1. Empowerment for women and girls and
the Millennium Development Goals
Dr. Arletty Pinel
5th Asian Women Parliamentarians’ and Ministers’ Conference
Beijing, 27 November 2007

2. Some facts about the region

3. Population and Development
§ Over 60% of the world's population live in Asia
and the Pacific region
§ 6 out of the world's 10 most populous countries
are in Asia: Bangladesh, China, India, Indonesia,
Japan and Pakistan
§ Over the past 20 years, Asia has shown a rapid
decline in population growth rates and fertility
levels
§ However because of Asia's huge population
base, half the world's annual population
growth occurs in Asia

4. HIV and AIDS in Asia
§ 8.6 million people are living with HIV or AIDS in
Asia, and about 1 million people become newly
infected each year.
§ 630,000 persons died from AIDS-related
illnesses in 2006 in the region
§ The number of people receiving antiretroviral
therapy (ARV) has increased more than three-
fold since 2003; this represents about 16% of the
total number of people in need of ARV in Asia.

5. Gender-Based Violence
Gender-based violence is a critical issue in Asia
§ Early marriage
§ Human trafficking
§ Physical and sexual violence
§ Forced abortion, infanticide and domestic violence
associated with boy preference
Despite high prevalence of gender-based violence,
physical, mental and social care system is still lacking.

6. Where do Maternal, Newborn and Child deaths
occur? Source: Black et al (2003)

7. Maternal mortality: an indicator of exclusion
and disempowerment

8. The Cost of Giving Birth
§ Over 300 million women in developing countries suffer from
complications of pregnancy and delivery
§ 536,000 die each year – one woman every minute;
11 million deaths since the launch of the Safe Motherhood Initiative
in 1987
§ 8.5 million deaths per year among mothers, newborns and stillborn
– HIV causes 2.9 million deaths per year
§ For every woman who dies, between 20 and 50 experience a long
or short-term morbidity
§ At least 2 million women living with OF and up to 100,000 new
cases each year

9. Maternal Mortality Ratio estimates by United Nations MDG
regions (WHO, UNICEF, UNFPA and The World Bank, 2007)
Region MMR (maternal deaths Number of Lifetime risk of
per 100,00 live births) maternal deaths maternal death
WORLD TOTAL 400 536 000 92
Developed regions 9 960 7 300
Countries of the commonwealth of 51 1 800 1 200
independent states (CIS)
Developing regions 450 533 000 75
Africa 820 276 000 26
§ Northern Africa 160 5 700 210
§ Sub-Saharan Africa 900 270 000 22
Asia 330 241 000 120
§ Eastern Asia 50 1 200 31
§ South Asia 490 188 000 61
§ South-Eastern Asia 300 35 000 130
§ Western Asia 160 8 300 170
Latin America and the Caribbean 130 15 000 290
Oceania 430 890 62

10. Vast inequities
§ Greatest disparity of any health indicator between
industrialized and developing countries
§ Lifetime risk:
1 in 16 in sub-Saharan Africa
1 in 46 in South-central Asia
1 in 2800 in more developed countries
§ Disparities within countries between the poorest and
wealthiest women

11. Effective interventions exist - they need to reach
more people
Maternal deaths would fall by 73%
if coverage of key interventions rose to 99%
Improved access to comprehensive
essential obstetric care Hemorrhage
Improved access to safe abortion services Puerperal Infection
Active management in third stage of Eclampsia
labor
Obstructed Labour
Magnesium sulphate for pre-eclampsia
Abortion Complications
Treatment for iron deficiency Malaria
Anemia
Drugs for preventing malaria
Tetanus
0% 10% 20% 30% 40%
deaths averted (as % current total)

12. So it s an issue of inequity… women die
because they are poor

13. Strategy for Reduction of Maternal Mortality and
Morbidity
1. All women have access to contraception to avoid
unwanted pregnancies and to plan their families
2. All pregnant women have access to skilled care at
the time of birth
3. All those with complications have timely access to
quality emergency obstetric care

14. Family planning
§ 200 million women with unmet need for family
planning
§ Family planning estimated to reduce
maternal mortality by 25 to 30%
§ Based on 2000 estimates, 90% of abortion-
related and 20% of obstetric related deaths
could have been averted if needs for family
planning were met

15. Skilled Birth Attendance (SBA)
§ Skilled attendance - a skilled provider
(midwife, doctor, nurse) working in an
enabling environment
§ Provide a continuum of care: family
planning, pregnancy, birth, postnatal
care
§ Urgent need for more skilled
attendants and to improve their
working environment
§ Only 59% of births by SBA in
developing countries
80% of maternal deaths during/right after delivery

16. Emergency obstetric care (EmOC)
§ Needs to be available 24
hours a day
§ Needs to be accessible –
transport, cost
§ Strengthening EmOC, as
part of health systems
§ Facilities, equipment,
supplies
§ Human resources
15% of women will § Quality of care
experience a
complication during
pregnancy or childbirth

17. But it is also about education and women s
empowerment
§ Gender based violence is another important
cause of maternal mortality
§ Midwives are a key health workforce to fight
maternal, newborn and child mortality – but
midwives are usually women and suffer the
same gender biases and lack of protection
§ Countries with high maternal mortality usually
have low girls enrollment in schools and fewer
midwives (skilled birth attendants) – if girls
cannot go to school and finish their secondary
education, how can they become university
trained midwives of nurses or doctors?

18. Improvements can happen…

19. Rapid gains are possible
"…maternal mortality can be halved in
developing countries every 7 to 10 years, …
regardless of income level and growth rate"
Source: World Bank (2003)

20. It can take less than 10 years …

21. Country example: Addressing obstetric fistula – a
common complication of childbirth -- in Bangladesh
§ Over 900 women with obstetric
fistula treated since 2003
§ 2000 skilled birth attendants trained
between 2002 and 2006
§ 73 doctors & 60 nurses trained in
fistula care since 2003
§ National fistula centre established, to
be regional Centre of Excellence
§ Reintegration centre established
§ Outreach camps held at 7 regional
medical college hospitals

22. Maternal mortality recognized as one of the 7
Millennium Development Goals (MDGs)
§ Goal 1: Eradicate extreme poverty and hunger
§ Goal 2: Achieve universal primary education
§ Goal 3: Promote gender equality and empower
women
§ Goal 4: Reduce child mortality
§ Goal 5: Improve maternal health
§ Goal 6: Combat HIV/AIDS, malaria and other
diseases
§ Goal 7: Ensure environmental sustainability

23. MDG 5: Improve Maternal Health
§ Target: Reduce maternal mortality ratios by 75% from
1990 levels
§ Indicators:
§ Maternal mortality ratio
§ Proportion of births attended by skilled personnel
§ Target: Universal access to reproductive health
§ Indicators (still to be endorsed):
§ Age-specific fertility rate for women aged 15 to 19
§ Contraceptive prevalence rate (move from MDG 6)
§ Unmet need for family planning
§ Proportion of women attending antenatal care (1 and 4+)

24. Global initiatives to address maternal,
newborn and child mortality

25. The Partnership for Maternal, Newborn and
Child Health
§ Launched in September 2005 as a global health
partnership merging the w
ü
ü
ü
§ Focus on mothers and children to support efforts
toward achieving MDGs 4 and 5
§ More than 180 partner organizations

26. Global Campaign for the Health MDGs
§ Launched jointly by the United Kingdom &
Norway, and joined by Canada, France and
Germany to build high level political thrust
around all health MDGs - and in particular
MDGs 4 & 5

27. The Global Campaign for the Health MDGs –
the International Health Partnership (IHP)
§ Led by the United Kingdom: Accelerate action to
scale up coverage and use of health services
(through public, private or non-governmental
channels); deliver improved outcomes against
the health related MDGs and universal access
commitments. No new institutions or funding
streams.

28. The Global Campaign for the Health MDGs –
what are the possible consequences for MNCH?
Led by Norway:
More action:
§ Do more for women and children. Development of a set
of new initiatives, most of which aim to accelerate
progress on MDGs 4 & 5 (“Deliver Now for Women and
Children”, “Catalytic Initiative”, “Global Network of
Leaders ”, “Performance Based Financing”, “Providing for
Health Initiative”)
Invest more:
§ More resources for MNCH health, at national and global
levels will be raised
§ Innovative sources of financing will be sought
§ Invest in a more effective way to produce results

29. The Global Campaign for the Health MDGs –
The Initiative to Save a Million Lives
§ Led by Canada in partnership with UNICEF, The
Bill & Melinda Gates Foundation, The World
Bank and others
§ Will strengthen health systems by training
frontline health workers and delivering affordable
healthcare services directly to local communities.
§ Will deliver basic, cost-effective and life-saving
health services to mothers and children in
countries where the needs are greatest

30. The Global Campaign for the Health MDGs –
Deliver Now for Women + Children advocacy drive
§ Called by the Prime Minister of Norway with support
from others to build a high level political thrust and
mobilization of resources to facilitate the attainment of
MDGs 4 & 5
§ Launched in New York Sept 26, 2007
§ Coordinated by the Partnership for Maternal, Newborn
and Child Health
§ Purpose:
ü Mobilizing public support and stimulating positive
behaviors that reduce maternal, newborn and child
deaths;
ü Generating political support for key messages and actions
to improve maternal, newborn and child health;
ü Raising significant new money for maternal, newborn and
child health as an integrated issue, in line with country-led
efforts to improve health systems and achieve MDGs 4
and 5.

31. Deliver Now for Women + Children: Launch (I)
Norway pledges $1 billion for MDGs 4 & 5 at the
Clinton Global Initiative annual meeting in New York
on Sept. 26, 2007.

32. Deliver Now for Women + Children: Launch (II)
Public Rally for Deliver Now in Bryant Park, NY:
Grammy winner Chaka Khan (right) performs.

33. Deliver Now for Women + Children: Launch (III)
Celebrity endorsements for Deliver Now:
Nicole Kidman, Chaka Khan, Liya Kebede, Ricki Lake

34. Deliver Now for Women + Children: Launch (IV)
UN leaders, heads of state, and global activists at the
Deliver Now launch on Sept. 26 in New York

35. Deliver Now for Women + Children: Web
Asking for civil society support: www.delivernow.org

36. The icon and its meaning: women are powerful

37. The icon can be dressed as it travels the
world

38. Art for Health – Empowering Women
§ Contemporary art, by
Italian artist Elisabetta
Farina, funded by WHO
§ Uses art to increase
awareness about
reproductive health issues
§ Promotes action towards
the improvement of
women s sexual and
reproductive health
conditions around the
world

39. Art for Health – Empowering Women
§ Difference in
reproductive health
status is the biggest
social injustice of our
time
§ The paintings send
Stara Thomas, Singer, Tanzania
positive messages for
greater gender equity
§ Encourage the viewer
to see this women as
willing and capable
partners to advance
women's health
Dr Margaret Chan, Director-General, World Health Organization

40. Art for Health – Empowering Women
Exhibits around the world:
§ June 2007- Rome (Italy)
§ October 2007- London
(UK), Cape Town (South
Africa)
§ Jan-Mar 2008: tour
around the US
§ April 2008: Auction by
Christie's

41. Countdown to 2015
§ The Countdown to 2015 group was established to
implement an overall mechanism for
accountability, recognize accomplishments in child
survival at the country-level, and convene a series
of meetings every two years to evaluate progress
§ In 2008, the Countdown to 2015 will include MDGs
4 and 5 for the first time
§ It will take place in April parallel to the 118th
Assembly of the Inter-Parliamentary Union (IPU) in
Cape Town, South Africa

42. What will the Asian women parliamentarians
and ministers do to join the growing global
awareness that ending maternal mortality is
also about demonstrating the benefits of
healthy, educated women to the future of
humanity?

44. Thank you pmnch@who.int
Xie Xie
www.delivernow.org
www.unfpa.org