Meeting of SEAR-TAG members and H6 Regional Working Group towards reducing preventable maternal and perinatal mortality

15–16 January 2019, New Delhi, India

Professor Vinod Paul, Chair of SEAR-Technical Advisory Group on women’s and children’s health, Dr Pem Namgyal, Dr Neena Raina, distinguished TAG members and Regional representatives from H6 agencies,

Welcome to the fourth meeting of the SEAR-Technical Advisory Group on Women’s and Children’s Health.

For the past four years this forum has focused on newborn mortality, child mortality and adolescent health.

This time we will focus on reducing preventable maternal and perinatal mortality, including stillbirths, which remain a challenge.

The reason we are shifting gear, albeit ever so slightly, is due to the important recommendations the TAG has made in recent years.

It has, quite literally, helped save millions of lives.

It is widely known that between 1990 and 2017, for example, under-five mortality was reduced by 70%. Neonatal mortality was reduced by 60%.

Several countries in our Region have already met the global Sustainable Development Goal targets for under-five mortality, while most countries are expected to achieve this by 2030 at the latest. The same applies to the 2030 target for neonatal mortality.

Due to these and other successes, we can now expand our focus and find areas where we can – and must – do better.

While reductions in maternal mortality have been significant in many countries, particularly between 1990 and 2015, a few countries are off track to meet the 2030 goal of a two-third reduction on the 2010 level.

Similarly – but more pronounced – the reduction in stillbirths has been concerningly slow, with only 31.7% less stillbirths between 2000 and 2015. Barring a few exceptions, many of the Region’s countries will struggle to reach the 2030 target.

As you appreciate, these two problems – preventable maternal mortality and stillbirths – are interlinked and interdependent, with our Region accounting for a disproportionate burden of both.

The factors that cause them operate across the life-course, from before conception to pregnancy and on to delivery and the immediate post-partum period.

Though that makes these problems appear uniquely complex, it also means that with the right mix of quality services and high coverage of essential interventions, especially around the time of delivery, we can save the lives of many mothers and their newborns, reduce stillbirths and accelerate towards our own Flagship Priorities, as well as the SDG targets.

In particular, we see that where women deliver in institutions and are provided high-quality care, maternal and newborn mortality and stillbirths are reduced, meaning institutional deliveries must be promoted by addressing supply and demand side factors.

Indeed, this is the triple investment we are here to discuss over the coming days.

Promoting universal access to sexual and reproductive services, including family planning, as well as information and education, must be central to our efforts.

Across our Region, unwanted pregnancies remain high, while contraceptive use varies between just 22% and 79%. This is in addition to early marriage and adolescent pregnancy, which increases the health risks to both mother and baby. More than six million women Region-wide are treated for complications related to unsafe abortions each year.

In several countries, cervical cancer is responsible for more deaths among women than maternal mortality. We should all welcome the Director-General‘s call to action, which was made last year, to eliminate cervical cancer as a public health problem across the world.

I am pleased to note that in 2015 our Region developed a strategic framework for the comprehensive control of cervical cancer, with two departments at the Regional Office collaborating on the issue.

The following year a Regional Vaccine Action Plan was devised as per the Global Vaccine Action Plan, making special mention of the need to scale up HPV vaccination. Several countries have already integrated HPV vaccination within their regular activities, while others are still pursuing it on a pilot basis. Nevertheless, early detection and treatment has been taken up by almost all.

Importantly, even as we accelerate reductions in maternal mortality and stillbirths, and work for universal access to sexual and reproductive health, including by addressing cervical cancer, we must also pay attention to health system-related challenges.

That means focusing on human resources for health, particularly midwives. It means focusing on financing for health. And it means ensuring the quality and availability of essential medicines. In other words, it means achieving universal health coverage. This is especially the case given 15% of all pregnancies end in unpredictable emergencies, including maternal death, if they are not provided 24/7 emergency obstetric care.

We are particularly concerned at our Region’s shortages of human resources for health. There is a direct relationship between the density of human resources to maternal and child survival and well-being. In our Region, the human resources to population ratio is 27 per 10 000 population, with only two countries above the new WHO benchmark of 44.5 per 10 000 population.

By investing in human resources for health these deficits will be overcome generally, with flow-on benefits for RMNCAH.

But before we begin, I would like to emphasize three points, each of which is vital to our progression; none of which we can do without.

First, we must all remain committed to high-level advocacy around RMNCAH issues, ensuring that they are placed at the center not only of national health discussions, but national discussions more broadly. Advocacy remains one of our greatest assets and we must use it wisely.

Second, we must increasingly focus on direct causes of maternal mortality as well as indirect causes in low mortality countries. There is no reason women across the Region should be dying from preventable causes, nor ending up with stillborn babies.

And third, we must focus on neglected sexual and reproductive health issues such as post pregnancy family planning, comprehensive abortion care, post-abortion care and the prevention of cervical cancer. High quality sexual and reproductive health services are integral to any drive towards universal health coverage.

Distinguished TAG members, representatives,

Through the TAG forum and the H6 partners present today we can build on our substantial achievements. We can make a real difference to reduce maternal mortality and stillbirths, expand services for sexual and reproductive health and enhance the well-being of women and families across the South-East Asia Region.

Let us take advantage of that opportunity and gain as much out of the coming two days as possible.

I wish you a productive meeting.