Maternal care during the pregnancy, birth and post-partum period is essential to reduce the high maternal mortality rate in Latin America. Credit: Courtesy of the Tigre municipal government

By Marianela Jarroud
SANTIAGO, Sep 23 2015 (IPS)

In the last 15 years, Latin America and the Caribbean have met several key targets included in the Millennium Development Goals (MDGs), such as reducing extreme poverty, hunger and child mortality, incorporating more girls in the educational system, and expanding access to clean water.

However, as the world is setting out on a new challenge, meeting the Sustainable Development Goals (SDGs) – the roadmap from here to 2030 – the region must make a bigger effort to fight, for example, maternal mortality and teen pregnancy, two of its biggest failures with regard to the MDGs, partly due to a patriarchal, sexist culture.

“We don’t have to wait for an analysis of the MDGs to understand that the region is lagging in these areas,” Chilean Dr. Ramiro Molina, founder of the Centre for Reproductive Medicine and Adolescent Development, told IPS.

“The spending needed on sexual and reproductive health is low,” he added. “It hasn’t been clearly understood that it is absolutely indispensable to invest more in this area.”

The eight MDGs, approved in September 2000 by 189 heads of state and government at a United Nations summit, were aimed at addressing development deficits in the first 15 years of the new millennium.

And on Sunday Sept. 27, at another summit in New York, leaders from around the world will approve the post-2015 sustainable development framework, which includes 17 SDGs that make up what is now called the 2030 Agenda for Sustainable Development.

With these new goals, the international community will continue to fight inequality and work towards sustainable and inclusive development.

“Latin America and the Caribbean: looking ahead after the Millennium Development Goals”, a regional monitoring report published this month by the Economic Commission for Latin America and the Caribbean (ECLAC), says the region has met the goal for reducing extreme poverty and hunger.

Between 1990 and 2015, this region more than cut in half the proportion of people living on less than 1.25 dollars a day: from 12.6 percent in 1990 to 4.6 percent in 2011.

The proportion of hungry people, meanwhile, was slashed from 14.7 percent in the 1990-1992 period to 5.5 percent in 2014-2016.

In addition, employment statistics are better today than at any other point in the last 20 years; access to and completion of primary education have increased; and the illiteracy rate among 15 to 24-year-olds fell from 6.9 percent in 1990 to 1.7 percent in 2015.

The region has also made significant progress in girls’ access to primary, secondary and tertiary education, and has narrowed the gender gap in politics.

But these advances stand in contrast to the lack of progress in other areas, especially with regard to MDG 5: reducing maternal mortality and achieving universal access to reproductive health.

The ECLAC report stresses that in 2013 the overall maternal mortality rate in Latin America and the Caribbean was 85 deaths per 100,000 live births, representing a 39 percent reduction with respect to 1990 – far from the 75 percent drop called for by the MDGs.

Adolescent pregnancy also remains a pressing problem in the region, with a live birth rate of 75.5 per 1,000 girls and women between the ages of 15 and 19.

Miriam Toaquiza and her daughter Jennifer in a hospital in Latacunga, Ecuador. She is the only girl in a special room for teenage mothers, thanks to public policies fighting the phenomenon. Credit: Gonzalo Ortiz/IPS

“Adolescence, their development and fertility are based on ignorance in our countries,” said Molina.

Tamara, now 23, is an illustration of this. When she was 13, her 27-year-old boyfriend got her pregnant.

The unexpected pregnancy forced her to drop out of school, although she was later able to complete her primary education. She never went to high school. Three years later she had her second son, with the same father.

“I missed out on several things: of course, support from my mother and my father, but above all, sex education,” the young woman, who preferred not to give her last name, told IPS.

Tamara had a difficult life. Her mother did not finish primary school and her father was a drug addict and alcoholic. She was a witness to domestic violence throughout her childhood.

From a young age, she was raped by the oldest of her six brothers, who went to prison for 10 years for what he did, when she finally decided to go to the police, without her mother’s consent.

Today, about to have her third child – with a different man this time, but someone just as absent as the father of her first two – she said she is fighting to make sure her children get an education.

“I make an effort every day for my kids to study, I try hard to educate them, because I don’t want them to suffer like I did. I want to break the circle,” she said.

In Molina’s view, to address the gaps in sexual and reproductive health, political intentions should translate into spending on primary sexual and reproductive health care services for adolescents, training on these issues for health professionals, and effective sex education programmes.

“Mexico’s good sex education programmes are only partially functioning; the excellent programmes that Costa Rica had have been discontinued; and Colombia has made enormous efforts to come up with really good sex education teaching materials, but they have practically been doomed to fail by political and strategic questions,” Molina said.

“Something similar is happening in Peru, where there have also been good programmes but they don’t have strategic or political support from the government,” he added. “Argentina gets good results, but with strong support from the government in developing sex education programmes. The same is true in Uruguay.”

According to the doctor, the case of Chile “is the worst of all,” because “we are plagued with opprobrium and shame.”

“We were the last country in the region to have a law protecting young people with sex education, which was passed in 2010 but did not enter into force until July 2014. The situation here is embarrassing,” he said.

He added that in order to meet the Agenda 2030 target for preventing teen pregnancies, merely making birth control available is not enough, “because I could drop condoms and pills from a helicopter but it wouldn’t be an effective measure.”

The issue, he said, is that people have to actually use the contraceptives, and need to know when and how to do so – which requires education.

“The goal is preventing the first pregnancy, and to do that what is needed is education, education, and when everything else has failed, education and more education. And as part of that education – broad, in-depth sex education, without ideological bias,” he added.

Molina also stressed that both maternal mortality and adolescent pregnancy “are no longer technical, but political, problems” which require that states be responsible and implement effective public policies, without worrying about facing up to conservative power groups “who are ignorant traditionalists, and cause us terrible damage.”

As the region gets ready to sign on to the SDGs, the new challenges call for a more holistic, participative, interdisciplinary and universal approach.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

A doctor examines a woman in an IDP camp in Bannu, a city in Pakistan’s northern Khyber Pakhtunkhwa (KP) province, where over 40,000 pregnant women are at risk due to a lack of maternal health services. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Oct 8 2014 (IPS)

Imagine traveling for almost an entire day in the blistering sun, carrying all your possessions with you. Imagine fleeing in the middle of the night as airstrikes reduce your village to rubble. Imagine arriving in a makeshift refugee camp where there is no running water, no bathrooms and hardly any food. Now imagine making that journey as a pregnant woman.

In northern Pakistan, a military campaign aimed at ridding the Federally Administered Tribal Areas (FATA) of Taliban militants has led to a humanitarian crisis for hundreds of thousands of civilians.

When the army began conducting air raids on the 11,585-square-km North Waziristan Agency on Jun. 15, residents were forced to flee – most of them on foot – to the neighbouring Khyber Pakhtunkhwa (KP) province, where they have now taken refuge in sprawling IDP camps.

“In Pakistan, 350 women die per 100,000 live births from pregnancy-related complications. In FATA, the situation is extremely bad, with 500 women dying for every 100,000 live births. The situation warrants urgent attention.” -- Fayyaz Ali, a public health expert in Pakistan's Khyber Pakhtunkhwa province
Officials estimate the number of displaced at just over 580,000, of which half are women.

In the ancient city of Bannu, which now houses the largest number of refugees, some 40,000 pregnant women are facing up to their ultimate fear: a lack of hospitals, doctors and basic medical supplies.

For 30-year-old Tajdara Bibi, a mother of three, these fears became a reality in June, when she had to flee her home in North Waziristan and trudge the 55 km to KP along with her fellow villagers.

The journey wore her down, and by the time she was admitted to the maternity hospital in Bannu, the doctors were too late: she delivered a stillborn baby a few hours later.

Muhammad Sarwar, who attended to Bibi, told IPS that an extreme shortage of female doctors has put pregnant women on a knife’s edge.

“At least four women died of pregnancy-related complications on the way to Bannu, while 20 others had miscarriages at the hospital,” he said.

“We have only four female doctors in the whole district, who are required to provide treatment to all the women,” he added.

With thousands of women now clamouring for care, the province’s limited healthcare services are falling short, sometimes with disastrous consequences.

Gul Rehman, a 44-year-old shopkeeper, is still reeling from a recent tragedy. He told IPS his wife went into labour prematurely during the arduous journey to Bannu.

“We could not find transport so we had to walk. When we finally reached the hospital, we were kept waiting… there were no doctors readily available.

“After 10 hours, they finally operated on my wife – but the baby was already dead,” he explained. Aside from the trauma of losing their child, the couple is also struggling to cope with the wife’s health condition, which has deteriorated rapidly after the stillbirth.

According to Fawad Khan, Health Cluster and Emergency Coordinator for the World Health Organisation (WHO) in Pakistan, existing health facilities are not equipped to deal with the wave of arrivals from North Waziristan.

The WHO is currently assisting the KP health department to “prevent unnecessary deaths”, the official told IPS, adding that 73 percent of displaced women and children in Bannu are in “desperate need of care.”

Some 30 percent of pregnant women among IDPs are at risk of delivery-related complications, a situation that could easily be addressed by upgrading existing facilities. There is also an urgent need for gynaecologists to provide antenatal and postnatal care, he stated.

Twelve health centres have already been established to tackle malnutrition among women and children in the camps. Without proper nourishment, officials fear pregnant women will face additional complications during birth, and low birth-weight among newborns could create additional challenges for health workers.

“Four percent of the total displaced women are pregnant and need immediate attention,” Abdul Waheed, KP’s director-general of health, told IPS, adding that some 20 basic health units have already been strengthened to take on those most in need.

Still, the crisis has reached proportions that even seasoned officials are scarcely able to comprehend. Waheed explained that Bannu has never before had to host such a large population of homeless people, and is struggling to cope.

Prior to the recent wave of refugees from North Waziristan, the KP province had already welcomed over 1.5 million people from FATA. This latest influx brings the number of displaced since 2001 to over 2.5 million.

“We are sending doctors from teaching hospitals in Peshawar [capital of KP] on a rotational basis to meet the situation,” he asserted.

The United Nations Children’s Fund (UNICEF) and the U.N. Population Fund (UNFPA) have joined the WHO in supporting the Pakistan government’s push for improved health services. Some 65 doctors from the Pakistan Institute of Medical Sciences (PIMS) in Islamabad have joined NGO workers in Bannu to provide urgent care.

Part of the problem, according to Ali Ahmed, KP’s focal person for IDPs, is that few medical professionals are keen to take up posts in the militancy-infested region. For years the Taliban have operated with impunity in these federal areas, hiding out along the mountainous border with Afghanistan that stretches for some 2,400 km.

The military’s counter-insurgency programme was launched in a bid to finally wipe out extremist elements that fled Afghanistan during the U.S. invasion in 2001 and took root along the porous border.

But until the region regains a sense of normalcy, it will be hard to lure professionals here, officials say. Despite being offered lucrative packages, doctors have refused to take up posts, even temporarily, in Bannu.

The government is looking to fill this gap by appointing 10 doctors, including five female doctors, to the newly renovated Women and Children Hospital, which remains understaffed and ill equipped.

The city’s other two category ‘B’ hospitals, the Khalifa Gul Nawaz Teaching Hospital (KGTH) and the District Headquarters Teaching Hospital, suffer similar setbacks, while the arrival of the IDPs has more than tripled the number of patients demanding services, Ahmed said.

Three rural health centres in close proximity to the refugee camps, as well as 34 basic health units, have received an injection of funds and resources, and 20 assistant nutritional officers have been deployed to cater to the needs of 41 percent of affected children, he told IPS.

But far greater efforts will be needed to tackle the crisis, which is compounding an already bleak picture of maternal health in Pakistan.

Fayyaz Ali, a public health expert here in KP, told IPS, “In Pakistan, 350 women die per 100,000 live births from pregnancy-related complications. In FATA, the situation is extremely bad, with 500 dying for every 100,000 live births. The situation warrants urgent attention.”

Edited by Kanya D’Almeida

Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services. Credit: Stella Paul/IPS

By Stella Paul
BASTAR, India, Sep 26 2014 (IPS)

Twenty-five-year-old Khemwanti Pradhan is a ‘Mitanin’ – a trained and accredited community health worker – based in the Nagarbeda village of the Bastar region in the central Indian state of Chhattisgarh.

Since 2007, Pradhan has been informing local women about government health schemes and urging them to deliver their babies at a hospital instead of in their own homes.

Ironically, when Pradhan gave birth to her first child in 2012, she herself was unable to visit a hospital because government security forces chose that very day to conduct a raid on her village, which is believed to be a hub of armed communist insurgents.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel." -- Daniel Mate, a youth activist from the town of Tengnoupal, on the India-Myanmar border
In the panic and chaos that ensued, the village all but shut down, leaving Pradhan to manage on her own.

“Security men were carrying out a door-to-door search for Maoist rebels. They arrested many young men from our village. My husband and my brother-in-law were scared and both fled to the nearby forest.

“When my labour pains began, there was nobody around. I boiled some water and delivered my own baby,” she said.

Thanks to her training as a Mitanin, which simply means ‘friend’ in the local language, Pradhan had a smooth and safe delivery.

But not everyone is so lucky. Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services.

This past June, for instance, 22-year-old Anita Reang, a Bru tribal refugee woman in the conflict-ridden Mamit district of the northeastern state of Mizoram, began haemorrhaging while giving birth at home.

The young girl eventually bled to death, Anita’s mother Malati told IPS, adding that they couldn’t leave the house because they were surrounded by Mizo neighbours, who were hostile to the Bru family.

According to Doctors Without Borders (MSF), a global charity that provides healthcare in conflict situations and disaster zones across the world, gender-based violence, sexually transmitted infections including HIV, and maternal and neonatal mortality and morbidity all increase during times of conflict.

This could have huge repercussions in India, home to over 31 million women in the reproductive age group according to the United Nations Population Fund (UNFPA).

The country is a long way from achieving the Millennium Development Goal (MDG) target of 103 deaths per 100,000 live births by 2015, and is still nursing a maternal mortality rate of 230 deaths per 100,000 births.

There is a dearth of comprehensive nationwide data on the impact of conflict on maternal health but experts are agreed that it exacerbates the issue of access to clinics and facilities.

MSF’s country medical coordinator, Simon Jones, told IPS that in India the “most common causes of neonatal death are […] prematurity and low birth weight, neonatal infections and birth asphyxia and trauma.”

The government runs nationwide maternal and child health schemes such as Janani Suraksha Yojana and Janani Shishu Suraksha Karykram that provide free medicine, free healthcare, nutritional supplements and also monetary incentives to women who give birth at government facilities.

But according to Waliullah Ahmed Laskar, an advocate in the Guwahati High Court in the northeastern state of Assam, who also leads a rights protection group called the Barak Human Rights Protection Committee, women wishing to access government programmes must travel to an official health centre – an arduous task for those who reside in conflict-prone regions.

In central and eastern India alone, this amounts to some 22 million women.

There is also a trust deficit between women in a conflict area and the health workers, Laskar told IPS. “Women are [often] scared of health workers, who they think hold a bias against them and might ill-treat them.”

For Jomila Bibi, a 31-year-old Muslim refugee woman from Assam’s Kokrajhar district, such fears were not unfounded; the young woman’s newborn daughter died last October after doctors belonging to a rival ethnic group allegedly declined to attend to her.

Bibi was on the run following ethnic clashes between Bengali Muslims and members of the Bodo tribal community in Assam that have left nearly half a million people displaced across the region.

Daniel Mate, a youth activist in the town of Tengnoupal, which lies on India’s conflicted border with Myanmar, recounted several cases of women refusing to seek professional help, despite having severe post-delivery complications, due to compromised security around them.

“When there is more than one armed group [as in the case of the armed insurgency in Tengnoupal and surrounding areas in northeast India’s Manipur state], it is difficult to know who is a friend and who is an enemy,” he told IPS.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel,” added Mate, who campaigns for crowd-funded medical supplies for the remotest villages in the region, which are plagued by the presence of over a dozen militant groups.

The solution, according to MSF’s Jones, is an overall improvement in comprehensive maternal care including services like Caesarean sections and blood transfusions.

Equally important is the sensitisation of health workers and security personnel, who could persuade more women to seek healthcare, even in troubled times.

Other experts suggest regular mobile healthcare services and on-the-spot midwifery training to women in remote and sensitive regions.

According to Kaushalendra Kukku, a doctor in the Kanker government hospital in Bastar, “When violence erupts, all systems collapse. The best way to minimise the risk of maternal death in such a situation is to take the services to a woman, instead of expecting her to come to [the services].”

Pradhan, who has now resumed her duties as a community health worker, agrees. “I was able to deliver safely because I was trained. If other women receive the same training, they can also help themselves.”

Edited by Kanya D’Almeida

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Only 65 percent of Senegalese women give birth in the presence of a skilled attendant. Credit: Travis Lupick/IPS

By Doreen Akiyo Yomoah
DAKAR, Sep 24 2014 (IPS)

Diouma Tine is a 50-year-old vegetable seller and a mother of six boys. In her native Senegal, she tells IPS, motherhood isn’t a choice. “If you’re married, then you must have children. If you don’t, then you don’t get to stay in your husband’s house, and no one will respect you.”

Despite this prevailing cultural outlook, becoming a mother here is neither easy, nor safe, with only 65 percent of Senegalese women giving birth in the presence of a skilled attendant.

According to available data, 54 percent of Senegal’s 13.7 million people live in rural areas. Of these, some 3.3 million are women of reproductive age, an estimated 85 percent of who live about 45 minutes from a health facility.

The country has a worryingly high maternal mortality rate (MMR). The last government survey taken in 2005 found that 41 women died per 1,000 live births, giving the country a ranking of 144 out of 181.

“In some regions, like the Kolda and Tamba Regions, you can find up to 1,000 deaths per 100,000 live births [since] some women are denied the ability to make decisions about when to go to hospital, [and] sometimes when roads are bad it’s difficult for them to get to a health centre.” -- Gacko Ndèye Ndiaye, coordinator of the gender cell at the Ministère de la Santé et Action Sociale (Ministry of Health and Social Action)
Between 2005 and 2010, the MMR in Senegal fell from 401 to 392 deaths per 100,000 live births, representing some progress but hinting at the scale of unmet need around the country.

One of the Millennium Development Goals (MDGs) is to achieve universal access to reproductive healthcare by 2015, but it is increasingly clear to health workers and policy makers that Senegal will not reach this target.

This year’s State of the World’s Midwifery Report produced by the United Nations Population Fund (UNFPA) projected that Senegal’s population was set to increase by 59 percent to 21.9 million by 2030.

“To achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services must respond to one million pregnancies per annum by 2030, 53 percent of these in rural settings,” the report stated, adding that the health system must be configured to cover some 66 million antenatal visits, 11.7 million births, and 46.7 million post-partum and postnatal visit from 2012 to 2030.

This past May, on the International Day of the Midwife, former Prime Minister Aminata Touré called attention to a gap of 1,336 midwives in the country, setting in motion a government-sponsored recruitment drive to rapidly increase the number of trained birth attendants.

The midwife shortage is felt most severely in rural areas: the Matam region in eastern Senegal, for instance, has only 14 midwives for a population of nearly 590,000, while Tambacounda, to the south of Matam, has only 38 for a population of about 670,000.

Senegal has both ‘sage-femmes’ (fully trained midwives), and ‘matrones’, direct-entry midwives who deliver the vast majority of babies in Senegal but lack proper education, and often learn their trade on site, sometimes spending less than six months in a clinical training setting before being taking up posts in rural areas.

“There is kind of a crisis in education,” Kaya Skye, executive director of the African Birth Collective, tells IPS.

“Matrones learn how to take blood pressure, but they don’t understand what that means. [With matrones] there is an urgency to get the baby out as soon as possible [and] an overuse of drugs, which is […] another cause of mortality,” she explained.

In fact, Touré stated during a speech on May 12 that 60 percent of maternal deaths in the country could have been avoided with “sufficient personnel, a suitable medical platform, [and] democratic access to women’s health services, notably the disadvantaged in remote areas.”

Gacko Ndèye Ndiaye, coordinator of the gender cell at the Ministère de la Santé et Action Sociale (Ministry of Health and Social Action), and a midwife by trade, tells IPS that numbers alone don’t tell the whole story.

“There are disparities between different areas,” she asserted. “In some regions, like the Kolda and Tamba Regions, you can find up to 1,000 deaths per 100,000 live births [since] some women are denied the ability to make decisions about when to go to hospital, [and] sometimes when roads are bad it’s difficult for them to get to a health centre.”

The National Agency of Statistics and Demography’s 2011 health indicators report found that over 90 percent of urban births are assisted by a trained assistant, but that number falls to just half for rural births.

Skye’s African Birth Collective works to fill these gaps, and recently built the Kassoumai Birth Centre in the Kabar village of the southern Casamance region to meet the needs of mothers and midwives.

According to Skye, “Traditional midwives said they wanted their own place to practice; that they didn’t feel welcome in government clinics. There was nothing in Kabar for women – they were giving birth in the showers behind their houses.”

Although the government does provide training for midwives, building this centre was “about creating infrastructure that is outside of government protocols and facilitating that dialogue where the traditional midwives can say ‘We do it this way’,” Skye says.

A long colonial history and post-colonial education in Senegal has meant that the Western obstetric model has been dominant.

Grassroots efforts, including the work of ENDA Santé, the health division of an international NGO called Environmental Development Action in the Third World, are helping to foster a better balance between Westernised birthing techniques and traditional methods.

The African Birth Collective and ENDA Santé have translated the educational manual ‘A Book for Midwives’ into French, giving birth attendants in Francophone West Africa access to crucial information, such as the case for non-supine positions, and inverted resuscitation methods.

For women like Tine, the pride that comes from being a mother will always outweigh the dangers and complications of pregnancy and childbirth.

But if the government of Senegal scales up its efforts to improve health services, it can remove the fear factor altogether, and make a strong contribution towards global efforts to ensure the health and safety of every mother.

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

Seven months pregnant, 24-year-old Shumi Begum has travelled 220 km from her village with her paternal grandmother to consult a specialist on childbirth.

“We seek treatment here because of the good reputation of the service providers. We have had childbirth in our family in the hands of the same service providers here and for safety reasons I think this centre is still the best choice,” Shumi’s grandmother Hosne-Ara told IPS.

She was waiting at a community maternity centre here in Jafargonj in Comilla district, about 55 km from capital Dhaka.

At the crowded two-storey maternity centre popularly known as Mayer Hashi (smiling mother), a project supervised by EngenderHealth and funded by USAID, Shumi anxiously looks at one of the birth attendants to check if she is next in queue to consult the childbirth specialist known as the family welfare visitor.

In the last decade, the Bangladesh government has invested in a maternal health programme with support from a number of foreign development partners. The health, nutrition, and population programme of Bangladesh has adopted a national strategy for maternal health focusing on emergency obstetric care for reducing maternal mortality, concentrating especially on early detection and appropriate referral of complications, and improvement of quality of care.

A maternal mortality and healthcare survey conducted in 2010 with the help of several development partners found that maternal mortality in Bangladesh fell from 322 deaths per 100,000 live births in 2001 to 194 in 2010 – a 40 percent decline in nine years.

Despite improved safe motherhood services in their hometown, Shumi’s grandmother did not want to take any risk during the expectant mother’s first childbirth.

Regardless of the improved state-owned health facilities, Jafargonj health centre is considered better than other centres. The family welfare visitors at Jafargonj are popular for their efforts to provide risk-free care during childbirth.

The centre is also women-friendly, since most of the attendants pay special attention to the personal needs of the clients. And the long journey to Jafargonj is now less hazardous due to improved road access.

In a career spanning 13 years, Kawser Hasina Pervin, a family welfare visitor at Jafargonj, has twice received awards from the prime minister for her outstanding professional care.

She told IPS that they treat about 20 to 25 patients daily and have seen a rise in the number of expectant mothers visiting the centre in the past five years.

“The obvious reasons are improved care and individual counseling.”

A private clinic would cost her family at least 400 dollars. At a state health centre she would have to spend only on medicines, which would be just 15 to 20 dollars. The problem is that at the government centres, the medicines are often not available.

“Customarily childbirth at home is still preferred by mother-in-laws and grandmothers, but with awareness and increased education of girls this trend is now changing,” Anjali Bala Das, one of the health providers at the centre who makes regular visits to the community, told IPS.

“[After] years of advocacy on safe motherhood, the ice is gradually starting to melt,” said Das, who has worked two decades as a family planning health promoter. “Elderly people have started to recognise the benefits of modern healthcare instead of sticking to the traditional myths.”

Sabrina Begum, 22 had similar views. “My mother-in-law is a very rigid person and she is highly religious. She refuses to have male doctors attending during childbirth, so she always preferred delivery at home.”

Begum’s mother-in-law has now come to the Jafargonj centre to consult health providers for a safer childbirth for her daughter-in-law. This is after she attended several advocacy programmes in her Ganganagar village in Comilla.

In Bangladesh, expectant mothers rarely decide where to give birth. Often malnourishment and early pregnancy lead to complicated delivery. That results in about 12,000 deaths every year.

In its country report in 2011, the United Nations Children’s Fund (UNICEF) stated that though maternal mortality has been reduced in Bangladesh, only half the mothers receive antenatal care from skilled providers. The report said that healthcare correlates with household wealth and educational background.

“We are working with the government to promote safer childbirth by continuously developing skills of professional group of people like the health providers, and community and religious leaders,” Dr Abu Jamil Faisel, country representative of EngenderHealth, told IPS. “The idea is to increase access to quality maternal healthcare services at no cost.”

Millions of women in Pakistan do not have access to family planning services. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Nov 14 2012 (IPS)

Thirty-year-old Shahida Saleem, who was not educated past the tenth grade, is a mother of two, living with her family in Karachi. Six months ago she suffered a miscarriage and her doctor, concerned about her anaemic condition, advised her to space out her next pregnancy by taking contraceptives.

“I don’t want to have any more children; it’s difficult to bring up two in these times of rising food prices,” Saleem told IPS.

Still, she is not planning to use any modern method of birth control.

“I tried pills after my first child but I developed a cyst in my ovary, which the doctor said was due to the contraceptive,” she said, explaining why she discontinued that particular method.

Neither she nor her husband has initiated the use of condoms.

Saleem is among the estimated 222 million women who, according to the ‘State of the World Population 2012’ report, released Wednesday by the United Nations Population Fund (UNFPA), “lack access to reliable, high-quality family planning services, information and supplies, putting them at risk of unintended pregnancy”.

According to the Islamabad-based Research and Development Solutions (RADS), six million Pakistani couples need contraception annually.

Overseen by the Department of Health and the Ministry of Population Welfare, the public health sector covers just 33 percent of these couples’ needs. Fifteen percent go to the private sector or non-governmental organisations for family planning services.

This leaves over 1.5 million people at the mercy of market-distributed family planning, which is often cost-prohibitive.

Changing a conservative mindset

But as the UNFPA’s research shows, “Shortages of contraceptives are only one reason why millions of people are still unable to exercise their right to family planning. Access to family planning may also be restricted by forces including poverty, negative social pressures, gender inequality and discrimination.”

A highly conservative mindset still dominates huge swathes of Pakistani society. The latest Pakistan Demographic and Health Survey (PDHS), tracking data from 2006 to 2007, states, “Many Pakistani women and men regard continuing contraceptive practices more threatening to their health than an occasional induced abortion.”

“We keep talking about unmet need; but having worked with women for many years, I have come to the conclusion that a lot has got to do with the mindset. No amount of contraception supplies in population welfare centres will help if the women are not convinced to use them,” Dr. Arjumand Rabbani of the Midwifery Association of Pakistan, told IPS.

Dr. Talat Rizvi, a leading medical practitioner, stressed that maternal health indicators will only improve if female education and economic empowerment are given due attention.

Pakistan lagging on MDGs

Zulfikar Bhutta, head of women and child health at the Aga Khan University in Karachi, is sceptical about Pakistan’s ability to achieve the fourth and fifth Millennium Development Goals (MDGs) of improving child health and reducing maternal mortality.

“Pakistan has failed to make substantive progress towards (achieving) the MDGs for health and has fallen way behind most countries in the region including Nepal and Bangladesh,” Bhutta, who is part of the seven-member independent Expert Review Group (iERG) for maternal and child health for the U.N. Secretary General, told IPS.

“Even northern Afghanistan seems to have made more rapid progress in recent years. The reasons for this lack of progress are manifold, including lack of political will to address maternal and child health, unbridled population growth, poor governance and accountability.

“Social determinants of health such as female education and empowerment, poverty alleviation and under-nutrition have received scant attention,” he lamented.

The situation is complicated by the population boom in the country.

On average, Pakistani women have four children. With almost 84 percent of women not using any form of modern birth control, keeping Pakistan’s population at a manageable level is a massive task.

If current trends continue, by the year 2020 the country’s population will reach 200 million.

“Any delay in addressing the issue of millions of uneducated and unemployed youth will lead to a disaster of unprecedented proportions in the near future,” Dr. Farid Midhet, a demographer and founder of the Safe Motherhood Alliance in Pakistan, told IPS.

Local efforts offer hope

Health experts are now turning their attention back to the Lady Health Workers (LHW) programme, whose army of 90,000 community health workers is perhaps Pakistan’s best bet to providing comprehensive reproductive healthcare and family planning.

The programme began in 1994, when government-trained medical professionals went door-to-door delivering temporary supplies of condoms, injections and birth-control pills, as well as other basic health needs.

If the programme hopes to reach the entire population of 180 million, 60 percent of which lives in rural areas, the country needs to double the number of workers to 180,000, health experts say.

“The health sector has failed to implement even one programme properly, with the exception of the LHW programme,” Bhutta said.

But in recent years, the programme has been undergoing a shift, with lady health workers increasingly tasked with managing other campaigns for tuberculosis, malaria and polio, which have eaten up much of their time and energy.

“I think if LHWs revert back to their original job description, they can do wonders with regards to both family planning and prenatal care,” Midhet said.

“They are discrete, known to the women, easily accessible and (able to provide) advice and support when women first start using a pill or injection,” he pointed out.

However, he hastened to add that other factors must improve simultaneously, such as salaries. The women must be “allowed the space to work independently of all political interference.”

(END)

In 2011, 300,000 women, almost all of whom live in developing countries, died from issues related to pregnancy and childbirth. Credit: Patrick Burnett/IPS

By Sarah McHaney
WASHINGTON, Oct 26 2012 (IPS)

In most developing countries, where a woman gives birth still determines whether she lives or dies, despite the availability of inexpensive new medication that is proven to save lives.

Most women dying from childbirth complications in developing countries do so simply because their need for medication is unknown, according to PATH, an international non-profit organisation focused on global health.

“We know maternal health medicines are safe, and we know they are effective and essential to keeping women healthy throughout pregnancy and childbirth. We also know these medicines are frequently not reaching women and community-based health facilities,” Kristy Kade, the primary author of a new PATH report, told IPS.

“What we do not know is the precise number of women for whom these essential maternal health medicines are not available – that is, women with an unmet need.”

This lack of data has led to a significant potential funding shortage. It is simply unknown how much money is being spent by affected countries and, therefore, how much more they need.

“It is very difficult to advocate for more supplies when we have almost no data on when, where, how much, how correctly, and to what standards these drugs are being used,” Kade said.

Last year, 300,000 women, almost all of whom live in developing countries, died from issues related to pregnancy and childbirth. The most common causes are postpartum haemorrhage, excessive bleeding after childbirth, and pre-eclampsia, hypertension during pregnancy.

Childbirth complications are almost nonexistent in the developed world because of effective medicines and high-quality health facilities. As these facilities are often rarely available in many developing countries, however, other medical means have been developed to address this need.

For years, Oxytocin and magnesium sulphate have been used as the primary drugs to treat complications. However, both drugs require specific storage temperatures and trained professionals to administer them, making these drugs inaccessible or even counterproductive at times.

There is also the chance that no one present at the birth will be trained in the correct way to treat the mother.

Misoprostol, a drug commonly used to treat stomach ulcers, has recently been hailed as a solution. It has the potential to reach women whose needs are currently unmet due to a lack of storage ability or trained medical professionals.

“Misoprostol is proven effective, proven safe, it is temperature stable, and no special training is required,” Adam Deixel, director of communications at Family Care International, told IPS. “This means it can be used when women birth at home or rural health facilities or where there is unreliable electricity for storing purposes.”

This drug is distributed in tablet form in the correct dosage needed if postpartum haemorrhage were to occur.

“Six million lives can be saved over the next few years with these new commodities,” Jagdish Upadhyay, with the United Nations Population Fund, told IPS. “We know the problem, we know the solution – we just need to work harder.”

Misoprostol has a fair share of complications as well, however. Although there are written instructions with the medication, it is not always in local languages and assumes the user is literate.

As with any new drug, the medical community is reluctant to see it become widespread without an appropriate level of oversight. There is also concern that women will see these pills as a lifesaving solution at home and fail seek out proper medical attention for their childbirth complications.

“The clear long-term solution is that every woman has access to the best care, well-trained medical staff and high-quality facilities,” Deixel said. “However, we cannot just write off the lives of those women because right now those facilities are just not there. This is a lifesaving option that can save lives right now.”

Misoprostol, similar to the other drugs, is easily manufactured, and developing countries, such as Ghana, have manufacturers making the drug locally. This keeps the drugs inexpensive to transport and sell.

The standards at these local manufacturers, however, often do not meet international regulation.

“Though these drugs are inexpensive, they are often sub-standard,” Kennedy Chibwe, from the U.S. Pharmacopeial Convention, told journalists in Washington earlier this week. “We need to demand quality products and keep the same standard for developed and undeveloped countries. To die from sub-standard medicine is just inexcusable.”

There is hope that these inexpensive and easily applied drugs will soon reach everyone who needs them.

“We have seen the incredible gains that can be made when there is the public support and the political will to save lives such as the millions of people receiving (drugs) as a result of HIV/AIDS activism,” Kade told IPS. “We have not seen the same amount of outrage and mobilisation for maternal mortality.”

When Philippines President Benigno Aquino III delivered his annual state of the union address in July, he appealed to the country’s lawmakers to break a  deadlock on progressive birth control laws in this predominantly Catholic nation.

An estimated 15 Filipina women currently die from pregnancy-related complications every day – up from a daily average of 11 a decade ago – and many of these are teenagers from among the urban and rural poor, according to a government survey.

In the decade after the law was originally proposed, unintended pregnancies have risen by 54 percent, according to the government’s ‘Family Health Survey-2011.’  The bill seeks to addresses this situation by offering contraceptive options, reproductive health care and sex education in schools.

According to the survey, the maternal mortality rate (MMR) reached 221 deaths for every 10,000 live births during the 2006 – 2010 period, marking a 36 percent increase from the 162 deaths during the 2000 – 2005 period.

In early August, the President’s allies in the House of Representatives had occasion to cheer as lawmakers in the Congress voted to end the fractious debate that had trapped ‘The Responsible Parenthood, Reproductive Health and Population Development Act’ in a Lower House parliamentary committee.

But, as the reproductive health (RH) bill makes its way through the Senate and the House for amendments, its sponsors face filibustering by a vocal minority trying to delay passage of the bill before Oct. 15 when the term of the current Congress expires.

“The anti-RH forces know that at the moment the pro-RH forces are likely to have the majority, so their strategy is to prolong the parliamentary process,” Congressman Walden Bello of the Citizens Action Party told IPS in an interview.

“Once we get to mid-October, it will be very difficult to muster quorums to take up legislation since most members of the House will be busy campaigning for reelection (for next May’s election),” Bello said.

According to Bello, the strategy of the vocal minority – about 120 members in the 285-strong Lower House –  is to leverage the political influence that the Catholic Church wields in this archipelago of 96.5 million people.

“The anti-RH forces hope that some of the pro-RH forces will waver and decide against voting for the bill for fear that the Catholic Church hierarchy will tell their Catholic constituents to vote against them,” Bello said.

The clout of the Church is playing out in the  Jesuit-run Ateneo de Manila University where some 190 academics supporting the RH bill have been threatened with heresy proceedings, according to local media.

“The first principle of canon law is that we don’t allow teaching that is against the official teachings of the Church,” Bishop Leonardo Medroso told a local radio station in an interview. “If there is somebody who is giving instructions against the teachings of the Church, then they have to be investigated immediately.”

The Church has also backed street protests against the controversial bill and one “people power” gathering drew an estimated 10,000 people in the capital.

Arguments trotted out against the bill at such meetings include loss of family values in a ‘contraceptive society’ and state interference in what is seen by many as a religious domain.

“The RH bill has become a political question because of the role of the Church in opposing it,” says Harry Roque, professor of constitutional law at the University of the Philippines. “The influence of the Church is ever persuasive.”

“But the reality is that we need this bill,” Roque said in a telephone interview from Manila. “It is important for the President to do what is right. He is deeply committed to supporting this bill.”

To do otherwise would expose the Aquino administration to charges of  being remiss in meeting United Nation’s Millennium Development Goal (MDG)  of slashing by three-quarters the maternal mortality ratio (MMR) by 2015 against what it was in 1990.

Local women’s rights groups and U.N. agencies monitoring the country’s progress in meeting MDG 5 (one of eight goals) relating to maternal health and reducing the MMR hold that the Philippines is likely to miss the target.

“The first RH bill, which was proposed in the Upper and Lower House in 2001, was meant to “respond to the various RH problems in an integrated and rights-based fashion,” says Junice L. Demeterio-Melgar, executive director of Likhaan, a centre for women’s rights and health that is backed by a national network of grassroots activists.

“It specifically wanted to call attention to existing but essentially tabooed issues like adolescent RH, post-abortion care and sex education,” Demetrio-Melgar said.

“A law was needed to mainstream the integrated health and rights-based approach, as well as to override the devolution of the Philippines healthcare system,” she told IPS. “The bill was meant to institutionalise the department of health’s RH programmes.”

The non-passage of the bill has adversely affected lingering poverty in a country  where nearly 20 percent live below the U.N.’s 1.25 dollars-a-day poverty line.

“The richest women want 1.9 children and have two; the poorest women want four children but have six,” says Demeterio-Melgar. “Unintended fertility keeps families poor and families with more than three children have difficulty feeding their children and sending them to school.”

By Zofeen Ebrahim
KARACHI, Pakistan, Aug 3 2012 (IPS)

“This is just a trailer of the horror that awaits us,” says noted demographer Farid Midhet, referring to Pakistan’s bulging population and the possibly corresponding  link to rising crime, including murders, robberies, rioting and extremist activity.

According to the independent Human Rights Commission of Pakistan, at least 1,257 people, including 64 children, have been murdered in different parts of Karachi alone, since the beginning of the year.

Karachi, Pakistan’s financial capital and the world’s fifth largest city, has an estimated population of 20 million, which is increasing at the rate of six percent per year.

Regarded also as one of the world’s most dangerous cities, 40 percent of Karachi’s  population livies in squalid shanty towns.

Data maintained by the Citizens Police Liaison Committee suggest that an average of 82 persons were kidnapped in Karachi per year between 2008 and 2010. Between 1997 and 2007, the average was 27 cases per year.

By the year 2020, Pakistan’s population is projected to reach 200 million and by 2050, in a business as usual scenario, the country will have 309 million people.

“If we start making efforts today, we may be able to apply brakes to the population in the next 30 to 40 years,” said Midhet, founder of Safe Motherhood Alliance. “The threat is the biggest ever in the history of mankind.”

“If population growth is slowed down to replacement level and concomitant investment made in the social sector, we could deal with this youth bomb,” says Zulfiqar Bhutta, member of the independent expert review group for maternal and child health for the United Nations Secretary-General.

Bhutta, co-chair of ‘Countdown to 2015’, a global scientific and advocacy group tracking progress towards the U.N. Millennium Development Goal Five pertaining to maternal health, told IPS that the fact that population growth would inevitably outstrip resources for education, employment and development, was always well recognised.

“It is just that the mismatch has become became apparent over time,” Bhutta told IPS. “Our current resources and investments cannot deal with a fresh birth cohort of 4.5 million every year and the proportion of people who are uneducated, unemployable and uncared for continues to grow,” he said.

Midhet said the plethora of donor-driven and country-cultivated family planning (FP) programmes had failed to significantly increase the use of modern methods of contraception.

But if the facts and problems are known; solutions seem obvious and resources available and there is an infrastructure on the ground, why cannot couples limit family size? “We (Pakistan) are doing a lot of things, but we are probably not doing them right,” Midhet explains.

Between 2005 and 2010, many South Asian countries, including Sri Lanka, Bhutan, the Maldives, Bangladesh, India and Nepal, brought their total fertility rates,  or the average number of children a woman bears in her lifetime, from 3.2 to 1.5, but Pakistan remained stuck at four.

As contraceptive prevalence picked up to 74 percent in adjacent Iran between 2005 and 2010, it stayed stuck at a dismal 30 percent in Pakistan during the same period.

Only half of Pakistan’s couples are using a modern temporary method (condom, pill or intrauterine device), while 7.7 percent couples are still opting for the traditional FP methods, which are far less effective than the modern methods.

“If in the last five decades we had implemented the FP programmes sincerely and efficiently, made education compulsory and provided technical skills, today we would have been ahead of South Korea, Thailand, Indonesia and even India, due to our demographic dividend,” said Midhet.

The main problem seems to be lack of political will says Bhutta. “None of the political parties backed it ever.”

A ‘lady health workers programme’ launched in 1994 held out the promise of delivering both FP and basic healthcare at the doorstep, but quickly fell into the doldrums because of overstretched staff.

Dr. Ayesha Khan, who heads Research and Development Solutions, a non-governmental organisation that focuses on public health issues, told IPS that the programme ended up providing a rushed four minutes to every woman client. “The workers’ time and energy is expended on other programmes, including campaigns on TB, malaria and polio,” she said.

The only way out of the present stagnation in FP is for the ministries of population and health to completely merge their field operations and give the programme the primary task of providing modern contraceptives to couples, says Midhet.

“Pakistan could have achieved less than one percent population growth and today the population would have been less than 100 million had Pakistan invested in FP and education of its population,” says Midhet.

“In addition, the secondary school education rate could have reached 100 percent and the higher education rate could have surpassed 50 percent among youth and young adults,” he added.

Of Pakistan’s 180 million, 20.6 percent are between the ages of 15 and 24. Of these, 32 percent are uneducated with no vocational and life skills. Pakistan’s youth bulge consists of disgruntled and unhappy young people.

At a seminar organised by the National Vocational and Technical Training Centre (NVTTC) and United Nations Educational, Scientific and Cultural Organisation in June, to find ways to get youth into technical education, NVTTC chairman Mumtaz Akhtar Kahloon termed the youth bulge “a window of opportunity.”

“But, if we are  to turn this youth bulge into a demographic dividend, they must be equipped with marketable skills,” Kahloon added.

“If youth are not put to productive use, they pose a threat to peace,” Bhutta said at the seminar. “Small wonder that some see employment options in these (extremist) outfits.”

Women’s rights champions are not prepared to let the dust settle on the Fourth High Level Forum on Aid Effectiveness that ended in this South Korean port city on Dec. 1 with the customary nod towards gender equality and empowerment.

An internally-displaced Kenyan woman cooks in her makeshift kitchen. Credit: Miriam Gathigah/IPS

The Busan Outcome Document’s paragraph 20 says: “We must accelerate our efforts to achieve gender equality and the empowerment of women through development programmes grounded in country priorities, recognising that gender equality and women’s empowerment are critical to achieving development results.”

Roselynn Musa, programme manager at the African Women’s Development and Communication Network, says, “Busan is not the end, but the beginning.

“As we turn a new leaf, there is no time to wait for the dust to settle before we roll up our sleeves and get our hands dirty. We need to start engaging with our governments to ensure that they move paragraph 20 of the Busan Outcome Document into the lives of women,” Musa said.

Although many gender experts continue to express discontent with the handling of the issue of women’s empowerment at the Busan conference, they agree that there was an increased show of interest in the plight of women compared to the previous forum in Accra, Ghana.

Says Monica Njenga, a gender activist in Kenya: “Previous international conferences offered many promises to women, hoodwinking them into believing that there is a real interest in fighting gender inequalities and narrow down gender gaps. Women need to take initiative and make paragraph 20 work.”

Njenga adds that many developing countries are facing major socio-economic challenges and may not prioritise the Busan commitment to gender.

“In Kenya, citizens continue to struggle as the cost of living continues to skyrocket. Labour unrest is now unprecedented with doctors in public hospitals having been on a week- long strike. The army is also at war with Al Shabab in Somalia. Gender equality is perhaps the last thing on the government’s list of priorities.”

In spite of these challenges, gender champions believe they can use the Busan document to leverage the gender agenda. One of these is Mayra Moro-Coco, development policy and advocacy manager at the Association for Women Rights in Development.

“The global partnership coming out of Busan will aim to reach effective development cooperation,” says Moro-Coco.

“Working for development effectiveness means promoting a development model that shifts the dominant development scenario towards an inclusive, sustainable, and just paradigm that recognises and values reproductive and unpaid work, promotes decent work and promotes the empowerment, human rights and emancipation of women and girls,” she said.

Moro-Coco lays emphasis on the need for various stakeholders to acknowledge that “development effectiveness requires democratic ownership by women and meaningful and systematic participation by civil society, especially women’s and feminist organisations.”

The global partnership that resulted from the Busan conference shows no real commitment to the human rights approach to development, says Moro-Coco.

This, she says, poses a challenge for initiatives and interventions geared towards “advancing development and poverty eradication in ways that are democratic and coherent with international human rights standards and give adequate attention to women’s human rights, the right to development and environmental justice.”

Moro-Coco expresses concern about the implementation of the Busan global partnership since the document “has not given adequate attention to women’s rights, the right to development and environmental justice.”

Paragraph 20 does express an interest in reducing gender inequality as “both an end in its own right and a prerequisite for sustainable and inclusive growth.”

It also recognises the need to “accelerate and deepen efforts to collect, disseminate, harmonise and make full use of data disaggregated by sex to inform policy decisions and guide investments, ensuring in turn that public expenditures are targeted appropriately to benefit both women and men.”

These, many feel, are not enough.

Says Njenga: “Promises are easy to make. Women need to show their leaders that they mean business. If indeed women account for a majority of the population, especially in developing countries where gross gender inequalities thrive, they need to make their votes count.”

Njenga believes that women should vote for leaders “who have tangible results to show as commitment to women rights.

“During campaigns, most leaders give gender issues lip service only to be voted in and disappear from the gender forums. This needs to change.”

Hillary Clinton at Busan Credit: Miriam Gathigah/IPS

By Miriam Gathigah
BUSAN, South Korea, Nov 30 2011 (IPS)

Women toil in the fields for most of their lives producing food and strengthening the largely agricultural economy of African countries, but when their fathers, husbands or older sons die, they are no longer welcome on land they may have tended for years.

This observation was made by Hillary Rodham Clinton, United States secretary of state, at a special session on the status of women at the ongoing Fourth High Level Forum on Aid Effectiveness (HLF4) in thi sSouth Korean port city.

Some 2,500 delegates, including members of ministerial teams from 160 countries, civil society leaders, experts from multilateral organisations and academics are attending the HLF4 to discuss international principles and rules to improve development co-operation.

Many agreed with Clinton’s observation that created a strong image of the status of women in Africa and Asia who earn their livelihoods from natural resources.

“Many years ago I travelled to Africa and everywhere I went there were women working in the fields, gathering firewood and in market stalls, and so I asked an economic analyst, how do you account for these contributions by women? And, he said that they didn’t. Because it wasn’t in the formal sector.

“If these women could stop working, even for a day, that would have a huge impact on the economy.”

The situation has not changed significantly for many women in Africa and Asia.

“Women still account for at least 70 percent of the 1.3 billion people living in abject poverty. Women work two-thirds of world working hours, produce at least half of the food. Yet, they only earn a paltry 10 percent of world income and own a negligible one percent of world property,” said Michelle Bachelet, executive director of U.N. Women, an entity concerned with gender equality and women’s empowerment.

Despite statistics showing that countries that engage women and recognise their contribution achieve greater growth, many African countries are only too willing to offer lip service to the course of gender equality to improve their image at global conferences such as in Busan.

Said Bachelet: “We are saying that this is the time to move from speech line to budget line.”

“I can sense the same frustration in Bachelet’s voice as she made a case for gender equality. The same frustration that I feel. I ask myself, how much longer do we have to make this case?” Clinton said.

Clinton said this is in spite of the fact that credible sources such as the World Bank and the International Monetary Fund have shown that the gross domestic product and per capita income could be higher if women were recognised and integrated into development.

From Clinton’s passionate plea for more commitment to gender equality in relation to better implementation of aid, she made it clear that discriminating against women hurts the economy.

“In Asia, statistics show that the economy loses about 89 billion dollars every year because of discriminating against women within the labour force. Sadly, this is a region with countries working hard to emerge as leading economies,” Bachelet said.

Leading champions of gender equality said women are empowered when they are given an opportunity to go to school, their children are better fed and they too stand a better chance of accessing a good education.

A majority of women remain poor with few opportunities to access work that is remunerated, little or no money and little chance to give their children a decent meal. During the recent drought in the Horn of Africa, U.N. statistics showed that of the four million people on the brink of death, two million were children.

But this could change. The Busan forum, that ends Thursday, can take this chance to redeem itself with a new and practical solution towards improving the lives of millions of women.

What is measured gets noticed, Clinton said. “We are now working on developing data on whose basis gender status can be improved. Today, I am pleased to announce a new initiative, the Evidence and Data for Gender Equality (EDGE).

“EDGE is a new initiative to improve the availability and use of statistics that capture gender gaps in economic activity. It capitalises on the United States’ call to action at the May 2011 OECD ministerial session on gender and development and builds on recommendations of the U.N. International Agency and Expert Group on Gender and Statistics.”

Often, Clinton said, loans are given to small business enterprises without assessing how many of these are owned or run by women. “Consequently, she said, “women continue to face difficulties in accessing credit.

“In many countries, a man and a woman can go to the same lender for credit and even have similar collateral, but a woman will be treated differently. We can reform credit policies that discriminate and disadvantage women.”

Clinton lauded the Busan forum saying that it created an opportunity for new initiatives and partnerships critical to advancing the struggle for gender equality and the empowerment of women.