SydMUN 2015 UNDP Briefing Paper
Briefing Paper: UNDP
The Question of Maternal Health & Fertility in Developing
Countries
Introducing your directors….
Hiya! I’m Jeanette one of your directors for the United
Nations Development Program (read: DANCE PARTY). My spirit animal is Mindy Kaling and I’m lactose intolerant but
I would eat icecream for every meal of the day if I could! I study Politics & International Relations and Media, Culture and Communications at Macquarie University. Aside from my love of lactose, Politics and Mindy I also have a deep appreciation for Model UN puns and memes. I have been
MUNing for two years now and have attended more conferences than my bank account can handle. I am often called out for my antics as The Democratic Peoples
Republic of Korea, but I’m not all about dictatorships, I do also love me some diplomacy. I’m also obviously writing
this briefing paper at the last possible minute so I’ll keep this part short and finish by saying that this will be my first time directing at a conference and I am very excited to meet you all!
G’day everyone, my name is Kyle (call me K if that’s too tricky) and I’m lucky enough to be your director for
SydMUN 2015 in the UNDP. My spirit animal is an owl because I’m practically nocturnal and if someone does wake me up unexpectedly I become a feathery ball of hatred. Currently I’m studying a Bachelor of Political,
Economic and Social Sciences in my second year at the
University of Sydney, majoring in political economy and
Asian studies. The UNDP was actually my first committee at AMUNC 2014, where I raged against the machine as the
USA; you may remember me as Zbigniew ‘Mr. B’
Brzezinski on the panel of experts at AMUNC this year, as well as operating as a spy for ASIA. Next year I will be leading USYD to WorldMUN in Rome as head delegates and many other events as Conferences Director for
SUUNS. Plus I’m under-‐secretary-‐general for socials at
SydMUN this year so if you have any question on how to party let me know. I can’t wait to see what you guys bring to the committee room and hope to see you all ready to go this December.
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Abstract
Maternal health and fertility is one the most fundamental contributors to family and there state stability, as such the maintenance of sound practices is necessary for progress in developing states in particular. This briefing paper will provide a short guide to the committee topic, focusing on key issues and players, as well as potential solutions and links to further research. Delegates should use this as the basic foundation for their knowledge of the topic and build upon it through individual research.
Introduction to the UNDP
The United Nations Development Program (UNDP) is the UN's global development network working in 177 countries and territories, advocating for change and connecting countries to knowledge, experience and resources to help people build a better life. UNDP coordinates all United Nations (UN) development activities at the country level as the manager of the Resident Coordinator system. In its resolutions
59/250 and 62/208, the General Assembly reiterated that; “..the management of the resident coordinator system “should continue[d] to be firmly anchored in the United
Nations Development Program”.
The UNDP bases its activities on the fundamental values of the United Nations while learning from its past and leveraging its core competencies and unique capabilities.
These include its dual role as a UN agency that delivers programming and coordinates the UN country office presence, extensive knowledge network, decentralized structure, and business model. In pursuing this course, UNDP is further guided by General
Assembly resolution 62/208.
The UNDP also administers the UN Capital Development Fund, which promotes microfinance in 38 least developed countries; and UN Volunteers, which fields over
7,500 volunteers from 160 countries in support of peace and development through volunteerism worldwide.
The four key objectives of the UNDP are:
1.
Poverty Reduction and achieving the Millennium Development Goals
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2.
Crisis Recovery and Prevention
3.
Democratic Governance and Peace Building
4.
Environment and Sustainable Development
Introduction to topic:
Maternal health is the health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimensions of family planning preconception, prenatal and postnatal care in order to reduce maternal morbidity and
mortality 1 .
A woman dies from complications in childbirth every minute – about 529,000 each year -‐-‐ the vast majority of them in developing countries.
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Globally, maternal deaths have dropped 45% between 1990 and 2013. While substantial progress has been achieved in almost all regions, many countries, particularly in sub-‐Saharan Africa, will fail to reach the Goal 5 target of reducing maternal mortality by 75% from 1990 to 2015. In fact, of all the Millennium
Development Goals, the least progress has been made toward the maternal health goal.
Daily, nearly 800 women across the globe die due to complications during pregnancy and childbirth, and 99% of these deaths occur in developing countries. Many developing nations have high rates of maternal mortality and high fertility, which are closely linked to high infant mortality and gender inequality.
Previous United Nations Action
1.
Convention on the Elimination of all forms of Discrimination Against Women
(CEDAW). a.
Gender inequality makes maternal health conditions worse: women are at times denied control of their bodies in deciding whether to become
1 WHO Maternal Health http://www.who.int/topics/maternal_health/en/
2 “Millennium Goal 5” United Nations http://unstats.org/unsd/mi/goals_2005/goal_5.pdf www.unausa.org/site/pp.asp?c=fvKRI8MPJpF&b=640975
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pregnant (using contraceptives or with safe abortions), and they do not have the power to refuse their partners’ wish to have children. CEDAW 3 determines that these are violations of women’s rights. Women should be granted the right to refuse sex and to refuse having children.
2.
The Millennium Declaration a.
Eight Millennium Development Goals (MDG) were set with the aim of improving conditions in developing countries; two of these goals, numbers 4 and 5, aim to reduce the child mortality rate by two-‐thirds and to reduce maternal mortality rate by three-‐quarters by the year 2015. b.
The fifth Development goal aims to ensure universal access to reproductive health by 2015. Focusing on increasing the use of contraceptives, decreasing the adolescent fertility rate, increasing prenatal care coverage, and reducing the unmet need for family planning.
3.
UNFPA Thematic Fund for Maternal Health 4 a.
In the year 2008, the United Nations Population Fund (UNFPA), created a
Thematic Fund for Maternal Health. This fund aims to help improve efforts to reduce mortalities in pregnancy and childbirth. Encouraging private sponsors and developed countries to contribute more towards bettering maternal health and care. The Thematic Fund aims to help countries increase their access to and use of quality maternal health services, increase the capacity of health systems, strengthen mechanisms to reduce health inequities, and empower women to exercise their right to maternal health.
4.
Resolution on Preventable maternal mortality and morbidity and human rights
2009 5
5.
Resolution on Preventable maternal mortality and morbidity and human rights
2011 6 a.
This resolution calls for the application of seven key principals of human rights-‐based approaches: accountability, participation, transparency,
3 “Convention on the Elimination of All Forms of Discrimination against Women,” Division for the
Advancement of Women, United Nations www.un.org/womenwatch/daw/cedaw
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5
http://www.unfpa.org/public/global/pid/979
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http://ap.ohchr.org/documents/E/HRC/resolutions/A_HRC_RES_11_8.pdf
http://daccess-ddsny.un.org/doc/RESOLUTION/LTD/G11/162/25/PDF/G1116225.pdf?OpenElement
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empowerment, sustainability, non-‐discrimination and international co-‐ operation; all to be applied in a systematic, practical and measurable way. b.
More specifically, the resolution calls for the development of practical guidance, through an expert workshop, to assist States, the United
Nations system and all stakeholders in applying human-‐rights based frameworks to programs and policies aimed at preventing maternal death and disability.
6.
Report of the Office of the United Nations High Commissioner for Human Rights 2014 a.
This report discusses initiatives to implement the technical guidance on the application of a human rights-‐based approach to the implementation of policies and programs to reduce preventable maternal mortality and morbidity.
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Key Issues:
Maternal health is an intersectional issue covering multiple concerns involved in addressing poverty, cultural values and general medical wellbeing. In this regard the key issues may sway into unexpected territory, however we trust delegates will be able
to discern whether an issues is within the purview and mandate of the UNDP to consider it debate worthy 7 .
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Gender Equity and Equality o Women as part of maternal health must have the right to autonomously control their body and use it in a manner they so wish. However in many developing states this is sadly not the case and as such maternal health is subjugated not to the child-‐bearers needs. o As such, the empowerment of women in these scenarios to take control of their bodies and assure greater maternal health is paramount.
Empowerment is defined as ‘the expansion in people’s ability to make strategic life choices in a context where previously not the case”. Two elements make up this movement, process towards gender equality and freedom/choice and agency 8 . o “In resource-‐poor settings such as Nigeria, women with more decision-‐ making autonomy are likely better able to advocate for and access health facility for childbirth. Thus programs and policies that focus on gender in addition to focusing on education and poverty have the potential to reduce maternal mortality even further.” 9
7 For the love for all that is holy do not steer debate into arguing definitions. http://i.imgur.com/kgluLdA.gif
The International Code of Diseases (ICD-10) definitions for maternal death and its subclassifications are as follows [ 3,4 ]:
Maternal death — The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes [ 3 ]. Most (62 percent) maternal deaths occurred in sub-Saharan Africa (179,000 deaths) [ 5 ].
Nearly a third of maternal deaths worldwide occurred in two countries: 17 percent in India (50,000 deaths in 2013) and 14 percent in Nigeria (40,000 deaths).
Late maternal death — The death of a woman from direct or indirect obstetrical causes more than 42 days, but less than one year, after termination of pregnancy.
Pregnancy related death — Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. These deaths may be from accidental or incidental causes.
8 https://www.icrw.org/files/publications/Targeting-Poverty-Gender-Inequality-Improve-
Maternal-Health_0.pdf
, p.5
9 Singh, K., Bloom, S., Haney, E., Olorunsaiye, C., & Brodish, P. (2012). Gender Equality and Childbirth in a Health Facility: Nigeria and MDG5. African Journal of Reproductive
Health , 16 (3), 123–129.
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o Women are in many developing states are disproportionately poor, low education, lack of autonomy and decision-‐making power; overall low social status.
The effects of gender unequal norms include: o Gender inequality is a critical and neglected factor
early marriage → early childbearing + high fertility = higher risk of maternal mortality and morbidity
norms restrict mobility → impedes utilization
limited education → less knowledge and tools for informed health decisions 10
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Contraception o It is estimated that 222 million women in developing countries want to delay pregnancy or prevent unintended pregnancies but are not using modern contraception methods.
11 o Unmet needs for contraception result in 54 million unintended pregnancies and 16 million unsafe abortions, resulting in
79,000 maternal deaths.
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http://www.un.org/esa/population/meetings/2010-panel-fertility/mehra-presentation.pdf
(International Conference on Family Planning, 2013).
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o Family planning reduces maternal deaths due to these unsafe abortions, and, as 40% of all pregnancies worldwide are unintended, family planning products can help to break the cycle.
12 o Furthermore, spacing pregnancies at least two years apart and limiting the total number of pregnancies improves survival chances and health for both mothers and children.
13 o A recent study study examined the role of family planning as a possible intervention in maternal mortality amongst women in an urban setting –
Benin City -‐ Edo State, South-‐West Nigeria. A total of 300 respondents, all females -‐ aged between 21 and 60 years were involved in the study. Well-‐ structured, in-‐depth questionnaires were used. About 150 (50%) of the respondents have used one family planning method or another and these included; oral contraceptives (30%); intrauterine devices –IUDs (25%) and the withdrawal method (5%). Knowledge of use of family planning amongst respondents included: prevention of unwanted pregnancies (70%); possible maternal death (60%); reduction in family size (60%) and child spacing
(45%). About 5% (15) of the respondents became pregnant while using the withdrawal method. There were many positive opinions amongst the respondents about the use of family planning and these were: public health education and awareness involving both rural and urban women (25%); family planning should be encouraged (30%); child spacing (25%); avoiding unwanted pregnancies and unsafe abortion (15%) and prevention of maternal death (65%).
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Poverty o Mothers in developing nations are often exposed to the inequality of opportunity and social adversity induced by impoverishment, thereby hampering overall maternal health and fertility in the process.
12 http://www.accesstomedicineindex.org/sites/2015.atmindex.org/files/2015_landscape_study
-access_to_maternal_and_reproductive_health-access_to_medicine_foundation.pdf
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(WHO and UNICEF, 2012)
14 http://www.regional.org.au/au/mwia/papers/full/33_flossy1.htm
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o Poverty means mothers may not be able to access effective medical treatment, food, pregnancy assistance or even basic needs during pregnancy. As a result upon the child will experience extreme hardship and difficulty to survive since the mother could barely attend to herself prior. This viscous cycle of poverty is one the major reasons for maternal deaths of mothers and children under five. o As discussed previously, one of the key methods in which maternal health and fertility can be improved in developing states is through economic and gender empowerment. The consequences are three fold:
1.
Women are able to family plan and thus assess the economic impact of starting a family, which in the long term will increase the standard of living across the community.
2.
Greater education of safer practices to assure maternal health increases utilisation of available options to manipulate fertility.
Utilisation previously has been inhibited by a lack of awareness, education and clash of local customs, however a new culture in this area has been proven to reap positive results.
3.
Engagement of women in economic activity while not only bringing profit to the family, increases opportunity and standard of living for the family. Thereby allowing greater agency for all members of the family and by extension the wider community.
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Key Players:
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African Union
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Local NGOs such as Red Cross or
Medicine Son Frontier
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Local municipal and state governments
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Aid agencies across the globe
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The United States of America, the
European Union, Japan, Norway and
Argentina as the top five biggest contributing donors to the UNDP.
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The women of developing states and their communities
Potential Solutions:
Development of effective and efficient health systems
Access to abortion services
Access to maternal healthcare o Transportation to services o Information – family planning, contraception o Screening services o Costs associated with the above
Addressing the effects of long-‐term circumstantial issues such as poverty,
HIV/AIDS, and war and conflict on maternal healthcare
Methods for training and equipping staff who can administer maternal healthcare;
Limitations on funding for maternal health programs
Engagement of nongovernmental in addressing this issue
15 http://open.undp.org/#top-donors/total
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Questions a Resolution Must Answer:
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Does this resolution assist in the sexual health of the mothers, including right to choose, contraction of STIs and access to birth control? It is naturally interlinked and one cannot effectively approach the main topic without covering sexual health.
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Why are current fertility patterns so and is the best trend for the family to prosper? Think in terms of socio-‐economic opportunity, cultural traditions and other national influences.
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Is this resolution going to provide a sustainable and beneficial outcome in the long term, so that mothers and born children can reap the rewards?
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How does this resolution work with local institutions to achieve it’s aims.
Further Research:
Hans Rosling TED Talks on the MDGs, fertility and population growth.
Statistics Website, http://www.gapminder.org
Funky Videos, https://www.ted.com/talks/hans_rosling_the_good_news_of_the_decade?language=en http://www.gapminder.org/videos/gapmindervideos/gapcast-‐11-‐reducing-‐child-‐ mortality/ http://www.gapminder.org/videos/hans-‐rosling-‐ted-‐talk-‐2007-‐seemingly-‐impossible-‐ is-‐possible/ http://www.gapminder.org/videos/poor-‐beats-‐rich/ http://www.gapminder.org/videos/religions-‐and-‐babies/ http://www.gapminder.org/videos/the-‐river-‐of-‐myths/
http://www.gapminder.org/videos/will-‐saving-‐poor-‐children-‐lead-‐to-‐overpopulation/
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UN Fact Sheet: http://www.un.org/millenniumgoals/pdf/Goal_5_fs.pdf
Centre for Gender Health and Equity
Right to Motherhood Report: http://www.genderhealth.org/files/uploads/change/publications/MH_Report_Summa ry_Upated.pdf
Country Profiles: http://www.genderhealth.org/media_and_publications/publications/category/country
_profiles/
World Bank Statistics
See sight for further figures
http://data.worldbank.org/news/over-‐99-‐percent-‐of-‐maternal-‐deaths-‐occur-‐in-‐ developing-‐countries
Berkley Women’s Health Maternal Health Academic Article http://bixby.berkeley.edu/wp-‐content/uploads/2015/03/2010-‐Prata-‐et-‐al-‐MM-‐in-‐
Dping-‐Cs-‐in-‐Womens-‐Health.pdf
Nutrition and Health in Developing Countries , Chapter 2, 2008 http://www.springer.com/cda/content/document/cda_downloaddocument/ 97819341
15244 -‐ c 1 .pdf?SGWID= 0 -‐ 0 -‐ 45 -‐ 577130 -‐ p 173779428 .
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