Progress in reducing maternal mortality and morbidity is still "tragically slow". Now, the United Nations has unveiled a global initiative based on government, civil society and private sector cooperation that could save the lives of up to one million women during pregnancy and childbirth.
A US$20 billion funding gap in maternal and child health in the world's least developed countries means that between 350,000 and 500,000 women die each year from preventable pregnancy-related causes and complications, and another 15 million suffer from equally preventable long-term disabilities.
The new Joint Action Plan for Women's and Children's Health calls on countries to push the health of women and girls to the front of the queue and create an overarching framework for integrated health systems.
A working draft of the plan was presented by Thoraya Obaid, Executive Director of the UN Population Fund (UNFPA), at Women Deliver, a global conference in Washington, US, which brought together 3,500 women health professionals and leaders from 150 countries.
Without a dramatic policy shift only 20 out of 68 countries will succeed in meeting the UN Millennium Development Goal (MDG) of reducing maternal mortality by two-thirds, and providing women with equal access to reproductive services by 2015.
"Our intent is to reach out to as many partners and actors as we can so this becomes a bigger effort," said Flavia Bustreo, director of the World Health Organization (WHO) Partnership for Maternal Newborn and Child Health. "Countries will set their own goals ... and then we will capture these commitments and get an accountability framework to reflect them, and measure them over the next five years."
|There's a lot of energy; that's a good thing. There's a lot of commitment; that's also very good|
The plan offers overarching formulas, like integrating health services, so a woman would not have to go to separate clinics for information on HIV/AIDS and sexual education - as often happens now – and strengthening health systems to better utilize funds.
However, there were concerns because women's rights as human rights, unsafe abortions, and especially vulnerable women were not included. "Unsafe abortions are the third leading cause of [death in] pregnant women and girls," said Alexandra Garita, programme officer of the International Women's Health Coalition, who noted that women and girls living with HIV and AIDS were also not specifically mentioned.
"When you don't have a mention of human rights you are allowing discriminatory policies to continue," said Serra Sippel, executive director of the Centre for Health and Gender Equality, a Washington-based policy advocacy group.
Bustreo said the draft would go through several phases before passing through the UN General Assembly in mid-September 2010. Mention of human rights was likely to be included in the final document, and appendixes could focus on especially vulnerable female populations.
On the contentious issue of abortion, she noted that the draft did not want to "make a blank check for every country on the issue of unsafe abortions" and "only wanted to make sure abortion would be safe where it is legal - it was important to make that distinction".
Abortion is not legal in more than half of the 68 countries that WHO's Partnership for Maternal, Newborn and Child Health is monitoring in the countdown to 2015.
Some organizations like Amnesty International have tried to sidestep the issue of unsafe and illegal abortion by focusing on increasing the number of skilled birth attendants.
When abortion was brought into the equation, "We get attacked by the Catholic church," Amnesty International's Executive Director, Larry Cox, told IRIN. "The Vatican issues a statement, saying: 'Good Catholics should not belong to Amnesty', and they close down groups in Catholic universities."
WHO Director Margaret Chan conceded that the plan would not "capture everyone's expectations", but noted that in her consultations with countries, civil society and the private sector, she had received this feedback: "There's a lot of energy; that's a good thing. There's a lot of commitment; that's also very good."