National data on women’s health mask inequalities, conference hears

BMJ 2013; 346 doi: (Published 06 June 2013) Cite this as: BMJ 2013;346:f3629
  1. Patralekha Chatterjee
  1. 1Kuala Lumpur

Women from ethnic minorities and poor or vulnerable women need to be targeted in efforts to improve women’s health, heard delegates at the Third Women Deliver conference held in Kuala Lumpur on 28-30 May.

Although national statistics in recent years have been highlighting improvements in the health of women and girl in many countries, these data often mask huge differences between regions and communities. Experts in public health at the conference underlined the importance of filling the gaps in the data to improve measurement and monitoring of maternal mortality.

The Countdown to 2015 accountability report from the World Health Organization and Unicef, launched at the conference, said that maternal and child mortality had been falling over the past two decades in most of the 75 countries that account for over 95% of the world’s maternal and child mortality (the “Countdown countries”). However, progress had been slow in some countries, particularly in sub-Saharan Africa, where fertility levels were still high.1 “These countries must be prioritized for collective global, regional, and national action,” the report recommended.

Cesar Victora, emeritus professor of epidemiology at the Federal University of Pelotas, Brazil, who chairs the Countdown working group on equity, told the conference, “Ten years ago the data on equity just weren’t available, and the issue wasn’t getting enough attention. Now, a lot more is happening on many fronts, and equity is a major focus in the development of post-2015 millennium development goals.”

The report also highlighted the need for urgent action on newborns, who now accounted for 40% or more of all child deaths in 35 of the 75 Countdown countries. Improving newborns’ survival included reducing numbers of preterm births and stillbirths.

Jeni Klugman, director of gender and development at the World Bank, said, “Maternal health in the post-2015 agenda is important because none of the world’s regions is on track to meet the fifth [millennium development] goal . . . to cut maternal mortality by three quarters.”

The meeting was attended by nearly 5000 delegates from 149 countries. It was organised by Women Deliver, an international organisation that works to improve the health and wellbeing of girls and women.

A report from the World Bank presented at the meeting said that many groups of women were missing out on health initiatives aimed at improving the health of women.2

It said that in Vietnam, for example, 60% of women from ethnic minorities gave birth without prenatal care, twice the proportion of women in the majority Kinh ethnic group. The report said that expanding women’s access to family planning services made good economic sense. Investments in reproductive health went beyond benefiting the individual to the economy, by increasing the female labour supply and productivity, reducing health expenditure, and shaping a better future for the next generation.

Anuradha Gupta, an Indian health official, said that the Janani Suraksha Yojana (Mother Protection Scheme), which is sponsored by the federal government, had led to a huge surge in the number of women giving birth in hospital. Traditionally, most women in India gave birth at home. Now the government has drawn up a list of 184 high priority districts, of the total 640 districts in the country, that will get 30% more resources because they have the worst health and social indicators.

Many impediments to better maternal health are moored in social and cultural practices, including child marriage and female genital mutilation, the conference heard. Legislation on reproductive health also continues to be controversial. Last December the predominantly Catholic Philippines passed a law that would increase poor people’s access to contraception and family planning.3 Supporters said that the law, which took nearly 15 years to pass, would reduce poverty and maternal mortality in a country with one of the highest birth rates in Asia.

However, Pia Cayetano, a senator from the Philippines who played a pivotal role in pushing through the law on reproductive health, said that the battle was not over. She told conference delegates: “A case is pending with the Supreme Court to question the constitutionality [of the law], and of course we have its implementation and a lot of challenges on hand.”


Cite this as: BMJ 2013;346:f3629