Amy Boldosser, a member of Family Care International’s global advocacy team, was in Toronto from Thursday through Sunday, for the G8 and G20 summits.  Amy’s coverage of the summits is being posted on Blog 4 Global Health, RH Reality Check, and the MHTF Blog.

Written by Amy Boldosser

(June 29th, 2010) The G8 and G20 Summits wrapped up after a tumultuous weekend. The protesters clashing with police got all the press but there were important developments for maternal and child health, HIV/AIDS and reproductive health as well.

The G8 released the details of its Muskoka Initiative for Maternal and Child Health on Saturday, a five-year, $7.3 billion package for improving maternal, newborn and child health and increasing access to reproductive health. The G8 countries have pledged US $5 billion of new money over the next 5 years and an additional $2.3 billion has been committed by non-G8 member states and foundations including the Netherlands, Norway, New Zealand, South Korea, Spain, Switzerland, the Gates Foundation and the United Nations Foundation. The communiqué notes that the G8 countries “fully expect” to mobilize more than $10 billion between 2010 and 2015 but doesn’t provide details on where that extra money might come from.

The G8 members call this “a comprehensive and integrated approach to accelerate progress towards MDGs 4 and 5 that will significantly reduce the number of maternal, newborn and under five child deaths in developing countries.” The G8 is working with partners to achieve the Millennium Development Goals (MDGs) by 2015 with a particular focus on MDGs 4 (Reduce by two-thirds the under-5 mortality rate by 2015) and MDG 5 (Reduce by three-quarters the maternal mortality ratio by AND achieve, by 2015, universal access to reproductive health). MDG 5 is farthest away from being achieved by 2015 and estimates are that another $20 billion is needed if we hope to reach those targets for reduction in maternal and child mortality and reproductive health access in time. The Muskoka Initiative doesn’t come close to meeting that $20 billion shortfall, but it is a start.

While the funds committed may not have been all we hoped for, there were some pleasant surprises in the communiqué details.  The funds will support strengthened country-led national health systems in developing countries and will help them to deliver key interventions along the continuum of care from pre-pregnancy, to pregnancy, to childbirth, to infancy and early childhood. The funds can specifically be used for programs on pre-natal care; attended childbirth; postpartum care; sexual and reproductive health care and services, including voluntary family planning; health education; treatment and prevention of diseases including infectious diseases; prevention of mother-to-child transmission of HIV; immunizations; basic nutrition and relevant actions in the field of safe drinking water and sanitation. The communiqué for the first time ever commits G8 countries to “promote integration of HIV and sexual and reproductive health, rights and services within the broader context of strengthening health systems.” The mere inclusion of the phrase “sexual and reproductive health and rights” in a G8 communiqué seems like cause for celebration to me!

The G8’s recognition that there’s a need for money for a range of critical, complementary interventions is important as well. As the Partnership for Maternal, Newborn and Child Health points out in its statement on the G8, “hemorrhage is the biggest reason why women die after delivery, but with HIV at the root of 20 percent of maternal deaths globally — and higher in Africa — it is clear that we must take a wider view of health, as women themselves do.” The communiqué also included a commitment to work towards universal access to prevention, treatment, care and support for HIV and AIDS and to continue to support funding the Global Fund to Fight AIDS, TB and Malaria.  G8 governments also express support for strengthening health information systems and sharing of innovations such as using mobile phones to provide health information and task shifting to make better use of scarce health workers.

Notably missing from the communiqué, not surprisingly, was any mention of abortion. Protestors on the streets of Toronto were seen carrying a banner that read, “Maternal health includes abortion!” but this fact was not recognized anywhere in the Muskoka Initiative. Unsafe abortions account for 13 percent of all maternal deaths worldwide and complications from the 19.7 million unsafe abortions performed annually are a serious public health threat.  The communiqué addresses sexual and reproductive health care and services, but fails to recognize that safe abortion, when and where legal, is a critical piece of women’s healthcare access.

As the Summits concluded, new voices were added to the call for continued support for maternal and child health including the crucial voices of youth and developing country governments (with a rock star thrown in for good measure). The delegates to the official international youth summit being held concurrently with the G-8 and G-20 summits issued a statement calling on G8 leaders to “move quickly in creating a long-term maternal and child health plan for developing countries,” and identified lack of specialist training in the developing world surrounding prenatal and newborn care, and access to essential obstetric expertise as causes they would like to see the G8 take up.

Leaders from Algeria, Ethiopia, Malawi (Chair of the African Union), Nigeria, Senegal and South Africa were invited to meet with the G8 in a special afternoon session to discuss maternal and child health, highlighting the important role of developing countries themselves in this process.  The communiqué indicates that, “G8 and African leaders recognize that the attainment of the MDGs is a shared responsibility and that strategies based on mutual accountability are essential going forward.”

African Union countries have already committed to devoting 15 percent of their budgets to health and we hope that this new working relationship with the G8 will signal willingness to meet and exceed those commitments. At the G20 Summit, leaders of the world’s 20 largest economies also recognized the role that all governments, including developing country governments, must play in supporting maternal and child health initiatives. While it was disappointing that the G20 did not specifically mention the Muskoka Initiative, it did announce that it is forming a Working Group to examine how it can play a greater role in development issues-a step in the right direction.

Not be outdone, Bono, U2 lead singer and co-founder of ONE, issued a statement saying that:

Prime Minister Harper’s plan for the G8 on maternal mortality is not everything that’s needed to tackle the moral affront of millions of mothers dying in childbirth, but it is a start on a job that world leaders need to finish when they gather at the UN in September for a special session on the Millennium Development Goals.

So what can be achieved with the money and the political commitments that we did manage to get from the G8 and G20? The communiqué says that this funding will help developing countries to prevent 1.3 million deaths of children under the age of five, prevent 64,000 maternal deaths, and enable access to modern methods of family planning by an additional 12 million couples.

Along with the G8’s stated new focus on accountability, the funding targets and promises to monitor progress towards achieving reductions in maternal and child mortality and expanded access to reproductive health services will also give advocates specifics that we can hold the G8 accountable for. Finally, as we move towards the September 2010 UN High-Level Plenary Meeting on the MDGs where governments will be asked to make additional renewed commitments to achieve the MDGs by 2015, this focus on maternal and child health is important. The Secretary General of the UN has launched a Joint Action Plan to Improve the Health of Women and Children, and advocates are pressing for the serious financial and political commitments that will be needed to achieve the goals.

The G8 and G20 have helped put maternal and child health on the map at this critical time. But awareness raising and promises are not enough. The protestors on the streets were yelling, “Whose streets? Our streets!” We must take up the call, “Whose lives? Women’s lives!” No woman should have to die giving life. We know what to do to improve maternal and child health. The governments of the G8 and G20 put themselves forward as the richest and most powerful leaders in the world. But that leadership won’t mean anything if they won’t commit to saving women and children’s lives.