ICPD Vision: Making Motherhood Safer

The problem

An unacceptable number of women – more than half a million each year – die as a result of complications of pregnancy or childbirth. For each woman who dies, as many as 30 more are injured or disabled. The most devastating of the childbirth injuries is obstetric fistula, which affects at least two million women throughout Africa, the Arab States and South Asia. The actual number may be much higher because women with the condition are often marginalized and suffer silently.

The promise

Neither ICPD nor ICPD + 5 specifically mentions obstetric fistula, although the issue is referred to under the general category of maternal morbidity. Both ICPD and ICPD + 5 call for actions to make motherhood safer.

“All countries should reduce maternal morbidity and mortality to levels where they no longer constitute a public health problem.” ICPD, para 8.21

“All countries … must expand the provision of maternal health services…[including] adequate delivery assistance that … provides for obstetric emergencies. All births should be assisted by trained persons…” ICPD, para 8.22

“In health sector reform, the reduction of maternal mortality and morbidity should be prominent and used as an indicator for the success of such reform.” ICPD+5, para 62 (b)

UNFPA's strategic approach

As a way to bring attention to this neglected public health issue, UNFPA has launched a global Campaign to End Fistula, which now covers some 30 countries. The campaign seeks to prevent fistula from occurring, to surgically repair women with the condition and to help them reintegrate back into their communities. It works in three phases: assessing the scope of the problem and the resources to deal with it in each country, planning interventions and implementing national strategies.

All the actions that UNFPA takes to prevent fistula are aligned with its larger effort to make motherhood safer for all women. Reducing maternal mortality by 75 per cent by 2015 is called for in the Millennium Development Goals as well as in the ICPD Programme of Action.

How are we doing?

No reliable indicators track the incidence of fistula. However, its prevalence probably correlates with maternal mortality ratios, which are unacceptably high, especially in Asia and Africa. Both maternal death and fistula occur when women experiencing complications of labour cannot get emergency obstetric care. In industrialized countries where women have access to emergency obstetric care, fistula has virtually disappeared, and women rarely die in childbirth. In the South, fistula is all too common, especially among the very young, the very poor and those living in remote rural areas. In some countries, one in 14 women die from complications of childbirth.

Several countries, notably China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka and Thailand, significantly reduced maternal mortality following coordinated transitions from home-based to facility-based delivery. But in other places, progress in reducing maternal mortality has stalled or even been reversed, in spite of considerable international attention to the issue.