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Maternal health strategy reducing maternal deaths: evidence and action - Third progress report

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Global headlines 2007

- Every minute a woman dies in childbirth. 536,000 women continue to die needlessly each year at a time which should be joyous - just when they are bringing life into the world. A further 300 million suffer from avoidable illnessand disability.

- The fifth Millennium Development Goal (MDG) which aims to 'improve maternal health' - is desperately off-track. We are not likely to achieve Millennium Development Target 5A which calls for a reduction by three quarters, between 1990 to 2015, of the maternal mortality ratio.

- The explanation for these deaths and health problems is simple - when a woman faces a problem, there is not a trained health worker on hand to help. High maternal mortality rates are the single most accurate barometer of how poor a health system is in a country.

- The shortfall in funds to meet the MDGs for maternal and child health amounts to only 2% of current development aid - a small fraction of world spending. Yet investing in women and their health strengthens families, communities and countries. Family budgets, local productivity and national wealth all flourish where maternal health is prioritised.

- Despite a decline in the worldwide abortion rate between 1995 and 2003, the proportion of abortion that is unsafe remains the same.

- To accelerate progress, a new Millennium Development Target 5B has been added to strengthen family planning and achieve, by 2015, universal access to reproductive health.

Summary of DFID's progress 2007

- In Asia there is progress, maternal mortality is falling in Nepal, Bangladesh and India (there are no recent data for Pakistan), but these improvements are not enough to be on track to reach the 2015 MDG target.

- In Africa, weak health systems, lack of access to family planning, unsafe abortion and HIV infection continue to delay progress against MDG 5. At present, all of DFID's focus countries are off-track and will not meet the MDG target. Constraints to progress include the weak in-country performance of multilaterals and financial barriers to accessing health services.

- In Europe, Middle East and the Americas, China, Cambodia and the Yemen are on track, but additional focus on reaching the poorest is needed.

- The year 2007, the 20th anniversary of the global Safe Motherhood Initiative, was an exceptional year for advocacy. The Prime Minister opened the landmark Women Deliver Conference in London.

- In September, the Prime Minister launched the International Health Partnership (IHP). Strengthened health systems are central to the IHP and core to improving MDG 5.

- The Norwegian Initiative for MDGs 4 and 5 was also launched in 2007. Gordon Brown is engaged in Prime Minister Stoltenberg's Network of Global Leaders initiative.

- DFID has updated its strategy on HIV and AIDS and will give greater attention to the impact of HIV on maternal health.

Forward look 2008

In 2008, we will focus on four priority policy areas to accelerate progress on MDG 5 - improve maternal health. These are:

- health systems strengthening - with greater focus on demonstrating progress on maternal health;

- targeting investments in interventions with a high impact;

- high level international advocacy through UN, G8 and EU; and

- support for civil society advocacy in DFID's focus countries.

Further details on these priorities are set out below.

1. Health systems strengthening

To provide the life-saving emergency obstetric care that an estimated 15% of all pregnant women will need requires a functioning health system. This includes: human resources (particularly midwifery but also referral level skills such as obstetric surgery and anesthesia); essential drugs and supplies; infrastructure (hospitals, clinics); transport and communications for referral; power, water and sanitation. Our support to health system strengthening is increasingly funded through budget support in stable environments and through a range of instruments in fragile states. There is an opportunity to maximise our investments by improving data availability and using progress on maternal health as an indicator of overall health systems improvement.

DFID's new AIDS strategy emphasises the importance of long-term predictable funding for health systems strengthening. The UK will be calling on the G8, EU and others to commit to build effective health services and systems and increase investment in health workers - see box on page 6 - priorities for UK international lobbying during 2008.

2. Targeting investments in interventions with a high impact

In addition to our efforts to strengthen overall health systems we will target investments in areas with a high return on maternal health and/or which are neglected or politically unpopular areas - specifically:

- Family planning: An estimated 32% of maternal deaths could be averted through family planning. It is one of the most cost-effective interventions in public health. Research has shown that every US$ 1 million spent on family planning can avert 360,000 unwanted pregnancies, prevent 150,000 induced abortions and save the lives of 800 mothers and 11,000 infants.

DFID's Policy and Research Division, in liaison with regional and other divisions, will prepare a new position paper on how to address the unmet need for family planning. We will work with other like-minded donors (particularly in the EU), the Bill and Melinda Gates Foundation and the Hewlett Foundation to increase global support to family planning.

- Preventing unsafe abortion: 13% of all maternal deaths are caused by unsafe abortion - this means that around 70,000 women (often the youngest and most vulnerable) are dying needlessly each year. Abortion remains one of the most politically contentious issues of our time and extreme divisions of views on women's reproductive rights have constrained an effective global response.

DFID is one of the few donors to actively support efforts to prevent unsafe abortion and plays a leading role in focussing attention - and challenging policies - on the issue; most recently at the Global Safe Abortion Conference in October 2007. DFID has provided £4m to the Safe Abortion Action Fund (SAAF) and a £6.5 million contribution to IPAS.

- Sexual and reproductive health (SRH): Universal access to SRH services (particularly for adolescents) would significantly improve maternal health. Maternal death is the leading cause of death for girls aged 15-19 in the developing world. The integration of SRH with HIV and AIDS services would also reduce maternal mortality. An HIV-infected pregnant woman is four to five times more likely to die in childbirth than one who is not infected.

3. High level international advocacy

2008 provides a number of opportunities for the UK to provide continued international leadership on maternal health (a role for which we have been credited by the recent International Development Committee (IDC) Inquiry on Maternal Health). The major opportunities for us to continue to influence others will be during the run up to the G8 and the UN High Level Meeting on MDGs:

- At the G8 summit in Japan in July, the UK Government should continue to build on the Japanese Government's steer to address MDGs 4 and 5, and press for commitments on health spend and on addressing the health workforce crisis.

- At the UN High Level Meeting on MDGs in New York on 25 September, we should increase pressure on all countries to make specific commitments.