An Introduction to the Project

The project will be producing detailed case studies, adovcacy, media strategies and independent journalism to support the MDG goal on ending maternal mortality. As a SID project it will be continue the strong thematic interest of the Society on reproductive health and rights and women’s empowerment and also development policy work on social and economic justice in the global South. see www.sidint.org. While focusing on the national and local concerns brought out by the case studies and national level research for practical action, as an international alliance the project also aims to place the issue into a broader framework of understanding from an international perspective, Most of all it hopes to help make the MDGs overall goal of halving poverty by 2015.

The project is therefore taking a strategic rather than technical approach to the issue of maternal health and well-being that aims to be holistic and constructive in its approach while recognizing the critical importance of the issue as the figures show. However, it is very important to understand that the reasons for maternal mortality and morbidity are complex and cannot be solved just by improving the 'figures' through better obstetrical care, more doctors, more emergency departments. What at stake are much deeper issues. To name just a few key concerns:

First, the issue of poverty which determines the facilities and the access to health care and education of women particularly those in rural areas and urban slums Second, the health systems, how they operate, and the financial and economic resources allotted to them Third, the need for medical and health training how they can take on board a reproductive health and rights approach Fourth, the need to empower women to take up opportunities offered, to be part of the decision making.

All of these are large agendas many of which are laid out in full in international agreements such as the Cairo +10, Beijing +10 WHO strategy on reproductive health and in the spirit of the Millennium Declaration and the 8 goals.

The project sees the MDGs as a tool that enables us to talk about many issues that would otherwise be side stepped in the current neo-conservative climate. The MDGs are important tools to end poverty, improve health systems, give greater access to women to appropriate health services and empower them to use them with a sense of dignity and pride and a say in what goes on.

The project has a healthy critical approach to the Millennium Development Goals, too often referred to as the minimum development goals.

We can note at the outset that in the MDGs, gender equality is being seen only in terms of education and that women’s sexual and reproductive rights is not measured even if it is a crucial indicator of progress under MDG 3, MDG4, MDG5 and MDG6. There are many women’s groups that are aiming to change that, the project however is not focusing on that debate but takes up specifically MDG 4 and 5.

The MDGs 4 and 5 underline that good care, nutrition and medical treatment necessary to save the 10 million children who die each year in the developing world can only be achieved if the structures, resources and women’s rights are also taken into consideration, particularly women’s reproductive rights and health. The 50 million women who suffer from poor reproductive health and pregnancy-related illness and disability particularly in Asia and Sub-Saharan Africa are often in difficulty when it comes to caring for their children. High maternal mortality rates in many countries are the result of inadequate reproductive health care for women and inadequately spaced births and the result is the death of many of their children. There is little argument that both these goals are extremely necessary and extremely complex to attain.

A major concern is that the MDGs, as they are framed, fail to bring in the paradigm shift made in Cairo and in the Cairo review process that focus on women’s sexual, reproductive health and rights. The Millennium Project, in dealing with this gap, has brought together maternal and child health and in that linkage has included sexual and reproductive health and rights. It does seem by failing to include VAW and sexual and reproductive rights that the framing of the MDGs is a decade behind, and is being influenced by the US government and other countries negative approach to women’s health and rights, but on the other hand it is good that maternal health has received attention and is on the top of the agenda. Certainly maternal mortality is linked so closely to poverty and inequity that it is a major indicator of the failure of development.

The approach taken by the Millennium Project ­ the think tank of the Millennium process led by Sachs ­ see Lynn Freedman’s article LINK - is to look at how development policy has impacted on health systems and thereby on women’s demand for and access to primary health as well as reproductive health care. They raise the key issue that health systems are not able to treat obstetrical complications due to inadequate health training and services to treat the complications that cause death or chronic ill health and morbidity as well as other socio-economic factors. Obstetrical training for community nurses, midwives, general physicians, for example, could enable many poor women in rural areas to survive child birth and prevent socially and physically disabling complications such as vaginal fistulae. This means not only changes in training and education of personnel but changes in legal and professional codes. Reducing maternal mortality requires funding and a reform of health systems that addresses the problems of the decimation of the public health system through privatisation and structural adjustment policies. Beyond financial provisions a strong health system recovery must also include further outreach and education of the population in ways that take into account how neglected health is the ‘norm’ for poor people ­ therefore health systems have to be seen as more than just delivery systems, but a core social institution that can tackle the complex issues around equity, social exclusion and gender bias.

Poverty needs to be understood as more than income poverty. It is about ensuring well-being and ensuring health systems work in a holistic sense for poor women. To address poverty given the existing power structures radical reforms are needed. Health systems have to provide care throughout a women’s life cycle from early age including antenatal care. In this sense maternal mortality and morbidity as a ‘health’ issue has to be seen not just in relation to disease but in relation to cross cutting concerns around ‘human resources for health’, ‘ensuring access to health’ and ‘finance for health’. This approach immediately links the concerns to Goal 8 around economic, trade and partnership and gives women the chance to be at the same table to discuss how maternal health has to be considered at the heart of the political and economic MDG discussions, not put to one side as a technical ‘medical’ issue.

The issue is not just bio-medical, nor is it simply the lack of resources, it is a complex mix of economic and socio-cultural factors that lead to gender discrimination, neglect and deprivation and ultimately the denial of women’s rights to well-being. The MDGs have to reinstate the ICPD paradigm shift, putting in place effective health systems, and ensure rich countries commitments to increase funding to reach the Goals, acutely aware of the economic and social requirements, equity and rights issues at stake.

Media visibility and independent journalism have an important role to play in creating the conditions for change and action, and promoting accountability.

The project will be exploring not only the practical strategies that emerge from the different realities on the ground but how to bring out these broader global strategic approaches. The bulk of the project work will be at the national level while at the same time the project will feed into regional and international level discussions on the 2005 processes around the MDGs ­ in UNFPA's work, in SID's international advocacy work, the independent journalism of IPS and in the SID south-south exchange on strategies for equality, democracy and human development.