Spreekpunten MDG-ambassadeur bij bijeenkomst COS Noord-Holland

Gelegenheid: Nieuwe Kerk

Key question for tonight: Are we on the right track with MDG5?

Let us remind ourselves once again of the target that we set in 2000, namely reducing the maternal mortality ratio by three quarters between 1990 and 2015. I will now read you some paragraphs from the report that the UN SG, Ban Ki-Moon submitted to the participants of the High Level Event on the MDGs in New York, on 25 September:

"In sub-Saharan Africa, a woman’s risk of dying from treatable or preventable complications of pregnancy and child birth over the course of her lifetime is 1 in 22, compared to 1 in 7300 in the developed world."

"The maternal mortality rate dropped by less than 1% per year, while 5,5% is needed to reach the target."

Two more statistics: today still more than 500.000 prospective mothers in developing countries die annually in childbirth or of complications from pregnancy. This is roughly the same rate as twenty years ago.

Although the morbidity rates related to pregnancy and childbirth are difficult to estimate, the figure of nine million women annually being affected is generally accepted.

These figures are staggering. They show that a lot remains to be done. Actually, MDG5 is the goal that is most off track. Or, to put it differently: maternal mortality is the most poignant illustration of the difference between the rich and the poor. Of course, this all makes for a rather gloomy picture. However, I should like to make an important addition: let me quote, once again, from the UNSG’s report:

"A skilled health worker (doctor, nurse of midwife) at delivery is critical to reducing maternal deaths"

and (from statistics provided by the World Bank): maternal mortality can be reduced by 25 up to 35% if something can be done about the unmet need for family planning.

What do I want to say by this? By this I want to say that we have the answers to do something about maternal mortality. We know what interventions are needed. We just need to make them possible. This is the good news. It means that achieving the millennium goals, and improving the situation of women more generally, is first and foremost a question of accountability: people need to be reminded of their respective responsibilities to improve the situation of hundreds of thousands of women. This goes especially for political leaders, both in developed and in developing countries.

Politicians in countries in the developed world need to live up to their commitments; this means that they cannot renounce their commitment of spending 0,7% of their GNI on development assistance. This is a matter of credibility. As the minister for Development Cooperation, Mr. Koenders, has repeated time and again: this also applies in a situation when we are faced with various other crises, be it in the financial sector, or the crises relating to food security or climate change. The minister has actually pointed out that it would be shortsighted if we would renounce on our commitments.

At the same time, leaders of developing countries need to do their share as well: good governance, fighting corruption and setting the right priorities; if countries do not reform their health sector in such a way that it really becomes accessible to the poorest, we will never manage to improve the figures of maternal and child mortality.

Our shared responsibility is the main message that the Netherlands delegation, consisting of PM Balkenende, the minister of Foreign Affairs and the minister for Development Cooperation, Mr. Koenders, brought with it to New York, where, about two weeks ago, the High Level Event on MDGs (MDG summit) was held.

In the opinion of the Dutch government, the MDGs can still be achieved on condition that everybody does his or her share. Reaching the millennium goals is our common concern – especially if we know the answers, if we know what needs to be done. So how can a High Level Event contribute to achieving our goals – and what was the main outcome of this summit, according to the Netherlands delegation to this Event?

The purpose of the summit was to review the progress that has been made with the MDGs, to establish which goals lag behind and identify the actions needed to get countries that are currently most off track, back on track. According to the Netherlands government, the summit in New York was a success in this respect. It provided a platform for discussions on the highest political level about the progress that has been made and that still has to be made with the MDGs.
But perhaps the most important outcome of the Summit in our opinion, is that it has moved the health related goals to the top of the UN MDG agenda. This can be concluded from the concluding remarks of both the UNSG and the president of the UNGA, Miguel d’Escoto, who addressed the issue in their final statements. More specifically, the chairman of the GA announced that he would launch ‘an initiative on strengthening global health’. The initiative will be implemented in multiple phases. First phase. Starting at the end of 2008/beginning of 2009, should consist of an 'informal thematic debate'. A high level debate should follow in June 2009.

Additionally, a joint initiative of the British prime minister and World Bank president Zoellick was announced, consisting of the setting up of a Task Force aimed at innovative financing of health care. This Task Force takes as a starting point the goals set out in the 'Global Campaign for the Health Millennium Development Goals', the campaign that aims to achieve access to basic health care for the poorest.

This implies that the Task Force starts from the idea that more money is needed to achieve the MDGs on health. Money which should be obtained in an innovative way, for example by making use of non traditional partners.

While the specific mandate and activities of this Task Force remain to be determined, the starting points of the TF are shared by the NL government. Governments alone cannot realize the MDGs; we need more partners, also non-traditional ones. The NL is hopeful that the ‘financing for development’ conference in Doha, end of November, will be aimed at financial commitments and will explore innovative ways of financing.

We will also look into ways of contributing to the TF through bilateral contacts with members of the TF, such as the British and the Norwegians. The membership of the Netherlands PM Balkenende of the ‘Network of Global Leaders for MDG 4 and 5’ provides us with another opportunity to contribute to the activities of the TF.

Now let me take you back once more to the report of SG Ban Ki-Moon. The report states that the single most important success to date has been the unprecedented breadth and depth of the commitment to the MDGs. Not only governments of developing and developed countries, but also private sector and civil society have adopted the MDGs as their framework for international cooperation. Indeed, his statement was endorsed by the presence in New York of many involved parties.

To underline that this viewpoint is shared by the NL governement, the minister for Development Cooperation and the prime minister held a meeting with international NGOs, including some active in the field of womens’ sexual and reproductive health and rights. The minister for Development Cooperation also participated in a side event on MDGs 4/5. The event was hosted by the presidents of Tanzania, Finland and Chile. But the participants were a mix of multilateral organisations, private sector representatives, ngo’s, donor- and host countries participated. All participants made commitments and/or shared successful interventions.
To give an example: WHO, UNFPA, UNICEF and the World Bank used the meeting to announce their new joint program to ensure universal access to family planning and skilled attendance at birth.
Of course, the minister used his participation in this event to highlight some important elements of Dutch policy in the field of MDG5 – actually one of the priorities of Dutch development cooperation as such.

First of all, it is important to underline that the Dutch government holds the view that MDG 5 is not ‘just’ about the moral tragedy of over 500.000 mothers dying annually. The social and economic consequences of this tragedy are extensive; women are dying in the (economic) prime of their lifes, families lose what is often their primary caretaker, thereby significantly reducing survival and development chances of the children within those families.

Furthermore, I would like to stress that the Dutch approach towards MDG 5 is a broad one in which sexual and reproductive health and rights are the cornerstone. Within this context, attention is given to family planning, sexual education and unsafe abortions in addition to specific care related to pregnancy and childbirth. Prevention of unwanted pregnancies and prevention of unsafe abortion can make a tremendous contribution to achieving MDG 5. The importance of the wider context of sexual and reproductive health and rights in which MDG 5 should be imbedded, was highlighted by the minister in his intervention at the maternal health side event.

Of course, these policy objectives can be translated in financial terms:

  • In 2007, the total development budget for health of the Netherlands – including HIV/AIDS and sexual and reproductive health and rights (SRHR) – was 424 million euros.
  • Over the coming four years, the Netherlands will contribute to UNFPA: 58,5 million per year.
  • On top of that, the minister has announced the contribution of an additional 30 million euros to the Global Program on Reproductive Health Commodity Security. This contribution will help to reduce the fast growing gap between women’s desire to use contraceptives and the availability of the means. We are also committing additional funding to the International Confederation of Midwives (ICM) in order to strengthen midwifery.

In addition to funds being allocated via bilateral programs, multilateral organisations and (international) NGOs, the ministry for Development Cooperation is also working actively to further develop our experience with public-private partnerships. We want to engage new partners (incl. from the private sector), because on the one hand, we believe that this is a helpful way to broaden the basis for our own efforts in development cooperation and, on the other hand, because we believe that they provide us with solutions that governments may not think of, or may not know they already exist.

An example of this type of cooperation is the partnership agreement on MDG 5, a partnership that brings together public and private actors in support of programmes and activities that promote maternal health. As part of this partnership, a yearly “Mothersnight” is organised in Amsterdam - an evening of debate, stories, music and performances to raise awareness about MDG 5, before celebrating our national “Mothersday”. The Mothersnight event was accompanied with a radio and TV campaign to highlight the MDGs, especially MDG 5.

The Netherlands has also – again in the framework of such a partnership - announced its willingness to contribute to the development of heat-stable oxytocin, an essential medicine which can be used to prevent excessive bleeding thus reducing maternal mortality. In addition, we took the initiative to support the development of an affordable female condom – an important product, to increase women’s choice to avoid unwanted pregnancy and to protect against hiv infection.

Closing remarks
I have tried to give you an overview of the situation on MDG 5 as well as what The Netherlands is doing in order to achieve the aim of a reduction of 75% of the global maternal mortality rate.
Much of this information is related to policy, the implementation of it and the money available to realize this. I am therefore pleased to be here tonight in the company of so many people working in the field of maternal health who can tell you much more about the pregnant women who are hidden behind the figures and politics.

I am looking forward to hear from our participants from Afghanistan, where the lifetime risk of maternal death is a staggering 1 in 8, what interventions work or could work within their context. As we all know the additional complicating factor in Afghanistan is the very difficult security situation in which one has to work.

As I have understood the challenges faced by our Ethiopian participants are for a large part related to a lack of qualified personnel to support women before, during and after childbirth. The Netherlands, who is active in the field of health in Ethiopia, is currently supporting a government program aimed at training 30.000 qualified health workers. In addition the unmet need for family planning is reportedly high in Ethiopia (35%). Given our health program in Ethiopia I am particularly interested to hear more from our participants on how to tackle MDG 5 in their context .
India bears the burden of 20 % of the total global maternal mortality rate. Positive developments have taken place in India over the past decade resulting in a reported drop in mortality figures between 1998 and 2003 of 24%. The Indian government is working towards facilitation and stimulation of delivery within medical facilities. I would like to hear more about the positive experiences of our participants from India as well as about the challenges they are still facing today fighting the relative high figures of mortality.

Without further ado, give the floor to them...