Last week I joined other leaders at the United Nations to review progress toward achieving the Millennium Development Goals, and discuss the future of global health and development. As I prepared for that meeting, I was haunted by the memory of a letter I received years ago.
I was serving as Botswana’s Minister of Health when I got the letter from a seven-year-old boy in a rural village. In neat, careful penmanship, he wrote that he had a huge problem: his mother was dead, his father was dead, he was living with his grandmother, and he had HIV/AIDS.
He had been told he didn’t have many years to live, but that medicines existed to help him. He had traveled with his grandmother to a distant clinic, but they were told the medicines were not available. “Can you help me?” he wrote.
I visited him and his grandmother. He was a brilliant little boy, receiving straight A’s in school, and he wanted to be a doctor to help other sick children like himself. I enrolled him in a support pilot through the Botswana-Harvard Partnership, and subsequently in the Baylor Children's Clinical Center of Excellence, after we had introduced the public sector ARV program. However he had started the treatment too late and he developed complications from an opportunistic infection. He died at age 13.
His death seared me, and I became determined that every single person in Botswana who needed HIV treatment would get it when they needed it. Many colleagues outside Botswana said I was unrealistic, that we should wait until prices came down.
I told them we couldn’t wait. I went outside my country to mobilize funds and my government committed to financing anti-retroviral drugs for all communities in Botswana.
In the years since then, we have made great progress in getting treatment to people living with HIV/AIDS. We have much to celebrate on other health and development issues, as well. Some of the Millennium Development Goals—on poverty reduction and safe drinking water, for example—have been reached ahead of the 2015 deadline.
But on women’s health, progress lags shamefully behind. Botswana can still do a lot more to save the lives of its women. Globally, every two minutes, at least one woman dies from complications related to pregnancy or childbirth–287,000 every year. Most of these deaths are completely preventable. We cannot wait for death to claim our women, newborns and children when the tools and interventions required to save them are affordable and easy to deliver.
Women die because they lack access to family planning commodities when they need them; quality effective pre-natal care; skilled birth attendants; emergency obstetric care and post-natal care. Only half of women in developing countries receive the recommended health care during pregnancy, at delivery and after delivery. Many die from unsafe abortions, because they are unable to prevent pregnancies that are unwanted or dangerous. Some 222 million women in developing countries have an unmet need for contraception.
While women’s health has improved in many areas, stark inequities remain. A woman in Niger faces a one in seven chance of dying in childbirth; for a woman in Sweden, that risk is only about 1 in 30,000.
The region I come from, sub-Saharan Africa, still accounts for more than half of all maternal deaths. Although we have made great strides in many areas of public health—for example, in access to prevention, treatment and care for HIV/AIDS and tuberculosis, and the control of malaria—we have dropped the ball on maternal and reproductive health. Sub-Saharan Africa still has the highest proportion of unmet need for contraception, the highest maternal mortality ratio, and the highest number of deaths from unsafe abortion. The Every Woman Every Child independent Expert Review Group’s 2013 report to the UN Secretary General, reflects that out of the 47 African countries targeted in the initiative, only Equatorial Guinea, Eritrea and Egypt are on track to achieve the Millennium Development Goal 5 on maternal and reproductive health.
This week at the UN, the Secretary-General and leaders from around the world restated their commitment to maternal and reproductive health. This high-level support is necessary and must be accompanied by a robust accountability mechanism at the country level. This comprehensive, transparent mechanism must have monitoring, review and response/action processes engaging all stakeholders at every level. This means that the village elders, mothers and fathers and in-laws, aunts and uncles, husbands and brothers are fully engaged with the health system as partners in the health of their women.
In the end success will be a product of our own effort and commitment.
I still think of my young friend, always in my heart, who wrote me that beautiful letter. And I think of my sisters–young and middle aged women across Africa, and around the world–who risk their lives to bring new life into the world. Like my young friend, their lives are on the line. They cannot wait any longer.
Joy Phumaphi is Chair of the Aspen Institute Global Leaders Council for Reproductive Health. She is the Former Minister of Health of Botswana and Former Vice President of Human Development at The World Bank. Follow the Aspen Global Leaders Council for Reproductive Health on Twitter at @GLCRHresolve.