Interview with Thoraya Ahmed Obaid, UNFPA
LONDON, Oct 22 2007 (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.
Thoraya Obaid Credit:
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.
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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 #39t improved much. We #39re 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 #39t 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 #39t just look at torture, imprisonment and so on, but see that the needless death of women is a violation of human rights.
