NGO Forum: Jill Sheffield on Integrating SRHR and the MDGs

By Jill Sheffield, President

Blazing Trails...

Looking back at all the watershed milestones that emerged from the 1994 ICPD, what thrills me the most is the course that was set to acknowledge the right for all people of the world, especially women, to have access to quality sexual and reproductive health. The case was made in Cairo that the journeys from poverty to self-sufficiency and from oppression to equality start with the sexual and reproductive health and rights of all people.

We know what to do and we know how to do it. The key now is to use our time and resources wisely. We cannot be engaged in more futile debates about whether family planning services that include abortion works – we know it does and we must get on with ensuring that EVERYONE, EVERYWHERE have access to the information and services they need. We cannot spend any more time or resources on debating the efficacy of huge new HIV/AIDS funding streams; instead we must integrate maternal and newborn health research, programs and advocacy with the HIV/AIDS community because really, it’s all connected. We cannot delay our work because of weak or non-existent health services; instead, we must bring maternal and newborn health services to where they are needed, and use our resources to build them where they are weak. But, in the meantime, there are interim strategies we can use!

Soon after Cairo, the Beijing Conference on Women affirmed that women’s health and rights are the foundation of any vibrant, economically sound community. There were more conferences and treaties and initiatives until the turn of the century that brought us the Millennium Development Goals – a set of goals that were widely perceived as right and overdue—enabling us to do well by doing good-- and that were presented without the comprehensive and consensus-driven programming needed to achieve them. The MDGs built on the decadonal global conferences of the 90s, but they did not come with a work plan. Fortunately, the population and reproductive health sector already had one: it was the ICPD Programme of Action and it has provided valuable consensus-driven guidance. So the MDGs that fall within the ICPD PoA, (#s 5,3,4,6) had more potential for success than the others.

But subsequent years were not, shall we say, enabling for our community. A formidable opposition took shape and power around the world: far right wing fundamentalist politicians emerged and they seized their opportunity to impede our progress with a wide range of setbacks.

This phenomenon was led by the dark forces of the Bush administration, which gained success in disassociating SRHR from maternal health as they escalated their war on family planning, which they irrationally condemned as a shell for abortion rights. They built on their destruction by forcing their multi-million, multi-year PEPFAR initiative to ignore the sexual and reproductive health and rights of millions of people, mostly women, in favor of more politically tenable interventions that focus on delivering costly and unsustainable HIV treatment programs.

But despite the opposition and the MDGs gauntlet, encouraging momentum is underway in at least one of the MDGs. In recent years, assessments of progress toward the MDGs revealed that #5, “Improve maternal health” is the Goal least likely to be achieved and the maternal health community is responding. And how! It seems that the world’s mothers are getting the message that MDG5 is in danger and they are mobilizing with amazing energy and determination.

Look at the evidence:

• massive new funding commitments from the world’s donors, most notably the Governments of Norway, Spain, and the UK; and the Bill & Melinda Gates Foundation;

• new multilateral partnerships that are forging policy consensus and stimulating action, such as the Partnership for Maternal and Newborn Child Health, the Maternal Health Task Force, the Maternal Mortality Campaign, the International Health Partnership, and, of course, Women Deliver;

• powerful attention to maternal health from a new coalition of African—and other-- First Ladies;

• important inclusion of critical maternal health policy and budget allocation needs in the annual G8 meetings.

And we have learned what to do. Thanks to the guidance we gleaned from 1994 ICPD PoA, we (mostly us NGOs) have been conducting sophisticated research, implementing a range of programs, and advocating policies to expand women’s access to the full continuum of quality pre- and post-natal services.

Progress in improving maternal health abounds in Tunisia, Sri Lanka, Indonesia, Bangladesh, India and Honduras where the government cut maternal deaths by 40 percent in seven year by directly attacking the five major causes. For hemorrhage, they invested in blood supplies and transfusion equipment. For infections, they distributed antibiotics. For high blood pressure, or eclampsia, they made it easier for pregnant women to get pre-natal checkups with paramedics. For obstructed labor, where the baby is too big to pass through the birth canal, most often caused by pregnancies in girls too young, delaying age at marriage and first births is one route. Another, more costly option, they invested in training surgeons and equipping clinics for caesarean sections. That same capacity for emergency care helped them deal with the fifth major cause of women’s deaths, damage from unsafe abortions. A major investment was to increase women’s access to family planning – because avoiding unintended pregnancies can prevent fully a third, perhaps even 40% of all mothers’ deaths. Forty percent! Just imagine that.

We’re gaining a deeper, more detailed understanding of the economic consequences of maternal death and disability. ICRW’s impressive scene-setting paper produced for the 2007 Women Deliver conference told us that the world loses 15 billion dollars every year in productivity that doesn’t happen because mothers and their newborns are dying. An investment of one-third of that yearly loss could save three of every four women who are dying even as we speak. And just think what that could mean. Just consider what women deliver. Not just babies! The African farmer and HER husband produce 80 percent of Africa’s food. In Southeast Asia it is women who provide 90 percent of the labour for growing rice. Around the developing world, women operate most of the small businesses. They are workers who deliver firewood and water, immunization and health care. They bring home income. The women of Africa carry on their heads or in their arms two-thirds of all the goods that are transported anywhere in Africa. Not trucks or planes, but women, according to DFID.

Finally, it’s been a long and often frustrating effort for the world’s maternal health experts to achieve consensus on the essential elements of maternal health programs and policies. But here it is, 2009, 15 years after Cairo and 6 years before the success of the MDGs is determined, and we’re there. We’ve achieved consensus; it’s evidence-based and pragmatic.

We have agreed that women and their families must have:

• Access to family planning – advice, services, supplies
• Quality and skilled care for pregnancy and childbirth:  ante-natal care, skilled attendance at birth, emergency obstetric care, neo-natal care; and postnatal care for mother and baby
• Safe abortion services when legal

We’ve made progress, for sure. And I don’t have to tell this audience that there is much more to be done. Although our capacities and skills have been expanded, it’s still not enough. Although more funding has been committed, it’s still not enough. Although public awareness has been raised, it’s still not enough. We need more – and better.

And right now we must commit to:

• generating increased political will. This is our biggest barrier to achieving MDG5. We can no longer tolerate lip service to saving women’s lives. In order to make this happen, we have to put everyone’s feet to the fire. We have the facts and we are on the right side. Maternal health has to be a priority on everyone’s agenda.

• pushing for more money from donors and from countries. And we are going to have to make sure the money at hand is used efficiently and effectively and not lost in a bureaucratic maze. As NGOs we are going to have to become skilled in following the money.

• enlisting new allies and going beyond our comfort level of seeking out allies in our communities..

Everyone has a stake in MDG5, everyone – and we need to reach out to Parliamentarians, First Ladies, and Regional Development Banks. Our arguments must resonate with decision-makers, so all of us need to get primed on the economic case as well as the humanitarian case for MDG5..

The progress we have made since those hot days in Cairo 15 years ago is impressive and we all should be proud of our accomplishments. We are indeed blazing trails in the maternal and newborn health movement. They are on fire with new momentum and enthusiasm, and I for one, am optimistic that the next 5+ will bring us darn close to achieving MDG 5 – the heart of the MDGs. Because women really are the heart of their families and their communities, and we know that when women survive, nations thrive. Now is the time to deliver for women.