Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action JUNE 2014 Kate Holt/Jhpiego Kate Holt/Jhpiego TABLE OF CONTENTS Message from the Administrator 3 Acronyms 4 Summary 5 Introduction 6 A Bold Vision 7 Global Targets Toward Ending Maternal Mortality 8 Achieving the Vision Is Possible 9 USAID’s Strategic Focus 10 Achieving the Vision 11 Measuring Progress 15 Reaching Vulnerable Women and Ensuring Life-Saving Care for All 16 Building on USAID’s Development Capacity 17 Moving Forward 18 References 19 2 | Ending Preventable Maternal Mortality MESSAGE FROM USAID THE ADMINISTRATOR I am very pleased to share with you the U.S. Agency for greater than 140 in 2030. These targets will move us toward a International Development’s (USAID’s) 2014–2020 Maternal world where a mother’s country does not determine her risk of Health Vision for Action to ensure no woman dies from pre- death related to pregnancy. ventable causes as a result of pregnancy and birth. A corner- stone of our commitment to empowering women worldwide, Created with input from our Missions, global health experts this Vision represents a new way of working – one driven by and an array of partners from science and civil society, this cutting-edge data analysis and groundbreaking partnerships Vision will target our resources where they are needed most that deliver real, measurable results. Most importantly, it re- and in the most effective manner. It will enable us to scale up flects the determination and commitment of the U.S. Govern- proven interventions and ensure that gains are sustainable. It ment to end preventable child and maternal death by 2035. will ground our efforts in evidence by investing in cutting-edge measurement and evaluation systems. And it will help us form Across the world, mothers give and protect life, nurture hope game-changing partnerships that allow us to innovate faster and potential and support communities large and small. Yet, for and mobilize more resources. too many women worldwide, bringing children into the world can be dangerous or even deadly. The reality that we know From Nepal to Rwanda, we’ve seen this approach realize today is unacceptable and heartbreaking as nearly 300,000 extraordinary results. By improving maternal and child survival, mothers and 3 million newborns continue to die every year we drive broad-based economic growth and reduce birth rates. from causes we know how to prevent. Families are able to invest more in nutrition, businesses and their children’s education, advancing the next generation of Furthermore, the disparity between rich and poor nations is leaders in the markets of the future. still staggering. Over a lifetime, a woman’s risk of dying as a result of pregnancy and birth in sub-Saharan Africa – at what At its core, this policy provides a blueprint for how we will should be one of the most joyous moments of her life – is work to achieve our vision of sustainable development, em- more than 47 times higher than here in the United States. powering local leaders to direct their own development. We will advocate for rapid progress through pragmatic action plans in With a new model of development grounded by high-impact 24 priority countries, promote public health through country partnerships and affordable, proven innovations, we can make programs and international partnerships, build capacity for strides toward a brighter future for mothers across the develop- scale and sustainability, seize opportunities to work collabora- ing world. We have played a significant role in building consen- tively, and invest in research to continuously advance progress. sus on global targets and the principles and strategies needed Focus also remains on the essential task of strengthening local to improve maternal survival. Important global trends – from health systems, including their financing and governance, hu- lower fertility rates to improved access to education – have man resources and health information technology. further shaped this moment as an unprecedented opportunity to accelerate progress. When a mother dies as a result of pregnancy or childbirth, it threatens her newborn’s chance of survival, lowers her other The Vision for Action for 2014–2020 builds on an improving children’s chances for survival and education, and hurts her evidence base and promotes action-oriented leadership. It fully family and her country’s prosperity. With a smart, focused, in- aligns with new global goals set in Bangkok in 2014: achieve novative approach, we know we can save millions of mothers an average maternal mortality ratio (MMR) of less than 70 per and their children and create ripples of change that transform 100,000 by 2030 and ensure no country will have an MMR the future for all. Rajiv J. Shah USAID Administrator June 2014 USAID Maternal Health Vision for Action | 3 ACRONYM LIST AIDS Acquired Immunodeficiency Syndrome EPMM Ending Preventable Maternal Mortality GH Global Health HIV Human Immunodeficiency Virus MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program MDG Millennium Development Goals MMR Maternal Mortality Ratio OECD Organization of Economic Cooperation and Development UN United Nations UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID U S Agency for International Development WASH Water, Sanitation and Hygiene WHO World Health Organization 4 | Ending Preventable Maternal Mortality SUMMARY Dave Burrows/Jhpiego Burrows/Jhpiego Dave he world has made impressive progress in reducing USAID has been a leading voice in the growing global Tmaternal mortality over the past two and a half decades. consensus to end preventable maternal mortality. Optimizing Despite this progress, 289,000 women worldwide still die maternal health and promoting female empowerment and each year as a result of pregnancy and childbirth. Most of gender equality are fundamental to achieving our mission: these women live in poor nations, and the disparities are im- partnering to end extreme poverty and promote resilient, mense: the lifetime risk of maternal mortality for a woman democratic societies while advancing our security and pros- living in sub-Saharan Africa is over 47 times greater than for perity. Millions of women around the globe still do not re- a woman living in the United States.1 We know that most of ceive the family planning and maternal health care they need these deaths are preventable. Women should not face unequal to survive and thrive. We envision a world where no woman risks of death or disability due to pregnancy and childbearing, dies from preventable maternal causes, and maternal and fetal simply because of where they live. We possess the knowledge, health are improved. Because of the beneficial impact that tools, and resources to end this disparity. With a concerted increased attention and care for childbearing women has on effort from the international community and with strong po- child survival, our efforts to end preventable maternal death litical commitment, we can end preventable maternal deaths will also contribute to the end of preventable newborn and within a generation. child death. Ending Preventable Maternal Mortality (EPMM), now an in- The Vision for Action for Ending Preventable Maternal ternationally accepted goal, reflects a convergence of rich and Mortality endorses an integrated, comprehensive, and holistic poor nations focused on reducing maternal deaths. Our goal is approach to improve maternal and fetal health at the country to reduce the maternal mortality ratio (MMR) to a global aver- level. Emphasis is placed on equity, respect for women and age of less than 70 per 100,000 live births by 2030, and to < 50 convergence of countries in reducing disparities in risk of per 100,000 live births by 2035. maternal death. In 2013, representatives from the World Health Organiza- The Vision outlines the strategic approaches, geographic tion and USAID proposed an ambitious but achievable goal areas of focus, and drivers which serve as a lens and guide for in The Lancet Global Health to reduce the global average MMR targeted, context-specific, country-based programming that to less than 50 per 100,000 live births by 2035.2 This level is will result in sustainable programs and improved maternal and the equivalent of the high end of Organization for Economic fetal health. In partnership with a wide array of stakeholders, Cooperation and Development (OECD) countries in 2010. USAID will advocate rapid progress, promote public health Subsequent to The Lancet article, at an April, 2014 meeting hosted through country ownership and international partnerships, by the WHO, the Maternal Health Task Force, United Nations build capacity for scale and sustainability, support innovation, Population Fund, USAID and the Maternal and Child Health seize opportunities to work collaboratively across disciplines Integrated Program, representatives from 30 countries agreed on and sectors, and invest in evidence and research to drive a 2030 global target MMR of less than 70 per 100,000 live births, progress toward the goal. For USAID, ending preventable ma- with no country level greater than 140. The 2030 target places ternal mortality is a development challenge as well as a health the world on a trajectory toward 2035 and the convergence of challenge, and as a development agency, USAID has unique rich and poor nations for risk of maternal death. Achieving these contributions to inform the global agenda to make the EPMM goals would effectively end preventable