Posted by: davidjolson | 05/20/2011

Where are the women in women’s and children’s health?

This guest blog was written by Chelsea Ricker of OneWorldUK and a member of the Global Health Council delegation to the World Health Assembly. This is being co-published on the blog of OneWorld UK.

GENEVA — This year’s World Health Assembly is also the site of the launch of a report from the Commission on Information and Accountability for Women’s and Children’s Health. The report is part of the follow-up on the Global Strategy on Women’s and Children’s Health, launched last year by U.N. Secretary General Ban Ki-Moon.

The report, titled “Keeping Promises, Measuring Results,” sets out a framework for accountability for the resources poured into health systems nationally and globally, with 10 recommendations and 11 key indicators for tracking progress on what is sometimes called women’s and children’s health, but more frequently called “maternal, newborn and child health.” Can you spot the difference? The 11 indicators include:

  1. Maternal mortality ratio (deaths per 100,000 live births)
  2. Under five child mortality, with the proportion of newborn deaths (deaths per 1000 live births)
  3. Children under five who are stunted (percentage of children whose height-for-age is below minus two standard deviations from the median of the WHO Child Growth Standards)
  4. Met need for contraception (proportion of women aged 15-49 years who are married or in union and who have met their need for family planning, i.e. who do not want any more children or want to wait at least two years before having a baby and are using contraception)
  5. Antenatal care coverage (percentage of women aged 15-49 with a live birth who received antenatal care by a skilled health provider at least four times during pregnancy)
  6. Antiretroviral prophylaxis amongst HIV-positive pregnant women to prevent vertical transmission of HIV and antiretroviral therapy for women who are treatment-eligible
  7. Skilled attendant at birth (percentage of live births attended by skilled health personnel)
  8. Postnatal care for mothers and babies (percentage of mothers and babies who received postnatal care visit within two days of childbirth)
  9. Exclusive breastfeeding for six months (percentage infants aged 0-5 months who are exclusively breastfed)
  10. Three doses of the combined diphtheria, pertussis and tetanus vaccine (percentage of infants aged 12-23 months who received three doses of diphtheria/pertussis/tetanus vaccine)
  11. Antibiotic treatment for pneumonia (percentage of children aged 0-59 months with suspected pneumonia receiving antibiotics)

Here’s the thing: None of those indicators have anything to do with women’s health outside of reproduction. Only one of them has anything to do with women’s health outside of birth and pregnancy. What about women who want access to barrier technologies for preventing HIV and other STIs? Women who need access to primary health care? Women who need regular health screenings as prevention for cervical cancer? Women who need access to emergency health services in situations where they are subject to violence or sexual assault? All of these things could easily be distilled into quantifiable indicators.

While I applaud the attention paid to the need to measure investments in maternal health and their results in clear, quantifiable and accountable ways, I can’t help but wonder when we’ll see a similar effort towards protecting women’s health, full stop.

I’m also left wondering about the role of policy in all of this. Many of the countries which have the worst records on maternal mortality also have policies and legislation which impede women’s equality and restrict women’s access to vital health services. That’s not a coincidence.

Where’s the policy accountability? Countries which receive resources to invest in maternal and child health should also be held accountable for policies and legal frameworks which damage women’s health. I look forward to the day that the World Health Organisation publicly calls out governments which drag their feet on women’s equality with as strong a statement as they’ve just released on accountability for resource commitments to maternal and child health.

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