1. Expanding the Agenda National Policy Dialogue 20th July, Islamabad Yasmeen Sabeeh Qazi Senior Program Advisor Packard Foundation MDGs

2. Goal 5: Improve Maternal Health Facts at a glance: Every minute one woman dies from complications related to pregnancy, childbirth, and the post partum period, almost all of them in developing countries Maternal Mortality statistics reflect the largest disparity between the developing & developed world of any health indicator [One out of 17 compared to one out of 4,000 women] Maternal Mortality- a shameful failure of development

3. Existing Target 6 Reduce by three quarters, between 1990 and 2015, maternal mortality Indicators – MMR & % of births attended by skilled health personnel Proposed Target 6: Reduce by three quarters, between 1990 and 2015, rates of unwanted pregnancies, unsafe abortion, maternal mortality & morbidity

4. Additional Indicators Maternal mortality rate by age and income quintile Proportion of birth attended by skilled and trained health professionals. Percentage of women aged (15 – 45) with anemia, obstetric fistula and uterine prolepses by income quintile Proportion of women dying due to the unsafe abortion and its complications by income quintile Proportion of women & men by age having access to public (comprehensive, affordable, quality) SRHR services and information at the Primary and Tertiary Level. (contraceptive services, ANC, EmOC, PNC, safe abortion, post-abortion and STD/RTI services) % of women expressing unmet need for contraception Adolescent fertility rate Proposed

5. Maternal mortality ratio Proportion of births attended by skilled birth attendants Contraceptive prevalence rate Total fertility rate Proportion of women 15-49 years, who have given birth during the last 3 years, who had attended at least one antenatal care consultation “Ensuring provision of quality health services including Maternal Health and well being of women in line with recommendations of ICPD” – Priorities for Development Assistance in Pakistan MDG Progress Report 2003 Existing Indicators Approved by GOP

6. Why we need to expand MDG 5 MMR = 300 – 700 / 100,000 Incidence of unsafe abortion = 1 million/year Maternal Mortality Rate per Year 76 % births at homes attended by untrained health personnel High incidence of morbidities High unmet need for FP (33%)

7. Realities: Demographic – ‘Missing Women’ Biological – Adolescent females (15 to 19 yrs) twice likely to die as women in 20s Political – A woman dying in childbirth is a “silent emergency”, happening outside the public eye Geographical – MMR one of the highest in the region Service Delievery – poor, inefficient & non responsive Social – low literacy, empowerment & status of women Policy – Right based framework missing

8. “ Safe Motherhood “ “Safe Motherhood is a human right. We must empower women and ensure choices …Our task and the task of many like us, is to ensure that in the next decade safe motherhood is not regarded as a fringe issue, but as a central issue” James D. Wolfensohn President – World Bank

9. “We know the causes. We have the solutions. We can make a difference.” [Joy Phumaphi; Assistant Director General, WHO]