New drive to save the lives of mothers and infants

By 2015, only a handful of African countries are likely to reach the Millennium Development Goals (MDGs) for child and maternal mortality. That means far too many women and children across the continent will succumb to avoidable deaths. However, commitment, money and innovation can help reduce high mortality rates. In an otherwise grim outlook for Africa’s hopes of achieving the Millennium Development Goals (MDGs), there is some good news. Rwanda is very likely to meet the MDG targets for child and maternal mortality, and will possibly be one of the few countries in Africa to surpass them by the 2015 deadline. Théophile Ndabereye, a worker at the Mayange Health Centre, is pleased by some major changes at his clinic, where new equipment and more staff contribute to safe and hygienic births. “We used to only have three trained nurses and most moms were giving birth at home. We now have eighteen,” Ndabereye explained, according to a case study by the UK’s aid agency, the Department for International Development (DFID). As a result, most of the mothers in the area now give birth at the health centre. Life expectancy for the babies has improved as well. The women and their families in Mayange can trace many of these changes to the government’s health insurance programme, Mutuelles de santé, which is run by community representatives and local health providers. Access to the programme increased from 7 percent to 85 percent of the population between 2002 and 2008. Those enrolled pay an annual premium equivalent to Rwf1000 (about US$2). Women who attend four appointments during a pregnancy deliver at no cost. The initial results are impressive. Child mortality has decreased by over 30 percent since 2005 and maternal mortality declined by 25 percent in the years up to 2005. A number of other areas of progress contributed to these results, including an increase in the use of insecticide-treated bed nets from 4 to 67 percent of the population between 2004 and 2007, and a decrease in the HIV prevalence rate to 3 percent. Rwanda’s achievements are all the more welcome on a continent where overall progress towards these goals has been barely perceptible. They demonstrate what is possible when political will, innovative policy and sustained donor support work in concert. Alarming mortality rates Global maternal mortality statistics are alarming, and particularly so in Africa. Of the 536,000 women worldwide who die each year from complications of pregnancy or delivery, 99 per cent are in developing countries. Of those, half are in sub-Saharan Africa. The deaths are the tip of the iceberg. For every one woman who dies, 20 more suffer injury, infection or lasting disabilities. The statistics for child mortality are equally alarming. Of the nearly 10 million children under the age of five who die worldwide each year, 99 per cent are from developing countries. In sub-Saharan Africa 160 children die for every 1,000 live births. Worldwide, child mortality has steadily declined over the past two decades. But there are indications that progress is slowing, and in some areas of sub-Saharan Africa an upward trend is becoming evident. In sub-Saharan Africa the annual rate of reduction is 0.1 per cent, far too slow to reach the goal of a 75 per cent reduction from 1990 to 2015. It is widely acknowledged that the vast majority of these deaths and disabilities are preventable. As the UN Children’s Fund (UNICEF) noted in its 2008 Report Card on Maternal Mortality, “The causes of maternal mortality and morbidity are so clear — as are the means to combat them — that it is difficult to avoid the conclusion they have remained unaddressed for so long due to women’s disadvantageous social, political and economic status in many societies.” Innovative responses In addressing this issue, “innovative financing” may be the key, given the state of the global economy, acknowledges UK Prime Minister Gordon Brown, a leading figure in efforts to boost progress towards the MDGs on child and maternal mortality. He calls on every country in the developed world to “help poorer nations trade their way out of recession and deliver essential health care to the most vulnerable.” UN Population Fund (UNFPA) Executive Director Thoraya Obaid expressed similar concerns about the MDGs. “We know what it would cost to meet our goals,” notes Ms. Obaid. “And, sadly, we know the cost of too little action.” The measures needed to reverse this crisis were spelled out by the UN-backed “Consensus for Maternal, Newborn and Child Health.” The consensus highlights the need for political leadership and community mobilization, with accountability at all levels. It also insists on adequate financial and human resources. The projected price tag to achieve this was estimated at $30 bn from 2009 to 2015, with annual costs rising from $2.5 bn to $5.5 bn over the period. A task force on innovative financing identified some $5.3 bn that could be raised through voluntary contributions with the purchase of airline tickets, debt conversions, the expansion of existing immunization financing facilities and other innovative methods. Yet, some argue that more than political will and increased funding is needed, given the other factors that hamper progress. These include child marriage, lower rates of education for girls and high illiteracy rates for women, lack of access to contraception, female genital mutilation, violence against women, lower nutritional levels for girls and women and the stigma associated with HIV/AIDS and fistula. Political leadership Rwanda and Ethiopia demonstrate that considerable progress is possible when appropriate funds are available and political leaderships act to change policies. Both countries have seen improvements in women’s equality. Other countries are taking their own initiatives. Burundi is providing free health care to all children under five and to pregnant women. Malawi is extending free health services through government- and church-run hospitals. Sierra Leone is planning to provide free health care to women and children. Ghana will exempt pregnant women, children under 18 and the elderly from health insurance premiums. Liberia is hoping to abolish user fees for health services with the help of donor financing. The goals relating to maternal health are achievable, UN Secretary-General Ban Ki-moon believes. “We know what to do. We know what it takes to save lives. We know how to improve the health of women, babies and children. It is said that a society can be judged by how it treats women and children. Just as no woman should die needlessly in childbirth, no person of conscience should stand by as such senseless deaths continue.” The author writes for United Nations Africa Renewal magazine. africarenewal@un.org