Health: Maternal Health

Lord Patel Excerpts

Wednesday 12th January 2011 Lords Chamber

Asked by

[Lord Patel]

To ask Her Majesty’s Government how they propose to meet Millennium Development Goal Five on improving maternal health and maternal morbidity.

[Lord Patel]

My Lords, before I introduce today’s debate, it gives me great pleasure to congratulate the Minister, the noble Baroness, Lady Verma. Last week, the Prime Minister of India bestowed on her the high honour of Pravasi Bharatiya Samman in recognition of her work.

I thank the long list of distinguished noble Lords from all sides of the House who are taking part in the debate. That demonstrates the huge interest that your Lordships’ House has in the subject and signifies the need for a longer debate. It is a pleasure to note that the noble Lord, Lord Green of Hurstpierpoint, will make his maiden speech. I look forward to that. Given his distinguished career, I have no doubt that the House will hear a lot more from him.

The topic of today’s debate is how the UK Government propose to meet millennium development goal 5, relating to maternal death, maternal health and maternal morbidity. It is fortuitous that the Government published at the end of December 2010 their framework, Choices for Women: Planned Pregnancies, Safe Births and Healthy Newborns, for improving maternal health in the developing world. I congratulate them on producing that document, which sets out clearly the vision of the UK Government and their ambition to improve maternal health globally. It sets clear goals in each of the areas mentioned for the UK Government to meet by 2015. It is a little less clear about how this will be done, but I have no doubt that we will explore that today.

An article appeared in Delhi’s Hindustan Times on 29 August 2010, the day before the start of the first global meeting on maternal health, organised by the Bill Gates Foundation and the Indian Ministry of Health, which exemplified the problem in relation to maternal deaths. The headline was:

“She gave birth, died. Delhi walked by”.

It was the story of a destitute woman who died having given birth on a pavement on a busy street in central Delhi as thousands walked by.

In sub-Saharan Africa and south Asia, women die in childbirth, not of disease or epidemics but of conditions that are easily treatable: prolonged labour, haemorrhage, high blood pressure, infection and unsafe abortions. There is a lack of skilled attendance at births and a lack of access to emergency obstetric care.

The commitment made by world leaders in 1990 to reduce by 75 per cent by 2015 the 570,000 maternal deaths that occurred annually at the time—millennium goal 5—is the most off-track millennium development goal. While there was estimated to be some reduction to 350,000 yearly deaths by 2008, unless efforts are accelerated, the goal of reducing deaths by 75 per cent by 2015 will not be met.

In September 2010, an international alliance that included the United Kingdom was launched at the UN General Assembly. The UK’s leadership is well recognised globally, as alluded to by Melinda Gates in her New Year blog.

The causes of death remain the same: lack of skilled attendance at births, poor access to emergency obstetric care and health system failure. The Government’s framework states that it will address all these issues. It commits the UK, working in high-risk countries in sub-Saharan Africa, to reduce annual deaths by 50,000 by 2015. On the basis of what evidence are the Government confident that they can meet this goal? I hope that the Government will support other African countries, too, such as Tanzania, where there is a will on the part of local and national government, professional organisations and the population to improve maternal health, with some good examples of strong health systems. The UK can and must provide the co-ordination and leadership required and draw on the experience of professional organisations and individuals in the United Kingdom, who will happily contribute to the national efforts.

For the next few minutes, I should like to address obstetric fistula, a subject about which I have spoken previously—I make no apology for doing so again. At long last, after nearly six years of campaigning by a small group of people, obstetric fistula, from which an estimated 3.5 million women suffer worldwide, has come to the notice of the world’s politicians. I, for one, was very pleased that, following the adoption of a resolution by the UN General Assembly, the Secretary-General of the UN, Ban Ki-Moon, is calling for at least $750 million to treat the 3.5 million women who suffer from obstetric fistula. Of course, that is not possible, but I hope that the problem will at least get greater attention. As Ban Ki-Moon said, obstetric fistula is one of the most devastating consequences of neglect during childbirth.

Like maternal mortality, obstetric fistula is almost entirely preventable with skilled care during labour and access to emergency obstetric care. Obstructed labour, a major cause of maternal death, is also the main reason for a mother ending up with a fistula and, in most cases, a stillborn baby. She is left incontinent in relation to urine and she smells. She is made to live in social isolation. To the 3.5 million women with the condition, an estimated 50,000 to 100,000 new cases are added each year. Cost-effective, sustainable strategies, albeit on a small scale, have been instituted by a few dedicated groups.

I am privileged to be involved with one such group, co-ordinated by the International Federation of Gynecology and Obstetrics and the Royal College of Obstetricians and Gynaecologists in London. Over the past four years, it has established training centres for doctors and nurses and is in the process of treating 2,000 women with obstetric fistula. It has trained 32 doctors and nearly 50 nurses in Tanzania alone at a cost of approximately $300 for a woman treated and cured. That is not much. The UK’s framework for maternal health recognises that there is a problem that needs to be addressed. Beyond that, there does not appear to be any commitment. I hope that the call by Ban Ki-Moon will now energise DfID into some action.

The UK can provide a global lead in shaping the strategy to help to tackle the problem. We have a cadre of experienced surgeons in the UK. We have produced competency-based training manuals that are accepted globally for the training of doctors and nurses. We have the experience of running successful programmes. The UK can lead and co-ordinate with other partners. I hope that the Government will commit to some action. I know that the professional organisations stand ready to help. I am hoping for a positive response from the Minister. The publication of the framework demonstrates the Government’s recognition of the problem relating to MDG 5. I hope that resources to meet the goals will now follow.