Memorandum by Plan UK
This submission has been prepared by the UK
division of Plan International, with strong input from Plan's
country offices.
Plan welcomes DFID's Maternal Health Strategy
and its contributions to multilateral donors and non-governmental
organisations but more action is urgently needed to reach the
fifth Millennium Development Goal (MDG) target of reducing the
maternal mortality ratio by three-quarters by 2015.
INTRODUCTION
1. Plan is an international child centred
development organisation committed to promoting the rights of
children world-wide. We currently operate in 49 developing countries.
Plan's approach to sustainable development takes place through
our child centred community development (CCCD) approach based
on a rights based approach guided by the UN Convention on the
Rights of the Child.
2. Maternal health is the leading cause
of death in young women aged 15-19 in the developing world.[159]
70,000 teenage girls in the developing world die from the complications
of childbirth and pregnancy each year.[160]
3. The highest proportion of births among
young women occurs in Sub-Saharan Africa, where more than one
in every four young women has a child by the age of 18.
4. An HIV infected women is four times more
likely to die in pregnancy and childbirth than an uninfected woman.
5. Female Genital Cutting (FGC) significantly
increases complications for women during childbirth and in Africa
results in the death of an additional 10-20 babies per 1,000 births.
6. Maternal newborn and child health (MNCH)
are interdependent and inseparable. At least 20% of the burden
of disease in children below the age of 5 is related to poor maternal
health and nutrition, as well as quality of care at delivery and
during the newborn period.
7. Maternal health is also affected by "3
delay":
(a) The delay of taking decision, by women
and the whole community to demand high quality maternal care (prenatal,
delivery, postnatal care).
(b) The delay of accessing health centres.
This is mainly due to the long distance to health facilities.
(c) The delay of providing high quality health
care services at the health centre.
8. This submission highlights the main areas
of concern regarding maternal health care as observed by a number
of Plan country offices, and puts forward a series of recommendations
for DFID to consider, and implement, in their maternal health
care policies.
Q1: How effective Family Planning is being
promoted as a way to improve maternal health
9. Plan promotes effective family planning
through a holistic approach to the provision of sexual and reproductive
health rights, family planning and AIDS education that incorporates
the learning of life-skills. Sexual health education must be inclusive
and should be expanded to include often neglected groups, such
as disabled children, as ALL children have the right to sex education
and to their sexual and reproductive rights.
The introduction of sexual health education, family
planning and STI/HIV/AIDS information into the school curriculum
10. All efforts should be made to ensure
the active participation of children and young people to enable
them to access reproductive health information. Plan Thailand
has piloted an adolescent sexual and reproductive health (ASRH)
education programme in 21 schools in collaboration with the Ministry
of Education and PATH[161]
to integrate HIV and related adolescent reproductive and sexual
health issues into the mainstream curriculum in both elementary
and secondary education.
Youth Clubs
11. Plan is promoting effective family planning
through youth clubs and similar spaces where young people can
address reproductive health issues as well as gender inequalities.
In Togo, communication between children and adults on sexuality
is traditionally poor. Plan responded by helping to establish
youth clubs in towns and villages in its programme areas, with
approximately 20 to 30 members of both sexes in each, ranging
from 13 to 19 years old. They developed their own activities,
ranging from sports and entertainment to education and other issues
of particular concern to them. Sex is no longer a taboo subject
and young people note that they can now discuss sexual matters
with their parents. Head-teachers report a decrease in the number
of pregnancies and abortions among school girls. This case highlights
the importance of creating spaces where young people can communicate
in which girls can be empowered, as well as the need to involve
men as part of such prevention strategies.
Training of Peer Educators
12. In Guinea Plan is implementing the child-to-child
methodology and training peer educators to transfer family planning
and birth spacing knowledge and positive attitudes gained in the
classroom to younger, in-school students and out-of-school peers
in the community through activities such as theatre, sports, discussions,
video, and song.
Information, Education and Communication activities
(IEC)
13. In Zambia, the Ministry of Health in
collaboration with Plan Zambia are looking at the production of
IEC materials as a way of sensitizing and raising awareness of
the various reproductive services available. IEC will provide
information to clients to enable them to make informed choices
thereby enhancing demand for access to quality reproductive health
services, behaviour change among communities and service providers.
Community-Based Events
14. In the Philippines Plan has promoted
family planning through a number of community events including
developing the guidelines on "Safe Pregnancy Campaign"
and supporting the inclusion of a Family Planning Month in the
National Health Calendar.
Media
15. Plan promotes effective family planning
through children's work with the media and methods chosen by children
themselves as ways of disseminating reproductive health messages.
Plan Kenya developed a programme using traditional media such
as drama, songs, poems and puppet shows to communicate messages
on HIV prevention, as these combined together education and entertainment,
reaching a broader part of the community.[162]
Enhancing Service Accessibility and Quality
16. Plan is promoting effective family planning
through enhancing service accessibility and quality. In the Philippines
Plan has done this through the training of professional and volunteer
service providers on basic family planning and surgical methods
and also through private sector mobilization to set up community-based
outlets for family planning methods at an affordable cost.
17. Plan Zambia is promoting effective family
planning through supporting community innovations towards community
transport and funding systems to address the problem of access
to health facilities.
Preventing Early Marriage
18. In Niger Plan began to educate community
members about the dangers of early marriage. Plan staff held discussions
with religious leaders about reproductive health issues and then
trained village leaders in these issues utilising the assistance
of the well-respected religious leaders. Plan also reinforced
girls' education and school youth programs to keep young people
engaged in healthy, stable environments. On the national level,
Plan has been working with the Ministry of Social Affairs to implement
the Code for the Child, which will discourage the practice of
early marriage, by recognising it as a violation of children's
rights.
Promoting Birth Registration
19. Universal Birth Registration (UBR) helps
girls to access services such as health and education and can
protect them from early marriage and abuse. In Nicaragua, Plan
works with a local organisation which brings local government
authorities and communities together in order to increase the
number of children registered at birth. During vaccination campaigns
the municipality now accompanies health unit teams on their visits
to communities where they set up a mobile registration desk. Mothers
bringing their children for vaccination are therefore also able
to register the birth of their children.
Ensuring Gender Equality
20. Plan looks more holistically at the
underlying causes of women and girls reproductive health, moving
away from a medical focus alone to explore the impact of gender
power relations and discrimination. The State of the World's Girls
report is a series of annual reports published by Plan examining
the rights of girls throughout their childhood, adolescence and
as young women. The first report, "Because I am a Girl",
(published in May 2007) documented the extent of discrimination
against girls across the world, in terms of access to education,
healthcare and other rights. This series is used as an effective
tool in advocating the rights of girls at national and international
forum.
21. A "male motivation" project
undertaken in Plan Zimbabwe proved the positive impact male involvement
can have on improving women's lives and health. The aim of the
project was to educate men and women about family planning and
so increase the use of family planning methods. Under the campaign
theme "Endhla wanuna—longa ndangu wawena (Be a man—plan
your family) the project employed a wide range of awareness raising
tools to promote joint family planning decision making between
men and women. These included talks for men, home visits, community
theatre, awareness raising in schools and condom distribution.
The result of the project was increased use of contraception and
increase in men and women discussing family planning issues and
taking family planning decisions as a joint couple responsibility.
22. In programmes designed to promote HIV
prevention Plan's experience shows that it is most effective to
design programmes to prevent HIV transmission from parents to
children, as opposed to referring to mother to child transmission.
It is essential that both parents are involved.
Awareness raising on the risks of Female Genital
Cutting (FGC)
23. Plan is promoting effective family planning
through our work on Female Genital Cutting (FGC). Plan Ethiopia's
family planning project includes a community based FGC component.
This project works within the local context utilizing traditional
"coffee meetings" to disseminate messages on the dangers
of FGC.
Q2: How DFID can catalyse progress towards
MDG 5
24. We recognise and commend the significant
gains made by DFID's assistance to programmes on maternal health
and urge for DFID's continued commitment, technical expertise
and leadership in achieving the goals of MDG 4 and MDG 5.
25. While recognising the commitments of
the Paris Declaration of harmonisation, alignment and management
of aid, we call on DFID to continue to remain a leading voice
in advocating pro-poor policies within the international donor
community.
Strengthening Health Systems
26. DFID should continue supporting health
systems strengthening through supporting national governments
to increase resource availability in the Health Sector by providing
planning and budgetary support. DFID should support programmes
to improve health human resource management and provide long-term,
predictable funding for salaries in the health sector.
27. DFID should support decentralisation
processes within the health system in developing countries in
order to provide quality maternal and child health services.
Supporting Community Based Maternal Care
28. DFID should strengthen program support
for community based maternal care programmes through scaling-up
of behaviour change communication/social marketing approaches
in local language highlighting information on antenatal care,
danger signs in pregnancy, delivery, newborn care and also through
educating the community on women's rights, benefits of health
services, nutrition guidelines for pregnant mothers, and other
healthy lifestyle practices.
Increased Access
29. DFID should support increasing physical
access to comprehensive maternal care through increasing public-private
sector collaboration for service delivery, scaling-up the inter-local
health system and support community innovations towards community
transport. DFID should also support social protection systems
to enable local communities to access health care services.
Increased Quality
30. DFID should support the provision of
quality health facilities and service providers through strengthening
basic and comprehensive emergency obstetric care, increasing the
numbers of fully trained health care providers and increasing
availability of emergency medicines and equipment. Quality of
service can also be achieved through supporting the updating of
clinical protocols and guidelines, eg mother-baby friendly indicators
for health facilities and ensuring data is disaggregated.
Education
31. DFID should support the introduction
of sexual and reproductive health education, family planning,
STI/HIV/AIDS information into the school curriculum from as early
a stage as possible to then be supported by youth clubs and extra-curricular
activities involving the entire community.
32. DFID should continue to support free
and compulsory primary education and provide support to secondary
education, including scholarships to enable girls to continue
their education. Our experience has shown the more educated a
girl is the more knowledge she gains in child health, child spacing,
nutrition and reproductive health.
Family Planning
33. DFID should support youth friendly Family
Planning (FP) health delivery services tailoring to the local
social and cultural context to ensure access and utilization of
available services and support programmes developed for males
mobilising them to take a responsible role in family planning
and maternal health decision making.
Legal Issues
34. DFID should support strengthening national
and local legislation to ensure the promotion and protection of
rights for girls and young women to access comprehensive medical
services. DFID should also hold Governments accountable to International
Conventions including the Convention on the Rights of the Child
(CRC) and the Convention on the Elimination of all forms of Discrimination
Against Women (CEDAW).
35. DFID can help decrease the early marriage
of young girls and promote UBR through supporting governments
to improve and implement legislation. This should be complemented
by public education campaigns to highlight the rights of girls
and should involve the entire community, including children, parents,
religious leaders and traditional authorities.[163]
Female Genital Cutting
36. DFID should support local grassroots
community awareness raising campaigns to make women, men and children
knowledgeable of the risks and dangers of FGC.
159 UNFPA-Maternal mortality Update (2004). Back
160
State of the Worlds Mothers-Children having Children (2004). Back
161
PATH is a non profit organisation with the mandate of improving
the health of people throughout the world. Back
162
Plan International (2005) Children's response to HIV: an examination
of how HIV impacts on vulnerable children through the creative
arts of children in Homa Bay District, Kenya. Back
163
Plan International (2006) Circle of Hope: Children's right in
a world of AIDS. Back
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