PHA-Exch> 'Women Need Help to Deliver': Interview with Thoraya Ahmed Obaid, UNFPA

[Claudio Schuftan]

From: Vern Weitzel <vern at coombs.anu.edu.au>
crossposted from: "[health-vn discussion group]" <health-vn at cairo.anu.edu.au
>

http://www.ipsnews.net/news.asp?idnews=39751

LONDON, Oct 22 (IPS) - The Women Deliver conference held in London last week
has
reminded a lot of people in the world of healthcare how much more they need
to
deliver to make pregnancy and childbirth safer for women.

More than 1,800 delegates from 109 countries, among them 70 ministers and
parliamentarians, met in London Oct. 18-20 to work out new ways of improving
maternal health. Thoraya Ahmed Obaid, executive director of the United
Nations
Population Fund (UNFPA) since January 2001, will inevitably be a leading
figure
in taking the new moves forward. She spoke with Sanjay Suri from IPS:

IPS: What did this conference deliver?

TO: It delivered a high level of attention to maternal health; this is what
it
intended to do, and it did it very well. The challenge is that it has now
raised
expectations; among ministers, NGOs, among us at the UN, there is now a high
expectation to deliver on the ground, so that is the big challenge coming
out of
it.

IPS: But what specifically should come out of it?

TO: The problem before was that everything was done vertically. Now with the
emphasis that maternal health is not just a medical issue, it is much more
an
issue of the community, and society, what we need to do is to ensure that we
integrate the various components of maternal health so that women at risk of
dying when giving birth – and it is usually the poor ones – will receive a
coherent, integrated package of health.

When there are services in the community they can go for pre-natal care,
they
can go for post-natal, they can go for delivery with skilled attendants,
they
can get HIV-AIDS counselling, and so the whole idea is to bring various
components together. This did not happen over the past 20 years because
provision of care was very vertical.

IPS: What does a shift from what you call a vertical approach mean on the
ground? Will it mean among other things less intervention from medical
authorities in government?

TO: Earlier a lot of emphasis was given to primary healthcare at the
community
level, and we have lost a great deal of that. Now there is a push to go back
to
effective community units of healthcare.

The health system does need to deliver at community level, and one thing
that
came out of the conference, and it was repeated in many forms, was that
maternal
health is the litmus test for the whole health system, in the sense that
services need to be in place. This means that there are clinics that will
take
care of her during pregnancy and after pregnancy, that the woman will have
skilled attendants at birth, and in case of emergency she can have necessary
care. This requires that you have a surgery room, it means you need to have
blood available for transfusion, it means you need to have equipment in the
surgery room. If you have all this at hand, then you can use this for all
the
other health problems that can arise.

IPS: What is the number of maternal deaths today relative to 20 years ago?

TO: The problem is that it hasn't improved much. We're still talking of half
a
million deaths a year, about the same figure 20 years ago. This is the
number of
deaths associated with pregnancy and childbirth.

IPS: Does sub-Saharan Africa still have the worst of this, and have there
been
any regional improvements?

TO: Yes, there are a number of countries that have been able to make the
jump.
We use Sri Lanka, Egypt, Honduras, Mexico as examples of countries where
there
was a great deal of investment in primary healthcare and integrating
programmes,
and where a jump in better maternal health took place. They have also moved
quickly to provide for emergency care so that women can be moved very
quickly to
hospitals.

IPS: Is a lot of funding going for the big three – AIDS, TB and malaria –
and
not enough into maternal health?

TO: Yes, the one that has suffered most is family planning. The three
interventions we need here are, one, to have skilled birth attendants, the
second is emergency obstetric care, and the third one is family planning,
because if a woman can plan her family, and ensure spacing between her
children,
that is good for her and for the child. But investment in family planning
went
down in the last 20 years, with investment in HIV/AIDS rising to large
amounts.

IPS: Is there a need for more education to bring down the incidence of
maternal
mortality?

TO: Yes, girls education. That is why we are saying this must be an
integrated
package, you have to promote girls education, you have to ensure
transportation
means to take the woman from her village to the health point where you can
have
medical intervention, so it is a whole system that has to be put in place.

IPS: Is there sufficient skilled medical care available?

TO: What is making things worse is that many skilled midwifes, nurses and
doctors are migrating. And so the whole issue of human resources is becoming
serious. We at the UNFPA have started working with the International
Federation
of Midwifes to put in place training of midwifes in many, many countries.

IPS: Was there anything at this conference to encourage you to think that
the
next 20 years might be better than the last 20?

TO: Yes, I think this conference has energised people. Donors, NGOs,
ministers
of health, the UN have all looked at one another and said we can't do it
alone.
We have to be together, otherwise we cannot deliver. We know each of us has
some
advantage that can fill the gap that the other cannot. Even though this is
common sense, it somehow hit home very hard at this conference that more of
fragmentation cannot work over the next 20 years. This is a very important
message that came out.

IPS: Any other?

TO: The other important message that came out is that the right to health is
a
human right. Within that, maternal health becomes a very basic human right.
And
this can change the way that things are looked at, so that human rights
organisations don't just look at torture, imprisonment and so on, but see
that
the needless death of women is a violation of human rights. (END/2007)
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