Lord Green of Hurstpierpoint
My Lords, as I rise to make my maiden speech, I am conscious that it is customary to thank the staff of the House for all their help, as I begin like a new boy at school to find my way around. Although everyone promised that this would be so, it is an absolute delight to find just how true it is. My thanks are absolutely the reverse of perfunctory.
My thanks go, too, to my sponsors, the noble Lord, Lord Griffiths of Fforestfach, and the noble Baroness, Lady Warwick of Undercliffe. Both are close friends of mine. The fact that one sits on these Benches and the other on the Benches opposite matters to me not a jot. I am normally happy to follow the conventions of the House, but on this occasion at least I can say that both, and indeed others on various Benches of this House, are my noble friends.
I thank the noble Lord, Lord Patel, for introducing today’s debate on maternal health in the context of the millennium development goals. I am keen to contribute, as I have taken on the role of Minister of State for Trade and Investment. I believe passionately that there is a vital connecting thread between trade and investment and the millennium development goals. My own perspective is formed not only by having worked in international management consulting, followed by an extensive career in international banking, but by having begun my working life in DfID, or rather its predecessor, the Overseas Development Administration, as it was then known.
I make four brief points. First, the various millennium development goals are of course intrinsically linked. The most obvious example of that, and directly relevant to today’s debate, is the connection between progress on gender equality, which is goal 3, improved maternal health, which is goal 5, and reduced child mortality, which is goal 4. The evidence is clear: children in poor communities are 10 times more likely to die before the age of five if the mother has died. The link, too, with disease—goal 6—is clear. HIV is the leading cause of death in women of reproductive age in sub-Saharan Africa and malaria alone is responsible for 20 per cent of child mortality there.
Secondly, progress in meeting the goals is mixed. There have been some important gains, with good progress in eradicating extreme poverty—goal 1. Some countries have made astonishing progress. China, for example, has lifted literally hundreds of millions of people out of poverty in recent years. Yet the mountain is still high and there is a long way to climb. Demographic patterns have meant that absolute numbers have declined much less sharply than the ratios of poverty, and the absolute numbers remain high by any standard. More broadly, across a range of targets, there is a long way to go. We have heard from a number of noble Lords about the difficulties in respect of maternal health.
Thirdly, specific interventions can be powerfully effective. Well targeted ODA and NGO-supported programmes in areas such as fistula can make a real difference to many people’s lives and indirectly to even more lives through the effect on children.
Fourthly, none of this will ever add up to sustainable, comprehensive well-being without progress—real progress—on goal 8. On the face of it, this is the woolliest goal of all. It seems like a ragbag of ideas bundled together as the last goal but it includes the all-important challenge to further develop,
“an open, rules-based, predictable, non-discriminatory trading and financial system”.
This is critical to everything else that we do. It is certainly not sufficient but it is absolutely necessary. Historians will note the importance of the words of the G20 communiqué from London in April 2009, where the heads of the Governments of 80 per cent of the world’s economy said that we start from the belief that,
“the only sure foundation for sustainable globalisation and rising prosperity for all is an open world economy based on market principles, effective regulation and strong global institutions”.
I see this as the basis for real hope. It is easy to be cynical, but that would be wrong. There is plenty to do. Progress is mixed and there are many lessons to be learnt from the global financial and economic crisis. One lesson not to learn, if we really care about the aspirations that infuse the development goals in general and goal 5 in particular, is the notion of some alternative to a central role for open, market-based engagement—properly supervised—as the main engine of the economic and social development that is essential if we are to banish today’s unacceptable levels of child and maternal mortality for good.
Trade and investment is an area of policy focus for the UK that is critical not only to the UK’s own ability to deliver sustainable growth for its citizens, which it certainly is, but also to the wider goal of a prosperous, open, growing world economy that is sustainable and inclusive. This aspiration is both our wider responsibility and in our wider interest.
Baroness Verma
My Lords, I thank the noble Lord, Lord Patel, for securing this important and very timely debate. From the level of interest, the number of speakers and the wit, knowledge and wisdom of your Lordships’ House, today yet again highlights the great strength of your Lordships’ knowledge. I know that time will not permit me to answer all questions today, so I ask noble Lords to allow me to write to them if I do not answer theirs. I join all noble Lords in congratulating my noble friend Lord Green of Hurstpierpoint on his most excellent maiden speech. I am sure that it was just a tiny nugget of the superb contributions that my noble friend will bring to your Lordships’ House, as well as carrying out his ministerial duties as our trade Minister, a field in which he already has enormous recognition.
We all know that millennium development goal 5, to improve maternal health, is one of the most off-track MDGs. Each year, more than a third of a million women and girls die in pregnancy and childbirth and some 50 million give birth without skilled care. There is not much with which I can disagree in what noble Lords have said today—there is so much to be done. But I assure all noble Lords that this Government are determined to do their best to meet all the targets that we are setting ourselves.
For every woman who dies, up to 30 more suffer a debilitating illness or permanent disability, as the noble Lord, Lord Patel, has highlighted, which is often accompanied by stigma and discrimination. I congratulate the noble Lord on the work that he and his organisation are doing. I am sure that the department would be pleased to hear much more about it.
On the question of how we measure what we are doing, the framework sets out how we will clearly measure our outputs, our programmes and of course our end results. Most deaths in pregnancy and childbirth in developing countries are entirely avoidable. Globally meeting the unmet need for family planning alone could avoid around one-third of maternal deaths and one-fifth of newborn deaths. Yet 215 million women who want to delay or avoid a pregnancy are not using an effective method of family planning. Each year there are 75 million unintended pregnancies, of which 44 million end in abortion. In 2008, an estimated 22 million unsafe abortions took place, resulting in around 70,000 maternal deaths.
I agree that conflict can seriously aggravate the challenges of tackling maternal mortality and morbidity, such as the high levels of sexual violence, as the noble Lord, Lord Chidgey, pointed out, which is why we support the UN Security Council resolution and its sequels to demonstrate the international commitment to improving the lives of women affected by conflict. The UK Government strongly support those efforts, as we have encapsulated in a new national action plan on women, peace and security, which was launched in November 2010. The Government are reorienting the development programme to put women at its heart, empowering women to make their own choices for their health and the health and well-being of their families.
The benefits of investing in women’s health are far reaching. Improved reproductive health can improve the status of women, enabling them to live free from maternal illness and to make choices about their bodies and lives. Improving women’s health during pregnancy and childbirth saves not just their lives but those of their children. Meeting the demand for family planning services, together with wider investments in education and women’s empowerment, will reduce unwanted fertility and slow population growth.
All those improvements would all have much wider benefits for families, societies and economies, as my noble friend Lord Green has pointed out. The millennium development goals, for example, will help eradicate household poverty, and will have a national benefit when mothers and babies are healthy and when high fertility rates fall.
The case for investing is strong. Evidence tells us that investing in reproductive, maternal and newborn health is excellent value for money. Family planning is one of development’s best buys in global health due to its low cost and far-reaching benefits. Responding to the unmet need for family planning will be one of the defining international development priorities of this Government.
The debate, of course, is very timely. On 31 December 2010 the Government’s new Framework for Results for improving maternal, reproductive and newborn health was published. Called Choices for Women: Planned Pregnancies, Safe Births and Healthy Newborns, it sets out how the UK will double its efforts on women’s and children’s health over the coming years.
The Government’s two main aims are to prevent unintended pregnancies by enabling women and adolescent girls to choose whether, when and how they have children, and to ensure that pregnancy and childbirth are safe for mothers and babies. The Government will double the UK’s efforts on women’s and children’s health to save the lives of at least 50,000 women during pregnancy and childbirth and 250,000 newborn babies by 2015; to enable at least 10 million more women to use modern methods of family planning by 2015, including up to 1 million young women; to prevent more than 5 million unintended pregnancies; and to support at least 2 million safe deliveries, ensuring long-lasting improvements in quality maternal health services, particularly for the poorest 40 per cent. This doubling of effort is backed by the doubling of resources for women and children’s health, as announced by the Deputy Prime Minister at the UN summit in 2010.
The noble Baroness, Lady Kinnock, asked about funds. This Government have pledged to enshrine in law 0.7 per cent of GNI by 2013. This is the UK’s contribution to an international global push to improve maternal health, supporting the United Nations Secretary-General’s global strategy for women’s and children’s health, which was agreed in September. Our new Framework for Results outlines a comprehensive approach to improve maternal health from before and during pregnancy, through delivery to the very important first few hours and weeks after birth, known as the continuum of care. It places a particular emphasis on reaching those who often find it the hardest to access services.
The framework has four pillars for action: to empower women and girls, to remove barriers, to expand the supply of quality services and, most importantly, to enhance accountability. We will implement these pillars across DfID’s country programmes. We will focus where the need is great and where the UK has a comparative advantage. We will improve the effectiveness of the global response, including that from international institutions and civil society. We will harness the UK’s expertise to improve maternal health in the developing world. To ensure that commitments are made a reality, though, we need good intentions, action at scale and clear, demonstrable outcomes that are tracked and monitored. The core results in the framework will be the basis by which we and others will monitor our performance in achieving our aims across our programmes.
My noble friend Lord Black is right: better transparency and accountability, of which a free press is a part, will contribute to improved service of delivery. The Framework for Results recognises the role that the media can play in enhancing accountability between women and wider civil society, service providers and governments.
The noble Lord, Lord Patel, asked about the framework and how it would be done. It sets out how we are going to achieve overall results, and a series of current reviews will be completed on all our DfID programmes, which we will then develop into operational plans over the coming months. We want to ensure that programmes are targeted towards those who will have the best possible opportunity to have improvement in their lives.
I know that this debate has stirred a lot of emotion among noble Lords, and with so many speakers it would be difficult to respond to each individual question. I hope that noble Lords will allow me to write to them in depth.
We have a unique opportunity. The United Kingdom wants to be at the heart of making progress in ensuring that MDG 5 is achieved by 2015. The UK will play its part, but noble Lords in this Chamber have so much expertise and wisdom that they are duty bound to ensure that they also help us in developing our programmes. We are always open to discussion, and we hope that noble Lords will take every opportunity to discuss the programmes with us.
Once again, I thank all noble Lords for their contributions. I thank my noble friend Lord Green for his immensely important contribution, and I look forward to hearing more from him.