MDGs

Expanding the Agenda

National Policy Dialogue 20th July, Islamabad Yasmeen Sabeeh Qazi Senior Program Advisor Packard Foundation

Goal 5: Improve Maternal Health

Facts at a glance:  Every minute one woman dies from complications related to pregnancy, childbirth, and the post partum period, almost all of them in developing countries  Maternal Mortality statistics reflect the largest disparity between the developing & developed world of any health indicator [One out of 17 compared to one out of 4,000 women] Maternal Mortality- a shameful failure of development

Existing Target 6

 Reduce by three quarters, between 1990 and 2015, maternal mortality  Indicators – MMR & % of births attended by skilled health personnel Proposed Target 6:  Reduce by three quarters, between 1990 and 2015, rates of unwanted pregnancies, unsafe abortion, maternal mortality & morbidity

Proposed Additional Indicators

   Maternal mortality rate by age and income quintile  Proportion of birth attended by skilled and trained health professionals.

Percentage of women aged (15 – 45) with anemia, obstetric fistula and uterine prolepses by income quintile Proportion of women & men by age having access to public (comprehensive, affordable, quality) SRHR services and information at the Primary and Tertiary Level. (contraceptive services, ANC, EmOC, PNC, safe abortion, post-abortion and STD/RTI services)  Proportion of women dying due to the unsafe abortion and its complications by income quintile  % of women expressing unmet need for contraception  Adolescent fertility rate

Existing Indicators Approved by GOP

 Maternal mortality ratio  Proportion of births attended by skilled birth attendants  Contraceptive prevalence rate  Total fertility rate  Proportion of women 15-49 years, who have given birth during the last 3 years, who had attended at least one antenatal care consultation  “Ensuring provision of quality health services including Maternal Health and well being of women in line with recommendations of 2003 ICPD ” – Priorities for Development Assistance in Pakistan MDG Progress Report

Why we need to expand MDG 5

 MMR = 300 – 700 / 100,000  Incidence of unsafe abortion = 1 million/year  Maternal Mortality Rate per Year  76 % births at homes attended by untrained health personnel  High incidence of morbidities  High unmet need for FP (33%)

Realities:

       Demographic – ‘Missing Women’ Biological – Adolescent females (15 to 19 yrs) twice likely to die as women in 20s Political – A woman dying in childbirth is a “silent emergency”, happening outside the public eye Geographical – MMR one of the highest in the region Service Delievery – poor, inefficient & non responsive Social – low literacy, empowerment & status of women Policy – Right based framework missing

“ Safe Motherhood “

 “Safe Motherhood is a human right. We must empower women and ensure choices …Our task and the task of many like us, is to ensure that in the next decade safe motherhood central issue” is not regarded as a fringe issue, but as a James D. Wolfensohn President – World Bank

“We know the causes. We have the solutions.

We can make a difference.” [Joy Phumaphi; Assistant Director General, WHO]