Countdown 2015 Global Roundtable

31 August 2004
Author: UNFPA

Statement by Thoraya Ahmed Obaid, Executive Director, UNFPA

LONDON—Good morning. Thank you Jill for the kind introduction. It is my great pleasure to be here today with all of you.

There is no doubt that a world safe for mothers would be a world safe for all.

It is in this spirit that we continue to work to improve maternal health and to improve respect for women’s rights.

It is in this spirit that world leaders have identified the improvement of maternal health as one of eight global priorities articulated in the Millennium Development Goals.

And it is in this spirit that 179 governments reached the historic Cairo consensus 10 years ago.

Making the world safe for mothers involves more than improvements in the health sector, and more than increased access to health clinics and hospitals, although this work is terribly important and vital to success.

Making the world safe for mothers means making the world safe for all women and girls. It means improving the status of women and securing broader opportunities and choices, and full participation in society for the female half of the human race.

The beauty and integrity of the Cairo consensus is that it links maternal health with universal access to sexual and reproductive health, and reproductive rights. The Cairo consensus links maternal health with the broader concepts of universal education and the empowerment of women and girls. It links maternal health with gender equality and male responsibility and the elimination of violence against women and girls. And it links maternal health with the reduction of poverty. The Cairo consensus provides us with a powerful plan and it has led to powerful partnerships. UNFPA is proud to be a partner with many of you here today to make the world safe for mothers and for all women and girls.

Ladies and Gentlemen,

In too many places today, too many young women have too few choices and opportunities.

In too many places, girls are kept out of school to care for the family and the home.

In too many places, girls are forced into marriage as child brides, their dreams stolen from them before their eyes.

In too many places, girls are underfed and undernourished.

In too many places, women are denied the right to plan their family and space their births.

In too many places, women are battered and bruised, and what is even more shocking is that many of them feel their mistreatment is justified, that they have no rights of their own.

We live in a world where dying during childbirth is practically unheard of—a rare occurrence—here in London and the rest of the developed world.

And, yet, for poor women in developing countries, dying during childbirth is considered a part of life.

Every year, over half a million women—an estimated 529,000—die from complications of pregnancy and childbirth, one woman every minute.

This tragedy is compounded by the fact that most of these deaths could be prevented easily.

And the women who die are just the tip of the iceberg. For every woman who dies, some 30 more women suffer complications from pregnancy, which lead to illness and disability, loss of productivity and tremendous suffering.

This means that up to 15 million women each year suffer complications from pregnancy and childbirth, a toll, which constitutes—by any standard—a public health crisis. And, yet, because it is poor women who are suffering and dying, maternal mortality is a crisis that does not get the urgent attention it deserves.

Ladies and Gentlemen,

I can assure you that if half a million men died each year and 15 million more were afflicted with suffering and poor health just from carrying out their reproductive function, the determination and funding needed to solve the problem would most definitely be summoned.

But because it is women, poor faceless women, many from rural areas, poor maternal health is considered as just one issue among many competing for attention and resources. And because it is women, the issue is invariably pushed to the bottom of the agenda. Yet, the consequences of putting women last are felt every day, and they have enormous economic and social costs.

Surely, all of us can agree that there is nothing more devastating to a child and a family than the loss of a mother.

Today, due to poor maternal health, millions—millions of children are left motherless each year.

Due to poor maternal health, millions of women are left damaged, robbed of their energy and vitality, robbed of their productivity and capacity to reach their full potential.

Due to poor maternal health, millions of women are unable to work their way out of poverty.

And yet, today, in our world of plenty, poor maternal health remains a leading cause of death and disability for women in the developing world.

There is no other health indicator, which exhibits such a glaring gap, such a discrepancy, between rich and poor nations as maternal mortality.

Today, 99 per cent of all maternal and child deaths are in low and middle-income countries, with the vast majority taking place in Africa and Asia, 4 per cent occurring in Latin America and the Caribbean, and 1 per cent in the developed world.

A woman born in the developing world faces a 1 in 61 risk of dying during pregnancy and childbirth, compared to 1 in 2,800 risk for a woman in the industrialized world. And invariably, it is the poorest and youngest women who fare the worst.

In India, to take one example, one out of six women who give birth are between the ages of 15 and 19. In the eastern state of Bihar, the village midwife tried for hours to help a severely anaemic 19-year-old woman deliver her second baby. The young woman was taken on a cycle cart down the bumpy village road to a hospital, two hours away. She died giving birth.

Almost two thirds of Indian women, mostly living in villages, give birth at home. More than half of the country's women are anaemic and only 20 per cent of mothers receive all the required components of prenatal care. As a result, every five minutes, an Indian woman dies from complications related to pregnancy and childbirth, adding up to more than 100,000 deaths a year.

In sub-Saharan Africa, a woman faces a 1 in 16 lifetime risk of maternal death. Given the situation, it is no wonder that many African women describe childbirth as a journey from which they may never return. In Malawi, when 24-year-old Melise Chisale went into labour, she was rushed to the local village birth attendant. Melise lived 40 kilometres from the nearest city and could not afford to hire a car to take her to hospital. Hers was a complicated labour. Since the birth attendant was not trained professionally, she failed to stop the bleeding. Four hours into labour, Melise died, along with her baby.

In Afghanistan, a pregnant woman was bleeding and in trouble. So Mullah Abdul, 42, helped load his terrified young cousin into a jitney van and sent her on the six-hour ride from her isolated village to the nearest hospital. Three hours later, in the midst of the journey across the Hindu Kush mountains, the woman died. So did her child, struggling to be born. The driver turned around and drove them home to be buried.

This young Afghani woman might have been saved by medicines that control bleeding and are available in every delivery room here in London. But in the woman's Bamyan Province village, there was no clinic, no doctor, no one who could help. The pregnant woman died surrounded by snow-swept mountain peaks, yet in a terrible sense she was far from alone: 23,000 Afghan mothers die in childbirth each year, making it the nation's leading cause of death for women.

Ladies and Gentlemen,

If a mother is denied access to health services or receives poor care, it is not only her life that is threatened, but also the life of her child.

Today, poor maternal health care causes nearly half, nearly half, of all infant deaths. Each year, more than 4 million newborn children die during the first month of life, and 4 million more are stillborn. And many of these deaths are due to complications their mothers experienced during pregnancy or childbirth.

My friends,

The good news is that nearly all of these lives could be saved. There are effective interventions and our challenge is to ensure that these interventions reach all women. Safe motherhood means ensuring that all women receive the care and opportunities they need to be safe and healthy throughout their lives and throughout pregnancy and childbirth.

One of the key interventions is access to emergency obstetric care. Today, we know that most maternal deaths—some 80 per cent—occur from complications at the time of delivery—complications that either go untreated or are not treated properly. We also know that 15 per cent of all deliveries will result in complications. Therefore, emergency obstetric care is absolutely critical.

Also critical to safe motherhood is health education, family planning, antenatal and post-natal care and skilled attendance at birth. Every mother needs:

· Access to voluntary family planning

· Prenatal check-ups with treatment of malaria and anaemia

· A skilled attendant at delivery

· Access to emergency obstetric care, and

· A referral system so that women with complications can reach emergency obstetric care services in time.

If these interventions were available to all women, maternal death would be as rare today in Asia and Africa as it is today in North America and Europe. It is that simple.

We know that 38 per cent of maternal deaths could be averted with improved access to emergency obstetric care.

We also know that family planning is absolutely essential. Universal access to family planning services could reduce maternal mortality by 20 per cent or more. If the unmet need for condoms were met, maternal mortality would drop by 20-35 per cent, and new HIV infections would also drop dramatically.

Another important factor that must be addressed is unsafe abortion. Each year, nearly 70,000 women die from botched back-street abortions, and many of these victims are young women.

Ladies and Gentlemen,

We all know that the issue of abortion causes heated debate. It gives rise to strong emotions and strong divisions. But there is a reality that forces itself on all of us in the form of women dying.

The reality is that every day, every day, nearly 200 women die from unsafe abortion, and they die painful and unnecessary deaths. Today, 13 per cent of all maternal deaths are from unsafe abortions.

In some cases, women are coerced into sexual relations. In some cases, they have no access to family planning. In some cases, they are coerced from using modern family planning methods because these methods themselves are wrongly perceived as forms of abortion. But, surely, we can all agree that, whatever the circumstances, no woman or teenage girl should be condemned to death from an unsafe abortion.

We all agree that abortion should not be used as a method of family planning, as was agreed in Cairo.

Ensuring universal access to reproductive health information and services is one sure way of decreasing abortion and allowing women to exercise their right to have a planned and wanted pregnancy.

Ladies and Gentlemen,

Young people today are growing up in a rapidly changing world. And they themselves are powerful agents of change. Young people are a positive and vital force for creating a world where there is greater equality and justice, for creating a world of opportunity for all.

Today, the world has the largest youth generation in human history. There are 1.2 billion adolescents and they are growing up in a world of unprecedented global change. But what does globalization mean to a young woman who is promised in marriage at the tender age of 8? What does globalization mean to a young woman who is promised a good job overseas, only to find herself sold as a sex slave on the open market? What does globalization mean to a young father who sees his young wife die during childbirth before his eyes?

Every year, 15 million teenage girls between the ages of 15 and 19 give birth, and 5 million have an abortion. And even though the risk of dying from pregnancy is twice as likely for adolescent girls as women in their 20s, it is adolescents who have the least access to reproductive health information and services. This lack of information and services results in a vicious circle of unwanted pregnancy and abortion, poorly spaced pregnancies, increasing rates of anaemia, and increasing rates of HIV infection among youth.

There is no valid reason whatsoever for denying young people information about their bodies and how to protect their health and their lives. And there is no valid reason for denying sexually active young people access to reproductive health services. In today’s world of HIV/AIDS, it is a matter of life and death. But, just as importantly, it is a matter of human rights.

What makes the Cairo agenda so visionary is that, for the first time in history, world leaders agreed that sexual and reproductive health is a universal human right. And yet, today, it is a human right that remains out of reach for millions of people.

Today, 210 million women want to use contraceptives, but do not have access to such services. Today, half of all pregnancies are unplanned and many end in unsafe abortions. Today, half of all new HIV infections occur among young people. And today, one woman dies every minute during pregnancy and childbirth.

But let us not fall into the trap of thinking that little or no progress is being made.

I am here today to state loud and clear that we are making progress.

Since 1990, access to skilled attendance at birth has increased by 24 per cent.

Since 1990, the use of antenatal care has risen by 21 per cent.

Since 1990, the increased availability of emergency obstetric care has led to more Caesarean sections. In fact, the use of C-sections has nearly tripled.

This is not just a bunch of statistics, this is solid progress and this is saving women’s lives.

The global survey of 169 countries we conducted last year to measure progress since Cairo shows that nations are taking strides to empower women in their reproductive health choices, to include reproductive health in health sector reform, to integrate reproductive health in primary health care, and to improve access to quality reproductive health information and services.

We are making progress when maternal mortality ratios have gone down in nations as diverse as Bolivia, China, Egypt, Honduras, Indonesia and Jamaica.

We are making progress when 58 per cent of all births in developing countries are attended by a health professional.

We are making progress when 40 per cent of all deliveries take place in a hospital or health centre.

And we are making progress when a group of us joined together as one to form the Partnership for Safe Motherhood and Newborn Health in January of this year.

UNFPA is proud to join this winning partnership to bring increased attention and resources where they are urgently needed to save lives.

We are proud to work with this partnership to build on the opportunity provided by the Millennium Development Goals to expand awareness and evidence-based action to improve maternal health in the decade to come.

The international goal is to reduce maternal mortality by 75 per cent by 2015.

But to make this goal a reality, much remains to be done. Together we must confront the challenges and obstacles that stand in our way. We must raise our voices against inaction. No woman, no matter where she lives, should be condemned to death while giving birth. The high levels of maternal mortality that exist in our world at the beginning of the 21st century are more than a shame—they are a crime—a crime of deadly neglect.

Making the world safe for mothers means generating the political will and the resources to save the lives of women and children.

It means scaling up needed services to reach all women. It means empowering women and ensuring their full participation in society.

It means building effective relationships and partnerships and making good things happen. It means working with and supporting women leaders to be forceful advocates. And it means holding ourselves – intergovernmental and non-governmental organizations – and governments accountable.

Today, let us all pledge to scale up our advocacy and put greater pressure on politicians to keep their promises.

To make the world safe for mothers, governments must keep the promises that were made in Cairo.

Thank you.

United Kingdom
Population : 67.9 mil
Fertility rate
Maternal Mortality Ratio
Contraceptives prevalence rate
Population aged 10-24
Youth secondary school enrollment
Boys 97%
Girls 97%

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