Cape Town Statement on Maternal, Newsborn and Child Survival and Tallin Statement on Europe-wide Support to SRHR

ISSUE 80 - 01 May 2008

This issue of the Global Population Policy Update highlights the outcome of two important meetings that took place recently on issues related to population and development.  One was on   "Maternal, Newborn and Child Survival" in Cape Town, South Africa and the other on "Increasing Europe-wide Support to Sexual and Reproductive Health and Rights: Towards the UN High-Level Meeting on HIV and AIDS 2008" in Tallinn, Estonia.

On 17-19 April, leading global health experts, policymakers and parliamentarians convened in Cape Town to address the urgent need for accelerated progress to reduce maternal, newborn and child deaths, if internationally-agreed targets are to be met.  

The three day conference concluded with a call by the ministers, parliamentarians and other participants attending the "Countdown to 2015" conference for scaled-up investment in basic health services and human resources to reduce the preventable deaths of over 10 million children and women each year.

According to the 2008 report Tracking Progress in Maternal, Newborn and Child Survival, which was released at the conference, few of the 68 developing countries that account for 97 percent of maternal and child deaths worldwide are making adequate progress to provide critical health care needed to save the lives of women, infants and children.

Over 10 million women and children still die each year from causes that are largely preventable and treatable.  The majority of maternal and child deaths occur in Africa and South Asia, with sub-Saharan Africa increasingly bearing the global burden of mortality.  One in five children are born in sub-Saharan Africa, yet some 50 percent of all child deaths globally occur in that region, as do half of maternal deaths worldwide. In Niger, for example, women face a lifetime risk of dying in pregnancy or childbirth, which is as high as one in seven. 

Parliamentarians attending the 118th Assembly of the Inter-Parliamentary Union, which coincided with the "Countdown to 2015" conference added their voices of support, committed to scaled-up action to reach MDGs 4 and 5, and agreed to review progress at their next Assembly to be held in Addis Ababa, Ethiopia in April 2009.  

On 31 March -1 April, parliamentarians from Denmark, Estonia, Finland, Latvia, Lithuania, Norway and Sweden gathered in Tallinn, Estonia for the third Nordic-Baltic Parliamentary Conference to reaffirm their support for sexual and reproductive health and rights (SRHR) and all the relevant internally agreed development goals.

The two day meeting was hosted by the Estonian Sexual Health Association and organized by the Vaestoliitto, the Family Federation of Finland, together with the Finnish All-Party Parliamentary Group on Population and Development. It was the third event in a twinning initiative between the Nordic and Baltic States aiming at promoting global SRHR in national and European Union development policies.

At the conclusion of the meeting, the parliamentarians reaffirmed their commitment to universal access to reproductive health services by 2015 and to universal access to HIV and AIDS treatment, prevention, care and support by 2010, with specific attention paid to the provision of youth friendly services. They also committed to addressing the funding gap concerning family planning, sexually transmitted infections, maternal and infant care and sexual and reproductive health and rights, while ensuring that the current high levels of funding for HIV and AIDS are maintained, and even increased.
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Parliamentary Statements of Commitment

1) Statement of Commitment Concerning Maternal, Newborn and Child Survival by Participants in the Countdown to 2015 conference, Cape Town, April 17-19, 2008

We, the Ministers, parliamentarians and all participants at the Countdown to 2015 Conference in Cape Town, South Africa, April 17 - 19, 2008

Recalling the 1994 International Conference on Population and Development in Cairo; the 1995 World Conference on Women in Beijing, and the Delhi Declaration on Maternal, Newborn and Child Health of April 2005;

Building on the first Countdown to 2015 Conference in London in December 2005, which launched a concerted effort to scale up country action to achieve MDG 4 on reducing child mortality; and acknowledging that progress towards MDG 5 - improving maternal health - is not sufficient in many countries;

Concerned that almost 10 million children and newborns die every year from largely preventable diseases and conditions, and more than half a million women die annually from the complications of pregnancy and childbirth;

Recognizing that first-time adolescent mothers, particularly poor, marginalized, disadvantaged girls, bear the highest risks of maternal morbidity and mortality;

Recognizing the enormous economic and social burden that results from poor reproductive, maternal, newborn and child health and the barrier this constitutes to development and alleviation of poverty;

Recognizing the impact of underdevelopment, poverty, HIV/AIDS, gender inequity, and conflict on the health of women and children;

Taking note that:

Progress in countries in reducing maternal, newborn and child mortality represents a major success for governments, stakeholders, civil society and development partners, and these efforts should continue and be intensified;

Greater investments in basic infrastructure and human resources are key to improving health services and stronger programming, guided by local evidence, is needed to reduce deaths of women and newborns around the time of childbirth, taking into account the different delivery strategies needed across the continuum of care;

The maternal, newborn and child continuum of care must cover the period from adolescence though pre-pregnancy, pregnancy and childbirth, and from birth until the age of 5 years;

Adequate nutrition, and food security, water and sanitation should be a priority at all levels and in particular at the family level, given their strong relationship to overall health, productivity and ultimately to social and economic development;

Communities need to be involved, informed and empowered about maternal and child health needs, utilize services, and demand accountability;

Reducing maternal, newborn and child deaths on a sustained basis will require a functional and reliable health system that can deliver preventive, promotive curative services through an integrated approach. New and ongoing initiatives must contribute to strengthening health systems while focusing on achieving measurable outcomes;

All new initiatives must strengthen collaboration with partners in line with national programmes, and comply with the Paris Declaration;

Maternal, newborn and child mortality reduction also requires interventions to keep adolescent girls in school, stop child marriages, promote gender equality, livelihood skills, positive health seeking behaviours, and address the unmet need for contraception,

To achieve the health-related MDGs requires a strong focus on Africa south of the Sahara, South Asia, and other countries with high mortality in other regions;

Policy, programmatic, financing and investment efforts that address inequities are needed now, supported by strong monitoring for continuous improvement. Special attention needs to be given to meeting the needs of marginalized and vulnerable groups, including the poor, rural populations and adolescent girls;

Mobilization of additional resources by governments and their development partners is necessary to make sufficient progress towards the health-related MDGs;

Investing in local research, monitoring, evaluation and dissemination of findings will contribute to the knowledge base needed to accelerated progress;

Affirming that the achievement of the MDGs must be based on a strong commitment of all governments, organizations, and partners to protecting the human rights of women, children and adolescents.

Commit ourselves to an intensive effort to:

• Sustain and expand successful efforts to achieve high and equitable coverage of effective and high-impact interventions that save lives and improve the health of mothers and children, and thereby contribute to the fight against poverty;
• Integrate efforts to address under nutrition with broader maternal and child health strategies;
• Support initiatives to stop early marriage, early childbirth and other harmful practices, to keep adolescent girls in schools and to promote good health-seeking behaviour among them;
• Strengthen primary health care, linked to the achievement of measurable results;
• Invest in strengthening health systems, including efforts to improve the quality, accessibility, affordability and coverage of essential health services, with a particular focus on priority periods within the continuum of care and strengthening links with interventions addressing HIV/AIDS; 
• Invest in infrastructure development and human resources in relation to ethical recruitment and training of health workers, particularly skilled attendants, at all levels, assuring a committed and motivated health workforce; 
• Allocate more resources to research, monitoring and evaluation for maternal, reproductive, newborn and child health, and strengthening use of data to guide implementation;
• Address inequities in coverage of care among different geographic, socioeconomic, age and gender groups;
• Hold governments, financing institutions and international organizations accountable for making adequate resources available to achieve MDGs 4 and 5, and other health-related MDGs;
• Ensure predictable, long-term financing for reproductive, maternal, newborn and child health which reflects countries' priorities and plans.

We call upon all leaders to champion reproductive, maternal, newborn and child health to ensure political priority and investment to achieve MDGs 4 on child mortality and MDG 5 on maternal health. We must all play our part and lead the change to improve the lives of women, newborns and children.

For further  information about the conference, visit: http://www.countdown2015mnch.org/

2) Tallinn Statement of Commitment, " Nordic-Baltic Conference, Increasing Europe-wide Support to Sexual and Reproductive Health and Rights: Towards the UN High-Level Meeting on HIV and AIDS 2008" Tallinn, Estonia, 31 March - 1 April 2008

We, Parliamentarians from Denmark, Estonia, Finland, Latvia, Lithuania, Norway and Sweden gathered in Tallinn, Estonia 31 March - 1 April, 2008 in the third Nordic-Baltic Parliamentary Conference to reaffirm our strong commitment to and support for the Programme of Action of the International Conference on Population and Development (ICPD, 1994), the Platform of Action of the 4th World Conference on Women (FWCW, 1995) , the Platform of Action of the 4th World Conference on Women (FWCW, 1995), the Dublin Declaration on Partnership to fight HIV and AIDS in Europe and Central Europe (2004), the Vilnius Declaration on Measures to Strengthen Responses to HIV and AIDS in the European Union and Neighbouring Countries (2004) and the Bremen Declaration on Responsibility and Partnership - Together Against HIV and AIDS (2007) as the foundation of our actions in achieving the Millennium Development Goals. We pledge to answer the urgent need to address the HIV/AIDS pandemic both inside and outside Europe.

We recognize the need to ensure that all possible measures are taken to prevent the spreading of the HIV infection and that all people living with HIV/AIDS, without discrimination, will receive proper treatment and care. Furthermore, we understand that a comprehensive sexual and reproductive health approach forms the basis for effectively fighting HIV and AIDS yet most of the international funding is directed towards HIV and AIDS rather than SRHR. We need to use this opportunity of large available funding for HIV and AIDS to better integrate these issues at a policy and operational level. We stress that in order to achieve these goals, real cooperation is needed among the various stakeholders including the civil society and especially young people on national, European and international levels.

We underline the imperative for placing human rights at the heart of the global HIV and AIDS response. The continuous violations of human rights hamper access to prevention, treatment, care and support services.

We acknowledge that there has been some important progress achieved in fighting the HIV and AIDS pandemic in the world since the Declaration of Commitment on HIV and AIDS was adopted at the special session of the UN General Assembly in 2001. The rate of increase in HIV resources has accelerated, treatment access has dramatically expanded and the number of people using HIV testing and counselling services has increased considerably.

However, we are concerned that the severity and implications of the pandemic is not taken seriously enough. In 2007, more than 33 million people were living with HIV worldwide of which 15.4 million are women. Every day over 6800 persons become infected with HIV and over 5700 persons die from AIDS. This is mostly due to lack of access to HIV prevention and treatment services. Sub-Saharan Africa remains the most seriously affected region, with AIDS remaining the leading cause of death there. Also the epidemic in Eastern Europe and Central Asia continues to expand.

We are deeply concerned with the feminization of the pandemic. Gender inequality increases the vulnerability of women and girls getting infected. About 50 % of the HIV infected are women and in Africa the figure may be as high as 59 %. In the 15-24 age group in Africa 3 out of 4 newly infected are women. Addressing gender power relations and involving men is necessary in order to empower women to decide freely on their own sexuality.

We note with concern that HIV prevention programmes are failing to reach those at greatest risk. Efforts to increase HIV knowledge and sexuality education among young people remain inadequate as does youth friendly services. The HIV infections spread mainly among young people from 15 to 24 years.

We note with concern that still today there is a lack of integration between HIV and AIDS and sexual and reproductive health and rights in policies, education, services and advocacy. This is the case although most of HIV infections are sexually transmitted or associated with pregnancy, delivery or breastfeeding which are fundamental sexual and reproductive health issues. In addition the roots of poor sexual health and HIV and AIDS are common: gender inequality, poverty, stigma and marginalization of the groups made vulnerable by society such as young people, sex workers, people living with AIDS, drug users and people marginalized on the basis of their sexual preference.

Despite the increased funding for HIV and AIDS responses, we acknowledge that there is inadequate financing for sexual and reproductive health and rights, skilled personnel and reliable and affordable commodities. We reaffirm the UN and EU political commitment to reach at least the 0.7 % of GNI in development aid of which 10 % or more should be allocated to sexual and reproductive health and rights, noting in particular the funding gap of 1.2 billion for reproductive health supplies.

CALL FOR ACTION

We, Parliamentarians commit ourselves to the following actions and call for action of the forthcoming UN High-Level Meeting on HIV and AIDS to:

• Place human rights, including sexual and reproductive health and rights, as the central point for the global HIV/AIDS response by empowering women, reaching and involving young people and involving men in exercising responsible sexual behaviour and by addressing the need to reduce stigma and discrimination towards people living with HIV, affected and at risk for HIV/ AIDS or on the basis of sexual orientation.
• Reaffirm the commitment to universal access to reproductive health services by 2015 and to universal access to HIV and AIDS treatment, prevention, care and support by 2010, with specific attention paid to the provision for youth friendly services.
• Acknowledge HIV and AIDS both as an exceptional issue, requiring both an urgent and a long term response in its own right, and as a cross-cutting issue, concerning all aspects of development.
• Create an environment that will enable people living with HIV and AIDS (PLHA), their families and those affected as well as those made vulnerable by society to being truly and meaningfully involved in the decision-making responses to the pandemic.
• Scale up comprehensive and evidence-based-prevention, treatment, care, and support programmes including a sustainable supply of commodities for an efficient response to the pandemic and to counter non-evidence-based, ideologically driven approaches in addressing HIV and AIDS, which often further fuel the spread of the pandemic.
• Address the funding gap concerning family planning, sexually transmitted infections, maternal and infant care and sexual and reproductive health and rights, while ensuring that the current high-levels of funding for HIV and AIDS are maintained and even increased.

We, Parliamentarians pledge to deliver this Statement of Commitment to the UN High-Level meeting on HIV and AIDS2008 and to carry out these actions and to actively monitor the progress we make in doing so. We further pledge to report regularly on this progress through parliamentary groups and networks and to meet again to assess the results we have made. We also pledge to provide the necessary political leadership and to continue the cooperation on global development issues among the Parliamentarians in the Nordic and Baltic States.

All previous issues of the UNFPA Global Population Policy Update can now be found on UNFPA's website at: http://www.unfpa.org/parliamentarians/news/newsletters.htm .

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This newsletter is issued by the United Nations Population Fund (UNFPA) in its capacity as the secretariat for the biennial International Parliamentarians' Conference on the Implementation of the ICPD Programme of Action (IPCI/ICPD). The first IPCI/ICPD was held in November 2002 in Ottawa, Canada, the second in October 2004 in Strasbourg, France and the third in November 2006 in Bangkok, Thailand. These dispatches are intended to highlight important developments taking place around the world so that parliamentarians can be kept informed of and learn from the successes, setbacks and challenges encountered by their fellow parliamentarians in other countries and regions in their efforts to promote the implementation of the Programme of Action of the International Conference on Population and Development (September 1994, Cairo, Egypt). It should be noted that UNFPA does not necessarily endorse all of the policies described in this newsletter.

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