UNNGO Briefings - Department of Public Information of the United Nations Presented.
The Impact Of Education In Achieving Mdgs 2 & 5:
“Achieving the MDGs: MDG 2 (Education) + MDG 3 (Gender equality) + MDG 5 (Maternal health) = 8.”
The Role Education Plays In Improving Universal Primary Education And Maternal Health In Order To Achieve The Mdgs
On Thursday, May, 12, 2011 - United Nations, HQ, NYC.

Every 90 seconds a woman dies from complications related to pregnancy or childbirth. This translates into one thousand women every day. Almost all of these women (99%,) live in developing countries.

Gail Bindley-Taylor Sainte, the Information Officer for NGO Relations, and DPI, commenced the presentations by stating today’s briefing entitled, “Achieving the MDGs: MDG 2 (Education) + MDG 3 (Gender equality) + MDG 5 (Maternal health) = 8.” She said that the meeting would mainly focus on MDG 5 to understand how it is directly linked to all other MDGs (in particular MDG 2 and 3.) Every 90 seconds a woman dies from complications related to pregnancy or childbirth. This translates into one thousand women every day. Almost all of these women (99%,) live in developing countries. Studies indicate that by providing a quality primary education, great advances regarding maternal and infant health can be made. According to UNICEF, when girls are educated for six years, their childbirth survival rate improve. Educated mothers tend to immunize their children 50% more often than those who are not educated; And their children have a 40% higher survival rate. Moreover, those educated mothers are also more cognizant of the importance of a good education, and therefore are twice as likely to send their children to school. Empowering women and promoting gender equality are also significant for the healths of mothers and children. Being able to exercise their rights as women is key to their survival and development as well as that of their children. It is also critical to build healthy communities and nations. She then proceeded to show a film produced by the UN Millennium Campaign entitled, “United Nations Millennium Campaign: Goal 5, Maternal Heath.”

3.2 million newborns die every year and 99% of these deaths occur primarily in Sub-Saharan Africa and South Asia.

The first speaker of the panel, Dr. Rene Ekpini, the Senior Health Advisor and Chief of the HIV/AIDS-PMTCT at the Health Section of UNICEF, began talking about his background in the HIV world and how happy he is to be a part of this specific discussion. He shared a personal story of how his mother did not go to school, was married to a school teacher, had ten children, and had no power in terms of making decisions on reproductive health; but he learned the power of love, will, and dedication, the main elements that make NGOs the key actors for change in resource-limited settings. In 2000, 189 governments committed to achieving MDGs by 2015 and reduce maternal deaths by three-quarters. Eight years later, in 2008, an estimated 358,000 maternal deaths were still occurring worldwide. Although this demonstrated remarkable achievement, progress has been slow; we need faster reduction rates than this. Consequently, every day over 1000 woman die related to pregnancy and childbirth. For each woman that dies, about 20 women suffer short or long-term consequences due to complications related to childbirth and pregnancy. 3.2 million newborns die every year and 99% of these deaths occur primarily in Sub-Saharan Africa and South Asia.

Maternal mortality and mobility represent the greatest health problems in our world. The inequity between the poor and the rich and poor is unacceptable. We have evidence about what works to prevent women from dying of unnecessary causes. One of these causes of maternal mortality is the increasing HIV epidemic. HIV/AIDS is now a major cause of maternal mortality worldwide and particularly, again, in Sub-Saharan Africa. Other causes are associated with lack of access to medical facilities, poor-quality services, weak referral systems between communities, socio-cultural barriers, and lack of education. It is also very important to question ourselves when pondering why we haven’t been successful in addressing the causes of mortality among women. Mr. Ekpini believes some of these factors are limited commitment, failure to prioritize maternal and child mortality, lack of reliable data to track data and progress-making, poor coordination among programs, partners in the country-level, fragmented approaches to service-delivery, gender inequality, and finally, social, cultural, and economic barriers to improving existing services. MDGs 2 and 3 are strongly linked to maternal health and mortality. There is evidence that empowering women, educating girls, and promoting gender-equality greatly reduces these deaths. Women leading in the developing world: this problem should be considered in terms of our collective failure in assuring basic rights and improving the social and economic status, and lack of political commitment.

But we still have hope; when we look at the current momentum and commitment, its time for us to take action. High maternal mortality reflects unacceptable inequality. Mr. Ekpini then called on all NGOs, global partners, civil society, and governments to increase global and national commitment to improving the healths of women and children and to make sure we all deliver in our promises. We need to foster human-rights and gender-sensitive approaches at the counter level, increase investments in improving access to reproductive services, to focus our support on how new techs can improve service-delivery, and not look at supply side and the facility side but addressing the specific needs of communities by involving individuals, communities, and women in our battle to combat these problems.

The next speaker of the Panel, Mary Papazian, Provost and Senior Vice President for Academic Affairs, Lehman College, began her presentation by discussing how education can provide a framework for how maternal health can be addressed. She thinks MDG 1 is as important as numbers 2 and 3. We still face challenges to gender equality and education today, and any progress is momentary unless we make deep social, deep cultural, and deep political changes, and then remain vigilant in terms of the values we believe in and accept healthcare as a human right. In order to ensure that that perspective is there, we have to make sure we educate our next generations to understand the value of social justice and ensure our curriculum encourage multi lingual, multicultural understanding and what we’ve seen lately is that more and more of programs are actually under attack. For example, SUNY closed the language departments this year. Similarly, one of the positives we’ve seen in education is a commitment to social justice, like an increase in service learning and community service. She believes it is educators’ responsibility to ensure these students respect people who are of different backgrounds and that it takes a partnership to bring about permanent change.

She emphasized that there is a question of primary education for girls and the impact on them and their future choices. We need to have some humility; we want to promote women’s leadership but that we are one of those countries who have not yet had a woman president or few CEOs. Its important to have women in leadership positions not only in developing countries but also in developed ones like America! The more women we promote and provide opportunities, the more we can ask the right questions to create the right results. If we can’t do it in this country where we have econ stability, how can we expect it in developing countries? Stronger economic conditions will allow girls to go to school and continue beyond primary school. Girls need education through secondary school to really be able to make the right choices to make a noticeable difference in the numbers seen. They will not need to drop out of school to work and they will not need to be married off. Instead, they will have more time to allow them to stay in school, to grow and develop intellectually and physically, and through their education, they will gain greater respect for themselves and their bodies. We not only have to educate girls, but we have to take care of entire countries and cultures altogether. Family planning takes two – it takes both the men and the women. We have to bring men into the solution as partners and not obstacles by educating them as well. After all, when a mother dies, it affects the whole family – not the children alone. Education for family planning would reduce disparity and bring about gender equality. While we are doing this however, we have to take into considerations the values and morals of the people living in these countries. We have to approach them in a way that makes sense for them, not necessarily in a way that makes sense for us.

Many health programs in the field of healthcare have often brought people from developing countries into developed ones in order to give them training, but the problem is that we cannot bring entire societies here. So one of the key things to do is to go to these regions to educate them and to do it in a way that suits the infrastructure of those countries. If we bring the training there, we teach people how to fish – not give them fish. We all realize that progress is slow but history shows that progress can happen and Dr. Papazian believes we will eventually reach a tipping point where things change for the better.

Dr. Vijaya Melnick, Professor Emeritus of Biological & Environmental Sciences at the University of the District of Columbia in Washington D.C., discussed a paper named “Women’s Rights: Development and Social Justice." The UN conference on women, held in Beijing in 1995, affirmed that human rights of women and female children are an inalienable integral and indivisible part of Universal Human Rights. The full enjoyment of all human rights and freedoms by girl is essential for the advancement of women and MDG 3 underscores the importance of this point. Many human rights and women’s groups agree that the indicators and targets set for 2015 regarding women’s rights and equalities are limited. Women form the majority of the population, yet not a single nation can claim that women are treated equally as men. In fact, they are often referred to as a “vulnerable minority” because in many parts of the world, women are indeed a minority when it comes to education, property ownership, political participation, access to banking and credit, paid work, and healthcare. These are basic needs imperative to leading an independent life. By denying the expression of the full-potential of women and inhibiting the contributions, they could make nations retard their development.

“The scale of maternal mortality is in a front to Humanity. The time has come to treat this issue as a human rights violation, no less than torture, disappearances, arbitrary detention, and prisoners of conscience.”

Dr. Melnick then mentioned that we must ask ourselves the questions, “does economic strength define real development? Does it help us understand how people actually live and the economic and social statuses of their lives?” The conventional categories do not report on the rights and freedoms enjoyed by nations’ citizens or opportunities to maximize their personal fulfillment. More than half a million women die every year from complications of pregnancy and childbirth. Indeed, these tragic and preventable deaths are culminations of human rights violations against girls and women. The UN high Commissioner for Human Rights observed, “the scale of maternal mortality is in a front to Humanity. The time has come to treat this issue as a human rights violation, no less than torture, disappearances, arbitrary detention, and prisoners of conscience.” Governments have the responsibility to make sure women have access to a wide-range of reproductive services. The application of a human rights approach to preventable mortality and morality can contribute to more equitable, sustainable, and participatory programs and policies. Significantly, when we take the human rights approach to understand maternal mortality, it clearly shows that this is not just a public health or medical issue, but the result of failing to implement a range of right aid for women.

“Never doubt that a small group of thoughtful, committed citizens can change the world."

The seven human rights principles of accountability, participation, transparency, empowerment, sustainability, international cooperation, nondiscrimination, form the foundation of governments’ obligations. But what is missing is a global resolve to acknowledge that women are entitled to all their freedoms and their rights. Doing so is in the global interest of all the citizens of this world. We are our sister’s keepers; and unless we decide to take collective action, this world will remain with crimes against women. “We have much work to do and a long way to go, even as we swim against the tide” she said. Dr. Melnick concluded with the words “never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”

“How many is too many? How many mothers have to die before we commit to taking action?”

Dr. Sorosh Roshan, President of International Health Awareness Network (IHAN), began her presentation by asking the participants, “why is safe motherhood so important? Why must we make the eradication of maternal mortality our top priority? How did we all arrive here?” As an obstetric gynecologist, over the past forty years, she has had the honor of delivering 15,000 babies in different parts of the world. “When our mothers went into labor,” she said, “was she able to get to a medical facility? Were there trained healthcare professionals there to help her at that critical moment? After your mother brought you here, did she survive?” Dr. Roshan wants to partner with those who care about mothers. “How many is too many? How many mothers have to die before we commit to taking action?”

Every year, 350,000 women die giving birth to a child. Every 90 seconds a mother dies; we must honor our own mothers by honoring all mothers, and making childbirth safe. She believes translating this love into action to decrease mortality rates should be by 1) Developing a plan of action and providing trained birth attendants at facilities; 2) Broadening awareness among affected communities; 3) Ensuring that our decision makers take necessary action to bring about permanent change. She would like the public’s support to provide an obstetric care-training program. The goal for that program is to invite nurses from Somaliland, Sudan, and Tanzania and educate them on how to deliver babies. These are the 3 countries Dr. Roshan and her team are working extensively in and going to go back to, in order to save pregnant women in their own countries and communities.

Question & Answer Session

Q: Is there any family planning aspect to the collaboration between Lehman College and the IHAN program?
A: (Dr. Sorosh Roshan): Family planning is the essential part of any education for reproductive health. Of course in our initiative there will be importance given to the proper information given about family planning; Access to proper family planning will reduce infant mortality significantly. I refer to the article on Mother’s Day by Nikolas Kristof, which talked about how in Somaliland, the lack of access to Family Planning has been an essential factor for increased maternal mortality. Proper spacing of pregnancies is one of the first lessons of reproductive health. The body needs time to recover from one pregnancy to the next. Educated women are willing to use contraception if available to them. We need to educate men and women about the importance of pregnancies, spacing of pregnancies, and the issue of maternal health. The other important factor is when the health of a society has improved and mortality rates go down, then parents don’t worry about how many healthy children they can have and they don’t continue reproducing in the hopes of being able to keep a few. Our program will cover contraceptives in detail.

Q: Many African women living in the Bronx without documentation don’t have proper access to healthcare and information. Because they fear deportation, they are afraid to come out of their homes; how do we bring information to women who don’t even know that they have some rights and access to E.R.s?
A: (Dr. Rene Ekpini): I know the answer for West Africa but honestly I don’t know the policies in the US. But the point I want to make is that the same issue when talking of advocacy for women to care, to address their needs, and I think if you look at the implication for their health, and the implications for their families, it is very important coming from the NGOs and International communities, to make sure that this issue around immigration, population coming from less fortunate nations should have access to basic care. The problem is not specific to the US. Even when you look at the disparities in between the rural and urban settings in Africa, it is important to have policies where people have access to basic services.

A: (Dr. Mary Papazian): I want to add also that we have to be mindful about the way we approach communities and the way we use materials with these communities. These materials should be created by members of those communities because after all, they know what they need the most and how they can use those materials most effectively. Fear is one of the biggest hindrances for women seeking support in this area, and I want to go back to the subject of “sex:” this is important because its about a woman’s sense of “self,” her ability to say “no,” and the cost of saying so. This is where you have to work from the bottom up.

A: (Dr. Melnick): We had very similar experience when I was doing research to reduce infant mortality in D.C. We were trying to figure out how to reach mothers to educate them about maternal care, and ended up building many facilities and clinics. However, mothers would not come there precisely for that reason (not having documentation) and so they would not come and also the language barrier. So we persuaded the mayor to have an announcement to all health care providers in D.C. that they would not ask for any documentation that revealed authenticity for their being in the United States and their nationality. Finally that information was given to community leaders and social workers, and that got to the mothers and we increased the number of mothers coming to clinics through that effort. They were afraid for their undocumented nature and of course the hospitals gave them bills to which they didn’t have the money to pay. Therefore, for example, they would move and say their address changed to avoid the bills.

Q: What are we doing to prevent exporting our western medicine mistakes in these other developing countries?
A: (Dr. Mary Papzian): It is not so much that we want to replicate what we have here but we have to create programs that make sense for communities in which people will be working. We will bring people here to study but the idea is that they will become educators in their own regions. The resources, materials, and infrastructures won’t be the same obviously, but it is a start. So we have to think about what makes sense for those societies. If we listen to what they tell us and don’t always think we know the answer, then we can find a combination and bring expertise, educate, and empower people to evolve what we teach. There is a lot of give and take in this process.

A: (Dr. Melnick): I want to underscore that mistakes are no one’s monopoly. Western people, Eastern people, tribal groups, etc., everyone makes mistakes. What we have to be cognizant of is the fact that when we go to other regions, we have to first study their societies: how do they interact? What are the questions they are most concerned with? How do they provide care? What is it that they are doing right now? And under the international awareness network, we have conducted workshops and education seminars in a number of countries, and the best thing we do is to have people from those places talk to us – to make us educated about their circumstances, interests, and concerns. Once they do that, we develop a partnership to find out how we can help with the resources and knowledge we have and by using their experiences, how to optimize success. We respect the communities we go to, and believe in their knowledge and help them get their needs met.

A: (Dr. Ekpini): In line with what you’re saying, we have to keep in mind that we have to respond to the needs of the people we’re supposed to support. We cannot assume that we know best what we have to do. Along with the support we are providing countries, country ownership is critical. It is about partnership and country ownership; its about building national capacities to make sure that the support you are providing is sustainable, responding to specific needs, and being sure that when providing the support, it is in line with country policies. We have to make sure that at the community level, the intervention you are giving is in line with the basic principles in these communities.

A: (Dr. Roshan): Any country that IHAN has had any program in, we have gone by invitation. A Nigerian sister once said to me, “Why have you not been here?” And I told her “we have not been invited!” So our program begins with an invitation and we only go to the countries that we have members of the community part of our team. And as Dr. Melnick said, the first few days we only participate in their activities to get to know our host country. Then we learn what they want us to do and what we can do, to move forward in a partnership.

Q: No body talked about sex, sex, and sex. I think the problem of women giving in, every time a man wants sex. Could you please address this issue?
A: (Dr. Melnick): I think that this is the reason why in my paper I thought that women’s rights is the key to many of these issues; their self worth, dignity and self-confidence is very important. No one can talk you into doing anything if you have those three things. We have to have women consider themselves with their rights and work with societies that do not give those rights. We know, for example, that in countries like Saudi Arabia, you need to get permission to drive. Some women tested this rule (some were doctors, some were lawyers) and their passports were confiscated. So there are societies that restrict these activities and suppress women. This is where we have to work towards the strengthening of women as a global entity, and consider each of them our sisters.

A: (Dr. Papazian): This is where we have to engage the full society. We also realize that women live within a larger society, and men have to be a part of the solution, not only a part of the problem. I was reading an article on female genital mutilation recently, and young girls want to be mutilated, because they say, “if I am not, I will not be accepted.” That is a tremendously difficult problem to solve. I agree – all these issues are important, but I think the issues that we can have the greatest impact on are those that specifically injure health and cause death. When we start with those issues, no culture can stand up with a straight face and say, “the result of death is what we admire.” Just by working on that, you empower women and slowly change the culture. Where we really have to draw the line is: when women are injured to the point of death, it is everyone’s problem, and we have a right to intervene.

A: (Dr. Ekpini): It is very important to consider society dynamics: Because you are dealing with the construction of cultures, we have to take into consideration the roles of men and women in this society. We must make sure we engage partners as part of solution. I want to give an example of what is going on in the HIV field: in terms of testing and counseling and we have women coming to clinics and being tested for HIV. However, if you really want to promote couple counseling and testing, it is very important to get men involved as partners.

Q: Women are strongly encouraged to have c-sections and I am opposed to it! Can you please address this issue?
A: (Dr. Roshan): There are times that c–sections will save the lives of the mother and child. There are also times that may be more convenient for patient or the doctor. I have had patients who have requested c-sections in order to avoid labor pains. My answer has been “I have to follow the rules and regulations of the hospital. There is an ethic committee in every hospital. If I do unnecessary sections, I will be called out and have to answer to the superiors.” So in good hospitals, it is not easy to do unnecessary sections. But there are times when there are obstructions during labor. For example, a baby’s head may not be able to get through the canal, and if you wait too long, you may have uterus rupture. The doctor has to be qualified, has to have good judgment, and I always tell my patients, “If you trust me, allow me to be the captain of this journey.”

Q: In developing nations where people do not have money, where disadvantaged will women get the cash to invest in healthcare for herself and her children?
A: (Dr. Melnick): I know for sure that disadvantaged women do not have bank accounts, so it is very difficult to get healthcare. I was recently in India doing medical workshops, and met with many doctors. During the course of that time, they discussed the problem of accessing healthcare even for the middle- class people because India is one of those countries where out-of-pocket money is one of the highest in the world. Some states provide free healthcare for poor and disadvantaged people, so we have evidence that it can be done. It really depends on the priorities a government has placed but many states do not have these priorities unfortunately. And I think the Indian government is working on a policy to provide some care for poor people. I don’t know how successful they have been, but I will go back there and report what I find.

A: (Dr. Ekpini): I think this is a central question. When you are dealing with primary healthcare, maternal health, and child health in resource-limited countries, there are three main parameters we have to look at: The first one is the availability of services. It is very important that the services you are providing are there. The second is about the quality of the services you are providing, and the third is about service utilization. You can have good-quality services, but women won’t come to use those services for various reasons. That is why it is very important to have what UNICEF is pushing for right now: the equity focus approach, which is making sure we have a clear understanding of why women are not coming to use the services. It could be cost reasons, cultural reasons, religious reason, but even indirect reasons such as transportation: taking into consideration what a family would have to sell in order to go to the hospital. You have to look at the cost of the service of the drugs and services provided in the hospital. We all know the issues about the constraints in terms of personnel motivation and human resource, so we have to improve the services and training of healthcare professionals.

A: (Dr. Papazian): I think America is a great model for this question, and we probably don’t want to export our mistakes. It comes down to, as a society, do we believe that health and healthcare is a human right?” If we do, as a society, we have to make the proper investments to make it possible.

The Briefing was attended by 140 NGO representatives of NGOs.

- For the DPI's Announcement of this Briefing
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