High Level Meeting on Maternal Mortality - Youth Experience

Below is the speech delivered by Imane Khachani, MD, Msc, from the Youth Coalition for Sexual and Reproductive Rights for the High-Level Meeting at the International Parliamentarians' Conference on the Implementation of the ICPD Programme of Action.

Dr Thoraya Obaid, Executive Director of UNFPA, Mr Bert Koenders, Minister for Development and Cooperation of the Netherlands, Mr Tedros Adhanom Ghebreyesus, Minister of Health of Ethiopia, our host country, Honorable Ministers, Members of Parliaments, Civil society and Private Sector representatives, Ladies and Gentlemen,

I would like to start by thanking the United Nations Fund for Population, our dear UN Youth ally, and the Ministry for Development and Cooperation of the Netherlands for inviting the youth voice to the table and for valuing our perspective on the crucial issue of Maternal Health. An issue of utmost relevance to adolescent girls and young women, yet an issue that is still too often dealt with ignoring, neglecting, or simply forgetting how adolescent girls and young women are disproportionately affected by pregnancy and childbirth-related mortality and morbidity.

500,000 deaths each year, a number you’re certainly all familiar with. More than one death per minute. Which means that since we all woke up this morning, took a shower, had breakfast and listened to the Ministers’ presentations, around 400 women died, and no less than 17,000 faced complications leading to severe morbidities, including chronic conditions.

Age disaggregation of data is usually poor when countries report back on maternal mortality and morbidity, and it is not easy to clearly picture the burden borne by young women and adolescent girls. But the little public health research done on that matter has shown that maternal mortality and morbidity among adolescent girls and young women is up to 4 times higher than older women.

Pregnancy and childbirth-related mortality is the leading cause of deaths among women aged 15 to 19. This means that a good proportion of the 400 women who died since this morning were my age or less. And this reality leaves me with a profound feeling of injustice. A profound feeling of injustice because while I am privileged to be sitting here with you, women my age and younger and adolescent girls  lost in some rural village in Sub-Saharan Africa, Central America or South-East Asia are dying.

Dying because they’ve been forced to marry early and pressured to become mothers while their bodies are still immature to child-bear.

Dying because of laws restricting their access to contraception to prevent a pregnancy they don’t want and to access safe abortion services to terminate it.

Dying sometimes because of a single antibiotic shot missing, or a transfusion blood bag received too late.

Dying because the hospital is too far, because there is no ambulance, or because they simply can afford none of the two.

I could go on and on listing causes. But this is en/ugh to say that what is happening today it is a tragedy.

It is a tragedy. It is a shame. And it is a failure. A failure for me and for my fellow physicians and other healthcare providers, for not being at the right place, the right time and with the right equipments and commodities to save these lives. A failure for governments for ensuring that the needed human resources, equipments and commodities are available and accessible to all pregnant women, young and older, married and unmarried, rural and urban, rich and poor, poor and poor. A failure for donors, which current funding is not sufficient to eradicate pregnancy and childbirth related Mortality and morbidity. We cal call it a global failure, a failure for all of us.  But we can also say that changing the odds is not a pipe dream if we join our efforts to take action. Concrete action. Action now.

Action now in Research, to investigate in detail the youth face of pregnancy and childbirth-related mortality and morbidity. To identify why are adolescent girls and young women dying, where and when, in order to be able to formulate adequate policy and programmatic responses.

Action Now, for Legal Action: Legal action to eradicate child marriage. At 13, a girl should not be taking care of a husband And becoming a mother, she should be at school, building her future. And this is something no culture, no religion and no traditions on earth should ever compromise. Legal action to eliminate all the barriers that prevent unmarried adolescent girls and young women from accessing sexual and reproductive health information and services. Legal action to make abortion a legitimate right for all women, and to lift restrictions on access to safe abortion services. Abortion has been a taboo for too long and many adolescents and young women’s lives have gone sacrificed for the sake of preserving this taboo. With 5 years left to 2015, it is time to have the courage to challenge taboos that kill.

Action now, for Programmatic Action, with no one-size-fits-all strategies, as women are a diverse group. The needs of pregnant adolescent girls and young women are different from the ones of older women and greater attention should be paid to these specific needs.
- Needs of active outreach
- Needs of comprehensive services free of charge, as user fees stand a major barrier to access care for youth populations.
- Needs to sensitize and train healthcare providers to adequately serve girls and young women.

And last, but definitely not least, Action now for Financing Action. 24 years ago, Rosenfield and Maine posed the question, “where is the M in MCH - maternal and Child Care”? There is another M that’s missing today, as MDG5 appears to be the least funded among all others. It’s the M of money. More money is needed to serve the specific needs of pregnant adolescent girls and young women. More money from donors and more money from countries. Maternal health has to become not only a health sector priority, as stated in the ICPD+5 but - let’s take it further for the ICPD @ 15 and beyond - maternal health has to become a public expenditure priority.

No woman should die choosing to give life; and No woman should die choosing not to give life. 2015 is around the corner, and let’s not wonder if we can achieve it, let us say it is our responsibility and duty to achieve it. And as Ministers, Parliament members, Donors and Civil society gather today and in the next 2 days for the International Parliamentarians’ Conference on the Implementation of the ICPD Programme of Action, let us make sure we all leave Addis committed to achieve it.

Thank you for your attention.

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