Memorandum submitted by the All Party
Parliamentary Group on Population, Development and Reproductive
Health
As the Chair of the All Party Parliamentary
Group on Population, Development and Reproductive Health (APPG
on PD&RH), I am writing to welcome your inquiry into Maternal
Health. Improving maternal health and reducing maternal mortality
by three quarters remains a great challenge.
The APPG on PD&RH has been very pleased
with the UK Secretary of State for International Development and
the Chancellor of the Exchequer's efforts over recent years in
developing pro-poor polices.
DfID's Maternal Health Strategy, published in
2004 and their first progress report in 2005 both provide clear
information on DfID's intentions and accomplishments.
DfID has taken steps to mainstream maternal
health across related policies including HIV/AIDS, Sexual and
Reproductive Health and Rights (SRHR), Gender equality and general
health policies. The latest example being this year's new health
strategy: Working together for better health.
DfID is and remains a leader in advocating for improved
SRHR policies and services and linking SRHR, including maternal
health with poverty eradication.
In support of our submission to the DfID's Select
Committee inquiry, I would like to draw your attention to the
Parliamentary Bangkok Statement of Commitment, 21st-22nd November,
2006 (full statement attached as appendix 1).
Around 300 parliamentarians, NGO representatives
and UN officials from over 100 countries assembled at the UN Conference
Centre, Bangkok, in November, 2006 to review, discuss and plan
new initiatives on population and development, reproductive health
and HIV/AIDS-related issues.
Parliamentarians from around the world committed
themselves to:
(a) "Attain at least 10% of national
development budgets and development assistance budgets for population
and reproductive health programmes including HIV and AIDS prevention
and especially, family planning and reproductive health commodities.
(b) Ensure that the new target on universal
access to reproductive health is immediately and fully integrated
into national development strategies and is given highest priority
in the plans, implementation and monitoring of relevant government
ministries.
(c) Mobilize our governments to support
the adoption of indicators by Member States of the United Nations
to monitor the target of universal access to reproductive health
by 2015 and to use those indicators as soon as they are adopted,
supplemented by additional programme indicators responsive to
national needs.
(d) Work closely with our national authorities
to ensure that the reform processes being undertaken in the United
Nations protect, promote and enhance sensitive mandates such as
population, gender equality and sexual and reproductive health
and that these areas are recognized as central to the support
of the United Nations for national development.
(e) Ensure that when laws are passed and
or policies adopted they are implemented. We must further ensure
that laws and policies include a provision for reporting to the
parliament on the progress of implementation.
(f) Build networks, coalitions and partnerships
with our parliamentary colleagues, government officials, local
NGOs and individuals in order to create the political will and
build the mass support needed to overcome opposition and to clarify
misperceptions about population and reproductive health issues.
(g) Advance awareness of, and legislation
and policy to address, the linkages between people, reproductive
health and the environment, including the need for sustainable
production and consumption patterns, sustainable and equitable
natural resources use, and measures to prevent environmental degradation
and to take action on climate change.
(h) Learn how to work effectively with the
media to ensure that our messages reach the widest audience possible.
(i) Create partnerships with regional parliamentary
groups and UNFPA to develop effective mechanisms to network with
other parliamentarians to exchange experiences and accurate information,
including model legislation and policies, share our successes,
learn from our failures and monitor our work.
(j) Lead national efforts to ratify and
implement key provisions of all relevant international conventions
on the protection and promotion of the rights of people, including
indigenous people, migrants, refugees, people with disabilities
and other marginalized and vulnerable groups.
(k) Ensure that national legislation takes
into account the aspirations of young people and their sexual
and reproductive health and rights, recognizing that they have
a crucial role to play in decision-making and development processes.
(l) Urge governments and the private sector
to give priority to and increase resources for continued research
and development of new disease prevention technologies, such as
vaccines and microbicides, as well as promoting access to the
newly developed HPV vaccine that potentially protects against
cancer of the cervix.
(m) Action to manage and prevent STIs in
order to increase wellbeing, and prevent infertility, cervical
cancer, maternal and newborn complications and deaths, and vulnerability
to HIV/AIDS."
The Bangkok Statement of commitment also reads:
"The Road Ahead
11. We need to package the clear evidence
that addressing population issues and sexual and reproductive
health are central to the achievement of development goals, in
order to facilitate national policy dialogue and legislation and
to review more effectively budget proposals.
12. We must convey information to the public,
our parliamentary colleagues, government officials, and the media
in clear, concise and simple language, including the following
messages:
(a) Every minute a woman dies of pregnancy-related
complications, including unsafe abortions, almost all of them
in developing countries.
(b) Obstetric complications are the leading
cause of death for women of reproductive age in developing countries.
(c) One third of all pregnant women receive
no health care during pregnancy; 60% of deliveries take place
outside of health facilities; only half of all deliveries are
assisted by skilled birth attendants.
(d) Some 200 million women in developing
countries have an unmet need for effective contraception. Meeting
their needs would prevent 23 million unplanned births a year,
22 million induced abortions, 142,000 pregnancy-related deaths,
including 53,000 from unsafe abortions, and 1.4 million infant
deaths.
(e) Almost 1 million new infections each
day from STIs, including HIV, account for 17% of economic losses
caused by ill-health in developing countries, and contribute to
an enormous burden of ill-health and death across the globe.
(f) Fewer than 20% of people at high risk
of HIV infection have access to proven prevention interventions.
13. We must convey clear messages on the
cost-benefit of addressing the unmet needs of 200 million women,
including the costs of providing emergency obstetric care, ensuring
that all deliveries are assisted by skilled birth attendants and
providing services for prevention, care, treatment and support
for people living with HIV and AIDS.
14. Most importantly, we must convey in
clear and concise terms the human, social and economic costs if
we fail to address these population and sexual and reproductive
health issues.
15. We must convince our parliamentary colleagues
and government officials that:
(a) Quality reproductive health care saves
lives, and reduces poverty.
(b) The failure of previous national development
plans can be attributed, among others, to the failure to invest
in sexual and reproductive health and to promote the rights of
women and girls.
(c) The MDGs, particularly the eradication
of extreme poverty and hunger, cannot be achieved if questions
of population, reproductive health and sustainable development
are not squarely addressed through greater investment in education
and health, and the prevention of preventable deaths among women.
16. We must engage constructively with all
sectors of society, listen to their concerns, discuss perceptions
and realities with them and debate sexual and reproductive health
issues publicly and in a civil manner.
17. We must secure the understanding and
support of different sectors of society that quality reproductive
health information and services, that are available, accessible
and affordable, including in rural areas, enables women to make
choices that safeguard their health and lives, fulfil their potential,
and contribute productively to society. Recognizing that unsafe
abortion is one of the leading causes of women's death, we must
also convey this information to our parliamentary colleagues and
to government officials who are responsible for implementing the
ICPD Programme of Action."
The APPG on PD&RH encourages Ministers to
advocate, during country visits, for increased and improved maternal
and reproductive health services. The Bangkok statement of commitment
is a useful tool.
Ministries of Finance need to be convinced that
improving maternal health is good value for money and has the
potential to save the lives of women and children, and therefore
has direct positive repercussions on poverty reduction and long-term
development.
It is of particular importance that Ministers
make reference to the new Millennium Development Goal target under
MDG5: universal access to reproductive health and its associated
indicators—contraceptive prevalence, unmet need for family
planning, adolescent birth rate and antenatal care coverage, as
well as the target of reducing maternal mortality and its associated
indicators—maternal mortality ratio and proportion of births
attended by skilled health personnel.
DfID should especially advocate for support
to the more controversial areas of maternal health, including
unsafe abortion and access to safe abortion services as well as
family planning.
Family planning needs to be more strongly promoted
as a way of improving maternal health, as essential to addressing
population growth and to ensuring that women have real choice;
as well as for more effectively preventing the spread of HIV and
AIDS, through services that are integrated at the point of delivery.
DfID must be a leader in seeking to attain at
least 10% of its official development assistance for population
and reproductive health programmes including HIV and AIDS prevention
and especially, family planning and reproductive health commodities.
Long term predictable financing is of particular
importance for scaling up maternal and general health services.
Financial and technical support is needed to
build up existing country health systems, with attention to basic
infrastructure, logistics, supplies, financing, regulatory frameworks
for private-public collaboration, insurance, information, management
information systems and trained and motivated health workers,
which include issues around incentives and staff retention.
As one sixth of the population of developing
countries live in "fragile states", where governments
are unwilling to provide services to most people, supporting NGOs
is paramount.
DfID country personnel must advocate for improvements
in maternal and child health. National development and poverty
reduction strategies need to reflect an analysis of the challenges
and responses needed to reduce maternal mortality.
The APPG on PD&RH welcomes the recent amalgamation
of the HIV/AIDS Policy Team and the Reproductive and Child Health
Policy Teams into the new AIDS and Reproductive Health Policy
Team, as a means to better linking HIV/AIDS and SRHR. It is important
that DfID monitor the effective working of this Policy Group to
ensure HIV/AIDS and Reproductive Health are given equal status
and commitment.
Improving individual and couples SRHR will reduce
poverty, deliver development quicker and respond to the needs
of poor people.
13 September 2007
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