Greater investment in women’s health yields multiple returns.

"...increasingly, good health and sound health systems policy have also been recognised as major drivers of economic growth."

Elayne Clift

Kakenya Ntaiya is one of the lucky ones. The oldest of eight children of a Masai tribal family in Kenya, she was engaged to be married at the age of five and expected to undergo ritual circumcision at puberty, at which time she would leave school to marry the man her parents had chosen. But Kakenya negotiated with her father. If she could stay in school, she said, she would agree to the circumcision. When she graduated high school with honours, she negotiated again, this time with the village elders. If she could study further in America, she would return to her village to build a school and a maternity hospital. The elders agreed and the village women raised money for her to travel to the US. Eventually, Kakenya earned a Ph.D at the University of Pittsburgh. Now married and a mother, she has raised almost $100,000 toward the school she promised to build.

In Darfur, Sudan, Awatif was not so lucky. Married at 10, by the age of 27 she had given birth to four children and was pregnant again, now in a refugee camp. In Awatif’s village, the nearest health centre was a three-hour walk away. But in the camp, complications could mean an even more arduous journey in a donkey cart to the nearest hospital. Awatif was frightened. She knew how dangerous childbirth could be in Sudan, where more than 500 women die for every one lakh live births, and there was every chance she would have to give birth without a midwife. The stories go on.

In Afghanistan, Fatima, a mother of nine, died during her tenth childbirth in a country where one in every six women will die giving birth. In Bolivia, Leonora, 21, went into labour in her high mountain village. Before help could reach her, she had bled to death, leaving three other children behind. In India, Sumo struggles against anaemia during her first pregnancy, while on a remote island in the Philippines, Ceni is dangerously tired, weakened from an obstructed two-day labour.

Thousands of women like these, mainly in the developing world, were at the heart of a landmark global conference held recently in London and attended by 2,000 world leaders in the fields of health, development and economics. Called the Women Deliver conference, its theme was ‘Invest in Women: It Pays’, underscoring the fact that greater investment in women’s health yields multiple returns.

The conference marked the 20th anniversary of the global Safe Motherhood Initiative, an attempt to improve maternal and child outcomes that has little to show for its efforts. More than half-a-million women still die every year in pregnancy or after childbirth despite two decades of efforts to reduce that toll.

Women are still dying of avoidable complications such as high blood pressure, haemorrhage, obstructed labour and infection, while tens of thousands more perish from backstreet abortions because they lack contraception or because abortion is banned in their country. Sadly, new figures show it is highly unlikely that the Millennium Development Goal (MDG) of slashing the 1990- level maternal death rates by 75 per cent by 2015 will be achieved.

“At the midpoint in the timeline to achieve the MDGs, the absence of progress in reduction of maternal mortality and morbidity is unacceptable,” says Thoraya Ahmed Obaid of the United Nations Population Fund (UNFPA). “The urgent and life-threatening circumstances of millions of women call for quick, concerted and decisive action to be taken now. After decades of experience, we know what works. ...Future efforts will not materialise unless the leaders of the world commit to substantial increases in funding for maternal health in the context of health system strengthening. There is so much that can be accomplished. Collaboration is the only way to promote the vision that no woman should die giving birth.”

One call for greater collaboration came from Elizabeth Mataka of the Zambia National AIDS Network. “The associations between maternal mortality and HIV are troubling. HIV+ women are at 1.5 to 2 times greater risk of maternal mortality than other women and in the high-prevalence setting of southern Africa, AIDS has become the leading cause of maternal mortality. And yet, neither the field of maternal health nor that of HIV has paid adequate attention to the association between maternal mortality and HIV, and especially the rights and needs of HIV+ pregnant women.”

Another area in need of better collaboration exists between economists and health professionals, and among the organisations they serve.

According to the World Bank, one study estimates the global economic impact of maternal and newborn deaths at $15 billion per year in lost potential production. “Investing in better health for women and their children is just smart economics,” says Joy Phumaphi, the World Bank’s Vice President for Human Development and former Health Minister for Botswana. “Good health is often thought to be an outcome of economic growth; but increasingly, good health and sound health systems policy have also been recognised as major drivers of economic growth.”

Among those in the public sector, stepping up to the fore are the leaders of Norway, UK and Canada. They are spearheading Deliver Now, a component of a broader Global Campaign for the Health Millennium Development Goals, which aims to reinvigorate action toward the 2015 health targets, agreed to by the global community in 2000.

Specifically, the campaign will draw the world’s attention to the over 10 million preventable deaths of women and children which occur each year in developing nations. Global health challenges are expected to be the focus of the 2008 G8 summit. In the private sector, the MacArthur Foundation announced that it would invest $11 million to reduce maternal deaths from postpartum haemorrhage in India and Nigeria. Through a grant to Pathfinder International, a package of low-tech interventions will be provided to several hundred health facilities in seven states in India and eight states in Nigeria — two countries that comprise one-third of all maternal deaths globally.

In another initiative, representing collaboration among 13 global organisations, Cervical Cancer Action was launched at the Women Deliver Conference. This new alliance will demand universal access to new lifesaving cervical cancer vaccines, screening tools, and treatment. It will call upon governments, multilateral organisations, civil society and private industry to make vaccines and screening technologies available to women in the developing world.

Ann Starrs of Family Health International, writing in The Lancet, summed up the Women Deliver Conference this way: “The Conference is a celebration and acknowledgement of the many ways in which women are the backbone of society — and a vigorous call for that role to be recognised and supported, not only because women deserve it, but also because societies need it.”

Women’s Feature Service

(This article was published in the Business Line print edition dated January 4, 2008)
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