World Bank Boosts Commitment to Lower Maternal Mortality

• by Jim Lobe (washington)
• Wednesday, May 12, 2010
• Inter Press Service

The initiative, laid out in a 66-page 'Reproductive Health Action Plan', is designed in part to inject new momentum into flagging global efforts to achieve a 75-percent reduction in the maternal mortality ratio between 1990 and 2015 - the fifth of eight Millennium Development Goals (MDGs) set by the United Nations in 2000. It also calls for access to universal reproductive health care by 2015.

Of all the MDGs, which include sharp reductions in child mortality rates, hunger, and extreme poverty, the least amount of progress has been made in improving maternal health, according to the latest statistics.

To achieve such a 75-percent reduction in maternal mortality over the 25 years, for example, countries would have to achieve annual decreases of some 5.5 percent. But the global average rate of reduction, according to the Bank, is currently less than one percent, and only 0.1 percent in sub-Saharan Africa, where mortality levels are the world's highest.

In releasing its plan, the Bank said it hoped to help reverse recent trends that have seen a steady relative decline in financial support for family-planning and other reproductive health programmes from low-income countries, donors, and aid agencies over the past 15 years compared to other health programmes, particularly for HIV/AIDS.

Thus, while development aid for health nearly quintupled - from 2.9 billion dollars in 1995 to 14.1 billion dollars in 2007 - aid for population and reproductive health increased far more modestly - from about 900 million dollars to 1.9 billion dollars 12 years later.

Nor has the Bank, the world's single biggest source of development assistance, been immune. The share claimed by reproductive health from its general health portfolio declined from 18 percent in 1995 to a mere 10 percent in 2007, the Bank said.

Globally, more than 350,000 women die each year - 99 percent of them in developing countries - due to pregnancy and childbirth complications. An estimated 68,000 women die each year, and more than five million more suffer temporary or permanent disability, as a result of unsafe abortions. In some countries, as much as 25 percent of maternal deaths result from unsafe abortions.

'A mother's unnecessary death in childbirth is not just a human tragedy. It's also an economic and social catastrophe that deprives her surviving children of nurture and nutrition and too often of the chance of education,' according to Julian Schweitzer, the Bank's acting vice president of human development.

'Maternal deaths are both caused by poverty and are a cause of it. The costs of childbirth are often the single biggest cause of casting a family into poverty. And, if the mother dies in childbirth, the chances of her baby surviving the first year of life are drastically reduced,' he added.

The Bank's total health portfolio in the current fiscal year is expected to triple to an unprecedented 4.1 billion dollars, a 40-percent increase over the previous year's record.

Much of the additional funding will be devoted to strengthening national and local health systems, particularly in ways that enhance access by women to family-planning and other reproductive-health services.

The plan calls for focusing on 58 countries with persistently high maternal death and fertility rates, including more than 40 poor African nations, as well as Iraq and Yemen in the Middle East; Afghanistan, Nepal, and Pakistan in South Asia; Cambodia, Laos the Philippines, and Timor Leste in Asia; and Bolivia, Guatemala, Honduras and Haiti in Latin America.

The plan calls for providing more contraceptive services. While the use of contraceptives has increased in all developing regions, it remains particularly low - about 22 percent in 2008 - in sub-Saharan Africa despite strong polling data showing a much higher demand.

In order to increase access to contraceptives, according to the Bank, it will work with its government and non-governmental partners to address logistical problems that have hindered the delivery of sufficient supplies at local clinics and pharmacies, expand health-education efforts directed at unmarried adolescents, and step up family-planning services that help to prevent or reduce unsafe abortions as part of a country's basic health programme.

The Bank also plans to promote more prenatal care for women who carry their pregnancies to term.

According to the plan, less than half of pregnant women in the period 2004-2008 were attended to at least four times - the recommended minimum by the World Health Organsation (WHO) and the U.N. Children's Fund (UNICEF) - during their pregnancy by skilled health personnel.

Moreover, only 61 percent of women in developing countries - and only 44 percent in sub-Saharan Africa and 42 percent in Southern Asia - delivered with the help of skilled birth attendants. Thus, the Bank said it will promote the training and use of midwives and other skilled professionals in national health systems.

The plan also calls for continued emphasis on education for girls and women, noting that high birth rates are closely correlated with little or no education, as well as entrenched poverty. Surveys in all developing regions have shown that women with secondary or higher education have fewer children than women whose schooling is more limited.

'Promoting girls' and women's education and the opportunity to succeed are just as important in reducing birth rates in the long run as promoting contraception and family planning,' according to Sadia Chowdhury, co-author of the new plan. 'Education and greater gender equity become a form of social contraception for women.'

The plan noted that the Bank will work closely with several other U.N. agencies, including WHO, UNICEF, and the U.N. Population Fund and bilateral donors, as well as the new Partnership for Maternal, Newborn and Child Health, which includes a coalition of more than 300 NGOs, in its implementing goals.

© Inter Press Service (2010) — All Rights ReservedOriginal source: Inter Press Service