In the years since the Millennium Development Goals were adopted as the global framework for action on development priorities, there has been substantial progress toward improving maternal health. However, of all the goals, MDG5, which seeks a 75 percent reduction in every country’s maternal mortality ratio by 2015 lags the farthest behind. Now, world leaders are working toward finalizing the next global development framework. The framework is expected to set the agenda for health programs and policies around the world when the MDGs expire in 2015. There is little question that the level of priority assigned to maternal health and related issues, such as HIV and AIDS and family planning will be of critical importance for millions of women and their families. Beyond simply affirming these issues as priorities for global action, the process for developing a new framework offers a vital opportunity to gather and apply lessons from the MDGs.
In May 2013, the High Level Panel of Eminent Persons (HLP), commissioned by UN Secretary Ban Ki-Moon, recommended in its final report that the UN adopt a set of 12 interrelated goals, each supported by a set of ambitious targets for achieving a vision of sustainable development. Among the goals and targets, the HLP recommended that maternal mortality ratio be reduced to “no more than X deaths per 100,000 births” (without yet defining “X”) by 2030 as part of Goal 4, which seeks to “Ensure Healthy Lives.” Unlike the MDG target, which proposed a 75 percent reduction in the maternal mortality ratio for all countries, regardless of what their MMR was at the baseline, this proposed measure would define progress against an absolute figure. Depending on how “X” is defined, then, many countries would start off having “achieved” the target, while others might be challenged to reduce their MMR by an even greater degree than the 75 percent set by the MDGs.
In the months since the HLP offered its recommendations, policy makers, researchers and others have begun to consider the proposed goal, as well as the implications that the shift from a relative to an absolute measure would have for global and national policies and programs focused on improving maternal health. In an August 2013 Lancet commentary leaders from USAID and WHO proposed that the UN adopt the overall target for countries to achieve an MMR of no more than 50 deaths/100,000 births by 2035, along with more specific targets and national strategies for countries that currently have maternal mortality ratios of over 400 deaths/100,000 births, as well as for addressing inequities within countries where overall maternal mortality is relatively close to the target (under 100/100,000) by focusing on improving maternal health among particular groups with higher than national average maternal mortality rates.
This important conversation is ongoing and will be strengthened by the inclusion of voices from around the world.
The Role of the MHTF
The MHTF is convening a guest blog series to support a virtual discussion and elicit debate on how the next framework should best address maternal health. If you would like to contribute to this conversation, please contact the MHTF.