The delegates heard presentations from experts on why reducing maternal mortality should be at the top of every nation’s development priorities; which programs and interventions have been shown to work best; what resources will be needed, globally and nationally, to implement effective interventions; and what kinds of political strategies will get us from where we are today to where we would like to be in 2015. In the first session Dr. Daisy Mafubelu (Assistant Director General, Family and Community Health, WHO) and Dr. Wendy Graham (Principal Investigator, Immpact/University of Aberdeen) emphasized how much progress has been made in understanding the extent of and solutions to maternal and newborn mortality. They outlined three pillars all health systems need to support better maternal and newborn health: family planning to prevent unwanted pregnancies, skilled care during delivery to prevent and manage complications and emergency care to prevent needless deaths.
During the second session Dr. Yoka M. G. Brandt (Deputy Director General for International Cooperation, Ministry of Foreign Affairs, The Netherlands) and Aparnaa Somanathan (Health Economist, Human Development, East Asia and Pacific Region, The World Bank) focused on resources –the amount needed to achieve MDG 5 compared to levels currently provided and the resulting funding gap. The speakers reviewed several key challenges that families face in accessing maternal and newborn care: inadequate knowledge on what to do, lack of access to services, and lack of financial resources to cover emergencies. They reviewed responses to these challenges, such as pro-poor resource and knowledge support, as well as the responsibilities of the international community to provide additional aid and of governments to increase the cost effectiveness of health care investments and reduce or eliminate user fees without penalizing providers. As a highlight of this session, Dr. Brandt announced that the Dutch Government will provide 125 million Euros over the next five years to support the achievement of MDGs 3 and 5, a significant contribution that adds to the growing commitment of other OECD nations, including Norway and the UK, to support global action.
In the third session, Anne van Lancker (Member of the European Parliament from Belgium) discussed what needs to be done in advocacy to generate political will. She addressed several key questions:
- What can be done to convince ministries to allocate greater resources to maternal and women’s health? What arguments would sway economic and budgetary decisionmakers?
- What can policymakers themselves do in their own countries?
- How do they work with the legislative branch of government?
- What about working with NGOs and the private/corporate sector?
- What strategies might work in getting political leaders to give maternal mortality reduction the priority they have given to, say, AIDS treatment and care or, 20 years ago, to family planning? What does it take to get a health issue to the top of the agenda?
- What specific mechanisms are effective to encourage investments in women?
After each of the expert presentations, the Ministers and country delegations discussed the context of maternal and newborn health in their own countries. Afghanistan’s Finance Minister reminded the group of the challenges of keeping maternal and newborn health on the political agenda, given the multiple development problems faced by many low- and middle-income countries. Resource allocation should not be, but often is, a zero-sum game. And in a point reflected by many of the delegates, he stressed the need to place health programs in a poverty-reduction context: “Poverty is the mother of all disease.”
This view was mirrored by a concern expressed by many delegates about far-reaching inequities that undermine indigenous populations and other marginalized groups. The delegate from the Dominican Republic stressed that the benefits of foreign assistance should reach across all needy countries, large and small, and within countries to the poor. The delegates also stressed the need to bring gender into the mainstream. The Pakistan Minister of Health, for example, highlighted the burden of female illiteracy, a barrier to better maternal and newborn health that needs to be lifted as quickly as possible.
The delegates emphasized the importance of addressing MDGs 4 and 5 cross- sectorally. The delegation from Bangladesh stressed the importance of micro-credit to address families’ income gaps. And the South Africa delegation emphasized the need to address the social determinants of poor health. Several countries mentioned the importance of good nutrition to better maternal and newborn health. There was universal agreement that violence and conflict undermine human rights and health.
The delegates expressed particular concern about human resources. The enormous challenge begins with an inadequate base of trained health workers, and is then compounded by a substantial brain drain from low- and middle-income to high-income countries, leaving health systems struggling to meet the demand for maternal and newborn care. As the Nigeria delegation put it, planning for adequate numbers of health care workers is a key component on the road map to better maternal and newborn health.
In the final session of the Ministers’ Forum, the delegations pledged to make achievement of Millennium Development Goals 4 and 5 a high priority on the national, regional and international health agenda. A drafting committee -- chaired by South Africa with representatives from Bangladesh, Bolivia, Brazil, Cote D’Ivoire and the Netherlands -- prepared a draft Ministers’ forum statement that reflected many of the issues aired during the substantive presentations and discussions. The draft also noted that not enough investment has been made since the 1987 Nairobi Safe Motherhood conference. Therefore, the global maternal mortality ratio has not declined significantly, although several countries have made important strides. The Health Ministers from South Africa and Malawi then led a dynamic discussion of the draft, during which delegates again emphasized the need to focus on inequities—particular poverty and gender—and the cross-cutting nature of the solutions to poor maternal and newborn health.
The final statement reflects Forum participants’ deep commitment to achievement of MDGs 4 and 5. They will take home renewed energy to address maternal and newborn health in their own countries, and they urge the world community to share this energy and commitment to:
- Convene a UN general assembly special session on maternal health that would result in a global plan of action.
- Create a global fund for women’s health, focused on maternal health.
- Realize commitments made at various conferences, for example, the 1994 Cairo and 1995 Beijing conferences, the Paris Declaration, the Monterey Consensus and the Johannesburg Plan of Implementation, that encourage donors to expand and align their support for country programs.