This week, the world's leaders will descend on New York City for a perfect storm of high-level events, including the United Nations Summit on the Millennium Development Goals. Millennium Development Goal No. 5 (MDG 5) -- improve maternal health -- will be top of mind. UN Secretary General Ban Ki-moon is expected to launch a Global Strategy for Women and Children's Health. And the Clinton Global Initiative Annual Meeting is dedicating an entire track to women's and girls' empowerment. Just this week, the UN released its latest maternal health estimates, reaffirming that, while there is evidence of progress, clearly there is much more work to be done. The good news is that the momentum behind this issue has never been greater.
Earlier this month, I had the privilege of attending the Global Maternal Health Conference 2010 in Delhi, India, with nearly 700 of the world's foremost experts in the field. The conference was a forecast of the topics and solutions that are likely to dominate discussions on MDG 5 this week. Here are the top five:
1. Solutions are only solutions if they land in the right hands. Severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions are the primary causes of maternal death. Safe, effective, and low-cost preventive measures and treatments exist; the challenge has been making sure that these medical technologies reach women, especially poor women, as quickly as possible. Health professionals are experimenting with new ways to effectively distribute lifesaving drugs. For example, a central strategy for expanding access to misoprostol to prevent postpartum hemorrhage involves using trained community volunteers to distribute the drug. This allows women, a majority of whom continue to give birth at home and may be far from the nearest health facility, to safely treat themselves at home postpartum.
2. Find creative solutions to increase the number of skilled health providers. The shortage of health professionals is a major barrier to reducing maternal mortality and morbidity. One approach has been to "task shift" -- train and deploy more nonphysician clinicians to take on a broader range of health services, including some emergency obstetric care. Studies of this practice have shown that, given the right training and support, these providers are up to the task, having success equal to that of doctors. But this strategy is a longer term prospect and should not detract from the equally important goal of training more skilled doctors, nor should task shifting result in any health provider becoming burdened with too many responsibilities.
3. Hold decision makers accountable. Government leaders worldwide have formally committed to achieving the MDGs, but accountability has been a problem. On this front, what happens outside the health clinic can be as important as what happens within it. Just as we need more people trained to provide maternal health services, we must also invest in training advocates to pressure ministers of health and other decision makers to make real investments in reproductive health care. In many countries, a key aspect of this work involves compelling governments to provide data on where money earmarked for maternal health is spent. The Ask Your Government campaign is doing innovative work on this front to learn the extent to which governments are actually deploying the resources needed to achieve the MDGs.
4. Connect the dots. Health providers are getting increasingly sophisticated about drawing links between the underlying cultural, social, and economic factors that contribute to maternal deaths. An expectant mother who is HIV-positive, for example, needs special attention to protect her health and to help her deliver a healthy baby. Maternal health is not a "vertical issue," but one that cuts across all of the Millennium Development Goals.
5. Strike the right balance between community- and facility-based care. For years, there has been debate about whether women are better served in health facilities or through community-based services. Such services may lack highly skilled doctors, but they also are often more accessible to poor women in rural areas. Experts at the Global Maternal Health Conference agreed that the time had come to reframe the discussion from "either or" to "both." Where facilities are inadequate, community-based interventions can potentially serve women's needs. But where facilities are adequate, community-based services still can be critical for supporting prenatal and postnatal care. The bottom line: Local context is everything. We need to use the approaches that best meet the realities of women in any given community.
MDG 5 consists of two specific targets. The first calls for a 75 percent reduction in maternal mortality between 1990 and 2015. This is the part that most people remember. The second part doesn't get as much attention: the goal of universal access to reproductive health care. Yet, as the five steps above demonstrate, the two parts are inextricably linked. If the initial launch of the Global Millennium Development Goals more than 10 years ago was to answer the what and why behind eradicating poverty and improving global health, then the focus now must be how we will do so.
Check out MDGFive.com, a new media initiative uniting global artists and activists for maternal health.