UN Photo/Kibae Park
UN Photo/Kibae Park

The UN and the World Bank recently celebrated the “achievement” of two important targets of the Millennium Development Goals (MDGs): access to clean water and halving poverty[1]. While we are reflecting on these accomplishments, it’s important to note that the same success story doesn’t extend to all MDGs. Many of the goals are still far from being met, and MDG 5, maternal health (MH), has been one of the least successful of all MDGs. It is not on track, and it doesn’t look like it will be achieved by 2015.

Assessing how far we are off track is difficult due to a lack of reliable and consistent data and reporting on maternal mortality. This is particularly true for rural areas of least developed countries, where lack of infrastructure and technology further compound inconsistent and unreliable data collection.

While MH isn’t a new issue, as an MDG it has remained, until relatively recently, on the periphery of the agenda - certainly in comparison to the support (financial and operational) that has been given to the other MDG target areas. And, in terms of making inroads toward the two MDG5 targets, i.e. reducing by three quarters the maternal mortality ratio and achieving universal access to reproductive health, developing countries have had very little success in achieving systematic and consistent results.

What are the reasons behind the limited results on MDG5?

First, there are problems with how to define what is needed to ensure maternal health. The lack of consensus on definition has meant that it’s hard to reach agreement on collective action that is needed to achieve the targets. For example, lines have been blurred as each donor separately interprets what actions contribute to achieving the targets.

Donors (governments, global partnerships, and NGOs) have focused on different areas of emphasis- some on, for example, reducing maternal mortality versus improving maternal health, and some have linked together MDG 4 and 5 (i.e. maternal, newborn and child health).

Second, there are disagreements between funders on which items should and shouldn’t be funded (e.g. disagreements over reproductive health), and at times, funders have found themselves working against each other. The inability to work together and reach consensus is arguably one of the contributing factors to the lack of success for MDG 5. Effective funding has been hampered by the fact that donor governments have linked their funding commitments to their political agendas.

Third, and most problematically, the related global development architecture is marred by gaps, overlaps and inefficiencies. On this particular issue, the web of funding (commitments and disbursements) is has become more complicated as more actors have become involved in increasingly complex funding schemes. Take the G8 countries for example - they are dispersing funds for MH through a variety channels; directly through bilateral aid, while also funding multilateral initiatives [2]. Do G8 governments track their contributions to ensure they are filling gaps and not overlapping? There appear to be shortfalls in such monitoring. This is not a problem that is confined to the G8 alone, but rather a system-wide issue that requires further analysis.

An article in The Guardian recently argued that the World Bank should re-evaluate its strategy for addressing MH, suggesting that it should reduce bank fees and increase its targeted spending on reproductive health. But as noted above, spending alone isn’t the problem, or the solution. Additional funding may help alleviate some of the funding shortfalls, but there are also pressing coordination problems between donors and delivery agents that also need to be addressed, if substantive progress is to be achieved.

International Women’s Day came and went last week, and it should serve as a reminder to us that we made a commitment to achieve MDG 5. Maternal health needs to be adequately funded, but new consensus is really needed on what is to be funded, and for there to be proper international coordination on the implementation of the commitments.

To make some progress on MDG5, the mantra now needs to be ‘ladies first.’

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[1] It is important to note that these are only targets within two of the eight MDGs. MDG 1 includes three targets, one of which is halving proportion of people whose income is less than $1 a day. MDG 7 includes four targets, one of which is halving the proportion of people without sustainable access to safe drinking water and basic sanitation. And it is also necessary to note that the reporting for these targets only measured ‘achieving access,’ i.e. for the target of access to water- this doesn’t take into consideration the quality, sustainability, or whether the water is consistently reliable.

[2] Funding is channeled through: the GAVI Alliance, The Global Fund to Fight AIDS, Tuberculosis and Malaria, WHO, UNFPA, UNICEF, UNAIDS, UNITAID, and the World Bank.

While maternal health isn’t a new issue, as an MDG it has remained, until relatively recently, on the periphery of the agenda
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