By: Dr. Frederick Torgbor Sai, a Ghanaian family health physician and honorary co-chair of Women Deliver 2010 conference
The eight MDGs are too well known to warrant repetition here. MDG 5 asked for a reduction of the maternal mortality ratio by three quarters between 2000 and 2015. Other goals related directly to MDG 5 are focused on child health, improvement in women’s status and the reduction of poverty. The attainment of all the other MDGs would also influence MDG 5, as would its attainment also impact all the others.
The MDGs as a whole have been the subject of academic and informed group criticisms over a period. Some of the criticism has been based on the lack of data for planning or evaluating progress. Others relate more to the validity of setting such average goals without considering the particular circumstances of nations and regions. Some of these criticisms are to be accepted as valid and could be useful in strategies and activities performed under the banner of the MDGs. MDG 5, in particular, had a most valid criticism; that is the original omission of access to reproductive health services, including family planning. Fortunately, a correction of some kind was made when universal access to reproductive health was added five years later.
The usefulness of the MDGs and particularly MDG 5 to international and national efforts to improve maternal, neonatal and child health cannot be disputed now. For MDG 5, in particular, most nations in the South have been trying through advocacy, research and active programmes to emphasize the priority. The problem of data is being tackled. Perhaps the best demonstration of international willingness to lead action in the fields is the creation of Women Deliver, an NGO devoted entirely to advocating the cause. The Secretary General’s 2010 launch of the Global Strategy for Women’s and Children’s Health, with funding pledged by stakeholders estimated at US$ 40 billion, and the creation of the high-level Commission for evaluating progress, have been remarkable calls to action.
Unfortunately, since 1987 the world has had financial problems which have made it necessary for the MDGs to have less support financially than they might have had. By 1987, the AIDS epidemic had raised its ugly head and funding for AIDS took pride of place in reproductive health funding till the present day. The international financial crisis and the currently on-going ones have made some governments hesitant to support the MDGs.
Some countries, particularly the Scandinavian Countries and the UK have been very supportive. My own country, Ghana, with support from DIFD of the UK, instituted free maternity care some three years ago. This is going well. Unfortunately, there is no complementary free reproductive health care in general. One sad result is that family planning services and supplies are not free. How could we really say we want to reduce maternal mortality if we do not support efforts to meet the unmet need for family planning? This effort alone, if successful, could cut out much unsafe abortion, a major contributor to high maternal mortality.
The MDGs in my country have helped generally too in giving high priority to universal education with emphasis on girl child education. A high priority is given to other aspects of women’s empowerment to the extent that the current government has a target of giving women at least 40% of all high level positions in government. This has not been reached at cabinet and other ministerial levels but the effort is being made.
The unsatisfactory situation of Ghana’s maternal mortality ratio figures is also being addressed. There was a time when the government was insisting that the figure was 214 per 100,000 live births whilst the international community was using a figure of 500+. Recent rigorous assessments for the evaluation of progress with MDG 5 have disclosed figures closer to 350 for the last seven years. What is more, the great regional disparity has been laid bare and active efforts are on the way to do better.
It is almost certain that without the MDGs much of Africa would still be plodding along with politicians thinking more of infrastructure and visible works rather than the saving of lives. Even with the MDGs we still have situations where the counting of numbers of school buildings and the so called enrollment overshadow the need for quality education. Serious high quality teacher training and supervision programmes are still not in the priority frontline.
Whilst it is clear that much of sub-Sahara Africa will not attain the MDGs by 2015, we should be happy that they have given the push and call for accelerated support—financial and in every other way. Failure to keep pushing these lofty goals will only send us backward. For MDG 5, in particular, the gap between developed and developing countries should always be a reminder to mankind of how empty our lofty ideals of a global village are.
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