INTERNATIONAL: UN to Ask $169 Billion Maternal Health Question

The U.N.'s $169 billion catch-up plan for global maternal health--the runt of the development-goal litter--faces a final checkup meeting in New York this week. As a maternal death clock tick-tocks in Times Square, the big question is money.

The U.N. this week will be considering plans to save 16 million women's lives by 2015, as part of a major meeting focused on poverty- reducing goals. The big billion dollar question is not how it can be done but whether the U.N. member states will provide enough funding.

"It's a wonderful plan, but if the funding doesn't show up and it isn't implemented, then it doesn't help much," said Mary Anne Mercer, director of the Timor-Leste program for Health Alliance International, a Seattle-based international public health organization.

The effort to put women's health back on the policy map comes days after Michelle Bachelet, the 58-year-old former president of Chile, was appointed head of the United Nations' new agency uniting four existing women and gender offices. The entity is called U.N. Women and has an unprecedented $500 million annual budget, more than double the existing resources available for all four agencies.

The special interest placed on women's health and gender equality couldn't come soon enough.

Millennium Development Goal No. 5--to reduce the maternal mortality ratio by two-thirds in 2015 from 1990 global-average levels of 400 maternal deaths per 100,000 live births--is lagging the most out of eight major initiatives on poverty, health and equality adopted by the U.N. 10 years ago (at the start of the new millennium, hence their name.)

Only a handful of goals--like doubling access to safe drinking water and halving the number of people living under the international poverty line--appear to be on track. Many are still teetering, able to flop either way, but MDG No. 5 already seems out of reach.

Recent U.N. estimates indicate maternal deaths have decreased by 34 percent since 1990, but the annual 2.3 percent decline--less than half the targeted 5.5 percent figure--hasn't dipped fast enough to reduce the number of approximately 1,000 women who die every day from complications in pregnancy and childbirth.

Maternal health is a key indicator of a nation's well-being. The loss of young women who provide care and leadership to families is also said to act as a major barrier for nations to build strong communities.

Death Clock Keeps Tally

To draw attention to the stalled progress, Amnesty International, the London-based rights group, launches a "maternal death clock" today in the show-biz epicenter of New York City's Times Square. The clock will keep tally of the real-world women dying every minute during the U.N.'s three-day meeting.

In a kick-start effort, Secretary-General Ban Ki-moon in June unveiled what has come to be called the Global Strategy on Women and Children's Health. It will cost $26 billion in 2011 and calls on all countries to integrate special health services for women into their health-delivery systems and to plan self-sustaining financing.

"This provides a starting point of a multi-year, multi-sector road map to work together to improve the health of women," said Jill Sheffield, president of Women Deliver, a global watchdog group focused on MDG No. 5. "I think there's new wind in our sails and it's important wind, it's not just hot air."

Some countries opted out of the initiative, but 25 other countries held consultative sessions this summer and will come to this week's 2010 Millennium Development Goals Summit with tailored catch-up plans.

Programs to discourage child marriage and provide sexual and reproductive health education to young people will also be proposed at the meeting.

Some countries will unveil budget increases for midwives, emergency obstetric care and free health care for pregnant women, said Laura Laski, chief of the United Nations Population Fund's sexual and reproductive health branch. Health budget increases could materialize if countries decide to announce re-appropriation of existing funds.

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Momentum Depends on Industrialized Nations
Steady momentum largely depends on the 22 industrialized countries in the Organization for Economic Cooperation and Development that have fallen behind on pledges to each year give 0.7 percent of their gross national income to development assistance. In 2009 the total official delivery assistance was equivalent to 0.31 percent of developed countries' combined national income.

The World Health Organization's Partnership on Maternal, Newborn and Child Health--a 260-member global health partnership of U.N. agencies, nongovernmental organizations and foundations--estimates that the annual funding requirement could reach $42 billion by 2015.

U.S. Secretary of State Hillary Clinton will be convening a gathering of female heads of state here this week, according to a U.S. official, and while the agenda isn't publicized, the maternal health goal may get some high-level notice there.

The question remains: Can the concerted efforts of advocacy groups such as Women Deliver and Amnesty International, U.N.-allied efforts such as EndPovery2015 and the 25 special summer sessions help drum up enough money to combat the problem?

A U.N. health official doubts it, saying the $7.3 billion committed to maternal health at the G-8 summit in June, a meeting of the world's eight most economically advanced countries, may be the biggest lump donation that comes in 2010.

The G-8 funding will be distributed over the next five years and is likely to be factored into the overall $169 billion needed from 2011 to 2015.

Minimal Impact Through Short-Lived Funding

Targeted funding that is short-lived could have a minimal long-term effect, says Pamela Gomez, international policy advisor for Oxfam International. She recently visited Sierra Leone, which started offering free health care to women this spring and will continue to do so for next four to five years.

"But it's uncertain what happens after that four to five years are up," Gomez said. "That isn't long enough to bring a country like Sierra Leone back on its feet."

The U.S. Agency for International Development unveiled a draft strategy for the U.S.'s role in helping to meet the Millennium Development Goals in July. That plan has been criticized as lacking specifics, especially on women's health. Maternal health is mentioned only twice in the document, reproductive health not at all.

"We're waiting for a revised strategy, because as it stands there is nothing here to really grab and say, this is an indicator that the U.S. is going to make the necessary financial and program commitments," said Serra Sippel, director of the Center for Health and Gender Equity, a Washington, D.C.-based organization that monitors U.S. health foreign policy and funding. "The question is if that is intentional, so there is no way to hold them accountable."

In a parallel, unilateral initiative, the Obama administration recently established a $63 billion framework for global health assistance that emphasizes maternal and child health, HIV-AIDS, tuberculosis and malaria. The initiative launched in eight pilot countries--Ethiopia, Kenya, Rwanda, Mali, Malawi, Nepal, Bangladesh and Guatemala--in July, guided by country-owned and tailored approaches to programming.