and men and women is a goal we can all support.

I am confident that if we are successful in achieving equality, many other aspects of this problem begin to fall into place. Perhaps, once achieved, we might even begin to have a significant impact on achieving MDG5.

Just think of all the good that could come from advocating for ensuring that women and girls have the right to access maternal and reproductive health care. Treating women and girls all around the world equally might eradicate early and forced marriage, keep girls in school, give women a say in their family planning, and end gender-based violence.

One of my take-aways from the conference was that women’s rights and access to maternal and reproductive healthcare must be a highlight of our global development agenda. The issue is too important to ignore, or be mired in obtuse political innuendo. With the right focus and attention, we can ensure that sexual and reproductive health is readily available and sustainable for all women.

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Global Maternal Health in 2013

Our week in Kuala Lumpur is almost over and we’ve had an amazingly busy and informative week of meetings, briefings and field visits. Whether visiting with the Malaysian government’s ministry of health, touring government facilities, sharing thoughts with one of the 4,000 delegates from around the world, or participating in roundtable discussions with experts in the field, I have been immersed in the issue and focus of the conference.

In 2000, all UN Member States committed to eight Millennium Development Goals (MDGs), which aim to significantly reduce extreme poverty and disease, ensure environmental sustainability, and enhance international coordination around development by 2015. That means that 189 countries committed to ending extreme poverty worldwide through the achievement of these MDG’s. The MDGs are the FIRST and ONLY international framework for improving the human condition of the world’s poor.

MDG 5 — Improve Maternal Health — set a target of reducing maternal mortality by three-fourths by 2015. And that has been one of the key focal points of this conference. Every year, between 350,000 – 500,000 girls and women die from pregnancy-related causes.

Medical solutions exist, but increased government attention is needed to implement policies to improve the supply of and demand for services that will help. While the numbers of deaths are decreasing, the progress is not enough or fast enough to meet the MDG goal by 2015. Almost all maternal deaths occur in developing countries; especially vulnerable are poor women. In fact, maternal mortality represents one of the greatest health disparities between rich and poor and between the rich and poor populations within every country.

Interestingly enough, providing the essential services needed to make significant improvements in maternal health are estimated to cost less than $1.50 per person in the 75 countries where 95% of maternal mortality occurs. The great majority of maternal and newborn deaths can be prevented through simple, cost-effective measures.

For instance, using a country closer to home, in Haiti, the maternal mortality rate is the highest in the Western Hemisphere with 350 deaths per 100,000 live births. In comparison, the rate in the U.S. is 12.7 deaths per 100,000 live births and Afghanistan’s rate was 1,600 deaths per 100,000 live births (2002). Several programs in Haiti have trained over 700 traditional birth attendants to assist with child birth since only 37% of all births in Haiti take place in a health facility.

Thanks to these attendants, pregnant women in Haiti have increased access to trained assistants who assist with safe deliveries. Identifying signs of high-risk pregnancies, and referring at-risk pregnant women to health facilities for care. In Afghanistan, thanks to skilled birth attendants and access to education about pregnancy, the maternal mortality rates went from 1,600 deaths per 100,000 live births in 2002 to 327 deaths in 2010.

Achieving MDG 5 is not only an important goal by itself, it is also central to the achievement of the other MDGs: reducing poverty, reducing child mortality, stopping HIV and AIDS, providing education, promoting gender equality, ensuring adequate food, and promoting a healthy environment.

The U.S. is a leader in funding these programs, but this is not just a U.S. government problem. It’s one that will take government, in partnership with other donors, governments, academia, the private sector, religious institutions, civil society and individual advocates.

Failure to invest in the maternal health of women in developing countries is a missed opportunity for development in those countries that need critical development gains the most.l

 
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Posted by on May 30, 2013 in International Affairs

 

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