Memorandum submitted by World Vision
INTRODUCTION
1. World Vision is a Christian relief, development
and advocacy organisation, dedicated to working with children,
families and communities to overcome poverty and injustice. Motivated
by our Christian faith, World Vision is dedicated to working with
the world's most vulnerable people. World Vision serves all people,
regardless of religion, race, ethnicity or gender.
2. World Vision is a member of the Partnership
for Maternal, Newborn and Child Health, an alliance launched in
September 2005 which is made up of some 130 members working to
ensure that all women, infants and children not only remain healthy,
but thrive.
STALLED PROGRESS
TOWARDS MILLENNIUM
DEVELOPMENT GOAL
5
3. Every year, 50 million women give birth
without the help of a skilled attendant.[206]
More than 500,000 women die every year as a result of difficulties
during pregnancy or childbirth.[207]
In sub-Saharan Africa, a woman's risk of dying from such complications
over the course of her lifetime in 1 in 16, compared to 1 in 3,800
in the developed world.[208]
What should be a time of joy and celebration is too often a time
of grief and loss. In addition to the women who die, many thousands
are left injured or infertile after childbirth.
4. A mother's death can be devastating to
the children left behind. In addition to the emotional trauma
and grief of losing a mother, these children are much more likely
to live in poverty, drop out of school, and be malnourished. Girls,
especially, are expected to take on the responsibilities of the
mother in caring for younger children, preparing food and carrying
out household tasks.
5. Aid and development organisations like
World Vision seek to improve maternal health by:
(i) Training and equipping midwives or birth
attendants to support mothers in labour.
(ii) Improving access for girls to primary
school. Educated girls are more likely to have fewer children
and give birth to them later in life. They are also more likely
to seek health care and have healthy babies.
(iii) Increasing access to emergency medical
care.
WORLD VISION'S
WORK IN
MATERNAL HEALTH
6. Afghanistan has one of the highest maternal
mortality rates in the world. According to UNDP figures from 2004,
one woman dies from pregnancy-related causes every 30 minutes.
To help stem the tide of these deaths women must be trained as
midwives and prepared to serve in remote, rural communities.
7. The best and most sustainable method
is one that recruits women from the community to be trained as
midwives. World Vision has been supporting a successful midwifery
training programme in Herat which has seen 142 midwives graduate
since opening in 2004.
8. Meanwhile neighbouring Ghor Province
has had to rely on midwives coming from Tajikistan because the
security situation deters midwives from Kabul and Herat from working
there. A handful of women from within Ghor province had attended
the midwifery training programme in Herat, but in Afghan society
it is rarely acceptable for women to live or study so far from
home.
9. So this year World Vision, supported
by JHPIEGO (an international health organisation affiliated with
Johns Hopkins University) is expanding its midwifery training
programme to address the dire need for midwives in the mountainous,
isolated districts of Ghor Province.
10. In collaboration with a local women's
NGO called STARS, the 18-month training programme will include
a furnished skills lab, practical clinic work, transportation
to training sites, and housing. It is hoped that by granting easier
access to training for women drawn from rural communities, the
Ghor programme will create inroads to better health for mothers
throughout the province.
11. In Indonesia, World Vision has been
part of a pilot research project as part of the Information Communications
Technology for Development Project (ICT4D) which has equipped
200 rural midwives with mobile phones. The study is to assess
whether or not mobile communications can be used as an effective
tool for impacting the quality of pre- and post-natal care in
Indonesia.
12. In one anecdotal report, the number
of pregnant women referred to hospitals by midwives with mobile
phones actually decreased when they got mobile phones, as they
could talk the problems through with the obstetrician, and in
many cases life-saving treatment could be provided by the midwife.[209]
HIV AND MATERNAL
HEALTH
13. There is growing evidence of the impact
of HIV and AIDS on maternal health in areas of high HIV prevalence,
with HIV reversing previous gains in maternal health in those
countries most severely affected. A study in the Rakai district
of Uganda showed the maternal mortality ratio was five times higher
in HIV-infected than HIV-uninfected women.[210]
14. Given that the 2005 World Health Report
states that 19 of the 20 countries with the highest maternal mortality
ratios are in sub-Saharan Africa,[211]
the impact of HIV and AIDS on maternal health must be considered
a priority in these countries.
15. DFID's 2007 progress report on its Maternal
Health Strategy states that:
"Maternal mortality in Zimbabwe has risen
from 395 deaths per 100,000 live births in 1992 to an estimated
1,068 per 100,000 in 2002. One of the main causes of this increased
risk is HIV and AIDS. Zimbabwe's HIV prevalence rate is among
the highest in the world at 18%, with some 1.6 million people
infected with HIV or suffering the effects of AIDS".[212]
16. Maternal health cannot be examined in
isolation from newborn and child health and the impact of HIV
on children is devastating. An estimated one third of infants
with HIV die before their first birthday and half do not reach
the age of two. In 2006 there were an estimated 530,000 children
newly infected with HIV, with over 90% of these new infections
occurring as a result of mother-to-child transmission.[213]
WHAT DFID CAN
DO
17. The Partnership for Maternal, Newborn
and Child Health is still in its infancy and struggles to have
a co-ordinated and concerted influence, with so many different
members, stakeholders and political voices. DFID can provide some
of the leverage needed to achieve focus and coherence in this
partnership. DFID's leadership in a strong Partnership is a key
opportunity to use the global stage to accelerate progress towards
Millennium Development Goals 4 and 5 and to bring together country-level
stakeholders to co-ordinate more effective programming in maternal
and child health.
18. Effective maternal and child health
programming cannot be achieved without serious and sustained investment
in health systems strengthening. DFID have reported early success
in their significant investment in health systems in Malawi through
their Emergency Human Resources Programme (EHRP) which aims to
increase the numbers of health workers. Alongside the EHRP is
a six-year Essential Health Package which includes specific support
to improving maternal health services, identified as a priority
due to Malawi's poor maternal mortality figures.
19. DFID has done much strategic work in
maternal health and has invested significant resources, including
bilateral spending of £243 million in 2004-05 and "significant
contributions" to the maternal health programmes of the EC,
the World Bank and international and national civil society groups.[214]
An analysis of what has worked and what hasn't would be of use
not only for DFID itself in terms of effectiveness and accountability,
but also to partners and stakeholders.
SUMMARY OF
RECOMMENDATIONS
World Vision recommends that the UK Government
should:
1. Engage fully and take a leadership role
within the Partnership for Maternal, Newborn and Child Health
(PNMCH), in particular by committing to work with the Partnership
in the area of advocacy at a global level, advancing the clear
division of labour needed between UN agencies working on maternal,
newborn and child health and being proactive in PMNCH working
groups (country support, monitoring and evaluation and effective
interventions) at the country level.
2. Taking lessons learned from the Malawi
Emergency Human Resources Programme (EHRP) and the accompanying,
targeted Essential Health Package, implement similar programmes
in other countries with similar resource issues and political
environments.
3. Ensure that maternal and child health
is appropriately represented in the $1.5 billion funding commitment
made by the G8 in 2007 for "maternal and child health and
voluntary family planning", indicating when and how it will
contribute its fair share of this commitment. Ensure that this
money is allocated to a recommended package of MCH services, working
within National plans and frameworks, and work with National governments
to address discrepancies in urban/rural resourcing etc.
4. Contribute its fair share towards the
funding commitments made by the G8 in 2007 of $1.5 billion for
the prevention of mother to child transmission, indicating when
it plans to do so and encouraging other G8 countries to do the
same.
5. Provide support to the UN Inter-Agency
Task Team (IATT) on PMTCT to provide technical assistance to national
governments in developing and implementing national PMTCT plans
to reach universal access to PMTCT for all pregnant women including
access to a continuum of anti-retroviral treatment, counselling
and support services after delivery.
6. Undertake meta-analysis research of DFID
programming in maternal health over the last 10 years. Determine
successful components of programmes and strategies and use this
information to better work with partners and stakeholders in future
programming.
September 2007
206 Global Health Council Maternal and Child Health
2006. Back
207
United Nations The Millennium Development Goals Report June
2007. Back
208
United Nations The Millennium Development Goals Report June
2007. Back
209
Information Communication Technologies for Development (ICT4D)
Update February 2006
(Available at: http://www.ntu.edu.sg/sci/sirc/download/Arul_presentation%20report.pdf) Back
210
Ronsmans, C and Graham, W. Maternal mortality: who, when,
where and why The Lancet, 2006. Back
211
World Health Organization Facts and Figures from The World Health
Report 2005 (Available at: http://www.who.int/whr/2005/media_centre/facts_en.pdf) Back
212
Department for International Development, DFID's Maternal Health
Strategy "Reducing maternal deaths: evidence and action"
Second Progress Report April 2007. Back
213
UNICEF Children and AIDS: A Stocktaking Report January 2007. Back
214
DFID Maternal Health Factsheet November 2006. Back
| 
