Developing World: Maternal and Neonatal Mortality

Lord Collins of Highbury Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this important debate.

As we have heard, the UN estimates that over the past two decades the under-five mortality rate has almost halved; and the number of deaths of children under five is being reduced faster than at any time in the past two decades, partly due to increased access to vaccination against deadly childhood diseases. As we have heard, the number of women dying in pregnancy and childbirth has also been cut by almost half in the same period.

However, as we heard from the noble Baroness, Lady Hayman, this progress has not been even because women, adolescents and children from poor and marginalised communities are being left behind. Noble Lords have referred to the fact that nearly 800 women die every day in pregnancy and childbirth, and HIV/AIDS remains the leading cause of death for women aged between 15 and 44.

With little control over their lives, millions of adolescent girls are forced into early marriage, putting them at risk of complications from pregnancy and HIV at a young age. Faced with an unintended pregnancy, many women and girls resort to unsafe abortion, which accounts for 13% of all maternal deaths; and for every woman who dies, 20 others suffer illness, injury or disability.

As we have heard, mothers and babies face the greatest risks in sub-Saharan Africa, which accounts for 62% of all maternal deaths, followed by south Asia, with 24%. As the noble Lord, Lord Patel, said, two countries account for one-third of all maternal deaths: India, with 17%, and Nigeria, with 14%. It is worth repeating these statistics, because those are countries that we now consider middle-income countries, which do not need development support. But inequality there is growing rather than diminishing.

The noble Baroness, Lady Hayman, highlighted the maternal mortality ratio, showing the highest discrepancy of all health indicators—the gap between high and low-income settings. Sierra Leone has been mentioned: it is estimated to have the highest MMR, at 1,100 per 100,000 live births—and as we have heard, this estimate is from 2013, before the Ebola epidemic. There is emerging evidence that as a result of the Ebola epidemic more maternal deaths are occurring, both as a result of the virus and as a result of lack of availability of routine care, with the focus on care for patients with Ebola and the collapse of existing health systems—which were, as we have heard, incredibly weak already. I do not know how many noble Lords heard the BBC’s excellent report yesterday highlighting the additional risks to healthcare workers treating pregnant women with Ebola. It was a shocking story.

We have heard about millennium development goal 5a, to reduce maternal mortality by 75% between 1990 and 2015: 11 countries are “on track” to meet it, 63 countries are “making progress”, and 13 are “not on track”. Factors associated with making progress include leadership, working in partnership, using evidence, and being innovative and able to adapt using both long and short-term strategies.

Maternal and newborn health are closely linked. As we have heard, motherless children are up to 10 times more likely to die within two years of their mother’s death. More than 6 million children under five died last year, primarily from complications of prematurity and birth, pneumonia, malaria and diarrhoea, with under-nutrition a major factor. The survival rate of the most vulnerable children—newborns—is improving too slowly: 44% of deaths under the age of five occur in the first month.

As we have heard, nearly all maternal, child and newborn deaths are preventable. Strong health systems, with sufficient skilled health workers and reliable supplies of affordable essential commodities, medicines and vaccines, providing equitable access to universal health care, are critical. Proven strategies to improve maternal and newborn health include increasing access to quality care in pregnancy and childbirth, including emergency obstetric and newborn care, reproductive healthcare and information, family planning services and, most importantly, safe abortion.

Poor nutrition is an underlying factor in almost half of all child deaths under the age of five. The UK Government are a leader in the fight against hunger and under-nutrition, but can the Minister assure the House that all bilateral maternal and child health programmes include a strong nutrition component? The next Labour Government will put universal health coverage at the heart of the global development agenda. Universal health coverage affirms the right of every person to have the opportunity for the highest standard of health, without suffering financial hardship or poverty as a result. It does not just help improve health outcomes, but would help reduce inequality and stop 100 million people a year falling into poverty. Health and economic development are interdependent. Healthy populations are more productive.

It is clear from this and other recent debates in this Chamber that universal healthcare will make countries more resilient to humanitarian disasters and outbreaks of disease. The ability of Nigeria, which has a relatively strong healthcare system, to contain and beat the Ebola virus this year sharply contrasts with the experience of Sierra Leone and Liberia, whose health systems were weak. Universal healthcare is a clear and quantifiable goal. Will the Minister commit the Government to it in considering the language of the health goal in the SDGs when negotiations start in New York next week? What is her department doing to ensure that the next development framework is ambitious and trans- formational to end all preventable, maternal, child and newborn deaths?

As we have heard from my noble friend Lady Kinnock, addressing the underlying causes of ill health and mortality is also critical. As we heard from the right reverend Prelate the Bishop of Derby, this means investing in women’s empowerment, girls’ education, preventing gender-based violence and ensuring access to clean water and sanitation. Will the Minister highlight what the UK Government are planning and doing to address these underlying causes?