The opening plenary, Global progress on maternal health: the numbers and their implications, of the Global Maternal Health Conference 2010 in Delhi focused on global progress on maternal health and explored recent maternal mortality estimates. Speakers discussed the numbers and asked questions not only about what the numbers mean–but also about how the maternal health community can use the numbers.
Over-arching questions from the session were:
Which numbers should we use, those published in the recent Lancet report or those soon to be published by the United Nations (presuming that the numbers will be quite different)?
Will these two sets of numbers prove to be a hurdle in the struggle to bring unity to the maternal health community? If so, how can we reconcile this and avoid a divide in the community?
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Will the two sets of numbers push the maternal health community to establish better and more robust methods of measuring maternal mortality and morbidity?
Has the maternal health community collectively neglected the measurement of maternal morbidity–and how can we begin to focus on measuring not only mortality but morbidity as well?
Brief insights from the opening plenary speeches:
Rafael Lozano, Professor of Global Health at the Institute for Health Metrics and Evaluation, succinctly summarized the statistical analysis behind the recent Lancet publication in one slide. (Presentations will soon be available online here: www.maternalhealthtaskforce.org/gmhc2010) He also described many of the lessons learned from the research that led to the Lancet piece–the gaining of ground in the reduction of maternal mortality, an improved picture of what the key drivers of progress really are, the correlation between HIV/AIDS and maternal health outcomes, and the importance of communication with countries and local researchers.
Lale Say, Medical Doctor and Epidemiologist at the World Health Organization, discussed the inter-agency approach of monitoring progress on maternal health–stressing the importance of country level consultations and technical collaboration. While she did not present the latest maternal mortality estimates, she talked in depth about the methodology that the World Health Organization, UNICEF, UNFPA, and the World Bank use to estimate global maternal mortality.
Wendy J. Graham, Principal Investigator with Immpact at the University of Aberdeen, urged the maternal health community to understand that failure is not a bad word. She explained that we often emphasize the successes of our efforts so much so that we neglect to learn from our failures. Wendy also reiterated the importance of context when implementing maternal health programs saying, “context, context, context”–and explaining that because an initiative succeeds in one place, there is no guarantee that it will succeed in the next. We must consider the unique context of each setting where we work.
Saroj Pachauri, Regional Director for South and East Asia at the Population Council, asked a number of thought provoking questions throughout her presentation; We count numbers but do numbers count for policy change? Is there a culture of evidence-based programming? How can we address measurement challenges and improve the use of information? Saroj also noted staggering inequities in maternal deaths between and within countries. She explained that the lifetime risk of maternal death in South Asia is 1 in 43 compared to 1 in 30,000 in Sweden–citing this as an example of a failure to bridge the divide between rich and poor.