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12.41 pm
Lord Patel: My Lords, I, too, congratulate the noble Earl, Lord Sandwich, on securing this important debate. In my view, it should be the topic of an annual debate.
I declare an interest. For 36 years I have been an obstetrician. I was born in Tanzania and I support several charities that work in maternal health in Africa. I am a patron of a charity called SafeHands for Mothers, whose director, Nancy Durrell McKenna, works tirelessly with Ethiopia. Another patron—also a Member of your Lordships’ House—is the noble Baroness, Lady Kennedy of The Shaws.
Today, I wish to speak only in relation to millennium development goal 5, which relates to maternal health. Its target is to reduce maternal deaths by 75 per cent
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During the time allocated for this debate, approximately 35,000 women will become pregnant, 5,000 of whom will suffer severe pregnancy-related complications. Many will live out the rest of their shortened lives with disability and increasing poverty, some discarded—yes, discarded—by their families and communities, and tragically around 180 to 200 will die, 99 per cent of them in developing countries. During every minute that your Lordships speak in this debate, one woman will die—one every minute. A mother’s death leaves a child without a mother; it sucks the lifeblood out of the family, drives the family further into poverty and destitution, and contributes to poverty in that society.
The current figure for global maternal deaths is likely to be grossly underestimated. There has been zero progress on millennium development goal 5, and it is the target that we are least likely to meet. Overall progress in reducing the number of maternal deaths—bar that in a few countries which have been successful in this regard, such as Sri Lanka, Malaysia and Thailand—varies from 0.1 to 1.1 per cent. We need a reduction in the maternal mortality rate of at least 5.5 per cent annually if we are to meet the target, although it is most unlikely that we will. At the current rate, south-east Asia will meet it by 2076, and Africa will probably do so 30 to 50 years later. In my view, the key impediments are a total lack of political commitment—more words than deeds—gender inequality and a lack of women’s rights in relation to health. It is true that Governments, including ours, are investing money and we hear reports of how the projects are supported, but there is no total commitment.
Therefore, I am absolutely delighted to congratulate Mrs Sarah Brown, who on several occasions recently has spoken powerfully and with passion and commitment on this issue in her role as patron of the worldwide organisation, the White Ribbon Alliance. Mrs Brown and many other influential women from the world of politics, business, the professions and other walks of life have come together in speaking out and committing themselves to the cause. I believe that women and women’s movements such as that will change Africa. As Mrs Sarah Brown said in one speech:
“It is clear that we are facing a global tragedy in maternal mortality. And I do not believe that we can begin to resolve any of the problems facing the developing world if we cannot first save the lives of these women. And when we know that 80 per cent of these deaths are easily avoidable, there is no excuse for delay in reducing them”.
For every woman who dies, 30 to 40 suffer from severe pregnancy-related complications. Dreadful conditions, such as obstetric fistula, affect upwards of 2 million women in sub-Saharan Africa alone. I feel that we need a new vision and a new strategy focusing on health systems, because changes in health systems have demonstrated success. I hope that the Minister can provide that vision. Let all of us here today and all those who listen to this debate make a pledge to mothers lost—tens of millions of them—that we will lose mothers no more.
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12.47 pm
Lord Hannay of Chiswick: My Lords, here we are, beyond the half-way mark between 2000 and 2015, and yet both overall and in many countries we are nowhere near hitting the targets that we set ourselves. The UN Secretary-General has—rightly, in my view—called for a high-level meeting in September this year to review progress and, we must hope and urge, to carry out a mid-course correction of a substantial kind. In declaring an interest as the chair of the United Nations Association of the UK, I should like to add how strongly that organisation supports both the noble Earl’s initiative in calling this debate and the UN Secretary-General’s review conference.
The title chosen for our debate, which focuses attention on the poorest countries, reveals in itself one of the weak spots in any system which sets overall goals for a huge diversity of countries—some already beyond the point where they can really be considered developing countries at all, some making good progress towards the goals, and some even moving sharply away from them in the wrong direction. In such a system, the successes of the few—particularly if, as is the case with a number of Asian countries, they are also hugely populous—can mask the failure of the many. Those poorest countries, many of them in sub-Saharan Africa, make up what has eloquently but shamefully been called by Professor Paul Collier the “bottom billion”. Not only are they at the bottom now but they are fated to stay there unless we and they do something about it. The plight of those countries, mainly in Africa, was recognised at Gleneagles, when specific targets were set for the delivery of increased aid to Africa, but those targets are not being met and they need to be if the situation of the bottom billion is not to get even worse.
Another weakness of an overall system of targets such as the MDGs is that it gives the impression that, if sufficient financial resources are made available, all will be well and the targets will be met. That is far from being the case. Civil wars, regional mayhem and bad governance can all completely frustrate any progress being made towards the MDGs in individual countries and in whole regions. One has only to look at the Congo, Liberia, Sierra Leone, Côte d’Ivoire, Somalia or the Darfur region of Sudan to see the first two of those phenomena in action and at Zimbabwe and Burma to see the third of them. So, stabilising the security situation, bringing civil wars to an end and post-conflict peace building are, and often will continue to be, a sine qua non for making any progress towards achieving MDGs across a considerable range of countries. That is why we need to devote more effort and give more support to the UN and regional organisations, such as the African Union, to help in these situations. I hope the Minister can say something of what is being done in that respect, and in particular what steps are being taken to make a reality out of that responsibility to protect—to which my noble friend Lord Jay referred—which was endorsed with such a flourish at the UN summit in 2005 but which has remained virtually a dead letter ever since.
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Bad governance is perhaps even more difficult to remedy, particularly when the neighbours of the countries so misgoverned are so reluctant to see any meaningful steps taken, and yet it is that same bad governance which can render the MDGs completely nugatory. You cannot progress towards the goals when your inflation rate is measured in thousands of percentage points or when a massive proportion of your gross national income goes into military expenditure. And yet that same international community which sets these laudable objectives and insists that they be met turns a blind eye to actions that make them inoperable. We surely need to move away from such an unhealthy tolerance of bad government.
We should recognise that such progress as has been made so far towards the MDGs has been due as much to the prolonged spell of economic growth which has benefited the whole world, developed as well as developing, as to the provision of official development aid. The combination of the two remains crucial. But with a probable global economic slowdown in the offing—indeed upon us in the developed world already—it will be even harder to achieve that than in the past. We must never forget that the economic slump of 1929 onwards which inflicted terrible damage worldwide to both developed and developing countries was caused by a financial crisis being turned into an economic crisis as a result of protectionist trade measures. The siren voices of trade protectionism are already being raised across the Atlantic in the US presidential campaign; they are to be heard in Europe too in connection with the development of policies to deal with climate change. They will need to be resisted if we are to have even the slightest chance of achieving the MDGs. If we are to allow false economies to be made in official aid as a result of an overall squeeze on public spending, then any hope of achieving them would rapidly disappear.
In recent months we have seen another threat emerging to achieving the MDGs: the rapid rise in food and energy prices. This is very much the subject of the moment with many ideas—some good, some misguided and some simply awful—being put forward to deal with these new threats. Yet there is no doubt at all that most developing countries, and certainly most of the poorest ones, are suffering grievously from high food and energy prices and the shortages that go with them. I therefore hope to hear from the Minister how the Government think we should deal with this both in the short term—strengthening the World Food Programme—and in the longer term, eschewing the sort of protectionist policies which we have heard from the French Minister of Agriculture in recent days.
As we head into choppier economic waters the European Union will surely need to continue to give a lead towards achieving the MDGs, and I welcome the Commission's recent communication on that. We need to do that not simply because we have a duty to help those less fortunate than ourselves, although that is indeed a compelling argument, but because it is in our own enlightened self-interest to do so. Globalisation means that we are all each other’s neighbours now. We will achieve neither security nor prosperity for ourselves if the poorest countries, that bottom billion, are left to founder.
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12.53 pm
Lord Patel of Bradford: My Lords, I too thank the noble Earl for initiating this debate. In this place, just two years ago, I made my maiden speech on the subject of water, sanitation and hygiene and meeting the millennium development goal for ensuring environmental sustainability. I have been very involved in that particular goal as a member of UNICEF's global task force for water sanitation and hygiene.
As we have already heard, we are now halfway through the MDG target of 2015. Although much good work has taken place, there remains so much more to do. Over 2 million children under the age of 15 live with HIV. Seventy-six per cent of deaths from AIDS in the world are in sub-Saharan Africa, even though the region accounts for only 12 per cent of the world's population. More than 1 billion people in the world struggle to find a drop of clean water. In many areas, women and children are forced to travel up to 12 hours a day to gather cooking, cleaning, and drinking water. When it is found, a single sip of contaminated water can bring disease and death, especially for children. As the noble Lord, Lord Patel, has already eloquently said, every minute, a woman somewhere dies in pregnancy or childbirth, from pregnancy-related causes—causes that could be easily prevented with the right help.
Bono, the lead singer of U2, who has been such a strong advocate for the G8 to take action in Africa, called the MDGs the,
He was speaking at a national prayer breakfast in the US attended by the president, Congress and various heads of state and he said,
He was making the point that we are quite good at charity, quite comfortable with charity, but that our charity is overwhelmed by the reality in Africa and other countries where people live and die day-by-day in extreme poverty and hardship.
Now, in the midst of a financial downturn, we are talking about the need to give more. But even in the midst of the current credit crunch we remain a wealthy country and we must not lose sight of that fact. We must not lose sight of the 26,000 children under the age of five who die around the world every day, mostly from preventable causes; we must not lose sight of the fact that some 1 billion people live on less than 50p a day; and we must not lose sight of the fact that 854 million people—most of them women and children—suffer from chronic hunger or malnutrition.
However, noble Lords are, sadly, too familiar with the appalling statistics. What we sometimes do less well is to recognise how much good work gets done—much, if not most of it, by NGOs. Those NGOs, who are entirely reliant on charitable and government aid, do great work and that can get lost in all the despair, so I would like to tell you briefly about some positive work that is being done by one of the leading NGOs in the field, World Vision. I first came across its work when I met one of its executive
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Reagan is a robust, healthy African boy. He is a lively and talkative character and he makes friends quickly. He has a bright, sharp intelligence and is very funny. His friends say that he could be a comedian one day. He is known in his village, not for that reason, but for the fact that he was born to an HIV positive mother. Thankfully he is free of the virus. His mother has spoken about this in gatherings in her village and made it clear that it was no accident. In March 2004, she enrolled in a World Vision programme called Preventing Mother-to-Child Transmission of HIV. Without that kind of intervention, the rate of babies getting infected by an HIV positive mother is 30 to 40 per cent. That rate is reduced by half with intervention. We need to see much more of that type of work.
I know from my work on water sanitation just how crucial women are to meeting the MDGs. Indeed, the empowerment of women is one of the goals. World Vision shared with me another example of how they are doing that. Alice is a traditional Masai woman, but she does a lot of things traditional Masai women do not do. For example, she owns a house and cattle. She is a mother of four, but she lives apart from her husband. At 32, she graduated from primary school and she has her sights set on becoming a human rights lawyer. However, her story did not start that way. In her own words she says,
“My father pulled me out of primary school and married me off at the ripe age of 16 to a 40-year-old, abusive man”.
She endured years of beatings and after one particularly severe flogging that almost cost her an eye, she left her husband. Frustrated by her lack of education, she enrolled in the same primary school as her two sons. It was not easy. She was older than the other students and was a mother, but she kept with it and thanks to the kind of on-the-ground local support that agencies such as World Vision can provide, she will continue with her education. In fact, she is looking to a future in which she will defend Masai women and girls and perhaps even change her culture in the process. These are simple stories about ordinary people, but how extraordinary the transformation of their lives has been as a result of the drive to fulfil the MDGs. Dedicated staff such as Keith Kall and organisations such as World Vision really make a difference to people's lives, and I hope others will join me in supporting their work.
The year 2015 is around the corner and we have no time to waste in ensuring that we do everything we can to meet the MDG targets. I commend the Government and the Prime Minister for the recent announcements of increased funding, but it is still not enough. The Prime Minister has called for the global community to redouble its efforts. We have to see even more significant increases in funding and support now if we are even to hope to help the 72 million
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the world cannot wait another 2,000 years. We have less than eight—less than eight years to make sure that all the children like Reagan and women like Alice have a chance to live happy and fulfilling lives; less than eight years to say that our time here made a difference and that we did not allow justice to be made a fool of.
1 pm
The Lord Bishop of Southwell and Nottingham: My Lords, I am grateful, like others, to the noble Earl for this timely debate. At the launch of the MDGs, the then Secretary-General of the UN stated:
“We will have time to reach Millennium Development Goals ... but only if we break with business as usual”.
In 2007, his successor suggested in a report foreword that there was a mixed record of delivery. He indicated that, despite some notable landmarks along the way such as the 2002 Monterrey conference and the 2005 world summit, we have fallen substantially short in realising these basic promises. Several speakers have made this point.
The 2007 report presents the most comprehensive global assessment of progress to date. The assessment is clear. Progress towards the MDGs is possible only when strong government leadership, policies and strategies that effectively target the needs of the poor are combined with adequate financial and technical support from the international community. Many developing countries—particularly in Africa—have made significant progress in preparing national strategies to achieve the MDGs, but the progress that developed countries have made in delivering fully on long-standing commitments to achieve ODA targets of 0.7 per cent of GNI by 2015 are much less impressive. The report notes that ODA fell between 2005 and 2007 as debt relief declined. We have yet to break the business-as-usual model.
It would be helpful to hear from the Minister how the Government are responding to the conclusions of that report. In particular, it would be good to hear about the steps they are taking to press other Governments to ensure that aid flows to individual countries that have secured national strategies are continuous, predictable and assured, and not tied to purchases in the donor country.
Despite the mixed picture painted in the report, I share the UN Secretary-General’s optimism that, if the political will exists, the MDGs are achievable. My optimism, however, is tempered by a growing awareness that the climate of development is become even more challenging. As our scientific understanding of climate change develops, so its impact upon development becomes ever starker. The Secretary of State for DfID in a speech last month at an event hosted at New York
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Climate change is a cross-cutting issue that affects a range of development concerns, not all of which, such as migration and conflict—already referred to—are captured by the MDGs, even if it threatens all these goals. The development progress outlined by the 2007 report will be increasingly hindered and, in some cases, reversed by climate change. In this sense, the battle against poverty and the battle against climate change are increasingly interrelated. Progress on one front means nothing if we do not make substantial progress on the other.
It is not enough merely to cut significantly our own emissions; we must also help those who are already experiencing the impact of climate change to pursue suitable adaptation policies. This requires not only better integrating climate change assessments into our own development policies, but actively working with countries in the developing world to mainstream climate change into their own national strategies. Despite the encouraging raft of policy announcements and initiatives emanating from DfID, we still have a long way to go on both these issues. Many of the world’s poorest countries still lack the capacity and resources to assess climate risks. Our response to adaptation and poverty reduction is still too top-down.
The existing multilateral financing mechanisms to help finance adaptation in the developing world have so far delivered only around $26 million. This is a derisory amount when compared with the $40 billion that UNDP estimates will be needed by 2015 to strengthen national strategies for poverty reduction. The inequality between countries in their capacity to adapt to climate change is becoming increasingly apparent. Not surprisingly, a number of commentators, including the former Archbishop of Cape Town, Desmond Tutu, now talk of adaptation apartheid. Expressed in diplomatic language, the international response to adaptation, like our response to the MDGs, has fallen far short of what is required. Being a man of faith I remain optimistic that we can, if we break with a business-as-usual model, address these twin challenges in an integrated way to avoid 21st century reversals in human development and catastrophic risks for future generations.
I have spoken in macro terms, but should like to finish by speaking in micro terms; I have always been convinced that small is beautiful. I am pleased to say that in my own humble diocese of Southwell and Nottingham we are launching an environmental policy in June of this year in the hope of substantially shrinking our carbon footprint. MDGs are not micro-distant. We are all intimately and personally involved in making our contribution to this process.
1.06 pm
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