| Summary
Millennium Development Goal 5 (MDG 5), which seeks to reduce by three-quarters the level of maternal mortality by 2015, has seen the least progress of all the MDGs. A key factor in this collective failure has been insufficient political will to drive actions to improve the health of women, both at the international and national levels.
The Department for International Development (DFID) has been a leading donor to maternal health programmes. It deserves credit for its creation of international partnerships, its willingness to address sensitive issues such as abortion, its support to research and its consistent focus on strengthening health systems.
Major challenges remain. Only two in five women in sub-Saharan Africa deliver their babies with the assistance of a skilled attendant and this is largely unchanged since the early 1990s. Addressing the huge shortage of midwives worldwide and increasing the availability of emergency obstetric care to all women has been and must remain at the centre of DFID's approach. Increasing access to basic drugs and equipment—including family planning supplies—is also vital.
It is also crucial to address the gender inequalities that prevent women fulfilling their right to health. Improvements to health information systems in developing countries need the continuing support of DFID so that policies and programmes can be evidence-based and progress towards MDG 5 can be tracked reliably.
Lack of data from countries with some of the worst death tolls, a tendency to under-report maternal deaths and the use of national averages create uncertainty about the real scale of maternal mortality, particularly in sub-Saharan Africa and Asia. Whilst the number of maternal deaths for 2005 is cited as 536,000, it could be as high as 872,000. We fear that the higher figure could indeed be nearer the truth. It has also been estimated that for each woman who dies, 30 further women will become disabled, injured or ill owing to pregnancy, so it is reasonable to assume that millions of women suffer in some way due to childbirth.
Inequalities in access to maternal care are driven primarily by poverty. DFID should continue to support the abolition of charges for health care and help governments to identify and address the major barriers to care, especially for the poorest women and in conflict settings where demand for maternal care is higher and access more difficult.
DFID cannot single-handedly bring about the progress needed to reach MDG 5. It needs to step back and prioritise carefully in order to maximise the series of crucial opportunities offered in 2008. The Department must play to its strengths and support other actors, especially the UN, in playing their part. Only then will maternal health receive the urgent political commitment that it deserves.
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