Gender 
'One woman dies every minute from childbirth complications'

The conference, "Saving Lives: Skilled Attendance at Childbirth," is sponsored by the Tunisian Ministry of Health and convened by the Safe Motherhood Inter-Agency Group, a consortium of international and national organizations, including the World Bank and Family Care International, dedicated to implementing the Safe Motherhood Initiative throughout the developing world. The conference opened yesterday and closes 15 November with announcements of the national strategies. It is being held in Tunis, Tunisia at the Le Palace Hotel.

Asked why the conference is organised, Safe Motherhood states that "every minute of every day, a woman dies of a pregnancy-related cause, adding up to more than 500,000 maternal deaths each year. Ninety-nine percent of these women die in the developing world." Here, almost one in 20 women dies from a pregnancy-related cause, according to the World Bank. 

- In addition, more than one in four women in developing countries currently suffer from short- or long-term illnesses related to pregnancy and childbirth, the agency informs. "Skilled attendance at childbirth can make a critical contribution to preventing these needless deaths and disabilities." Only about half of deliveries in the developing world receive care by skilled attendants and in some countries this figure is as low as 20 percent, according to the World Bank.

Skilled attendants play a crucial role in protecting the life of mother and infant by:
· Ensuring clean and medically sound delivery procedures; 
· Identifying and managing any complications promptly; and
· Providing high-quality, culturally appropriate, and considerate care.

Tunisia is recognized as a leader among developing countries for its impressive record of improving maternal health. Currently, just over 90 percent of women giving birth in Tunisia are assisted by skilled professionals and the number of women dying during pregnancy and childbirth has fallen from 310 per 100,000 live births in 1971 to 63 per 100,000 live births in 1994 -- an 80 percent decrease in just 23 years. 

- It is likely that the pace will be accelerated, said Hedi M'henni, the Tunisian Minister of Health in his keynote address to the conference. M'henni noted that "the President of the Republic has issued clear instructions that appropriate actions be taken to reduce the maternal mortality rate in Tunisia to less than 50 per 100,000 live births before the end of 2001."

Also Botswana has made significant progress on improving national maternal health. Alongside with Tunisia, Setswana government representatives will share their experiences in implementing skilled attendance at delivery as a key intervention in reducing maternal mortality. The Setswana and Tunisian government was asked to provide information about the types of strategies utilized, challenges encountered and issues related to sustainability. 

Low lifesaving costs
The financial cost of basic maternal and child health services that could prevent these problems is, on average, only US $3 per person per year in developing countries and the cost of maternal health services alone can be as little as US$ 2 per person per year, according to the World Bank. "Finding and using such resources to fight maternal mortality is an essential element to poverty reduction," a Bank spokesman says. 

- Increasing attendance at births by skilled health care workers is crucial to reducing maternal mortality, World Bank President James D. Wolfensohn said on the conference. "The World Bank strongly supports ensuring safe motherhood world-wide through consultation and lending. We urge government authorities, the private sector and our partner institutions to act quickly and decisively to end the needless, preventable deaths of our world's mothers."

With their participation in the Safe Motherhood Initiative and their representation at this conference, 11 governments (Burkina Faso, Mozambique, Nigeria, Senegal, Uganda, Bangladesh, Nepal, Botswana, Malaysia, Tunisia and Sri Lanka) have demonstrated a high level of commitment to strengthening their societies by promoting and implementing skilled attendance during childbirth. 

Teams from these 11 countries are gathering in this unique forum to share strategies and learn from their counterparts in other developing countries. Through this south-to-south exchange of expertise and experiences, national action plans will be devised that will enable policymakers and advocates to push for increases in resources and expansion of programs for skilled care at childbirth. 

Fred Sai, President of the Ghana Institute of Arts and Sciences and Chair of the conference said in his welcoming remarks, "Maternal and child health is at the root of the vicious cycle of poverty that restrains our communities from realizing their potential. We must never forget that women are the backbones of our communities and that our children are our future."

Safe motherhood a human right
- Defining maternal death as a "social injustice" as well as a "health disadvantage" obligates governments to address the causes of poor maternal health through their political, health and legal systems, the Safe Motherhood agency states. "International treaties and national constitutions that address basic human rights must be applied to safe motherhood issues in order to guarantee all women the right to make free and informed decisions about their health, and access to quality services before, during and after pregnancy and childbirth."

A policy statement of the agency therefore demands that "all national development plans and policies should include safe motherhood programs, in recognition of the enormous cost of a woman’s death and disability to health systems, the labor force, communities and families."

The Safe Motherhood Inter-Agency Group is a consortium of international and national organizations that implement the Safe Motherhood Initiative. Family Care International, an international NGO based in New York, serves as secretariat for the IAG. As a group and as individual organizations these agencies raise international awareness about safe motherhood, set goals and programmatic priorities for the Initiative, support national programs, conduct research, share information and mobilize resources. The IAG was founded in 1987. 

Sources: Based on World Bank and Safe Motherhood

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