Check against delivery

High-Level Event on The Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA)

Statement by Dr. Babatunde Osotimehin Executive Director, United Nations Population Fund

20th Ordinary Session of the Assembly of the African Union
Addis Ababa, Ethiopia
27 January 2013

 
Excellences, other Heads of State and Government,
H.E. Mr. Boni Yayi, President of the Republic of Benin,
H.E. Mr. Goodluck Jonathan, President of the Federal Republic of Nigeria,
H.E. Mr. Ali Bongo Ondimba, President of the Republic of Gabon,
H.E. Mrs. Joyce Banda, President of the Republic of Malawi,
H.E. Mr. Hailemariam Desalegn, Prime Minister of the Federal Republic of Ethiopia,
H.E. Dr. Nkosazana Dlamini-Zuma, Chairperson of the African Union Commission,
H.E. Mr. Ban Ki-moon, Secretary-General of the United Nations
Distinguished Colleagues,

Ladies and Gentlemen,

I am truly grateful to see so many of you joining us for this high- level event to reinforce the Campaign on Accelerated Reduction of Maternal Mortality in Africa – CARMMA.

As a physician and a former Minister of Health, I am very pleased to be personally involved in CARMMA and Maternal Health in Africa in general as this issue is very close to my heart. [Something personal from Nigeria]

I want to specifically thank your Excellency, President Boni Yayi, for hosting this event, which is jointly supported by the African Union Commission, the United Nations Population Fund and the African Development Bank.

I also want to take this opportunity to commend your continuous leadership and commitment to supporting the health and well-being of mothers and children in Africa, and for inviting and encouraging other Heads of States and Government to joint us here today.

I also sincerely thank each of you, Excellencies, for your commitment and support to the health of women and children in your countries. Since the African Union, UNFPA and partners initiated CARMMA, many of you and many of the First Ladies present here today have been involved and have taken the responsibility to launch and support CARMMA in their respective countries. Many of you have also personally followed up to ensure implementation of maternal health programmes, and tirelessly mobilised more resources to support maternal health programmes.

Through your leadership, many countries have done outstanding work to mobilise communities for CARMMA – I specifically thank Malawi, Sierra Leone, Liberia, Uganda, Swaziland, Ethiopia, Nigeria, Togo, Niger, Namibia, the Chad – just to name some.

Your work gives the campaign and the issue of maternal and child mortality the priority it deserves and the visibility it needs. We very much appreciate your enormous efforts in this regard.

CARMMA is an African Union Commission initiative to promote and advocate for renewed and intensified implementation of the Maputo Plan of Action for the Reduction of Maternal Mortality in Africa and to accelerate progress towards Millennium Development Goal 5, improving maternal health. CARMMA is about saving lives of mothers and children in Africa.

I am happy to report that since the campaign started in 2009, a total of 37 Countries have launched CARMMA and are standing ready to intensify the fight against maternal mortality. In fact, these 37 countries have also pledged to improve maternal health through their commitments to the United Nations Secretary General’s Global Strategy on Women’s and Children’s Health. I wish to thank the Secretary General for being here at this event today, showing his commitment and support.

I want to acknowledge the United nations Secretary General personal commitment to women’s health and issues of young people, which are two priority areas for UNFPA. I also want to acknowledge the partnership between development partners under the H4+ to support Maternal, Newborn and Child Health.

UNFPA and other development partners, support the African Union Member States to use the CARMMA to galvanise efforts under the Child Survival Summit, the Family Planning Summit, United Nations Life-saving Commodities Commission, Education First, and the Getting to Zero of the HIV and AIDS, to continue to improve the health of women and children in the region.

Achievements and progress made in Africa

Having all of you leaders, political drivers and thinkers in this room together today also presents a wonderful opportunity to take stock and celebrate the tremendous achievements and progress made in reducing maternal mortality in Africa in the last years.

Data released in 2012, shows that Africa has been able to reduce maternal deaths by 41% between 1990 and 2010, with a significant decrease between 2005 and 2010. There is also a decrease in the number of women of child-bearing age who want to delay pregnancy but do not have the means to do so, from 226 million women in 2008 to 222 million in 2012. This indicate the unmet family planning need gap is closing, but not fast enough.

This would not have been possible without your leadership. You have been crucial to make this progress and to address reproductive health issues, raise awareness, mobilize communities, improve antenatal care, distribute safe delivery kits or ensure free-services for pregnant women, nursing mothers and children under five years. Your efforts and success stories are not only very encouraging but also inspiring and highly contributing to improving the health of women and children in Africa.

I want to commend the efforts of the African Union and its Member States, your commitment to CARMMA, to the United Nations Secretary General’s Global Strategy for Women’s and Children’s Health, the well-articulated Sexual and Reproductive Health and Rights Policy in 2005, the ambitious Maputo Plan of Action in 2006 and the Gender policy that makes access to reproductive health a priority.

These policies and many others underline and highlight what needs to be done to reduce maternal deaths in Africa.

Much more needs to be done for Maternal Health

However these successes, unfortunately, only tell one side of the story. Still far too many women on our precious continent are dying from pregnancy-related causes. In fact the number is 165,000 women every year. That is an average of 450 women dying every day from pregnancy related causes in Africa – causes which are preventable.

In sub-Saharan Africa, the life-time risk of maternal death for women is 1 in 39. While in industrialized countries it is 1 in 4,700. These figures are just unacceptable for Africa.

Better health is a goal in itself and a human right – rich or poor, everyone has the right to health. Health is also one of the main drivers of economic growth and social cohesion. Healthy people, including mothers, women, and young girls, can contribute to the productivity of the whole economy and drive a country forward for prosperous and sustainable development.

No country in the world can afford to lose its women, mothers, daughters and sisters, who represent half of the population. Let me explain why they are still dying and what leads to these high rates of maternal death in Africa.

The causes of maternal deaths in Africa include what we call, the 3 delays: (1) Delay to take the decision to access health services because of gender barriers and other socioeconomic and cultural factors; (2) Delay in getting to the health facilities due to a lack of availability of health facilities in rural areas, poor road networks and transportation; and, (3) Delay in accessing quality health care at the facilities because of lack of skilled birth attendants, lack of Emergency Obstetric and Newborn Care (EmONC).

Women die during pregnancy, delivery and after delivery because of bleeding, obstructed labour, high blood pressure, and infection –sepsis. Pregnant women and girls with HIV/AIDS are at even greater risk as their immune systems are already weak. In addition, underlying causes like poverty - the inability of pregnant women to pay for costs of health services - illiteracy, and lack of access to family planning worsen the situation, leading to these high numbers of maternal deaths in Africa.

Universal access to Family Planning

Universal access to family planning - which can reduce maternal deaths by as much as 30% - is not available to every woman, couple or young person, who wants to protect themselves and plan the number of children they want, and the timing. In the developing world as a whole, the number of women and girls with an unmet need for family planning declined slightly between 2008 and 2012, from 226 million to 222 million. However, in the 69 poorest countries, many of which are in Africa, the number has actually increased, from 153 to 162 million women. The need is increasing fast and we have to find ways to meet it.

In the sub-regions of Africa, there are large variations in married women’s level of unmet need for and use of modern contraception. Modern contraceptive prevalence ranges from 7% in Central Africa and 9% in West Africa to 45% in Northern Africa and 58% in Southern Africa. Conversely, the unmet need for family planning for married women ranges 16% in Southern Africa to 30% in West Africa. Ensuring that family planning is available and acceptable to every woman, man and to young people who need it, will improve the health of both mothers and children, and save health care systems much unnecessary expenditure.

UNFPA is helping countries to meet the need. Apart from supporting countries around family planning and reproductive health, we are the biggest international supplier of contraceptives to developing countries. We are engaged in international efforts to ensure a consistent, adequate supply of modern contraceptives when and where they are needed.

Women, men and young people have different needs and those also change during lifetime. It is vitally important, both for respecting human rights and contraceptive effectiveness, to ensure that everyone gets the right information and services.
I also want to speak to the specific needs of young people. At this moment, we have the largest youth generation the world has ever seen and many of them live in Africa. Having such a large youth population brings opportunities but we can only harness this great potential if we address the needs of our young people, include and empower them to become agents of change.

In UNFPA, at the request by governments, we promote age appropriate sexuality education for all young people, male and female alike – because young men also need to know how to act responsibly. Avoiding unintended pregnancies is only one goal of age appropriate sexuality education. Safe and responsible sexual behaviour also protects against sexually transmitted infections, including HIV/AIDS.

Through CARMMA, our aim, together with the First Ladies, is to enable our sons and daughters and the people we love to protect themselves. Our aim is to make it possible for young people, women and men alike, to fulfil their potential as human beings. By doing so, we are contributing to the productivity and economic growth of Africa.

Another contributing factor to the high levels of maternal mortality in Africa is that many young women are married and become pregnant at a very young age. Pregnancy is a threat to a young girl’s life and health - married or not. A girl who gives birth before she is 18 is twice more likely to suffer death or disability than her sister who postpones her pregnancy. Early pregnancy is a major cause of fistula, a dreadful birth injury. Young girls need to know how to protect themselves against pregnancy which could kill them or disable them for life.

Next steps to move CARMMA forward

In May 2009, we embarked on CARMMA because it became clear that reducing maternal mortality by 75% until 2015- based on figures from 1990 – as suggested in the Millennium Development Declaration is a daunting challenge for many African countries. We needed a more focused and concentrated effort, and a platform where we could share good practices and learn from each other – CARMMA provides all this – under the umbrella of Every Woman Every Child - and now it is time to move CARMMA to the next level.

I am here today to ask all of us to come together to combine and strengthen efforts to save the lives of Africa’s women and girls. Let us improve and save the lives of our sisters, mothers and daughters – we know what to do and how to do it. It is now in our hands to follow through.

I reaffirm that UNFPA is standing beside you and is 100% committed to supporting the African Union and all countries and governments in Africa to improve Women’s Health and Development.

What can African countries do?

Excellencies, many of you Heads of States and Government Officials ask me, how you can be more involved in CARMMA to contribute to women’s health and maternal mortality reduction.

We all know and agree that without health, no country can flourish and develop, and without the health of mothers and children, none of us would be here today. I call on Heads of States and governments to:

1. Increase your personal commitment, including mobilising the entire country and promoting everyone’s involvement to improve the health of mothers and children, making maternal health a top priority;

2. Increase and ensure better use of domestic resources for maternal health. This includes thinking about creative and innovative financing and public private partnerships;

3. Empower your ministries of health to intensify, share and replicate good maternal health interventions and involve other health related sectors.

More involvement of First Ladies in your respective countries is also a means to a healthier, wealthier Africa. UNFPA looks up to the First Ladies, policy makers, parliamentarians, opinion leaders, and communities to help advance issue of reduction of Maternal Mortality in Africa. We also look forward to the continued partnership between the Offices of the First Ladies at regional and country levels and UNFPA.

UNFPA’s commitment

But you are not alone. UNFPA, while reaffirming the strong and mutually reinforcing partnership between CARMMA and the United Nations Global Strategy on Women’s and Children’s Health, is ready to scale up and we are committed to:

1. Continue supporting the African Union and its Member States to monitoring the progress of CARMMA and other maternal health interventions as recommended at the July 2010 AU Summit in Kampala;
2. Facilitating effective partnerships with the African Union, respective Governments, sister agencies and development partners under CARMMA as part of its secretariat functions;
3. Help ensuring that commitments made, both by governments and development partners are focused, effective and honoured in order to increase accountability through measurable outcomes;
4. Advocating for additional accelerated and sustainable investments in the area of sexual and reproductive health to improve maternal and child health, understanding that additional resources are needed to move CARMMA to the next level;
5. Increasing technical support at country and regional level to make reliable, segregated data consistently available and indicators aligned with the UN Secretary General’s Global Strategy on Woman’s and Children’s Health in order to understand progress made in the continent.

In closing, your Excellences, I know that if we all commit ourselves and your respective Governments to these ambitious but very doable plans, with the support of development partners and everyone’s engagement, we will soon see a new Africa where no woman will die giving life.

Thank you.