PRESS BRIEFING BY FOUR UN AGENCIES ANNOUNCING JOINT EFFORT TO REDUCE MATERNAL MORTALITY

Press Briefing

PRESS BRIEFING BY FOUR UN AGENCIES ANNOUNCING JOINT EFFORT TO REDUCE MATERNAL MORTALITY

Every minute of every day, somewhere in the world, a woman died as the result of complications arising during pregnancy and childbirth, according to a joint statement by four United Nations agencies issued at a Headquarters press briefing this morning.

The joint statement on “Reduction of Maternal Mortality” was introduced by: the Director-General of the World Health Organization (WHO), Dr. Gro Harlem Brundtland; the Executive Director of the United Nations Population Fund (UNFPA), Dr. Nafis Sadik; the Executive Director of the United Nations Children's Fund (UNICEF), Carol Bellamy; and Vice-President of the World Bank, Eduardo Doryan.

Dr. Brundtland said the four partner agencies were expressing their common commitment to reducing maternal mortality, which was a continuing tragedy and part of an unfinished health and development agenda. Making pregnancy safer was a matter of reducing inequities, addressing the human rights of women and creating a social movement to promote and protect the health of women and their infants at the vulnerable time of pregnancy and childbirth. To ensure that women moved safely through pregnancy and childbirth, a series of social, cultural, behavioural, economic and biomedical changes were required.

The joint statement summarized those changes, she continued. It was important from several perspectives. From the technical point of view, it presented a clear summary of what needed to be done and aimed to ensure that human and financial resources were used properly. From the strategic perspective, it presented key approaches and strategies that countries could embark upon, according to their resources. The statement was also politically important, as it represented partnership between the four organizations. While the inputs of each agency would vary, all would be judged by the same outcomes -- reduced mortality and morbidity among pregnant women and their infants.

The goal was to ensure that all women, especially the most vulnerable, had access to quality services and that all deliveries were overseen by a skilled attendant who was, in turn, backed by a functioning health system when complications arose, she explained. The joint statement represented a major step in bringing together health and development agencies, and civil society, the private sector and non-governmental organizations. A movement must be generated around the world to take up the challenge of safe motherhood as a global concern and a responsibility for everyone. Investing in safe motherhood meant investing in the common future.

Dr. Sadik said the effort being launched today was to coordinate the undertakings of the four organizations and thereby have greater success in preventing preventable maternal deaths. Out of all health statistics, the largest gap between rich and poor nations was found in maternal mortality levels. Of the 600,000 maternal deaths that occurred annually, 98 per cent were in the developing world. Out of 133 million births each year, 50 per cent were unplanned, she stressed. Also, 50 per cent were not attended by a qualified health worker. Fifteen per cent of women had complications -- 20 million each year. They needed access to a skilled attendant with access also to equipment and a well-organized health service.

There was no mystery as to what actions were needed, but inputs must be focused on the country level, she continued. The first step was preventive action, beginning with the birth of the girl-child. The nutrition of the girl infant was not adequately addressed. The second step was to delay the age of first pregnancy, as young girls who got pregnant had a much higher maternal mortality level. The third step was to eliminate unwanted pregnancies. Meeting that demand would itself reduce the number of ill-timed pregnancies by 25 per cent.

The most important intervention was emergency care for complications, she continued. But, also of great importance was the need to increase information about pregnancy and childbirth. It took two for pregnancy to occur. Men must be educated, so the partnership shared responsibility from conception through birth.

Ms. Bellamy said that complications in pregnancy and childbirth were killing and disabling more women and girls of childbearing age than any other set of causes. Yet, the vast majority of those complications were treatable and preventable. The same factors that contributed to the nearly 600,000 maternal deaths a year -- poor health, poor nutrition, lack of care -- also hastened the death of young children. More than 3 million infants died in the first week after birth from factors that were related to pregnancy and labour. Those factors included poor maternal health and hygiene, lack of immunization against tetanus, inadequate care, inefficient management of delivery, and lack of essential care for the newborn. Another three million pregnancies ended stillborn each year. Also, the chances of young children surviving to their fifth birthday dropped by 50 per cent if their mother died.

Those deaths were tragic on the human level, but they also impeded development, as communities and societies were deprived of incalculable human potential, she said. But safe motherhood was more than a health and development imperative; it was a fundamental human right that had been overwhelmingly acknowledged by a galaxy of human rights instruments, including the Convention on the Rights of the Child.

Over the past 12 years, much had been learned about promoting safe motherhood using measures that were cost-effective, straightforward and logical, she said. They included focussing on nutrition and environment before birth and even before pregnancy. They also included improving nutrition of the girl-child during formative years and enhancing the lives of women through quality education and marketable skills.

UNICEF's agenda for the twenty-first century was to end the cycle of global poverty, she said. The poverty cycle could be broken by ensuring that infants were born healthy and nurtured in a caring environment, that all children reached the age of entering primary school healthy and were able to attend primary school and receive quality education, and that adolescents were able to grow and experience their full potential. Those goals were achievable, but only if significant progress was made in reducing preventable deaths and disabilities among mothers and expectant mothers.

Mr. Doryan said the purpose of the joint statement was to call the world's attention to a health crisis about which many were unaware. It was a crisis that need not exist-- a global tragedy afflicting individual women and their families, and draining vital resources from the economies of the developing world. It was a problem whose solution was inexpensive and technically feasible. If the will and energy was mustered, the problem could be solved.

The World Bank and United Nations partners must commit themselves to make pregnancy safer for several reasons, he said. The first had to do with human rights and equity. Maternal mortality was a social injustice. The indicator represented the widest disparity of all human development indicators, within developed and developing nations and within countries. Only about $3 per person, per year would prevent the overwhelming majority of maternal deaths, one half of all infant deaths and the pregnancy-related disabilities that millions of women suffered in low-income countries.

Reducing maternal mortality and morbidity was an integral part of the Bank's effort to eliminate poverty, he said. Family planning and maternal health interventions were among the most cost-effective interventions available. The Bank was now the largest external source for safe motherhood. Where only 10 Bank- financed projects included maternal and family planning interventions in 1987, now there were more than 150 projects in 80 countries, ranging from services for midwives to maternal nutrition and access to credit. The Bank had developed a safe motherhood action plan with several components. At the country level, reducing maternal and infant mortality was a central piece of its comprehensive development framework.

Next year's World Development Report would empahsize the link between poverty and high maternal mortality, he said. In countries with high maternal- mortality ratios, the Bank was ensuring that its country assistance strategy included that issue as a core element. Safe motherhood was a human right. The task was to ensure that it remained a central issue in all efforts to reduce poverty and increase human development.

A correspondent asked why it had taken so long for the agencies to collaborate on such an important issue. Dr. Sadik said the Safe Motherhood Initiative existed, with more than four organizations participating. But after 10 years, maternal mortality rates had not dropped sufficiently, indicating the need for more strategic priorities and interventions. That was why the preventive aspects were being discussed now, including nutrition, social mobilization and emergency services. Also, the organizations had not been working together as actively at the country level, which was another area for additional effort.

Today, issues affecting women and girls were more widely recognized, she continued. Female genital mutilation, gender violence, the marriage of young girls to older men -- those factors all were related to maternal mortality. But the overall atmosphere for addressing them had improved.

Had the World Bank programmes made a difference? a correspondent asked. Mr. Doryan stressed that while statistics remained high, there was need to look at what the situation would have been had those interventions not been in place. Also, the issue was now considered a development issue. Maternal mortality was an indicator of a society's overall well-being. Initiatives for safe motherhood, bundled with girls' education, had a tremendous impact on reducing unwanted pregnancy. Many issues must be addressed together.

Dr. Brundtland said that social and economic development in many countries had not continued to increase -- declines had been witnessed in some. Maternal mortality was strongly linked to poverty and lack of access to health services. Women were dying from bleeding because they lacked access to simple interventions. The indicator of maternal mortality was very sensitive to development, health and poverty. Without the efforts of the past 10 years, the rates might be worse, as in the HIV/AIDS epidemic.

To a question on cultural factors, Dr. Sadik said there were numerous examples. In Nigeria, girls as young as 12 years old were married to older men, resulting in early pregnancy and other complications. Another example was the preference for boys over girls, which was strong, particularly in South Asia. Social and cultural aspects must be addressed through education and social mobilization. In today's climate, those matters could be addressed more openly. Maternal mortality statistics were not easy to obtain, she added -- the 600,000 number was only an estimate.

Ninety-eight per cent of the deaths were preventable, she stressed. Motherhood was glorified, yet not enough attention was paid to it. But, there were examples of success from the introduction of simple services, such as trained attendants.

Ms. Bellamy added that much had been learned over the past 10 years. The percentage of women having skilled birth attendants had improved about 1 per cent per year; it was now estimated at 58 per cent. But the range of interventions did not only fall into the health sector. Transportation, for example was an essential matter.

When a correspondent asked about the WHO's work regarding tobacco, Dr. Brundtland stressed the need for international cooperation. The argument against doing something was often that if tobacco was taxed at a higher rate, to provide a disincentive to use it, that would result in cigarette smuggling. But, if there was international agreement on what countries should do, then States could feel fairly certain that their work would not be undermined by other countries doing the opposite.

She added that 108 countries had participated in the working group in Geneva to develop a framework convention, showing interest across the world to take the matter seriously. Cooperation would address higher taxation, avoiding or banning advertising, and working actively against smuggling. Court cases in the United States had made available hundreds of thousands of formerly secret industry papers. A group had been appointed to look at the papers and provide advice on what action was warranted. Already, it seemed that industry had influenced United Nations institutions, governments and intergovernmental bodies, sometimes beyond acceptable practice. Those matters would be investigated.

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