Perspectives on Post-MDG Targets From on the Ground and Around the World
Members of the White Ribbon Alliance contributed the following comments regarding post-MDG maternal mortality targets
As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!
By Rahmatullah Niazmal, Consultant for PDM 1 & 2 and Overall Supervisor for RHP2, JICA-Reproductive Health Project Phase 2, Ministry of Public Health, Afghanistan
Afghanistan is one of the countries which has high maternal mortality ratio (MMR). The current MMR is about 327/100000 live births. Respectively under-five mortality is 97 /1000 live births and, and the infant mortality rate is 77/1000 live births, according to the Afghanistan Mortality Survey, and the contraceptive prevalence rate is about 20 percent. The Ministry of Public Health (MoPH) has committed to improving access to maternal and reproductive health care; and enhancing the quality reproductive health care services is one the MoPH’s top priorities. However, still, there are challenges that MoPH has been competing with. Despite huge efforts that have been put by MoPH for the last one decade, much work remains to be done to maintain the current progress and improve further.
The following are the goals for reaching beyond 2015:
- Increase access and utilization of quality reproductive health services
- Increase deployment and distribution of trained SBA at national level
- Decrease the number of home deliveries – which currently account for a greater proportion of births than institutional deliveries
- Fill the gap between knowledge(>90%) and utilization (20%) of family planning services
- Lower the adolescent birth rate and reduce child marriage in the country.
- Build capacity at the national level about breast and cervical cancer for early prevention and treatment
- Enhance capacity for obstetric fistula treatment, prevention and re-integration at the national level
- Raise awareness about STIs, HIV and AIDS among adolescents and vulnerable populations.
By Ronald Wonder, Managing Partner, PLUS CONSULTS, Uganda
My thinking on this issue is that targets are useful in driving progress in countries including Uganda but absolute targets are much better. It should then go further to set quotas for respective districts, starting with those with high mortality rates and trickle down to household in the sub counties.
This would give more meaning to policy makers, individual and civil society organization making an effort to curb this problem among expectant mothers in Uganda.
Keep the fight on to protect our mothers.
By Jonas Fadweck, Youth Director and patron of Thuchila Youth Empowerment Programme, Project Officer of WHCCA-Malawi, member to White Ribbon Alliance for Safe Motherhood, and Girl Rising Regional Ambassador, Uganda
In order to improve maternal health in countries such as Malawi, I believe the following should be made priorities under the next development agenda:
- To increase rural bicycle ambulances for easy transport, especially in the community, for pregnant women: many women die before reaching the hospital, and many others deliver on the road before reaching a health facility – which is a disaster.
- To train other community members and/or increase expertise in the field in order to reduce the work load for nurses and midwives.
- To establish community mobilization campaigns to help people realize the importance of women to deliver at the hospital, attending antenatal clinics, and the consequences of teenage pregnancies.
- To introduce and increase maternity wings to health centres that now have no maternity services.
- To promote and encourage transparency and accountability.
These are some of the contributions we can make to enshre more women and reach target goals.
By Kezaabu Edwidge, Project Coordinator, Health Community Empowerment Project, Uganda
There is a great concern on maternal health and the situation is alarming: mothers are still dying in labour and post delivery due to problems related to pregnancy, labor and pueperium. Involvement of all stakeholders is of paramount importance. In Uganda, young people, in particular adolescents and youths engaged in unprotected sex – who face unwanted pregnancy – require more attention. This is important to address the issue of teenage pregnancy, and related concerns such as abortion. The issue of male involvement at all levels starting with the families, then to managers and leaders of all categories. Family planning is also a concern as most people shun off services because of ignorance, the myths and misconception and the unmet need.
By Jonathan Lugemwa
A percentage target is appropriate: taking into account previous methodologies used in communities before these formal interventions came into practice because our current surveys describe that formal interventions which are brought to the people in a provisional standards without their consent are less eligible to create permanent change so its very much vital to include especially the local populations.
By Uhawenimana Thierry Claudien, Public Relations and Communications Officer, University of Rwanda, College of Medicine and Health Sciences
There are considerable efforts underway to reduce neonatal mortality and maternal mortality in Rwanda, which now has a maternal mortality ratio (MMR) of 340 deaths per 100,000 live births. However, a lot needs to be done in order to ensure no mother or child should die as a result of child birth or pregnancy complications.
In some rural areas in Rwanda – mainly in the mountainous areas that are hard to reach – I have noticed that the physical settings may be the leading factor in maternal and child deaths. Some villages are far from the health facilities (7-8 kms) and the roads leading there are not well furnished. This leads some pregnant mothers to not complete the four recommended antenatal care (ANC) visits, which are vital to the safe pregnancy and delivery. Some women deliver along the way to the health center due to circumstances leading to the delay at home, and the delay to reach the health facility.
Thus I would like that in the next targets to reduce maternal and child mortality, governments should put much emphasis on making the population aware of the birth preparedness and complication readiness; and also removing the barriers that impede the population from accessing obstetric services in a timely way, such as reducing the distance to the health facilities in areas that are hard to reach, availing ambulances at health centers that are far from the district hospitals, increasing the community health workers’ skills and knowledge to deal with some pregnancy related complications.
As the number of adolescent girls who become pregnant increases in Rwanda, there is a need to educate them on health policies, including on how they can receive adolescent friendly services near them; and mobilize the whole community to go beyond the limits of culture and religion and support the sexual and reproductive health information on behalf of the adolescent. By doing this, no adolescent girl will be stigmatized because she has used contraceptives, and those who will accidentally get pregnant will not hide it; something that put them under the risk of death or injury. In addition, the rate of abortion will be reduced among this age group.
There is a need to involve men in maternal and child health initiatives by giving them the knowledge and necessary skills required for them to support mothers and babies, as well as helping them understand their interests in embracing that role. Thus, there will play a key role in empowering the girls to be confident of themselves and to say no to unwanted sexual intercourse pulses, or will not seek to exploit you girls sexually.
As for family planning, there is a need to train more professionals in providing services of family planning and who are experts in contraception usage. There is a tendency nowadays that nurses or midwives only administer any method of FP to a woman and at the end of the day, she faces side effects some of which may be fatal. But, if we have experts in contraceptives’ administration and counseling, some of the issues and myths preventing people from accessing the services will be kept at arm’s length. In addition to this, there is a need to keep on increasing the number of skilled birth attendants so that they be proportional to the number of deliveries taking place in health centers and hospitals. This will improve the service delivery given to the mothers and will reduce some of the risks associated with overloading the health personnel.
Lastly, laws related to maternal and child health should be incorporated in the country’s legal framework and on top of that, the existing laws should be revised and even hold accountable men who impregnate girls and abandon them or those who refuse to support their pregnant partners among many others.