Les dernières négociations intergouvernementales sur l’élaboration de l’ordre du jour de l’après-2015 se sont tenues à New York du 20 au 31 juillet 2015 et ont abouti à l’adoption par 193 États Membres de Transformer notre monde : Ordre du jour de 2030 pour le développement durable le dimanche 2 août au soir, après de longues négociations difficiles. De concert avec l’UNFPA, les représentants des réseaux régionaux de santé et droits sexuels et reproductifs du monde entier ont infatigablement plaidé durant ces négociations – comme nous l’avons fait au cours de chacune des sessions précédentes des négociations intergouvernementales – pour veiller à ce que l’ordre du jour de l’après-2015 garantisse les droits humains, notamment la santé et les droits sexuels et reproductifs de tous les individus où qu’ils soient, place l’égalité des sexes au premier plan, reconnaisse le rôle des jeunes en tant que principaux agents du changement et inclue la participation active de la société civile à forger le développement mondial, tant au niveau national qu’au niveau international.
Entre el 20 y 31 de julio de 2015, se llevaron a cabo las negociaciones finales entre los gobiernos en torno a la agenda de desarrollo post 2015 en Nueva York. Estas culminaron el domingo 2 de agosto con la adopción del documento de consenso: Transformar nuestro mundo: la agenda de desarrollo sostenible 2030, por parte de 193 Estados Parte, luego largas y arduas negociaciones.
The final intergovernmental negotiations on the post-2015 development agenda took place in New York July 20-31, 2015 culminating in the adoption of Transforming Our World: The 2030 Agenda for Sustainable Development by 193 Member States on Sunday evening, August 2 after long and arduous negotiations. Representatives of regional sexual and reproductive health and rights (SRHR) networks from around the world, together with UNFPA, advocated tirelessly at these negotiations–as we have during each of the previous intergovernmental negotiation sessions–to ensure that the post-2015 agenda guarantees human rights, particularly the SRHR of all people everywhere; brings gender equality to the forefront; recognizes young people’s role as key agents of change; and includes the active participation of civil society in shaping global development, both at country and global levels.
What happens when a mother dies? In the West, the most ready and obvious answer is grief – the harrowing emotional and psychological toll of losing a loved one. A mother’s death is largely viewed as a private tragedy that will grow more manageable in time.
But in many developing countries, a mother’s death is much more than an emotional crisis, often leading to long-term social and economic breakdown, both for her immediate family and the wider community. This topic is explored in new depth, in a special issue launched today in Reproductive Health (an open-access journal).
“The True Cost of Maternal Death: Individual Tragedy Impacts Family, Community and Nations” focuses exclusively on the immediate and longer-term effects of maternal death on surviving children, households, and communities. It features seven studies, with data drawn from four African countries – Ethiopia, Kenya, Malawi, and South Africa.
The research was conducted by two research groups, one led by Harvard’s FXB Center for Health and Human Rights, and the other a consortium made up of Family Care International, the International Center for Research on Women, and the Kenya Medical Research Institute (KEMRI)-CDC Research and Public Health Collaboration. The results provide hard evidence that a mother’s loss can devastate the livelihoods, quality of life, and survival chances of those she leaves behind.
By Emily Maistrellis
Emily Maistrellis is a policy coordinator at Harvard University’s FXB Center for Health and Human Rights and a research study coordinator at Boston Children’s Hospital. This article originally appeared on Boston NPR station WBUR’s CommonHealth blog.
Walif was only 16 and his younger sister, Nassim, just 11 when their mother died in childbirth in Butajira, Ethiopia.
Both Walif and Nassim had been promising students, especially Walif, who had hoped to score high on the national civil service exam after completing secondary school. But following the death of their mother, their father left them to go live with a second wife in the countryside. Walif dropped out of school to care for his younger siblings, as did Nassim and two other sisters, who had taken jobs as house girls in Addis Ababa and Saudi Arabia.
Nassim was married at 15, to a man for whom she bore no affection, so that she would no longer be an economic burden to the family. By the age of 17, she already had her first child. Seven years after his mother died, Walif was still caring for his younger siblings, piecing together odd jobs to pay for their food, although he could not afford the school fees.
In all, with one maternal death, four children’s lives were derailed, not just emotionally but economically.
More than 1,000 miles away, in the rural Nyanza province of Kenya, a woman in the prime of her life died while giving birth to her seventh child, leaving a void that her surviving husband struggled to fill. He juggled tending the family farm, maintaining his household, raising his children and keeping his languishing newborn son alive.
But he didn’t know how to feed his son, so he gave him cow’s milk mixed with water. At three months old, the baby was severely malnourished. A local health worker visited the father and showed him how to feed and care for the baby. That visit saved the baby’s life.
As these stories illustrate, the impact of a woman’s death in pregnancy or childbirth goes far beyond the loss of a woman in her prime, and can cause lasting damage to her children — consequences now documented in new research findings from two groups: Harvard’s FXB Center for Health and Human Rights, and a collaboration among Family Care International, the International Center for Research on Women and the KEMRI-CDC Research Collaboration.
The causes and high number of maternal deaths in Ethiopia, Malawi, Tanzania, South Africa, and Kenya — the five countries explored in the research — are well documented, but this is the first time research has catalogued the consequences of those deaths to children, families, and communities.
The studies found stark differences between the wellbeing of children whose mothers did and did not survive childbirth:
- Out of 59 maternal deaths, only 15 infants survived to two months, according to a study in Kenya.
- In Tanzania, researchers found that most newborn orphans weren’t breastfed. Fathers rarely provided emotional or financial support to their children following a maternal death, affecting their nutrition, health care, and education.
- Across the settings studied, children were called upon to help fill a mother’s role within the household following her death, which often led to their dropping out of school to take on difficult farm and household tasks beyond their age and abilities.
How do we use these new research findings to advocate for greater international investment in women’s health?
At a webcast presentation earlier this month, a panel of researchers, reproductive and maternal health program implementers, advocates and development specialists discussed that question.
Central to the discussion was the belief that the death of a woman during pregnancy and childbirth is a terrible injustice in and of itself. The vast majority of these deaths are preventable, and physicians and public health practitioners have long known the tools needed to prevent them. And yet, every 90 seconds a woman dies from maternal causes, most often in a developing country.
The panelists expressed hope that these new data, which show that the true toll of these deaths is far greater than previously understood, can help translate advocacy into action.
It’s important to recognize that, beyond the personal tragedy and the enormous human suffering that these numbers reflect — some hundreds of thousands of women die needlessly every year — there are enormous costs involved as well. -Panelist Jeni Klugman, a senior adviser to the World Bank Group and a fellow at the Harvard Kennedy School of Government.
“So quantifying those effects in terms of [children’s] lower likelihood of surviving, the enormous financial and health costs involved and the repercussions down the line in terms of poverty, dropping out of school, bad nutrition and future life prospects are all tremendously powerful as additional information to take to the ministries of finance, to take to the donors, to take to stakeholders, to help mobilize action,” said Klugman.
Just what does “action” mean? Currently, the countries of the world are debating the new global development agenda to succeed the eight Millennium Development Goals, an ambitious global movement to end poverty. Advocates can use this research to make the case that reproductive, maternal, newborn, and child health should play a central role in this agenda, given that it reveals the linkages between the health of mothers, stable families, and ultimately, more able communities, according to Amy Boldosser-Boesch, Interim President and CEO of FCI.
Panelists also called for more aggressive implementation of the strategies known to prevent maternal mortality in the first place; as well as for the provision of social, educational, and financial support to children who have lost their mothers; and for continued research that outlines the direct and indirect financial costs of a woman’s contributions to her household, and what her absence does to her family’s social and economic well-being.
But action is also required outside of the realm of health care, said Alicia Ely Yamin, lecturer in Global Health and Population at the Harvard School of Public Health and policy director of the FXB Center.
In fact, the cascade of ill effects for children and families documented by this research doesn’t begin with a maternal death. The plight of the women captured in these studies begins when they experience discrimination and marginalization in their societies: “It [maternal death] is not a technical problem. It’s because women lack voice and agency at household, community, and societal levels; and because their lives are not valued,” she said.
Klugman added that this research adds to work on gender discrimination, including issues like gender-based violence, which affects one in three women worldwide.
It’s a tall order: advancing gender equality, preventing maternal, newborn, and child death, and improving the overall well-being of families. But panelists were hopeful that this research can show policy makers, and the public, that these issues are intertwined, and must be addressed as parts of a whole.
As Aslihan Kes, an economist and gender specialist at ICRW and one of the researchers on the Kenya study concluded, this research is “making visible the central role women have in sustaining their households.”
This is an opportunity to really put women front and center, making all of the arguments for addressing the discrimination and constraints they face across their lives. -Aslihan Kes
On October 7, 2014, a panel of experts in maternal health—moderated by Dr. Ana Langer, the Director of the Maternal Health Task Force—gathered at the Harvard School of Public Health to discuss the socioeconomic impact of a maternal death on her family and community. Several studies were summarized and priorities for how to use this research were discussed by the panel and audience at “Women’s Lives Matter: The Impact of Maternal Death on Families and Communities.”
What does the research say?
In many countries around the world, the household is the main economic unit of a society. At the center of this unit is the mother and the work—both productive and reproductive—that she provides for her family. A study in Kenya, led by Aslihan Kes of the International Center for Research on Women (ICRW) and Amy Boldosser-Boesch of Family Care International (FCI), showed great indirect and direct costs of a mother losing her life. This cost is often accompanied by the additional cost and care-taking needs of a newborn. “Once this woman dies the household has to reallocate labor across all surviving members to meet the needs of the household. In many cases that meant giving up other productive work, loss of income, hiring an external laborer, girls and boys dropping out of school or missing school days to contribute [to household work],” shared Kes. In addition, the study done in Kenya determined that families whose mother died used 30% of their annual spending for pregnancy and delivery costs; a proportion categorized by the WHO as catastrophic and a shock to a household.
Similar research was conducted in South Africa, Tanzania, Ethiopia, and Malawi by Ali Yamin and colleagues. In addition to similar socioeconomic findings to those in Kenya, Yamin found that less than 50% of children survived to their fifth birth if their mother died compared to over 90% of children whose mothers lived. An even more dramatic relationship was found in Ethiopia with 81% of children dying by six months of age if their mother had died. In South Africa, mortality rates for children whose mothers had died were 15 times higher compared to children whose mothers survived.
Increasing the visibility of maternal death
While a family is grappling with grief they are also making significant changes in roles and structure to meet familial needs. Dr. Klugman emphasized this point when she said, “Quantifying [the] effects [of maternal death]… and the repercussions down the line—in terms of poverty, dropping out of school, bad nutrition, and future life prospects—I think are all tremendously powerful. [This] additional information [is] very persuasive—to take to the ministries of finance, to take to donors, to take to stakeholders—to help mobilize action for the interventions that are needed.”
Apart from the economic and social costs, is a foundation of human rights violations and gender inequalities. The high rate of preventable maternal mortality is no longer a technical issue, but a social issue. “Maternal mortality it is a global injustice. It is the indicator that shows the most disparities between the North and the developing world in the South. It’s not a technical problem, it’s because women lack voice and agency at household, community, and societal levels and because their lives are not valued. Through this research of showing what happens when those women die, it shows in a way how much they do [and how it] is discounted,” said Dr. Yamin, whose research focuses on the human rights violations in maternal health.
Leveraging this research for improved reproductive, maternal, newborn, and child health
The research findings are clear: prevention of maternal mortality is technically feasible, the right of every woman, and significantly important for the well-being of a family and a community. Boldosser-Boesch provided three reasons why making the case for preventing maternal mortality is critical at this time.
- These findings strengthen our messaging globally and in countries with the highest rates on the importance of preventing maternal mortality, by increasing access to quality care, which includes emergency obstetric and newborn care.
- This research supports integration across the reproductive, maternal, newborn, and child health (RMNCH) continuum to break down current silos in funding and programs.
- “We are at a key moment… for having new information about the centrality of RMNCH to development, because… the countries of the world are working now to define a new development agenda, beyond the MDGS, post-2015. And that agenda will focus a lot on sustainable development… and we see in these findings… , connections to the economic agenda…, questions of gender equality, particularly what this means for surviving girl children, who… may experience earlier marriage or lack of access to education,” shared Boldosser-Boesch.
In order to move the agenda forward on preventing maternal mortality and ensuring gender equality, ministries of health and development partners must be engaged. In addition, donors can fund the action of integration to address a continuum approach and media outlets should be leveraged to disseminate these findings and hold governments accountable for keeping promises and making changes. The prevention of maternal mortality is a human rights-based, personal, and in the socioeconomic interest of a family, community, and a society.
This panel included:
- Ana Langer, Director of the Maternal Health Task Force
- Alicia Yamin, Lecturer on Global Health at the Harvard School of Public Health
- Amy Boldosser-Boesch, Interim President & CEO, Family Care International
- Jeni Klugman, Senior Adviser at The World Bank Group
- Aslihan Kes, Economist and Gender Specialist, International Center for Research on Women
Watch the webcast here.
Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the Healthy Newborn Network (HNN) blog.
This year’s UN General Assembly was full of high-profile moments that reinforced the need for investment and action to improve reproductive, maternal, newborn and child health (RMNCH): the launch of a Global Financing Facility to Advance Women’s and Children’s Health; the release of reports tracking stakeholders’ fulfillment of commitments to Every Woman Every Child; new data on maternal, newborn and child survival from Countdown to 2015; and a plethora of side events focusing on strategies and country progress toward MDGs 4 and 5. For Family Care International, which advocates for improved reproductive, maternal, and newborn health, this unprecedented level of attention to women’s and children’s health is a welcome sign that our advocacy is having an impact, and that global commitment to ending all preventable maternal and child deaths is stronger than ever.
RMNCH was a key theme in many other important discussions during the week, demonstrating the centrality of the health of mothers and newborns to a range of development challenges.
- Events began with a Climate Summit that brought together leaders from more than 120 countries. The Partnership for Maternal, Newborn & Child Health noted during the Summit that “women and children are the most vulnerable to the effects of a changing climate, and those who are more likely to suffer and die from problems such as diarrhoea, undernutrition, malaria, and from the harmful effects of extreme weather events such as floods or drought.”
- There was a special session to review progress towards achieving the International Conference on Population and Development Programme of Action. The ICPD agenda highlights the importance of ensuring universal access to sexual and reproductive health and rights and the importance of quality and accessible maternal health care, recognizing that healthy girls and women can choose to become healthy moms of healthy babies.
- The UN Security Council held an emergency meeting where President Obama called for swift action on the Ebola epidemic that is destroying lives and decimating African health systems. This crisis highlights already-fragile health systems that lack sufficient health workers, supplies, and essential medicines–the same failures that contribute to maternal and newborn mortality. A recent news story details how pregnant women who are not infected with Ebola risk dying in West Africa due to lack of access to maternal health services, and the same risk exists for newborns and young children. The loss of skilled healthworkers, particularly midwives, could have enormous long term impacts on the ability of women, newborns and children to access life-saving care.
- Finally, the UNGA week included high-level meetings on humanitarian crises in Syria, South Sudan and many other countries. According to the State of the World’s Mothers 2014 report, more than half of all maternal and child deaths occur in crisis-affected places. Discussions of humanitarian response in crisis settings included recognition of the disproportionate impact on women and children of violence, including gender-based violence, displacement, lack of access to food and lack of access to crucial maternal health services and early interventions for newborns. These crises and fragile health systems make achieving the Every Newborn Action Plan recommendations on ensuring quality care for mothers and newborns during labor, childbirth and the first week of life more difficult, but also more critical.
While this long list of world crisis may seem overwhelming, there is some good news on maternal, newborn and child survival. As the UN Secretary-General reminded us, the world is reducing deaths of children under the age of five faster than at any time in the past two decades and significant declines in maternal mortality have occurred in the past 10 years. As the world works together to shape the post-2015 development goals, these experiences during UNGA show that the new agenda must prioritize continuing to address maternal, newborn and child mortality which is linked to many of the world’s pressing development challenges, including poverty. As a recent editorial in The Lancet says, “As governments slowly come to an agreement about development priorities post-2015, it is clear that maternal and newborn health will be essential foundations of any vision for sustainable development between 2015 and 2030.”
Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the MDG456Live Hub, curated coverage of women and children during the UN General Assembly.
During the UNGA this week, many partners are committing to deliver on promises to accelerate progress on MDGs 4 and 5. There has also been a renewed focus on the importance of solid data to track progress on reproductive, maternal, newborn and child health and to hold governments and other stakeholders accountable for meeting their commitments. New research conducted in Kenya by Family Care International (FCI), the International Center for Research on Women (ICRW), and the KEMRI-CDC Research and Public Health Collaboration has the potential to increase the momentum of efforts to save the lives of nearly 300,000 women who die each year (5,500 of them in Kenya) from causes related to pregnancy and childbirth.
Each of these avoidable, premature deaths is a tragedy in its own right, and a terrible injustice. Each of these women — some of them barely more than girls — has a right to life and health, and to a standard of health care that protects her from preventable illness, injury, and death.
But we who work to improve maternal health have argued for years that each of these deaths also brings countless additional layers of loss, pain, and destruction. The tragic, sudden death of a woman in the prime of life — in many cases already a mother and often the most economically productive member of the family — begins a cascade of loss and pain that upends the lives of those around her: her newborn baby (if it survives) and her older children, husband, parents, and other members of her family and community. The cost of a maternal death is, quite literally, a price too high to bear.
This new study provides urgently needed data to help persuade governments, donors, and policy makers that investments in women’s health and maternal health are also investments in newborns and children, in stable families, in education and community development, in stronger national economies and, ultimately, in sustainable development.
Based on interviews and focus group discussions with families, across a poor rural area in Siaya County in western Kenya, that had lost a family member to maternal death over a two-year period, we found that:
- When a mother dies in or around childbirth, her newborn baby is unlikely to survive.
Of 59 maternal deaths in the study, only 15 babies survived their first two months of life.
- A mother’s death harms the educational and life opportunities of her surviving children.
Many children had to leave school because the loss of a mother’s income meant that they couldn’t pay tuition fees, needed to work for a living, or had to take up essential household chores.
- The cost of emergency care (even when unsuccessful), combined with high funeral costs, puts families under a crushing economic burden.
Families spent more on funerals than their total annual expenditure on food, housing, and other household costs, after having already spent 1/3 of their annual consumption expenditure on medical costs.
- Loss of income and high, unexpected costs send many families into a spiral of debt, poverty, and instability.
Many families, under desperate financial pressure, had to sell household property, borrow from moneylenders, or move children out of the family home.
At the national launch of the research findings, Kenya’s Cabinet Secretary for Health, Hon. James Macharia, said, “A mother’s death ignites a chain of disruption, economic loss, and emotional pain that often leads to the death of her baby, diminished educational and life opportunities for her surviving children, and a deepening cycle of poverty for her family.” As the MDG deadline approaches and the post-2015 development agenda is defined, we hope this research will help to catalyze renewed commitment to ending preventable maternal mortality, so that no woman has to pay the high price of losing her life, and so that families, communities and nations no longer have to bear the burden of maternal death.
Learn more: On October 7th, 2014 (2:30 – 3:30 PM EDT), Harvard’s FXB Center for Health and Human Rights, Family Care International (FCI), and the International Center for Research on Women (ICRW) will host Women’s Lives Matter: The impact of a maternal death on families and communities, a live webcast. The webcast will feature research findings from the Kenya study as well as those from four other African countries which document the dramatic economic and social impacts of a maternal death. Panelists will also discuss opportunities and strategies for using these important findings to advocate for political commitment, policy change, and sustained investment in reproductive, maternal, and newborn health in the context of the evolving post-2015 global health and development agenda.
More information on the webcast and subsequent Q&A:http://bit.ly/WomensLivesMatter
Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the MDG456Live Hub, curated coverage of women and children during the UN General Assembly.
As we move into the intergovernmental negotiations for defining the post-2015 development agenda, continued advocacy will be needed to link sexual and reproductive health and rights (SRHR) to sustainable development. Do you have the talking points you need to make the case that governments must ensure the comprehensive inclusion of sexual and reproductive health and rights within the post-2015 development framework?
A new tool Briefing Cards: Sexual and Reproductive Health and Rights (SRHR) and the Post-2015 Development Agenda can help. The briefing cards detail the linkages between SRHR and other key development issues including environmental sustainability, gender equality, economic growth, educational attainment, and broader health goals. Produced by FCI, with support from the UN Foundation, and co-authored by partners in the Universal Access Project, each one page card provides advocates with succinct arguments and key Facts at a Glance about the impact of SRHR on the broader development agenda. Each card also includes recommendations for inclusion of SRHR in the post-2015 development framework in a cross-cutting way, for example, by encouraging targets and indicators that address and measure the strong connections between girls’ education and their sexual and reproductive health and rights. All of the partners involved in developing the Briefing Cards hope that they will be a useful tool for advocates worldwide working to shape the social, economic and environmental aspects of the post-2015 sustainable development agenda. The cards are available for free download; please share them with your partners and help us make the case with governments and other stakeholders in the post-2015 process that sexual and reproductive health and rights are integral to the achievement of all shared development goals.
By Katie Millar
Katie Millar is a technical writer for the Maternal Health Task Force (MHTF), where this article originally appeared.
Today, at the London School of Hygiene and Tropical Medicine, The Lancet launched its newest series Midwifery. This series provides concrete actions for stopping preventable maternal and newborn death and ensuring perinatal health. The knowledge that midwives are key to preventing perinatal death is not new. However, scaling up the utilization of midwives on a systems level is lacking, which has prevented this solution from becoming a reality.
The Midwifery Series was created to provide concrete guidance and frameworks on how to utilize midwives and a new standard of care for Quality Maternal and Newborn Care (QMNC). At the center of this model of care are the needs of women and their newborn infants. Even though the needs of women across the world seem to differ greatly, this series clarifies that no matter where a woman lives, care led by a midwife is the answer to ensuring health. The series comprises four separate papers which were created by a multidisciplinary group, including academics, researchers, advocates for women and children, clinicians, and policy-makers. This multidisciplinary approach is necessary for addressing current gaps in perinatal care.
The current maternal and newborn health landscape often offers fragmented solutions and interventions to address the needs of women and their newborns. This fragmentation is a barrier to adequate perinatal care. These gaps in care lead to 98% of the annual 289,000 maternal deaths, 2.6 million stillbirths, and 2.9 million neonatal deaths. In order to mitigate these preventable deaths, improvements in the quality throughout the continuum of care and emergency services are imperative. The series supports a whole-system approach to improving perinatal care by ensuring skilled care for all.
The Lives Saved Tool (LiST) was used in the series to model different levels of scale-up of essential interventions for reproductive, maternal, and newborn health (RMNH) which are within the scope of practice of a midwife. In low-resource settings even a 10% increase in the interventions covered by midwifery would decrease maternal mortality by 27%. Therefore, more rigorous scale-up could have an incredible impact on reducing maternal mortality.
The standard for QMNC presented in the series is globally applicable as it not only focuses on the scale-up of essential interventions, but also the harmful effects and necessary mitigation of over-medicalization of birth and perinatal care. Professor Petra ten Hoope-Bender, of the Instituto do Cooperación Social Integrare, Barcelona, Spain, said, “Although the level and type of risks related to pregnancy, birth, postpartum and the early weeks of life differ between countries and settings, the need to implement effective, sustainable, and affordable improvements in the quality of care is common to all, and midwifery is pivotal to this approach. However, it is important to understand that to be most effective, a midwife must have access to a functioning health-care service, and for her work to be respected, and integrated with other health-care professionals; the provision of health care and midwifery services must be effectively connected across communities and health—care facilities.”
In order to assist the development of health systems and their integration of midwives, the series provides three new tools:
- The Framework for Quality Maternal and Newborn Care is applicable to all countries on not only what needs to be implemented, but how to implement strategies to reduce maternal, neonatal, and infant mortality and morbidity, improve quality of care, and increase efficiency of health systems.
- Country diagrams can be used to identify the most important elements required to strengthen a country’s health systems to provide quality midwifery services.
- Pragmatic steps provide a guide to initiate or further develop their midwifery services.
Midwives not only provide care at the time of birth, but work with women from before their pregnancy through their newborns infancy to prevent death and ensure health. This life course approach is essential for having a large impact on the needless numbers of deaths and morbidities. Check out The Lancet’s Midwifery Series for more details on how midwives will make a large difference in the lives of women and their children in the coming years as the post-2015 agenda is implemented.