Déirdre de Búrca (Green Party)

I also welcome this opportunity to recognise the important contribution that Ireland is now making towards achieving the millennium development goals, in particular goal No. 5, which has been referred to by other speakers, to improve maternal health and specifically to reduce by three quarters the maternal mortality rate in developing countries. Under this commitment the aim is to reduce maternal mortality by 75% over a period of 25 years. This is a significant and ambitious target, but it is entirely achievable. It is clear from this debate that so many of these deaths are avoidable. They are deaths which would not occur if the mothers were living in the developed world and are due to the lack of antenatal services which is the cause of a great number of the complications that arise around childbirth.

Some 75 of the poorest countries will be targeted by the millennium development goal and Ireland has made a substantial financial contribution both to the UNFBA fund of €2 million and also the trust fund on female genital mutilation, operated jointly by UNICEF and UNFBA. Currently, female genital mutilation or cutting affects between 100 million and 140 million women and girls — and 3 million girls are at risk of the practice annually. The programme is designed to work with cultural and religious leaders to encourage a societal change and the abandonment of the practice. That more constructive approach is to be encouraged as sometimes we may express cultural disapproval of practices in the developing world without understanding the long traditions and roots in particular communities. A process of education and encouragement is a more productive approach. Funding of €500,000 will be provided for that along with another €500,000 from the Government to the fistula schematic trust fund.

Again, this was established as part of the UNFBA's campaign to end fistula. Obstetric fistula is typically the result of prolonged and obstructed labour, most usually when medical intervention or Caesarean section is not available. The pressure of the baby's head against the mother's pelvis causes extensive tissue damage, making her incontinent, and in most cases the baby does not survive. This programme aims to prevent the condition by ensuring skilled attendance at births and to provide treatment from those who have suffered from fistula.

It is very important that the half a million who die every year in sub-Saharan Africa and southern Asia from treatable and preventable complications of pregnancy and childbirth will now be supported, and hopefully other EU member states will also contribute to these funds. Ireland has been one of the first to do so. When expected outcomes for mothers in sub-Saharan Africa are compared to the prognosis for women giving birth in developed countries, the risk of a mother dying in the former region from childbirth related complications over the course of her lifetime is one in 16 as compared to one in 3,800. Those differentials are unacceptable. I am not a mother, but any woman in the developed world who is, must have an instant sense of concern and responsibility for women who find themselves in those situations in less developed parts of the world, and who face much poorer outcomes.

What can be done in terms of trying to address this very ambitious target of a reduction of 75% in maternal deaths? Other speakers have referred to the importance of introducing appropriate reproductive health services, before, during and after pregnancy and also through life-saving interventions if complications arise. This involves attendance at deliveries by skilled health personnel, doctors, nurses and midwives, who are trained to detect problems early and can effectively provide or refer women to obstetric care when needed. The regions with the lowest proportions of skilled health attendance at birth are sub-Saharan Africa and southern Asia but unfortunately, they also have the highest numbers in term of maternal deaths. Disparities in the supports available to women during pregnancy and childbirth are also evident both among countries and within them.

According to surveys carried out between 1996 and 2005 in 57 developing countries, 81% of urban women deliver with the help of a skilled attendant, as against only 49% of their rural counterparts. The difference the increased supports that are available to urban women make stand out in comparison to their rural counterparts. Hopefully the UNFBA programme will focus to a large extent on the rural women who seem to have much poorer outcomes.

Some 84% of women who have completed secondary or higher education are attended by skilled personnel during childbirth. That is more than twice the rate of mothers with no formal education. While educational level plays an important part in outcomes, such as in childbirth, this will have to be taken into consideration. Antenatal care has long been recognised as a core component of maternal health services and can serve as an important entry point into the wider health care system for women who, perhaps, do not avail of important and critical health services. Since 1990, every region in the developed world has made progress in ensuring that prospective mothers receive antenatal care at least once during pregnancy. Even in sub-Saharan Africa where the least progress has occurred, more than two-thirds of women receive antenatal care at least once during pregnancy. This is stated in the UN's millennium development goal report in 2007. That same report states that for antenatal care to be effective, international experts recommend as essential at least four visits to a trained health care practitioner during pregnancy. Another point made very clearly in this report is that no single intervention can address the multiple causes of maternal deaths, and that efforts to reduce maternal mortality need to be tailored to local conditions, since the cause of maternal deaths can vary across developing regions and countries in Africa and Asia.

In Africa and Asia haemorrhage is the leading cause of maternal deaths while in Latin America and the Caribbean, hypertensive disorders during pregnancy and childbirth pose the greatest threat. Obstructed labour and abortion account for 13% and 12%, respectively, of maternal mortality rates in Latin America and the Caribbean and in Asia, while anaemia is a major contributor to maternal deaths, but is a less important cause in Africa and a negligible factor in Latin America.

It is important that whatever programmes are developed are very much tailored to local needs. The last issue to which I wish to refer — the report touches on it — is that of preventing unplanned pregnancy and the need to make contraceptive services and contraception more freely available to young women, particularly in developing countries. It is estimated that at present, 137 million have an unmet need for family planning in the developing world. An additional 64 million women are using traditional methods of contraception with high failure rates. Contraceptive prevalence has increased slowly, from 55% in 1990 to 64% in 2005, but it remains very low in sub-Saharan Africa, at 21%. These are all issues that need to be tackled, but I commend the Government on the important financial support it has given towards achieving the millennium development goal of reducing maternal deaths. I look forward to a further opportunity to address this topic, perhaps in a year's time, when we can review the issue again and see what type of progress has been made.