Session 17: Equity and Maternal and Child Health: From Epidemiology to Human Rights

By: Jennifer Kitts, Consultant

Three speakers participated in the session “Equity and Maternal and Child Health: From Epidemiology to Human Rights” on Sunday afternoon. The session was moderated by Janet Hatcher Roberts, Executive Director of the Canadian Society for International Health.

Dr. Zulfiquar Bhutta, of the Aga Khan University in Pakistan, and Dr. Ian Pett, of UNICEF, both discussed the importance of equity in achieving better health outcomes for women and children. Although we are making progress in reducing child and maternal mortality, success is not spread evenly across countries and within countries. Dr. Bhutta pointed out that most of the world’s approximate 350,000 maternal deaths annually occur in sub-Saharan Africa andSouth Asia. The 10 countries of the world that account for the majority of maternal deaths also account for the majority of newborn deaths and stillbirths.

Great discrepancies can be found within countries. Some parts ofPakistanhave maternal and child health indicators that “are as good asMontreal, while other parts have similarities to sub-SaharanAfrica,” said Dr. Bhutta. There is a significant difference between what interventions are available for the rich and for the poor. “We know what works,” he said, “the big challenge is how to reach the unreached.” Similarly, Dr. Pett said that, whileBrazilhas had success in the area of child mortality, when the statistics are analyzed by state and by municipality, pockets of higher mortality are evident -“getting interventions to the most marginalized is key.” The service delivery model must be assessed to determine whether it rationally, equitably and efficiently addresses the nation’s burden of disease.

Greater support is needed for prioritized interventions on the basis of the evidence. Dr. Bhutta spoke of the need for more attention to family planning. “It is impossible to produce the impacts in maternal and child health that we would like to see without greater attention and resources to family planning”. Dr. Pett suggested that more support should be given to key issues such as diarrhea, pneumonia, postpartum sepsis.

Community-based approaches were also emphasized, which have been shown to reduce up to 30% of neonatal deaths and 25% of maternal deaths. Moving forward, Dr. Pett said that it is useful to consider countries that have achieved success in sub-Saharan Africa andSouth Asia. Peer-to-peer influence is increasingly important. Also, there is a need to pursue equitable ways to remove financial and other barriers to access and use of services.

Sandeep Prasad, of Action Canada for Population and Development, brought a different approach to the issue in his presentation of how civil society organizations around the world have been working, with great success, to put the issue of maternal mortality and morbidity on the human rights agenda. They have helped to ensure that 3 resolutions were adopted on the issue by the UN Human Rights Council, the primary intergovernmental body mandated to protect and promote human rights. The most recent resolution (September 2011) recognized that maternal mortality and morbidity is underpinned by 7 human rights principles: accountability; participation, transparency, empowerment, sustainability, international cooperation, and non-discrimination. Giving effect to these principles is the core of a human rights approach to eliminating maternal mortality and morbidity.

Prepared by Jennifer Kitts, a Canadian consultant, working in the area of global health and human rights.

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