Statement by DAWN, 22 September 2010

World leaders gathering in New York for the 2010 High-level Plenary Meeting on the Millennium Development Goals will proudly unveil pledges and commitments to accelerating the achievement of the goals by 20151. In this midst is frenzy over how to rescue the poor performance in reducing maternal mortality particularly in low and middle income countries of the economic South where 98% of maternal deaths occur. But will the show of sincerity assuage the grief over the losses and the shortfalls?

The MDGs have created silos of intervention in development strategies and plans. Government programs and official projects are focused on targets and indicators and less concerned about inter-sectoral approaches and complementarities. Nowhere is this clearer than in the area of maternal mortality. Lacking the holistic analytic of the Programmes of Action from the International Conference on Population and Development and the Fourth World Conference on Women and often de-contextualized from past global consensuses around human rights, gender equality, and development, tracking “progress” of the MDGs dangerously resembles a demographic numbers game.

India and Nigeria in the economic South and Mexico now a member of the OECD2 are countries where high rates of maternal mortality have been a key issue for many years and continue to be a vital concern. Here, the MDGs have had varying influence over public and policy discourses on rights, gender, health, and development. The MDGs have had less of a direct impact on policies and programs in India and Mexico while in Nigeria the MDG is at least in part an engine fuelling state programs. On a positive note, civil societies in both India and Mexico are using the MDGs as a means to check state accountability especially in regard to public provisioning for the poor.

DAWN’s global research on SRHR in these countries had uncovered comparable trends pointing to dire consequences of a maternal mortality silo, as follows:

• Maternal Mortality narrowly channels concern on deaths instead of also calling attention to the serious range of morbidities and injuries women face in pregnancy and in the course of their sexually active and reproductive years.

• There is the creeping return of family planning and population control discourse. While some NGOs engage the MDGs to direct discussion to SRHR issues, a growing number of funders and other stakeholders take on the MMR bandwagon along with a revival of the pre-ICPD population control and population management language that is often directed at the poor. In Nigeria this had led to a side tracking of the comprehensive and integrated SRHR agenda found in the Maputo Plan of Action.

• The maternal health focus of local level SRHR programs in Mexico, Nigeria and India subtly ignores and excludes the unmarried and younger groups within the population without recognising their rights to access contraception. In the case of Mexico, despite a specific Action Plan from the Federal Health Ministry ordering the public health system to address the reproductive health of teenagers, few steps have been taken to enforce it. The SRHR of young people is also oft neglected when linkages between the MDG on reducing HIV/AIDs and the MDGs on gender equality are weak. The link to safe abortion which is of particular importance to young women is perhaps one of the weakest within the silos of the MDGs.

• Donor influence also facilitates fragmentation into policy and programmatic silos. In contexts where aid is the main if not exclusive source for funding specific MDG related programs and projects, as in the case of Nigeria, governments take on a donor’s preferred focus instead of being in a position to make lasting health investments in infrastructure and quality of care.

Realizing that one of the biggest policy victims of the MDG was the ICPD Programme of Action, government leaders meeting at the World Summit in 2004 adopted the additional target of achieving universal access to reproductive health (MDG Target 5B). Yet, the World Health Organization had recently reminded leaders that “… Greater attention to improving sexual and reproductive health care and universal access to all its aspects are required to prevent unintended pregnancies and unsafe abortions, to manage abortion complications, to prevent morbidity and mortality due to sexually transmitted infections (including HIV) and to provide high-quality pregnancy and delivery care, including essential obstetric care.” 3

In 2015 both the MDGs and the ICPD POA will end. Even now, decisive steps need to be taken to rescue maternal mortality from the MDG 5 silo. DAWN calls on world leaders to resurrect, reconfirm and return to center stage the more holistic and integrative rights-based sexual and reproductive health and rights agenda of the ICPD.

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1 SG Ban is set to announce the Global Strategy for Women and Children’s Health. The Clinton Global Initiative Annual Meeting is dedicating an entire track to women’s and girl’s empowerment. There is also the G8’s Muskoka Initiative for the reduction of maternal mortality rates and improvement of maternal and child health care.

2 Organization for Economic Cooperation and Development is an association of some of the world’s high income countries that are committed to increased world trade and economic growth.

3 Accessed from http://www.who.int/making_pregnancy_safer/topics/mdg/en/index.html.