Women Deliver Conference – Day one-Afternoon plenary by Rafi Rogans-Watson
A star attraction at the conference
Hi there—Rhona here. The next few blog spots will be from the Women Deliver Conference in London. Sorry, they will be a bit out of synch. We (our TheLancetStudent.com correspondents, Islean Kinghorn and Rafi Rogans-Watson, and I) have been so busy running around that I have not been able to post the entries ’til a bit later. So this one is from Rafi from the afternoon of 18th October, the first day of the conference. —Rhona
Rafi Rogans-Watson
Working on Common Ground… But whose ground?
Today I was fortunate enough to attend the Women Deliver conference in London, a global meeting of 2000 delegates that aims to focus political will and financial resources on addressing the continuing burden of female ill health and mortality. The conference marks the 20th anniversary of the launch of the Safe Motherhood Initiative (in Nairobi, 1987), hailed during its time (and still today) as a landmark event that helped to move maternal health into the limelight.
So where are we today? Well, a notable step forward presents itself immediately in the name of the conference, which finally recognises the fact that women are not just mothers, or indeed simply wives or daughters. They are, in the words of Margaret Chan, Director-General of the WHO, “agents of change.” Maternal mortality can not only indicate the value that is placed on women in a society, it can act as a proxy for the state of a country’s health system and to some extent the level of development. Additionally, by improving women’s health and concentrating on the factors that do so (access to family planning services, adequate antenatal and obstetric care, improved education and opportunities for work), the possibility for development will dramatically increase.
Unfortunately, despite the optimism held 20 years ago, despite the myriad of ‘Initiatives’, ‘Alliances’ and ‘Coalitions’ that have sprung up since 1987, and despite the fact that today there is a pretty strong consensus on what needs to be done to tackle the problem of maternal mortality, the figures paint a sobering picture: 536,000 women still die every year during pregnancy or childbirth. An appalling 99% of these deaths occur in developing countries, which may go some way to explain why they are still the least developed in the world: the circumstances for their ‘agents of change’ have changed very little. Families and communities in the developing world are torn apart when one of their women die. How can they be expected to ‘develop’, when one dies every 60 seconds?
The afternoon plenary of the conference was titled ‘Working on Common Ground’, and the panel aimed to explore ways in which current international actors working in the field of maternal health could collaborate to ensure that meaningful progress would be made in the future. It was encouraging to see such large organisations as the WHO, the International Labour Organisation (ILO), and UNAIDS talk about collaboration in the context of reproductive health. Nafis Sadik, the Special Advisor to the UN Secretary General for HIV/AIDS and former head of the UN Population Fund (UNFPA), called for greater synergy between the maternal health and HIV organisations, because they were essentially “targeting the same population” and lessons in effective delivery could be learned from both. She also praised the Global Fund for HIV, TB and Malaria, for announcing that it would spend at least 40% of its money on health systems. All the panellists agreed that without a functioning health system, any interventions and policy changes would be useless.
In fact, the discourse surrounding the solutions to the problem of maternal mortality was very positive. Regarding the necessary interventions, the phrases “we already know what to do”, and “we need to work together” were repeated a number of times throughout the session. However, the more difficult question of ‘how will we do it together‘ seemed to be less answerable. Almost all the panellists felt that what was needed was leadership, and they called for the WHO to take on this role on a country by country basis. Disappointingly, Chan rejected all calls for her organisation to be the coordinator of this collaboration.
It seems that in principle, everyone wants to work together, and when there are two parties (such as local government and NGO, WHO and ILO) this can work very effectively. However, once the field becomes flooded with organisations all striving for the same outcome, whether they “know what to do” and are reading from the same page or not, collaboration becomes a lot more complex.
I left with the feeling that there was one speaker missing: someone who could fulfil the role of leadership. People were motivated, but they couldn’t quite agree on how to ensure that this motivation was coordinated. In the end, Margaret Chan summed up this feeling of prevailing indecision, saying, “If you want to go fast: go alone. If you want to go far: go together. For women’s health, we need to go far. And fast.” Raphael (Rafi) Rogans-Watson