Maternal health

The largest international women's health convention is currently under way in Washington. The 2010 Women Deliver conference has brought together some 3,000 delegates to discuss ways to improve women's and children's health as part of the United Nations' Millennium Development Goals.

Among the key speakers at the conference is Mary Robinson, founder of ‘Realizing Rights - The Ethical Globalization Initiative'. Robinson was the first female president of Ireland and later served as the United Nations High Commissioner for Human Rights.

Deutsche Welle: Over the last several years, there have been successes in efforts to improve maternal health. What, in your opinion, is the reason for this improvement?

Mary Robinson: It is much more of a priority now in countries, including with presidents as well as the ministers of health, which is very encouraging. In countries like Sierra Leone and Malawi, the health minister no longer feels isolated and without a proper budget - that is very welcome. Even with that prioritizing, we still have very real issues to deal with in the poorest countries. There are the health components that we know. There must be a functioning health system which works in rural areas, so that women have birth attendants and have access to emergency obstetric care. A number of African countries are addressing the lack of fully qualified medical obstetricians by having trained non-physician clinicians to carry out that, and that's important because they would stay in the rural areas, by and large. But then you have all the other issues, which I call the “wives human rights issues”, the barriers, the cultural barriers, the second class status often of the woman or the girl child. There is the lack of economic independence and a lack of access to family planning and reproductive health. These are issues that require a much broader concerting in a country. This includes at community level, and women's groups, human right's groups, and development groups need to come together.

Would you say there is one thing that needs to be done in the future that would help bring success in the areas you mentioned?

What I would like to see now, and I think it s beginning to emerge but not enough, is a real collaboration in countries, bearing in mind the Paris principles and Accra principles, that it must be country-led. We work with the health ministries in some of the African countries and in Nepal, and they are not well-equipped themselves to drive the very policy they want to implement, so they need to be supported in that. Then we need the UN to work more closely as one, and we see that that is recognized and they are prioritizing certain countries and going to really make a special effort. But we also need civil society, we need women themselves, we need to address the boys and men in the society so that it becomes a goal of the whole society, and it just brings together different energies to bear on it in a very collaborative way. From a human rights point of view, I am keen to draw on the lessons we’ve learned in realizing rights - that you do economic and social rights, like right to health differently from ‘no torture’ and tackle corruption of the police and rule of law issues. There you can advocate and hold the government responsible in a kind of finger-pointing way, but with right to health you actually have to work with the government, with local authority and hold them to accountability in a supportive way. It is a different language.

You have criticized the UN Secretary General's Joint Action Plan for Women's and Children's Health. What exactly is your criticism?

I was making two points - one that the Secretary General happily has taken the initiative of a global action plan, and secondly, said this is for consultation, we want to hear back how it can be strengthened before the development summit [in September]. So this gives an opening for the human rights community to say, you aren't going to be as effective because you haven't framed this sufficiently in terms of women's rights or human rights. Access to health is a human right. Why is that important? Precisely because it helps with the accountability. The accountability is mentioned, but it's an accountability for efficiency. Where as, in fact, accountability must go much further. It has to address the issues of discrimination, of gender-based violence, of early child marriage, lack of access to family planning, the barriers that are there. Women themselves must feel empowered as rights holders, the right to the access to family planning, the right to access to safe motherhood, to hold governments accountable for that. It's a huge energizing which we would need if we are going to have that collaboration on a country level. So I welcome the action plan, but I particularly welcome the fact the Secretary General has said that it is open for comment and improvement. I think there is room for improvement in couching it much more expressly in human rights language.

In other words, saying that improving maternal health is an economic issue is missing the point.

He's done a bit more. In fact, a lot of the issues are there, but if you don't reference at all the human rights framework, you don't have a context for full accountability. The Human Rights Council now passes resolutions about maternal health as a human right. There is a rapporteur on right to health. Margret Chan as head of the World Health Organization has spoken very eloquently about health as a human right. Thoraya Obaid, [the executive director of the UNFPA, says our starting point, our central issue, is human rights of girls and women. To not have this reflected in the key human rights approach is disappointing.

This conference is taking place in Washington D.C. With the new administration in the White House, things have changed a lot, the United States has started to fund the United Nations Population Fund (UNFPA). What difference does this make for the general goal?

I think it makes quite a big difference, because there is no doubt that the policies of the previous administration had a very dampening effect globally. First of all, the lack of funding to UNFPA, but also the self limiting of many NGOs afraid they would have their funding cut and so we had many, many unmet needs. We weren't addressing the needs for access to family planning and we now have at least 200 million women and girls who want access to contraceptives and who don't have information or access. This has led to, I think, a higher rate of botched abortions. It is a very significant contributing factor to maternal mortality in poor countries. It's so sad, because, the culture and the traditions of the women would be that they don't want abortions but they can't take another pregnancy. The pregnancy may be because of rape may be because of gender-based violence. There is a need to be aware of how important it is that we emphasize access to reproductive health and family planning as part of addressing maternal health. I am in the process of putting together a high level, global leaders council on reproductive health and family planning, which will have very high level and, I hope, very respected voices of presidents and former presidents and those who are loved in this society speaking on this issue to counter the negativity and the silence over the issue that we've seen globally. We've gone backward since Cairo and we have to reverse that and come forward again.

Would you agree that the Millennium Development Goal 5 is not achievable until 2015?

I think that there will be a number of poor countries where it will not be achieved, despite renewed efforts now for the next five years. I think that in some middle income countries, it will be statistically achieved, but there will be big pockets of very poor and minorities where it won't be achieved. So we need to think of post-2015. And I think that increasingly we see a strong argument for a global fund for the health MDGs which would somehow develop on from the global fund for HIV, Tuberculosis and Malaria, the GAVI (Global Alliance for Vaccines and Immunisation) alliance fund, which I currently chair, for immunizing children. These funds do very good work and increasingly work together on strengthening health systems. We have a common platform with the WHO and with the World Bank. But I think we need to actually broaden the remit in a new well-resourced global fund which can be built up over the next five years to take us beyond 2015.

What is the biggest obstacle to overcome to actually achieve maternal health?

MR: (pauses) If I had been asked that question at the London conference [the first Women Deliver Conference in 2007] I would have said because we are talking about women and there isn't the same prioritizing. Now we are getting that prioritizing. But it's against a backdrop of the fact that millions of women in societies are still second class, without options, without income, without independence, without land rights, without property rights. I am very encouraged by the greater prioritizing of health and of maternal and child health in particular in developing countries. The gap, I suppose for me, is one of how do we now get the in-country-wide collaboration to achieve the objectives in a more coherent and comprehensive and rapid way.

Interview: Christina Bergmann
Editor: Ranjitha Balasubramanyam