Slide 1

Choice for women:

wanted pregnancies,
safe births

Public consultation
on reproductive, maternal and
newborn health in the developing
world to inform the UK
Governments forthcoming
Business Plan


Picture: Robert Yates / Department for International
Development
Slide 2
Our mission
Improving reproductive, maternal and newborn health
in the developing world is a major priority for the UK
Government.

DFID is developing a new Business Plan, which will
determine our contribution towards achieving
Millennium Development Goal (MDG) 5 to improve
reproductive and maternal health as well as reducing
newborn deaths (thereby contributing to MDG 4 to
reduce child mortality).

The views and opinions expressed during this
consultation exercise will be used by DFID to give us
a greater understanding of where we should target
our aid interventions.

The new business plan will be published to
http://www.dfid.gov.uk/choiceforwomen
Picture: Storyline / Storyline / Safe Motherhood Programme /
Department for International Development
Slide 3
Get involved
How to use this presentation: please use this presentation to inform your thinking and structure your
discussions - and then send us your responses either online where others can view them or downloading
the template provided and emailing a completed version to us.

Duration: the consultation runs until 20 October 2010.

Enquiries: for enquiries about the consultation - please email: choiceforwomen@dfid.gov.uk

How to respond: for more information on the issues and questions, please submit your responses online
on DFIDs website http://www.dfid.gov.uk/choiceforwomen. If you have difficulty accessing the internet
or a low bandwidth connection, please download and complete the template response document and
email it to choiceforwomen@dfid.gov.uk. Alternatively you can post your response to:
AIDS and Reproductive Health Team, DFID, 1 Palace Street, London, SW1E 5HE, UK
Slide 4
Choice for women wanted pregnancies
Investing in family planning is one of the most effective development interventions and the most cost
effective way to reduce maternal mortality.

215 million women in the developing world would like to delay or avoid a pregnancy (see map 1 on the
next slide), but do not have access to modern family planning methods. Each year there are up to 75
million unintended pregnancies.

Young womens unmet need for family planning is double that of older women. Adolescent birth rates are
high, particularly in Africa (see map 2 on next slide). The youth population of the world is rising, so
demand will increase.

Failing to prevent unintended pregnancy leads some women and girls to seek an abortion. Globally, 20
million of these abortions are in unsafe circumstances and result in up to 70,000 maternal deaths each
year.



Slide 5
Map 1: Unable to choose: Unmet need for family planning source: White Ribbon
Alliance, Atlas of Birth, 2010

Uganda (40%)
Rwanda (38%)
Ethiopia (34%)
Ghana (34%)
Slide 6
Map 2: Mothers too soon: Adolescent pregnancies source: White Ribbon
Alliance, Atlas of Birth, 2010

In Bangladesh, 65 percent
of 20- to 24-year-old
women were married
before the age of 18.
(source UNICEF).

Adolescent girls and young women
are at high risk of contracting sexually
transmitted diseases or HIV. In Malawi
and Ghana, around one third of girls
reported that they were not willing at all
at their first sexual experience.

Slide 7
Choice for women safe births
More than a third of a million women die due to complications in pregnancy or childbirth each year.

Women and girls in Afghanistan and Sierra Leone have a 1 in 8 chance of dying in childbirth. Se map 3
on the next slide.

The few minutes and hours around childbirth is the time when the risk of death is greatest for both
mothers and babies.

More than 3.5 million newborn deaths (more than 40% of deaths in children under 5 years of age) occur
in the first month of life up to 45% of these in the first 24 hours. See map 4 for newborn death rates.

Pregnant girls aged 15-19 are twice as likely to die in pregnancy and childbirth than women in their
twenties. Those under 15 are 5 times more likely to die.


Slide 8
source: White Ribbon Alliance, Atlas of
Birth, 2010
The 15 least developed
countries that have been
affected by conflict
during the years 2000 to
2006 have worse
indicators than non-
conflict affected countries
11 countries account for
65% of maternal deaths
including India, Nigeria,
Ethiopia, DRC, Afghanistan,
Bangladesh, Pakistan, and
Tanzania
Map 3
Slide 9
source: White Ribbon Alliance, Atlas of
Birth, 2010
Map 4
Slide 10
The importance of the continuum of care
Most maternal and newborn deaths are preventable if women and babies have access to a functioning
continuum of care (see below) - quality reproductive and maternal health services before and during
pregnancy, during labour and after the birth. Women and girls fail to access the systems at critical points for
ensuring that every pregnancy is wanted and that every birth is safe and baby healthy (see figure 1 on
following slide).





Pre pregnancy
(adolescent girls and women and men
of reproductive age)
Pregnancy & Newborn
Birth to 28 days
Child
Up to 5 years (infant 1
month to 1 year)
Birth
Family Planning Safe Ante natal Safe Post-birth Newborn Child
Within wider SRH abortion care delivery care care Health



CONTINUUM OF CARE
Reproductive, Maternal and Newborn Health
The continuum of care through to child health is important. DFID invests significantly in child health
in a number of ways please go to the Consultation website for more information.
Slide 11
Figure 1: Important gaps in coverage of key services for women and
girls the example of Tanzania
Source: Wendy J Graham & Ann E Fitzmaurice, Immpact, University of Aberdeen
Data sources: Countdown to 2015 (2008) Report; Tanzania DHS 2004-05
100


80


60


40


20


0

All women: 68 Priority countries
Tanzania:
poorest women
x
x
x
x
x
x
x
x
x
x
x
x
X X X X
ANC Skilled birth attendant DTP3 (child) Contraception

% uptake
Tanzania:
all women
Slide 12
Question 1. What should we aim to achieve?
We want to improve womens control of their
reproductive lives and to save mothers and
newborn lives. What should we be trying to
achieve?

Things you might like to consider include:

Reduce the unmet need for family planning
Reduce the number of unsafe abortions
Reduce the adolescent fertility rate
Increase the number of births attended by skilled
birth attendants
Increasing newborn survival
Increase the availability of prevention of mother-
to-child transmission (PMTCT) services
Improve maternal nutrition
Reduce the prevalence of malaria in pregnancy
Do you have any other ideas to share with us?
Picture: ALAFA / Franco Esposito
Slide 13
Question 2. Which interventions, or combination of
interventions, should we prioritise to have the
most impact?
Things you might like to consider include:

Comprehensive family planning
Better safe abortion services
Antenatal and post natal care services
Skilled birth attendance
Maternal nutrition interventions before and during pregnancy
Emergency obstetric care
Newborn care
Exclusive breastfeeding
Prevention and treatment of malaria for pregnant women
PMTCT services, at and after birth
HIV prevention with sexual and reproductive health services
Stronger health services to deliver quality services along the
continuum of care
Do you have any other ideas to share with us?

Picture: Storyline / Storyline / Safe Motherhood Programme /
Department for International Development
Slide 14
Question 3. Where should we work?
Although family planning is a cost-effective intervention and provides good value for money, progress in
meeting the unmet need for modern and effective family planning methods has been slow, especially in
Africa and Asia where the unmet need is greatest.

The difference in the lifetime risk of maternal mortality between developed and developing nations is the
largest of any health indicator. The chances of dying from maternal causes over a womans lifetime is 1 in
7 in Niger compared to 1 in 8,200 in the UK.

There are also substantial differences between and within developing countries in the ability of women to
access quality care at the time of birth. The poorest women in all countries are those least likely to have
skilled attendance at delivery.

Should we prioritise where we work on the basis of:
The countries with lowest contraceptive prevalence rates? The countries with the highest unmet need for
family planning?
Those with the highest absolute numbers of maternal deaths? Or those where the lifetime risk of maternal
death is greatest?
Those with the greatest inequity in access to services between rich and poor?
Those countries classified as fragile states?
A combination of all of the above? By some other criteria?

Slide 15
Question 4: What are the most important approaches
we should consider to tackle inequalities in
reproductive, maternal and
newborn health?
There are huge and persistent inequalities in
reproductive, maternal and newborn health outcomes
between different socio-economic groups, different
geographical areas, different ages and marginalised
groups such as those living with HIV.
What inequalities are most important to tackle, and how?

You might want to consider:
Cash transfers and other mechanisms (like vouchers) to
remove financial barriers faced by the poorest and offer
choice where relevant.
Innovative and community based solutions, like transport for
women in need of referral.
Making services women and girl friendly.
Better and more transparent data to track if results benefit the
poorest
Other suggestions?
(source: Countdown, 2010)
Slide 16
Question 5. How can we improve the realisation of
womens rights and womens and girls
empowerment?
Womens lack of control over their own sexuality and fertility and their poor access to
reproductive, maternal and newborn health services is closely linked to a general lack of respect
for womens rights, including their right to health. Which actions should we prioritise to address
this?

Options you might like to consider include:

Political commitment to girls and womens health at all levels
Girls education, including post-primary
Womens economic empowerment (income and employment opportunities)
Legal frameworks for girls and womens rights
Reducing violence against girls and women
Girls and womens participation and organisation for their own and their babies health
Social change (social norms, attitudes and practices that drive girls and womens control over resources
and own body)
Other suggestions

Slide 17
Pregnancy among adolescents aged 15-19 years of age has fallen since 1990 in all developing
regions, but progress is slow.

About 19% of pregnancies globally end in induced abortion; unsafe abortion accounts for 13% of all
maternal deaths. 70,000 women die as a result of unsafe abortion every year; many more are
permanently injured. Lowering abortion-related maternal death is a key way to reduce maternal mortality
given that nearly all maternal deaths from unsafe abortion are preventable.

In some societies, a strong preference for sons leads to sex-selected abortions and infanticides.
In 2005, UNFPA estimated some 60 million missing girls in Asia.

Violence against women by a partner is a global public health problem and a human rights violation
directly linked to womens lack of status and power.

Female genital mutilation/cutting (FGM/C) is a human rights and a health issue for both mothers and
babies. Complications in deliveries are significantly more likely among women with female genital
mutilation/cutting

Obstetric fistula is a hole that occurs as a result of prolonged and obstructed labour. It is an injury that
leaves women and girls leaking urine or faeces from the vagina, usually uncontrollably. WHO estimates
that more than two million women are living with fistula in developing countries.

Question 6: Which neglected and sensitive issues
should we prioritise in our work?

Slide 18
Options you might want to consider include:

Improving adolescents sexual and reproductive
health and rights
Delaying age at first pregnancy
Improving access to safe abortion services
Infanticide of girl children
Reducing violence against girls and women
Addressing female genital mutilation/cutting
Addressing obstetric fistula
Any others?

Source: Atlas of Birth, 2010
Which neglected and sensitive issues should
we prioritise in our work?
Slide 19
Question 7. How can we deliver better results
through multilateral aid?
DFID currently supports work to improve
reproductive, maternal and newborn heath in the
developing world through the following multilateral
organisations:

European Commission (EC)
United Nations Population Fund (UNFPA)
United Nations Childrens Fund (UNICEF)
The Joint United Nations Programme on HIV/AIDS
(UNAIDS)
World Bank
World Health Organization (WHO)
Global Fund to fight AIDS, Tuberculosis and
Malaria (GFATM)
UNITAID

How can we deliver better results through
multilateral aid? Who should we work with to
improve reproductive, maternal and newborn
health?

Picture: Robert Yates / Department for International Development
Slide 20
Question 8. How should we work with private and
other non-state actors more to deliver successful
reproductive, maternal and newborn health
outcomes?

The vast majority of DFID funding for health is currently channelled to public sector health services. The
case for the public sector role in health is clear: the state needs to be involved in order to protect the
public, avoid excessive costs and reach the poor.

Non-state actors include private for-profit companies and a wider range of informal for-profit healthcare
providers, such as non-governmental, faith-based and community-based organisations.

We recognise the role of the private sector in health, for example in the provision of commodities and
services.

Civil society organisations play an important role in increasing equity, empowerment and accountability in
health.



Slide 21
Question 9. What are optimal models of service
delivery for delivering reproductive, maternal and
newborn health outcomes?

What can we learn from experience in delivering reproductive, maternal and
newborn health outcomes around the world?
Slide 22
Question 10. How should we work in fragile and
conflict affected states and humanitarian
situations?

Should reproductive, maternal and newborn health
be included as part of the response to rapid onset
emergencies?

You might like to consider

Working bilaterally to strengthen national health systems
if possible and as appropriate in fragile states
Working through non-state actors to deliver reproductive,
maternal and newborn health services, information and
supplies
Work through multilateral channels to deliver improved
reproductive, maternal and newborn health outcomes
Strengthening the humanitarian cluster system to deliver
coordinated reproductive, maternal and newborn health
services
Include reproductive, maternal and newborn health as
part of a response to rapid onset emergencies
Are there other ways in which we could be working?
Picture: Russell Watkins / Department for International Development
Slide 23
Question 11: What should we support in terms of
knowledge, research and innovation?

What are the key gaps in the global knowledge about how to improve reproductive, maternal and
newborn health, and which should we seek to fill? How can we ensure existing research is used?

You might want to consider:

Continue to provide funding for high quality research to improve reproductive, maternal and newborn
health programmes, along with implementation or operational research to ensure findings are effectively
translated into front-line programmes
Invest in data and information systems for registering births and deaths and for tracking results in
developing countries
Support innovation and development of reproductive health commodities, including family planning
methods
Improve the way that research findings are used and translated into policy and practice
Other suggestions?

Slide 24
Question 12. If we could do only one thing to
improve reproductive, maternal and newborn
health outcomes, what should it be and why?
Slide 25





Thank you for contributing
Slide 26
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