Social Protection in Health for Women, Newborn and Child Populations

1. Social Protection in Health for Women, Newborn and Child Populations Dr. Oscar Viscarra Zuna

2. Poverty is the social issue that constitutes the strongest violation against human rights. It is also a determining factor in the health outcomes – illness, mortality and suffering - of women and men in all countries in the world. “Human Rights and Poverty: Toward a Rights-Based approach” UN, 2000

3. Female poverty and mortality • Determinants of poverty that increase female mortality • Unhealthy environment • Reproductive burden • Deficient nutrition • Lack of access to quality health services. • Female mortality increases poverty • Loss of family income and savings • Decrease in productivity at the national level.

4. INCOME maximize utility, in other words, provide the maximum benefit to the greatest number of people aimed at the goal of well-being emphasizes the role of personal or family income in poverty. CAPACITIES poverty is defined by the deficiencies existent in health, education and other areas related to quality of life aimed at social justice the use of income takes place according to the capacity that each person has for distributing resources in an optimal way. Two concepts of poverty

5. As a result • Access to education and health = greater capacity to solve the problem of low income. • High income + poor health = will not be poor in economic terms, but will be in terms of the capacity to enjoy a healthy, full, higher-quality life. • A just social system that defines beforehand the context in which women and men develop their capacities and simultaneously provides a framework of opportunities and rights in which every person can equitably achieve certain goals. Sen, A (1999) “Poverty as capability deprivation”

6. Once basic needs are defined by the people themselves, improvements can be proposed, supporting the development of human capacities and the participation of individuals in the family, community and social spheres, creating strategies that can take them out of poverty. • The improvement should take place in the sector of the population that confronts the greatest deficiencies, and it would have to be sustainable. • By giving priority to health, public policies should be targeted at the most vulnerable among the poor: women, adolescents and youth, and disadvantaged ethnic/racial groups.

7. “Poor sexual and reproductive health conditions are both a consequence and cause of poverty and hunger. This negatively affects economic well-being, decreasing the individual’s capacity to work, just as treatment costs can consume scarce family income; women that live in poverty conditions have less access to information and services.” Kofi Annan, Secretary General of the United Nations

8. The burden of disease attributed to sexual and reproductive health is 22% for women while it is only 3% for men. • Maternal health is the dominant burden in terms of diseases related to sexual and reproductive health among women. In LAC, it represents 11.3% of the total burden of disease. • The sexual and reproductive health burden is not limited to effects on the woman herself, but also has intergenerational effects: perinatal causes are 10% of the total DALYs lost that are associated with reproductive illness. DALYs: Disability Adjusted Life Years. • Ten-year projections suggest that disease related to reproductive health will be the largest cause of death and disability on a global level. (Gwatkin, D R 2002 “The burden of disease among the Global Poor”)

9. As a response to the challenge: • Effective interventions • Focus on health, and sexual and reproductive rights • Throughout the lifespan Three strategies in the Regional Consensus: • Contraceptives • Skilled care for all births • Essential Obstetric Care in the service network

10. Contraceptives • Primary component for reducing maternal mortality from the perspective of avoiding unwanted pregnancies. • Based on evidence and the concept of Human Rights. • Particularly important for adolescents. Graphic 13 Bolivia: Desired and observed global fertility rate, by wealth quintile Intermediate Fourth Second Desired TFR Observed TFR Source: National Institute of Statistics – INE; National Demographic and Health Survey - ENDSA, 2003

11. Skilled Care at Birth • Have skilled personnel that are responsible for delivery care, that have the competencies and skills necessary for ensuring competent care and that are strategically distributed. • Enabling environment: medicines, supplies, functioning obstetric, newborn and community networks. Sub-Saharan Africa South Asia East Asia and Pacific Middle East and North Africa Latin America/Caribbean Central, Eastern Europe/ Baltics/ CEI* North America Source: PRB, using data from Maternal Mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, 2001.

12. Skilled care by income quintile 100 90 80 70 60 50 40 30 20 10 0 + low + high Total Haiti Peru India Togo Chad Niger Mali Brazil Benin Nepal Kenya Bolivia Ghana Turkey Malawi Nigeria Zambia Uganda Senegal Namibia Pakistan Morocco Comores Tanzania Viet Nam Colombia Paraguay Indonesia Uzbekistan Nicaragua Zimbabwe Cameroun Kazakstan Guatemala Philippines Bangladesh Kyrgyz Rep. Madagascar Côte d’Ivoire Mozambique Burkina Faso Dominican Rep. Central Afr. Rep Source: World Bank, 2000

13. Obstetric and Newborn Emergency Care • Recognize, manage, stabilize and carry out effective, timely referrals in the case of complications. • Capacity to effectively solve obstetric and newborn emergencies related to causes of maternal and newborn death. TABLE 10 Level of Emergency Obstetric Care by Type of Establishment Bolivia August-October, 2003 Basic EmOC (-1) Basic EmOC CompleteEmOC CompleteEmOC (-1) No EmOC Type of Establish-ment Level I Level II Level III The condition Complete EmOC (-1) is met when the establishment performs all of the indicated functions except assisted delivery with vacuum and/or forceps The condition Complete EmOC (-1) is met when the establishment performs all of the indicated basic functions except assisted delivery with vacuum and/or forceps

14. In conclusion ........

15. SRH matters not only during the reproductive years, but also as a concept that emphasizes a health focus centered on people’s life cycle. • Covers issues that are sensitive and important for individuals, partners and communities, such as sexuality, gender discrimination, and power relationships between men and women. • To achieve a better state of SRH, it is crucial to protect sexual and reproductive rights, a set of norms from different internationally agreed-upon human rights instruments that have been accepted for many years. Public choices, private decisions: Sexual and reproductive health and the Millennium Development Goals Stan Bernstein 2006

16. “We cannot attain the Millennium Development Goals, particularly the eradication of extreme poverty and hunger, unless we decidedly tackle issues of population and reproductive health; for this reason, it is essential to intensify efforts to promote women’s rights and increase investments in education and health, including reproductive health and family planning.” Kofi Annan, Secretary General of the United Nations

17. Thank you !!! “...finally, health should not be seen as a blessing that we can wish for, but as a human right that we should fight for” – Kofi Annan, Secretary General of the United Nations