United Nations High level Event on the Millennium Development Goals and related events

MEDIA CLIPPINGS RELATED TO MATERNAL, NEWBORN & CHILD HEALTH

September 24-29, 2008

GUARDIAN, UK: Thirty-year setback means more will die

Goal 4: Child mortality Insufficient funding and a lack of coordination has thrown efforts to reduce child mortality off track, resulting in more preventable deaths

Alison Benjamin,

Under-five mortality has fallen below 10 million to 9.7 million, yet millennium development goal 4 - to reduce it to fewer than five million deaths annually by 2015 - is so off track that, at the current rate of reduction, the target will not be met until 2045, 30 years past the deadline.

Countdown to 2015, a consortium of non-governmental organisations, countries and academic institutions that monitors progress towards goals 4 and 5 - which aims to cut maternal mortality by three-quarters. It found earlier this year that less than one-quarter of the 68 priority countries were on track to meet their targets.

The biggest killers for under-fives are respiratory infection, mainly pneumonia, followed by diarrhoea, malaria, measles, HIV/Aids and neonatal conditions. Together, they claim the lives of around one in six children in the least developed nations before they reach their fifth birthday; four million of them within the first four weeks of their life. In contrast, just one in 167 children under five years of age die in industrialised countries.

What is more shocking than the daily 27,000 death toll of young children is the fact that most of these deaths could be prevented.

Between 2003 and 2006, donations from the international community increased by almost two- thirds, to $3.5bn (£1.9bn), despite , Greece and reducing their level of funding. But it is not enough.

The Partnership for Maternal, Newborn and Child Health - a global coalition of 250 organisations working to achieve goals 4 and 5 - called in July for G8 leaders to commit to $10.2bn (£5.75bn) per year to meet the goals. They refused.

In response, Dr Francisco Songane, director of the partnership, says: "There is no way we can meet the targets without this extra money."

Short-term donations

But throwing money at the problem is not a panacea. Analysis by the School of Hygiene and Tropical Medicine concluded in April that there were too many agencies making uncoordinated, inconsistent and short-term donations through hundreds of separate projects. 2

"This volatility makes effective planning and provision of appropriate levels of funding for strategic priorities difficult for developing countries," the authors reported.

Almost all the funds are targeted at disease-specific prevention projects, of which some have made a huge impact. Distributing insecticide-treated bed nets to prevent malaria, for example, has cut under-five child mortality by 20% in sub-Saharan Africa, and a global measles vaccination campaign has reduced childhood deaths from the illness to zero in some African countries and by more than 90% across the continent.

The UK government is among those contributing to a $4bn (£2.25bn) global immunisation initiative over 20 years that is estimated could save five million lives by 2015, as a G8 member it has also committed to providing 20 million bed nets by the end of 2010. Vaccines are being developed to protect children against pneumonia, meningitis, cholera and typhoid.

But there are fears that immunisation is swallowing funds to the detriment of building countries' health services and increasing the number of frontline health workers.

Only 5% of international funds are being used to build urgently needed health clinics and hospitals, and train physicians, nurses and midwives that could provide continuous care to women and children.

"Donors have to change their attitude," says Songane. "The new fashion this year is to give money for malaria intervention. If we don't invest in infrastructure we'll be in exactly the same position as we are now in 10 years' time."

There are success stories. Political leadership in , Haiti and several countries in east Africa, together with increased funding, has put them on track to cut under-five mortality by two-thirds. Tanzania, for example, reduced under-five deaths by almost one-quarter between 2000 and 2004 by doubling public expenditure on health to fund a universally accessible local health system. This was alongside the distribution of insecticide-treated nets and vitamin A supplements to combat malnourishment, immunisation against childhood illnesses and promoting breastfeeding.

Bangladesh has also made good progress. Neighbouring , however, which accounts for 21% of under-five mortality, was identified in a Children's Fund (Unicef) report last month as a major obstacle to achieving goal 4.

Unicef wants resources targeted at rolling out programmes that have been shown to work. Yet malnutrition contributes to more than one-third of deaths in children under five globally. Unsafe drinking water and inadequate access to proper sanitation may cause as much as a quarter of all child deaths, according to WaterAid.

Dramatic reductions

It points to the dramatic reductions in child mortality that coincided with sanitation investment in the UK at the turn of the 20th century and calls for much more investment in sewerage systems in the developing world. "Improving access to sanitation has the greatest potential to get the millennium development goal target for child mortality back on track," argues Oliver Cumming, WaterAid's sanitation expert. "Developing vaccinations for pneumonia is 100 times more expensive than improving sanitation."

Ann Veneman, executive director of Unicef, agrees that the only way to make "real sustainable progress" on cutting under-five mortality is to make progress on all of the millennium development 3 goals. She warns: "Unless the targets on and the provision of clean water and sanitation are met, progress on the child and maternal mortality targets cannot be achieved."

GUARDIAN, UK: Goal 5: Maternal health: Safe childbirth is at the heart of all the other millennium goals, so why is it the one in greatest danger of failing?

Sarah Boseley, The Guardian

Every minute, a woman dies in pregnancy or childbirth and 30 more are disabled or damaged - a massive and shocking toll from what we think of as a normal and natural event. Childbearing is not a disease. Yet the millennium development goal the world is most in danger of missing is on the reduction of maternal mortality.

Half a million women die every year, the vast majority in sub-Saharan Africa and Asia. Most commonly, they die of haemorrhage or sepsis, because of obstructed labour or unclean conditions. The goal is to reduce the death toll by three-quarters, but progress has been painfully slow and uncertain. To complicate matters, women's deaths from pregnancy and childbirth in many countries are not properly counted or ascribed to the right reasons - and nor are those of their newborn babies, whose fate necessarily depends on their mother's.

There has been a lot of hand-wringing over the past 20 years over this sad state of affairs, and some agonised debate about the best way forward, which may have delayed progress, but there are clear signs now that women's health has risen up the agenda. In the UK, it has been championed by Sarah Brown, the prime minister's wife, who is patron of the White Ribbon Alliance for Safe Motherhood. It has been on the agenda at the recent big global meetings - the World Economic Forum, the G8 and this month's UN in New York.

Maternal health, says Sarah Brown, is at the heart of all the other millennium development goals. "If we can fix things for women - who take care of education, health and nutrition for their families, as well as putting food on the table - we can improve life for the whole community," she says. "Conversely, the loss of a mother can plunge a family into poverty, while her daughters are pulled out of school, married off too young - and the whole cycle starts again. Her baby is 10 times more likely to die, too.

"We do know what to do to prevent women dying in childbirth - and at least 80% of maternal deaths are preventable. But as yet, the survival of mothers has not been a priority for the world's decision makers. Poor women in developing countries - where 99% of maternal deaths happen - have little power to make their voices heard. Women who have died are totally silenced."

Ending the deaths of mothers is clearly as much a political issue as a health issue, because it will require significant social change. The White Ribbon Alliance, supported by Gates Foundation money, is taking the argument through its civil society groups - it has members in 104 countries - to governments that are, says Brigid McConville, director of the UK Alliance, increasingly prepared to listen.

The UK government, for instance, is part of a G8 commitment to help increase Africa's health workforce by 1.5 million health workers and plans to spend $420m on health in , Kenya, Mozambique and Zambia in the next three years.

They have three "asks", she says: $10bn (£5bn) a year to be spent globally in addition to normal health spending, 4 million more healthcare workers (of whom a quarter should have midwifery 4 skills) and maternal mortality to be made the key indicator of a good healthcare system. It's an agenda adopted by a broad group including UN agencies, but she acknowledges it is radical. "It involves empowering women and educating women and enabling them to know their rights, elevating their status so they can control their fertility," she says.

Practical answers

We know what to do, say campaigners. A major series in the Lancet medical journal in 2006 investigated the reasons women die and offered practical answers. The main causes were haemorrhage during childbirth and, in some countries, unsafe abortion. Diseases such as HIV/Aids and malaria had a significant impact where they were prevalent. In the poorest parts of the world, the risk of dying was one-in-six, compared with one-in-30,000 in northern Europe.

Wendy Graham, professor of obstetric epidemiology at Aberdeen University, who was behind the Lancet series, says what women need is access to quality care in a health facility. Where there are scarce resources, they go furthest if pooled in a maternity unit to which many women can get access. "But it's not a one-size-fits-all," she says, "which is sometimes a great challenge to certain decision makers who want you to describe what can be done everywhere in one sentence. The goal should be quality facility deliveries, but the path to get there will vary enormously."

Home-based care and community health workers all have a part to play, she says, but it is important not to channel significant funding into temporary solutions - in case they become permanent. Medical kits and training for traditional birth attendants can all help, but when a woman has a haemorrhage - the biggest cause of death - "it doesn't matter how skilled you are, sooner or later she will need emergency transport to emergency facilities."

It means that, if the death toll is to be cut, health systems have to be improved - a point on which everybody can agree. Measuring those systems by the outcomes for women in pregnancy and childbirth will ensure that serious progress is made - and for the first time there seems to be the will to get there.

The New York Times: Failing the World’s Poor

September 24, 2008 EDITORIAL

Good intentions wither fast, especially when it comes to helping the world’s poor.

At the turn of the millennium, world leaders committed to cutting extreme global poverty in half and to achieving deep reductions in malnutrition and child mortality rates. They followed that up in 2005 with a pledge to increase development assistance to $130 billion a year by 2010 (about $151 billion in today’s money).

That was then. Today, even as soaring energy and food prices exacerbate the suffering of the world’s poor, the richest nations are falling far behind on their aid commitments — and behind their past giving.

The current financial turmoil could make it even less likely that the wealthy nations will fulfill their promises to the poorest of the poor. Without that money, many of the development goals announced with such fanfare will go unmet. 5

Aid from the world’s developed countries fell by almost 13 percent between 2005 and 2007 — to under $104 billion, after inflation. The aggregate aid budget of the most developed nations amounts to 0.28 percent of their gross national income, woefully below the target of 0.7 percent agreed to by world leaders in 2002 .

Only , Norway, the Netherlands, Luxembourg and meet the target. ’s overseas aid amounts to 0.28 percent of its income. ’s is 0.17 percent. The , shamefully, is at the bottom of the list, spending 0.16 percent of its income on development assistance.

Many countries tie too many strings to their largess — such as requirements to buy supplies from donor countries. (Aid flows are often swayed by domestic politics in the donor nations, making them unpredictable and difficult to manage by receiving nations.)

Aid isn’t the only area where the developed world is failing. After the 2001 terrorist attacks, wealthy countries acknowledged that poverty can be a fertile ground for and pledged to open their markets to exports from the world’s poorest nations. Those promises collapsed along with global trade talks this year.

The world’s poor still desperately needs the help. According to a new study, 1.4 billion people lived in extreme poverty in 2005. Twenty-seven percent of children under 5 in the developing world were underweight. Their mortality rate was 83 per 1,000 live births, about 14 times the rate in rich nations. And whatever gains have been made against the most abject poverty, they risk being undone by the rising price of food.

Speaking to the United Nations this week, the secretary general, Ban Ki-moon, warned that the world is facing a “development crisis,” and he expressed his fear that wealthy nations would now fall even further behind in their commitments. We share that fear.

PANA: Poor nations make progress in mother, child health, disease reduction

New York, US - Health leaders meeting here have said that significant progress towards reducing child and maternal mortality is being made in the world's poorest nations. However, they said that to meet the Millennium Development Goals 4,5,6 (reduce child mortality, improve maternal health and combat HIV/AIDS, Malaria and other diseases), strategies aimed at reaching the world's most inaccessible, marginalised and vulnerable populations will be required, according to a statement from the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation), a public-private partnership of major stakeholders in immunisation.

Ethiopia's Minister of Health and the heads of four leading global health organisations, the GAVI Alliance, UNAIDS, the Global Fund to Fight AIDS, TB and Malaria, and UNICEF said Tuesday that immunisation coverage, large-scale campaigns to prevent malaria and access to AIDS and malaria treatments had improved in developing countries, thanks to more resources, new partnerships and technologies, stable, long-term donor support and improved coordination among health actors.

Ethiopia's Minister Tedros Adhanom Ghebreyesus expressed his country's strong commitment to achieving the MDGs and stated that "Ethiopia is on track to meet MDG 4" but must rely on strong donor support for its national health plan to continue its progress.

Increasing immunisation rates are recognised as essential to achieving MDG 4, a two-thirds 6 reduction in childhood mortality by 2015, the experts said.

''Polio teeters on the edge of eradication; measles, a major killer of children in the poorest countries, has been dramatically reduced; malaria deaths have been cut by half in parts of Africa due to a concerted effort and expanded access and use of insecticide-treated bed nets; and the deadly Hib disease, a leading cause of meningitis, has been virtually eliminated in some parts of Africa.

''Last year, nearly one million more people were receiving antiretroviral therapy than in 2006, and today some three million people living with HIV are now on treatment globally – two million in sub- Saharan Africa,'' the statement said.

It said over the past eight years, global investments to fight malaria had increased 10-fold and AIDS investment eight-fold.

The Global Fund alone has financed programmes worth US$11.4 billion since its creation in 2002, and the unprecedented increase in resources is already showing encouraging results in reducing mortality and morbidity.

GAVI has achieved success in delivering essential childhood vaccines in the developing world. Since its creation in 2000, GAVI's support has prevented 2.9 million future deaths and protected 36.8 million additional children with basic vaccines. Immunisation rates have increased to more than 70% in many countries.

"Many more people are living longer and healthier lives today thanks to increased access to HIV treatment. This could not have happened without substantial financial investments and improved health systems," said Dr Peter Piot, Executive Director, UNAIDS.

"The challenge now is to sustain these gains and to ensure more equitable access for people who have been marginalised," he said.

"Recent statistics show that under-five mortality continued to decline in 2007," said Ann M. Veneman, Executive Director UNICEF. "Continued success in measles and tetanus immunization rates, distribution of insecticide-treated nets (ITN), and prevention of mother to child transmission of HIV should maintain this positive trend."

Even with these improvements, the experts agreed that to reach the MDGs and achieve equitable distribution of public health across social, gender, ethnic and geographic levels will be more complex and costly.

"However successful we have been so far, we still face major challenges in ensuring vaccines reach the most vulnerable children. It's getting harder; the distances are getting greater and, in the areas we need to reach, the health systems are weakest. We must determine the best strategies with which to reach those girls and boys who are still missing out on immunisation," said the GAVI Alliance's Executive Secretary, Dr. Julian Lob-Levyt.

"The progress in fighting malaria alone can reduce child mortality enough to reach the MDG 4 target," Dr. Michel Kazatchkine, the Executive Director of the Global Fund said. "However, the great progress we have seen recently must be consolidated into lasting, sustainable progress in mother and child healthcare."

Pointing to the lessons learned through the AIDS response, Dr. Piot said: "Involving civil society and ensuring a rights-based approach can help strengthen health systems and deliver results to the people."

The experts also argued that development should be led by national priorities and a country's 7 long-term plans.

"Altering business-as-usual and embracing a country-driven approach should be a core principle for development agencies, donor organisations and civil society organisations worldwide," said Lob-Levyt.

New York - 23/09/2008

AFP: World leaders to give new impetus to fight against poverty by Gerard Aziakou Gerard Aziakou Wed Sep 24, 2:23 pm ET

UNITED NATIONS (AFP) – UN chief Ban Ki-moon was Thursday to host a summit here to galvanize world support for achieving key poverty-reduction goals by 2015 despite soaring energy and food prices compounded by the financial crisis.

Nearly 100 world leaders are to join top private sector officials, including billionaire Microsoft founder Bill Gates, foundations and civil society, to pledge new commitments to revive the flagging battle to the achieve Millennium Development Goals (MDGs).

Among those expected at the plenary session and 40 partners events on malaria, education and health will be British Prime Minister , his Chinese counterpart Wen Jiabao, Brazilian President Luiz Inacio Lula da Silva, World Health Organization head Margaret Chan, World Bank President and U2 singer and global anti-poverty campaign Bono.

In 2000, the United Nations adopted eight goals to be met by all the world's countries by 2015.

They include eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health, combating diseases such as HIV/AIDS, ensuring environmental sustainability and creating global partnerships for development.

Despite some progress, "We're still significantly off track on a number of MDGs," British Secretary of State for International Development Douglas Alexander told reporters Wednesday, citing "the 75 million kids without no classroom and teachers to teach them, more 55 percent of them young girls."

In other setbacks, more than 500,000 mothers in developing countries die in childbirth or from pregnancy complications every year and almost half of the developing world population still lacks sanitation facilities.

"I hope the meeting would mark an occasion whereby words of commitments can be turned into plans for action," Alexander said. "We will be keen to see at the conclusion of the summit practical actions being taken by a number of different states to make sure that we step up our commitments at this point, half way through 2015."

Monday a high-level meeting on Africa's development ended with call for rich countries to honor their pledge to double their annual aid to the continent, which is trailing the rest of the world in achieving the MDGs. 8

"We are concerned that, at the current rate, the commitment of doubling aid to Africa by 2010 as articulated at the (2005) G8 summit in Gleneagles (Scotland) will not be reached," a statement issued at the end of the meeting said.

"We call for the fulfillment of all official development assistance-related commitments, including the commitments made by many developed countries to achieve the target of 0.7 percent of gross national income for official development assistance by 2015," it added.

The OECD said rich countries were behind in their aid commitments and needed to increase the level by 12 percent by 2010.

Alexander said that despite the global financial crisis and high energy and food prices, it was in everybody's interest to ensure that the MDGs are met. He singled out the need to take action to address problems in the global food market.

"We need not just immediate humanitarian relief, we also need to see a significant uplift in agricultural productivity" to feed the world's growing population, he said.

Wednesday, the World Food Program announced a ground-breaking initiative called Purchase for Progress (P4P) to help hundreds of thousands of poor farmers in sub-Saharan Africa and Central America gain access to reliable markets to sell surplus crops at competitive prices.

The Bill and Melinda Gates Foundation, the Howard Buffett Foundation and the Belgian government jointly earmarked 76 million dollars for the scheme.

Alexander said significant debt relief was behind some of the successes in several African countries.

"We made significant progress on debt relief, we made progress on aid but a lot more needs to be done on trade," he added.

The breakdown of Geneva talks in July to bring the Doha round of trade liberalization talks to a successful conclusion was a major setback for developing nations seeking to capitalize on expanded global trade opportunities to curb poverty, UN officials say.

DPA: Billionaires, politicians join forces against global woes - Update

Posted on : 2008-09-25 | Author : DPA News Category : US

New York - Major charity foundations, government leaders and politicians of all stripes joined forces on Thursday to push for progress in ending poverty and hunger and fighting diseases that continue to kill thousands of people each year. UN Secretary General Ban Ki-moon launched the one-day session on reviewing progress achieved so far on implementing the Millennium Development Goals (MDGs). He warned that a financial crisis sweeping across advanced economies would actually have its greatest effect on the poor.

Ban said the financial turmoil besieging many countries, including the largest donors like the United States, was only adding to food and energy crises already affecting developing countries. "The current financial crisis threatens the well-being of billions of people, none more so than the poorest of the poor," Ban told the UN General Assembly. "This only compounds the damage being caused by much higher prices for food and fuel." 9

"We must rise to all of these challenges immediately," he exhorted the nearly 100 world leaders attending meetings at UN headquarters in New York to achieve the MDGs by its target date of 2015.

Ban called on governments to be "bold" and "generous" in their commitments during the meeting. Bill Gates and his wife, who run the Bill and Melinda Gates Foundation, and Howard G Buffett, whose foundation provided hundreds of millions of dollars to global programmes fighting poverty and diseases were present at UN meetings to answer calls for generosity.

The billionaires pledged this week initial funding of 76 million dollars to the World Food Programme that will provide seeds and assistance to farmers over the next five years. The scheme hopes to help a total of 350,000 farmers in 21 developing countries by the end of that period and feed hundreds of thousands of people.

British Prime Minister Gordon Brown told the MDGs session presided over by Ban that the hungry are dying while the UN debated on programmes.

"Facing betrayal of the MDGs, we say again we will come, but many continue to die while we wait," Brown said. "And I believe our greatest enemy is not war or inequality or any single ideology or a financial crisis; it is too much indifference."

"Our global leadership itself is being questioned and let us face the shameful truth that while we have made huge advances - 40 million more children at school, 3 million children living who would otherwise have died, 3 million getting treatment for AIDS -the 2015 goal to cut maternal in infant mortality will not be met even in 2020 or 2030, not before 2050," he said.

There are still 75 million of the world's children not attending school, and the goal of providing education to every child will not be met on present trends in 2015 or 2025 or even in 2100, Brown said.

"I say to the richest countries of the world the poorest of the world have been patient, but a hundred years is too long to wait for justice," he said. Brown said he expected around 8 billion dollars in new development initiatives to be put forward during the day. The goal of reducing maternal mortality has so far eluded the UN despite global efforts involving various governments and organizations. At the UN, Norwegian Prime Minister Jens Stoltenberg launched Thursday a progress report on the global campaign for health.

The report called for urgent and effective international action to accelerate progress towards the UN goals of reducing maternal and child deaths by 2015.

It said in order to save 3 million mothers and 7 million newborns from death each would require an additional 2.4 billion dollars in 2009, and rising to 7 billion dollars in 2015. The report called for mobilising international support for stronger health systems, including the training and recruitment of over 1 million health workers.

Stoltenberg and Brown announced a new taskforce that would look at new methods of financing for health programmes. Bill Gates called health the "gateway to progress," something that wealthy nations have all too often taken for granted.

10

BBC News: Economic storms threaten development

By Stephanie Holmes BBC News

The Millennium Development Goals were hailed as a new framework for development - tangible targets that would propel and direct change in the spheres of hunger, health and human rights, equality and education.

But, as politicians, advocates and experts gather in New York, the economic storm clouds of soaring commodity prices and a global slowdown threaten to overshadow the future.

"We are very worried about the financial crisis," says Thoraya Obaid, the head of the United Nations Population Fund, whose agency focuses on maternal and reproductive health.

She admits that there is a risk that international aid priorities - and funding - will slip off the political agenda as governments and individuals grapple with their own domestic crises.

"Next year is supposed to be the year of reconciliation - of solidarity among nations - but the global crisis will affect everyone, not only at the national or government level, but also at the individual level."

The UN concedes that eight years on from member states pledging to halve the proportion of people who live on $1 (0.68 euros; £0.53) a day and reducing by 50% the hundreds of millions who go hungry each night, the results are mixed.

Towards the targets

The overarching goal of reducing absolute poverty by half is within reach for the world as whole, the UN says, but not in sub-Saharan Africa.

Some 80% of children in developing countries are now vaccinated against measles, yet one in four is still undernourished and underweight.

The [Indian] government talks about doubling and trebling expenditure, but they aren't increasing spending on a par with economic growth

Lysa John, Keep the Promise

Though the goals risk painting even progress as failure, Ms Obaid defends them as a tool.

"Without goals… we cannot monitor what we are doing and demonstrate results. It is a way for governments, international organisations and non-governmental organisations to hold each other accountable and people to hold their governments accountable."

Yet the targets have not been unquestioningly welcomed by campaigners who warn that some fundamental issues have not been directly addressed.

"Many women's groups in India feel that the Millennium Development Goals (MDGs) do not speak of social exclusion. They look at the sum of all things but not at socially excluded groups - 11 like women, minorities, children or young people," explains Lysa John, of Keep the Promise, an Indian NGO which campaigns to ensure the government meets its MDG pledges.

MILLENIUM DEVELOPMENT GOALS Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality Reduce child mortality Improve maternal health Combat HIV/Aids Ensure environmental sustainability Develop a global development partnership

Perhaps as a result, though India's economic success has fuelled progress on many goals - in particular access to education - the targets around maternal health are far from being met.

"The health indicators are where India has fallen off track," Ms John says. "We have the highest number of maternal deaths in the world."

The UN estimates that India has the highest number of women dying during childbirth anywhere in the world - one woman dying every three to six minutes from preventable causes, according to campaigners - yet the country spends less than 0.9% of its Gross Domestic Product on public healthcare.

"Women and children don't have a strong political voice," Ms John says. "Even beyond marginalised communities, the issue of maternal death is completely invisible - it is seen as God's hand, as your fate."

In reverse

Ms Obaid agrees: "It would cost the world $6bn (4bn euros; £3.24bn) to stop women dying during childbirth, less than the amount spent in a day and a half on the military, so you can see how a little investment could help to transform women's lives".

Economic success in countries across Asia is pushing down overall poverty levels but many of the poorest families within countries have been the hardest hit by the rise in staple foods like rice, wheat, corn and oil.

"It is the poorest of the poor - those who spend a large proportion of their income on food - who have been most affected by the increasing prices," explains Kostas Stamoulis, of the UN Food and Agriculture Organisation's Agricultural and Economics Development division. "It's the female- headed household, the landless people, the urban poor."

Until prices spiked, he explains, many countries were roughly on track to meet the first MDG - that of halving hunger.

"But if this trend does not get reversed then it will be very difficult to do it," he adds.

The FAO says an additional 75 million people joined the ranks of the hungry last year, pushed over the edge by increasing food costs. 12

"We believe we can still achieve it. But if food prices fall - even substantially - it will not necessarily cancel out these effects. Many households in distress have already sold assets that are difficult to build up, leaving them more vulnerable."

Political priorities

Long-term under-investment in the agricultural sector, Mr Stamoulis says, is only part of the reason why this particular MDG is proving so difficult to address, particularly in sub-Saharan Africa, where conflict combines with poor infrastructure.

"We also have to look at the political process in developing countries. We have to be even- handed, it's not just about the donors but also the recipients. Looking at the facts, agriculture was never a sexy sector to develop. It's about having the political will to focus on it."

India, Ms John points out, should channel a greater proportion of the growing funds available into meeting the health-related MDGs.

"The government talks about doubling and trebling expenditure, but they aren't increasing spending on a par with economic growth, the economy is growing far faster," she says.

There is also some anger, within the UN building, that the US government is considering a massive financial rescue package to bail out Wall Street, not so many blocks away across town.

"Why is it possible to find $700bn (477bn euros; £378bn) to help save the private sector on Wall Street and not find the money that is needed - in this case $6bn - to save women from dying?" asks Ms Obaid. "The issue becomes about where the priorities are."

Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/in_depth/7634525.stm

Published: 2008/09/25 10:46:00 GMT

© BBC MMVIII

THE NEW YORK TIMES : U.N. Receives New Pledges of Aid Totaling $16 Billion September 26, 2008 By NEIL MacFARQUHAR

UNITED NATIONS — Ban Ki-moon , the United Nations secretary general, announced on Thursday that the organization had received an additional $16 billion in pledges to fight a host of global ills like hunger and malaria, calling it an important signal that the world financial crisis would not impair aid efforts. “That expression of the global commitment is all the more remarkable because it comes against the background of a global crisis,” Mr. Ban said at a news conference. But his optimism was not shared universally, with some other senior officials suggesting that the ripple effects from the credit crisis would eventually force governments to cut back the amount of money they actually donate. 13

The new pledges emerged from a special series of meetings attended by 96 heads of state or heads of government, which were held on the sidelines of the annual General Assembly , all focused on a series of eight development goals. They included $4.5 billion for education, $3 billion to combat malaria and $1.75 billion in aid to prevent starvation in the Horn of Africa. Some of the bigger donations came from oil powers. Norway pledged $1 billion over 10 years to reduce child and infant mortality, while Saudi Arabia committed $500 million toward enrolling an additional 24 million children in primary school by 2010. China offered to provide a battery of programs to improve agricultural yields, health care and education, as well as to promote clean energy in Africa. On the extended list of new pledges released by the United Nations, the only donation listed from the United States was $61 million over five years to help African farmers get better seeds. A spokesman for the United States Mission to the United Nations said it was checking the figure, which was released late on Thursday. Gordon Brown , the British prime minister who shared the podium with Mr. Ban at the news conference, said an economic crisis was precisely the wrong time to reduce development aid. Given the rising cost of food, fertilizer and fuel, for example, it was more important than ever to help African farmers improve their yields, he said. But other officials said people expecting the latest commitments to be met were kidding themselves because the financial crisis was likely to cause Western governments to cut their budgets. “Promising to get people more money for development?” Bernard Kouchner , the French foreign minister, said during a breakfast with reporters on Thursday. “This is not true. We are lying.” The Group of 8 industrialized nations pledged in 2005 to donate more than $25 billion to Africa by 2010, but figures released by the United Nations this month showed that only $4 billion had actually been provided. Mr. Kouchner said the only likely way to increase aid was to get more donations from the private sector, which has been particularly effective in improving health care worldwide. Indeed, Bill Gates , the billionaire founder of Microsoft, also shared the spotlight with Mr. Ban and Mr. Brown at a series of events around the United Nations on Thursday. Among the donations announced on Thursday, the Bill & Melinda Gates Foundation made among the largest commitments from a nongovernmental entity. It pledged $168.7 million for fighting malaria and joined with the Howard G. Buffett Foundation in a $76 million pledge to help poor farmers win competitive prices for their crops. Critics of the Millennium Development Goals , as the eight targets are known, said they put too much emphasis on raising new money and not enough on improving the efficiency with which it is delivered. Copyright 2008 The New York Times Company

The Associated Press: UN chief: $16B being given to help world's poor

Friday, September 26, 2008

UNITED NATIONS: Bill Gates said Thursday the U.N.'s goals to fight poverty have grabbed the world's attention — and the U.N. chief said the world has responded with more than $16 billion despite the current financial crisis.

"This has exceeded all our expectations," Secretary-General Ban Ki-moon said at the end of a day- long event to generate fresh political and financial support to achieve the Millennium Development Goals by the target date of 2015. 14

At the event on the sidelines of the U.N. General Assembly, Ban said around $16 billion in pledges were announced, but an exact accounting needs to be made.

"If so, that expression of global commitment would be all the more remarkable because it comes against a backdrop of financial crisis," Ban said.

Ban, Gates and British Prime Minister Gordon Brown praised the broad coalition of government leaders, business executives, philanthropists, civil society and nongovernmental organizations that made commitments to achieving the U.N. goals, which were adopted by world leaders at the Millennium Summit in September 2000.

"This is the broadest-ever alliance assembled to fight for a common goal — the war on poverty — and we are going to make the greatest endeavor in pursuit of the boldest and noblest of causes ... to end the poverty emergency," Brown said.

Ban called the global partnership "the way of the future."

Gates said partnership is critical because "the world understands that no sector acting alone can achieve the goals for humanity that are the mission of the United Nations."

A recent U.N. report said not a single country in sub-Sahara Africa was on target to meet the U.N. goals.

"I love the Millennium Development Goals. They are one of the best ideas for fighting global poverty I've seen in my lifetime," he said in a speech before nearly 100 world leaders. "With all the mountains of measures and studies and reports in the world — the Millennium Development Goals have broken through and grabbed our attention."

The successes in reaching the goals should be celebrated, and the disappointing progress in some areas should be acknowledged and decisions should be made on what to do next, the Microsoft founder said.

"So I disagree with those who focus only on the disappointments and try to spread around blame and guilt," Gates said. "People aren't motivated by blame and guilt. People are motivated by success. And we have phenomenal opportunities for success."

A coalition of governments, charities and U.N. agencies pledged $4.5 billion — the biggest commitment — to get all the world's children in school by 2015.

Rock stars and humanitarians Bono and also pledged to do their part by opening two new teacher training colleges in Malawi and Rwanda.

The second largest pledge — nearly $3 billion — came from nations, private donors and non- governmental organizations to virtually eliminate malaria as a mass child killer by 2015.

Among the other pledges were $1 billion to save the lives of 10 million mothers and children by the year 2015, $1 billion from Norway to fight deforestation in the Amazon, and an additional $730 million from the European Commission to the U.N. World Food Program during 2009-2012 to fight poverty.

China pledged to double the number of agricultural technicians it sends to developing countries and to train 10,000 doctors and nurses, and Pakistan said it would provide $21 a month to 3.4 million low- income households under a program named in honor of assassinated former prime minister Benazir Bhutto. 15

Britain's Brown said the $16 billion in pledges is "a demonstration to the world that in the face of economic challenges we must do more and not less to help the poorest in the world."

But earlier Thursday, French Foreign Minister Bernard Kouchner told reporters the global financial crisis is making many of the U.N. goals unrealistic. "To talk about development, or to talk about the millennium goals, in the middle of such a crisis, this is sort of unfair — a difficult-to-accept position," he said.

American economist Jeffrey Sachs, the head of Columbia University's Earth Institute and director of the U.N. Millennium Project, said it was "preposterous" to use the financial crisis as an excuse not to support the U.N. goals, which include cutting extreme poverty by half, ensuring universal primary education and halting the HIV/AIDS pandemic, all by 2015.

Asking developed nations to spend 0.7 percent of their gross national product to fight hunger, disease and poverty is a small amount of money for a rich world, he said.

"Wall Street paid itself more in bonuses every year in recent years than the whole world gave in aid to Africa," Sachs told a news conference. "So let's be clear that it's preposterous to claim that now is not the time" to help bring hundreds of millions out of poverty and create a safer world.

Gates said he is convinced that progress on the goals "will help fuel the broad-based economic growth that leaders seek for their countries."

"This is an important reason why they should have the strong support of governments," he said.

IPS: DEVELOPMENT: Presidents Boost Maternal and Child Health

By Heike Barkawitz

UNITED NATIONS, Sep 26 (IPS) - As world leaders gather at the United Nations to discuss progress toward achieving the Millennium Development Goals (MDGs), Presidents Michelle Bachelet of Chile, Tarja Halonen of Finland, and Jakaya Mrisho Kikwete of Tanzania are calling for more attention to be paid to maternal and child health.

"In too many countries of Africa women’s ability to survive childbirth remains a matter of chance," Kikwete stressed at a special event Thursday on the sidelines of the General Assembly.

Improving maternal and child health -- embodied in MDG four (to reduce by two-thirds, between 1990 and 2015, the under-five mortality rate) and five (to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio, and to achieve, by 2015, universal access to reproductive health) -- is often referred to as the "heart of the MDGs", because the achievement of the other MDGs depends on the success of these two.

The other six MDGs -- also with a target deadline of 2015 -- include a 50 percent reduction in extreme poverty and hunger; universal primary education; promotion of gender equality; combating the spread of HIV/AIDS, malaria and other diseases; ensuring environmental sustainability; and developing a North-South global partnership for development.

Bachelet, Halonen and Kikwete asked heads of state, heads of U.N. agencies, senior government officials, civil society organisations, foundations and private sector companies present at the event to renew their commitments to maternal and child health and introduce specific initiatives.

"We will not achieve the MDGs unless we invest more in the health and rights of women and 16 ensure universal access to reproductive health. The MDGs were designed to put our world on a more secure and sustainable path. And it is hard to envision a safe future without safe motherhood," Thoraya Obaid, Executive Director of the United Nations Population Fund (UNFPA), pointed out.

Chile, Finland and Tanzania announced that they had each strengthened their commitments to improve maternal and child health. In September Chile launched a regional campaign in Santiago entitled ‘Deliver now for women and children’ to reduce child mortality in Latin America and the Caribbean.

Finland has joined the International Health Partnership (IHP) to promote more a coherent approach to health sector cooperation at the country level.

Tanzania made health care for pregnant women free.

However, "MDGs four and five are the least likely to be met in virtually all the regions of the world," Margaret Chan, director general of the World Health Organisation (WHO), told reporters.

Norwegian Prime Minister Jens Stoltenberg added that MDG five was "one goal where we hardly make any progress at all" due to "ignorance, neglect and discrimination against women."

German Federal Minister of Development Cooperation Heidemarie Weiczorek- Zeul added, "I was just reflecting what would have happened to the MDGs four and five if men were to give birth to children. We would have reached them."

The facts are daunting. Each year, half a million women die in pregnancy or childbirth. This adds up to 10 million preventable deaths in a generation. After giving birth, 10 to 15 million women suffer serious or long-lasting illnesses or injuries -- costing the world 15 billion dollars in lost productivity annually.

Additionally, about three million newborns die each year during the first week of their lives and approximately three million babies are stillborn.

"The majority of maternal and child deaths occur in Africa and South Asia, with sub-Saharan Africa increasingly bearing the global burden of mortality," according to the report ‘Tracking Progress in Maternal, Newborn and Child Survival’, launched at the second Countdown to 2015 Conference held in Cape Town, in Apr. 2008. Altogether, 68 developing countries account for 97 percent of maternal and child deaths worldwide.

An estimated six million of these lives could be saved every year, if women, newborns and children in developing nations gained access to basic health services, according to UNFPA.

But despite all the discouraging facts, Stoltenberg believes that MDGs four and five can still be achieved by the year 2015, if the world "mobilises more financial resources, spends money in a more effective way and increases awareness".

UNFPA in cooperation with the International Confederation of Midwives (ICM), for instance, launched a new initiative to tackle the severe lack of midwives in developing countries. The initiative will begin in eleven of the hardest-hit countries with the highest levels of maternal deaths and disability, and the lowest rates of births attended by skilled workers -- Benin, Burkina Faso, Burundi, Cote d'Ivoire, Djibouti, Ethiopia, Ghana, Madagascar, Sudan, Uganda and Zambia -- and will later expand to include at least 30 more countries.

The WHO estimates that there is a need for an additional 334,000 midwives. A skilled attendant at delivery -- backed up by emergency obstetric care -- could reduce the number of women dying in pregnancy and childbirth by about 75 percent. 17

"We need some strong advocates who can call on governments to invest in much needed midwives. But we also need to work with governments to ensure the scaling up and quality of midwifery services. They need to take ownership," ICM President Bridget Lynch said.

In her speech, Bachelet called for governments and especially for industrialised countries "to put underway more initiatives and to call for more financing. We need to promote global and regional initiatives, inviting the governments to participate, and a coordinated action of international organisations." Beyond that, she appealed for a widespread global awareness and for "transferring new commitments into action".

"It is estimated that 5 billion dollars will be required annually by 2010 and an additional 8 billion dollars will be required annually by 2015," according to Kikwete. "Raising these additional resources is the question. It’s a question of mobilising political will. But what is 5 billion dollars in a world where the total GDP is worth hundreds of trillions?"

FINANCIAL TIMES: Donors pledge record $3bn to help eradicate malaria deaths

By Andrew Jack at the United Nations Published: September 26 2008 03:00 | Last updated: September 26 2008 03:00

Governments and other donors yesterday made a record pledge of nearly $3bn to help eliminate the 1m annual deaths caused by malaria, one of the world's leading infectious disease killers. The offers came after Ban ki-Moon, United Nations secretary-general, told world leaders at a poverty summit that the financial crisis compounded the recent difficulties of rising food and fuel prices in hindering economic development. Speaking at a special summit at the halfway point towards reaching the 2015 Millennium Development Goals (MDGs) agreed in 2000, he said: "While we are moving in the right direction, we are not moving quickly enough . . . We must inject new energy into the global partnership for development. "The current financial crisis threatens the wellbeing of billions of people, none more so than the poorest of the poor," he said, in calling for another summit in 2010 to take stock. Mr Ban's remarks came ahead of a series of fresh pledges by governments around the world towards meeting the goals, which include efforts to reduce poverty, fight disease, increase education and foster environmental sustainability. Leaders endorsed a global action strategy to "reduce to near zero" deaths caused by malaria by 2015, with longer term plans to eliminate its transmission in countries most affected at a malaria summit in parallel with the UN session. The World Bank, the Global Fund to Fight Aids, TB and Malaria, individual governments and philanthropists pledged support to boost provision of existing treatments and prevention methods as well as research towards vaccines and new drugs. "I hope that we will be able to look back on 2008 as the year when the MDGs were put on track," said Mr Ban. The fight against malaria, estimated to require $5.3bn (€3.6bn, £2.9bn) next year, includes expanded uses of bed nets and indoor insecticides, as well as broader use of diagnostics and effective drugs. It says a further $750m-$900m a year is needed for research for new pharmaceutical products. 18

In an unprecedented level of political support, both US presidential candidates, John McCain and , also pledged their support for redoubled efforts to eliminate malaria and other tropical diseases. "Today's launch is a real and vital turning point," said Gordon Brown, the British prime minister. "It brings together a new coalition of forces - government, the private sector and NGOs - to ensure we all rise to the challenge of eradicating malaria deaths by 2015." He pledged support for a new mechanism designed to subsidise malaria drugs, as well as another plan to train 1m doctors, nurses and midwives worldwide to help strengthen weak health systems in poor countries. Copyright The Financial Times Limited 2008

AP: Britain pledges money for health care

By MICHAEL ASTOR Associated Press Writer

(AP:UNITED NATIONS) British Prime Minister Gordon Brown says his country will spend more than $800,000 over the next three years as part of a wider initiative to reduce the number of newborns and mothers who die each year during childbirth.

Brown made the announcement Thursday during the release of the first-year report on the Global Campaign for Health Millennium Development Goals. The report said that while progress has been made in some areas, hardly a dent has been made in reducing the number of mothers who die at a rate of about one-per-minute around the world during childbirth.

"While funding for global health has more than doubled since 2000 saving millions of live, global maternal mortality ... has remained largely unchanged for the last 20 years," Brown said. "What should be the happiest time of a life, when a new baby is born, turns out for half a million mothers a year as the saddest as they face death as a result of the inadequate treatment."

The report estimated that an additional $7 billion would be needed to save the lives of 3 million mothers and 7 million newborns by 2015.

"I can say that over the next three years the will make available an estimated 450 million pounds ($832 million) to back health plans for eight countries," Brown said, adding the money would go to Ethiopia, Burundi, Mozambique, Kenya, Zambia, , Cambodia and Nepal.

Brown also announced the creation of a Task Force for Innovative International Finance for Health Systems that will report to the G-8 summit next year and will develop recommendations on innovative financing to improve global health care.

Brown will co-chair the task force together with World Bank President Robert Zoellick.

Norwegian Prime Minister Jens Stoltenberg, who will participate in the task force and who was also responsible for the progress report, called for global cooperation in dealing with the problem.

"Unless we mobilize the international community, unless there is a radical change in the way we raise money and unless there is a radical change in the way we spend money, we will fail to reach the health-related Millennium development goals," Stoltenberg said.

He added: "This is an expression of the most brutal neglect for women I can possibly imagine. It 19 is really a big paradox that while we see progress on all the other millennium goals, we don't see progress on maternal health."

Microsoft Corp. co-founder Bill Gates, who appeared together with Brown and Stoltenberg, praised the efforts to focus on innovative financing mechanisms and suggested the money might be best spent on community health workers.

In July, Gates stepped away from his daily duties at the software company to focus on the work of his $38 billion Bill & Melinda Gates Foundation. His wife, Melinda Gates, also has stepped up her time commitment to the foundation.

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

The Lancet: Innovative finance for women and children

Eight ambitious Millennium Development Goals (MDGs) were set at the UN in 2000. 1 Three are specifically related to health: number 4 to child health, number 5 to maternal health, and number 6 to HIV/AIDS, malaria, and tuberculosis. As a result of unprecedented global commitments and funding for infectious diseases and vaccinations, some countries are making good progress— particularly in reducing deaths from HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. 2 The Global Fund against AIDS, Tuberculosis and Malaria, the GAVI Alliance, and PEPFAR (US President’s Emergency Plan for AIDS Relief) represent new ways of providing aid to obtain results. Additionally, a range of innovative financing mechanisms are being developed to attract, channel, and use additional resources in new ways.

However, for the maternal, neonatal, and child goals embodied in MDGs 4 and 5, the picture is very different. Global progress is very uneven. Although many countries have made great strides over the past decade, over 85% of current maternal deaths continue to occur in sub-Saharan Africa and south Asia. 3 Efforts to reduce fertility rates and improve other aspects of sexual and reproductive health are being made in these regions. At the start of the millennium the world was bold—not only to provide more funding but also to be innovative and take risks. It paid off . Now we must mobilise the same global commitment and spirit of innovation to improve the health of mothers and children.

Millions of mothers continue to die from the same causes identified by WHO 20 years ago—ie, haemorrhage, infection, anaemia, and obstructed labour. Unsafe deliveries result in a double tragedy, killing both mothers and their newborn babies. They can be prevented with antenatal care and if women give birth in clean and effective health facilities. We urgently need to tackle the financial, physical, and cultural barriers that restrict these efforts so that women can demand, and be assured of, the safe delivery of their babies. What will this take?

First, more money is needed—in the order of US$2–7 bil lion per year over the next 7 years. Countries can make real progress toward MDG 5 and contribute to MDG 4 if they scale up deliveries in good-quality health facilities to 95% by 2015. The cost of doing this in the 51 poorest, high-priority countries, while also strengthening their health systems, is $2 billion in 2009, increasing up to $7 billion per year by 2015. 2 This approach includes, for example, ramping up the capacity to assure quality deliveries with an additional 1 million trained midwives, nurses, and doctors. 2

Second, we need to use that money in new and more effective ways that address the identified gaps, strengthen health systems, and promote innovative results-based financing. This can foster 20 local leadership and remove obstacles to good-quality health care. For example, we need to provide financial support to poor women so they can overcome the hidden costs of care—paying for transport to the facility, buying food while they are away from home, and paying for medicines or services that may not be free. We also need to pay performance incentives to health workers in health facilities—public, private, and those run by nongovernmental organisations—to provide good-quality services to poor people. Innovative ways of using funds can lead to substantial changes in a short time.

In India, a programme that pays for mothers to deliver their babies in health facilities has led to a ten-fold increase in beneficiaries (from 700 000 beneficiaries in 2005–06), and is reportedly having a significant effect on increasing institutional deliveries among poor women. 4 In Gujarat, contracting with private obstetricians to provide services to poor women resulted in a major increase in obstetrician assisted deliveries in just 2 years. 5 The introduction of results-based financing in Rwanda has contributed to an increase in birth deliveries in facilities from 39% to 52% over a 3-year period, and a 30% reduction in child mortality (from 152 per 1000 to 103 per 1000 livebirths). 6,7

Governments and development partners must make room for innovation and focus on results rather than inputs. Results-based financing opens the door to addressing barriers to improved performance in decentralised national health services. During the past year, support to do much more on MDGs 4 and 5 has grown considerably. 2 The goals were a prime focus of the G8 Heads of Government meeting in the summer, 8 and the International Health Partnership 9 is building collaboration among key stakeholders in this area. Global funding plays a key catalytic role in fostering innovation and spurring progress, but more is needed. We need to develop the most eff ective channels for that funding and use it to deliver results on the ground. Let us be as bold as the world was at the start of this millennium.

Let us build on that same spirit of urgency and collaboration, and galvanise international action on innovative financing for health and MDG 4 and 5. Let us have an advanced proposal by the Doha Development Financing Conference 10 in late November and conclude next year. Only then will pregnancy and childbirth bring joy, not fear, to the lives of so many mothers in the developing world. We each commit to play our part to ensure a successful and rapid outcome. A child dies every 3 seconds, a mother every minute. We have no time to lose.

Jan Peter Balkenende, Jakaya Kikwete, *Jens Stoltenberg, Robert Zoellick Prime Minister, The Hague, Netherlands (JPB); President, Dar-Es-Salaam, Tanzania (JK); Prime Minister, Oslo, Norway (JS); and President, World Bank, Washington DC, USA (RZ)

[email protected]

We declare that we have no confl ict of interest. 1 UN. End Poverty 2015. 2005. http//:www.un.org/millenniumgoals (accessed Sept 18, 2008). 2 The Global Campaign for the Health Millennium Development Goals. 2008. http://www.norad.no/Globalcampaign (accessed Sept 18, 2008). 3 WHO, UNICEF, UNFPA, World Bank. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. 2007. http:// www.who.int/whosis/mme_2005.pdf (accessed Sept 19, 2008). 4 Routine data from the Monitoring and Evaluation Division, Ministry of Health and Family Welfare. Government of India, 2008. http://health.nic.in/NRHM/MIS/MIS%20for%20NRHM%20as%20on%2030th%20April%202008.xls (accessed Sept 19, 2008). 5 Mavalankar DV, Singh A, Bhat R, et al. Indian public private partnership for skilled birth attendance. Lancet 2008; 371: 631–32. 6 Institut National de la Statistique du Rwanda (INSR), ORC Macro. Rwanda Demographic and Health Survey 2005. Calverton, MD: INSR/OCR Macro, 2006. 7 National Institute of Statistics of Rwanda (NISR), Ministry of Finance and Economic Planning, Ministry of Health of Rwanda, Macro Health International Inc. Rwanda Interim Demographic and Health Survey 2007–08. Preliminary Report. Calverton, MD: NISR/Macro International Inc, 2008. 8 Wikipedia contributors. 35th G8 summit. Wikipedia, The Free Encyclopedia. Sept 21, 2008. http://en.wikipedia.org/w/index.php?title=35th_G8_summit&oldid=239932299 (accessed Sept 23, 2008). 9 International Health Partnership and Related Initiatives, 2008. http://www.internationalhealthpartnership.net (accessed Sept 22, 2008). 10 United Nations Economic and Social Development. Financing for development. Doha Review Conference on Financing for Development, Doha, Qatar, Nov 29 to Dec 2, 2008. http://www.un.org/esa/ff d/index.htm (accessed Sept 19, 2008).

21

The Observer, UK: Why are mothers still dying in childbirth?

More than 500,000 women die in pregnancy or childbirth every year in the developing world due to lack of proper care, report Rebecca Seal and Katrina Manson.

• Rebecca Seal and Katrina Manson, The Observer , Sunday September 28 2008

It is one of the world's greatest hidden epidemics, but the search for a solution is hopelessly underfunded. On average, every minute of every day a woman somewhere dies in childbirth or pregnancy, the overwhelming majority in developing countries.

It is estimated that they number more than half a million every year, in what Norway's Prime Minister, Jens Stoltenberg, told the United Nations last week was 'the biggest expression of brutality to women I can imagine'.

One of the UN's eight Millennium Development Goal s in 2000 was to reduce the ratio of maternal mortality - the number of mothers who die per 100,000 - recorded over the period 1990- 2015 by three quarters. But as the 2015 target date gets ever closer, it has become clear that attempts to lower the death toll have failed.

Even as Sarah Brown, wife of the British Prime Minister, became a patron last week of the campaign to reduce deaths in childbirth, Margaret Chan, director-general of the World Health Organisation, was conceding how little had been achieved. 'Despite two decades of efforts,' she said, 'the world failed to make a dent.'

Chan was addressing a high-level UN taskforce, whose members - including Gordon Brown, the World Bank president Robert Zoellick and French Foreign Minister Bernard Kouchner - are calling for billions more dollars in aid: $2.4bn next year, rising to $7bn by 2015. 'We still have time, but just barely, to make up for this failure,' Chan added. 'The number of maternal deaths will not go down until more women have access to skilled attendants at birth and to emergency obstetric care.'

With almost 99 per cent of maternal deaths occurring in the developing world, the differences in risk for women in those countries, in comparison with Europeans, are staggering. One in every seven women in Niger will ultimately die of pregnancy-related causes, whereas in Sweden the lifetime risk is one in 17,400.

Sierra Leone remains a stark reminder of that contrast, suffering one of the highest maternal mortality rates in the world, with one in every eight women dying in childbirth, according to Unicef. The experience there mirrors that in most of sub-Saharan Africa, where the maternal death rate has remained almost unchanged since 2000.

Thousands of women die every year in childbirth in Sierra Leone, which is at the bottom of the UN's human development index and where life expectancy is 41. Although care is officially free for pregnant women and under-fives, the health service is failing miserably. Only 40 per cent of the population has access to healthcare.

For the million-strong population of the capital, Freetown, there are only 162 government health workers trained to deliver a baby. Countrywide, there is one doctor for every 33,000 people or more, compared with one to 600 in the UK. 'Women are dying unnecessarily in pregnancy and childbirth,' says Barbara Stocking, director of Oxfam, which is calling for universal access to 22 healthcare and for donor aid to go straight to national health budgets. 'It destroys families - children are motherless; husbands without wives; parents lose a daughter; siblings lose a sister.'

The health of mothers is crucial for the survival of families and economies, and cuts to the heart of any society. Pregnant women in Sierra Leone need what pregnant women need everywhere: trained midwives and doctors, access to properly equipped hospitals and essential medicines.

Deaths relating to obstructed labour, eclampsia, severe bleeding, anaemia and infection are often avoidable through simple measures, such as provision of better prenatal care and primary health facilities with trained staff.

Official government policy is to provide free drugs, consultations and essential vaccinations for vulnerable groups, including children under five, children attending school and pregnant and breast-feeding women. Common drugs are also meant to be provided on an affordable basis to everyone.

However, this is far from the reality: a recent survey found 90 per cent of respondents were paying for drugs, 43 per cent for consultation fees and 21 per cent for basic vaccines. In the eastern region of the country, around 90 per cent of those surveyed were still paying for antenatal and under-fives' healthcare.

The White Ribbon Alliance for Safe Motherhood, led by Sarah Brown and supported by Naomi Campbell, Erin O'Connor and Claudia Schiffer, is campaigning to help these women, as are NGOs such as Oxfam.

What can be achieved in this area has been shown by the experience of Sri Lanka, a developing country that now has a trained midwife for every 1,800 people. While Sri Lanka now suffers a total of 190 maternal deaths per year, Niger, which has a smaller population, has 14,000 maternal deaths every year - and only one midwife for every 33,500 people.

Despite the urgent need to reduce the death rate of women in childbirth, Robert Zoellick delivered a note of caution over the UN's ability to raise the billions of dollars that are needed, saying that he was 'concerned' over the impact that the global financial meltdown might have on programmes such as the Millennium Development Goals.

THE OBSERVER, UK: 'We owe it to all women and children'

• Sarah Brown, patron of the White Ribbon Alliance • The Observer , • Sunday September 28 2008

Extracts from a speech to the United Nations last Thursday

It is a great honour to be talking to you today at this Commitment to Progress for Mothers, Newborns and Children event. As far as I know, this is the first time such an event has taken place and the first time that the health of mothers and children has been seriously on the table for so many powerful people. That is a great achievement. 23

Twenty years ago, experts from around the world met in Nairobi to commit to safe motherhood for the half-a-million women dying in pregnancy and childbirth. Since then, researchers, health workers and communities have all agreed what needs to happen to change this situation.

Yet 20 years on, despite fantastic advances in some countries and regions, the same number of women die in childbirth, leaving just as many vulnerable children behind.

If you save mothers, you improve the chances of children. To be able to save mothers and children, you need to invest in education, fill the health worker gap and make health care accessible to even the most vulnerable.

The ingredient needed to unlock progress is political will. We know how to save the lives of mothers and children; we do not need to invent a cure. We simply need to decide to follow in the steps of those who have already succeeded.

Maternal and child mortality rates drop when women are able to have access to skilled health workers. A large part of what is required is the integration of the way health care is provided, the improvement of training standards and the increase in the numbers of qualified health workers.

Maternal and child health lies at the heart of the Millennium Development Goals and touches so many issues that it cannot be tackled vertically. Rather, when resources become available and new initiatives are formed, it is critical that a wide variety of partners work together to make MDGs 4 and 5 a reality.

That is why it is crucial that there are so many people speaking about maternal and child health for the first time now. The challenge is to make sure that the momentum we have created here is maintained. Right now, in this room, we have the political will to commit to work together as government, private sector and civil society. Right now, we have momentum. That momentum must now spread beyond this room.

Each one of us must play our part in making progress towards Millennium Development Goals 4 and 5 and encourage others to join us. We owe it to the millions of women who give birth in fear of their lives. And we owe it to the millions of newborns and children who deserve their future.