Michael Kitt (Galway East, Fianna Fail)

I welcome the opportunity to address the Seanad on the pressing international development issue of maternal health and mortality. I thank Senators for their contributions and I am pleased the motion is agreed.

In 2000, maternal health was selected as one of the eight highest priorities for the future of developing countries. By including the issue in the millennium development goals, heads of state and governments underscored the magnitude of this problem and its tragic implications not only for the women affected but also for their children. I regret to say, however, that the challenge is not being met by the international community. Despite the promises made in MDG No. 5 to reduce the maternal mortality ratio by three quarters by 2015, the mortality rate has remained at the same level as in 1990. The actual number of women dying has increased, from 529,000 in 2000 to 536,000 at present.

This mortality rate varies hugely by geographic region. With 96% of maternal deaths worldwide, sub-Saharan Africa and Asia suffer disproportionately. In some African countries the lifetime risk of death in childbirth for women is as high as one in seven. Within Africa the figure can vary wildly from country to country. Deaths per 100,000 live births are 230 in South Africa, 1,000 in Mozambique and a shocking 1,800 in Malawi according to the most recent figures. There is no sign of this overall picture changing despite pockets of encouraging progress. While progress has been slow in all regions, sub-Saharan Africa shows the least progress in the maternal mortality rate, dropping by only 0.1 % annually compared to the target of 5.5%. This lack of progress has been due to a number of factors. For many years, the largest obstacle to progress in maternal health has been a lack of political will and resources. In the competition for scarce resources in over-stretched health systems, women's needs have tended to be pushed aside. Emergency obstetric care has been often viewed as a luxury rather than as a basic right. Access to contraception is also a major factor. When women in the developing world cannot choose to control the spacing between births, their ability to return to health between births can be compromised. This increases the chances of complications in pregnancy, bringing greater risks to their health and to that of their child.

The latest maternal mortality figures have evoked a reaction not only among the donor community but also in developing countries. It is now clear there will be no progress on the fifth millennium development goal unless there is a sea change in thinking. This includes major advances in funding from donors and the prioritisation of the issue by developing countries.

The total human cost of these unnecessary deaths is increasingly clear. The cost is not only the loss of these young women and the trauma to their families but also the added vulnerability of the children they leave behind. It has been shown in many UN studies that children who lose their mothers at a young age have an increased risk of dying before the age of five and those who do survive have a lower likelihood of attending school. They also have a greater lifetime risk of extreme poverty. Therefore, these young women are not only important in their own right but are vital to the lifetime prospects of their children. MDG No. 5 on maternal health and MDG No. 4 on child survival are intrinsically linked. Safer childbirth for the mother is also safer for the child, reducing the number of children dying shortly after birth. A link has been also identified between maternal mortality and malaria, HIV and AIDS and a number of other medical conditions. Issues as basic as human resources for health, access to functioning medical equipment, adequate supplies and medical hygiene are all key factors in improving survival rates.

In the past year donors have taken additional steps to address this important issue. A number of European governments, including Ireland, have increased their funding to issues around maternal mortality and attempted to bring to public attention the shocking loss of life being sustained by women in developing countries. In the White Paper on Irish Aid, the Government clearly outlined its commitment to supporting the specific health needs of women. The White Paper states that, "addressing women's health needs, particularly in the areas of basic healthcare and maternal and reproductive health must lie at the heart of an effective overall response to improving health in developing countries".

Since the White Paper's publication, Irish Aid has developed a health policy which addresses issues of maternal mortality, including the determinants of maternal mortality. It strengthens systems, especially those serving the poor, and it contributes to an effective international response to their health needs. Irish Aid does this through bilateral assistance, regional partnerships where appropriate, global partnerships and civil society. In our bilateral programmes we support priority country governments in sub-Saharan Africa to deliver a package of basic health care, including reproductive health care. Additional support is granted for specific initiatives on maternal health, such as the new midwifery school in Northern Province, Zambia, which opened in 2006. Another example is our commitment of €2.3 million in 2006 to a four-year project in Tanzania, Mozambique and Malawi to improve the provision of maternal health services by mid-level health workers. In addition to this funding, Irish Aid works through several partner agencies in the UN system to address maternal health and contraception. Ireland gives significant support to WHO, UNICEF, UNFPA, UNAIDS and UNDP and the Global Fund for Aids, TB and Malaria, all of which contribute to reducing maternal mortality.

One of the main barriers to achieving universal access to reproductive health is the lack of empowerment of women in developing countries. These issues form the core mandate of the United Nations Population Fund, UNFPA, which is one of Ireland's key partners in the UN system. The importance of its work on gender, reproductive health, maternal mortality and HIV-AIDS is recognised by the 180 governments worldwide that contributed to its funds in 2007. In light of its important mandate, the Government increased core funding to UNFPA in the past five years from €1.8 million in 2003 to €4.5 million in 2007. In addition, in 2007 the Government made a contribution of €1 million to the UNFPA trust fund for global reproductive health commodities security, which aims to ensure that governments have a constant supply of reproductive health products. These include basic supplies for obstetric care and to allow for safer births.

Its particular focus on reproductive health and maternal health made UNFPA the natural home for a new UN trust fund to harness the donor commitment to maternal health. This new campaign — No Woman should Die giving Life — was launched in December 2007. Ireland was among the first countries to donate to the fund, contributing €2 million. Those responsible for the fund will work with governments to increase capacities in three specific areas which have been proven to reduce maternal mortality, namely, family planning, skilled attendance at birth and emergency obstetric care.

The need for family planning is one of the most important factors contributing to the current unacceptable rates of maternal mortality. UNFPA estimates that 200 million women who want to space their children cannot currently do so. This lack of empowerment has a serious adverse impact on their health and increases their risk of dying in childbirth. In countries where the age of marriage is lower, family planning can avert many of the dangers associated with high-risk adolescent pregnancies.

Having skilled attendance at birth has been proven to be the most effective intervention in reducing maternal mortality. In some countries the percentage of women with access to skilled midwives is as low as 5%. Predictably, these are the countries with the highest mortality rates.

The most common cause of death in childbirth is post-partum haemorrhage. A woman can bleed to death in under two hours. For this reason, UNFPA will work with governments to introduce a network of emergency obstetric centres. These will deal with emergencies that are beyond the training of attendants with basic skills.

The fund has divided its work into two periods. For the period 2008-11, it will operate in 25 of the worst affected countries, developing the most effective strategies and adapting them as needs be. In the second period, 2012-15, the fund will extend its work to a further 50 countries in an effort to make the much needed progress before the millennium development goal deadline of 2015. In light of the excellent reports that I hear back from Irish Aid offices in the field and UNFPA's record in delivering good results for women in developing countries, I am confident that this trust fund will make a very positive impact on maternal health.

Irish Aid is pleased to have also contributed to two other UNFPA trust funds intended to improve the quality of life of mothers. We have contributed €500,000 to the trust fund to support UNFPA's work in obstetric fistula. This fund was launched in 2001 and has drawn extensive attention to this distressing condition affecting women in developing countries. Obstetric fistula is typically the result of prolonged labour and in most cases the baby does not survive. The humiliation of the condition often leads women to be stigmatised within their communities and abandoned by their husbands. The prevalence of this condition is highest in sub-Saharan Africa. However, the condition is easily preventable, by ensuring skilled attendance at birth. Treatment for those who have suffered from fistula costs only €200.

Ireland is also supporting work on female genital mutilation through a trust fund established by UNFPA and UNICEF. These two organisations are working jointly in 17 countries to encourage the abandonment of this practice, which currently affects between 100 million and 140 million women and girls and 3 million girls are at risk annually. This programme is designed to work with cultural and religious leaders to encourage what Senator de Búrca referred to as a societal change and the abandonment of the practice. Those responsible for its operation have selected 17 countries and are working systematically at government and local level to change attitudes. I announced Ireland's contribution of €500,000 to the trust fund this month.

We are now more than halfway towards the deadline for the achievement of the millennium development goals. It is unacceptable that maternal health continues to lag behind the rest. This issue remains a priority for Irish Aid. We are proud of the contribution we have made to date but we are acutely conscious much more remains to be done.

I share the concerns of Senators Fitzgerald and O'Malley in respect of adolescent motherhood. UNFPA is doing important work in this area, which we will support. The Senators will be aware that empowerment and access to family planning are key factors in improving the circumstances of adolescent women. This aspect lies at the core of UNFPA's work and is a priority for Irish Aid in its support for the latter.

I agree with Senator Twomey's comments regarding audits, oversight and scrutiny in respect of our overseas development programme. We discussed this issue at this morning's meeting of the Joint Committee on Foreign Affairs. The Senator also referred to value for money. We carry out value for money audits, particularly in respect of HIV-AIDS.

Senators Cummins and Mullen asked if UNFPA is involved in promoting abortion. The policy laid down by the governing council of UNFPA in 1985 states that it is the policy to the fund "not to provide assistance for abortions, abortion services or abortion-related equipment and supplies as a method of family planning". Through our membership of the UNFPA's executive board and as a result of our missions in developing countries, we are confident that UNFPA abides by the policy laid down by its governing council. Furthermore, we received a categorical assurance from UNFPA that it does not support any acts relating to abortion.

We will continue to work at country level and with our partners in the global development system to improve conditions for women and to ensure they receive a suitable level of health care. Success is vital, not just for the sake of the women concerned but also for their children and for the societies in which they live.