You are here: Home > Work with us > Consultations > Choice for women: wanted pregnancies, safe births
> Introduction
-
Bookmark this page
Development partners can contribute to our technical consultation in this area by adding your individual, group, or organisational responses. You can read the evidence more fully and consider some suggested criteria. If you want to discuss it with colleagues, partners or users of services first, you can download our slideshare presentation and have your own debate. This will also give you a useful overview of the evidence and questions. For those who do not have good internet access or would prefer to submit their response privately, you can use our response template outlining all the background information and questions, and submit your feedback by emailing choiceforwomen@dfid.gov.uk.
Background
Millennium Development Goal (MDG) five to improve maternal health is the most off-track MDG, and yet has a critical impact on the achievement of all the other MDGs. More than a third of a million women die every year from complications during pregnancy and childbirth. For every woman that dies another 20 women suffer from chronic ill-health or disability. MDG 4 to reduce child mortality is also off-track. More than 8 million children die every year before their fifth birthday – at least 3.5 million of these deaths are of babies who die within the first month of life.
Improving reproductive, maternal and newborn health in the developing world is a major priority for the UK Government. DFID is therefore developing a new business plan, which will determine the UK’s contribution towards achieving MDG 5. We want to ensure that every pregnancy is wanted and that every birth is safe. In doing so, we know that we will also make an enormous contribution to reducing child mortality – particularly through improving the survival chances of newborn babies.
Choice for women - wanted pregnancies
Investing in family planning is one of the most effective development interventions and the most cost effective way to reduce maternal mortality. There are 215 million women in the developing world who would like to delay or avoid pregnancy, but do not have access to modern family planning methods – each year there are 75 million unintended pregnancies.
Failing to prevent unintended pregnancy leads some women and girls to seek an abortion. Every year 35 million of all pregnancies in the developing world end in induced abortion. An estimated 20 million of these abortions are unsafe and result in up to 70,000 maternal deaths each year.
Choice for women - safe births
More than a third of a million women die due to complications in pregnancy or childbirth each year. Young women are particularly vulnerable. Most of these deaths would have been prevented if women had access to quality reproductive, maternal and newborn health services before and during pregnancy, during labour and after the birth.
The few hours and minutes around childbirth is the time when the risk of death is greatest for both mothers and babies. More than 3.5 million newborn deaths (accounting for more than 40% of deaths to children under five years of age) occur in the first month of life – half of these in the first 24 hours.
Women’s rights, empowerment and choice
Women and girls’ ability to take action for their own and their children’s health, and to access contraception and services for a safe pregnancy and delivery, is essential for their empowerment. A girl or woman’s ability to make choices (with her partner whenever appropriate) about if and when she becomes pregnant, and what information and services she accesses, depends on her ability to negotiate and control these issues. Her status within a family and wider society determines the importance given to her health.
Integration of health services
Success in tackling HIV and AIDS, malaria, tuberculosis, and other diseases will contribute to the achievement of MDG 4 and 5, particularly in areas where these conditions are highly prevalent and underlie significant numbers of maternal, newborn and child deaths. By focusing on strengthening health systems and integrating services, effort towards MDG 5 will also support progress towards MDG 6 to tackle HIV and AIDS, malaria and other major diseases.
How you can get involved
We are developing our policies and plans of action in a number of ways. We are working with partner governments and other donors in country to determine what to support and how best to deliver; global experts give us advice; our research provides strong evidence, and we are looking at the budget and resources available to support programmes of activity.
We particularly want to hear what people around the world have to say on the subject of reproductive, maternal and newborn health. We want to know more about your views, opinions and experiences. This will help us to understand different viewpoints, how these issues might vary in different countries, and how DFID could work better with partners.
The views and opinions expressed in this survey and online discussion forum will be assessed by DFID and will give us a greater understanding of reproductive, maternal and newborn health issues around the world. Thank you for contributing your ideas.
Comments 
Comments closed
This consultation has closed.
Our thanks for all the comments submitted. All of the ideas and suggestions put forward will feed into our new policy, helping to shape the direction of our work.
Once the final policy document is released you will be able to find it at www.dfid.gov.uk
I verdad disfrutado El sitio web. Excelente puestos Muy bueno Muy bueno contenido. Por favor, mantenga gran bien cotent.
DfID are absolutely right to give the highest priority to better reproductive health and family planning. But this is not only a “win” for individual mothers and children. By slowing population growth, lower fertility will also help the development of all developing countries, and reduce pressure on the planetary environment – a classic “win. win, win”. DfID’s initiative would have more impact globally if this were spelled out clearly.
Definitely agree with what you stated. Your explanation was certainly the easiest to understand. I tell you, I usually get irked when folks discuss issues that they plainly do not know about. You managed to hit the nail right on the head and explained out everything without complication. Maybe, people can take a signal. Will likely be back to get more. Thanks
This new approach by DFID is praiseworthy.There was food shortage in Ethiopia in 1984. A huge effort was organised to improve agriculture, distribution of food etc. 25 years later food shortage was again reported. During this time the population has risen from 40 to 80 million. Maternal mortality is 100 times that in the UK and infant mortality 50 times. I am pleased to learn that Family planning clinics and special clinics for children under 5 will be a core part of your development programme.
i can see me in the picture of choice for women-safe births, i was very close to being a maternal mortality victim- GOD SAVED MY LIFE!!!!!
When i came out i took the advocacy lead to see how my little effort can save women in our rural communities who have no access to life saving information and services.
DFID, keep up the good work. It will also be great if you put back the small grant for grass root NGOs in Developing Countries you once launced but latter suspended. it will help us to reach and save more lives in our little waylaunceh, we applied
In some instances, that may prove true, however what about the large numbers of human beings who have no ability to write in this way? Do we just discard them just because they have little influence in this earth?
Education of FP methods and availability is key for women and girls to make informed decision. Sex education should also be introduced to the education curriculum at the tertiary education level.
Additionally, governments in developing world are constrained with resources for adequate support to MCH. DfID would come in handy to support Community Health Workers, Mid wife and Traditional Birth Attendants in a view of ensuring safe births. In building of skills and provision of equipments for MCH.
Great approach: choice, safety and rights! (Excellent to establih the online consultation, also.) The big challenge will be how to strengthen health systems and at the same time to keep a focus on these priority areas. A great deal of creativity will be needed to develop a truly diagonal approach, integrating the lessons learned from vertical programs into broader systems which incorporate the dynamic non-profit sector in a flexible way.
I can really observe your excitement within the work you write. The planet can do with increased passionate writers as if you that aren’t frightened to express that they really feel. Usually go after your own heart.
WaterAid congratulates DfID on this important undertaking. We believe that in order to deliver results on reproductive, maternal and newborn health, it is crucial that DfID recognise the most neglected and off-track areas of development and act on these at headquarters and country-office level, using integrated approaches and avoiding narrow, sector-specific interventions.
Failure to reach MDG 5 is inextricably linked with the poor progress on MDG 4 to reduce child mortality; it is just as important to recognise that lack of progress on other MDGs also hinders the achievement of MDG5.
While there has been some encouraging progress on maternal health since 1990 , much remains to be done. Maternal and newborn health is inextricably linked with access to sanitation, safe drinking water and hygiene. The sanitation MDG target is currently the most off track target in sub-Saharan Africa – at current rates it will not be reached until the 23rd century. This situation continues to compromise the achievement of further gains in maternal and newborn health.
Our key messages:
1. tackling maternal mortality requires not only strengthening healthcare systems, but also tackling the broader determinants of maternal health and mortality;
2. DfID should take a comprehensive approach that incorporates healthcare and health promotion interventions and ensuring access to safe sanitation and drinking water and sound hygiene practices;
3. Interventions to improve women’s access to sanitation and drinking water are not only essential for the survival of mothers and newborns during and immediately after childbirth; they also play a crucial role in improving gender equality and women and girls’ empowerment – both of which are major determinants of women’s health.
WaterAid congratulates DfID on this important undertaking. We believe that in order to deliver results on reproductive, maternal and newborn health, it is crucial that DfID recognise the most neglected and off-track areas of development.
While there has been some encouraging progress on maternal health since 1990 , much remains to be done. Maternal and newborn health is inextricably linked with access to sanitation, safe drinking water and hygiene. The sanitation MDG target is currently the most off track target in sub-Saharan Africa – at current rates it will not be reached until the 23rd century. This situation continues to compromise the achievement of further gains in maternal and newborn health.
Our key messages:
1. tackling maternal mortality requires not only strengthening healthcare systems, but also tackling the broader determinants of maternal health and mortality;
2. DfID should take a comprehensive approach that incorporates healthcare and health promotion interventions and ensuring access to safe sanitation and drinking water and sound hygiene practices;
3. Interventions to improve women’s access to sanitation and drinking water are not only essential for the survival of mothers and newborns during and immediately after childbirth; they also play a crucial role in improving gender equality and women and girls’ empowerment – both of which are major determinants of women’s health.
Thank you so much DFID for your concern and care for humanity. There is need to sensitize society on the way of life if one is to live a health enjoyable sickness free life. Cleanness at all levels is absolute. There is no way we are going to fight disease with related implications when people are so dirty both in and outside their bodies, the environment in which the majority live in is extremely dirty. People must be taught about all these facts. What people eat is very important in building our bodies and enhancing our immunity system. We are what we eat. Diet affects the workings of our brain and thus our thinking and our attitude. Ignorance is no excuse, when people continue to live in ignorance no matter what the world does people will continue to suffer the repercussions of the things they are ignorant about. Put in a touch of understanding and Love and you will see the difference. I thank those who are sincerely looking for ways and means of touching people’s lives for the best.
i agree with what you stated. Your explanation was certainly the easiest to understand. I tell you, I usually get irked when folks discuss issues that they plainly do not know about. You managed to hit the nail right on the head and explained out everything without complication. Maybe, people can take a signal. Will likely be back to get more. Thanks
The background information used for this consultation seems to be based on a highly partial understanding of the literature relating to unwanted pregnancy. For example, statements such as “Much of the slow progress in reduction of adolescent births is due to unmet need for contraception” and “Investing in family planning is one of the most effective development interventions and the most cost effective way to reduce maternal mortality” are simply unsustainable in the light of the actual empirical evidence on these issues both from developing and developed countries. At best, these are open questions and to present them as otherwise does no service at all to women and children facing difficulties relating to pregnancy and birth.
Without a recognition of the contradictory evidence on these points, this consultation seems to be a worthless exercise. This is a wasted opportunity to reappraise the ideologically-driven agenda of recent UK policy on maternal health and to return to a focus on the genuine health needs of mothers and children in developing countries.
Safe and legal abortion hasn’t really solved any problems. It’s a well-known fact that any abortion has negative mental, emotional, psychological and physical side effects. The highest number of pregnancy and birth related issues is highest in the countries with highest numbers of abortion (legal abortion at that).
To save women and children, they need education, they need jobs and ways to support themselves, they need affordable and accessible healthcare.
I think it’s great what you are trying to do for women and girls around the world.
I only wish you could extend your passion to the welfare of the unwanted unborn child, the biggest victims of all.
I wish more people could see what abortion does to a small baby, say, ten weeks after conception, it is horrific. More people should know the truth, then this modern day holocaust might come to an end.
You state that “We want to ensure that every pregnancy is wanted and that every birth is safe”. This sounds quite nice. However, given the anti-life leaning choices in your questionnaire, it must be asked whether you really mean by “every pregnancy wanted” is “every unwanted pregnancy aborted”. Is this what you really mean?
Based on the most recent evidence, we emphasise the following:
1. In the last two decades we have seen a marked reduction globally in maternal mortality from 500,000 deaths per annum to 350,000 per annum. The vast majority of these are still in the developing world.
2. The interventions that have reduced this mortality rate have been multi-level: addressing social attitudes towards women, pregnancy and child birth; providing education for girls and the empowerment of women; increasing access to good quality obstetric and midwifery care (in the local community and in accessible secondary care institutions); and providing family planning services to allow better birth spacing, etc. We hold that the evidence suggests that only such multi-level interventions will have significant or lasting success in tackling maternal mortality; and further, that strengthening health systems for maternal health will have collateral benefits for other areas of health need.
3. Positive engagement with religious leaders, communities and faith based organisations (FBOs) is vital, as they are not only significant providers of services, but also hold the key to challenging and changing social attitudes and values that can devalue women and their health needs.
4. Empowering women, and changing socio-cultural and religious values that disenfranchise women and girls and deny them access to healthcare and education, are priorities. This requires engagement with community leaders in general, and religious leaders and communities in particular, in their own terms and context, rather than imposing Western worldviews and values.
5. Single issue interventions are damaging to wider health needs in the long term. We advocate strengthening the broad range of health infrastructure and provision (both primary and secondary) in developing nations. This includes appropriate training (undergraduate and postgraduate), professional support for healthcare staff, and adequate provision of properly maintained equipment with appropriate supply chains.
An approach largely based on abortion and family planning seems to be somewhat missing the point in this case. What you are essentially saying is that you are too poor to have children and so we are going to strongly advise you not to, and help you abort any child that slips through the first net. This doesn’t really empower anyone, or make their life particularly any better. It is not a methodology we would welcome in this country i.e. “we are cutting back on maternity wards so here is a free abortion voucher and some condoms”, so why exactly are we trying to push it on developing countries?
Additionally, as mentioned before, the whole thing neglects to mention the rights of the unborn child.
What women need today is to get out of poverty.
Stopping and preventing wars are badly needed today for the benefits of women and all people.
Culture sensitive Health education is important for having a healthy society.
Proper funds are needed today in order to organise the free health services to women and to all poor people.
Please DFID Don’t give money to Governments and hold NGO’s ,working in developing countries, very accountable for their use of the money given to them. Work with missionaries actually living with the poor and who are trying to help them to help themselves.
Start with a clean water supply, decent sanitation and fuel supplies which will give safety to children and women.Train local bicycle doctors and nurses, birth attendants, encourage beast feeding and provide an immunisation program. Give small grants for food growing and animal husbandry to help women feed their family and pay for basic education.
Educate girls to raise the level of their self esteem, encourage the delay of sex untill at least 18years and teach the Natural Family Planning method to them, to be used in a stable and committed relationship providing protection from sexually aquired diseases and early unwanted pregnancies, be honest and tell them that abortion brings it’s own risks for them.
Educate boys and men to take a pride in their families and country and stop relying on hand outs from the western world or their own corrupt governments, who will take the rich resources of their countries for themselves and will do little to raise the levels of their own poor. Provide new roads, railways, electricity, agriculture for their own needs not for western demands, canning industries etc.
It is in the interest of the rich to ignore and keep the poor down, providing contraception and abortion only helps the Pharmacutical industry and the anti life lobbies who mistakenly may think they are helping, better to leave the people to fight for their own rights than to pretend to help in order to aquire what we want from their country
Debate on abortion is normally centred on the argument of morality or immorality. Like any other arguments that are based on moral values, there will never be a consensus and that debate will continue for many years to come. Similarly, the medical, religious, legal and philosophical arguments do not bring the two opposing views any closer, simply because the issue of morality cannot be excluded in the decision making process.
It is important to note that history tells us that, all cultures of different religions have been terminating pregnancies going back from the time human beings lived on earth. There is no one group of people, religion or otherwise that invented abortion. Equally every culture, society, country has had the means, ability and reason to perform abortions, with the one objective – to end an unwanted pregnancy. Reasons for abortions range from medical/health (child or mother) political on population control (China), or social expectation/convenience in the case of teenage pregnancies or using abortion as a form of contraception.
While abortion is an age old practice, recent attitudes, technical procedures, religious doctrines and laws pertaining to abortion have changed. Abortion was previously a practice that women undertook in private. It was always the preserve of women to perform abortions, with the procedure being undertaken by a midwife or another trained layperson.
The discussion and debate about when a foetus becomes a baby thrives, however the issue of whether the pregnancy is wanted at all becomes the steering factor. Even with all the advances in medicine and changes in technology, there remain terminations on medical grounds, which extend to whether the foetus is the right sex.
Developed countries have gone to the length of putting provisions in place to protect the rights of both unborn and mother. By contrast, undeveloped countries have gone to the extent of criminalising abortion and yet the practice still goes on in these countries using old methods or paying doctors privately who have to cover up their actions. The result of this is that any complications that occur cannot be openly addressed so there are higher mortality rates for women.
The woman is disempowered in this system. The unnecessary deaths and complications which befall these women may well be avoided if there was a system of legalised abortion. This should not be seen as advcating for abortion per say, but as advocating for the safety and the provision of healthcare for the women who find themselves in that situation.
We agree with DFID’s emphasis on women and children in addressing development issues and the themes highlighted such as the Unmet need for family planning; Adolescent fertility; Unsafe abortion; Antenatal care; Skilled attendance at delivery; Emergency obstetric and newborn care; Newborn deaths; Prevention of mother to child transmission of HIV; Nutrition; and Malaria in pregnancy. These are all very important issues to reduce maternal and child mortality and they are interlinked to a large extent.
Aim 1:
Minimise acute and chronic maternal and child undernutrition in both development contexts as well as in humanitarian, fragile and conflict-affected states in order to prevent its acute/short-term and chronic/long-term impacts. In the short term, consequences include mortality, morbidity and disability. In the longer-term consequences include reduced adult-size, diminished intellectual ability, restricted economic productivity, reproductive performance as well as metabolic and cardiovascular diseases that blight the lives of those who are lucky enough to survive. This should include addressing chronic energy and micronutrient deficiencies as well as provision of safe water in its capacity as an essential non-calorific micronutrient. Safe water is also essential for personal, household and community sanitation and hygiene, particularly during pregnancy and lactation.
Aim 2
In order to enable women to breastfeed as fully and adequately as recommended, women need to have their workload reduced as much as possible. Reliable sources of safe drinking water, work close to home, national policies that protect a woman’s right t o breast feed fully and other such initiatives will help greatly towards preventing 1.4 million deaths in children under 5 years attributed to suboptimum breastfeeding.
Aim 3
Target women who have the greatest need and create demand and enable access to health care services in rural and urban areas, for the poorest, least educated and/or unemployed.
Rationale:
Prevent stunting in all children, most especially females in the most vulnerable groups. Stunting (short height-for age) in girls increases the risk for adverse pregnancy effects on their pregnancy outcomes such as caesarean section. Minimising stunting will reduce the requirement for skilled birth attendants and the need for advanced medical interventions. This is particularly desirable when it is well documented that the majority of women in developing countries deliver their babies at home and have minimal access to antenatal care or medically supervised birthing suites. It will take years to increase skilled midwives to attend to these women. In the mean time, we should scale up what we know minimizes risks for women, i.e. ensuring the nutritional well being of women before and during pregnancy and whilst breastfeeding. Low maternal weight or body mass index is associated with increased risk for reduced growth of the child whilst in the womb or intrauterine growth retardation (IUGR). Stunting, severe wasting, and intrauterine growth restriction are together responsible for 2•2 million deaths child deaths under 5yeasrs of age. Decreasing neonatal deaths therefore also depends to a significant extent on ensuring mother have access to and consume an optimal diet during pregnancy and lactation.
Even though maternal undernutrition has a minimal effect on the amount or quality of breast milk, unless in the case of extreme malnutrition, the concentration of vitamins such as Vitamin A, iodine, thiamine, riboflavin, pyridoxine, cobalamin and Vitamin D in breast milk are dependent on the mother’s diet and ensuring an adequate intake of these vitamins during pregnancy and lactation may mitigate the requirements for child supplementation programmes.
This is my first time i visit here. I found so many interesting stuff in your blog especially its discussion. From the tons of comments on your articles, I guess I am not the only one having all the enjoyment here! keep up the good work.
We believe the following priorities should be chief in designing the program:
- Reaing the poorest, most marginalized and vulnerable populations
- Ensuring full and comprehensive Family Planning, including working towards an access to family planning services
- Increasing programmtic focus on youth, including developing youth-friendly services and ensuring comprehensive sexuality education
I would first like to congratulate DFID for all that you are doing towards helping to achieve the MDG goals 4, 5 tand 6 – towards improving maternal health; reducing child mortality and tackling HIV/AIDS and other diseases such as Malaria.
I am sure this consultation will go a long way in helping you to hear what peope around the world have to say on the subject of reproduction, maternal and new born health and especially towards reducing child mortality.
I personally believe that the best way to achieve these goals is in educating the people concerned. Their would be much less risk of pregnancy – whether it is unwanted or unintended if the society concerned had more education – particularly in learning about not going into relationships before they are mature enough to cope with those relationships: Learning about character development (not just sex education). Teenagers are involving themselves with sexual partners before they have even grown or matured into ‘adulthood’ themselves. Teenagers (being the most vulnerable – as pointed out in your consultation – and of course their peers – all men and women in their societies) need to understand that having respect for each other and of course for themselves; (and their bodies); their partners and the future of their societies (or in other words, the children of their future), needs to be the first seeds to plant. This of course doesn’t only apply to teenagers, but to all women and men of society. Teenagers (as an example) need to learn to wait before entering into relationships that they are clearly not ready for. Men and Women need to learn how to set precedents in each other’s lives: They each need to accept that there needs to be respect for negotiation, having choices, human rights, empowerment, independence and each to have control of their lives.
The issues overall run much deeper than a few comments on this document, but I believe that this would be a way to safeguard themselves and each other and protect the yet unborn child, unwanted abortions etc.
This Education would also need to work alongside other good pratices already in effect, but certainly should be one of them. Fundamentally, because this is a core issue and prime attention needs to be given to the core problems that exist.
Introducing core education values on issues to raise awareness, understanding and empowerment will also help societies to address MDG 6 – in tackling HIV, Aids and other diseases.
I hope that the goals that the DFID is hoping to attain, ie “to ensure that every pregnancy is wanted and every birth is safe…”, can and will be achieved. I believe in this statement too.
It is quite a big statement in consideration of the 75 million unwanted pregnancies : Especially considering that of these; every year 35 million of all pregnancies in the developing world end in induced abortion: With a further estimated 20 million of these abortions being unsafe; resulting in up to 70,000 maternal deaths each year. That is a high toll.
But, again, I believe – alongside the DFID – that these goals can be met, if a substantial part of the budget on behalf of this consultation can go into the Education side of this major global concern.
If society just sticks a plaster on it – the issues may never heal…and, may never get resolved…
What is needed are the ordinary humanitarian answers to maternal health and survival of their babies – clean water, good food, education, maternity services and most of all the education of men so that they know these things are needed by their wives and daughters.
There are many ways of reducing maternal deaths such as better and more widespread training of midwives. However, it would be a totally false notion that reducing maternal deaths should be achieved by increasing the availability of abortion. It would be wrong to attempt to reduce one form of death by simply increasing another. The unborn have as much right to life as anybody else. One of the strongest proponents of the right of the unborn to a life as much as anybody else was Dr. Mildred Jefferson, an American civil rights pioneer who recently died. Her famous explanation to the American Feminist magazine in 2003 for why she dedicated herself to the fight for the right to life was that: “I am at once a physician, a citizen and a woman, and I am not willing to stand aside and allow this concept of expendable human lives to turn this great land of ours into just another exclusive reservation where only the perfect, the privileged and the planned have the right to live,” she said. It is important to protect the right to life of all unborn babies and not just those who are deemed by the condescending to be worthy of living. We should celebrate the diversity of all human life, whether the person is rich or poor, able-bodied or disabled, healthy or ill rather than promote the culture of death.