Making the Right Decisions for the Health of Girls and Women

1. Making the Right Decisionsfor the Health of Girls and Women Ruth Levine, PhD

2. Characteristics of Good Public Policymaking • Respectful of fundamental human rights • Reflects the community’s values • Weighs costs and benefits, near- and long-term • Promotes efficiency • Adapts as new evidence and ideas emerge

3. Rapid Progress Toward Better Maternal Health Is Possible • We have a great deal of knowledge • Biomedical, behavioral • We have seen successes • Rapid declines in maternal mortality among some populations • Sustained improvements in maternal health • There is strong leadership and support now

4. What We Know • Maternal mortality is highly concentrated among populations • 13 countries account for 70 percent of all maternal deaths • Poor, marginalized, disproportionately young • Death tends to occur around the time of delivery. • Two-thirds of maternal deaths occur between onset of labor or abortion and 48 hours postpartum or postabortion • Maternal mortality can be reduced through concerted efforts that address both clinical care and social factors

5. What We Know: Six Successful Approaches • Family planning • Skilled care • Safe abortion when and where legal • Placing priority on young people • Strengthen health systems with a bias toward girls and women • Advance and protect the human rights of girls and women

6. Reduces risks of “too early, too many, too late” Women can start childbearing after adolescence Women can space births Women can limit births after reaching desired family size Prevents use of unsafe abortion Family Planning

7. Skilled Care Skilled birth attendant: “accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns”

8. Variation in Skilled Birth Attendant Coverage Source: UNFPA, 2002

9. Safe Abortion When and Where Legal Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2003 42 million abortions Annually …20 million unsafe

10. Availability of quality family planning / reproductive health services Financing, supervision arrangements that incentivize responding to the needs of girls and women Youth-friendly health services • Specially trained staff • Respect for young people • Privacy and confidentiality honored • Adequate time for client and provider interaction • Peer counselors available • Separate space and special times set aside • Convenient hours and location • Adequate space and sufficient privacy • Youth involvement in program design Strengthen Health Systems with a Bias Toward Girls and Women

11. Advance and Protect the Rights of Girls and Women “governments express grave concern for the unacceptably high rates of maternal mortality and morbidity [throughout the developing world], acknowledge that [maternal health] is a human rights issue and commit to enhance their efforts at the national and international level to protect the lives of women and girls worldwide” – United Nations Human Rights Council, June 17, 2009

12. Characteristics of Good Public Policymaking • Respectful of fundamental human rights • Reflects the community’s values • Weighs costs and benefits, near- and long-term • Promotes efficiency • Adapts as new evidence and ideas emerge Strategic, evidence-based focus on reducing maternal deaths