Marise Payne (NSW, Liberal Party, Shadow Parliamentary Secretary for Indigenous Affairs) Share this | Link to this | Hansard source

I want to speak tonight about the 2009 UNICEF State of the World’s Children report. Every minute somewhere in the world a woman dies from complications in childbirth—more than 500,000 women every year. The vast majority of these deaths, around 99 per cent of them, occur in developing countries. Millions more suffer from disability, disease, infection and injury. If you are a woman in sub-Saharan Africa you have a one in 16 chance of dying in pregnancy or childbirth compared to a one in 8,000 chance in the developed world.

The causes of maternal death and disability vary. Haemorrhage, infection, obstructed labour, hypertensive disorders in pregnancy or complications from unsafe abortion can lead to injury or death. For children below the age of five, at least 20 per cent of the burden of disease is related to poor maternal health and nutrition as well as quality of care at delivery and during the newborn period. Annually, eight million babies die before or during delivery or in the first week of life. Many children are left motherless each year and are then 10 times more likely to die within two years of their mothers’ deaths. Malaria is another risk. It can lead to anaemia, which increases the risk of maternal and infant mortality and developmental problems for babies. Nutritional deficiencies contribute to low birth weight and birth defects. Of course, HIV infection is an increasing threat and is becoming a major cause of maternal mortality in southern Africa. In fact, up to 45 per cent of HIV-infected mothers also transmit infection to their child.

Frustratingly, so many of these deaths and diseases are preventable. Access to skilled health care during pregnancy, childbirth and the first month after delivery is key to saving women’s lives and the lives of their children. In the last few years, in pursuit of the Millennium Development Goals, much effort has been directed towards reversing these devastating effects of poor maternal and child health in many developing countries. Of the eight Millennium Development Goals, two directly address maternal and child health. MDG4 is to reduce by two-thirds between 1990 and 2015 the under-five mortality rate, and MDG5 is to reduce by three-quarters between 1990 and 2015 the maternal mortality ratio and achieve universal access to reproductive health.

Plainly, though, the message is simple: healthy children need healthy mothers. The time and effort and resources that have been invested in achieving these MDG goals in particular have had some positive impact on improving maternal and child health. For example, vaccinations have slashed child deaths from measles. Antenatal care is actually on the rise everywhere. But those successes have been overshadowed by slow progress in many other areas. Deaths of children under five remain unacceptably high. Little progress has been made in saving mothers’ lives. An unmet need for family planning undermines the achievement of several other goals. In fact, progress is so slow that the MDG goal on maternal health—to reduce maternal mortality rates by three-quarters—simply cannot be achieved by the deadline in 2015. And just how far we have to go was highlighted in UNICEF’s 2009 report.

If you start at 1990, the base year for the MDGs, an estimated 10 million women have died from complications relating to pregnancy and childbirth and some four million newborns have died each year within the first 28 days of life. That represents around 40 per cent of all under-five deaths. Although the number of under-five deaths worldwide has consistently fallen, from around 13 million in 1990 to 9.2 million in 2007, maternal deaths are stubbornly intractable. Sub-Saharan Africa continues to fare the worst, with progress on reducing maternal mortality rates virtually nonexistent since the Millennium Declaration was signed. In fact, together Africa and Asia account for around 95 per cent of maternal deaths and 90 per cent of neonatal deaths. Two-thirds of all maternal deaths in the world occur in just 10 countries. India and Nigeria together account for one-third of maternal deaths worldwide, and India alone has 22 per cent of the global total.

Both premature pregnancy and motherhood continue to pose very considerable risks to the health of girls as well. The younger a girl is when she falls pregnant, the greater the health risks for her and her baby. Nearly 70,000 girls worldwide die each year as a result of maternal deaths related to pregnancy and to childbirth.

So on any assessment, and as the UNICEF report points out, maternal health has advanced very little in decades. That, according to the report, is the result of a multiplicity of underlying practice factors. It often reflects the overall effectiveness of national health systems, which in many developing countries suffer from weak administrative, technical and logistical capacity, from inadequate financial investment and from a lack of skilled health personnel. But we cannot walk away from the fact that the root cause may lie in the disadvantaged position that women still hold in many countries and cultures.

The report is actually quite dispiriting, but there are some reasons, we think, for optimism. Simply, most maternal and neonatal deaths can be prevented through adequate nutrition, through improved hygiene, through antenatal and postnatal care, through skilled health workers assisting at births and through emergency obstetric and newborn care. In fact, the research says that around 80 per cent of maternal deaths are preventable if women have access to essential maternity and basic healthcare services. They are not complicated interventions at all, but globally they require a great deal more activity from governments, both developed and developing, if we can ever make sustained reductions in global maternal mortality rates.

The report provides some way ahead. It proposes a human rights based approach to improving maternal and neonatal health which focuses on enhancing healthcare provision and addressing gender discrimination and inequities in society through cultural, social and behavioural changes, and through targeting those countries and communities which are most at risk. In practice, what that means is better health care and improved national health systems and education. It means antenatal HIV testing, increasing the number of births that are attended by skilled health personnel, by providing access to emergency obstetric care where necessary and providing postnatal care for mothers and babies. They could all sharply reduce maternal and neonatal deaths. And so would enhancing women’s access to family planning, adequate nutrition and affordable basic health care.

Educating women and girls is one of the most powerful ways of breaking the poverty trap and creating a supportive environment for maternal and newborn health. Early marriage and pregnancy, HIV and AIDS, sexual violence and other gender related abuses increase the risk of adolescent girls also dropping out of school and that entrenches the vicious cycle of gender discrimination, poverty and high rates of maternal and neonatal mortality, so education is a vital part of breaking that cycle.

It is not impossible or impractical to reverse these numbers, but it does call for proven cost-effective measures that women of reproductive age have a right to expect. This global financial crisis is likely to have a serious impact on funding for maternal and child health, and that is a very serious concern. The government and the opposition have both acknowledged this danger in discussions. The World Bank estimated recently that as a result of the global financial crisis it is possible that between 200,000 and 400,000 more children will die each year as the crisis continues. That is one of the most alarming statistics I have heard out of the entire GFC discussion, and the government has made some commitments to improve women and children’s health in the Asia-Pacific region and strengthen national health systems.

The coalition also had a strong record in supporting improvements in the areas of maternal and child health. In our last budget, we provided significant spending in health and education which was designed to strengthen the focus on the health of women and children, to see 10 million more children in the region in schools and to provide better education for another 50 million. Those coalition measures directly supported the achievement of the MDGs because, without better access to health and education, maternal and child mortality rates will remain dangerously high.

Better maternal and child health is—I hope—achievable, but it requires a really concerted international effort. It would be so much better if the 2010 UNICEF State of the world’s children report could have a more positive message than the 2009 report. The report’s message is simple and it is really worth repeating: healthy children need healthy mothers. I know that we can all support that. This is a report which is well worth reading and well worth looking at and it is well worth contemplating what we can do to raise awareness in our country and further afield about addressing the tragedies that I have spoken about tonight.

John Hogg (President) Share this | Link to this | Hansard source

Before proceeding to Senator Bilyk, I would like to acknowledge the presence in the chamber of former senator Rosemary Crowley. Welcome back. It is nice to see you enjoying the pleasures of adjournment in the Senate.