Investing in MDG 5: Maternal Health

The Role of mediaDr. Saramma Thomas Mathai

Regional Team Coordinator and MH Advisor UNFPA Asia Pacific Regional Office, Bangkok

UN MDG workshopMay 28, 2012

2

MATERNAL HEALTH – PROGRESS AND CHALLENGES

Section 1

3

MDG 5: Improve maternal health-Targets and indicators

Target 5. a: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Indicators:• Maternal mortality ratio (MMR)• Proportion of births attended

by skilled health personnel

Target 5.b: Achieve, by 2015, universal access to reproductive health

• Contraceptive prevalence rate • Adolescent birth rate• Antenatal care coverage

(at least one visit and at least four visits)

• Unmet need for family planning

Progress in reducing maternal mortality ratio, no time for complacency

0 100 200 300 400 500 600 700

220

420

590

199020002010

• Southern Asia

0 100 200 300 400

150

230

380

199020002010

• South-Eastern Asia

Source: United Nations, The Millennium Development Goals Report 2011 and UN trends in maternal mortality 1990-2010

Maternal deaths per 100,000 live births

Target : 75% reduction in MMR

Bhutan, Maldives, Iran, Nepal and Vietnam achieved MDG 5. Others on track.

Proportion of deliveries attended by skilled health personnel (%)

0 20 40 60 80 100

50

32

19902009

Southern Asia

0 20 40 60 80 100

72

49

19902009

South Eastern Asia

Source: United Nations, The Millennium Development Goals Report 2011

6

Family planning is critical for MDG 5- stagnating rates of adolescent fertility

and unmet needs of FP

0 20 40 60 80 100

53

59

89199020002008

Southern Asia -Adolescent fertility

0 20 40 60 80 100

44

40

54199020002008

South Eastern Asia – Adolescent fertility

0 5 10 15 20 25

15

17

20

199020002008

Southern Asia- Unmet needs of FP

0 5 10 15 20 25

11

11

15199020002008

South Eastern Asia- Unmet needs of FP

Source: United Nations, The Millennium Development Goals Report 2011a. Adolescent fertility= Number of births per 1,000 aged 15-19 b. Unmet needs of FP= women who want to space or limit a family, but not using a method

Cost effective strategies are well known, but unattainable for many women in Asia

Social, cultural, political, economic factors determine access

Skilled birth attendants (SBA)

Emergency obstetric care (EmOC)

Health systemsFamily and community determine access

Family planning

The three pronged strategy to save lives of mothers and their newborns

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Why is Asia lagging behind in MDG 5?

Equity: maternal death and ill health

clustered among poor, excluded, geographical Coverage and quality issues due to health

system constraintsDespite economic developments, investments in health continue to be low and out of pocket expenditures are high and when there is a complication, the family is further drawn down the spiral of poverty

Human resources gaps (inequitable distribution, retention)

Data gaps (inadequate and incomplete data systems, vital registration systems)

Social and cultural challenges M Mortality – an indicator of the way the way women are cared for in

a society and create obstacles to accessing care

9

Poor still have no access to skilled care

Year 2005 2010 2007 2011 2007 2011Country Cambodia Bangladesh Nepal

0

5

10

15

20

25

30

35

40

45

Delivery by C-Section

Lowest Q

Highest Q

Yea

r

2005

2010

2007

2011

2007

2011

Coun-try

Cambodia Bangladesh Nepal

0

20

40

60

80

100

120

Delivery by Skilled Birth At-tendants

Lowest Q

Highest Q

Source: Demographic Health Survey of Cambodia (2010) Bangladesh (2007) and Nepal (2011)

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WHAT CAN MEDIA DO TO ADVOCATE FOR MATERNAL HEALTH

Section 2

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MDG 5 is central to achieving other MDGs and future generations

Economic facts: An estimated US $ 15 billion in lost productivity every year due to maternal

and newborn mortality Women are the sole income earners for over 25% of households worldwide

and women’s unpaid work equals about 1/3 of the world’s GNP 30-50% of Asia’s economic growth from 1965-90 can be attributed to

improvements in reproductive health and reductions in infant and child mortality rates

Social facts Mother’s survival is linked to the survival of her newborn or her children

below five years Mother’s survival is essential for instilling social and cultural values and

ensuring education of young girls who otherwise would take on responsibility of the family

While MDG 5 contributes to achieving all MDGs, it is a major contributor to MDGs 4, 3, 6 and 1

Source: UNSG’s global strategy for women’s and children’s health

1. Media can help governments accountable to meet commitments

2010 Afghanistan Bangladesh Cambodia China India Indonesia Nepal

2011 Lao PDR Mongolia Myanmar Papua New

Guinea Vietnam Sri Lanka

BBC World Trust committed US $30 million for five years to scale up its work in Africa and Asia to help build the capacity of local communities to use media and communications to improve health.

2. Report on maternal deaths Media can mobilize commitment to “save mothers’’

from policy makers, professionals and communities Success stories (few examples) In the early 1930s the media reports on maternal deaths

galvanized the medical community to investigate maternal deaths.

The New York times: reported on a maternal death in Cameroon that led to focus on the issues and increased budget and also has focused on the issue of fistula

BBC: In Bolivia, reporting on maternal health led to opening midwifery schools and other commitments

India – sting operation by TV channel, vernacular newspaper reports

Bangladesh: Grass root level journalists go beyond reporting Indonesia: Maternal mortality Philippines – RH bill

3. Facilitate social audits, mobilize communities

Fuel high level commitment through social audits to explore the “road to death” individual woman take including accounts of family and health care providers ---- no ‘witch hunting”

Mobilize community level actions in creating awareness about danger signs, birth preparedness and skilled care as well as support for community insurance schemes for the poor (revolving funds) and transport

Culturally appropriate advocacy to deal with son preference and promoting the value of girls (good examples from India)

Present the story from a rights perspective and be persistent and present as a national issue

Reporting could be challenging With status of women being low in most of

the countries, the topic of maternal health may be considered not newsworthy

• It may not be seen as a development issue• It is about a single woman – unlike an

epidemic when many die• There is no quick fix and it can be difficult to

explain

However---A maternal death is not a mere statistic---It could be your wife, sister, daughter–

would you stop reporting???

A commitmentThe pain of childbirth may fade quickly from a woman’s memory, but the pain of a woman’s death in childbirth

lingers on forever for the children and family she leaves behind (source: women deliver article)

As people who influence communities and societies, let us resolve not to let another day pass with maternal death being a silent tragedy and not to let any woman die giving life. If dead mothers could talk, they will tell you the injustice we have done to them.

THANK YOU