Maternal Health: MDG 5

Toespraak | 26-10-2009

Ladies and gentlemen,

It is very good to see you all here. I am grateful to the United Nations Population Fund and to Ethiopia for making today possible.

This conference is the result of a process that began in November 2007, when the Dutch parliament passed a motion to raise the prominence of MDG5 on the international agenda. I welcomed this motion, because sexual and reproductive health and rights and, by extension, MDG5, are one of my policy priorities as Minister for Development Cooperation. Chantal Gill’ard, who introduced the motion, is with us here today. I know that she is as proud as I am to see this meeting transformed from dream to reality. And rightly so!

It is fantastic that you have all come to Addis Ababa to talk about sexual and reproductive health and rights and maternal health. Today is an important day for the women I met last week in a hospital in Gaoua, Burkina Faso. The organisation of and access to health care in Burkina Faso have improved greatly in recent years. Parts of the public health system have been outsourced to capacity-building NGOs and community-based organisations. The Ministry of Health has been signing performance-based contracts with NGOs to carry out the action plans needed to attain MDGs 1, 4, 5 and 6 on time. This approach has already helped reduce maternal mortality, because the number of women giving birth under the care of someone with medical training has increased from 33% in 2004 to 65% in 2008.

Today is an important day for Maritza in Masaya, Nicaragua, which I visited in June 2007. Maritza was 19 and pregnant with her third child. Her first child was being raised by her grandmother, her second by her mother. Maritza is single; the fathers of her children do nothing for them, financially or otherwise. She works in a ‘maquila’, a sweatshop, and has no time to raise children.

Today is an important day for the woman in the Kayes region of Mali, near the Senegalese border, who has given birth to her eleventh child. The birth was long and difficult; each successive birth is more dangerous than the one before. It is an important day for her doctor – luckily she has a doctor, who sees her come back every eighteen months and each time tells her husband that another pregnancy will be even more life-threatening for mother and child. Today is an important day for her husband too. Of course he doesn’t want to lose his wife or more children. But he feels bound by the values and standards of his region and family.

Today is important for women all over the world, and their children and partners. In fact, it is important for everyone, because MDG5 affects us all.

MDG5 is the mother of all MDGs – an investment in it promotes the attainment of all the other MDGs too. In extensive areas of the world maternal mortality is a tragedy that affects almost everyone. Although motherhood is valued highly in all cultures, women and mothers are not always protected as they should be.

Today in my view marks the beginning of efforts to raise the profile of MDG5 and of more targeted actions. Next year, in 2010, we will be reviewing progress on all the MDGs. What we learn today, and the political and financial commitment I am sure you will all be making, must be translated next year into action. In 2010 we want to make up ground on MDG5, and ensure that there is greater access to the sexual and reproductive health information services and commodities people require. This is a universal right.

Over the course of this day we will hear about your experiences, and learn how we can move forward, overcome obstacles and mobilise many more players in the interests of achieving sexual and reproductive health and rights. We will also learn how to devote more financial resources to MDG5 and how to make the best possible use of the money we have.

We can also share success stories today. One example was just mentioned and can be found right here in Ethiopia, where the healthcare infrastructure of health posts, health centres, hospitals and training for healthcare professionals is undergoing a dramatic expansion, which I could see yesterday during my trip to the Somali region. By the end of 2010 15,000 health posts will have been built, in the space of 3 or 4 years. This year a new programme was launched, which will soon be training 300 midwives a year. A start has also been made on scaling-up training for health officers and setting up a Master’s programme in Emergency Obstetric Care.

Ladies and gentlemen,

Maternal health is more necessary than ever. Over the last 20 years little progress has been made on achieving the first target of MDG5, reducing maternal mortality. The same is true of progress post-2000, when the MDGs were drawn up. This was my personal biggest shock when I began work as development minister. Each year 536,000 women die from pregnancy-related complications, nearly all of them in developing countries. More than half a million preventable deaths. That’s more than the entire population of The Hague, the city in the Netherlands where government is based. Later today we will be hearing about the current situation in certain countries.

So it is high time that real progress was made on MDG5, both on reducing maternal mortality and on the often-overlooked second target, the right of everyone to have access to sexual and reproductive health information, education, services and commodities.

That’s not to say that nothing has been done. On the contrary, we have learnt important lessons about what does and doesn’t work, and innovative ideas have been developed, for example on how to stop postpartum bleeding. A number of major studies have been conducted and reports published, most recently by the Centre for Global Development and, just two weeks ago, by the Guttmacher Institute. The latter report concluded that, while banning abortion does not reduce the number of abortions, it does affect the conditions under which women have abortions. Reliable studies and data are vital; they allow us to base decisions on facts rather than ideologies.

Some studies in trend-setting media reveal facts that we had long suspected. For example, Lancet papers have proved that the more drastic the circumcision that mothers are subjected to, the higher the rate of infant mortality. As far as I know there is still no scientific proof that circumcised women are more likely to die in childbirth, but every doctor and nurse familiar with the situation knows that it’s true.

Many countries are working hard to achieve MDG5. It is not easy. Unfortunately, the overall global picture is not much improved. In some countries maternal mortality rates are declining somewhat. But in others no progress is being made in reducing the unmet need for family planning, or female and maternal health is in a perilous state.

You and I know how incredibly complex this issue is. Not only the medical problems but also communicating the need for family planning is crucial. How can we change centuries-old traditions, standards and values? I once spoke with a medical professional who told me about her experience in West Africa. Tradition and the need for security in old age often made it impossible to convince people of the advantages of having fewer children. So public education focused on waiting more between children. The consequence, however, was that instead of having fewer children women continued giving birth at higher ages, which in fact meant riskier childbirth.

We have the most ground to make up in fragile states, conflict and post-conflict areas and emergency situations, for example following natural disasters. That is where the Dutch government is concentrating its efforts, directing investment to where it is needed most.

Take Afghanistan. I am happy we have a delegation here from Afghanistan. In some parts of the country, being pregnant and giving birth is literally a matter of life and death. This results from a combination of several factors. Women have very limited access to health care; only 10% of villages have a health clinic. Cultural factors also play a great role. And there are all too few female medical staff. So it is a major step forward that midwives are now being trained in Afghanistan, by the UNFPA, among others. Later today we will be hearing more about Afghanistan from the minister of Public Health himself.

The Netherlands has a reputation to maintain when it comes to building bridges and reaching consensus. More than 100 years ago, we were home to the first female champion of contraceptives: Aletta Jacobs, the first woman to qualify in our country as a doctor. She held free consultations for the poor in Amsterdam, gave family planning courses, and popularised the diaphragm as a means of contraception. And make no mistake about it, 100 years ago in the Netherlands this was a very sensitive issue. Aletta Jacobs did not only help many individual women; she inspired many in the Netherlands and elsewhere to campaign for women’s rights and what we know today as sexual and reproductive health and rights.

We are keen to boost investments in family planning. These have fallen dramatically in recent decades, a decline thrown into sharp contrast by increased investment in combating diseases.

I believe that the tide needs to be turned. The Netherlands has invested 5 million Euros in the female condom. And in 2008 I increased our contribution to the Global Programme on Reproductive Health Commodity Security from 5 million to 30 million Euros over four years. We need more of those investments.

This brings me to the second MDG5 target: universal access to reproductive health. This target was added later to MDG5, but is in my opinion just as important as reducing maternal mortality. I believe it is being overlooked. That is wrong, but in some cases I can understand why.

Sexual and reproductive health and rights touch on subjects considered sensitive, and they are, and they are considered private, and they are, or even taboo in many countries and cultures. After all, they relate to very personal decisions on family planning, relationships and sexuality. But these sensitive issues have to be raised, if we are all to move closer to achieving MDG5.

Research has shown that more than 200 million women worldwide would have chosen not to get pregnant, or to get pregnant later in life, had contraceptives been available. 200 million women say they want to use contraceptives, but have no access to them.

We need to respond to this unmet need for contraception, which affects so many women the world over. It is in the interests not only of the women themselves, but of their children, their partners and society as a whole.

This makes clear why it is so important to invest in women and girls and in their education. Research has shown that educated women choose to have fewer children, later in life. Children from small families are more likely to go to school and receive health care and good nutrition. Small families are also often better able to rise out of poverty. And the mothers are more likely to have a paid job, which benefits the family’s income.

In times of economic crisis, rising food and fuel prices and negative projections of the effects of climate change, thinking about national population trends becomes more pressing. This is a global problem. Especially in countries where the population is booming – as it is in many developing countries – it is going to be difficult, if not impossible, to provide enough food, water, schools, houses and jobs for a rapidly growing, young population.

One country in which the close link between rapid population growth, poverty reduction and the impact on sustainable environment and water supply is painfully clear is Yemen. One year ago I signed an agreement with the Yemeni authorities on reducing infant and maternal mortality. Yemen is facing very rapid population growth of between 3 and 4% a year. It is estimated that the current population of 21 million will have reached 71 million by 2050. Yemen is a country with a strong tribal culture and structure and a relatively underdeveloped economy. The rate of unemployment is 34%, rising to around 50% for the younger generation. It goes without saying that this can be destabilising, certainly if the population continues to grow at the current rate. This may in turn result in security risks, in both Yemen and the region. This is one example of a specific situation in which sexual and reproductive health issues may turn out to have far-reaching cross-border consequences. The Yemeni government is, however, aware of this, and we are working with them to tackle this many-sided problem. The Yemeni minister will be discussing this issue in more detail later today. It is a great honour to have him here today.

Players from all over the world, from many walks of life, are attending this conference today. From ministers and MPs to members of the business community and young people – you’re all here. I call on each and every one of you, once you have returned home from this conference, to redouble your efforts to improve sexual and reproductive health and rights and help us achieve MDG5.

Each of you can make a contribution in your own way. Governments have a clear responsibility. Health and development ministers have a major role to play, as do – perhaps even more so – education and finance ministers. As a former Member of Parliament, I am pleased to highlight the key role MPs can play, through policymaking and legislation and – last but not least – adequate funding. MPs also know better than anyone how their constituents are thinking, because they hear the discussions in the villages. This gives MPs a great responsibility for raising awareness.

One more point: although our focus today is MDG5, women’s rights are also obviously essential for MDG3.

The group we should focus on most is young people. About one half of the world’s population is under 25, and that proportion is growing. Everything depends on their choices and their opportunities. They are, quite literally, our future. Young women and men must be able to choose, and they must be able to have children safely. They must have a say in how many children they have, and when.

Young people need to determine what the agenda will be in practice. And they need to take the lead. That is why young people, men as well as women, are playing an active part in this debate. And make no mistake; it will touch on sensitive issues, such as family planning, sexuality, the power balance in relationships and violence against women and girls. Above all, it is vital that they have access to sexual and reproductive health information, education, services and commodities. This is a universal right, with no exceptions.

I should also say how delighted I am to see the business community represented here. Governments cannot do it on their own. I strongly believe in a public-private partnership that complements public services. I believe that exploring innovative approaches and creative ideas, and collaborating with new partners who are not always the obvious first choice, is the wave of the future. This is what modern development cooperation means.

One inspiring example is the work of the Nike Foundation, which has been focusing on adolescent girls in developing countries for the last five years. Ms Maria Eitel, President of the Nike Foundation, is here with us today and will be sharing her experiences.

Last but not least I would like to mention the activists, NGOs and expertise centres. It is important that we form alliances. Without their efforts we would have made far less progress than we have. You are the pioneers who draw up new agendas, the watchdogs who champion the rights. Without them we would have many fewer reliable research results and less statistical information.

Cooperation at national and international level is also vital. The only way to turn the tide is by working with a range of partners and looking for new partnerships and alliances. This is the approach we adopt with my colleagues in government and with many other national and international partners. The ultimate aim is to improve the position of countries and population groups – usually women – who have poor access to the services.

I do realise that it will take many more players than are here today to bring about profound change – for example, human rights activists and medical professionals. But let today be a catalyst for change!

Ladies and gentlemen,

In conclusion, I have high expectations for this meeting – and I hope you do, too. Today’s programme is very promising, with panels of impressive speakers on a wide range of topics. Together we will be looking at how to change the direction of sexual and reproductive health and rights policy, and how to turn high-flown rhetoric on the importance of MDG5 into a real-life budget. We are here to learn from each other and store up inspiration, which we can convert when we get home into more and better action.

As the organisers of the conference we have, of course, thought about possible outcomes. We hope that we will leave this hall tonight with a number of concrete ideas about what each of us can do. Ministers can formulate policy and ensure it is implemented. MPs too have a key role to play: not only developing legislation and ensuring that policy is correctly implemented, but also by approving budgets. Businesses can take much more effective measures to promote sexual and reproductive health and rights, both for their own staff and by organising broader activities. But these ideas are not set in stone. I am looking forward to being inspired by today’s debates, and I’ll come back at the close of the conference to formulate a way forward.

I hope that today’s discussion will be frank, constructive and to the point. All of us are here today to learn from and inspire each other, so we can really make progress on MDG5.

Today is a unique opportunity. An opportunity for new alliances and establish a policy community. Sexual and reproductive health and rights and MDG5 are too important to let them vanish from the political agenda. They deserve a place at the top of everyone’s agenda, from ministers to doctors, from North to South. I will continue to work to promote sexual and reproductive health and rights and thus the achievement of MDG5. And I am sure you will do the same. I wish you all an inspiring conference.

I will now hand the floor over to Thoraya Obaid, Executive Director of the United Nations Population Fund, who has been instrumental in making this conference possible and has done so much for this cause.

Thank you.