Achieving the health Millenium Development Goals

A couple of years ago I was organising a conference on population, peak oil and climate change and their impact on the MDGs. “What are the MDGs?” asked some of the invited speakers. I was slightly shocked that they didn’t know. But neither did a whole lot of friends, even when I spelt out it out: Millennium Development Goals.

In 2000, all 192 member states of the United Nations agreed to eight development goals, the MDGs, that they agreed to achieve by 2015. The eight goals include three concerned directly with health:

• MDG 4 to reduce the child mortality rate;
• MDG5 to improve maternal health; and
• MDG 6 to combat HIV-AIDS, malaria and other diseases.

It is now 2010, two thirds of the way to 2015. Many countries are on track; many are not. Indeed the number of women dying during childbirth in Papua New Guinea has not declined; far worse, it doubled in the past 14 years.

Fortunately, ignorance about the MDGs does not extend to the non-government organisation (NGO) community, and more than 2,000 NGO representatives flocked to Melbourne at the end of August for the 63rd Annual United Nations Department of Public Information UN DPI/NGO Conference, entitled “Advance Global Health - Achieve the MDGs”.

Roundtable plenary sessions were interspersed with numerous workshops including one organised by the Australian Reproductive Health Alliance (ARHA) focusing on MDG5 - maternal health. Some 400,000 women and girls die each year from pregnancy and childbirth related causes, and millions more suffer illness and disability. Many of them die from a lack of trained health professionals during childbirth. In Latin America, unsafe, botched abortions cause one-quarter of all maternal deaths - 6,000 each year. Globally, poor sexual and reproductive health makes up two-thirds of the burden of disease for women of reproductive age. Pregnancy and childbirth is the largest killer of girls aged 15-19.

The ramifications are horrendous. The death of either parent, but particularly the mother for a young child, is traumatic. Children whose mothers died are much more likely to die themselves, particularly those under one-year-old.

Yet most of these maternal deaths and disabilities can be prevented. What is needed is a wide range of reproductive health services including: family planning, or birth spacing, services; antenatal care; skilled attendance at delivery; postnatal care; management of obstetric and neonatal complications and emergencies; prevention of gender-based violence; and many more. Recognising this, the international community at the 2005 World Summit added a new target, MDG5b: universal access to reproductive health by 2015.

New Zealand-born Director-General of the International Planned Parenthood Federation (IPPF), Dr Gill Greer, claimed in June this year at a UN General Assembly side-event that "MDG 5b -the promise of universal access to reproductive health - is, in many ways, the cornerstone that underpins the MDG framework". And this is exactly what we agreed to in the ARHA workshop: that adoption of MDG5 was critical to achieving all the MDGs, not just that relating to maternal health. Women hold up half the sky, they say. No society can afford to lose women in their child-bearing years - many still teenagers - from essentially preventable causes.

The combination of maternal and infant mortality costs $15 billion annually. To deal with this in the 75 countries with the highest rate would cost $4-6 billion. For economic reasons alone, never mind the prevention of untold distress and misery, it would seem prudent to find the money from somewhere. At one of the roundtable sessions, Dr Sue Wareham, from the Medical Association for the Prevention of War, put the question of finance in perspective. Global military spending is $1.4 trillion annually. To achieve all the MDGs it would cost less than a tenth of this - $135 billion: $4-6 billion is a fraction even of this.

By the end of the second day of the DPI-NGO conference, the organisers had posted a draft Declaration on the doors to the plenary hall. It would be put to the attendees the next, the final, day. It recognised that more than 340,000 die each year of pregnancy-related causes, but in its recommendations there was no mention of reproductive health nor even gender equality that must go hand in hand with measures to achieve good maternal health. My friends and I indulged in some small scale graffiti, adorning the draft document with our suggestions. The next morning, ARHA officials and those from Sexual Health and Family Planning (SHFPA) advocated hard for the inclusion of access to reproductive health in the recommendations.

But it was not to be. The organisers had belatedly included the words “Ensure gender equality, empower women and expand programs to end violence against women”. Fine and good, but no mention of reproductive health. The Declaration nevertheless passed overwhelmingly.

Ian Howie, Board Member of AHRA and former Country Representative of the UN Population Fund in Vietnam, while acknowledging afterwards that the Declaration covered many needy areas, protested that ignoring sexual and reproductive health “runs contrary to an internationally accepted MDG goal”.

So what’s the problem? Does it relate to the fact that so many NGOs are faith-based and they associate the words “reproductive health” with abortion? Does the fact that sexual and reproductive health are complementary make people uneasy? Safe motherhood is a worthy objective, but we don’t want teenagers having sex before marriage, do we? Does it lie in some deep-rooted misogyny? How can a declaration recommend for gender equality but not recommend for the very services that would ensure that equality? How can a UN conference not include one of its own MDG targets?

The UN meets again in New York later in September to address all the MDGs. Let’s hope they get it right this time.