Claire Moore (Queensland, Australian Labor Party) Share this | Hansard source

by leave—This evening at the inaugural EMILY's List Oration, which was held in the theatrette upstairs, the Prime Minister, Julia Gillard—amongst other things—announced the appointment of Australia's first Global Ambassador for Women and Girls. Ms Penny Williams, a career public servant in the Department of Foreign Affairs and Trade, has taken on this appointment. Her role will be absolutely essential in the development of Australia's work for women and girls, not just at home but across the globe. The Prime Minister said that in her role Ms Williams will ensure that the needs of women and girls are properly represented in Australia's overseas development program and in foreign policy more broadly.

I have spoken many times in this place about the enormous need for the role of women to be acknowledged. We know that women make up two-thirds of the one billion people in the world who lack basic literacy skills, with almost 35 million girls worldwide not getting even basic primary-level education. The Millennium Development Goals, which are a commitment from all countries on this planet, are particularly focused on empowering women to ensure that education levels are attained, that women have appropriate health services and that women are engaged in political decisions and their own lives.

It is extremely important that Ms Williams receives the support she will need to make sure these goals are reached not only here in our own nation but, most particularly, in the Asia-Pacific. The government has agreed that Ms Williams's role will focus particularly on the Asia-Pacific region. We know that this area—our own neighbours—was ranked lowest in the world by the United Nations Development Programme on a range of gender indicators, including access to education, employment and political participation. I congratulate Ms Williams on her appointment. It is a real challenge for her and our country, and it is important that we are there to support her in her role.

My major comments this evening, though, are around a focus we had in August, when Dr Sid Naing, Country Director from Marie Stopes International in Burma, along with the Parliamentary Group on Population and Development, hosted a parliamentary breakfast where many parliamentarians and people who work in this place, as well as those interested in international development issues, came together to find out more about some of the important work the Australian government supports in our region.

Marie Stopes International provides family planning and reproductive health services to some of the poorest men and women in over 42 countries around the world. Last year their services prevented over four million unintended pregnancies and over 13,000 maternal deaths—again, clear areas under which the MDGs are being assessed across the globe. Ninety-nine per cent of the health impact is directly for women and men in developing countries. It is estimated that these services will save healthcare systems in developing countries US$650 million dollars. The economic benefits for families who are able to manage their family size is immeasurable. We know that this is the key to reducing the crippling effects of poverty and inequality, and for this reason our aid program has prioritised maternal health interventions in a number of priority countries.

At the parliamentary breakfast Dr Naing presented on some of the daily realities of delivering family planning and reproductive health services in Burma. Marie Stopes actually produces a factsheet on the issues around Burma, or Myanmar. One of the comments we did make was that you are going to offend some people no matter what you call the country. I will use Burma this evening. We got a quick snapshot of this wonderful, troubled and beautiful country. Burma's health indicators are among the worst in the Asia-Pacific region, and that has been established in the UN process. One woman dies for every 260 babies born—a rate 40 times higher than in developed countries. Only one in three women use any modern method of contraception, have access to it, know how to use it and can make decisions about their own health. Less than two per cent of GDP is spent on health care. There is no provision for family planning in the government's health budget and skilled healthcare professionals are extremely limited. An underfunded and underresourced public health system means that services delivered by non-government organisations are essential in order to create access to even basic healthcare. Marie Stopes International is one of the very few providers able to work in Burma, and since 1998 it has provided best practice integrated sexual and reproductive healthcare services to hundreds of thousands of people in the area.

Dr Sid Naing, who spoke with us, could talk from personal experience working in the field. The challenges of reaching the poorest of the poor with essential reproductive and maternal health services are beyond the imagination of most of us. Most public health facilities lack adequate equipment and are without skilled staff to provide the services. There is currently no provision of family planning within the national health budget, meaning that without the support of organisations like Marie Stopes International more women and men will simply not access family planning and will resort to more unsafe abortions as a means of managing their family's size. Dr Naing and his team work with public providers by training them, refurbishing the site, making sure there is the necessary equipment and working side by side to deliver life-saving reproductive and maternal health services. They also deliver services through their 24 independent clinics and mobile teams. These different channels mean that they are able to reach the urban poor, the displaced, and remote communities. Many of these people are unable to get to a public facility. Last year alone the Marie Stopes team in Burma delivered 300,000 voluntary family planning and maternal health services to women and men. Dr Naing, a highly regarded doctor in his own country, came from the UN to work with Marie Stopes International after seeing his niece needlessly die after receiving a backyard abortion.

Stories like these remain a common feature of women's lives in Burma. Only 33 per cent of women are using contraception, yet 50 per cent say that they want no more children and another 20 per cent of women say they want a break before becoming pregnant again. It is no surprise that pregnancy related complications are the leading causes of death for women of reproductive age. Meeting the family planning revolution and eradicating unsafe abortion is achievable, and voluntary family planning is a 'best buy' in global health and development. Investment in reducing the rate of unintended pregnancy is the quickest, cheapest and most effective strategy to reduce maternal deaths.

The Australian government is an active member of the International Alliance for Reproductive, Maternal and Newborn Health. The purpose of this alliance is to ensure a harmonised approach to improving women and children's health outcomes and to make sure that important areas, such as increasing access to family planning, stay on the agenda. Membership of the alliance includes DFID—the UK aid agency—USAID and the Bill and Melinda Gates Foundation. Membership of this alliance reminds us that we are not alone. We do have allies and we also have evidence based policy that is up there with some of the best in the world. But we do need to stand up and continue to ensure that these high-level commitments translate into more services on the ground that will reduce the needless deaths of the poorest women in the world. This must be our challenge.

The Australian government has committed to investing $1.6 billion in maternal and child health in the countdown to the Millennium Development Goals 2015 deadline. We must ensure that women benefit from this funding, and we must ensure that this funding is fairly allocated and invested in preventing those unintended pregnancies that lead to maternal death and disability. We know, and I have said it many times in this place, that adequate investment in family planning and reproductive healthcare means that current initiatives—the things that work and can demonstrate impact—are scaled up to reach even more of those with an unmet need for family planning. We must show leadership in this area and meet our commitment to millennium development goal 5, which is to improve maternal health, measure the impact and communicate that to everyone in our community.

Focusing on MDG5 is a priority. It is the most underperforming of all of the goals, yet maternal deaths are largely preventable. We have the knowledge and technology we need to prevent maternal deaths. There is evidence and agreement on what works. These are good, client centred, voluntary family planning programs that include access to long-term or permanent methods such as IUDs or vasectomies, skilled care for mothers and newborns, and access to immediate family planning methods to prevent further unintended pregnancies. If done well, these interventions will reach the poor, the young and the remote; they will strengthen health systems, and make the private and informal health systems better. Meeting MDG5 will positively influence every single goal. A mother's death has an impact on an infant's survival. Access to family planning—a vital MDG5 indicator—will see human rights realised, poverty alleviated, lives saved, women empowered and development efforts sustained. Women need choice and deserve safe, affordable, quality services in a service setting that suits their needs. This means working with public providers so they can deliver better services out of a government facility or out of an independent clinic, and it includes being able to cheaply access contraceptive methods such as pills and condoms at the community level from a trusted community member with good referral pathways to services for women and men.

In countries where there are simply not enough medical staff we need to think of alternatives. For example, in Cambodia after the genocide fewer than 25 doctors survived. If there are not enough doctors, can a midwife be trained to do this service? Of course they can. If there are not enough midwives, can a nurse be trained to provide this service? And what about a local health worker? For the types of services we are talking about the answer in many cases is 'yes'. If we are able to meet the needs of women and men and drastically reduce maternal deaths, innovation in healthcare delivery is essential. This is how pioneering organisations are able to meet women and men's family planning needs. In Cambodia and Timor Leste, Marie Stopes runs a Midwives on Motorbikes program, bringing contraception to the poorest women in the most remote villages. It is this kind of creative thinking and commitment to excellence, despite all barriers, that will complete the family planning revolution and eradicate unsafe abortion.

Recently Senator Trish Crossin and I had the opportunity to visit Timor Leste and meet with the Marie Stopes clinic in this area. I particularly want to acknowledge Mary and Mai who spent time with us and introduced us to their staff, who are local, committed midwives operating the program about which I spoke. They take services into the remote community and work with women and their families and they are there for their health services.

One of the stories we heard was about a woman called Marciana who is 38 years old and has eight children. She lives in a remote mountain village in Timor Leste about six hours drive from the nearest hospital. After miscarrying her ninth child she was worried about falling pregnant again so, when she heard that an outreach team was coming to a nearby village, she decided to find out about her options. Marciana had never had access to family planning before but, after discussing the different types of contraception available to her with a local trained midwife, she decided to have an IUD.

However, when Fernanda, a midwife from the Marie Stopes team, examined her, she immediately realised that Marciana needed emergency surgery because she had had complications from her recent miscarriage. If this had not been treated immediately, infection would have set in and Marciana would almost certainly have been another sad statistic. Fernanda, the local midwife, gave Marciana an injection to help stop her bleeding, safely inserted the IUD and gave her antibiotics. Then Marciana could go home to her own family and make sure that she continued to live her life. Doing this kind of work is not easy. It requires focus, adequate investment and talented individuals at the front line. We do not hear enough good stories like that of Marciana's and how the tireless efforts of field staff ensure that the good work continues in the most difficult settings in countries like Afghanistan, Sudan, Yemen and even closer to home in Papua New Guinea where Marie Stopes International is also active.

As a result of the recent independent review of aid effectiveness, AusAID is currently investing in improved monitoring of our aid program. We need to measure our impact and we need to share 'what works' far and wide. There are global, peer reviewed research tools available that can capture our impact so that all Australian non-government organisations implementing maternal health activities can demonstrate the outcomes of their effort, including working to MDG5 level, such as improving the contraceptive prevalence rate and responding to the unmet need for family planning. If we capture this data, we can then stand up and be counted alongside our global partners and say: 'We have done what we committed to. We promised that we would reach the MDG goals and we now can do that.'

We also must keep alert to any efforts to take the MDG5 off track. Restricting information and programming that goes against the international evidence and the MDG indicators, which we signed up for, must be monitored. We must speak out and just say that it is not good enough. This will not reduce maternal deaths and is not good for women. As Australians, we take for granted our right to manage our family size. But many of us sitting here today do not really know families in our current world that have nine, 10, 11 or even more children. We need to ensure that women have the right to choose and we need to know that they can be empowered to make that choice. We need to have that sense that the community is behind them and that we understand the service that can be provided to them.

We are on track to reach the Countdown to 2015 and we must have adequate investment and good quality reproductive and maternal health interventions and we must ensure that this progress will be protected. We now have a Global Ambassador for Women and Girls in our own structure. One of her jobs will be to ensure that MDGs are kept on the agenda and, in particular, that MDG5, 5A and 5B, which look at issues around reproductive health, will be on the agenda, that we will be able to ensure that women like Marciana in East Timor and so many other women across the globe will have safe health and that we, in Australia, have been part of the solution, not maintaining a problem.