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11 Nov 2009 : Column 129WH—continued
7.59 pm
The Minister of State, Department for International Development (Mr. Gareth Thomas): Let me, in the usual way, congratulate the hon. Member for Harrogate and Knaresborough (Mr. Willis) on securing the debate. I share the concerns that he raised and welcome his interest. I join him in acknowledging the important work of the all-party group on population. I was interested in his description of eRanger, particularly as it is a social enterprise, and as the vehicles it facilitates the building of are delivered through a co-operative. As chair of the Co-operative party and a Co-operative MP, I have a particular ideological interest in the business model he is promoting. He asked several questions and asked for a number of assurances, which I shall come to. I shall respond initially by giving some context to the debate.
As the hon. Gentleman rightly said, female mortality is a critical development issue: it is central to three of the millennium development goals, which the international community and the British Government are striving to support the achievement of. In many countries, the HIV/AIDS epidemic is slowing, but it is still the leading cause of death for women in Africa. We know that it is young girls who are disproportionately affected, because they have little control over key aspects of their lives, including sexual behaviour, schooling and access to health care, and little ability to mitigate the impacts of the epidemic on other aspects of their lives.
In sub-Saharan Africa, 250,000 women die each year from pregnancy-related complications. In some countries, the figure is much higher. Almost half the maternal deaths occur in just four countries: Nigeria, Democratic Republic of the Congo, Ethiopia and Tanzania. Sierra Leone has one of the highest reported rates; indeed, a woman in Sierra Leone has a one in eight chance of dying due to pregnancy, so the information that the hon. Gentleman provided about the deployment of eRanger vehicles to Sierra Leone gives a further sign of encouragement for us to take from the debate. The other countries with high reported rates are Rwanda, Malawi and Nigeria. In Africa, many women die due to their unequal access and outcomes, based on class, custom, wealth and power. In Nigeria and Malawi, over 70 per cent. of women say that their husbands alone make the decisions regarding their health care-a terrifying statistic that demonstrates the low status of women in some communities.
One strategically encouraging sign has been the commitment-finally-of the United Nations to establishing a gender agency, for the first time bringing together disparate parts of the UN community to create a much more powerful agency, with a high-ranking leader within the UN system. I hope that that will raise the profile of women and give voice to the many women
who, as the hon. Gentleman will recognise, are not heard at the moment in the communities in which they live.
The hon. Gentleman knows that it is difficult to measure maternal mortality accurately. While there seems to have been considerable progress in some countries-we can take heart from the example of Zambia-overall, as he rightly says, there has been negligible progress. Skilled attendance at birth is easier to measure. That means of measuring progress in getting support to women is a core component of a strategy to reduce maternal deaths that we are deploying, and which other donors are getting behind. However, that measurement is not always reliable or consistent. Skilled attendance at birth is very low in most of sub-Saharan Africa, reflecting the higher rates of maternal mortality. For example, in Ethiopia only 28 per cent. of pregnant women receive pre-natal care and only 6 per cent. of births are attended by skilled health staff. That gives some indication of the scale of the challenge that the hon. Gentleman rightly alluded to, and which we recognise.
Our efforts are focused on trying to reduce child mortality and, of course, maternal mortality, but also on reducing the spread of HIV/AIDS as part of the overall drive to reduce female mortality. There has been some progress. The average life expectancy of women in Africa, despite the AIDS epidemic, is slowly increasing and now stands at 54 years. There has been a 20 per cent. reduction in child mortality since 1990, but a girl in Africa is still 25 times more likely to die before her fifth birthday than a girl born in the UK.
The hon. Gentleman is absolutely right to say that while there has been progress in some areas, maternal mortality levels remain unacceptably high and progress seems to have stalled. In many countries, as in the UK a century ago, there is still an acceptance that women will die in childbirth. That is compounded by the low social status of women in parts of Africa and by a lack of access to services.
As the hon. Gentleman suggested, a series of key interventions can be made to make a real difference to women's survival rates. Family planning and access to safe abortion services are crucial examples, as both are often stigmatised, poorly resourced and, in the case of abortion, illegal in some countries.
Sadly, the truth is that there has been inadequate investment in health systems in general and in maternal health in particular for far too long. For an individual family it might be very costly to access care, and the result is that women are left to die at home. Caring for a woman through pregnancy and delivery requires health services that work, with trained and equipped staff. We know that there is a massive shortage of health workers across the continent, and many health systems are so weak that they offer little or no effective care, particularly in critical areas such as family planning, safe abortion and, crucially, obstetric care. The unmet demand for family planning, for example, results in one third of maternal deaths, including the 13 per cent. from unsafe abortion.
I will give a more graphic example of the differences between Africa and Europe and Asia: while over half of sexually active couples in Europe and Asia use contraception, the average prevalence of contraception across the continent of Africa is only 20 per cent. In many countries, particularly in west and central Africa,
rates are less than 5 per cent. Access to contraceptives is probably the most cost-effective way of reducing maternal mortality.
The hon. Gentleman and others may well ask what we are doing about such a grim picture. As he said, we have a strategy on maternal mortality and reproductive health, and it is being updated with an evidence paper to help guide our future work and that of other donors. Politically, we are beginning to see an unprecedented international interest in maternal mortality, partly driven by the White Ribbon Alliance, which has been championed by the Prime Minister's wife, Sarah Brown, and is beginning to catalyse the support of women across the globe and, in particular, the support of African leaders.
The UK has tried to support that process by leading efforts with international partners to develop a broad-based, global consensus for maternal, new-born and child health. That consensus sets out a framework for action, hopefully aligning political will alongside advocacy and finance, behind a set of five agreed policies and priority interventions to try to save the lives of women and children. The financing issues to put those interventions in place are being addressed.
The hon. Gentleman may remember that the high-level taskforce on innovative international financing for health systems, jointly led by the Prime Minister, hosted an event at the UN General Assembly in September, where more than £3 billion was announced to strengthen health systems in developing countries. Leaders from Malawi, Ghana, Liberia, Burundi and Sierra Leone announced expanded access to free health care, which in the long term will result in millions of children and pregnant women gaining access to essential services.
As for my Department's financing, 15 per cent. of UK development aid goes to health. The UK has committed itself to investing some £6 billion to strengthen health systems until 2015. Much of that money goes to supporting and strengthening general health services.
For example, in Ethiopia we have committed some £25 million over four years to increase the number of community health workers tenfold. With our support, access to contraceptives has already increased from just over 20 per cent. to just over 51 per cent. Our support to the health sector in Malawi has contributed to an increase in skilled birth attendance from just under 40 per cent. to some 45 per cent. in 2007-08.
The hon. Gentleman mentioned a number of international organisations, including UNICEF, which does vital work. We help to fund work of UNICEF, the World Health Organisation and UNFPA, which also works in that area.
The hon. Gentleman made a specific plea for further engagement with eRanger, the organisation and social enterprise in his constituency. I am aware that a series of motorcycle and bicycle ambulance schemes are making a real difference. I have seen them in action in Nepal, where they are clearly helping to save lives. I am aware also of the DFID programmes that support eRanger programmes in Malawi and Kenya. The hon. Gentleman asked me to ensure that eRanger sees a copy of the strategy; I am happy to give him that assurance. I would be happy also to follow the example of the Under-Secretary of State for International Development, my hon. Friend the Member for Worcester (Mr. Foster), who met the hon. Gentleman and eRanger; if necessary, I shall meet them again. I shall certainly write to the hon. Gentleman with a contact for eRanger to use; in turn, I hope that that will help eRanger to gain access to the relevant person at the DFID office in-country.
I cannot guarantee that eRanger will always be the contracted organisation. We have to allow the developing countries concerned to take those procurement decisions for themselves. However, I would want social enterprises and co-operatives to have access to the information that will enable them to make their pitch.
8.13 pm
Sitting adjourned without Question put (Standing Order No. 10(11)).
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