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GLOBAL
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18-20 October 2007
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Overview: Why Women Deliver^ Why Now?
Every minute of every day, a woman dies needlessly in pregnancy or childbirth, most
in the developing world. Ten million women are lost in each generation - our
mothers and sisters, daughters and grandmothers, wives and partners, friends and
neighbors.
Fully 42 percent of all pregnancies worldwide suffer complications, and in 15
percent of all pregnancies, the complications are life-threatening.1
Huge disparities exist in women’s survival rates between rich and poor countries,
and between the rich and the poor in all countries.2
In the ten top-ranked countries, where women are guaranteed good-quality
health and family planning services that minimize their lifetime risk, fewer than
one in 16,400 women will die from complications of pregnancy and childbirth.
One in 4,800 women will die of these causes in the United States. The rate for
black U.S. women in 2000 was nearly four times that for white non-Hispanic
women.
In sub-Saharan Africa, where high fertility multiplies the dangers women face
over their lifetimes, one in every 22 women will die in pregnancy or childbirth.
In Niger such complications kill one in every seven women.
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2007 is a critical year for advancing the health and rights of women.
Women Deliver marks the 20th anniversary of the launch of the global Safe
Motherhood Initiative. Its research led to impressive gains in many places.
We now know how to save the lives of most of those who die needlessly
worldwide. But maternal and newborn health still receives inadequate attention
and funding.
In 2000, world leaders agreed on Millennium Development Goal #5: improve
maternal health (and its target of cutting maternal mortality by 75 percent by
2015).
This is often called the heart of the MDGs, because if it fails, so will the other
MDGs.
In 2005, world leaders and the UN Secretary General recommended to the
General Assembly another target for Goal #5: Achieve universal access to
reproductive health by 2015. Women Deliver comes at a point haltway to 2015.
The numbers of women who die in pregnancy and childbirth (more than 536,000
per year) and of newborns who die before they are one month old (about 4 million
per year) - mainly from preventable causes - have not dropped significantly in 20
years, in large part due to lack of political will.
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The leading killers:
Haemorrhage: uncontrolled bleeding can kill a healthy woman in two hours. Most
developing countries lack adequate supplies of safe blood, especially in rural areas.
Eclampsia (high blood pressure): this condition is often undiagnosed until too late.
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The Eight Millennium Development Goals
Goal #1: Eradicate extreme poverty and hunger.
Smaller families and wider birth intervals from reproductive health care, including
contraceptive use, allow families to invest more in each child’s nutrition and health.
When a woman is too ill, anaemic or hungry to work, her household economic
situation deteriorates and poverty increases; her children are less likely to attend
school. A woman’s death in childbirth deprives her family and community of her
contributions.
Goal #2: Achieve universal primary education.
Every year of education for girls and women improves their families’ health and
nutrition and raises their economic output. Families with fewer children can afford to
invest more in their education, making it more likely that girls will be sent to and stay
in school.
Goal #3: Promote gender equality and empower women.
Women who can plan the timing and number of their births and count on safe
motherhood will have greater opportunities for work, education and civil involvement.
Discrimination and violence against girls and women not only abuse their human
rights, but also rob society of critical energy, economic production and creative
talent.
Goal #4: Reduce child mortality.
Care for the health of mothers is inseparable from the health of newborns. Those
whose mothers die are three to 10 times more likely to die within two years than
those whose mothers survive. Young girls married off at puberty bear children at risk:
babies born to girls under 15 are five times as likely to die as those born to women in
their 20s.
Goal #5: Improve maternal health.
Improving maternal health - by cutting maternal mortality by three-quarters by 2015
and guaranteeing universal access to reproductive health ~ is often called the heart
of the MDGs, because if it fails, the other MDGs will too. Investment in reproductive
health care, education, emergency obstetric services and skilled care at delivery will
enable women to deliver ~ not just the next generation but also paychecks and
productivity - everything development advocates work to achieve.
Goal #6: Combat HIV/AIDS, malaria and other diseases.
Comprehensive sexual and reproductive health care includes preventing and treating
HIV/AIDS and other sexually transmitted infections. Antenatal and post-natal care
facilities can bring mothers and their families into the health care system,
encouraging diagnosis and treatment of many other illnesses for many more people.
Goal #7: Ensure environmental sustainability.
Helping women avoid unintended pregnancies and to stay healthy and economically
productive through pregnancy and motherhood helps stabilize rural areas, slows
urban migration and balances natural resource use with the needs of the population.
Goal #8: Develop a global partnership for development.
Healthy and economically productive women can be half of every country’s engine
for growth and development. Affordable prices for drugs, global economic stability
and a secure supply of commodities would greatly advance reproductive health
programmes, and are especially needed in developing countries.
9
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October 2007
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New Figures for 2005
On October 12, 2007, an unprecedented joint UN agency working group released
new estimates, the first in five years, on maternal mortality worldwide.
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The World Health Organization; UNFPA,the United Nations Population Fund;
UNICEF (the United Nations Children’s Fund); the UN Population Division; and The
World Bank together developed a new approach to estimating maternal mortality that
seeks both to generate estimates for countries with no data and to correct available
data for under-reporting and for misclassification.
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Maternal Mortality Scorecard
Inconsistency in data on deaths and on classification of those deaths creates broad
uncertainties in many places, even in developed countries. But all estimates almost
certainly understate the problem. The 2005 approach differs from those used in
1990, 1995, and 2000, so the new figures cannot be reliably compared to previous
estimates.
However, the task force conducted two kinds of trend analysis to supply information
on progress toward achieving the Millennium Development Goal 5 target of reducing
maternal mortality by 75 percent by 2015. Both these analyses showed declines in
maternal mortality ratios since 2000 that are insufficient to achieve the MDG goal.
The assessment of risk given below takes into account both the probability of
becoming pregnant and the probability of dying as a result of that pregnancy in 171
countries with populations of more than 250,000, cumulated across a woman’s
reproductive years. This is the lifetime risk of maternal death.
The New Country Rankings
Among the ten top-ranked European and other industrialized countries, where
women are guaranteed good-quality health and family planning services that
minimize their lifetime risk, fewer than one in 16,400 will die from complications of
pregnancy and childbirth. At the other end of the scale are ten countries where high
fertility and shattered health care systems raise women’s lifetime risk so that more
than one in every 15 women will die of pregnancy-related causes.
Rank by lifetime risk of death from pregnancy-related causes
1 in 47,600 will die and in...
1 in 29,000
1 in 26,600
1 in 25,900
1 in 21,500
1 in 19,200
1 in 18,100
1. Ireland
2. Bosnia and Herzegovina
3. Italy
4. Greece
5. Austria
6. Germany
7. Czech Republic
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-28. Denmark
9. Sweden
10. Spain
11. Slovenia
12. Slovakia
12. Switzerland
14. Australia
14. Hungary
16. Iceland
17. Japan
18. Canada
19. Poland
20. Croatia
21. Netherlands
22. Kuwait
23. Finland
23. Latvia
25. Malta
26. United Kingdom
27. Belgium
27. Israel
27. Lithuania
30. Norway
31. Bulgaria
32. France
33. The former Yugoslav Republic of Macedonia
34. Cyprus
34. Portugal
36. Singapore
37. Republic of Korea
38. New Zealand
39. Ukraine
40. Luxembourg
41. Belarus
41. United States of America
43. Serbia and Montenegro*
44. Barbados
45. Republic of Moldova
46. Mauritius
47. Chile
47. Romania
49. Brunei Darussalam
49. Puerto Rico
49. Estonia
52. Qatar
52. Russian Federation
52. Bahamas
55. Uruguay
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1 in 17,800
1 in 17,400
1 in 16,400
1 in 14,200
1 in 13,800
1 in 13,800
1 in 13,300
1 in 13,300
1 in 12,700
1 in 11,600
1 in 11,000
1 in 10,600
1 in 10,500
1 in 10,200
1 in 9,600
1 in 8,500
1 in 8,500
1 in 8,300
1 in 8,200
1 in 7,800
1 in 7,800
1 in 7,800
1 in 7,700
1 in 7,400
1 in 6,900
1 in 6,500
1 in 6,400
1 in 6,400
1 in 6,200
1 in 6,100
1 in 5,900
1 in 5,200
1 in 5,000
1 in 4,800
1 in 4,800
1 in 4,500
1 in 4,400
1 in 3,700
1 in 3,300
1 in 3,200
1 in 3,200
1 in 2,900
1 in 2,900
1 in 2,900
1 in 2,700
1 in 2,700
1 in 2,700
1 in 2,100
-31 in 1,400
1 in 1,400
1 in 1,400
1 in 1,400
1 in 1,400
1 in 1,300
1 in 1,300
1 in 1,100
1 in 1,000
1 in 980
1 in 880
1 in 850
1 in 840
1 in 670
1 in 670
1 in 610
1 in 560
1 in 560
1 in 530
1 in 530
1 in 500
1 in 500
1 in 490
1 in 450
1 in 420
1 in 370
1 in 360
1 in 350
1 in 300
1 in 290
1 in 290
1 in 290
1 in 280
1 in 270
1 in 240
1 in 240
1 in 230
1 in 230
1 in 220
1 in 210
1 in 200
1 in 190
1 in 170
1 in 170
1 in 170
1 in 160
1 in 160
1 in 150
56. Costa Rica
56. Cuba
56. Uzbekistan
56. Saudi Arabia
56. Trinidad and Tobago
61. China
61. Bahrain
63. Georgia
64. United Arab Emirates
65. Armenia
66. Turkey
67. Sri Lanka
68. Mongolia
69. Azerbaijan
69. Mexico
71. Venezuela
72. Belize
72. Malaysia
74. Argentina
74. Suriname
76. Tunisia
76. Thailand
78. Albania
79. Jordan
80. Oman
81. Brazil
82. Kazakhstan
83. Libyan Arab Jamahiriya
84. Iran
85. Colombia
85. Lebanon
85. Turkmenistan
88. Viet Nam
89. Panama
90. Jamaica
90. Kyrgyzstan
92. Dominican Republic
92. Egypt
94. Algeria
95. Syrian Arab Republic
96. Maldives
97. El Salvador
98. Ecuador
98. Namibia
98. Paraguay
101. Fiji
101. Tajikistan
103. Morocco
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103. Nicaragua
105. Democratic People’s Republic of Korea
105. Peru
105. Philippines
108. Botswana
109. Cape Verde
109. Swaziland
111. Myanmar
111. South Africa
113. Solomon Islands
114. Indonesia
115. Honduras
116. Guyana
117. Bolivia
118. Pakistan
119. Iraq
120. Guatemala
121. India
122. Bhutan
122. Papua New Guinea
124. Gabon
124. Sudan
126. Comoros
127. Bangladesh
128. Cambodia
129. Ghana
129. Lesotho
129. Mozambique
132. Haiti
132. Eritrea
134. Zimbabwe
135. Kenya
135. Yemen
137. Madagascar
137. Togo
139. Djibouti
139. Timor-Leste
141. Lao People's Democratic Republic
142. Gambia
143. Nepal
144. Equatorial Guinea
145. Cote d’Ivoire
145. Ethiopia
145. Zambia
148. Central African Republic
148. Uganda
150. Cameroon
150. United Republic of Tanzania
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1 in 150
1 in 140
1 in 140
1 in 140
1 in 130
1 in 120
1 in 120
1 in 110
1 in 110
1 in 100
1 in 97
1 in 93
1 in 90
1 in 89
1 in 74
1 in 72
1 in 71
1 in 70
1 in 55
1 in 55
1 in 53
1 in 53
1 in 52
1 in 51
1 in 48
1 in 45
1 in 45
1 in 45
1 in 44
1 in 44
1 in 43
1 in 39
1 in 39
1 in 38
1 in 38
1 in 35
1 in 35
1 in 33
1 in 32
1 in 31
1 in 28
1 in 27
1 in 27
1 in 27
1 in 25
1 in 25
1 in 24
1 in 24
-5-
1 in 22
1 in 22
1 in 22
1 in 21
1 in 20
1 in 19
1 in 18
1 in 18
1 in 16
1 in 16
1 in 15
1 in 13
1 in 13
1 in 12
1 in 12
1 in 12
1 in 11
1 in 8
1 in 8
1 in 7
152. Burkina Faso
152. Congo
152. Mauritania
155. Senegal
156. Benin
157. Guinea
158. Malawi
158. Nigeria
160. Burundi
160. Rwanda
162. Mali
163. Democratic Republic of the Congo
163. Guinea Bissau
165. Angola
165. Liberia
165. Somalia
168. Chad
169. Afghanistan
169. Sierra Leone
171. Niger
* Serbia and Montenegro became separate entities in 2006.
October 2007
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Real Stories About Women and Girls:
Putting a Face on Women Deliver
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Targeted investments can save the lives and improve the health of real women,
mothers and newborn babies around the world - real people like these:
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Leonora Pocaterrazas and Albina Chambe, Bolivia
In Bolivia, indigenous tradition often means women give birth at home, fully clothed,
squatting on the floor, with only family members to help. When Albina Chambe, 15,
went into labour in a poor suburb of La Paz, her fiance Grover, only 18 himself,
wanted to take his wife to a hospital. But Albina’s mother had delivered 13 children at
home, without skilled assistance, and argued that Albina should follow tradition.
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Soon, however, Albina’s pains worsened, so Grover half-carried Albina on a 20minute uphill climb to the nearest dirt road. He spent more than a day’s pay for a taxi
to the hospital. There a medical team safely delivered Luz Belen, the couple’s new
baby girl.
Leonora Pocaterrazas, 21, was not so lucky. When she went into labour in the high
mountain village of Columpapa Grande, weeks ahead of schedule, her husband
wasn’t ready. “She told me she was in pain. I gave her a massage and then I went to
ask my sister for help,” he told visitors. “When I got back she had already had the
baby.”
The sister couldn’t stop Leonora’s bleeding, and the baby wasn’t breathing. “The
baby was too small. He died half an hour later,” the husband said. Leonora died as
well, leaving three other children behind.
For lack of measures against such risks over their lifetimes, one in every 89 Bolivian
women will die in pregnancy or childbirth - one of Latin America’s highest rates.
UNFPA, the United Nations Population Fund, supports Bolivian government efforts
to integrate skilled midwives and healthcare providers into the country’s health
system so that women at risk, like Leonora, are brought to hospitals in time for
emergency care that can save their lives - and those of their newborns and their
other children.
Fatima M., Afghanistan
Fatima’s story illustrates the dire consequences a mother’s death has for her family
and her community. She and her husband Ahmed already had nine children and
were barely surviving on his salary as a security guard when she became pregnant
again. He nearly lost his job taking care of the family during her difficult pregnancy.
Then Fatima died giving birth to twin boys in a Kabul hospital. Because
Afghanistan’s shattered health care system multiplies their lifetime risks, one in every
eight Afghan women will die in this way, from complications of pregnancy and
childbirth.
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Fatima’s hospital expenses put Ahmed deeper into debt, so he took their 13-year-old
son out of school to work. The twins had to be fed on goats’ milk and expensive
infant formula and they were often ill with diarrhea or acute respiratory infections, the
most common killers of infants worldwide. The family’s 11-year-old daughter was
taken out of school to care for them. At seven months, the smaller twin died of a
respiratory infection.
Ahmed remarried, adding to his debt and poverty, so he married off his oldest
daughter when she turned 13. She became pregnant at 15, before her body was
ready, and suffered an agonizing obstructed labour. Her baby was born brain
damaged and she was left with an obstetric fistula, an opening between her vagina
and bladder that made her incontinent. The resulting wetness and odor caused her
acute humiliation. Her husband abandoned her, and she had to return to her father’s
home to continue a life of poverty.
Kakenya Ntaiya, Kenya
Kakenya Ntaiya’s story shows how education can change all the cards in the hand a
young girl is dealt at birth. The oldest of eight children of a Maasai tribal family, she
was engaged to be married when she was five years old. She grew up caring for
cattle and her siblings in a small village 20 miles from the nearest paved road. She
often was the only person to help her mother give birth in their hut. She was
expected to undergo ritual circumcision at puberty, leave school and marry the man
her parents had chosen.
Kakenya had other ideas. She told her father she would undergo the circumcision
only if she could stay in school. Her father agreed, and at 13 she joined the
estimated 2 million women who have suffered female genital cutting worldwide.
Undeterred, Kakenya finished high school with top marks and decided she wanted to
attend college - in the United States. No girl in her village had ever done that. So
she negotiated again, this time with the village elders. If they let her go, she
promised, she would come back and help build a school and a maternity hospital.
It worked. The village women united to raise the money to send Kakenya to the
United States. They knew pregnancy in Kenya often means death: one in every 39
women will die there of complications in pregnancy and childbirth, one of the world’s
highest rates.
Kakenya graduated from Randolph-Macon Women’s College in 2004, and her
mother came from Kenya to attend the ceremony. Kakenya went on to a PhD
program in education at the University of Pittsburgh, determined to become a leader
in helping others get an education in Kenya. She has now raised more than
US$75,000 toward the school she promised to build in her village.
Kakenya’s success has inspired millions of people. She has been the subject of a
Washington Post series, a BBC documentary and many magazine articles. She
married in 2006 and is expecting her first child in September 2007.
“Now all the village women want their daughters to stay in school,” she tells
audiences throughout the world.
October 2007
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Glossary of terms
AIDS orphan - A child under 18 who has lost one or both parents to AIDS. There
are more than 15 million AIDS orphans in the world today, 12 million of them in subSaharan Africa. UNAIDS projects that the total will be 25 million by 2010.1
Anti-retroviral drugs (ARVs) - Drugs taken to fight HIV. They inhibit reproduction
of the human immune-system retrovirus (HIV) that causes adult immune-system
deficiency syndrome (AIDS). Short courses of anti-retroviral drugs during pregnancy,
delivery and post-delivery reduce the risk of mother-to-child transmission of
HIV/AIDS.
Child survival - A goal of programs aimed at preventing or treating common
diseases of children.
Emergency obstetric care - Consists of skilled medical personnel with the
antibiotics, sedatives, blood transfusions and other equipment they need to deal with
complications of pregnancy and childbirth, including obstetric surgery if necessary.
Family planning - The conscious effort of couples or individuals to plan for the
number of their children and to regulate the spacing and timing of their births,
through contraception and the treatment of involuntary infertility.
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Female genital cutting - All procedures involving partial or total removal of the
external female genitalia, or other deliberate injury to the female genital organs,
whether for cultural, religious or other non-therapeutic reasons. Often called “female
genital mutilation” or “female circumcision,” it has been inflicted on an estimated 130
million living women, usually with crude instruments and without anaesthesia.2
Fistula (obstetric) - An opening or rupture linking two areas such as the vagina,
rectum, bladder and/or abdominal cavity, usually caused by obstructed labour,
unsafe abortion or traditional practices such as female genital cutting. The result is
uncontrollable leakage of urine or faeces, odor, infections and usually social
ostracism for the woman or girl.
Gender bias - Any distinction, exclusion or restriction made on the basis of socially
constructed gender roles and norms that prevents a person from enjoying full human
rights. While the term technically refers to discrimination against either males or
females, in practice the near-global preference for boys leads to sex-selective
abortions, abandonment or neglect of girl infants and children, and restrictions on the
feeding, health care, education, legal rights and social and political participation of
girls and women. Elimination of gender bias is increasingly seen as both a human
rights issue and as a precondition for, and indicator of, sustainable, people-centered
development.
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-2Gender-based violence - Violence that targets women or men, girls or boys on the
basis of their gender or sexual orientation. It includes, but is not limited to, sexual
assault and domestic violence, and is often used as a weapon of war.
Gender-disaggregated data - Facts and figures that break out data by gender. Use
of this data allows decision-makers to focus on issues of particular relevance to
women and men, girls and boys, and their different roles and positions in society.
Statistics on household distance from water or fuel, for example, have different
implications for women and men since women usually collect these necessities.3
Human rights - The rights people have simply because they are human beings,
held inalienably, universally and forever. Citizenship, nationality, race, ethnicity,
language, gender, sexuality and abilities are irrelevant. Human rights only become
enforceable when they are codified as conventions, covenants or treaties, or as they
become recognized as customary international law.4
Maternal death - A woman’s death due to complications of pregnancy or childbirth,
usually restricted to deaths of women pregnant within 42 days before death. Some
definitions specify a woman be pregnant within three to 12 weeks before death.5
Maternal mortality rate - The number of maternal deaths per 100,000 women of
reproductive age (15 to 49).6
Maternal mortality ratio - The number of maternal deaths per 100,000 live births
during the same time period.7
Maternal-newborn health - The health of newborn babies is so intimately linked to
the health and survival of the mother that the World Health Organization (WHO) now
refers to newborns’ health only in this way.8
Micro-enterprise - A manufacturing business with four or fewer employees, or a
firm in trade with 10 or fewer employees, and little working capital. Such businesses
account for an estimated half of all businesses in many countries, more than 80
percent of those in Latin America and the Caribbean.9
Millennium Development Goals (MDGs) - An eight-point agenda for reducing
poverty and improving lives worldwide, agreed upon by world leaders at the
Millennium Summit in 2000. For each goal, one or more targets have been set, most
for 2015, using 1990 as a benchmark. The eight goals are: 1. Eradicate extreme
poverty and hunger; 2. Achieve universal primary education; 3. Promote gender
equality and empower women; 4. Reduce child mortality; 5. Improve maternal health;
6. Combat HIV/AIDS, malaria and other diseases; 7. Ensure environmental
sustainability; and 8. Develop a global partnership for development.10 Following the
2005 World Summit, universal access to reproductive health was added as a target
under Goal #5 in 2006.
Morbidity rate - The number of individuals who become ill with a particular disease
within a susceptible population during a specified time period.11
Mortality rate - The ratio of the number of deaths from a particular disease to the
total number of cases of that disease.12
Neonatal - Referring to the first four weeks of a child's life.
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PMCT ~ Abbreviation for programmes to Prevent Mother-to-Child Transmission of
HIV/ AIDS. Such programmes administer anti-retroviral drugs to newborns, and less
often to their mothers and siblings. The most successful programmes provide two
ARV doses to both mothers and newborns and also offer confidential HIV counseling
and testing.13
Reproductive health - The state of complete physical, mental and social well-being
- not merely the absence of infirmity - in all matters relating to the reproductive
system and to its functions and processes.
Safe motherhood - A family, community and social environment that allows women
to experience a pregnancy to full term without unnecessary interventions, and
delivery of a healthy infant into a postpartum period of medical and social support for
the physical and emotional needs of the woman, infant, and the entire family. Safe
motherhood begins before conception with proper nutrition, health care and a
healthy lifestyle for the mother, and continues with appropriate antenatal care, the
prevention of complications when possible, and the early and effective treatment by
trained medical personnel of complications, if any, followed by post-natal medical
care for mother and child.14
Safe Motherhood Initiative - A global campaign launched in 1987 by WHO;
UNICEF; UNFPA, the United Nations Population Fund; the World Bank; Family Care
International and other organizations, to ensure all pregnancies are wanted, all
women can go safely through pregnancy and childbirth, and infants are born alive
and healthy.15
Safer sex - Any sexual practice that aims to reduce the risk of unintended
pregnancy and of passing HIV and other sexually transmitted infections from one
person to another. Examples are non-penetrative sex or vaginal intercourse with a
condom. During unsafe sex, fluids that can transmit HIV and other STIs (semen,
vaginal fluid or blood) may be introduced into the body of the sex partner.16
Sexual and reproductive health care rights and services - The full spectrum of
education, information, affordable and effective supplies and services necessary to
allow all couples and individuals to decide freely and responsibly the number,
spacing and timing of their children, and to attain the highest standard of sexual and
reproductive health. These rights also include the right of all to make decisions
concerning reproduction free of discrimination, coercion and violence.17
Sexual rights - The rights of all persons, free of coercion, discrimination and
violence, to the highest attainable standard of health in relation to the following:
sexuality, including access to sexual and reproductive health care services; the right
to seek, receive and impart information in relation to sexuality; sexuality education;
respect for bodily integrity; choice of sexual partner; the decision to be sexually
active or not; consensual sexual relations; consensual marriage; the decision of
when and whether or not to have children; and to pursue a satisfying, safe and
pleasurable sexual life. These
rights are already recognized in national laws and international human rights and
consensus documents.18
- more -
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Son preference (or boy preference) - A desire to have male rather than female
children. This is usually due to the perception that sons contribute more to their
families and/or cost the family less than girls, through remunerative work, continuing
the family line and carrying out family rites and rituals, and providing security to the
parents in old age.19
Unsafe abortion - A procedure for terminating unintended pregnancy, either by
persons lacking the necessary skills or in an environment lacking minimal medical
standards, or both.20
Women of reproductive (or childbearing) age - Women age 15 to 49, according
to WHO.
' UNAIDS, “Orphans,” Uniting the World Against AIDS, www.unaids.org/en/lssues/Affected_communities/orphans.asp
(accessed April 25, 2007).
World Health Organization, “Female Genital Mutilation,” Fact Sheet No. 241, June 2000.
3 Glossary, International Development Research Centre, IDRC, http://www.idrc.ca/en/ev-42971-201-1-DO_TOPIC.html
(accessed April 13, 2007).
^Amnesty International, “A Human Rights Glossary," Human Rights Here and Now,
http://www.globaled.org/curriculim/amnesty/glossary.html (accessed April 25, 2007).
5 International Planned Parenthood Federation, Glossary, IPPF, London, 2006.
6 UNFPA, UN Population Fund, "Reproductive Health in Refugee Situations: An Inter-Agency Field Manual,” Appendix Three:
Glossary of Terms), New York, 2006.
7 UNFPA, United Nations Population Fund, “Reproductive Health in Refugee Situations: An Inter-Agency Field Manual,”
Appendix Three: Glossary of Terms, New York, 2006.
8 International Federation of Gynecology and Obstetrics, “FIGO Saving Mothers and Newborns,” 2007.
9 Schreiner, Mark, and Leon, J., Microfinance for Microenterprise: A Source Book for Donors, Microfinance Risk Management,
Center for Social Development, Washington University, St. Louis MO, November 2001, p. 2;
http://www.microfinance.com/English/Papers/Source_Book_for_Donors.pdf (accessed April 25, 2007).
10 United Nations, “What are the MDGs?” U.N, Millennium Development Goals, http://www.un.org/millenniumgoals/ (accessed
April 25, 2007).
" National Institutes of Health, Glossary, http://science.education.nih.gov/supplements/nih1/diseases/other/glossary/act1qloss1.htm (accessed April 25, 2007).
National Institutes of Health, Glossary, http://science.education.nih.gov/supplements/nih1/diseases/other/glossary/act1qloss1.htm (accessed April 25, 2007).
UNICEF, “Programme Recommendations for the Prevention of Mother-to-Child Transmission of HIV: A Practical Guide for
Managers,” HIV/AIDS Working Paper, http://www.unicef.org/pmtctunicefevalprogmgr.pdf (accessed April 25, 2007)
14 Centers for Disease Control and Prevention, “Safe Motherhood," Reproductive Health,
http://www.cdc.gov/reproductivehealth/index.htm (accessed April 25, 2007).
15 UNFPA, United Nations Population Fund, "Safe Motherhood," Office of Oversight & Evaluation, #10, New York, January
1999.
16 International Planned Parenthood Federation, Glossary, 2006, http://www.ippf.org/en/Resources/Glossary.htm (accessed
April 25, 2007).
17 Programme of Action of the International Conference on Population and Development. Geneva: United Nations, 1994, para
7.3, http://www.unfpa.Org/icpd/icpd_poa.htm#ch7.
'8 World Health Organization, Geneva, 2002, http://www.who.int/reproductive-health/gender/glossary.html.
19 International Planned Parenthood Federation, Glossary, IPPF, London, 2006.
20 UNDP/ UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human
Reproduction (HRP), “Preventing Unsafe Abortion, The Persistent Public Health Problem," http://www.who.int/reproductivehealth/unsafe_abortion/index.html (accessed April 16, 2007).
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Conference Organizers
The conference core planning group includes the Department for International
Development, UK (DFID); Dutch Ministry of Foreign Affairs; Family Care
International (FCI); International Planned Parenthood Federation (IPPF); Norwegian
Agency for Development Cooperation (Norad); The Partnership for Maternal,
Newborn & Child Health; Save the Children; Swedish International Development
Agency (Sida); UNFPA, the United Nations Population Fund; UNICEF, the United
Nations Children’s Fund; The World Bank, and the World Health Organization
(WHO).
Family Care International (FCI): FCI works to ensure that women and adolescents
have access to life-saving services and information to improve their health,
experience safe pregnancy and childbirth and avoid unintended pregnancy and HIV
infection, www.familycareintl.org
Department for International Development, UK (DFID): DFID, part of the UK
government, manages Britain’s aid to poor countries and works to eliminate extreme
poverty, www.dfid.gov.uk
Dutch Ministry of Foreign Affairs: The Ministry of Foreign Affairs is the channel
through which the Dutch Government communicates with foreign governments and
international organizations. It coordinates and carries out Dutch foreign policy.
www.minbuza.nl/en/ministry
The International Planned Parenthood Federation (IPPF): IPPF is a strong global
voice safeguarding sexual and reproductive health and rights for people everywhere.
www.ippf.org
Norwegian Agency for Development Cooperation (Norad): Norad is a directorate
under the Norwegian Ministry of Foreign Affairs. Its most important task is to
contribute to international cooperation to fight poverty, www.norad.no
The Partnership for Maternal, Newborn & Child Health: The Partnership is a
membership organization of 150 groups concerned with Millennium Development
Goals (MDGs) #4 and #5. It resulted from a merger among the Partnership for Safe
Motherhood and Newborn Health, the Child Survival Partnership and the Healthy
Newborn Partnership, www.who.int/pmnch/en
Save the Children: Save the Children is an independent global organization
creating change for children in need. It works with families to define and solve the
problems their children and communities face while employing a broad array of
strategies to ensure self-sufficiency, www.savethechildren.org
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agency providing technical assistance and funding throughout the world.
www.sida.se
UNFPA, the United Nations Population Fund: UNFPA is the lead United Nations
agency supporting reproductive health care in 150 countries worldwide. It works to
prevent women from dying in pregnancy and childbirth through technical, political
and financial assistance. Activities range from providing family planning, advocating
health reforms and upgrading health facilities, training midwives and doctors,
mobilizing communities and promoting women's rights. All activities are undertaken
in close partnership with national governments, sister United Nations agencies, civil
organizations and The World Bank, www.unfpa.org
UNICEF, the United Nations Children’s Fund: UNICEF is mandated by the United
Nations General Assembly to advocate protection of children's rights, to help meet
their basic needs and to expand their opportunities to reach their full potential.
www.unicef.org
The World Bank: The World Bank is a vital source of financial and technical
assistance to developing countries around the world. It provides low-interest loans,
interest-free credit and grants for education, health, infrastructure, communications
and many other purposes, www.worldbank.org
World Health Organization (WHO): WHO is the authority for health within the
United Nations system. It provides leadership on global health matters, shaping the
health research agenda, setting norms and standards, articulating evidence-based
policy options, providing technical support to countries and monitoring and assessing
health trends, www.who.int/en
The Women Deliver organizing committee includes more than 40 NGOs. Family
Care International is the organizing partner. The NGOs include:
Action Aid, Johannesburg, South Africa
Action Canada for Population and Development (ACPD), Ottawa, Canada
Advocates for Youth, Washington, D.C.
Asian-Pacific Resource and Research Centre For Women (ARROW), Kuala
Lumpur, Malaysia
Asian Forum of Parliamentarians on Population and Development, Bangkok,
Thailand
Averting Maternal Death and Disability (AMDD), New York, NY
CARE, Atlanta, GA
CEDPA - The Centre for Development and Population Activities, Washington,
D.C.
CHANGE - Center for Health and Gender Equity, Takoma Park, MD
DSW - German Foundation for World Population, Hannover, Germany
EngenderHealth, New York, NY
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Federation of Obstetrics and Gynecology (FIGO), London, United Kingdom
Feminist Majority Foundation, Arlington, VA
Global Health Council, Washington, D.C.
The Guttmacher Institute, New York, NY
Human Rights Watch, New York, NY
The Hunger Project, New York, NY
IMMPACT - Initiative for Maternal Mortality Programme Assessment, Aberdeen,
United Kingdom
Inter-European Parliamentary Forum on Population and Development (IEPFPD),
Brussels, Belgium
International Center for Research on Women (ICRW), Washington, D.C.
International Community of Women Living with HIV/AIDS (ICW), London, United
Kingdom
International Council of Midwives (ICM), Hague, Netherlands
The International Rescue Committee, New York, NY
International Women’s Health Coalition (IWHC), New York, NY
Ipas, Chapel Hill, NC
Japanese Organization for International Cooperation in Family Planning
(JOICFP), Tokyo, Japan
JHPIEGO, affiliate of Johns Hopkins University, Baltimore, MD
Latin American & Caribbean Women's Health Network (LACWHN)/Red de Salud
de las Mujeres Latinoamericanas y Caribe has (RSMLAC), Santiago, Chile
Partners in Population and Development, Mohakhali, Bangladesh
Population Action International, Washington, D.C.
PATH, Seattle, WA
Rainbo, London, United Kingdom
White Ribbon Alliance, Washington, D.C.
The Womens’ Commission on Refugee Women and Children, New York, NY
Y-Peer- the Youth Peer Education Network, New York, NY
The Youth Coalition, Ottawa, Canada
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Why So High?
USA Facts on Maternal Mortality
Americans tend to be complacent about pregnancy and childbirth. Most believe it is
now more or less routine and no longer the deadly risk it was for their grandmothers.
This is true for most U.S. women, but by no means for all.
Maternal mortality is a continuing US problem
About six million U.S. women become pregnant every year, and about four million
give birth. Miscarriage and abortion account for the rest.1
In 2004, a total of 540 U.S. women were reported to have died of maternal
causes, the highest number in decades, according to the Centers for Disease
Control.
When a UN agency working group calculated the risk of death from complications
of pregnancy and childbirth over a woman’s reproductive lifetime, it found that
one in 4,800 U.S. women will die from these causes.2
This 2005 figure puts the U.S. 41st among 171 countries in the latest UN list.
The overall U.S. maternal mortality ratio is now 11 deaths per 100,000 live births,
one of the highest rates among industrialized nations.
The level is thought to reflect both more detailed reporting on the causes of
women’s deaths and rising U.S. rates of obesity, high blood pressure and
diabetes.
U.S. maternal deaths have remained roughly stable
since 1982 and have not
o
declined significantly since then - 25 years ago.
The Centers for Disease Control estimates that the true level of U.S. maternal
deaths may be 1.3 to three times higher than the reported rate.
The major direct causes of U.S. pregnancy-related deaths are embolism,
haemorrhage, complications of medical conditions, and hypertensive disorders of
pregnancy (eclampsia and pre-eclampsia).4
Goals of the Healthy People 2000 project of the U.S. Department of Health and
Human Services, launched in 1990, included lowering the U.S. maternal mortality
ratio to 3.3 deaths per 100,000 live births. Only three states met that goal, and
the target was revised upward to 4.3 for Healthy People 2010 5
In the U.S., women over age 35 have higher pregnancy-related deaths than
younger women. Women age 35-39 are 2.5 times more likely and women over
age 40 are 5.3 more likely to experience a pregnancy-related death.6
Major disparities persist
Maternal mortality among black women in 2000, the latest date for which figures
are available, was almost four times the rate among non-Hispanic white women
(34.7 per 100,000 live births vs. 9.3 per 100,000 live births)/
The white-minority disparity holds true even across income levels and regardless
of the level of antenatal care they receive.
American black women are at rising risk of suffering premature deliveries and low
birth-weight babies.8
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Complications are widespread
For every woman who dies, several thousand suffer disability. One in five U.S.
women experiences major complications during pregnancy and one in four will
have serious complications during and after delivery.9
About 43 percent of U.S. deliveries (1.7 million per year) experience some kind of
maternal morbidity (defined as any illness or injury caused or aggravated by, or
associated with, pregnancy or childbirth).10
Eclampsia is the most common
Eclampsia (toxemia, or pregnancy-induced hypertension) or pre-eclampsia is the
most common complication for pregnant U.S. women, affecting 4,000 women per
year.11
Pre-eclampsia leads to about 18 percent of all U.S. maternal deaths, compared
to 15 percent worldwide.
Risk factors include multiple pregnancies, obesity, diabetes, or a history of high
blood pressure, kidney disease or connective tissue disease (like arthritis or
lupus).
The U.S. incidence of pre-eclampsia has risen 40 percent in the last decade.
1 Except where otherwise noted, this section from Centers for Disease Control and Prevention (CDC), “Decths: Final Data for
2004,” National Vital Statistics Reports, Vol 55 #5, Aug. 21, 2007, pp. 12-13 and 102-103
2 World Health Organization, UNICEF (United Nations Children’s Fund), UNFPA (United Nations Population Fund), the UN
Population Division, and The World Bank, Maternal Mortality in 2005, World Health Organization, Oct. 12, 2007, p. 27.
3 Geller, Stacie E. et al, “Morbidity and Mortality in Pregnancy: Laying the Groundwork for Safe Motherhood,” University of
Illinois, Chicago, IL, 2006, p. 176.
4 Geller, Stacie E. et al, “Morbidity and Mortality in Pregnancy: Laying the Groundwork for Safe Motherhood,” University of
Illinois, Chicago, IL, 2006, p. 178.
5 Centers for Disease Control and Prevention, “Maternal, Infant and Child Health,” Midcourse Review, Healthy People 2010,
Health and Human Services Administration, Atlanta GA, 2005, p. 20.
6 Geller, Stacie E. et al, “Morbidity and Mortality in Pregnancy: Laying the Groundwork for Safe Motherhood,” University of
Illinois, Chicago, IL, 2006, p. 178.
7 Minino, A.M., et al., "Deaths: Final Data for 2004," National Vital Statistics Report, Centers for Disease Control, Atlanta GA,
Vol. 55 No. 19, Aug. 21,2007, pp. 12-13.
8 Centers for Disease Control and Prevention, “Maternal, Infant and Child Health,” Midcourse Review, Healthy People 2010,
Health and Human Services Administration, Atlanta GA, 2005, p. 20 .
9 Geller, Stacie E. et al, “Morbidity and Mortality in Pregnancy: Laying the Groundwork for Safe Motherhood,” University of
Illinois, Chicago, IL, 2006, p. 178-179.
10 Geller, Stacie E. et al, “Morbidity and Mortality in Pregnancy: Laying the Groundwork for Safe Motherhood," University of
Illinois, Chicago, IL, 2006, p. 177.
11 This section from the Preeclampsia Foundation, "Preeclampsia Fact Sheet," “Statistics" and "Frequently Asked Questions,”
http://www.preeclampsia.org/ (accessed June 20,2007).
October 2007
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1948: United Nations Universal Declaration of Human Rights spelled out for the
first time a global agreement that every woman, man and child had certain rights
merely because they were human beings. No exceptions for “cultural practices,”
“national traditions,” “family matters” or “religious teachings.” No exceptions for
gender, skin color, ethnicity, political views, religion or nation. No exceptions.
1968: International Conference on Human Rights, Teheran, affirmed that couples
“have a basic human right to determine freely and responsibly the number and
spacing of their children.”
1975: First UN World Conference on Women, Mexico City, set three goals: full
gender equality and elimination of gender discrimination; integration and full
participation of women in development; and increased contribution by women to
strengthening world peace. Delegates called for an international covenant to protect
women’s rights.
1976-1985: United Nations International Decade for Women (IDW), a product of
the 1975 conference, led to establishment of UNIFEM, the UN Development Fund
for Women. Two-thirds of UN member states adopted some form of national “plan”
for Women.
1979: CEDAW, the Treaty for the Rights of Women, approved at the UN. The
Convention on the Elimination of all forms of Discrimination Against Women
(CEDAW) is the most comprehensive international agreement on women’s basic
rights. Ratified by more than 180 countries (but not the United States), it has become
an important tool for ending human-rights abuses and promoting the well-being of
women and girls worldwide.
1980: Second World Conference on Women, Copenhagen, identified three
priorities: equal access to education, employment opportunities and adequate health
care.
1985: Third World Conference on Women, Nairobi, recognized that relatively few
women had benefited from progress so far and that the need for gender equality
pertained to all areas of human activity. It set categories for assessing progress: in
constitutional and legal measures, social participation, and political participation and
decision-making.
1987: Safe Motherhood Conference, Nairobi. The enormous toll of women dying
in pregnancy and childbirth worldwide led WHO, the World Bank and UNFPA (the
United Nations Population Fund) to spearhead the research and advocacy Safe
Mother Initiative to promote investment in measures to save women’s lives. In its 20year history, the SMI has made reduction of maternal mortality an essential health
goal for the global community.
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1992: UN Conference on Environment and Development (“Earth Summit”), Rio
de Janeiro, recognized the vital role of women in sustainable and social
development and affirmed the rights of adolescents.
1993: UN International Conference on Human Rights, Vienna, declared that
women’s rights are human rights, condemned violence against women as human
rights abuse, and led to the naming of a UN Special Rapporteur on women’s
situation worldwide.
1994: International Conference on Population and Development (ICPD), Cairo,
said meeting reproductive health and other needs of individual women and men was
the best path to development and slowing population growth. Leaders of 179
countries reached consensus on a 20-year Programme of Action - the “Cairo
Consensus” - that called for investments in women of $21.7 billion per year by 2015.
1995: United Nations Fourth World Conference on Women, Beijing, spelled out
in its Platform for Action 12 critical areas of concern for achieving equality,
development and peace. It set targets and explained measures that governments,
donors, multilateral agencies and non-governmental organizations should take to
meet the goals.
2000: Millennium Declaration and Millennium Development Goals (MDGs), New
York. At a global summit meeting, world leaders agreed on eight broad development
goals for achievement by 2015, along with related targets and indicators for
progress. The goals are: 1) Eradicate extreme poverty and hunger; 2) Achieve
universal primary education; 3) Promote gender equality and empower women; 4)
Reduce child mortality; 5) Improve maternal health; 6) Combat HIV/AIDS, malaria
and other diseases; 7) Ensure environmental sustainability; and 8) Develop a global
partnership for development. In 2006, the UN General Assembly agreed to add
universal access to sexual and reproductive health and rights to the list as a target
under MDG #5.
2002: World Children’s Summit, New York, called for essential and emergency
obstetric care before, during and after pregnancy and delivery as the best way to
save the lives of women and children worldwide.
2002: World Summit on Sustainable Development, Johannesburg, focused on
economic and financial approaches to development rather than on women’s role or
rights-based policies.
2004: Global Roundtable Countdown 2015, London, assessed progress on
sexual and reproductive health and rights in the decade since the Cairo Consensus
of the ICPD. More than 700 activists, parliamentarians and world leaders expressed
disappointment at the pace of investment and policy change but committed
themselves to renewed action on behalf of girls and women worldwide - especially in
integrating reproductive health with HIV/AIDS initiatives and in bringing young people
into policy-making councils.
2005: Commission on the Status of Women 10-Year Review and Appraisal,
New York, found that the 1995 Beijing Platform for Action had sparked major
improvements for women in some places although reaction had worsened conditions
in others. Promises were not being kept.
October 2007
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Healthy women deliver for their families, communities and nations.
Women’s unpaid household, caregiving and farm work worldwide equals about a
third of the world’s Gross National Product.
Women’s income is more likely than men’s to go for food, education, medicine
and other family needs.
Death or disability of a mother raises death and illness rates for children, destroys
families, takes children out of school and lowers household and community
economic productivity.
Women are the sole income earners for 25 to 33 percent of all households.
In 2001, the U.S. Agency for International Development estimated the global
economic impact of maternal and newborn mortality at US$15 billion in lost
potential production per year - half associated with women and half with
newborns.
The return on investment in women is enormous.
Investment in educating girls one extra year beyond the average boosts their
eventual wages 10 to 20 percent.
Investment in female secondary education yields returns in the form of higher
wages that range from 15 to 25 percent, according to Yale economist Paul
Schultz.2
Credit extended to women increases household consumption about twice as
much as men’s borrowing.
Providing emergency obstetric services and equipment to save women’s lives
also creates the capacity to perform operations and transfusions for accidents
and other emergencies.
Investing in family planning services lowers the rate of unintended pregnancies,
which reduces unsafe abortions, which reduces health care costs.
In some low- and middle-income countries, hospitals spend up to half their
obstetric and gynecological budgets to treat women with complications from
unsafe abortions.
A 1993 World Bank study found that antenatal and delivery care and family
planning were among the six most cost-effective health interventions for lowincome countries.
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Investment in women creates a “virtuous circle”
Educated, employed and economically productive women are more likely to use
health care systems.
One study found that unemployed women have more than four times the chance
of maternal death than employed women, and a greater chance of maternal
health complications and illness after childbirth.
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Women who use maternal health services are more likely to use other
reproductive health services, such as HIV/AIDS testing and treatment, and family
planning.
Women who use maternal health care services are also more likely to obtain
vaccinations for themselves and their children.
Job status is more important to improving maternal health than overall household
economic status, perhaps because paid work increases women’s power over
household resources.
The necessary investment is well within reach.
Several reports estimate that the package of services essential to make
significant improvements in maternal health would cost less than US$1.50 per
person in the 75 countries where 95 percent of maternal deaths occur.
The World Health Organization estimated that international development
assistance for maternal and newborn health totaled US$530 million in 2004.
WHO estimated it should be an additional ten times as much ($5.5 billion per
year) to achieve MDG#5 by 2015 in the 75 countries where 95 percent of
maternal deaths occur.
Projections suggest that such funding requirements could be met if countries
invested 15 percent of their national budgets in health and if official development
assistance climbed further towards 0.7 percent of Gross National Income in the
OECD countries.
That sum is only 0.016 percent of global GNP and 2 percent of aid, well within the
grasp of donor countries. And it would return three times as much in the maternal
and newborn productivity that would otherwise be lost.
1 Figures in this fact sheet, except where indicated, from K. Gill, R. Pande and A. Malhotra, “Women Deliver for Development,”
International Center for Research on Women, Washington DC, July 24, 2007, pp. 37-41.
2 These two points on education from B. Herz & G. Sperling, ‘What Works in Giris’ Education: Evidence and Policies from the
Developing World," Council on Foreign Relations, New York, 2004, pp. 3-6
October 2007
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Healthy women deliver for their families, communities and nations.
Women’s unpaid household, caregiving and farm work worldwide equals about a
third of the world’s Gross National Product.
Women’s income is more likely than men’s to go for food, education, medicine
and other family needs.
Death or disability of a mother raises death and illness rates for children, destroys
families, takes children out of school and lowers household and community
economic productivity.
Women are the sole income earners for 25 to 33 percent of all households.
In 2001, the U.S. Agency for International Development estimated the global
economic impact of maternal and newborn mortality at US$15 billion in lost
potential production per year — half associated with women and half with
newborns.
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The return on investment in women is enormous.
Investment in educating girls one extra year beyond the average boosts their
eventual wages 10 to 20 percent.
Investment in female secondary education yields returns in the form of higher
wages that range from 15 to 25 percent, according to Yale economist Paul
Schultz.2
Credit extended to women increases household consumption about twice as
much as men’s borrowing.
Providing emergency obstetric services and equipment to save women’s lives
also creates the capacity to perform operations and transfusions for accidents
and other emergencies.
Investing in family planning services lowers the rate of unintended pregnancies,
which reduces unsafe abortions, which reduces health care costs.
In some low- and middle-income countries, hospitals spend up to half their
obstetric and gynecological budgets to treat women with complications from
unsafe abortions.
A 1993 World Bank study found that antenatal and delivery care and family
planning were among the six most cost-effective health interventions for lowincome countries.
Investment in women creates a “virtuous circle”
Educated, employed and economically productive women are more likely to use
health care systems.
One study found that unemployed women have more than four times the chance
of maternal death than employed women, and a greater chance of maternal
health complications and illness after childbirth.
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Women who use maternal health services are more likely to use other
reproductive health services, such as HIV/AIDS testing and treatment, and family
planning.
Women who use maternal health care services are also more likely to obtain
vaccinations for themselves and their children.
Job status is more important to improving maternal health than overall household
economic status, perhaps because paid work increases women’s power over
household resources.
The necessary investment is well within reach.
Several reports estimate that the package of services essential to make
significant improvements in maternal health would cost less than US$1.50 per
person in the 75 countries where 95 percent of maternal deaths occur.
The World Health Organization estimated that international development
assistance for maternal and newborn health totaled US$530 million in 2004.
WHO estimated it should be an additional ten times as much ($5.5 billion per
year) to achieve MDG#5 by 2015 in the 75 countries where 95 percent of
maternal deaths occur.
Projections suggest that such funding requirements could be met if countries
invested 15 percent of their national budgets in health and if official development
assistance climbed further towards 0.7 percent of Gross National Income in the
OECD countries.
That sum is only 0.016 percent of global GNP and 2 percent of aid, well within the
grasp of donor countries. And it would return three times as much in the maternal
and newborn productivity that would otherwise be lost.
1 Figures in this fact sheet, except where indicated, from K. Gill, R. Pande and A. Malhotra, “Women Deliver for Development,”
International Center for Research on Women, Washington DC, July 24, 2007, pp. 37-41.
2 These two points on education from B. Herz & G. Sperling, “What Works in Girls’ Education: Evidence and Policies from the
Developing World,” Council on Foreign Relations, New York, 2004, pp. 3-6
October 2007
www.womendeliver.org/media/Fact_sheets.htm
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Women Deliver When They are Educated
Educating girls raises lifetime incomes for them, their families and their
countries.1
: The World Bank found in a study of 100 countries that every 1 percent increase
in the proportion of women with secondary education boosted a country’s annual
per capita income growth rate by about 0.3 percentage points.
Girls who have one more year of education than the national average earn 10 to
20 percent more, on average - even more than the increase for boys.
Crop yields in Kenya could rise up to 22 percent if women farmers had the same
education and inputs (such as fertilizer, credit, investment) as men farmers.
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Educating girls and women fosters democracy and women’s political activity.3
A Bangladeshi study found educated women three times more likely to take part
in political meetings than those without schooling.
Educated women are more likely to resist abuses such as domestic violence,
traditions like female genital cutting, and discrimination at home, in society or the
workplace.
Educating girls and women saves children’s lives.4
Every year of education delays a girl’s marriage and reduces the number of
children she has.
Educated women are less likely to die in pregnancy or childbirth and more likely
to send their children to school.
If mothers have a primary school education, the mortality rate for their children
under 5 is halved: they provide better nutrition and health care and spend more
on the children.
Children of uneducated mothers are half as likely to attend primary school as
those whose mothers attended primary school themselves.5
Educating adolescents and young people is critical for development
Young people under 25 - half the world’s 6.5 billion people6 - need vocational
and life skills and access to sexual and reproductive health information and
services, if they are to take full part in their countries’ development and contribute
to it.
Secondary and higher education, especially for girls, provides high returns for
poverty reduction, economic growth and reproductive health.
Enabling young couples to choose when to marry and have children leads to
smaller families, slower population growth, increased productivity and rising
incomes.
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Girls’ education still lags behind schooling for boys.
Of 163 million illiterate youth in the world, 63 percent are female.7
Of the 104 million children 6 to 11 not in school, 60 million are girls. Nearly 40
percent of those girls live in sub-Saharan Africa and 35 percent in South Asia.8
Although the gap is closing in primary school enrollment, one out of five girls in
the developing world does not complete sixth grade.9
Only 43 percent of secondary-school-age girls are in class in developing
countries.10
Factors that lower girls’ school attendance include: fees for tuition, transport,
books or uniforms; cultural biases or traditions that educate boys only or keep
girls to work at home; lack of female teachers; lack of sanitary napkins; lack of
separate toilet facilities; sexual harassment or abuse by teachers or other
students; and child marriage.
Where girls are expected to work at home and to join their husbands’ families at
marriage, parents may see sending them to school as all loss and no gain.
Girls who suffer setbacks or long absences in primary school may not get the
help they need to catch up.
Teachers may require less from girls than they do from boys: one in three girls
who complete primary school in Africa and South Asia cannot read, write or do
simple math.11
High-level political leadership can raise public understanding and create
conditions for girls’ education in the developing world.
Education costs are immediate to parents, but benefits are distant, so
governments must make universal education mandatory - at least for primary
grades, and eventually for secondary grades as well.
Eliminating or cutting school fees typically causes enrollments to skyrocket.
Stipends for tuition, books, uniforms etc. dramatically lower dropout rates.
Schools can be made more girl-friendly with private latrines, female teachers,
sanitary supplies, and an end to harassment and discrimination against girls.
Rural and community school construction should increase and include community
support, flexible schedules and child-care programs.
Comprehensive sexual and reproductive health education should be mandatory
in schools, especially for adolescents.
1 This section from Herz, Barbara, and Sperling, Gene B., What Works in Girls’ Education: Evidence and Policies from the
Developing World, Council on Foreign Relations, New York, 2004, p. 2-3
2 UNFPA, UN Population Fund, State of World Population 2005: The Promise of Equality, UNFPA, New York, 2005, p. 47
3 This section from Herz, p. 6
4 This section from UNICEF, The State of the World’s Children 2007, UNICEF, New York, 2007, p.4-6
5 UNICEF, p. 27
6 UNFPA, p. 45
7 UNFPA, p. 46
8 Herz, p. 2
9 UNICEF, p. 4
10 UNICEF, p. 4
11 Herz, p. 2
October 2007
www.womendeliver.org/media/Fact_sheets.htm
18-20 Octoter 2007, Lonte
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Women Deliver-Against HIV/AIDS
AIDS has a woman's face
HIV is spreading fastest among women. Of the estimated 39.5 million people
living with HIV, 48 percent are women - nearly 19 million people - and half of all
new infections occur among women.1
Young women age 14 to 24 in parts of Africa and the Caribbean are up to six
times more likely to be HIV-positive than young men their age.2
In sub-Saharan Africa, 57 percent of all people living with HIV are women.3
Women are more vulnerable than men to HIV infection - for biological, economic
and cultural reasons (such as discrimination, gender inequality and violence).4
A 2005 UNFPA report found that only about 8 percent of pregnant women and 16
percent of sex workers worldwide were being reached with prevention efforts.5
In 2005, only 15 percent of those in need of anti-retroviral drugs were receiving it.
Six in ten of those receiving treatment were women.6
Cultural factors drive the pandemic
The stigma surrounding AIDS is a major obstacle to curbing it, especially for
women, who avoid testing and treatment for fear of abandonment, violence or
ostracism.
In many of the worst-hit countries, frank discussion of gender equality, HIV
prevention, contraception, or any other sex-related issue is taboo, yet ignorance
of positive HIV status is death - for both infected people and their partners.
Only 5 percent of all HIV-positive people in the world are aware of their status.7
While one person dies every 11 seconds from AIDS, one person is infected with
HIV every six seconds - so the total number of infections is growing.8
HIV-positive women are often denied health care, information and services to
prevent pregnancy and HIV transmission because health workers assume or
believe that they do not have sex and will not (or should not) have children. This
is a violation of their human rights.
In many countries, having sex with many women is a measure of male virility and
prestige. Where extra-marital affairs are common, marriage can actually raise a
woman’s risk of contracting HIV.
Interventions targeted at women could slow the spread of HIV
Every year of education for a girl lowers her risk for HIV infection.9
A survey of 24 sub-Saharan African countries found that two-thirds of young
women lacked understanding of HIV transmission. Men’s knowledge was
greater.10
Most people become sexually active during adolescence, yet most young people
have no access to prevention programs.1'
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Family planning and maternal care clinics are often a woman’s only contact with
a developing country’s health system, but “stovepiping” approaches by donors,
which restricts funds to HIV/AIDS uses, has led to parallel care systems in some
areas. This is inefficient, reinforces stigma and creates a cadre of health care
workers uninvolved in meeting basic needs.12
Programs to prevent mother-to-child transmission of HIV must as a matter of
human rights treat both mother and child.
Saving women also saves the next generation
Treatment for HIV-positive mothers as well as their children is the most costeffective approach, as motherless children are far less likely to survive to
adulthood.
In 2005, more than two million children 14 or younger were living with HIV.13
By 2006, at least 13 million children - 12 million of them in sub-Saharan Africa had lost one or both parents to AIDS. Such AIDS orphans are likely to number
15.7 million worldwide by 2010.14
1 Population Resource Center, “World AIDS Day: December 1, 2006,” http://www.prcdc.org/Wortd_AIDS_Day.pdf (accessed
10/3/07), p. 1
2 UNICEF, The State of the World's Children 2007, UNICEF, New York, 2007, p.5
3 UNFPA, State of World Population 2005: The Promise of Equality, UNFPA, New York, 2005, p. 37
4 World Health Organization, ‘Women and HIV/AIDS," 2007, http://www.who.int/gender/hiv_aids/en/ (accessed 10/3/07)
5 UNFPA, p. 37
6 World Health Organization Bulletin Vol 84 #2, Feb. 2006, http://www.who.int/bulletin/volumes/84/2/1 45.pdf (accessed 10/5/07)
7 UNFPA, p. 40
8 UNFPA, p. 52
9 Herz, Barbara, and Sperling, Gene B., What Works in Giris' Education: Evidence and Policies from the Developing World,
Council on Foreign Relations, New York, 2004, p. 5
10 UNICEF, p. 5 and 11
11 UNFPA, p. 52
12 Garrett, Laurie, “The Challenge of Global Health,” Foreign Affairs, Council on Foreign Relations, New York, Jan-Feb 2007
13 UNICEF, p. 5
14 UNICEF, p. 30-31
October 2007
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Population Action International’s
2007 Global Report Card on Reproductive Risk
Population Action International (PAI), a Washington-based nonprofit organization,
has rated the countries of the world on nine indicators of reproductive risk that
women face during their lifetimes. The Netherlands is the world’s safest country for
women in this broad evaluation, while Niger ranks last.
The report card, A Measure of Survival: Calculating Women’s Sexual and
Reproductive Risk, documents continuing stark disparities in reproductive risk
between rich countries and poor ones. “Pregnancy and childbirth are deadly to more
than half a million women worldwide every year,” the report begins, “a fact that is
unacceptable, but not unavoidable.”
The report, the fourth in PAI’s series, rates each country on indicators from the 1994
International Conference on Population and Development (ICPD) and the Millennium
Development Goals (MDGs) of 2000, as amended in 2006. The report classifies 130
countries of at least one million in population into five roughly equal groups: lowest
risk (28 countries), low risk (26), medium risk (26), high risk (24) and highest risk
(26).
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The framework looks at the “life cycle” of reproductive health and considers a
woman’s risk at each point of the reproductive cycle: (1) sex, (2) pregnancy, (3) birth,
and (4) survival. It judges risk for the first three events according to whether they are
safe and whether or not they are voluntary.
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“This system paints a picture of a woman’s risk in each country by looking holistically
at all the factors that affect her reproductive years,” said PAI President and CEO
Amy Coen. She noted that poor-quality service often poses as much risk as sheer
lack of service: sporadic supply and limited choice of contraceptive methods lowers
overall contraceptive use, which raises women’s lifetime risk, for example.
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The nine indicators of a country's reproductive risk for women are:
Percent of HIV prevalence among adults 15 years or older;
Adolescent fertility rate (births per 1,000 women age 15-19);
Percent of girls married before age 18;
Percent of women receiving antenatal care in at least four visits;
Percent of family planning demand met;
Percent of births attended by skilled health personnel;
National policies on abortion;
Maternal mortality ratio (deaths per 100,000 live births); and
Infant mortality rate (deaths per 1,000 live births).
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Reproductive Risk”
The countries with the highest overall reproductive health risk for women, in
order, are Niger, Chad, Mali, Yemen and Ethiopia.
• All 26 countries at highest overall risk are in sub-Saharan Africa, except for
Haiti, Yemen and Laos, the poorest countries in their respective regions.
The lowest-risk countries, in order, are the Netherlands, Switzerland,
Singapore, Germany and Belgium.
Maternal mortality has been all but eliminated in most industrialized countries,
where investment in women has given them means and status to obtain access
to health care.
Pregnancy remains the leading killer of women of reproductive age in most
developing countries.
Unprotected sex is the primary cause of women’s reproductive risk: for
transmission of HIV and other infections, for complications from pregnancy and
childbirth, and from unsafe abortions of unintended pregnancies.
Condom use remains uncommon among married couples and regular partners, in
part because of an inadequate global supply of all modern contraceptive
methods.
Antenatal care coverage can be used as a general indicator of women’s
exposure to the health care system. Rural and poor women routinely fare worse
than urban and wealthier women.
Some interesting comparisons
The United States has the highest adolescent fertility rate of all developed
countries (43.7 births per 1,000 women age 13-19). The UK and New Zealand
rate is 27.1.
Caribbean countries straddle all five categories, from Haiti in the Highest Risk
category to Cuba in the Lowest Risk category.
• Cuba has the same level of adolescent fertility as the United States.
• Haiti, unlike other Caribbean countries, has low levels of antenatal care and
skilled attendance at delivery.
Except for Sri Lanka (which has practically universal antenatal care coverage
and skilled attendance at delivery), South Asian countries have very low rates of
skilled attendance at delivery. Some are at par with levels in Niger, Chad and
Ethiopia.
The report called for better distribution of reproductive health care services and
greater attention to local needs. “Women must have comprehensive services,
especially care in pregnancy and childbirth and for sexually transmitted infections,”
said Coen. “These services are critical to preventing deaths and improving the health
of women and their families.”
To view and download a full copy of the Reproductive Risk Report Card, visit
the Population Action international Web site: www.populationaction.org
October 2007
www.womendeliver.org/media/Fact_sheets.htm
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