By Alicia Ely Yamin
This article was published in leading Spanish newspaper El País on Monday, September 20.
Right now, the world’s governments are gathering in New York for a United Nations summit to assess progress on the Millennium Development Goals (MDGs). Adopted in 2000, the MDGs constitute a wide-ranging set of globally-supported development commitments. They establish specific, measurable benchmarks and targets to tackle extreme poverty and the wide-scale human rights deprivations associated with it, such as lack of adequate water and sanitation, and the death of children from preventable diseases.
Spain has demonstrated strong commitment to the MDGs, for example through its creation of an MDG Achievement Fund in 2006 and President Zapatero’s recent co-chairing of the MDG Advisory Group convened by the UN Secretary General.
Of all the MDGs, MDG 5, which focuses on improving maternal health, has been the most neglected and underfunded. Not surprisingly, it has shown very uneven progress. It aims to reduce the maternal mortality rate by three-quarters from 1990 levels by 2015, and assure universal access to reproductive health services. According to the most recent UN MDG global monitoring report, the rate of reduction is still well short of the 5.5 percent annual decline needed to meet the target.
More than one woman still dies every 90 seconds from preventable causes. And for every woman who dies, approximately 20 others are left with life-long, debilitating complications. Improvements in some countries mask gaping disparities at sub-national levels, and unfortunately deadly synergies with HIV/AIDS have meant little or no progress in some sub-Saharan Africa countries.
So what’s to be done? In the lead up to the UN MDG Summit next week, there have been some impressive declarations of commitment to address this issue.
In 2009, the UN Human Rights Council issued a historic resolution recognizing high levels of maternal mortality around the world as a denial of women’s basic human rights, including the rights to life, health, education and freedom from discrimination. In June 2010, the second international “Women Deliver” conference was attended by thousands of people in Washington, D.C. A parade of prominent policymakers declared their commitment to tackling maternal mortality and meeting MDG 5. Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, promised greater funding. Just weeks later, G-8 leaders promised an additional US$5 billion by 2015 toward its Muskoka Initiative on Maternal, Newborn and Child Health.
But we have yet to see whether these commitments will translate into effective actions. We know what is needed to save women’s lives; we have known for 60 years what care women need when they face obstetric complications. We also know that unsafe abortion is a leading cause of maternal death, and highly touted programs that ignore this reality are likely not to be effective in the long run.
Technocratic solutions—even better funded ones—are simply not enough. Maternal mortality is fundamentally an issue of gender justice. The reasons women are still dying in childbirth is that women’s lives are not valued, because their voices are not listened to, and because they are discriminated against and excluded in their communities and by health care systems that fail to prioritize their needs. Human rights approaches that emphasize accountability, for donors as well as national governments, equality, and active participation are the key to addressing maternal mortality.
However, human rights concerns were almost completely relegated to an annex in the Joint Action Plan that will be adopted at the UN Summit. In a climate of economic recession, governments seem to want to continue to deal with development as a matter of humanitarian largesse rather than fundamental human rights and women regrettably are likely to be among those that suffer most.
Spain has a chance to show real leadership at this critical juncture and yet large cutbacks in the international cooperation budget earlier this year have raised questions as to whether its development commitments are seen as expendable in the current climate. More steadfast support, both political and financial, for efforts to promote safe motherhood worldwide would be not only give greater legitimacy to Spain’s claim to be a champion of the MDGs; it would also be consistent with the leadership role the government has sought to play in promoting gender equality at home and abroad.
Alicia Ely Yamin is Joseph H. Flom Fellow on Global Health and Human Rights at Harvard Law School and chair of the board of the Center for Economic and Social Rights, an international human rights organization with offices in Madrid and New York.