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Reproductive Health Matters. 2009 May; 17(33):91-104.This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
In: Family planning. Meeting challenges: promoting choices. The proceedings of the IPPF Family Planning Congress, New Delhi, October 1992, edited by Pramilla Senanayake and Ronald L. Kleinman. Carnforth, England, Parthenon Publishing Group, 1993. 7-14.The International Planned Parenthood Federation (IPPF) has been guided by the belief that family planning is a basic human right. The United Nations Population fund (UNFPA) and IPPF have had a long-standing cooperative relationship in this arena. Family planning is not only a human right, it is a necessity; projections indicate that world population will increase to 8.5 billion by 2025 and to 10 billion by 2050. The high and medium projections diverge sharply after the year 2000 depending on the effect of family planning acceptance and the spread of contraceptive prevalence. In 1989 the international community set a target of increasing contraceptive prevalence in developing countries from 387 million to 567 million by 2000. First the existing need for FP has to be met, since about 400 million couples do not have access to services. At least 150 million would use FP if services were available. The total cost of providing FP services would be $9 billion annually, which is a minute amount compared to total military expenditures. The positive impact of FP depends on voluntary acceptance, age, family, status, and parity, which fact rules out setting quotas or targets. A choice-based approach is preferred, which negates single-method FP programs. FP policies can succeed only if they invest in women with regard to education: this could end early marriage. The growing problem of adolescent pregnancy also has to be tackled. Maternal mortality and morbidity can be prevented by existing medical technology to treat their causes (hemorrhage, hypertension, infection, obstructed labor, and unsafe abortion). The promotion of breast feeding is important both for the child's health and for its temporary contraceptive effects. FP programs should also combat HIV/AIDS by providing information and counseling for women. In recent years the quality of care has come to the forefront in FP clinics where accessibility, privacy, and confidentiality of services are needed.
In: Women's health and apartheid: the health of women and children and the future of progressive primary health care in Southern Africa, edited by Marcia Wright, Zena Stein and Jean Scandlyn. New York, New York, Columbia University, 1988. 84-9.There is a large discrepancy between maternal mortality rates in developed and developing countries, with maternal mortality as a leading cause of death of young women in poor countries. There has been renewed interest in maternal mortality among international agencies and major foundations quite recently. Women and children form up to 2/3 of the population of many developing countries, and over 1/2 of primary health care resources are devoted to maternal and child health programs. Nevertheless, little of this is directed at maternal mortality; most goes to immunization, oral rehydration for diarrhea, monitoring children's growth, and promoting breastfeeding. While some of the international health community attribute the long neglect of maternal mortality to not knowing the extent and severity of the problem before, prior data existed demonstrating the alarmingly high rates. Low maternal mortality in the West may have distracted attention from the international problem. Sexism may have been a major factor, as even today efforts to reduce maternal mortality need to be justified in terms of the implications for the family, children and society as a whole. The reasons for the current concern are not clear, but may relate to an interest in concrete issues after the United Nations Decade for Women, or real surprise in the international community once the problem was pointed out. As various agencies rush to establish maternal mortality programs, it is imperative to evaluate which approaches will be really effective. Critical evaluation of programs is necessary to capitalize on the current interest.