1. Investing in MDG 5: Maternal Health The Role of media Dr. Saramma Thomas Mathai Regional Team Coordinator and MH Advisor UNFPA Asia Pacific Regional Office, Bangkok UN MDG workshop May 28, 2012

2. MATERNAL HEALTH – PROGRESS AND CHALLENGES Section 1 2

3. MDG 5: Improve maternal health- Targets and indicators Target 5. a: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Indicators: Maternal mortality ratio (MMR) Proportion of births attended by skilled health personnel Target 5.b: Achieve, by 2015, universal access to reproductive health Contraceptive prevalence rate Adolescent birth rate Antenatal care coverage (at least one visit and at least four visits) Unmet need for family planning 3

4. Progress in reducing maternal mortality ratio, no time for complacency Southern Asia South-Eastern Asia Source: United Nations, The Millennium Development Goals Report 2011 and UN trends in maternal mortality 1990-2010 Maternal deaths per 100,000 live births Target : 75% reduction in MMR Bhutan, Maldives, Iran, Nepal and Vietnam achieved MDG 5. Others on track.

5. Proportion of deliveries attended by skilled health personnel (%) Source: United Nations, The Millennium Development Goals Report 2011

6. Family planning is critical for MDG 5- stagnating rates of adolescent fertility and unmet needs of FP 6 Source: United Nations, The Millennium Development Goals Report 2011 a. Adolescent fertility= Number of births per 1,000 aged 15-19 b. Unmet needs of FP= women who want to space or limit a family, but not using a method

7. Cost effective strategies are well known, but unattainable for many women in Asia Social, cultural, political, economic factors determine access Skilled birth attendants (SBA) Emergency obstetric care (EmOC) Health systems Family and community determine access Family planning The three pronged strategy to save lives of mothers and their newborns

8. Why is Asia lagging behind in MDG 5?  Equity: maternal death and ill health clustered among poor, excluded, geographical  Coverage and quality issues due to health system constraints  Despite economic developments, investments in health continue to be low and out of pocket expenditures are high and when there is a complication, the family is further drawn down the spiral of poverty  Human resources gaps (inequitable distribution, retention)  Data gaps (inadequate and incomplete data systems, vital registration systems)  Social and cultural challenges  M Mortality – an indicator of the way the way women are cared for in a society and create obstacles to accessing care 8

9. Poor still have no access to skilled care 9 Source: Demographic Health Survey of Cambodia (2010) Bangladesh (2007) and Nepal (2011)

10. WHAT CAN MEDIA DO TO ADVOCATE FOR MATERNAL HEALTH Section 2 10

11. MDG 5 is central to achieving other MDGs and future generations  Economic facts:  An estimated US $ 15 billion in lost productivity every year due to maternal and newborn mortality  Women are the sole income earners for over 25% of households worldwide and women’s unpaid work equals about 1/3 of the world’s GNP  30-50% of Asia’s economic growth from 1965-90 can be attributed to improvements in reproductive health and reductions in infant and child mortality rates  Social facts  Mother’s survival is linked to the survival of her newborn or her children below five years  Mother’s survival is essential for instilling social and cultural values and ensuring education of young girls who otherwise would take on responsibility of the family  While MDG 5 contributes to achieving all MDGs, it is a major contributor to MDGs 4, 3, 6 and 1 Source: UNSG’s global strategy for women’s and children’s health 11

12. 1. Media can help governments accountable to meet commitments  2010  Afghanistan  Bangladesh  Cambodia  China  India  Indonesia  Nepal  2011  Lao PDR  Mongolia  Myanmar  Papua New Guinea  Vietnam  Sri Lanka BBC World Trust committed US $30 million for five years to scale up its work in Africa and Asia to help build the capacity of local communities to use media and communications to improve health.

13. 2. Report on maternal deaths  Media can mobilize commitment to “save mothers’’ from policy makers, professionals and communities  Success stories (few examples)  In the early 1930s the media reports on maternal deaths galvanized the medical community to investigate maternal deaths.  The New York times: reported on a maternal death in Cameroon that led to focus on the issues and increased budget and also has focused on the issue of fistula  BBC : In Bolivia, reporting on maternal health led to opening midwifery schools and other commitments  India – sting operation by TV channel, vernacular newspaper reports  Bangladesh: Grass root level journalists go beyond reporting  Indonesia: Maternal mortality  Philippines – RH bill

14. 3. Facilitate social audits, mobilize communities  Fuel high level commitment through social audits to explore the “road to death” individual woman take including accounts of family and health care providers ---- no ‘witch hunting”  Mobilize community level actions in creating awareness about danger signs, birth preparedness and skilled care as well as support for community insurance schemes for the poor (revolving funds) and transport  Culturally appropriate advocacy to deal with son preference and promoting the value of girls (good examples from India)  Present the story from a rights perspective and be persistent and present as a national issue

15. Reporting could be challenging  With status of women being low in most of the countries, the topic of maternal health may be considered not newsworthy It may not be seen as a development issue It is about a single woman – unlike an epidemic when many die There is no quick fix and it can be difficult to explain However---  A maternal death is not a mere statistic---  It could be your wife, sister, daughter– would you stop reporting???

16. A commitment  The pain of childbirth may  fade quickly from a woman’s memory,  but the pain of a woman’s death in childbirth lingers on forever for the children and family she leaves behind (source: women deliver article)  As people who influence communities and societies, let us resolve not to let another day pass with maternal death being a silent tragedy and not to let any woman die giving life. If dead mothers could talk, they will tell you the injustice we have done to them.  THANK YOU