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

2. 2 UNFPA: Who we are l World’s largest source of funding for population programmes l Since 1969, has provided nearly $6 billion in assistance to developing countries l Works with governments and NGOs in over 140 countries l Programmes in RH, HIV/AIDS, gender, population and development

3. 3 MDGs l Goal 1: Eliminate extreme poverty and hunger l Goal 2: Achieve universal primary education l Goal 3: Promote gender equity and empower women l Goal 4: Reduce child mortality l 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 l Goal 6: Combat HIV/AIDS, malaria, and other diseases l Goal 7: Ensure Environmental Sustainability l Goal 8: Develop Global Partnership for Development

4. 4 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, e ssential for meeting MDG targets by 2015, especially on poverty, child and maternal mortality, HIV/AIDS, gender and education

5. 5 MDGs and Reproductive Health l 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

6. 6 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

7. 7 Mortality and Morbidity by income level

8. 8 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

9. 9 Addressing Disparities

10. 10 What do we mean by RH? Reproductive Health Maternal Health Family Planning HIV/AIDS and STIs Harmful practices, Cancers, infertility BCC Gender Adolescents and Youth

11. 11 Causes of Maternal Mortality l Maternal mortality: Death of a woman while pregnant or within 42 days of termination of pregnancy l 5 major causes of MM: bleeding, infection, high blood pressure, obstructed labour, and complications arising from miscarriages

12. 12 Dimensions of Maternal Mortality and Morbidity l Each year, 529,000 deaths l Estimated 40 times more disease and disability, ie obstetric fistula l 95% of deaths occur in Africa (251,000 deaths) and Asia (253,000 deaths) l Average MM Ratio is 400 per 100,000 LB l Africa MMR highest at 830, followed by Asia (330), Oceania (240), LAC (190) and the developed countries (20) l Women in Africa face 1 in 16 chance of maternal death; in developing countries this chance is 1 in 2800. l Growing role of indirect causes of MM: HIV/AIDS, malaria, TB

13. 13 Source: World Bank Development Group

14. 14 MDGs and Young People In 2004 – Four Years after the Millennium Declaration Millions of young people live in poverty l Almost half of the world's youth (15-24) live in low- income countries l One in four of all youth (15-24) live on less than $1 a day l Poor young people have the least access to health care and other social services l Poverty, underdevelopment, gender inequities and illiteracy are principal contributing factors to the spread of HIV/AIDS

15. 15 MDG Targets related to Young People l Goal 1: Halve the proportion of people whose income is less than $1 a day l Goal 2: Ensure that boys and girls alike will be able to complete primary schooling l Goal 3: Eliminate gender disparity in primary and secondary education l Goal 5: Reduce by three-quarters the maternal mortality ratio l Goal 6: Have halted and begun to reverse the spread of HIV/AIDS l Goal 8: Develop and implement strategies for decent and productive work for youth

16. 16 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 year o Young women are also most vulnerable to obstetric fistula, a devastating morbidity of pregnancy

17. 17 The UNFPA Vision and Strategy for Reduction of Maternal Mortality and Morbidity 3-pronged approach: l Family Planning l Skilled Attendance at (all) births l Emergency Obstetric Care

18. 18 Family Planning l Strongest component of MM reduction remains prevention of unwanted + potentially dangerous pregnancies l High Unmet Need (lack of services for those who most need them) l Focus on particular needs of adolescents l Provision of commodities

19. 19 Skilled attendance at birth l A skilled attendant is capable of performing at least the 6 basic delivery functions, in a (non-surgical) facility with infrastructure, equipment, and supplies l Also capable of referring severe cases to comprehensive facilities, and managing them during transport

20. 20 What is Emergency Obstetric Care EOC may be basic or comprehensive. Generally, this service is l Based in a health center or hospital l Requires an operating theater or facility l Requires drugs (e.g. antibiotics, anti convulsants) l Includes safe blood transfusion l Includes ceasarian section

21. 21 UNFPA: Programming in Maternal Mortality Reduction l 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) l 4 MM Reduction pilot projects: Morocco, State of Rajasthan in India, Mozambique, and Nicaragua specifically focused on improving provision of emergency obstetric care l Overall Goal: improve quality, availability, and use of emergency obstetric care services l Also addresses issues related to infrastructure, management, monitoring and evaluation, partnerships, human resources, policy and sustainability, and community involvement

22. 22 Challenges in Promoting Maternal Health l Need to address issues related to gender, sexual and reproductive health and rights, in overall context of poverty reduction and sustainable development l Political commitment: integrating maternal health into national health policy/strategy l Human Resources: equitable and sustainable deployment of skilled providers, addressing brain drain l Securing resources: financial support, equipment and supplies; technology l Developing partnerships with all sectors, going beyond health

23. 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. »