Developing World: Maternal and Neonatal Mortality
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The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)
My Lords, like other noble Lords, I pay tribute to the noble Baroness, Lady Hayman, for securing today’s debate, and for her long-standing commitment to maternal and neonatal health. I commend the other contributions we have heard today, which, as ever in your Lordships’ House, have ranged very widely. I also thank noble Lords for their tributes to DfID for our work. We have heard the devastating figures, and as my noble friend Lady Hodgson pointed out, a human face was given to those figures.
The noble Baroness, Lady Hayman, my noble friend Lady Hodgson, the noble Baroness, Lady Kinnock, the right reverend Prelate, the noble Baroness, Lady Tonge and now the noble Lord, Lord Collins, have all pointed out that this relates fundamentally to the rights of women and their unequal status, unequal access to nutrition and education and being forced into early marriage—we have heard the range of challenges. Gender inequality is key.
This is a very timely debate, coming right at the start of 2015, the final year of the millennium development goals and the year in which new goals will be agreed at the UN in September. Globally, as the noble Baronesses, Lady Hayman and Lady Tonge, said, we have made significant progress in reducing maternal mortality. The maternal mortality ratio dropped by 45% between 1990 and 2013. Each region of the world has seen significant improvement, though none, as noble Lords pointed out, has yet reached the goal of a 75% reduction in mortality.
These improvements have been driven largely by more women having access to skilled birth attendants—nearly 70% of births now take place with a skilled attendant. I note what the noble Baroness, Lady Tonge, and the noble Lord, Lord Alton, said about the high level of maternal morbidity. I pay tribute to the All-Party Parliamentary Group on Population, Development and Reproductive Health for its outstanding report, Better off Dead?, as well as to the work on fistula by the noble Lord, Lord Patel. It is not just a matter of physical morbidity. As my noble friend Lady Hodgson pointed out, the mental health of mothers is key. I hope that my noble friend will be pleased to note that mental health is included in the targets for the SDGs proposed by the open working group.
The noble Baroness, Lady Hayman, noted the number of neonatal deaths and that it had not moved in the direction that maternal mortality had. The MDGs did not include targets for newborns; consequently, they received less attention and less progress has been made. The noble Lord, Lord Patel, in particular emphasised how much more we still need to do. Nearly 3 million newborns still die every year, accounting for around 44% of all deaths of children under five, and 1 million of these die on their first day of life, as noble Lords noted. Eighty-five per cent of newborn deaths result from three preventable causes, as the noble Lord, Lord Patel, and other noble Lords pointed out.
The noble Lord, Lord Patel, emphasised the high incidence of neonatal deaths in a few countries, identifying particularly large numbers in the populous countries of India and Nigeria—the noble Lords, Lord Collins and Lord Alton, made reference to that as well. As the noble Lord, Lord Patel, noted, it is shocking to see the proportion of babies not breastfed in the first 24 hours. I was shocked when I visited India early last year to discover that this was indeed widespread. I can assure the noble Lords, Lord Patel and Lord Alton, that prioritising women and girls and seeking to address neonatal health is uppermost in our discussions in India. My right honourable friend Lynne Featherstone has been to India this week as a champion to combat violence against women and girls, so it is very high in the Government’s priorities.
As noble Lords made clear, faster progress in these crucial areas will be achieved only when girls and women are able to access the care and services that they need when they need them. They include better nutrition, access to education and access to clean water and sanitation. The United Kingdom has a strong track record of working to improve maternal and newborn health—and I thank noble Lords again for their tributes. In 2010, we made commitments to save 50,000 maternal lives and 250,000 newborn lives by the end of 2015, and we intend to meet them. We have already exceeded our target for maternal lives saved through a combination of increased investments in family planning, skilled birth attendants and making health systems stronger—all issues that noble Lords addressed. A number of noble Lords emphasised family planning, and we share their view that this is crucial, which is why we emphasised it at the London summit in 2012. A recent report shows that we are broadly on track to meet our commitments. Nevertheless, we are not complacent; we know how extremely important that issue is.
I agree with the noble Baroness, Lady Kinnock, that we need to make sure that we have adequate funding for sexual and reproductive health and that that includes funding from the country Governments themselves. The summit was encouraging, and I hope that the noble Baroness was able to see the commitments that came forward. We need to make sure that those are delivered. We agree that it is vital that girls and women should be able to access comprehensive packages of sexual and reproductive health.
Ensuring that the post-2015 development agenda continues to advance the social, economic and political empowerment and human rights of girls and women remains a top priority for the United Kingdom, and we will continue to work tirelessly to ensure that the final framework advances the needs of girls and women. The noble Baroness, Lady Kinnock, mentioned prioritising what women want in terms of safe abortion. Where girls and women have taken the decision to terminate a pregnancy, our aim is to ensure that they do not put their own lives at risk. Improving access to safe abortion saves maternal lives and reduces maternal ill health; I stress that very strongly.
Beyond international targets, we know what is needed on the ground. We need to see high-quality reproductive midwifery and emergency obstetric services being delivered through well functioning health systems. There is much more that we need to do. Most of these deaths are preventable. We must ensure that clear targets for improved sexual and reproductive health and rights are included to prevent maternal and newborn deaths. They must be secured in a post-2015 framework. We are working extremely hard on this and anything that noble Lords can do working with southern voices in these next crucial months is vital.
My noble friend Lady Tonge mentioned the omission of “sexual rights” from the UN Secretary-General’s recent synthesis report. This report is one of many inputs into the process. We still wish to see the full sexual and reproductive health and rights package reflected in the final framework. We need to ensure that women can access contraceptives if they wish to prevent pregnancy and, if they become pregnant, have access to skilled health workers who have the right drugs and equipment at the right time in the right place to be able to respond to complications during pregnancy and childbirth. I was very moved at the Christian Aid carol service to hear some of the stories from Kenya.
We need health financing systems that mean women do not have to make choices between accessing care and feeding their families. I agree with the right reverend Prelate in terms of finance that a sustainable solution can come only when countries finance their own healthcare adequately. He is absolutely right that tax reform is a key part of that.
We need supporting information systems that tell us whether our efforts are working and how and where to improve them, ideally taking advantage of new technologies, as the noble Lords, Lord Alton, Lord Collins and others mentioned. All this is why universal health coverage must be an important part of the post-2015 agenda. Strong health systems are vital. It is because Sierra Leone and Liberia have fragile health systems as fragile countries that the Ebola epidemic was able to take hold. That is why we are involved in such countries and why such health strengthening has received 20% of DfID’s budget.
We need to continue to work on the social determinants of health, such as poverty, better nutrition, education, and so forth, as I have said. Crucially, as noble Lords have made clear, we need the empowerment of girls and women, to enable them to have voice, choice and control within their households, their wider communities and across their nations. Noble Lords have made a powerful case for that. That means working at every level. I agree with the right reverend Prelate that that clearly involves working at community level and we have our aid-matching system as one of the key mechanisms for that. There are others in our portfolio of support for civil society.
All this is doubly important when we are talking, as noble Lords have, of the hardest-to-reach groups: the youngest, the poorest, the most geographically isolated and those affected by conflict—those left behind by the progress towards the current MDGs. That is why the new set needs to ensure that they leave no one behind. More rapidly declining rates of maternal and newborn deaths will tell us when we are getting this right.