Over the last three days, 700 technical experts have provided solutions to decrease maternal mortality. In the last year, governments have committed billions of dollars to implement such solutions. Yet, we’ve been here before, reminded Sigrun Mogedal of the Norwegian Ministry of Foreign Affairs during the final plenary session of the Global Maternal Health Conference. “Just look at ICPD, Beijing, and CEDAW. Obviously, there must be something wrong with accountability,” she said, since 15 years later women continue to die every minute giving birth.

Wrapping up the conference with a discussion of accountability makes sense – we need to learn from the past and close the gap between commitments made and real action on the ground. So what does today’s buzzword, “accountability,” mean, and how do we enforce the realization of commitments made…or lack thereof?

“Accountability is power, and includes transparency, answerability, and enforceability,” said Lynn Freedman of Columbia University. Through international law, budget transparency, and grassroots mobilization it is possible to ensure that policies make a difference to improve women’s lives.

A review of the Ministry of Finance’s allocation for health can tell us a lot about the government’s real commitment to eradicating maternal mortality. As the overarching instrument of policy the “budget is inextricably linked to development and exists for those who have less,” said Helena Hofbauer of the International Budget Project. “If there were greater transparency of government spending, we could have done more to push for change five years ago,” said Hofbauer. This is indeed true; however, it is also true that if governments simply followed through on the international agreements they are signatories to, women would be better protected.

Accountability through the legal system is possible and Nancy Northrup of the Center for Reproductive Rights demonstrated how international law has overhauled programs and sparked governments into action. For example, in India, the high court recently ruled that the government must execute audits and report back on the steps taken to align programs with policies that ensure a woman’s right to skilled birth attendance.

In order to bring about such judicial interventions a social movement must first be in place to build awareness and demand accountability. Building such a movement starts at the grassroots level and Aparajita Gogoi of CEDPA presented strategies for empowering local communities with a global voice. By providing a safe space for dialogue, communities are given the opportunity to share concerns and demand action from local health facilitators and government officials.

Increasing opportunities for dialogue allows for bottom up solutions and ensures that contextual variables are taken into consideration. “We need arenas for brokering diverse groups to compare notes and streamline synergies, ” said Mogedal. I am energized by the lessons learned today and eager to apply these key messages next week in Washington, DC during the seventh meeting of the Advancing Policy Dialogue for Maternal Health at the Woodrow Wilson International Center for Scholars that will further address “Monitoring, Transparency, and Accountability for Maternal Health.”

Originally posted on the Medscape blog Global Mamma, by Calyn Ostrowski of the Woodrow Wilson International Center for Scholars, Coordinator of the Maternal Health Dialogue Series in partnership with the Maternal Health Task Force and UNFPA.

Photo Credit: “Mothers and children waiting at the Bolemba healt centre” courtesy of flickr user hdptcar.

Four days ago a young woman died giving birth in a bustling marketplace in New Delhi. Just steps away from Parliament, this woman was left to die and no emergency care was sent to her – no midwives, nurses, or doctors; just people walking around her accepting the situation as normal and an uncontrollable way of life. But this is Delhi…not a remote tribal village where the nearest health clinic is hours away (on foot).

This juxtaposition lingers on in me as I sit in the plenary session of day two at the Global Maternal Health Conference and listen to Syeda Hameed, member of the Indian Parliament Planning Commission, discuss her recent visit to a remote village where every house has 10 children living in filth, flies, and emptiness.

Although I have been working on such development issues for the last five years I do not work in the field, nor do I visit the developing world on a regular basis. Hearing these stories, coupled with my firsthand experience of witnessing poverty here in Delhi reminds me of the daily reality of those 342,900 women who die every year. This is their way of life and I think it’s poignant that today’s sessions emphasize community based care, family planning, accountability, behavior change, and culture.

“Context, context, context,” said Wendy Graham of IMMPACT at yesterday’s plenary session. I agree, the context of social and cultural norms is an underlying factor that must be taken into consideration when implementing maternal and child health (MNCH) programs. With a background in psychology, I appreciated when Dr. Zulfiqar Bhutta, of Aga Khan University, recognized the toll of poverty on the imagination and the mentality of fatalism.

That is why it is so essential to “ask the people how they feel and bring their voices into the forums where policy decisions are made,” said Hameed. It is also important to hold key players accountable and include men in MNCH activities.

During the side session Male Involvement in Reproductive and Maternal and Newborn Health six field experts (in which half the panelists and audience members were men!) discussed effective methods for increasing male participation in family planning, vasectomies, gender equality, and hospital care.

The key findings from this discussion include:

• Targeted interventions that educate men about danger signs and pregnancy complications correlates with behavior change and increased facility births.
• Many young married men feel pressured to prove their fertility. A sample of men was evaluated and those who had increased education and income were more likely to delay first pregnancy.
• Vasectomy is not something men want to talk about with family planning fieldworkers; however, official recognition of the vasectomy benefits by the government did increase referrals.
• Puppet and theater shows that demonstrate gender equity behaviors provide an opportunity for dialogue. Women in this study reported increased gender equity in family planning decision-making.

There are so many variables that exacerbate the maternal mortality cycle, but evidence presented here provides REAL solutions. It is time to scale up these solutions and political willpower will be essential.

Originally posted at Maternal Health Task Force, by Calyn Ostrowski of the Woodrow Wilson International Center for Scholars, Coordinator of the Maternal Health Dialogue Series in partnership with the Maternal Health Task Force and UNFPA.

Photo Credit: “Parliament Street” courtesy of flickr user ~FreeBirD®~.

As the final American combat brigade pulls out of the country, the prevailing opinion in the United States about Iraq at the moment seems to be one of “bad politics are better than no politics,” and that despite continued violence (albeit significantly lessened from 2006-2007 levels), the American mission is largely finished. However, serious challenges remain, one of the most significant being the government’s continued inability to supply basic services to a growing population.

“We do not need new legislation… we need affordable, effective, and scalable solutions,” said Shn Gulamnabi Azad, Minister of Health, India, at the opening ceremony of the first-ever Global Maternal Health Conference in New Delhi. Co-hosted by the Maternal Health Task Force and the Public Health Institute of India, this three-day technical meeting builds upon the momentum of Women Deliver and the G8 summit by bringing together 700 researchers, program managers, advocates, media, and young people to exchange ideas, share data, develop strategies, and identify solutions for reducing maternal mortality.

In order to reduce India’s maternal mortality rates, Azad called for the repositioning of family planning programs to include maternal and child health and not limit the scope of services to population control as historically executed. Improving family planning and maternal health services must also address the reproductive health needs of adolescent girls, and India is currently developing a new ministry that will target gender inequality, poverty, early child marriages, as well as other critical health issues important to young girls such as the dissemination of sanitary napkins.

“Although the legal age of marriage is 18, there are districts in India where 35 percent of the population is married between the ages of 15-18,” said Azad. During the side event “Adolescent Girls: Change Agents for Healthy Mother and Child,” technical experts such as Anil Paranjap of the Indian Institute of Health Management presented evidence that girls who marry between 15-18 are five times more likely to die during childbirth than women in their early 20’s.

“We still have deep-rooted subordination that makes it very difficult for young women to realize their sexual and reproductive health rights,” said Sanam Anwar with the Oman Medical College. Interventions such as the UDAAN project – a private-public partnership between the Center for Development and Population Activities (CEDPA) and the Government of India – demonstrate promising solutions for empowering young people through the use of existing infrastructure. In collaboration with teachers, parents, principals, and students, this project successfully increased leadership skills and improved youth knowledge on menstruation, health, friendship, peer pressure, early marriage, and reproductive health, said Sudipta Mukhopadhyay of CEDPA.

Empowering “young people” to improve maternal health also requires that the community support committed new thinkers and future leaders. The Young Champions of Maternal Health Program is a unique and refreshing group of young professionals from 13 countries dedicated to improving maternal health, and I look forward to learning how this new energy will further the maternal health agenda.

Originally posted at Maternal Health Task Force, by Calyn Ostrowski of the Woodrow Wilson International Center for Scholars, Coordinator of the Maternal Health Dialogue Series in partnership with the Maternal Health Task Force and UNFPA.

Photo Credit: “Indian Girl” courtesy of flickr user Jarek Jarosz.

The 2010 Global Maternal Health Conference kicked off today, perhaps fittingly, in India – one of the world’s fastest growing nations but one that also faces serious reproductive health challenges. The Wilson Center’s Calyn Ostrowski is in New Delhi for the conference and will be providing updates to The New Security Beat throughout the week.

Those interested can also find a schedule of events and list of participants on the conference website as well as live webcasted events on the main page. Stay tuned!

Photo Credit: “Mumbai, India, November 2009” courtesy of flickr user travelmeasia.

“Staggered by the scale of destruction from this summer’s catastrophic floods, Pakistani officials have begun to acknowledge that the country’s security could be gravely affected,” reports the Washington Post. The Pakistani government – already cash-strapped between fighting “the war on terror” and trying to prevent an economic collapse – now faces recovering from the worst flooding in over 80 years.

This month’s Foreign Policy has two features on India’s ongoing internal conflict with Maoist and tribal rebels – perhaps the least known insurgency and resource conflict in the world.

By Marie Rumsby of the Royal Society’s In Verba blog.

In the years that followed the Iranian revolution, when Ayatollah Khomeini returned from exile to Tehran and the country went to war against Iraq, the women of Iran were called upon to provide the next generation of soldiers. Following the war the country’s fertility rate fell from an average of over seven children per woman to around 1.7 children per woman – one of the fastest falls in fertility rates recorded over the last 25 years.

Iran is an interesting example but every country has its own story to tell when it comes to population levels and rates of change. The global population is rising and is set to hit 9 billion by 2050. And whilst fertility rates in Ethiopia are on the decline, its total population is projected to double from around 80 million today, to 160 million in 2050.

Earlier this month, the Royal Society announced it is undertaking a new study which will look at the role of global population in sustainable development. “People and the Planet” will investigate how population variables – such as fertility, mortality, ageing, urbanization, and migration – will be affected by economies, environments, societies, and cultures, over the next 40 years and beyond.

The group informing the study is chaired by Nobel Laureate Sir John Sulston FRS, and includes experts from a range of disciplines, from all over the world. With names on the group such as Professor Demissie Habte (President of the Ethiopian Academy of Sciences), Professor Alastair Fitter FRS (Professor Environmental Sciences, University of York) and Professor John Cleland FBA (Professor of Medical Demography, London School of Hygiene and Tropical Medicine), there’s bound to be some lively discussions.

Linked to the announcement of the study, the Society held a PolicyLab with Fred Pearce, environmental journalist, and Jonathon Porritt, co-founder of Forum for the Future, to discuss the significance of population in sustainable development.

Both speakers have been campaigning against over-consumption for many years. Jonathon Porritt has been a keen advocate for fully funded, fully engaged voluntary family planning in every country in the world that wants it.

“In my opinion, that would allow us to stabilize global population at closer to 8 billion, rather than 9 billion. And if we did it seriously for forty years, that is an achievable goal.” Porritt thinks that stabilizing global population at 8 billion rather than 9 billion would save a large number of women’s lives, and suggests “you cannot ignore the gap between 8 billion and 9 billion if you are thinking seriously about climate change.”

Fred Pearce acknowledges that population matters, but stresses that it is consumption (and how we produce what we produce) that we need to focus on. He feels it is too convenient for us to focus on population.

According to Fred, the global average is now 2.6 children per woman – that’s getting close to the global replacement level of 2.3 children per woman.

“It is no longer human numbers that are the main threat……It’s the world’s consumption patterns that we need to fix, not its reproductive habits,” said Pearce.

The Society will be taking a long look at some of these issues, assessing the latest scientific evidence and uncertainty around population levels and rates of change. The “People and the Planet” study is due for publication in early 2012, ahead of the Rio+20 UN Earth Summit. The Society is currently seeking evidence to inform this study from a wide-range of stakeholders.

The deadline for submissions is October 1, 2010. For more information on submissions, please see the Royal Society’s full call for evidence announcement.

Image Credit: “In Verba” courtesy of the Royal Society.