The fifth of the eight MDGs pledges set by the UN’s 193 members is to achieve universal reproductive health and reduce their maternal mortality rates by three quarters of the 1990 levels.
But although rates have been halved since 2000, one maternal death was still reported every ten minutes in India in 2012, double the target rate. Many parts of sub-Saharan Africa report similar or even more horrifying figures.
“It is a failure of the fight against poverty,” Eva Joly, the French Green MEP and chair of the European parliament’s development committee told EurActiv. “For sure it is not acceptable but it is also linked to other questions.”
“It is not sufficient to write [MDGs] on paper,” she added. “You need countries to take ownership of them.”
The MDG targets were based on a continuation of trends recorded between 1965 and 1990 up until 2015, so the shortfall for maternal mortality improvements indicates not just a failure of UN policy in this area, but a slowing of progress.
Even the United Nations Development Fund admits that “inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health”.
For Hafsat Abiola, a Nigerian state minister with responsibility for MDGs, funding is closely linked to other key issues such as power and gender relations.
“When I took over the MDG office in Ogun state, and saw that the amount of resources we had to achieve those MDG goals –1.69 billion Nigerian Naira (€800,000) a year – I couldn’t believe it,” she said. “I thought ‘this is incredible, we can do so much, but when you think that the state has about 5 million people, 60% of whom are living in poverty, our resources are just drops in the bucket.”
Abiola is the daughter of the late elected Nigerian president, Moshood Abiola, who died in custody after a military coup in 1993.
Nigerian maternal mortality rate
Nigeria’s maternal mortality rate is still around 350 women per 100,000 - compared to below 20 per 100,000 in many European countries. But Abiola says the death rate has fallen by around 70% since 2000.
“If you save a woman’s life, you have secured her children but if that woman dies, however much aid you give her children in school, their lives will not be the same,” she told EurActiv.
On a visit to China, she herself went into labour three months before her term was due, and so had to give birth in difficult circumstances. “If I had not had good health care there I might not have survived and maybe because of that I’m very sensitive to fact that we have to help mothers and save their lives,” she said.
Ogun state was the first in Nigeria to implement a conditional cash transfer aimed at helping 5,000 of the poorest pregnant women there (1,000 have so far benefitted) by paying for their nutrition, transport, communication and medical needs.
“These women can’t be using traditional birth attendants because if there are any complications at all, the attendant’s skills will not be sufficient, and by the time they have found this out, the woman will have bled to death,” Abiola said. “When the woman goes to the clinic, we have a better chance of securing her life.”
Traditional patriarchal roles have also proved a problem. One aspect of the MDG programme in Ogun is to provide cellphones to pregnant women in remote districts of the state “but our programme monitors sometimes called the women on these cellphones and a man would pick up the phone!” Abiola exclaimed. “Their phones had already been taken from them by their partners. Something has to be done around this issue of power and rights.”
Inequalities in gender rights stretch well beyond the maternal mortality issue. A UN progress report earlier this year found that women were more likely to be engaged in vulnerable employment than men by ratios of 85% to 69% in sub-Saharan Africa, and 44% to 26% in northern Africa.
Gender disparities in education were supposed to be eradicated by 2005 – or 2015 at the latest – but in northern Africa, girls account for 79% of out-of-school children, in south Asia, 55% and in West Asia, 65%.
Abiola, who was honoured as a Global Leader of Tomorrow at the 2003 World Economic Forum, said that she had been working to get a domestic violence bill passed in Ogun, criminalising violence against women.
“We don’t have a problem getting girls into schools,” she said. “But in society as a whole it is more commonly accepted that women should be seen and not heard, that the man is the head of the household, and women should give way and let them take decisions.”
Nigerians - and all African men should remember the legacy of slavery, when three-fifths of enumerated slaves were counted for representation purposes, Abiola argued.
“No black person on earth - especially not in Nigeria - would think that makes sense today," she said. "But at the same time, many would say that women are essentially three-fifths of a man, and they again use religious texts to justify denying equal rights."
"These things have to change,” she said.