Roselyne Sachiti Features, Health and Society Editor
The world has been struggling with three problems which have been hampering developmental programmes in many countries, especially those in East and Southern Africa.
The three issues — which are rates of maternal deaths, increased cases of gender-based violence and harmful practices, and failure to meet the family planning needs of countries — have been a nagging headache keeping governments and development partners awake as they come pregnant with high costs.
For example, in the SADC region, Malawi has one of the highest maternal mortality ratios globally, currently estimated at 574 maternal deaths per 100 000 live births, according to latest estimates by USAID.
Mozambique is also among countries with the highest maternal death rates in the world, estimated at 489 deaths per 100 000 live births in 2015. One in five of these maternal deaths occur in women under 20.
In Zimbabwe, the mortality rate stands at 650 deaths per 100 000 live births, which is among the highest in the world.
As UNFPA Country Representative for Zimbabwe Dr Esther Muia puts it in an interview ahead of the International Conference on Population and Development (ICPD25) summit last week, maternal mortality is a thorn in the flesh.
“Much as we say it had gone up and came down, it is not coming down fast enough.
“When you talk of 650 women dying out of a 100 000 live babies born, that’s a very high number. I always equate it with an airplane crash. How many people does a Boeing carry, it is about 200? Recently, when the Ethiopian airline plane crashed in Addis Ababa, it had a 157 passengers.
“The story made the headlines daily, it was on CNN and on BBC. Then we have 650 women dying every year and no one makes it a headline. It is like three jet planes crashing. For sure if three jets crash, we saw Boeing grounding it? How much awareness are we having that something is not right?”
While SADC grapples with these challenges, the world is watching and bringing out the cost brought about by the scourge.
At the ongoing ICPD25 summit in Nairobi, Kenya, new findings revealed the high cost of ending maternal deaths, GBV and the unmet need for family planning.
The price tag to achieve these three world-transforming results in the next decade — ending preventable maternal deaths, eliminating gender-based violence and harmful practices, and meeting the family planning needs of women in high-priority countries — is US$264 billion, according to new research made public on Tuesday.
Currently, only US$42 billion in development assistance is expected to be spent on advancing these goals. That means some US$222 billion in investments is required over the next decade, whether in the form of foreign investment, domestic allocation or private spending.
These are the main findings of a joint study by researchers from UNFPA and the Johns Hopkins University, in collaboration with Victoria University, the University of Washington and Avenir Health.
Achieving these results is a precondition to meeting the Sustainable Development Goals, a set of global goals agreed by the world’s governments, by 2030.
It will also generate cost savings over generations, as healthier women and girls are empowered to contribute their productivity and creativity to society.
“We now know how much and where we need to invest. These figures are a drop in the ocean compared to the dividend expected and the funds available,” said UNFPA Executive Director Dr Natalia Kanem.
“These are smart, affordable investments that will transform the lives of women and girls, their societies, and our world. The cost of inaction is much higher.”
“We have a collective responsibility and opportunity to deliver on our promises — now,” said Dr Kanem.
“We cannot wait another 25 years. It’s time to fill these resource gaps and make this a decade of delivery. It’s time to get the job done. With strong financing momentum we can achieve these transformative results, complete the ICPD Programme of Action and meet the Sustainable Development Goals on time by 2030.”
The new research shows the cost of each objective to be within reach.
Ending preventable pregnancy and childbirth-related deaths in the 120 countries that account for over 95 percent of maternal mortality will cost US$115,5 billion in key maternal health interventions. This includes paying for medical staff, drugs and obstetric supplies, and is roughly equivalent to 46 of the world’s most expensive military planes.
Ending unmet need for family planning in 120 priority countries — which comprise the majority of low-and middle-income countries — will cost US$68,5 billion.
The money would go towards ensuring a steady, reliable supply of quality contraceptives and other efforts to strengthen national health systems.
Ending gender-based violence will require investing US$42 billion in 132 priority countries. That money would go to programmes that provide psychosocial assistance, medical treatment and rape kits to survivors, and promote the right of all women and girls to live free of violence and abuse, among other interventions.
Ending female genital mutilation will require US$2,4 billion for interventions related to education and changing social norms in 31 priority countries.
The research shows that just US$95 can prevent a girl from having her genitalia cut for non-medical reasons.
The price tag for putting an end to child marriage is US$35 billion. This would be enough to ward off 90 percent of child marriages.
In other words, it only takes US$600 to spare a girl from becoming a child bride.
But meeting these goals will require broad-based action.
“Without everyone pushing the oars together, the boat is not going to move far, and if we are not in sync, we will simply turn in circles,” notes Victoria Chou, a researcher with the Johns Hopkins Bloomberg School of Public Health.
“Closing the substantial gap with investment of urgently needed resources will ultimately improve health among women and their families and that vision is what should motivate us looking forward after the Nairobi Summit.”
Despite the slow pace of ending maternal deaths, SADC has the Protocol on Health, which was developed with the aim of harmonising and rationalising resources in the implementation and the attainment of health objectives in the region. It was ratified by more than two thirds member states and put into force in August 2004.
SADC Implementation Plan
According to the Sexual and Reproductive Health Strategy for the SADC region 2006-2015, the Protocol on Health was developed to operationalise implementation.
The SADC Protocol on Health contains three important articles, which are key to sexual and reproductive health. These are articles 10, 16 and 17.
Of note is Article 16: Reproductive Health which states that state parties shall formulate coherent, comparable, harmonised and standardised policies, particularly in developing a surveillance system for monitoring maternal and new-born mortality; developing strategies to reduce maternal and new-born mortality; the reduction of genetic and congenital disorders leading to birth defects; empowering men, women and communities at large to have access to safe, effective, affordable and acceptable methods for the regulation of fertility.
Then in November 2018, SADC groundbreaking and far-reaching Regional Strategy for Sexual and Reproductive Health and Rights (SRHR) 2019–2030, and corresponding Score Card to measure progress, were approved by the ministers of health and ministers responsible for HIV & AIDS from the 16 SADC member states.
According to UNFPA East and Southern Africa Regional office (ESAR), the Sexual and Reproductive Health and Rights (SRHR) Strategy for the SADC Region (2019–2030) provides a framework for member states to fast-track a healthy sexual and reproductive life for the people in the region, and for all people to be able to exercise their rights.
With SADC countries among those renewing their commitments this week in Nairobi, there is need for member states to cooperate by pooling resources — both financial and human — to fast-track these commitments and ensure maternal deaths become a thing of the past.
If timely interventions improve, then there is no need to worry about the high rates of maternal deaths and unmet targets for family planning.