Hi. My name is Teresa Chiesa, and I am a health specialist and program manager at CARE Canada. It is my hope today that I can clarify questions pertaining to maternal, newborn, and child health and provide information on the economic and social costs that justify our investing in this initiative.
First, I want to tell you a little bit about my experiences. In my current role with CARE Canada, I manage and provide technical backstopping to a Canadian-funded child survival project based in rural Zambia. This project provides hands-on experience in an initiative that works to build the skills of front line health workers to save the lives of children under five years of age. More than 200,000 children and their families benefit from these CIDA funds.
Prior to CARE, I lived in sub-Saharan Africa for seven years, in the countries that consistently appear at the bottom of the UNICEF maternal and child mortality tables. I worked in delivering primary health care services, inclusive of maternal and child health programs, to women and their families in rural communities. My years of living and working in these communities have confirmed for me who will benefit from this Canadian initiative: those without a voice and those who need it the most.
During my years in Africa, I have had the good fortune to celebrate and participate in the births of newborn children with mothers who survived their pregnancies and to witness children laughing and playing as we imagine they should. But I've also had the first-hand experience of the profound grief that comes with the unexpected death of a mother, a newborn, or a young child. A death for these families and communities is overwhelming, and while we can understand it in our context, you can imagine, when the main breadwinner, maybe, has passed away, who is left behind. You wonder whether the children who are left behind will survive, or how the father who is now alone will raise these children, and the community continues to want to know why this keeps happening.
In some cultures, naming of a newborn child is delayed until many weeks after birth; these communities know that many newborn children will not survive their first month of life. But these deaths aren't happening because the health community doesn't know how to prevent them. They are dying because the world is failing to help.
I just want to clarify what we mean when we talk about an effective continuum of care and about maternal, newborn, and child health, reproductive health, and family planning. These words are being tossed around, and I want to make sure that we all understand what we're talking about. I'll be happy to answer questions afterwards as well.
An effective continuum of care delivers essential services for mother and children at critical points from adolescence up to pregnancy, during birth, post-natal, and neo-natal periods, and up to the child's fifth birthday. That's what we mean when we talk about a continuum of care. The essential services are delivered by skilled, equipped, and motivated front line health workers, which this government is pledged to, at key locations close to the household and in the community. These services are provided through outreach interventions or in health facilities where they can be readily accessed by women and children. Community partnerships in health are essential components of the continuum of care. Health care must be responsive to the needs of the communities and delivered in a culturally appropriate manner, if women are to use it.
CARE has found that barriers to seeking health care include inadequately trained and equipped health care workers, lack of privacy and respect for clients, and bureaucratic delays. Evidence shows that one in four women experience birth without a skilled assistant, and up to 80% of deaths in children under five years of age occur at home, with little or no contact with health care providers. That's 80%.
Bringing skilled equipment and culturally sensitive health care closer to home and focusing it on the leading causes of maternal, newborn, and child health is critical if we want to save these lives.
Maternal, newborn and child health is a basket of programs and services. Within this basket we find maternal health, sexual and reproductive health, and child health. Typically in the past child health had been separate and in its own specific vertical intervention, but the international community has realized the economical and practical efficiencies and benefits associated with linking these services.
As Elly mentioned before, and as Canada has agreed, the basket includes services such as: access to voluntary family planning information services and commodity, thereby empowering women to voluntarily plan their families and giving them the freedom to decide what method is most appropriate for them; antenatal care, so intermittent prevention of malaria; folic acid and iron; any other tetanus vaccinations; skilled attendance at birth, including emergency obstetrical care—we know that the majority of women are dying during the pregnancy and the childbirthing period—for postpartum hemorrhage, obstructed labour, those issues; immediate postpartum care for the mother and newborn, because most children will die within the first day, or subsequently the first month of life, and then the first year. These are the key points.
Exclusive breastfeeding is part of this package, and also prevention of mother-to-child transmission of HIV; education and counselling on reproductive health and parenting; and a package of life-saving interventions for children, including immunization, breastfeeding and appropriate complementary feeding to improve their nutritional status, vitamin and micro-nutrient supplementation—we know that most of these children, because they are malnourished, do not have adequate micro-nutrient and vitamin levels—and care and treatment for sepsis, pneumonia, malaria, and diarrhea. These are the majority of killers in children under five.
As we heard from Elly, an estimated 300,000 or 500,000 mothers die worldwide during pregnancy and childbirth, 41% of newborns will die within their first four weeks of life, and 8.8 million children will die before reaching the age of five. But I'd like to introduce you to a new statistic that you may or may not have heard. I think the most striking statistic I ever heard was that in many countries where CARE works, a girl is more likely to die during pregnancy than to attend school.
The United States Agency for International Development estimates that maternal and newborn mortality accounts for $15 billion in lost potential production globally each year. Maternal mortality adversely affects the welfare of surviving children. The loss of a mother's income due to maternal death or illness can be particularly devastating for female-headed households. Women are estimated to be the sole income earners for 25% to 33% of households in the world. Such families are likely already to be struggling with poverty, and when a mother dies her family breaks apart. Her children are less likely to go to school, get immunized against diseases, and eat well, and are up to ten times more likely to die in childhood.
According to the UN Millennium Project, women account for the brunt of non-paid work throughout the world. This unpaid work has an economic value, because it saves expenditures and replaces income in times of economic crisis. If given an economic value, the total contribution of women's unpaid work in the household would add the equivalent of one-third to the world's gross national product.
Rural women are responsible for the production of half of the world's food. In developing countries, and Africa especially, they produce 60% to 80% of the food and 70% to 80% of the health care. Thus what we've been saying is that poor maternal health can significantly diminish women's ability to provide essential economic contributions to the household, including food production, water collection, and caring for children, the sick, and the elderly.
In 2001 the director general of the WHO appointed a commission on macroeconomics and health to respond to the need to place health at the centre of the development agenda. In the report, the experts argue that the linkages of health to poverty reduction and economic growth are much more powerful than is generally understood.
The evidence supports the argument that health is critical to economic development in poor countries. Disease blocks economic growth, and a previously held argument that health will automatically improve as a result of economic growth is unfounded. Disease will not go away without specific investments in health interventions.
Just to summarize, maternal and child mortalities are nothing short of an epidemic. Worldwide, hundreds of thousands of women die from complications during pregnancy or childbirth, and millions of children die before their fifth birthday every year. These mothers and children aren't dying because the health community doesn't know how to prevent their deaths, they're dying because the world is failing to help. The low-cost interventions necessary to change maternal and newborn health mortality are skilled, equipped, and supported front-line health workers focused on the leading causes of death for mothers and newborns, for children under five, access to voluntary family planning, education, information, and services.
The health of women and children needs to be at the centre of the development agenda. Evidence shows that linkages of health to poverty reduction and economic growth are more powerful than previously understood. Health is critical to economic development in poor countries.
As we have found at CARE, the mother is the pillar of the family unit, and the family unit is the pillar of a society. When we save the life of a mother, we are actually saving a society.
Congratulations to Canada for taking on this initiative.