Global Health

Baroness Flather Excerpts

Monday 25th March 2013 Grand Committee

[Baroness Flather]

My Lords, I have just had tea with a friend from Nigeria. She said that she spoke to her mother over the weekend. Her mother told her about her cousin, who had come home from having a baby and had blown up because part of the placenta had been left inside her. Nobody could give her antibiotics—no antibiotics were available—so she died. This is what we are talking about today. I unashamedly say that I am passionate about women’s issues and how women in Africa and India suffer the most. I know because I have had opportunities to visit and see for myself what goes on for women. Nobody really cares: “A woman dies, so what? There are so many others”. That is why this debate and the report of the noble Lord, Lord Crisp, are so valuable. Everything the noble Lord said is absolutely correct. Any support that can be given for what he wants done would be wonderfully valuable.

We have talked about birth attendance, village women helping and so on, but it has never been done in a proper way. The noble Lord is so right to say that if things are not done properly, it is better not to do them at all. My friend also told me that in her village, the woman with the smallest hands pulls the baby out and the mother usually ends up with a fistula. Things are not getting better; they are getting worse in the developing countries and we have to recognise that. Why are they getting worse? Because the population is increasing by a very large number and more people need help.

We know that family planning is absolutely essential. We have a shortage of nurses, skilled midwives and obstetricians and an increase in population to more than 7 billion people. Every day, 800 women die from easily preventable pregnancy or childbirth-related complications. There are 215 million women in urgent need of family planning services.

Current health systems cannot meet these demands. Mix changes could increase women’s access to services, which is exactly what the noble Lord, Lord Crisp, is saying. We need access at least to the most basic of services because sometimes basic services can change a woman’s life. They can make the difference between life and death, or a woman being inflicted with a lifelong problem.

I am an active member of the APPG on Population, Development and Reproductive Health. We produced a report some years ago about maternal morbidity. No one knows the figures because we just cannot get them. However, we took a figure of 25%. The report was called Better Off Dead because, in many cases, the women would be better off dead than suffering through a lifetime of problems due to pregnancy and childbirth.

In India there were a lot of not quite hospitals but places where there were doctors and nurses. The problem has always been that doctors and nurses do not want to work in rural areas because they can earn more money in the towns. They would go to work in the towns and when people arrived at those rural centres there would be no one there. The idea was that either the nurse or the doctor would be there at all times, but this was not always the case.

While I have sympathy for the view of the noble Viscount, Lord Eccles, on tropical disease, the Gates Foundation has really taken that on board and has certainly done a lot in regard to African diseases. As the noble Lord, Lord Crisp, has mentioned, Mozambique, Tanzania and Malawi have seen success in the strategy of people being trained to do something. There are quite a lot of things that semi-trained people can do, such as giving antibiotics. In some places they perform surgery and it has been found that their obstetric operations are no worse than those of the doctors. If you have no one else, it is absolutely amazing that someone can do that.

I hope that this will become an issue with DfID, which has put girls and women at the top of its agenda for almost the first time. However, to be fair, Andrew Mitchell also put girls and women at the top of the agenda. We need to remember that the value of girls and women in African countries is pretty well zero. If women die or are sick, it is of no importance. If children die, it is of very little importance—perhaps a tiny bit more, but not much. It is there for us all to know and all to see.

We held a family planning summit last year. It was a wonderful thing for us to have done and I am very proud of the fact that our Government initiated it. Family planning by itself saves lives and money. One pound spent on family planning can save lives and many pounds if it is available. I hope that we will keep in mind that it is cost-effective and necessary.

I hope the Government will promote skills-mix changes and task-sharing in low and middle-income countries where family planning programmes are now being rolled out. That will improve access to family planning for the hardest to reach. They are the ones who will probably respond more to someone who is familiar with them than to someone who is from elsewhere.

Nothing can be more effective than this initiative, and I hope that the Minister will take that on board. I am not sure how much our Government can do, but perhaps the Governments in those countries could be involved. A lot of money was promised at the family planning summit, but the problem is always to get the Government of the country to support the programme. If the Government of the country do not support the programme, no matter what outside Governments do, it will never work as well as it should.