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Parliamentarians Take Action for Maternal
and Newborn Health and Survival
Report on WHO/IPU meeting, Kampala, the Republic of Uganda, 23-25 November 2009
2 Parliamentarians take action for maternal and newborn health and survival
WHO/MPS/10.04
© World Health Organization 2010
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This publication is a report of a meeting of parliamentarians in Kampala, Uganda, from 23-26 November
2009. It does not necessarily represent the decisions or policies of the World Health Organization.
Compilation: Alice Duffil
Editing: Marie-Agnes Heine
Design: Duke Gyamerah
Photo credit: WHO / Marie-Agnes Heine
Making Pregnancy Safer
3
Contents
Parliamentarians take action for maternal and newborn health
Executive summary 4
Political power and commitment 5
Background
Maternal and newborn mortality worldwide 6
Millennium Development Goals 6
Day one
Opening plenary 7
Breaking down barriers 7
Taking action worldwide 8
Address by the President of the Republic of Uganda 8
Introductory session 9
Maternal and newborn health 10
Maternal mortality in Africa 11
The health system: at the core of reducing maternal and newborn mortality 11
Country report: Uganda 12
Maternal and Newborn Health in Crisis Situations 13
Case Studies 13
Day two
Site visits 15
Removing barriers for women: Promoting good practice 19
Day three
Global initiative to improve maternal health 21
Case study: Soroti, Uganda 22
Closing session 24
Annex1: The seven pillars 26
List of Participants 29
4 Parliamentarians take action for maternal and newborn health and survival
Pa rli a m e nt a r i a n s t a ke a c t i o n Executive summary
fo r m ate r n a l a nd n ew b o r n
healt h The objective of the meeting was to build awareness of
the challenges facing maternal and newborn health in
Parliamentary representatives from 32 countries came many develping countries and to urge parliamentarians to
together in Kampala, Uganda on 23-25 November 2009 to raise the issue at the highest level in their home countries.
Participants were encouraged to develop a common vision
continue international discussion on how parliamentarians
for governmental policies that will help to achieve the MDGs
can contribute to the improvement of maternal and
on maternal and child health.
newborn health. The three-day meeting was the third
annual event under the Parliamentarians Take Action The Kampala meeting also presented an opportunity to
for Maternal and Newborn Health and Survival series of review progress made since the 2008 meeting in The Hague.
international discussions hosted by the World Health Parliamentarians from the countries represented discussed
Organization (WHO). The series was first launched in 2007 in their achievements and best practices to collectively map out
response to interest expressed by parliaments to enhance the next steps for each country and to strengthen effective
governmental capacity to advance the health of mothers parliamentary cooperation nationally and internationally.
and babies. At the invitation of the Ugandan Parliament, the Host country Uganda showcased its achievements in
Kampala meeting aimed to build upon discussions held by reaching targets for MDG 6 (Combat HIV/AIDS malaria and
parliamentarians from developing and developed countries other diseases) and its action plan to replicate the same
success for MDGs 4 and 5. Rwanda’s health insurance scheme
in the previous two years. The inaugural meeting in London
was also highlighted as an effective country-based action
in March 2007 aimed at promoting parliamentary action on
to help reduce maternal mortality. Meeting representatives
investment and interventions to reduce maternal mortality
also resolved to develop a network for discussion among
and putting maternal and newborn health and survival parliamentarians, international organizations and civil society
on the government agenda. The second meeting, held in around the world.
The Hague in 2008, identified parliamentary strategies to
achieve Millennium Development Goals (MDGs) 4 and 5 set
by the United Nations in 2000. These goals aim to reduce
the maternal mortality ratio by three quarters, to achieve
universal access to reproductive health, and to reduce the
under-five child mortality rate by two thirds between 1990
and 2015. The Kampala meeting brought together male and
female parliamentarians, health officials from developing and
developed countries and representatives from international
agencies and non-governmental organizations.
Making Pregnancy Safer
Parliamentarians take action for maternal and newborn health and survival 5
Parliamentarians attending the Kampala meeting agreed on the
Po l i t i c al p ower and following key discussion objectives:
co mmi tment Creating a common awareness and understanding of key
policies and interventions needed for countries to achieve
Discussion at the conference focused on the role of MDGs 4 and 5;
parliamentarians in efforts to meet the health-care needs Reviewing progress made and/or setbacks encountered in
of pregnant women, mothers and babies at various levels participants’ countries;
in their home countries. Participants also reviewed ways to Sharing experiences from developing and developed
secure necessary funds for maternal and newborn health countries;
interventions, showcasing the Ugandan and Rwandan
Fostering global debate on maternal and newborn health;
experiences as models for other countries.
Strengthening international and national political will and
commitment;
Facilitating cooperation and solidarity among members of
parliament worldwide.
Over the past few years, closer attention has been directed
to the role of parliaments and their members in achieving
progress for the health and survival of women and babies.
Parliamentarians in many countries are aware of the tragic
health crisis facing many women and newborns, and have
subsequently taken action to find solutions to the situation.
At the 2007 London meeting, which was jointly hosted by WHO
and the Parliament of the United Kingdom, parliamentarians
agreed on the need to make maternal and newborn health a
key national and international priority. In 2008, participants
at The Hague meeting adopted a road map for members of
parliament to take action on maternal and newborn health. The
Dutch Parliament joined WHO and IPU in hosting this second
event in the series.
Making Pregnancy Safer
6 Parliamentarians take action for maternal and newborn health and survival
health. MDG 6 is aimed at combating HIV/AIDS, malaria and
B a ckg roun d other diseases and is a goal closely linked with maternal and
child health. Under the United Nations MDG initiative, the 189
Member States committed to reduce under-five mortality by
Maternal and newborn mortality two thirds and maternal mortality by three quarters and to
worldwide achieve universal access to reproductive health between 1990
and 2015.
Every year, approximately 358 000 women die due to
complications during pregnancy and childbirth. In the last While many countries have made progress in reducing under-
decade, over 7 million women died from pregnancy-related five mortality, maternal and perinatal mortality rates have
causes and millions more suffered motherhood-related stagnated or even increase in 43 countries1. The HIV/AIDS
disabilities. Every year, 4 million babies die within their first pandemic has caused serious setbacks, with the overwhelming
28 days of life and another 3.3 million are stillborn. And every majority of HIV transmission related to sexual intercourse,
year, 600 000 newborns are infected with HIV, mainly through pregnancy, childbirth and breastfeeding. Malaria infection
mother-to-child-transmission. Despite this, maternal and during pregnancy also poses a major threat to the mother and
newborn health remains a largely neglected public health issue. her unborn child. MDG 6 emphasizes the need to prioritize
the health of women and children in combating HIV/AIDS and
Data analyses and studies of maternal and newborn mortality malaria and to ensure that both sexual and reproductive health
worldwide reveal a global disparity and inequity in healthy initiatives and initiatives for the prevention and treatment of
childbirth between rich and poor, and between urban and HIV/AIDS and malaria must be mutually reinforcing.
rural populations. Differences not only occur regionally, but
also within countries themselves. Most maternal and newborn At the current pace, it will take many years to attain MDG 4
deaths and disabilities are preventable with cost-effective and 5 in sub-Saharan Africa and South Asia. Governments,
interventions. However, the appalling numbers of maternal parliaments, civil society and the international community
and newborn mortality and morbidity will continue to rise until need to redouble their efforts and join forces internationally
these interventions are implemented, with necessary budget to reach global maternal and newborn health and survival
allocations and improvements in national health services. targets by 2015.
Millennium Development Goals
In 2000, the international community adopted eight key
thematic targets - the United Nations eight Millennium
Development Goals (MDGs) - to halve the world’s poverty by
2015. MDGs 4, 5 and 6 are directly related to health. MDG 4
aims to reduce child mortality, while MDG 5 seeks to improve 1 The World Health Report 2005: Make every mother and child count. World Health
maternal health and achieve universal access to productive Organization, Geneva
Making Pregnancy Safer
Parliamentarians take action for maternal and newborn health and survival 7
Republic of Uganda, Yoweri Kaguta Museveni, who was present
Day O n e during the opening session of the meeting.
There is an urgent need for drastic measures to be taken by all
countries represented to reverse the bleak outlook for mothers
Opening plenary and babies worldwide. Of all the MDGs, MDG 5 is the least
Uganda likely to be met and parliamentarians must assess the progress
made towards improving maternal and newborn health at a
Ms Rebecca Kadaga governmental level and address the obstacles hindering the
Deputy Speaker of Parliament, Uganda
process. According to Dr Saweka, universal coverage of skilled
Ms Rebecca Kadaga welcomed birth attendance can be achieved through boosting trained
participants to the third meeting of the personnel by 330 000 additional midwives. The most effective
Parliamentarians Take Action for Maternal intervention to reduce newborn mortality is the provision of
and Newborn Health and Survival series, programmes that offer a continuum of care for both mother
and the first to be hosted by a developing and baby before, during and after birth.
country. As host of the meeting, Ms
Kadaga urged all parliamentarians to Breaking down barriers
evaluate what their governments had
done to overcome basic barriers to Governments must oversee and maintain accountability for
improving maternal health. maternal and newborn health-related policies, including
monitoring the delivery of health services. Parliamentarians
“We have gathered here to discuss how quickly a mother can should be encouraged to use their legislative powers to
reach help. Are the roads there? Are the facilities there? We facilitate better access for mothers and babies to essential
want to examine the first port of call,” she stressed. health care. Among the global support for maternal and
newborn health, Dr Saweka highlighted the Task Force on
WHO Innovative Financing for Health Systems, an initiative of the
Dr Joaquim Saweka International Health Partnership (IHP+). In September 2009,
WHO Representative, Uganda Country Office
the Task Force had announced new financial commitments
totalling US$ 5.3 billion to help prevent millions of women
Dr Joaquim Saweka praised the efforts of and babies in developing countries from losing their lives at
the Ugandan Government in achieving its childbirth.
MDG 6 target for combating HIV/AIDS and
called for similar efforts to improve the In the face of the global economic crisis, Dr Saweka reiterated
health of women and newborns. “Under the request of WHO Director-General Dr Margaret Chan to take
your commitment and leadership, history urgent action, both within the health sector and beyond, “to
could be repeated for MDGs 4 and 5,” he improve the health and lives of girls and women around the
said, addressing directly the President of the world from birth to older age.” Despite pressures to cut health
Making Pregnancy Safer
8 Parliamentarians take action for maternal and newborn health and survival
and social sector spending, governments need to increase to data collection and monitoring have enabled better
investment in this priority area for global health. understanding of the current situation, identification of gaps
and appropriate actions at both national and international
levels. “Change is, therefore, possible,” Mr Chungong
underlined.
IPU
Mr Martin Chungong
Director, IPU Division for the Promotion of Democracy Address by the President of the Republic
Mr Martin Chungong called on of Uganda
parliamentarians to “pool their resources
and energies” to make sure all countries
Mr Yoweri Kaguta Museveni
fulfil the objectives of MDGs 4 and 5. Every
President of the Republic of Uganda
woman should be in a position to decide
about the timing of her childbirth and the President Museveni talked about the
spacing of her children. She also should be belief of the Ugandan Parliament
aware of her health needs and know when in the importance of having a
to seek medical attention. He quoted IPU simple focused plan of action. Using
Secretary-General Mr Anders Johnsson Uganda as an example, the President
who underlines that, “sustainable change will require a collective set out steps to be taken to achieve
response in which we all have a role to play.” Referring to the tangible changes in the maternal
identification of seven pillars of action at the 2008 meeting in and newborn health situation at a
The Hague, Mr Chungong emphasized the importance for all national level. He pointed out that it
sectors of society to have access to adequate healthcare. “This is necessary to
conference will focus precisely on access,” he said. Pregnancy adopt a simple and adequate distribution of health units,
should not be synonymous with a death sentence for women. split by sub-counties;
focus on the range of personnel needed in each unit
Taking action worldwide including medical assistants, a midwife and two nurses;
Parliamentarians worldwide have a duty to oversight and ensure adequate supply of drugs and equipment;
lawmaking powers to pressure governments and assist encourage prenatal attendance at clinics, with larger
in developing and implementing national action plans. health units at county level and hospitals at district level.
Developed countries can also help through financial support (Each health unit must include ambulances, an operating
for development aid programmes focusing on maternal and theatre and a qualified doctor);
newborn health. Other legislative changes that have a direct undertake community-focused campaigns against under-
impact on maternal health, such as gender equality and anti- age marriage and harmful traditional practices;
discrimination laws, also need to be addressed. Improvements
Making Pregnancy Safer
Parliamentarians take action for maternal and newborn health and survival 9
promote good nutrition, particularly through radio Mr James Kakooza
campaigns, using simple language that the population can State Minister for Health (Primary Health Care), the Republic of Uganda
understand. According to State Minister
The Ugandan Government had set up inspection units James Kakooza, maternal
where doctors can monitor the structure and operations of mortality figures indicate that
health units to deter corruption and theft of drugs that are approximately 6000 women die
sometimes moved illegally from government hospitals to every year in Uganda. Pregnancy-
private clinics. Despite this problem, private clinics remain related complications are
an integral part of the programme. “If the clinic is efficient, among the leading causes of
the people will come,” President Museveni said. death and disability for women
aged between 15 and 49 years.
While current health systems
Introductory session are constrained by low staffing rates, poor skills and badly
equipped health facilities, the State Minister expressed
confidence that the country would find the necessary funds
Uganda to improve maternal and newborn health by 2015. His
Ms Sylvia Ssinabulya announcement of a new allocation of US$ 25 million by the
Member of Parliament, the Republic of Uganda Ministry of Health to provide beds and help midwives at
health centres was applauded by the plenary.
Ms Sylvia Ssinabulya welcomed
all parliamentarians to Uganda and Availability and access to transport and education are
expressed her hope that the three- key components to ensuring high quality of health care.
day meeting would encourage open Mr Kakooza called on the parliamentarians represented to
discussion and sharing of ideas and work collaboratively across government sectors to address
experiences about best practices the problem. This involves commitment from the agricultural
in the promotion of maternal and sector to maintain food security to ensure that the nutritional
newborn health worldwide. She also needs of mother and child are met; support from the finance
drew attention to this meeting as an sector to allocate funds to the health sector; the provision
opportunity to advance strategies set out in two key working of safe water and attention to gender-based issues related
documents developed at the 2008 meeting in The Hague. to culture, tradition, vulnerability and equity. “We need to
Both, the Roadmap and the Seven Pillars for MDG 5, provide a ensure commitment at all levels and by all sectors. If we do
framework for parliamentary action which identifies priorities this, by 2015, we shall achieve our goals,” Mr Kakooza said.
and set out innovative strategies to prevent the needless
deaths of women and babies.
A summary of the Seven Pillars can be found in Annex 1 of the
report.
Making Pregnancy Safer
10 Parliamentarians take action for maternal and newborn health and survival
Maternal and newborn health the rich still have three times higher access than the poor.
Similarly, only 43% of the women from the poorest communities
in Indonesia have access to maternal health services, compared
World Health Organization to 95% of the women from the rich communities. In Zambia, the
Dr Monir Islam percentage of the poorest women with access to health services
Director of the Department of Making Pregnancy Safer, WHO has dropped from 4% to 1.2%, whereas the access of rich women
has increased from 4% to 9%. In Ethiopia, most women deliver at
Dr Monir Islam summarized the proposed
home because they lack access to services.
strategies for improving maternal and
newborn health at a parliamentary level,
The model of Three Delays
including the prioritization of investment
and the improvement of the status of Dr Islam identified access to efficient quality care as a key
women. component of all strategies to reduce maternal and newborn
mortality. He urged the participants to use their parliamentary
Closing the gap power to help overcome the barriers preventing women
from accessing maternal health services. In order to reduce
The WHO Making Pregnancy Safer Director
maternal and newborn deaths, parliamentarians need to
used a comparison of data from countries in Africa and Japan
address the reasons why a large percentage of women
to highlight the large disparities in access to maternal health
with obstetric complications fail to get the care they need
care between rich and poor countries and between rich and
in time to save their lives and the lives of their babies. The
poor, urban and rural women within countries. Maternal
model of Three Delays shows at which point in time of her
death from pregnancy-related complications is a serious and
pregnancy a woman’s access to receiving care can be blocked
prevalent health issue in developing countries. In Niger, one in
due to different factors. There can be an initial delay during
seven women die due to pregnancy and childbirth problems,
pregnancy when women need to seek antenatal care but
compared to Japan where only one in 12 000 pregnant women
when it is not up to them to make the decision to do so. The
face the same risk. There is also a serious imbalance in the
second delay can occur once the decision has been made
death rate among newborn babies between developing
that a woman should go to the health facility. But then no
countries such as Sierra Leone where there are 56 deaths per
transportation, no road or no money is available. The third
1000 live births, and developed countries such as Japan where
delay can happen at the facility when, for example, no skilled
the equivalent figure is 1 per 1000 live births.
personnel or no drugs are available. Any of these three delays
Dr Islam emphasized that every woman “should have access can result in a woman’s death.
to skilled care, so that when complications arise there are
emergency care services available.” Changes need to take
Eradicating each of these barriers would significantly reduce
place to also address the disparity of access within countries
maternal and newborn mortality as well as stillbirth. Saving
themselves, notably in rural populations where access to health
the lives of mothers also helps to save the lives of their
services is often more limited than in urban areas. For example,
children, and has thus a positive impact on the livelihood of
although 43% of all women in Uganda have access to services,
families and communities.
Making Pregnancy Safer
Parliamentarians take action for maternal and newborn health and survival 11
Maternal mortality in the African human resources, skilled birth attendance, emergency obstetric
care and family planning are ongoing weaknesses in health
Region
systems that need to be tackled. Parliamentarians also need
to push for the adoption of legislation against female genital
Dr Tigest Ketsela mutilation and early marriage.
Director of Family and Reproductive Health,
There is opportunity for better coordination of government-
WHO African Region
run programmes and policies with NGOs, as well as private and
“No mother should die of public sector activities. Linking maternal health interventions
preventable causes” with malaria and HIV/AIDS prevention and treatment
Dr Tigest Ketsela explained that programmes is an example of a combined approach that could
maternal and newborn health can further help to increase the coverage of major interventions.
be better promoted in Africa if it is Special attention should be paid to the plight of women in


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