Your
Excellencies,
Mrs Chissano
Ladies and Gentlemen,
It gives me great pleasure to be here with you in this beautiful and historic country
which has so much to teach us in the realms of culture, art and history. I am very pleased
to be in Africa, the continent in which humankind was born. A continent of hope, strengths
and resources.
Today, when we talk about health, and particularly when we talk about the health of
mothers and their children, we are really talking about human development – about the
unrivalled capacity of human societies to change and evolve, enabling the individuals and
families within them to grow and develop.
The purpose of development is to widen the range of choices in people's lives;
choices in the basic opportunities of life – work, health, education. Development is
meaningless and will not be sustainable if it is not people-centred; if it is not
development of the people, by the people and for the people.
Development involves investing in human capabilities, energy and creativity, and
presupposes access to resources, education, and health. Development implies that the
fruits of people's efforts be distributed widely and fairly. Development means that everyone
has the chance to participate in what shapes their lives. Billions enjoy this right to
development. Never before have so many enjoyed a high level of health. But there is a
growing number of people who are denied this right – and a large majority of them are
women.
Health - a fundamental human right - is still denied to many women throughout the
world. Often their health and well being are compromised by a combination of neglect and
abuse, frequently culminating in high rates of maternal mortality. While there are
impressive improvements in the rates of infant mortality, no such trend is to be seen for
maternal mortality. Tragically, giving birth is a perilous undertaking for far too many
African women.
The risks associated with pregnancy and childbirth in Africa are among the highest in
the world. In parts of Africa, women face a one in 16 risk of death because they do not
receive the care they need when they are pregnant. By contrast, in most of Europe and
North America, such a tragedy will hit only one woman in 4 000. No other indicator so
starkly reflects the disparities between the developed and developing worlds. Small wonder
then that African mothers, about to give birth, sometimes bid their older children
farewell, telling them "I am going to the sea to fetch a new baby but the journey is
long and dangerous."
Every death is a tragedy. The death of a young woman, who may have other children who
depend on her, is a multiple tragedy. The loss of the mother is frequently associated with
the death of the infant for whom her life has been sacrificed, followed by the impaired
health and nutrition of the remaining children.
Let us be very clear about this issue. Women who suffer and die in this way are not
dying because of disease. Pregnancy is not a disease, it is a normal part of human
development and should be a time of joy and happiness. Around the world, all women suffer
and die from the same complications – bleeding, infection, hypertension, obstructed
labour and complications of abortion.
Of the 150-200 million pregnancies worldwide each year, at least 23 million develop
these complications, and half a million of them die as a result. Over 20 million women
undergo unsafe abortions with the attendant risks to life and health. Some 15 million
women survive but with a range of long-term disabilities.
Let us remind ourselves that these are the same causes of death and disabilities among
newborn infants. Women and infants go through the drama of delivery together. Woman and
fetus, mother and infant, should be seen as a dyad or duality – two units treated as
one.
The fate of the newborn is inextricably linked to the health of the mother before and
during pregnancy and delivery. Of the more than 4 million deaths of infants aged less than
one month each year, 3 million occur within one week of delivery, largely as a consequence
of poorly managed pregnancies and deliveries. In Africa, each year around 2 million
infants are stillborn or die during the first few days of life. Millions more are crippled
by birth trauma and asphyxia during delivery, or suffer lifelong consequences.
Africa simply cannot afford such a drain on its precious human resources. The social
and economic costs are important barriers to development, especially when this burden
occurs among women in the prime of life when their potential, responsibilities and
productivity are at their highest. Imagine the costs to individuals, families and to
society, of this burden of ill health among women with family responsibilities, at a
period in their lives when they have the potential to be most productive for their
communities and societies.
Changing the trends need not be costly. The resources needed to address maternal
mortality should not be seen as a cost but as an investment in future health
and development. No country can afford NOT to address these issues. Safe motherhood is
a matter of economic good sense.
The knowledge and skills to enable women to give birth in safety exist if the political
will is there. Making pregnancy safer is not only a health issue – it is also a moral
issue underpinned by guiding principles of human rights, social responsibility, equity and
participation.
Why, then, does the burden of suffering and ill health persist?
Many African women still embark on pregnancy too early and in poor health. They suffer
from endemic diseases such as malaria, tuberculosis, or HIV/AIDS; they are anaemic; many
are stunted as a result of childhood malnutrition.
Second, they do not have access to good quality health care during pregnancy and
childbirth. In Africa, only one woman in three has the assistance of a skilled health care
professional during delivery. Yet such care is vitally important if normal and complicated
deliveries are to be handled as they should.
The causes of death that we are speaking of represent only the end point in a longer
chain of causation that includes poverty, lack of education, early and too frequent
childbearing, women's low status, and the restricted choices many of them have in
their lives. Addressing these underlying issues will require sustained and long-term
social, cultural and economic changes.
But we should not be misled into believing that we cannot tackle maternal mortality
until such changes occur. Countries cannot afford to wait for development to solve the
problem, because the problem is itself one of the causes of underdevelopment.
So what can be done? And what will WHO do?
We know, on the basis of research and action around the world, that the vast majority
of these deaths are preventable with feasible and cost-effective interventions. Three
factors are vital:
One: Every pregnancy should be wanted.
Two: All pregnant women must have access to skilled care. And
Three: All pregnant women must be able to reach a functioning health care
facility when complications arise.
These interventions are feasible, measurable and cost-effective, even in settings where
resources are limited. Looking at countries such as China, Cuba, Sri Lanka, and Viet Nam,
we see that relatively low levels of maternal mortality have been achieved despite low
GNP. Reducing maternal mortality is not simply a matter of a country's wealth, but
depends more critically on the level of political commitment and social willingness to
allocate scarce resources in ways that maximise the benefits for those who need it.
What does this mean in practice?
It means that women have the right to decide on the number and spacing of their
children, and to deliver in safety. It means that each newborn has the right to take that
first step in life in the best possible conditions. Rights cannot exist without
responsibilities. Making motherhood safe is a state responsibility with respect to
mothers, fathers, newborns and families. It cannot be achieved without equity in access to
health services that are acceptable, affordable and of high quality. It involves the
participation of individuals, families and communities as equals in the planning and
implementation of policies and programmes. Safe motherhood is a matter of social
responsibility.
It is, therefore, a particular pleasure for me to be able to make this statement on
maternal mortality here in Mozambique, a country with a demonstrated commitment at the
highest levels to addressing this grave problem. Mozambique has shown the way forward,
developing new approaches to increase access to life-saving care, training new cadres of
health care providers, and forging partnerships between the health care system and civil
society.
The personal dedication and leadership of your Prime Minister has been instrumental in
this process.
An important lesson has been learned here in Mozambique: when it comes to reducing
maternal mortality, approaches applied in piecemeal fashion do not work. Just by
themselves, training health care providers, or informing women about the risks of
pregnancy and childbirth, distributing micronutrients, establishing antenatal care and
family planning programmes will not be enough to make a difference. Efforts and resources
must also be directed into strengthening the health system.
WHO's message is clear: a well-functioning district health system is a
prerequisite for reducing maternal mortality.
This is the challenge. We recognize that health systems face continuing difficulties in
coping with present demands, and that major institutional issues limit health sector
reform. These include public sector pay and incentives, deployment of health care
providers, unregulated private sector growth and the politics of priority setting.
We have much to learn from each other. Activities at country level permit an improved
understanding of what works and the translation of experience into evidence. At global
level, WHO's research and standard-setting activities provide valuable information on
best practices.
Last year on World Health Day, WHO's slogan was "Pregnancy is special –
let's make it safe". Today, a year later, as we take stock five years after the
Population Summit in Cairo, I pledge renewed commitment to MAKE PREGNANCY SAFER. I
will be seeking to forge new partnerships, globally, regionally and at country level. I
will seek to involve other sectors, particularly those with responsibility for finance and
planning.
I will remind every Finance Minister that he, too, (and it is usually a man) is also a
Minister of Health, probably a father, with responsibilities towards the health sector and
the health needs of the poor. That he is also responsible for unnecessary lives lost in
childbirth. I will remind development banks and aid agencies of their responsibilities in
this key area of public health. I will call upon all agencies of the UN system to mobilize
additional support for safe motherhood activities in countries.
At country level, I will propose new partnerships. Let us forge alliances between
health care providers and women's groups, between those responsible for the provision
of health care and those receiving it. Only by working together at the community and
health system levels can we mobilize the necessary resources, and maintain the level of
commitment that is vital for success. I am happy to acknowledge that here in Mozambique,
the UNDAF health theme group has identified maternal mortality as a priority. Coordinated
efforts and strengths of each UN agency to support the government will accelerate the
implementation of programmes to decrease maternal mortality.
WHO's renewed initiative to Make Pregnancy Safer will support governments in
implementing three key interventions that will lead to:
- access to family planning information and services
, including expanded contraceptive
method mix and improved quality of care and the prevention and management of unsafe
abortion;
- access to health care and to providers with essential midwifery skills and referral
,
logistics, managerial and supervisory support, particularly among the poorest population
groups;
- mobilization of families, communities and nations
for support of women during
pregnancy and childbirth including strengthened policy, legislative and regulatory
framework for maternal health and improved nutrition, including micronutrient
supplementation, for pregnancy and lactating women.
A famous writer once said, "At the moment of childbirth, every women has the same
aura of isolation, as though she were abandoned, alone". For too many women in
Africa, that sense of isolation is real enough. I hereby pledge the support of WHO to all
those working to ensure that women no longer face pregnancy and childbirth alone.
Thank you. |
