In a Comment in this week's Women Deliver Special Edition of The Lancet, Editor Dr Richard Horton discusses the 10 reasons why he believes women and children remain invisible, despite more than two decades elapsing since the Safe Motherhood Initiative and exactly 20 years passing since the UN Conventions on the Rights of the Child.
- Social mission. In the 18th and 19th centuries, health was framed in a broad political context. In the 18th and 19th centuries, health was framed in a broad political context. But as the UN system has gradually quietened its political voice, so the social mission around women and children's health, especially gender equity, has been gradually extinguished.
- Our attitudes. Large numbers of the public remain unaware of the predicaments facing women and children, and some believe that a mother's or a child's death is simply not valued in the same way in some countries. Our attitudes can be unintentionally discriminatory. They strengthen the conditions for invisibility.
- Evaluation. Unless we invest in systematic rigorous evaluations of the effects of interventions in developing and implementing health policy, we will have no sound basis for turning fine words.
- Translation. Even when we do have science to guide policy, we frequently fail to apply it, compounding one invisibility with another.
- Prevention. The failure to address the causes of the causes of maternal and child ill-health only worsens invisibility. We simply have no collectively agreed plan to make the determinants of child and maternal survival core national or global health concerns.
- Integration. Our failure to integrate our science, practice, and advocacy hurts everyone, not least mothers and children themselves. (see linked Viewpoint).
- Empowerment. Too often, the health community ignores the potential power of women to mobilise for health. Maternal and child health advocates have still not fully learned the lessons of the AIDS movement— namely, that self-organisation can deliver not only political success, but also tangible improvements in health outcomes.
- Organisation. If empowerment is taken to a national or global level, even greater transformation can occur.
- Ninth, advocacy. Who is best placed to advocate on behalf of women and children? Co-opting high-profile figures who are utterly ignorant of the issues they are invited to advocate for may simply create confusion and breed suspicion—and add to existing invisibility.
- Leadership. Is it fair to say that the maternal and child health communities have many leaders, but no leadership? That statement may be harsh. But there is certainly insufficient coordination between groups representing maternal, newborn, child, and reproductive health. This lack of strategic alliance risks failing to take advantage of an important window of political and financial opportunity.
Dr Horton says the global health community needs to listen harder to the voices from countries where most maternal and child deaths take place. He says: "Too often, we ignore these voices. If we listened, we would hear pleas to help strengthen primary health care systems, especially in rural areas. We would hear a call for greater attention to newborns. We would hear about the importance of education and social protection. We would hear about the need for higher quality medicines and supplies. We would hear more about the political status of women. We would hear about the need for safer abortion services."
He adds that to make progress, funders need to focus on expanding research, measurement, and analytic capacities in countries. Global reports are frequently submitted to The Lancet, but good quality countries studies are much harder to come by.
Finally, Dr Horton calls for the maternal and child health community to professionalise their advocacy, concluding: "Despite the wealth of data available, advocates have failed to give decision makers clear 'asks', with costed returns on investment, scenario options, and evaluation programmes and platforms to monitor the performance of investments. Without these details, advocacy groups are inviting donors to gamble on a hope and a promise. In 2010, that kind of well-intentioned request is simply not good enough."
Lancet Press Office T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
For full Comment see: http://press.thelancet.com/wdrh.pdf
For full Viewpoint see: http://press.thelancet.com/viewpointwd.pdf
Journal
The Lancet