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    "ocrText": "World Health Day - April 7, 1998\nInvest in the Future: Support Safe Motherhood\n© 1998 American Association for World Health\nRESOURCE BOOKLET\nAmerican Association for World Health\n1825 K Street, NW, Suite 1208 Washington, DC 20006\nwww.aawhworldhealth.org (202) 466-5883\nClinton Presidential Records\nDigital Records Marker\nThis is not a presidential record. This is used as an administrative\nmarker by the William J. Clinton Presidential Library Staff.\nThis marker identifies the place of a publication.\nPublications have not been scanned in their entirety for the purpose\nof digitization. To see the full publication please search online or\nvisit the Clinton Presidential Library's Research Room.\n\"How is it possible, that in the midst of\nStrengthening Maternal Health in\nTHE WORLD BANK\nBangladesh\nunprecedented economic growth and technological\nDID YOU\nKNOW THAT\nbreaktbroughs, we have managed to allow alarming\nIn 1976, the Government of Bangladesh declared family planning a\ntop priority, and the World Bank joined the international communi-\nnumbers of young women to continue dying during\nty to help Bangladesh achieve its national family planning goals.\nEach year almost\npregnancy and childbirth?\"\nWhile primarily focused on family planning, the first World Bank-\n600,000 women die\nfinanced project also included efforts to reduce maternal mortality\nfrom complications of\nJames D. Wolfensohn, President, The World Bank\nby training traditional birth attendants and providing maternal and\npregnancy and child-\nchild health kits. Later projects reflected the government's growing\nbirth.\ncommitment to maternal health, and included training of medical\nIn many developing\nstaff and expanding access to maternal health services as well as\ncountries, maternal\nGaggero/PAHO\nC\nomplications of pregnancy and childbirth constitute the\nimproving the nutrition of pregnant and lactating mothers. The gov-\ndeaths account for 25\nleading cause of death and disability among women 15 to\nernment's 1997 Health and Population Sector Strategy, prepared with\nto 33 percent of all\n49 years of age, and 99 percent of these deaths occur in\nBank support, contributed to the design of a new health and popu-\ndeaths of women of\ndeveloping countries. The problem is particularly acute in Africa\nlation project, which includes activities to improve antenatal, deliv-\nand South Asia, where women's access to maternal health care and\nery, and post-natal care, and emphasizes developing basic and com-\nchildbearing age.\nfamily planning is especially limited. Making motherhood safer is\nprehensive emergency obstetric care in health centers and hospitals.\nAt least 40 percent of women who become pregnant each\nfundamental to improving human welfare, reducing poverty and\nyear experience complications that require treatment\npromoting economic development, which are the World Bank's\nPartnerships Bring Progress to India's\nfrom a trained provider, and one in 10 requires hospital-\noverarching goals.\nUrban Slums\nization.\nThe World Bank was a co-founder of the Safe Motherhood\nMore than one-half of all pregnant women in developing\nInitiative, launched in 1987. The Initiative seeks to reduce illness\nThe World Bank has a large portfolio of safe motherhood-related\ncountries are anemic.\nand death related to pregnancy by ensuring that women have the\nprojects in India. This includes nine population projects and sev-\nThe total cost of saving the lives of a mother or infant\nbest chance of having a safe pregnancy and delivery and a healthy\neral nutrition projects. A new, nation-wide reproductive and child\nthrough antenatal, delivery and postnatal care is only US\nbaby. The ingredients necessary for making motherhood safer\nhealth project has just been launched, and a woman and child\n$230, while the benefits to families, communities, and\nMAKING\ninclude prenatal care, safe delivery, postnatal care, family planning,\ndevelopment project focusing on nutrition will soon be underway.\ncountries is immeasurable.\nand good nutrition. Also essential, is information to raise awareness\nIn the poorest and most disadvantaged neighborhoods of\nBy improving maternal health and nutrition and immedi-\namong pregnant mothers and their families about the importance of\nHyderabad, the capital of Andhra Pradesh, a World Bank-financed\nate postnatal care we could prevent about 75 percent of\nMOTHERHOOD\nmaternal health care and family planning services.\nfamily welfare project is tackling the city's high maternal and child\nThe Bank's support for safe motherhood has increased substan-\nmortality and fertility rates through an innovative partnership. The\nperinatal deaths, more than 50 percent of infant deaths,\ntially over the decade. In 1986, the Bank's overall lending program\nwomen of the slums, NGOs, and government health staff have joined\nand 99 percent of maternal deaths.\nhad less than 10 projects that included maternal health and family\nforces to improve the quality and expand family health services in\nSAFER\nplanning. Recognizing the magnitude of the problem, the Bank sig-\nsome of Hyderabad's poorest neighborhoods. Experience from ear-\nnificantly expanded its efforts to make motherhood safer. Today, it\nlier programs showed that a top-down, centralized approach to\nFor more information please contact:\nis the largest single source of external assistance for safe mother-\ndelivering health care and family planning services was not effective.\nhood, financing some 100 projects that address this issue. A few\nThe Municipal Corporation of Hyderabad turned to 24 NGOs to\nBank-financed projects are devoted mainly to safe motherhood.\nassist in reaching out to the core slum areas not previously covered\nHowever, most Bank-supported safe motherhood activities are part\nby maternal and child health services. They educate communities\nof broader health projects. These activities employ a variety of\nabout good maternal and child health practices and family planning,\nHuman Development Network\nstrategies, including multi-sectoral approaches and partnerships\ntrain community link volunteers, organize group savings and com-\nThe World Bank\nwith other international agencies and non-governmental organiza-\nmunity development activities, and are expanding access to mater-\n1818 H Street N.W., Washington, D.C. 20433\ntions (NGOs).\nnal and other health care services.\nDelivering Safe Motherhood Services in\nReversing the Tide of Maternal Death in\nHealth Around the World,\" through grants to the World Health\nIndonesia\nRomania\nOrganization's Safe Motherhood Program; the \"Technical\nConsultation on Safe Motherhood: 10 years of lessons learned in\nIndonesia launched its \"village midwife\" program in 1988 with the\nWorld Bank support for Romania's health sector began in 1992 with\nresearch and practice,\" held in Sri Lanka in October 1997; and\nambitious target of placing a midwife in every village by the year\nthe Health Rehabilitation Project. The project was designed to\nmaternal and reproductive health curriculum development by the\n2000. The Bank supported training and deployment of these mid-\nreverse a long decline in health indicators, including maternal\nPakistan College of Physicians and Surgeons. Together with the\nwives, SO that 54,000 are now in place. The Bank has continued its\nhealth. In partnership with the European Commission, UNICEF,\nCanadian International Development Agency, the Bank supported\nsupport. Most recently, a new Bank-financed project brings togeth-\nWHO, and USAID, the project aimed to reduce maternal mortality by\nthe Safe Motherhood Demonstration Project (SMDP), imple-\ner the powerful and successful community information apparatus of\nimproving reproductive health care services; rehabilitating rural\nmented by The Population Council. This research demonstrated\nthe national family planning program and maternal health and other\ndispensaries to expand women's access to health care; and provid-\nthe effectiveness of training midwives at the primary and referral\nbasic services provided by the Department of Health. Partners in\ning equipment needed to improve care for pregnancy complica-\nlevels in life saving skills in Ghana and Viet Nam and medical sec-\nthis project include both public and private sector agencies involved\ntions, as well as for neonatal intensive care. The project provided\nond opinion for reducing unwarranted cesarean sections in\nin maternal health activities. The project's objectives include creat-\ntraining and equipment to upgrade 10 reproductive health referral\nEcuador.\ning individual, family and community-level demand; linking the\ncenters at university hospitals and 50 maternal/neonatal referral\ndemand with improved quality of services at the community and\nunits in both district and university hospitals. It also set up a net-\nFuture Directions\nreferral levels; developing sustainable systems to maintain the com-\nwork of 240 local family planning units and greatly increased the\nmunity midwife program; improving the technical skills of hospital\navailability of contraceptives. During this period maternal mortali-\nThe Bank is fully commited to making motherhood safer. By\nstaff to manage obstetric emergencies; and investing in the future\nty dropped substantially.\nworking with countries to build a favorable policy environment\nthrough an adolescent reproductive health education program.\nand help target resources cost-effectively, many lives can be\nToward Safer Births in the Villages of\nsaved. Investments in safe motherhood will have an impact\nPromoting Reproductive Health in the\nYemen\nbeyond improving women's status and the survival and health of\nPhilippines' Provinces\ntheir families. They will also strengthen development capacity\nExtending the Reach of Safe Motherhood\nThe World Bank is assisting Yemen in implementing its National\nand promote sustainable economic growth.\nin Zimbabwe\nThe Philippines, with World Bank assistance, is implementing a\nPopulation Strategy through the Family Health Project, begun in\ncomprehensive, nation-wide reproductive health program, with\n1993. The project is working to reduce unwanted fertility and\nFor Further Reading\nThe World Bank has supported Zimbabwe's health sector since\nspecial emphasis in 41 provinces. Despite a well-developed health\nmaternal and infant mortality. These objectives are being met by\n1987. This support has included efforts to improve the health sta-\nsystem, more than 70 percent of women deliver their babies at\nimproving the access to and quality of maternal and child\nMeasham, Anthony and Richard Heaver, 1996, India's Family\ntus of mothers and infants, increase family planning services, and\nhome. The Women's Health and Safe Motherhood Project address-\nhealth/family planning services, initially in district hospitals and\nWelfare Program, Washington, D.C.: World Bank\nstrengthen the government's capacity to plan and manage maternal\nes the issues that have prevented women from seeking appropriate\nthen at the village level. Special focus is being placed on managing\nTinker, Anne and Marjorie Koblinsky, 1993, Making Motherbood\nand child health and family planning services. The first project\ncare in the past and includes services essential for safe motherhood.\nobstetric emergencies, blood banking, and operating theaters. The\nSafe, World Bank Discussion Paper 202, Washington, D.C.:\ntrained health workers in family planning and midwifery, upgraded\nSeveral key factors enabled the government to plan this program\nproject provides vehicles for patient referral, as well as fellowships\nWorld Bank\nhealth centers, and provided information and education about\neffectively and are central to its success. First, a national survey was\nto attract women to train as midwives. At the national level, the pro-\nhealth and family planning. By project's end in 1994, 48 percent of\nconducted to carefully assess women's health status. National-level\nject supports the training of health care workers by providing train-\nWorld Bank, 1998, \"Improving Reproductive Health: The Role of\ncouples were using contraceptives, more than 90 percent of all\npolicy dialogue culminated in acceptance of the 1994 International\ning facilities and technical assistance on curricula development for\nthe World Bank\", Washington, D.C.: World Bank\nwomen received antenatal care, and 70 percent had a facility-based\nConference on Population and Development's Program of Action,\nprimary health care and continuing education.\nWorld Bank, 1998, Improving Women's Health in Pakistan and\nassisted delivery. The ongoing project, which began in 1991, con-\npositioning women's health and safe motherhood as one of six pri-\nSaving Lives, Washington, D.C.: World Bank\ntinues efforts to expand access to basic health, family planning and\nority health issues. Finally, reorganization of the Department of\nThe Safe Motherhood Grants Program\nWorld Bank, 1996, Improving Women's Health in India,\nnutrition services, especially for poorer families. It is also upgrad-\nHealth placed family planning, maternal and child health, and nutri-\nWashington, D.C.: World Bank\ning the youth advisory services which include counseling and a\ntion programs under one office and linked that office with hospital\nThrough its grants program, the World Bank supplements its lend-\nWorld Bank, 1994, A New Agenda for Women's Health and\nschool-based family life education program.\nadministration, which is essential for ensuring care for obstetric\ning for safe motherhood by providing three to four small grants per\nNutrition, Washington, D.C.: World Bank\nemergencies.\nyear for innovative activities. Examples include development of the\nMother-Baby Package and production of a wall chart on \"Maternal\nSAFE MOTHERHOOD ACTION MESSAGES\n1.\nAdvance Safe Motherhood Through Human Rights. Defining maternal death as\na \"social injustice\" as well as a \"health disadvantage\" obligates governments to\naddress the causes of poor maternal health through their political, health and legal\nsystems. International treaties and national constitutions that address basic human\nrights must be applied to safe motherhood issues in order to guarantee all women the\nright to make free and informed decisions about their health, and access to quality\nservices before, during and after pregnancy and childbirth.\n2.\nSafe Motherhood Is a Vital Social and Economic Investment. All national\ndevelopment plans and policies should include safe motherhood programs, in\nrecognition of the enormous cost of a woman's death and disability to health\nsystems, the labor force, communities and families. Additional resources should be\nallocated for safe motherhood, and should be invested in the most cost-effective\ninterventions (in developing countries, basic maternal and newborn care can cost as\nlittle as US$3 per person, per year).\n3.\nEmpower Women, Ensure Choices. Governments, community leaders and\nwomen's advocates need to address social, economic and cultural factors that limit\nwomen's choices and decision-making abilities. Legal reform and community\nmobilization is essential for empowering women to understand and articulate their\nhealth needs, and to seek services with confidence and without delay.\n4.\nDelay Marriage and First Birth: Reproductive health information and services for\nmarried and unmarried adolescents need to be: legally available, widely accessible,\nand based on a true understanding of young people's lives. Community education\nmust encourage families and individuals to delay marriage and first births until\nwomen are physically, emotionally and economically prepared to become mothers.\n5.\nEvery Pregnancy Faces Risks: During pregnancy, any woman can develop\nserious, life-threatening complications that require medical care. Because there is no\nreliable way to predict which women will develop these complications, it is essential\nthat all pregnant women have access to high quality obstetric care throughout their\npregnancies, but especially during and immediately after childbirth when most\nemergency complications arise. Antenatal care programs should not spend scarce\nresources on screening mechanisms that attempt to predict a woman's risk of\ndeveloping complications.\n6.\nEnsure Skilled Attendance at Delivery. The single most critical intervention for\nsafe motherhood is to ensure that a health worker with midwifery skills is present at\nevery birth, and transportation is available in case of an emergency. A sufficient\nnumber of health workers must be trained and provided with essential supplies and\nequipment, especially in poor and rural communities.\n7.\nImprove Access to Quality Maternal Health Services. Health services should be\nlocated as close as possible to where women live, and must offer affordable, high-\nquality care. In order to meet required standards, health systems should have: an\nadequate number of trained staff; a regular supply of drugs, equipment and supplies;\nand functioning referral systems. Services should also be respectful of - and\nresponsive to - women's needs, preferences and cultural beliefs.\n8.\nAddress Unwanted Pregnancy and Unsafe Abortion: Program planners should\naim to reduce the number of maternal deaths from unsafe abortion (which are the\nmost easily preventable maternal deaths) by ensuring that all safe motherhood\nprograms include: client-centered family planning services to prevent unwanted\npregnancy; contraceptive counseling for women who have had an induced abortion;\nthe use of appropriate technologies for women who experience abortion\ncomplications; and, where abortion is not against the law, such abortion services\nshould be safe. In all cases, women should have access to quality services for the\nmanagement of complications arising from abortion.\n9.\nMeasure Progress. Because it is difficult and costly to estimate maternal mortality\naccurately, alternative ways of measuring the progress and impact of safe\nmotherhood programs must be used. Since maternal mortality is directly linked to\nthe coverage and quality of maternal health services, information on such indicators\nas who cares for women during childbirth, where the delivery takes place, and the\nquality of services at health facilities should be collected and analyzed.\n10.\nPower of Partnership: Reducing maternal mortality requires sustained, long-term\ncommitment and the inputs of a range of partners. Governments, non-governmental\norganizations (including women's groups and family planning agencies),\ninternational assistance agencies, donors, and others should share their diverse\nstrengths and work together to promote safe motherhood within countries and\ncommunities and across national borders. Programs should be developed, evaluated\nand improved with the involvement of clients, health providers and community\nleaders. National plans and policies should put maternal health into its broad social\nand economic context, and incorporate all groups and sectors that can support safe\nmotherhood.\n\"Each of the co-sponsors of the Safe Motherhood Initiative implements these\nactivities according to its specific mandate.\nSafe Motherhood:\nA Matter of Human Rights and Social Justice\nFor a woman to die from pregnancy and childbirth is a social injustice. Such deaths are rooted in women's powerless-\nness and unequal access to employment, finances, education, basic health care and other resources. These factors set\nthe stage for poor maternal health even before a pregnancy occurs, and make it worse once pregnancy and childbear-\ning have begun.\nMaking motherhood safer, therefore, requires more than good quality health services. Women must be empowered, and\ntheir human rights - including their rights to good quality services and information during and after pregnancy and\nchildbirth - must be guaranteed.\nThe Powerlessness of Women¹\nMillions of women in the developing world do not have\nPercentage of Women Aged 15 to 49 With No Education³\nthe social and economic support they need to seek good\nhealth and safe motherhood. Physical and psychological\n100\n83%\nbarriers include:\n79%\n80\n- Limited exposure to information and new ideas: In many\n60\n48%\ncommunities pregnancy is not seen as requiring special\n38%\n40\ncare, and women do not recognise danger signs during\npregnancy. Even if they are experiencing pain and suffer-\n20\n11%\n10%\ning, they may have been raught that these conditions are\n0\ninevitable, and therefore do not seek medical care.\nBurkina\nPakistan\nEgypt\nUganda\nMexico\nThailand\nFaso\n- Limits on decision-making: In many developing countries,\nmen make the decisions about whether and when their\nwives (or partners) will have sexual relations, use contra-\nHealth services that are insensitive to women's needs, or\nception or bear children. In some settings in Asia and\nAfrica, husbands, other family members or elders in the\nstaffed by rude health providers, do not offer women a real\ncommunity decide where a woman will give birth and\nchoice: In many cultures, women are reluctant to use\nmust give permission for her to be taken to a hospital.\nhealth services because they feel threatened and humiliated\nby health workers, or pressured to accept treatments that\n- Limited access to education: In much of Africa and Asia,\nconflict with their own values and customs.\n75% of women age 25 and over are illiterate.² When girls\nare denied schooling, as adults they tend to have poorer\nHOW CAN EMPOWERING WOMEN MAKE MOTHERHOOD SAFER?'\nhealth, larger families and their children face a higher risk\nIt enables women to:\nof death.\nspeak out about their health needs and concerns.\n- Limited resources: Poverty, cultural traditions and national\nseck services with confidence and without delay.\nlaws restrict women's access to financial resources and\ndemand accountability from service providers, and from governments\nfor their policies.\ninheritance in the developing world. Without money, they\ncannot make independent choices about their health or\nparticipate more fully in social and economic development.\nseek necessary services.\nPolitical Commitment to Safe Motherhood⁴\nNational policy-makers can establish a legal and political\n- Ensuring that all women have the right to make decisions\nbasis for safe motherhood by defining maternal mortality\nabout their own health, free from coercion or violence,\nas a \"social injustice\", as well as a \"health disadvantage\".\nand based on full information.\nBy doing so, they will commit their governments to:\n- Guaranteeing that all women have access to good quality\n- Identifying the powerlessness that women face -\ncare before, during and after pregnancy and childbirth.\nthroughout their lives as well as during pregnancy - as\nan injustice that countries must remedy through political,\nhealth and legal systems.\nUsing International Human Rights to Advance Safe Motherhood\nInternational human rights treaties can be used to advance\n- Governments participating 111 the 1994 International\nsafe motherhood (see below). These documents, as well as\nConference on Population and Development and the 1995\nmost national constitutions, guarantee:\nFourth World Conference on Women agreed that women\nand men have the right to decide it. when and how often\n- The right to life, liberty and the security of the person.\nThese rights require governments to provide access to\nto bear children, and should have access to reproductive\nhealth services. They also pledged to cur the number of\nappropriate health care, and to guarantee that citizens can\nchoose when and how often to bear children.\nmaternal deaths in half by the year 2000, and in half again\nby 2015. Although these commitments are non-binding,\n- Rights that relate to the foundation of families and of\nthe Committee on the Elimination of Discrimination\nfamily life. These rights require governments to provide\nAgainst Women, which monitors the Women's Convention\naccess to health care and other services women need to\n(see below), is using them as standards for the 161 coun-\nesrablish families and enjoy life within their families.\ntries that signed the Convention.\n- The right to health services (including information and\nTHE FOLLOWING INTERNATIONAL TREATIES PROVIDE FRAME-\neducation) and the benefits of scientific progress. These\nWORKS THAT CAN BE USED TO ADVANCE SAFE MOTHERHOOD:\nrights require governments 10 provide reproductive and\nConvention on the Elimination of All Forms of Discrimination\nsexual health care to women.\nAgainst Women (the Women's Convention);\n- The right to equality and nondiscrimination. These rights\nInternational Covenant on Civil and Political Rights;\nrequire governments to ensure that all women and girls\nInternational Covenant on Economic, Social and Cultural Rights;\nhave access to services (such as education and health\nConvention on the Rights of the Child;\ncare)-regardless of age, marital status, ethnicity or socio-\nEuropean Convention on Human Rights;\neconomic status.\nAmerican Convention on Human Rights: and\nRecent international conferences and conventions set\nAfrican Charter on Human and Peoples' Rights.\nexplicit goals that support and protect women's reproduc-\nEach is monitored by a group that develops performance standards\ntive health needs.\nfor member countries and tracks compliance through periodic\nreports provided by each country.\nWhat Can Be Done\nGovernments must provide a framework for ensuring safe\n- Allow women greater freedom to make their own health\nmotherhood by:\nand life choices, encourage them to question unfair prac-\nrices, and give them opportunities TO learn about their\n- Reforming laws and policies that contribute to maternal\nrights and health and to develop a feeling of entitlement\nmortality (e.g. those that restrict women's access to\nto medical care and other services.\nreproductive health services and information) and imple-\nmenting laws and policies that protect women's health\n- Help men understand their role in expanding choices for\n(such as prohibitions against child marriage and female\nwomen, and in ensuring responsible sexual and family life.\ngenital mutilation).\nEveryone, including women's health advocates and\n- Guaranteeing all women access to good quality mater-\ndonors, must:\nnal health care and accurate information, and involving\n- Hold governments accountable for effectively protecting\nwomen in planning, implementing, monitoring and eval-\nthe human rights of their citizens by reporting any viola-\nuating health programmes.\ntions to constitutional courts and international\nCommunity leaders, women's advocates, private organisa-\nmonitoring bodies.\ntions and individuals must:\nSources:\n1: S.J. Jejeebhoy, \"Empower Women, Ensure Choices: Key (1) Enhancing Reproductive\nInternational Planned Parenthood Federation (IPPF). and the Population Council; FCI\nHealth\". Presentation at Safe Motherhood Technical Consultation in Sri Lanka, 18-23\nserves as the secretariat.\nOctober 1997.\nThese fact sheets have also been prepared in a more detailed version for technical andi-\n2: The World's Women, 1970-1990, Trends and Statistics. United Nations, New York,\nences. For more information or copies of available materials, contact any IAG member, or\n1991.\nthe Sex retarial #:\n3: Women's Lives and Experiences: A Decade of Findings from the Demographic and\nHealth Signeys Program. Macro International, Calverton, MD. 1994\nFamily Care International\n4: R.J. Cook, \"Advancing Safe Motherhood Through Human Rights\". Presentation at Safe\n588 Broadway, Suite 503\nNew York, NY. 10012. USA\nMotherhood Technical Consultation III Sri Lanka, 18-23 October 1997.\nTel: (212) 941-5300\nPrepared by Family Care International (FCD and the Sape Motherhood Inter-Agency\nFax: (212) 941-5563\nGroup HAG). The TAC includes: the United Nations Children's From (UNICE). United\nForal:\nNations Population brand (UNTPA). World Back. World Health Organization AWHOR\nW. size\nMaternal Mortality\nIn many developing countries, complications of pregnancy and childbirth are the leading causes of death among\nwomen of reproductive age. More than one woman dies every minute from such causes; 585,000 women die every\nyear.¹ Less than one percent of these deaths occur in developed countries, demonstrating that they could be\navoided if resources and services were available.¹\nIn addition to maternal death, women experience more than 50 million maternal health problems annually.²\nAs many as 300 million women - more than one-quarter of all adult women living in the developing world - -\ncurrently suffer from short- or long-term illnesses and injuries related to pregnancy and childbirth.³\nMaternal Death\nEvery woman can experience sudden and unexpected\nWomen risk death and disability each time they become\ncomplications during pregnancy, childbirth, and just after\npregnant. Women in developing countries face these risks\ndelivery. Although high-quality, accessible health care\nmuch more often, since they bear many more children than\nhas made maternal death a rare event in developed coun-\nwomen in the developed world.¹\ntries, these complications can often be fatal in the\ndeveloping world.\nWomen's Risk of Dying from Pregnancy and Childbirth\nRegion\nRisk of Dying\nAll developing countries\n1 in 48\nCauses of Maternal Death Worldwide'\nAfrica\n1 in 16\nIndirect causes 20%\nAsia\n1 in 65\nSevere bleeding 25%\nLatin America & Caribbean\n1 in 130\nOther direct causes* 8%\nAll developed countries\n1 in 1,800\nEurope\n1 in 1,400\nObstructed labour 8%\nInfection 15%\nNorth America\n1 in 3,700\nEclampsia 12%\nUnsafe abortion 13%\n.\nOther direct causes include: ectopic pregnancy. embolism. anaesthesia-related\nCountry-level differences are even more dramatic: for\n:.\nIndirect causes include: annemia. malaria, healt disease\nexample, in Ethiopia, 1 out of every 9 women die from\npregnancy-related complications, as compared to I in\n8,700 in Switzerland.'\nDeaths of Infants and Children\nEach year, almost 8 million stillbirths and early neonatal\nA study in Bangladesh found that a mother's death sharply\ndeaths (deaths within one week of birth) occur. These\nincreased the probability that her children. 11/1 to age 10,\ndeaths are caused largely by the same factors that lead to\nwill die within two years. This was especially true for her\nmaternal death and disability-women's poor health during\ndaughters.\npregnancy, inadequate care during delivery and lack of\nnewborn care.\"\nMaternal Disabilities\nAt least 40% of women experience complications during\nlife-threatening problems.¹ Long-term complications can\npregnancy, childbirth and the period after delivery. An esti-\ninclude chronic pain, impaired mobility, damage to the\nmared 15% of these women develop potentially\nreproductive system and infertility.\nSAFE MOTHERHOOD FACT SHEET\nWhy Are Women Dying?\nMost maternal complications and deaths occur either\n- During pregnancy: The percentage of women who seek\nduring or shortly after delivery. Yet many women do\nantenatal care at least once is 63% in Africa: 65% in Asia;\nnot receive the essential health care they need during\nand 73% in Latin America and the Caribbean. At the\nthese periods:\ncountry level, however, use of such services can be\nextremely low. In Nepal, for example, only 15% of women\nCoverage of Maternal Health Services'\nreceive antenatal care.⁷\nDeveloped countries\n100\n97%\n99%\nDeveloping countries\n- During childbirth: Each year, 60 million women give birth\n90%\nwith the help of an untrained traditional birth attendant or\n80\na family member, or with no help at all. Almost half of\n65%\nbirths in developing countries take place without the help\n60\n53%\nof a skilled birth attendant (such as a doctor or midwife).7\n40\n30%\n- After delivery: The majority of women in developing coun-\n20\ntries receive no postpartum care. In very poor countries\n0\nand regions, as few as 5% of women receive such care.⁷\nAntenatal\nSkilled Attendance\nPostpartum\nCare\nat Delivery\nCare\nWhy Do Women NOT Seek Services?\nThe factors that prevent women in developing countries\n- multiple demands on women's time;\nfrom getting the life-saving health care they need include:\n- women's lack of decision-making power within the family.\n-- distance from health services;\nThe poor quality of services, including poor treatment by\n- cost (direct fees as well as the cost of transportation, drugs\nhealth providers, also makes some women reluctant to use\nand supplies);\nservices.\nWhat Can Be Done\nEnsure access to maternal health services. Most maternal\n- postpartum family planning and basic neonatal care.\ndeaths, many health problems among women and chil-\nSuch care would cost about $3 per person per year in\ndren, and the deaths of at least 1.5 million infants each\nlow-income countries. Basic maternal care alone can cost\nyear could be prevented through:\nas little as $2 per person.*\n- routine maternal care for all pregnancies, including a\nImprove women's status and raise awareness about the\nskilled attendant (midwife or doctor) at birth:\nconsequences of poor maternal health. Families and com-\n- emergency treatment of complications during pregnancy,\nmunities must encourage and enable women to receive\ndelivery and after birth; and\nproper care during pregnancy and delivery.\nSources:\nI: \"Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF\".\nS: \"Mother-Baby Package Costing Spreadsheet\" (unpublished), World Health Organization,\nWorld Health Organization, Geneva, 1996.\nGeneva, 1997.\n2: \"Healthy Pregnancy and Childbearing.\" in Reproductive Health in Developing Countries:\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\nExpanding Dimensions. Building Solutions. A.O. Tsui, 1. N. Wasserheit. and J.G. Haaga, eds.\n(IAG). The IAG includes: the United Nations Children's Froud (UNICEF). United Nations\nWashington, DC, National Academy Press. 1997.\nPopulation Fund (UNFPA). World Bank. World Health Organization (WHO). International\n3: The Progress of Nations UNICEF New York, 1996.\nPlanned Parentbo Federation (IPPF). and the Population Comeil: FCI serves as the secretariat.\n4: \"Coverage of Maternal Care: A Lasting of Available Information, Fourth Edition\". World\nThese fact sheets have also been prepared in more detailed versions for technical audiences. For\nHealth Organization, Geneva, 1997.\nmore information or copies of available materials. contact any IAG member. or the secretariat at:\n5: M.A. Strong, \"The Health of Adults in the Developing World: The View from Bangladesh\",\nFamily Care International\nHealth Transation Review. 2(2):215-24, 1992.\n588 Broadway, Suite 503\nNew York, NY. 10012, USA\n6: W. Graham, \"A Question of Survival? A Review of Safe Motherhood\". Ministry of Health,\nTel: (212) 941-5300\nKenya, 1997.\nFax: (212) 941-5563\n7: \"Coverage of Maternal Care: A Listing of Available Information, Fourth Edition\". World\nEmail: [email protected]\nHealth Organization, Geneva, 1997.\nWeb site address: uwusafemotherhood.org\n1998\nMaternal\nHealth:\nA\nana\nEconomic\nOne-quarter of all adult women living in the developing world today suffer from some kind of illness or injury\nrelated to pregnancy and childbirth. Each year, maternal health complications are responsible for the deaths of\n585,000 women, and contribute to the deaths of at least 1.5 million infants in the first week of life, and 1.4 million\nstillborn infants.¹ The social and economic cost of these disabilities and deaths - to families, communities, the\nlabour force and countries - is enormous.\nThe financial cost of basic maternal and newborn health services that could prevent these problems is, on aver-\nage, only US$3 per person per year in developing countries; the cost of maternal health services alone can be as\nlittle as $2 per person.² The total cost of saving the life of a mother or infant is approximately $230.\nWhy Focus on Maternal Health?\nIn developing countries, pregnancy and childbirth are the\nLeading Causes of the Burden of Disease\nleading causes of death, disease and disability among\n20%\nin Women Aged 15-44\n18.0%\n18%\nin the Developing World, 1990'\nwomen of reproductive age. They account for at least 18%\n16%\nof the burden of disease in this age group - more than any\n14%\n12%\nother single health problem.³\n10%\n8.9%\n8%\nMaternal health interventions are among the most cost-\n6.6%\n7.0%\n5.8%\n6%\neffective investments in health.\n4%\n3.2%\n2.5%\n2.5%\n2%\n0%\nRespiratory\nAnnemia\nSelf\nDepressive\nHIV\nTuberculosis\nSTD\nMaternal\ninfection\ninflicted\ndisorders\ncauses\ninjuries\nThe Toll on Children\nAt least 30 to 40% of infant deaths are the result of poor\nChild Deaths When a Parent Dies, per 1,000'\ncare during pregnancy and delivery. These deaths could be\nSons\navoided with improved maternal health, adequate nutrition\nDaughters\n200\n190\nand health care during pregnancy, and appropriate care\nduring childbirth.\"\n150\nPoor maternal health and nutrition contributes to low birth\n100\n80\nweight in 20 million babies each year - almost 20% of all\n55\nbirths. These babies die more often than babies of normal\n50\n41\n28\n31\nweight, and are at greater risk for infection, malnutrition\nand long term disabilities, including visual and hearing\n0\nNo parent dies\nFather dies\nMother dies\nimpairments, learning disabilities and mental retardation.⁵\nMotherless children are likely to get less health care and\neducation as they grow up. A study in Bangladesh found\nthat when a mother dies, her children - especially daugh-\nters - are much more likely to die than children whose\nparents are both alive.\"\nThe Economic Cost\nWomen account for 70% of the 1.3 billion people who live\nAt least 60% of pregnant women in the developing world\nin absolute poverty.\" When women cannot work because of\nare anaemic, which reduces their energy - and can depress\nhealth problems, the loss of their income, as well as the costs\ntheir incomes.\nof treatment, can drive them and their families into debt.\nStudies in Sri Lanka and China found that anaemia\nIn India, a study found that disability reduced the produc-\nreduced productivity among women tea plantation and\ntivity of the female labour force by about 20%.8\nSAFE MOTHERHOOD FACT SHEET\nimpact of iron supplements.\"\nclothing for young children. When a household is headed\nby a woman - which is the case for at least 20% of\nWhen women cannot work the consequences can be espe-\nhouseholds in Latin America and Africa - her poor health\ncially severe for children. Women are more likely than men\ncan cause severe problems for the family.\"\nto spend their own income on improving family welfare\nBenefits for Governments and Health Systems\nPrevention and early treatment are cost-effective. Millions of\nGood maternal health services can strengthen the entire\npremature deaths, illnesses and injuries can be avoided by\nhealth system. A health facility that is equipped to provide\nhelping women prevent unwanted pregnancy and get prompt\nessential obstetric care - such as blood transfusions,\ntreatment for reproductive health problems. These steps also\nanaesthesia and surgery - can also treat accidents, trauma\nhelp governments avoid the higher costs of treating serious,\nand other medical emergencies for the community.\nundetected health conditions, and the costs of providing\nBuilding women's trust promotes preventive care. Women\nhealth care and social services for women with long-term\nwho receive good care during pregnancy and childbirth are\ndisabilities, and for their families in case of their deaths.\nmore likely to seek services for children's health, family\nplanning and other health problems, including treatment of\nsexually transmitted diseases.¹\nWhat Can Be Done\nGovernments, non-governmental organisations, interna-\n- Ensure that every woman has access to a continuum of\ntional agencies and other funders must make a concerted\ngood-quality safe motherbood services offered at the\neffort to:\ncommunity level, in health centres and in district and\nregional hospitals.\n- Acknowledge the social and economic benefits of good\nmaternal health, and include efforts to ensure maternal\nhealth in all national policies and plans.\n- Allocate resources to make maternal health services\navailable, especially in poor and rural areas. Existing\nhealth care resources can be used to support the most\ncost-effective interventions.\nSources:\n1: A. Tinker, \"Sate Motherhood as an Economic and Social Investment\". Presentation at Safe\n9: A New Agenda for Women's Health and Nutrition. World Bank, Washington, DC. 1994.\nMotherhood Technical Consultation in Sri Lanka, 18-23 Derober 1997.\n10: United Nations Department of International Economic and Social Affairs, The World's\n2: \"Mother-Baby Package Costing Spreadsheet\" (unpublished). World Health Organization,\nWomen: Trends and Statistics United Nations, New York. 1991.\nGeneva, 1997.\nPrepared by Family Care International (FCI) and the Safe Motherlood Inter-Agency Group\n3: World Development Report 1993: Investing in Health. World Bank. Washington, DC, 1993.\n(TAG). The IAG includes: the United Nations Children's Frond (UNICEF). United Nations\n4: \"Perinatal Mortality: A Lisung of Available Information\". World Health Organization,\nPopulation Friend (UNI-PA). World Bank. World Health Organization (WHO). International\nGeneva. 1996.\nPlanned Parentbood Federation (IPPF). and the Population Council: FCI serves as the secretariat.\n5:C Bellamy, The State of the World's Children 1998. UNICEF New York, 1998.\nThese fact sheets have also been prepared III more detailed versions for technical audiences. For\nmore information or copies of available materials. commet any IAG member, of the secretariat at:\n6: M.A. Strong, \"The Health of Adults in the Developing World: The View from Bangladesh\".\nHealth Transition Review 2(2):215-24. 1992.\nFamily Care International\n588 Broadway, Suite 503\n7: Human Development Report 1995. United Nations Development Programme, New York,\nNew York. NY. 10012. USA\n1995\nTel: (212) 941-5300\nS: M. Chatteriee, Indian Women: Their Health and Productivity. World Bank Discussion Paper\nFax: (212)941-5563\n109. Washington, DC, 1991.\nEmail: [email protected]\nWeb site address: www.safemotherhood.org\n1998\nis\nThe Safe Motherhood Initiative\nWhen the Safe Motherhood Initiative was launched in 1987, death from the complications of pregnancy and child-\nbirth was a little-known, seriously neglected problem. Ten years later, preventing these deaths is an international\npriority, and many countries have made significant progress in expanding and improving maternal health ser-\nvices. The global Initiative has become a unique partnership of governments, donors, technical agencies,\nnon-governmental organisations and women's health advocates in more than 100 countries. These partners are\nnow working to protect the health and lives of women, especially during pregnancy and childbirth.\nWhat We Know\nComplications of pregnancy and childbirth are the leading\nhospitals located as close as possible to where women live,\ncauses of disability and death among women between the\nand must be linked by an emergency referral and transport\nages of 15 and 49 in developing countries.¹\nsystem.\nEvery woman is at risk. During pregnancy, any woman can\nSafe motherhood strategies must be comprehensive. Even\nexperience life-threatening and unpredictable complications\nwhen good quality health services are available, social, eco-\nthat require immediate medical care.\nnomic and cultural limitations can prevent women from\nusing these services. Safe motherhood programmes empha-\nIn order to reduce deaths, good-quality maternal health\nsise the need for action on these root causes, and also on\nservices must be readily available - and must be used -\nother reproductive health problems, including unwanted\nespecially during and immediately after childbirth. Services\npregnancy and sexually transmitted diseases.\nshould be provided by trained health workers, clinics and\nThe Next Ten Years\nIn the last several years, safe motherhood has been\nChanges in Attendance at Delivery, 1985-1996\nembraced by governments all over the world. They have\nTrained attendant 1985\n100\ninitiated programmes to reduce maternal death, improve\nSkilled attendant 1996\n98% 99%\nreproductive health services, and protect and promote\n80\n75%\nwomen's health and well-being, especially during preg-\n64%\n60\nnancy and childbirth.\n52%\n53%\n49%\n42%\n40\n34%\n34%\nTo help governments and private organisations meet their\nmaternal health goals, safe motherhood partners from\n20\naround the world met in October 1997 to identify the most\n0\nefficient and cost-effective ways to improve maternal\nAfrica\nOceania\nAsia\nLatin America Developed\n& Caribbean Regions\nhealth. Participants discussed research results, new tech-\nliamed attendant includes indwife Inctor and named inditional birth attendant\nStilled attendant Includes only doctor and midwite\nnologies, model programmes and lessons learned during the\nInitiative's first decade. The meeting identified ten essential\naction messages for improving maternal health (fact sheets\non these messages are available for both general and tech-\nnical audiences), and led to an agreement on the key health\nservices that should be available to make motherhood safer.\nThis package of services is described in the box on the fol-\nlowing page.\nSAFE MOTHERHOOD FACT SHEET\nA comprehensive package of services for safe motherhood\n- Throughout the Reproductive Life Span: Abortion-\nshould include:\nrelated care.\n- During Pregnancy: Antenatal care and counselling.\nHigh-quality services for treating and managing compli-\ncations of unsafe abortion should be available through\nDuring pregnancy, health workers should: educate\nall health systems. Services require: staff who are trained\nwomen about how to stay healthy during pregnancy;\nhelp women and families prepare for childbirth; and\nand authorised to treat complications; appropriate equip-\nment; protocols for care: and effective referral networks.\nraise awareness about possible pregnancy complications\nWomen with abortion complications should also have\nand how to recognise and treat them. Health workers\nshould also identify and manage any complications early\naccess to other reproductive health services, including\nand improve women's reproductive health and well-being\nfamily planning.\nthrough preventive measures (iron supplements, tetanus\nWhere abortion is not against the law, safe services for\nimmunisation) and by detecting and treating existing\npregnancy termination and compassionate counselling\nproblems (such as sexually transmitted diseases).\nshould be available.* Health workers must be informed\nabout the legal status of abortion and protocols for pro-\n- During Childbirth: Skilled care during labour and delivery.\nviding it. Appropriate technologies, including new\nDuring childbirth, every woman should be helped by a\nmethods such as non-surgical abortion, should be avail-\nhealth professional who can manage a normal delivery as\nable where feasible.\nwell as derect and manage complications such as haemor-\nrhage, shock and infection. Skilled attendants should have\n- During Adolescence: Reproductive health education\naccess to a functioning emergency and transport system so\nand services*.\nthat they can refer women to an appropriate health facility\nAll young people should have information on sexuality,\nfor higher level medical care (such as Caesarean delivery or\nreproduction, contraception, decision-making skills and\nblood transfusion) when necessary.\ngender relations in order to help them make informed\ndecisions about sexuality and to negotiate abstinence or\n- After Delivery: Postpartum care.\nFollowing childbirth, women should be seen by a health\nsafer sex. Sensitive, respectful and confidential reproduc-\ntive health counselling and services for married and\nworker, preferably within three days, so that any prob-\nlems (such as infection) can be detected and managed\nunmarried adolescents should emphasise the prevention\nof unwanted pregnancy, unsafe abortion and sexually\nearly. An additional postpartum visit within the first six\ntransmitted diseases (STDs).\nweeks after delivery enables health workers to make sure\nthat the mother and baby are doing well, to provide\n- For Women and Families: Community education.\nadvice and support for breastfeeding and to offer family\nKey health topics for women and their families include\nplanning information and services.\nhow to prevent unwanted pregnancy and avoid unsafe\n- Before and After Pregnancy: Family planning.\nabortion; how to recognise complications of pregnancy,\nchildbirth and unsafe abortion and where to seek\nFamily planning counselling and services should be avail-\nable to all couples and individuals, including adolescents\ntreatment; and the dangers of certain traditional prac-\ntices during pregnancy and childbirth. Education is also\nand unmarried women. Family planning services should\nneeded for decision-makers - from husbands to com-\noffer complete information and counselling as well as a\nwide choice of modern contraceptives, including emer-\nmunity leaders to national policy-makers - to promote\ngency contraception, and should be part of a\nsafe motherhood and improvements in women's health\nand status.\ncomprehensive programme that addresses other sexual\nand reproductive health needs.\n*Each co-sponsor of the Safe Motherhood Initiative implements these\nactivities according to its specific mandate.\nSources:\nI: World Development Report 1993: Investing in Health. World Bank, Washington, DC,\nWorld Health Organization\n1993.\nMaternal and Newborn Health/Safe Motherhood Programme\n2: \"Coverage of Maternal Care: A Listing of Available Information, Fourth Edition\".\nDivision of Reproductive Health (Technical Support)\nWorld Health Organization, Geneva, 1997.\n1211 Geneva 27 Switzerland\nThe Safe Motherhood Co-sponsors\nInternational Planned Parenthood Federation (PPF)\nAssistant Secretary General\nThe Safe Motherhood Initiative is led by a unique alliance of co-sponsoring agencies who\nSexual and Reproductive Health Technical Support Group\nwork together to raise awareness, set priorities, stimulate research, mobilise resources, pro-\nRegent's College. Inner Circle, Regent's Park\nvide technical assistance and share information. Each of these agencies implements safe\nLondon NW1 4NS England\nmotherhood activities according to as specific mandate. The co-sponsors include:\nThe Population Council\nUnited Nations Children's Fund (UNICEF)\nInternational Programs Division\nDivision of Communication\nOne Dag Hammarskjold Plaza\nSUN Plaza\nNew York, New York 10017 USA\nNew York. New York 10017 USA\nFor further information and copies of available materials, including additional fact sheets.\nUnited Nations Population Fund (UNFPA)\nplease contact the Safe Motherbood Initiative secretariat:\nTechnical Branch, Technical and Policy Division\n220 East 42nd Street\nFamily Care International\nNew York, New York 10017 USA\n588 Broadway, Suite 503\nNew York. New York 10012 USA\nThe World Bank\nTel: 212 941-5300 Fax: 212 941-5563\nHealth, Nutrition and Population\nEmail: [email protected]\nHuman Development Network\nWeb site address: www.safemotherbood.ong\n1818 H Street, N.W.\n1998\nWashington D.C. 20433 USA\nO\nThe \"Year of Safe Motherhood\"\nSafe Motherhood is a global effort to increase maternal safety and\nreduce the number of deaths and illnesses associated with\npregnancy and childbirth\nWomen need not die while giving life to future generations.\nEvery minute of every day. somewhere in the world and most often in a developing nation, a woman\ndies from complications related to pregnancy or childbirth. Her death is more than a personal\ntragedy. although that alone would merit our most serious concern. In addition, her death represents\nan enormous cost to her nation. her community and her family. Any social and economic investment\nthat has been made in her life is lost. Her family loses her love. her nurturing and her productivity\ninside and outside the home. Half of all infant deaths can be attributed to poor maternal health.\nMoreover. the child that survives a mother's death is up to ten times more likely to die within two\nyears than a child with two living parents.\"\nThe greatest tragedy is that these approximately 600.000 maternal deaths and over 50 million cases of\nmorbidity that occur each year are largely preventable. A decade of research has proven that\nsurprisingly small and affordable measures can significantly reduce the health risks that women face\nwhen they become pregnant.\nIn 1987 a coalition of the world's leaders in maternal and child health. the United Nations Population\nFund (UNFPA). the United Nations Children's Fund (UNICEF). the World Health Organization\n(WHO). the World Bank. the International Planned Parenthood Federation (IPPF) and the Population\nCouncil. joined forces and developed an Inter-Agency Task Force on Safe Motherhood to assess this\nproblem and recommend solutions.\nNow it is time to act upon what has been learned over the past ten years of research and model\nprojects. before one more woman loses her life needlessly.\nTo achieve this goal. World Health Day. 7 April 1998 will kick-off a year-long series of activities to\npromote Safe Motherhood.\nOn that day a call to action will be issued to governments. business leaders. policy makers. and\ncitizens of every country of the world. The call to action consists of four simple messages:\nI. International aid agencies are urged to provide overseas assistance to programs that promote\nmaternal care as an essential component of reproductive health services.\n2. Governments or developing countries are urged to reduce maternal mortality and morbidity by\ndeveloping and implementing health. nutrition and education programs that promote the health of\npregnant women and their infants.\n3. Corporations around the world are urged to encourage governments and private organizations in\nthe countries where they do business to provide funds and develop programs that foster safe\nmotherhood. and to support safe motherhood among their employees and customers.\n1. Women. men and families everywhere are urged to demand and seek quality prenatal and\nobstetric care to ensure that no woman dies or suffers long-term complications from childbirth.\nO\nwww.safemotherhood.org\nSafe\nMotherhood\nwhat's on the site?\nwww.safemotherhood.org aims to provide visitors with comprehensive and up\nto date information on the Year of Safe Motherhood and the issue of maternal\nmortality.\nInter-Agency Group\nfor Safe Motherbood\nwww.safemotherhood.org will be updated throughout the year as new stories,\nUNFPA\ndevelopments, and statistics emerge.\nUNICEF\nWHO\nWORLD BANK\nMain Features\nIPPF\nPOPULATION COUNCIL\nП What is safe motherhood?\nAn overview of the principles and components vital to ensuring safe and\nhealthy pregnancies\nП Introduction\nAn introduction to the Year of Safe Motherhood, including aims and objectives\nП Principles of Safe Motherhood\nTen Safe Motherhood action messages\nП Facts & Figures\n*\nData presenting global maternal health issues and causes of maternal\ndeath in graph, map and table format\nП World Health Day\nThe Agenda for events surrounding World Health Day - 7th April 1998\nП Responsible Agencies\nThe members of the organisations behind the Safe Motherhood Initiative\nand links to their websites\nChairing Agency:\nIPPF\nRegent's College, Regent's Park\nForthcoming attractions\nLondon NWI 4NS. UK\nTelephone: 44 171 487 7864\nFax: 44 171 487 7865\nП Safe Motherhood Success Stories\nemail: [email protected]\nCase studies of successful programmes to help pregnant women around the\nworld\nSecretariat:\nFamily Care International\nП Visitors Bulletin Board\n588 Broadway, Suite 503\nComments. questions and opinions from visitors on safe motherhood issues\nNew York, NY 10012 USA\nTelephone: 212 941 5300\nFax: 212 941 5563\nemail: [email protected]\nO\nSafe\nMotherhood\nInter-Agency Group\nfor Safe Motherbood\nCorporate Initiative for Safe Motherhood\nUNFPA\nUNICEF\nStatement of Principles\nWHO\nWORLD BANK\nMotherhood 1998\nIPPF\nPOPULATION COUNCIL\nEvery day at least 1,600 women die from the complications of pregnancy and\nchildbirth. The remarkable advances in other areas of public health worldwide\nhave not been matched by improved survival for childbearing women. The same\nfactors that contribute to maternal illness and death also lead - each year - to\nas many as eight million stillbirth and infant deaths within the first week of life. In\nthe developing world. a mother's death leaves her children more vulnerable to\nillness and death.\nThe business leaders who have created the Corporate Initiative for Safe Motherhood\nrecognize these principles:\nMotherhood represents an unequivocal commitment to the future of humankind.\nAs business leaders, we can have a vital role in educating our employees about the\nsimple measures that can prevent needless deaths and injury related to childbirth.\nOur positions of leadership give us an opportunity to raise awareness of Safe\nMotherhood among our business peers and within the communities in which we\nconduct our business.\nChairing Agency:\nWe recognize the importance of inter-sectoral partnership in addressing the\nIPPF\ncomplexity of improving the health of childbearing women and their children.\nRegent's College, Regent's Park\nLondon NWI 4NS. UK\nTelephone: 44 171 487 7864\nFax: 44 171 487 7865\nemail: [email protected]\nSecretariat:\nFamily Care International\n588 Broadway, Suite 503\nNew York, NY 10012 USA\nTelephone: 212 941 5300\nFax: 212 941 5563\nemail: [email protected]\nO\nSafe\nMotherhood\nSAFE MOTHERHOOD ACTION MESSAGES\n1.\nAdvance Safe Motherhood Through Human Rights. Defining maternal\ndeath as a \"social injustice\" as well as a \"health disadvantage\" obligates\ngovernments to address the causes of poor maternal health through their\npolitical. health and legal systems. International treaties and national\nInter-Agency Group\nfor Safe Motherhood\nconstitutions that address basic human rights must be applied to safe\nUNFPA\nmotherhood issues in order to guarantee all women the right to make free and\nUNICEF\ninformed decisions about their health, and access to quality services before,\nWHO\nduring and after pregnancy and childbirth.\nWORLD BANK\n2.\nSafe Motherhood Is a Vital Social and Economic Investment. All national\nIPPF\nPOPULATION COUNCIL\ndevelopment plans and policies should include safe motherhood programs,\nin recognition of the enormous cost of a woman's death and disability to\nhealth systems, the labor force. communities and families. Additional\nresources should be allocated for safe motherhood. and should be invested in\nthe most cost-effective interventions (in developing countries, basic maternal\nand newborn care can cost as little as US$3 per person, per year).\n3.\nEmpower Women, Ensure Choices. Governments. community leaders and\nwomen's advocates need to address social. economic and cultural factors that\nlimit women's choices and decision-making abilities. Legal reform and\ncommunity mobilization is essential for empowering women to understand\nand articulate their health needs. and to seek services with confidence and\nwithout delay.\n4.\nDelay Marriage and First Birth: Reproductive health information and\nservices for married and unmarried adolescents need to be: legally available,\nwidely accessible, and based on a true understanding of young people's lives.\nCommunity education must encourage families and individuals to delay\nmarriage and first births until women are physically. emotionally and\neconomically prepared to become mothers.\n5.\nChairing Agency:\nEvery Pregnancy Faces Risks: During pregnancy. any woman can develop\nIPPF\nserious. life-threatening complications that require medical care. Because\nRegent's College. Regent's Park\nthere is no reliable way to predict which women will develop these\nLondon NW1 +NS. UK\ncomplications, it is essential that all pregnant women have access to high\nTelephone: 14 171 487 7364\nquality obstetric care throughout their pregnancies. but especially during and\nFax: 14 171 487 7865\nimmediately after childbirth when most emergency complications arise.\nemail: [email protected]\nAntenatal care programs should not spend scarce resources on screening\nmechanisms that attempt to predict a woman's risk of developing\nSecretariat:\ncomplications.\nFamily Care International\n588 Broadway, Suice 503\nNew York. NY 10012 USA\nTelephone: 212 941 5300\nFax: 212 941 5563\nemail: [email protected]\n6.\nEnsure Skilled Attendance at Delivery. The single most critical intervention for\nsafe motherhood is to ensure that a health worker with midwifery skills is present at\nevery birth, and transportation is available in case of an emergency. A sufficient\nnumber of health workers must be trained and provided with essential supplies and\nequipment, especially in poor and rural communities.\n7.\nImprove Access to Quality Maternal Health Services. Health services should be\nlocated as close as possible to where women live, and must offer affordable, high-\nquality care. In order to meet required standards. health systems should have: an\nadequate number of trained staff; a regular supply of drugs. equipment and supplies;\nand functioning referral systems. Services should also be respectful of - and\nresponsive to - women's needs, preferences and cultural beliefs.\n8.\nAddress Unwanted Pregnancy and Unsafe Abortion: Program planners should\naim to reduce the number of maternal deaths from unsafe abortion (which are the\nmost easily preventable maternal deaths) by ensuring that all safe motherhood\nprograms include: client-centered family planning services to prevent unwanted\npregnancy: contraceptive counseling for women who have had an induced abortion;\nthe use of appropriate technologies for women who experience abortion\ncomplications: and. where abortion is not against the law. such abortion services\nshould be safe'. In all cases. women should have access to quality services for the\nmanagement of complications arising from abortion.\n9.\nMeasure Progress. Because it is difficult and costly to estimate maternal mortality\naccurately, alternative ways of measuring the progress and impact of safe\nmotherhood programs must be used. Since maternal mortality is directly linked to\nthe coverage and quality of maternal health services. information on such indicators\nas who cares for women during childbirth. where the delivery takes place, and the\nquality of services at health facilities should be collected and analyzed.\n10.\nPower of Partnership: Reducing maternal mortality requires sustained, long-term\ncommitment and the inputs of a range of partners. Governments. non-governmental\norganizations (including women's groups and family planning agencies),\ninternational assistance agencies, donors. and others should share their diverse\nstrengths and work together to promote safe motherhood within countries and\ncommunities and across national borders. Programs should be developed. evaluated\nand improved with the involvement of clients. health providers and community\nleaders. National plans and policies should put maternal health into its broad social\nand economic context, and incorporate all groups and sectors that can support safe\nmotherhood.\nEach of the co-sponsors of the Safe Motherhood Initiative implements these\nactivities according to its specific mandate.\nBACKGROUND INFORMATION\nThe World Bank\nMaking Motherhood Safe\nTen years after the launch of the Safe Motherhood Initiative, more than 1,500\nwomen die every day in the developing world from preventable pregnancy-related\ncomplications. Nearly 20,000 pregnancies a day result in stillbirths or infant deaths\nwithin the first week of life. The death of a woman of reproductive age translates into\nsubstantial economic and social hardship for her family and community. By ensuring\nthat women receive sufficient maternal care, and by providing women with effective\nfamily planning services, many of these deaths can be avoided.\nA SOCIAL AND ECONOMIC CHALLENGE\nAlthough women's health is vital to sustainable development, it receives little\nattention in the developing world. Maternal mortality rates, for example, show the widest\ndisparity between industrial and developing countries of any human development\nindicator. Calculations by the World Bank show that improving health care for women\naged 15-44 offers the biggest return on health care spending for any demographic group\nof adults (men or women). Furthermore, instead of crippling their nations' economies\nhealthy women become productive members of their societies and so do their healthy\nchildren. Studies have shown that women are responsible for:\nProviding 70 to 80 percent of the health care in developing countries;\nHeading at least 20 percent of all households in Africa and Latin America;\nGrowing 80 percent of the food consumed domestically in parts of Africa and at least\n50 percent of export crops; and\nEarning 40 to 60 percent of household income, if home production is valued.\nAs the World Bank recognizes women's role in eradicating poverty and enabling\ndevelopment, the Bank supports member governments, along with other assistance\nagencies and non-governmental organizations to develop programs and implement\npolicies that will make pregnancy and birth as safe as possible for women and children.\nThe World Bank now has over 100 projects with women's health components in over\nseventy countries. Lending has averaged US$490 million over the last three years for\nreproductive health (family planning, maternal health and STDs/AIDS control) compared\nto US$170 million in 1990.\nWORKING TOGETHER\nSafe motherhood is a community responsibility. It can only happen if\ngovernments, international development organizations, community-based grass-roots\ngroups, businesses, and private citizens work together. In an effort to reduce the high toll\nof maternal morbidity and mortality, the World Health Organization, United Nations\nChildren's Fund, United Nations Fund for Population Activities, the World Bank, IPPF,\nand the Population Council formed the Inter-Agency Group for Safe Motherhood in 1987\nand launched the Safe Motherhood Initiative. The initiative was launched in response to\nthe lack of cohesion and information available and the inevitably faltering political and\ndonor commitment to safe motherhood interventions. The goal of the program is to\nreduce maternal mortality and disability by sharing existing information and establish a\nconsensus on the most effective interventions, revitalize the existing commitments, and to\nraise awareness among new audiences, specifically businesses and social leaders, about\nthe importance of safe motherhood practices.\nSAFE MOTHERHOOD IN ACTION\nIn India, the government's Child Survival and\nSafe Motherhood Initiative, was launched in\nReproductive and Child Health: India\n1992 with the assistance of the World Bank\nIn this unprecedented World Bank-supported\nand UNICEF. The project has contributed to\nproject the government is working hand in\na 20 percent increase in the number of\nhand with the community it is trying to help.\nchildren fully immunized and a steadily rising\nConsultation with the private sector and the\nproportion of pregnant women who receive\ncommunity groups enables the creation of\npre-natal care and deliver their children in\nreforms that most directly address the\nhospitals.\nproblems of the rural poor. As a result of\nthese consultations, reform targets are\nfocused on providing accessible quality\nIn the fifth of a series of population projects\nhealth and information services to the rural\nin India, the World Bank has supported the\npoor, in addition to providing contraception\ngovernment's goal of improving the\ninformation.\navailability and quality of family planning\nand maternal and child health services for poor urban families through the \"Fifth\nPopulation Project.\" This project reduced sickness and death for about 2.5 million\npoor women and children by increasing the availability, quality, and use of temporary\nbirth control methods; by promoting birth spacing; and by supporting child health\nservices.\nThe Bangladesh Population and Health Project, financed by a consortium of donors,\nsupports Safe Motherhood by strengthening family planning and other health\nservices, including comprehensive maternal and neonatal care, training of birth\nattendants, and upgrading health facilities.\nIn Indonesia the approach to Safe Motherhood is through partnership. By involving\npublic and private sector agencies and NGOs involved in maternal health, this project\nseeks to improve the supply and demand for maternal health services, and to\nstrengthen the sustainability of these services at the village level.\nSafe Motherhood goals are being obtained in Morocco by increasing availability to\ncontraceptives, reorganizing prenatal service delivery at the provider and facility\nlevel, and by training traditional birth attendants.\nInvesting in women's health enables women to participate more fully in the\nprocess and benefits of development, and is an integral part of the Bank's poverty\nreducing strategy. By addressing the key problems affecting women throughout their life\ncycle, governments can improve human welfare and national economic efficiency. The\ninternational disposition to work towards better women's health is unprecedented. In\npartnership, governments, other international assistance agencies, and local communities\nhave the power to build on this positive global outlook and on the models and strategies\nthat have been developed locally to improve the health and nutrition of women. Both as a\ncatalyst for, and a partner in development, the World Bank acknowledges that\ngovernments and people must make their own decisions about their future and the Bank\nstands ready to assist them.\nRECENT WORLD BANK PUBLICATIONS ON SAFE MOTHERHOOD\n1997. Investing in Young Lives: The Role of Reproductive Health\n1997. Health, Nutrition, & Population Sector Strategy Paper\n1996. Improving Women's Health in India\n1996. India's Family Welfare Program\n1995. Safe Motherhood Initiative Pamphlet\n1994. A New Agenda: For Women's Health and Nutrition\n1994. Population and Development\n1994. Women's Health and Nutrition: A World Bank Discussion Paper No. 256\nPrepared by External Affairs, February 1998\nFOR MORE INFORMATION\nCONTACT: Benna Holden\n(202) 973-0369\n\"Year of Safe Motherhood\"\nFACTS AT A GLANCE\nEvery minute of every day. somewhere in the world, a woman dies from complications related to pregnancy or\nchildbirth (defined as a maternal death).\nApproximately 50 million women a year (equivalent to the total population of the countries of Spain and\nPortugal) suffer maternal health complications.\nIn developing countries, pregnancy and childbirth are the leading causes of death, disease and disability among\nwomen of reproductive age:\nLeading Causes of the Burden of Disease in Women Aged 15-44 in the\nDeveloping World, 1990\nRespiratory infection\nwhich\n25%\nAnema\n-\n25%\nSelf inflicted injures\n3.2%\nDepressive disorders\n5.8%\nHIV\n6.6%\nTubercurosis\n7.0%\nSTD\n8.9%\nMaternal causes\n18.0%\n0%\n2%\n4%\n6%\n8%\n10%\n12%\n14%\n16%\n18%\n20%\nSource: World Development Report 1993: Investing in Health. World Bank. Washington. DC. 1993\nWorldwide. there are 430 maternal deaths for every 100,000 live births. In developing countries, the figure is\n480 maternal deaths for every 100.000 live births; in developed countries there are 27 maternal deaths for\nevery 100.000 live births.\nA woman's risk of dying from pregnancy and childbirth varies widely by region:\nRegion\nRisk of Dying\nAfrica\n1 in 16\nAsia\nI in 65\nLatin American & Caribbean\nI in 130\nNorthern Europe\nI in 4,000\nNorth America\nI in 3,700\nAll developing countries\n1 in 48\nAll developed countries\n1 in 1,300\nCountry-level differences are even more dramatic: for example, in Ethiopia, 1 out of every 9 women die from\npregnancy-related complications. as compared to 1 in 8,700 in Switzerland.\nThere are five main causes of maternal death worldwide:\nCauses of Maternal Death\nsevere bleeding\n25%\ninfection 15%\nindirect causes\n20%\nother\neclampsia 12%\ndirect causes 8%\nobstructed labour\nunsafe abortion\n8%\n13%\nSource: Maternal Health Around the World. WHO. 1997\nDeliveries by Relatives or Alone, Selected Countries\nEach year, 60 million deliveries take place in\nwhich the woman is cared for only by a family\nDelivery by\nDelivery alone\nmember. an untrained traditional birth\nrelative/other (%)\n(%)\nattendant -- or no one at all.\nMalawi\n41\n7\nUganda\n35\n12\nNiger\n24\n17\nNepal\n56\n11\nPakistan\n52\n2\nSource: Demographic and Health Surveys. selected countries. various years.\nSkilled Attendance at Delivery and Maternal\nMortality Ratios, selected countries\n98%\n100%\n94%\n1000\n1000\nCountries where skilled attendance at delivery\n77%\n850\n800\n75%\nis low tend to have higher rates of maternal\nSkilled Attendance at\n650\n250\nMaternal Mortality Ratio\ndeath and disability. In 1996, skilled birth\n600\nDelivery\n46%\nattendants were present at only 53% of births\n50%\nin the developing world. In developed\n31%\n400\ncountries. skilled attendance is nearly\n25%\nuniversal.\n200\n140\n5%\n20\n0%\n0\nTrinidad\n&\nSriLanka\nBotswana\nBolivia\nNigeria Bangladesh\nTobago\nSkilled Attendance at Delivery\nMaternal Mortality Ratio\nSource: \"Revised 1990 Estimates of Maternal Mortality\". WHO. 1996 and \"Coverage of Maternal Care\". WHO. 1997\nChild Deaths When a Parent Dies, per 1,000\n200\nMotherless children are likely to get\n150\nless health care and education as they\ngrow up. A study in Bangladesh\n100\nfound that when a mother dies, her\n50\nchildren - especially daughters - are\n0\nmuch more likely to die than children\n:\nno parent dies\nfather dies\nmother dies\nwhose parents are both alive.\n:\nsons\ndaughters\nSource: Mother Buby Package Implementing Sufe Motherhood in countries. WHO, 1994\nMost maternal deaths, millions of cases of disease and disability. and the deaths of at least 1.5 million infants\neach year could be prevented through:\n=\nbasic maternal care for all pregnancies, including a skilled attendant (doctor or midwife) at birth:\n=\nprevention and treatment of complications during pregnancy, delivery and after birth; and\n11\npostpartum family planning and basic neonatal care.\nThese health care services would cost approximately $3 per person per year in most developing countries.\n###\nMEDICUS GROUP\nSafe Motherhood Initiative\n\"To be a Mother\"\nTV :60\n3/11/98\nANNCR VO:\nHow to hold your baby.\nhow to be there for your baby. If you die\nAnd if you die, chances are your baby will\nTo be a mother, you must know these\nFeed and care for your baby.\nwhile giving birth, you can't be there.\ntoo.\nthings.\nBut most important,\nSo if you or someone you love is pregnant,\nto take action if you see any of these signs\nIf your waters break, even a little.\nBecause before you can hold and comfort\nsee a healthcare worker. And be prepared\nBleeding, severe headache, or fever.\nIf your birth pains last more than a day,\nand love,\nget to a healthcare worker immediately.\nO\nSafe\nMotherhood\nS\nUNFPA\nUNICEF\nWHO\nTHE WORLD BANK\nPPF\nCreative: Lisa Reswick, Paula Raymond,\nPOPULATION COUNCIL\nPenny Hawkey - Medicus Group\nProducer: Maxine Danowitz\nbefore you can care for your baby, you\nThe Safe Motherhood Initiative.\nBecause our mothers are our future.\nEditor: Alan Eisenberg - Horn/Eisenberg\nmust first care for yourself.\nSound: Leonard Hospidor - Russo/Grantham -\nBack Pocket Studios\nMEDICUS GROUP\nSafe Motherhood Initiative \"I thought my baby\n\"\nTV :60\n3/11/98\nOVERLAPPING MOTHERS' VO:\nI knew she'd have lots of curly\nI thought he'd be strong\nHer father's smile\nI thought I'd be there to see it\nI thought my baby would look\nhair,\nThe biggest eyes\n(Mothers fade away)\njust like me\nANNCR VO: Every minute of\nAlmost 600,000 women each\nsisters, workers, wives.\nAnd when they die or become ill,\nYet, more than 90% of these\nevery day, a woman dies during\nyear - a tragic loss of our\ntheir babies often do too.\nwomen could be saved\npregnancy or childbirth.\nnation's daughters,\nO\nSafe\nSafe\nMotherhood\nUNFPA\nS\nis\nMotherhood\nUNICEF\nFCI\nWHO\nP.O. Box 902\nTHE WORLD BANK\nNY, NY 10274 USA\nIPPF\nPOPULATION COUNCIL\nwww.safemotherhood.org\nfor as little as $2 per person per\nsimple, affordable health and\nTo find out how your government\nThe Safe Motherhood Initiative.\nBecause our mothers are our\nyear. The Safe Motherhood\neducation programs save lives.\nand community can help, visit our\nfuture.\nInitiative has developed\nwebsite or write us today.\nCreative: Lisa Reswick, Paula Raymond, Penny Hawkey - Medicus Group\nProducer: Maxine Danowitz\nEditor: Alan Eisenberg - Horn/Eisenberg\nSound: Leonard Hospidor - Russo/Grantham - Back Pocket Studios\nis\nAdolescent Sexuality and Childbearing\nAdolescent pregnancy is alarmingly common in many countries. Every year, adolescents* give birth to 15 million\ninfants.¹ These young girls face considerable health risks during pregnancy and childbirth. Girls aged 15-19 are\ntwice as likely to die from childbirth as women in their twenties; those under age 15 are five times as likely to\ndie.² Because early childbearing is SO frequent, and carries SO many health risks, pregnancy-related complica-\ntions are the main cause of death for 15-19 year old girls worldwide.³\nSexual Behaviour and Childbearing\nGlobally, most people become sexually active during ado-\nSexual Activity Among Women Age 15-19⁴\nlescence. Rates are highest in sub-Saharan Africa, where\nMarried\n60%\nmore than half of girls aged 15-19 in seven countries are\n60\nSingle, sexually active\n52%\nsexually experienced.\n50\n48%\nMillions of adolescents are bearing children. In sub-\n40\nSexual Activity %\n35%\nSaharan Africa, more than half of women give birth before\n30\n26%\nage 20. In Latin America and the Caribbean, this figure\n20%\n20%\n20\n18%\n18%\ndrops to one third.⁵\n11%\n10\n6%\n5%\nn/a\nn/a\n0\nBotswana\nUnited\nJamaica\nKenya\nCusta Rica Bangladesh Indonesia\nStates\nWhy Is Adolescent Pregnancy so Common?\nA lack of information and services: Adolescents often have\nCultural values: In many developing countries, female sta-\npoor information about reproduction and sexuality, and\ntus is equated with marriage and motherhood. Adolescents\nlittle access to family planning and reproductive health\noften marry early; more than 50 countries allow marriage\nservices.\nat age 16 or below, and seven allow marriage as early as\nage 12.\" Even the youngest brides face immediate pressure\nIn Sri Lanka, one-third of young adults age 16-24 did not\nto prove that they are fertile.⁷\nknow the duration of a normal pregnancy. Fewer than 5%\nhad discussed reproductive health with their parents.\nHealth Risks\nReproductive health problems and deaths are more com-\nMaternal Mortality* by Age⁸\nmon among sexually active adolescents than among\n1400\n20-34 years\nwomen in their 20's and early 30's.\" Physiologically and\n1270\n15-19 years\n1200\n1100\nsocially, adolescents are more vulnerable to:\n1000\n860\n- Maternal death: Girls age 15-19 are up to twice as likely\n800\nto die during pregnancy or delivery as women age 20-34.\n600\n575\n479\n526\n436\n400\n- Infant and child mortality: Children born to adolescents\n223\n200\nare more likely to die during their first five years of life\n80\n108\n0\nthan those born to women age 20-29.\"\nEthiopia\nIndonesia\nBangladesh\nNigeria\nBrazil\n- Sexually transmitted diseases (STDs): Each year, I in 20\nMaternal deaths per 100,000 live births\nadolescents worldwide contracts an STD (including\nHIV/AIDS).¹\nAt Kenyatta Hospital in Nairobi, one-quarter of girls age\n15-19 seeking antenatal care had an STD (gonorrboca,\nchlamydia or herpes).\"\n*The World Health Organization defines adolescence as the period of life between ages 10 and 19.\nSAFE MOTHERHOOD FACT SHEET\n- Violence/sexual abuse: Adolescent girls may lack the confi-\n- Unsafe abortion: Each year, girls age 15-19 undergo at\ndence and decision-making skills to refuse unwanted sex.\nleast five million induced abortions.¹ Because abortion is\nGirls who are subject to sexual abuse and rape can suffer\nlegally restricted in many countries, adolescents often resort\nserious, life-long physical and emotional consequences.\nto unsafe procedures by unskilled providers. Adolescent\ngirls therefore suffer a significant - and dispro-\nIn interviews with adolescents in Peru and Colombia,\nportionate - share of death and disability from unsafe\n60% said they had been sexually abused within the previous\nabortion. 130\nyear.¹¹\nSocial and Economic Problems\nA young mother's ability to meet her own needs and those of\nIn Kenya, 10,000 girls leave school each year due\nher children can be jeopardised by:\nto pregnancy.\"\nA lack of education. Young women are often expelled\nA lack of income. It can be difficult for young mothers,\nfrom school if they become pregnant, and few ever return.\nespecially those without education or marketable skills, to\nsupport themselves and their families financially.\nGiving Girls Other Opportunities\nAge at marriage: Delaying marriage often delays first birth,\nEducation: Women who have some secondary schooling\nand can also reduce the total number of children a woman\nare less likely to give birth during adolescence.\" On aver-\nhas, since she will spend fewer years in childbearing.\"\nage, women with seven or more years of education marry\nfour years later and have 2.2 fewer children than those\nwith no education.14\nWhat Can Be Done\nLong-term policies and programmes must address the\n- Removing legal, regulatory and cultural barriers to sexu-\nunderlying social, cultural and economic factors that con-\nal and reproductive health information and services for\ntribute to adolescent sexual activity and childbearing.\nadolescents.\nThey must improve the status of women and girls and\nexpand their opportunities by:\n- Providing appropriate, accurate sexual and reproductive\nhealth education for young people, both in- and out-\n- Encouraging family and community support for delayed\nof-school.\nmarriage and childbearing.\n- Designing and providing sensitive and confidential\n- Expanding girls' access to higher quality education and\nreproductive health services that respond to young peo-\ntraining, and helping them build marketable skills.\nples' particular needs; help them make informed decisions\n- Increasing income-earning abilities, opportunities to\nabout sexuality and negotiate safer sex; and emphasise\nearn income and access to other resources for adolescent\nthe prevention of unwanted pregnancy, unsafe abortion\ngirls and women.\nand STDs.\nMore immediately, programmes must make it possible for\n*Each of the co-sponsors of the Safe Motherhood Initiative (see below)\nall adolescents to take responsibility for, and protect, their\nimplements these activities according to HS specific mandate.\nsexual and reproductive health by*:\nSources:\n11: \"Adolescent Reproductive Health\". Network, 17(3). Spring, 1997.\nI: \"Issues in Brief: Risks and Realities of Early Childbearing Worldwide\". Alan Guttmacher\n12: S. Koontz and S.R. Conly, Youth at Risk: Meeting the Sexual Needs of Adolescents.\nInstitute, New York, 1997.\nPopulation Action International, Washington, DC, 1994.\n2: United Nations Dept. of International Economic and Social Affairs, The World's Women:\n13: S. Singh, \"Adolescent Childbearing and Pregnancy in Developing Countries: A Global\nTrends and Statistics 1970-90. United Nations, New York, 1991.\nReview\". Workshop organized by Alan Guttmacher Institute. New York. 1997.\n3: \"Too Old for Toys, Too Young for Motherhook UNICEE New York. 1994.\n14: N. Sadik, State of the World Population 1990. New York. UNFPA. 1990.\n4: Senderowitz, \"Adolescent Health: Reassessing the Passage to Adulthood\". World Bank\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\nDiscussion Papers #272, Washington, DC. 1995.\n(IAG). The IAG includes the United Nations Children's Froud (UNICEF). United Nations\n5:J. Hoberaft, notes prepared for the Safe Motherhood Technical Consultation in Sri Lanka, 18.\nPopulation Fund (UNFPA). World Bank, World Health Organization (WHO), International\n23 October 1997.\nPlanned Parentbood Federation (IPPF). and the Population Council: FCI serves as the secretariat.\n(v: \"Adolescent Health and Development: The Key to the Future\". World Health Organization,\nThese fact sheets have also been prepared in more detailed versions for technical audiences. For\nGeneva, 1995.\nmore information or copies of available materials. contact any IAG member, or the secretarial at:\n7: N. Sadik, The State of World Population 1997. UNFPA. New York. 1997.\nFamily Care International\n588 Broadway, Suite 503\nS: \"The Health of Youth. Facts for Action: Youth and Reproductive Health\". World Health\nNew York. NY. 10012. USA\nOrganization, Geneva, 1989.\nTel: (212) 941-5300\n9: G. Bicego et al., \"Infant and Child Mortality\", DHS Comparative Studies, No. 20. Macro\nFax: (212) 941-5563\nInternational, Calverton, MD, 1996.\nEmail: [email protected]\nWeb site address: wwwe.safemotherbood.org\n10: \"Adolescent Reproductive Health in Developing Countries\". CommonHealth: The Bulletin\nof the Commonwealth Medical Association, #2. 1995.\n1998\nis\nEvery Pregnancy Faces Risks\nEvery time a woman is pregnant - which happens an estimated 200 million times every year around the world -\nshe risks a sudden and unpredictable complication that could result in her death or injury, and the death or injury\nof her infant. At least 40% of all pregnant women will experience some type of complication during their preg-\nnancies. For about 15%, this complication will be potentially life-threatening, and will require immediate\nobstetric care.'\nWhich Women Are at Risk?\n\"Maternal risk\" is defined as the probability of dying or\nSome groups of women are more likely to develop preg-\nexperiencing a serious complication as the result of preg-\nnancy complications than others (for example, if they had\nnancy or childbirth.\na complication during a previous pregnancy). However,\nit is almost impossible to predict which individual woman\nwill develop a life-threatening complication.3\nWhat Is \"Risk Assessment\"?\nRisk assessment is a tool used by health systems that aims\nRisk assessment was developed to help health providers\nto separate women into categories - typically \"high risk\"\nallocate their time and resources to the women who need\nand \"low risk\" - according to certain social, demographic\nthem most, especially in communities with limited\nor physical characteristics such as educational status, age,\nresources. However, a review conducted for the World\nheight, and number of pregnancies.³ Ideally, women who\nHealth Organization found that risk assessment has not\nare defined as \"high risk\" are then given special care to\nbeen an effective strategy for preventing maternal death.4\nprevent or manage any health problems they may develop.\nRisk assessment is usually conducted as part of antenatal\ncare during pregnancy.\nWhy Doesn't Risk Assessment Work?\nThe broad characteristics used by most risk assessment sys-\nThe same study in Zaire found that 71% of the women\ntems are not precise enough to predict an individual\nwho did develop obstructed labour did not have any\nwoman's risk.256 As a result, a large number of women are\nbistory of problems.\nidentified as \"high risk\", even though they never develop\nEven if a woman is correctly identified as being at risk of\nany complications.\ncomplications, there is no guarantee that she will get\nA study in Zaire found that 90% of women who were\nappropriate care. Many health systems cannot provide ade-\nidentified as \"at risk\" for obstructed labour ended up not\nquate services. Also, women themselves may be unable or\nhaving any problem during delivery.⁷\nunwilling to seek medical care when they are told they\n- Most of the women who develop complications do not\nare \"high risk\". They may lack financial resources to pay\nhave any risk factors, and are therefore classified as\nfees, be too busy, face opposition from family members\n\"low risk\".\nor simply not want to go.\nWhen Risk Assessment Fails\nWomen may not receive life-saving care. Women who are\nHealth systems are overburdened: Misdiagnosing women\nidentified as \"low risk\" can be fulled into a false sense of\ncan create a serious problem for health systems. They may\nsecurity. If this happens, they may fail to recognise the signs\nfind themselves overloaded and have to spend scarce time\nof complications, and fail to seek appropriate services.⁵\nand resources on unnecessary treatment for \"high risk\"\nPersonal cost and inconvenience is high. Women who\nwomen who in fact never develop any complications.\nare identified as \"high risk\" may waste valuable time and\nSince risk assessment cannot predict which women will\nspend scarce funds seeking unnecessary treatment.\nexperience pregnancy complications, it is critical that all\nSAFE MOTHERHOOD FACT SHEET\nwomen who are pregnant, in labour or recently had a baby\nhave access to high quality maternal health care. This\ncare must include services to manage serious pregnancy\ncomplications if and when the need arises.\nWhat Can Be Done\nGovernments and health providers need to recognise that\nreferrals; and treatment of a woman who is experiencing\nevery pregnancy is special, and should ensure that all\ncomplications until she can be transferred safely to a\npregnant women have access to high-quality maternal\nhigher level of care.\nhealth services by:\n- Ensuring that a functioning system of communication\n- Educating women and their families about the risk of\nand transportation links health workers who are working\ncomplications faced by all women, and about actions\nin communities, health centres and hospitals SO that\nthey should take if and when a problem arises.\nwomen with pregnancy complications can receive prompt\nand appropriate medical care.\n- Providing adequate care as close as possible to where\nwomen live. Services should include clean deliveries by\n- Improving women's overall well-being and reproductive\nhealth workers who have been trained in midwifery;\nhealth through prevention and through screening and\nprompt recognition of complications and appropriate\ntreatment for existing problems that contribute to poor\nreproductive health.\nSources:\n1: M. Koblinsky, et al., \"Mother and More: A Broader Perspective on Women's Health\", III M.\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\nKoblinsky, et al., eds., The Health of Women: A Global Perspective. Westview Press. Oxford,\n(IAG). The IAG includes: the United Nations Children's Fund (UNICEF). United Nations\n1993.\nPopulation Froud (UNFPA). World Bank. World Health Organization (WHO). International\n2: Winikoff, \"Maternal Risk\". Paper presented at Berzelius Symposum, Stockholm, Sweden,\nPlanned Parentho of Federation (IPPF). and the Population Council: FCI serves as the secretariat.\n1991.\nThese fact sheets have also been prepared IN more detailed versions for technical audiences. For\n3: W. Graham, \"Every Pregnancy Faces Risk\". Presentation at Safe Motherhood Technical\nmore information OF copies of available materials. contact any IAG member, or the secretariat at:\nConsultation in Sn Lanka, 18-23 October 1997.\nFamily Care International\n4:C. Rooney, Antenatal Care and Maternal Health: How Effective Is IR? A Review of the\n588 Broadway, State 503\nNew York, NY. 10012 USA\nEvidence\" (WHO/MSM/92.4). World Health Organization, Geneva, 1992.\nTel: (212) 941-5300\n5: E.A. Yuster, \"Rethinking the Role of the Risk Approach and Antenatal Care in Maternal\nFax: (212) 941-5563\nMortality Reduction\". International Journal of Gynecology and Obstetrics 50(2). 1995\nEmail: [email protected]\n6: JE. Rhodes, \"Removing Risk from Safe Motherhood\". International Journal of Gynecology\nWeb site address: www.safemotherbood.org\nand Obstetrics 50(2). 1995.\n1998\n7: Maine, Safe Motherbood Programs: Options and Issues. Center for Population and Family\nHealth, Columbia University, New York. undated.\nis\nSkilled Care During Childbirth\nThe single most important way to reduce maternal deaths is to ensure that a skilled health professional is pre-\nsent at every birth. However, there is a serious shortage of these professionals in developing countries. Whether\nby choice or out of necessity, 60 million women in the developing world give birth each year without skilled\nhelp - cared for only by a traditional birth attendant, a family member, or no one at all.¹\nSkilled care during childbirth is important because millions of women and newborns develop serious and hard-\nto-predict complications during or immediately after delivery. Skilled attendants - health professionals such as\ndoctors or midwives who have midwifery skills - can recognise these complications, and either treat them or\nrefer women to health centres or hospitals immediately if more advanced care is needed.\nUnassisted Births Are Common and Can Be Fatal\nMore than three-quarters of all maternal deaths in develop-\nSkilled Attendance at Delivery and Maternal\ning countries take place during or soon after childbirth.\nMortality Ratios, selected countries¹, 3\n100\n98%\n94%\n1000\n1000\nIn 1996, skilled birth attendants were present at only 53%\n80\n77%\n850\nof births in the developing world.¹ In developed countries,\n800\nskilled attendance is nearly universal.\nSkilled Attendance at Delivery %\n650\n60\n600\n46%\nCountries where skilled attendance at delivery is low tend\n40\n31%\n400\nto have higher rates of maternal death and disability.\nMaternal Mortality Ratio\n250\n20\n200\n140\n5%\n90\n0\n0\nTrinidad &\nSri\nLanka\nBotswana\nBolivia\nNigeria Bangladesh\nTobago\nSkilled Attendance at Delivery\nMaternal Mortality Ratio\nMaternal Deaths per 100,000 Live Births\nWho Should Provide Care During Childbirth?\nThe best person to provide assistance during childbirth is a\nSkilled attendants include doctors, nurses, midwives and\nhealth professional with midwifery skills who lives in or\nother health workers with midwifery skills who can diag-\nnear to the community he or she serves.\nnose and manage complications during childbirth, as well\nas assist normal deliveries.\"\nMost midwives work in hospitals and urban areas. They\nare scarce in rural areas - where 80% of developing coun-\nAdequate equipment, drugs and supplies are essential to\ntry populations live.\nenable skilled attendants to provide good quality care. In\naddition, skilled attendants need to be supported by appro-\nIn parts of Asia and Africa, there is only one midwife for\npriate supervision. When delivery is taking place in the\nevery 15,000 births.⁵\nvillage (at home or in a local health facility), an emergency\ntransport system must be available to take women to facili-\nNumber of Midwives per 100,000 Births, Selected Countries⁴\nties that can provide more advanced care.\n120\n102\n100\n80\n60\n40\n40\n20\n16\n14\n5\n0\nDom. Rep\nIndia\nHaiti\nGhana\nKenya\nSAFE MOTHERHOOD FACT SHEET\nCare in the Community\nIn developing countries, women commonly seek the help of\nIn many places, especially in Asia and Africa, women give\ntraditional birth attendants: community members who\nbirth with the help of a relative, or alone.\ndeliver infants according to local customs and beliefs. In\nsome - but not all - communities, these attendants may\nDeliveries by Relatives or Alone, Selected Countries'\nhave some training to help them avoid harmful practices,\nDelivery by\nDelivery alone (%)\nrelative/other (%)\nconduct clean deliveries, recognise danger signs and refer\nwomen to health facilities if they have any complications.\nMalawi\n41\n7\nHowever, without emergency back-up support (including\nUganda\n35\n12\nNiger\n24\n17\nreferral to a district hospital), training traditional birth\nNepal\n56\n11\nattendants does not decrease a woman's risk of dying in\nPakistan\n52\n2\nchildbirth.7\nTraining Needs\nAs countries try to ensure that a qualified health profes-\n- Supervision and refresber training in family planning and\nsional is present at the birth of every child, they face a\nmaternal health are often inadequate.* In Uganda, for\nnumber of significant problems:\nexample, a study found that only 28% of midwives had\never taken a refresher course.\"\n- Existing health workers often lack the skills they need to\nsave the lives of women who suffer emergency complica-\n- Many midwives and physicians have no training in tra-\ntions. These skills include the ability to prevent, identify\nditional belief systems, communication and community\nand treat problems such as shock, haemorrhage, infection\norganising.* These topics are needed to ensure that a\n(sepsis), and eclampsia (convulsions from high-blood pres-\nhealth worker is an accepted part of the community she\nsure), and to manage abortion complications.\nor he serves.\n- Curricula used to teach midwifery skills are often out of\ndate and do not reflect new techniques and research.\nMany of these curricula are adapted from developed coun-\ntry models and do not reflect the limited resources and\npoor working conditions in developing countries.\nWhat Can Be Done\nIncrease the number of health professionals with mid-\nUpgrade, establish and expand comprehensive midwifery\nwifery skills in under-served regions, particularly poor\ntraining programmes that include life-saving skills for\nand rural areas.\ndealing with obstetric emergencies.\nTrain, authorise and equip midwives, nurses and commu-\nCreate clearly-defined protocols for routine care and the\nnity physicians to provide all feasible obstetric services\nmanagement of complications.\nneeded within communities, especially emergency interventions, and\nEstablish systems for supervising and supporting skilled\nto prescribe medication. Establish systems for training, supervising\nbirth attendants, and for emergency referral and treatment.\nand supporting these providers, and for linking them to higher-level\nhealth facilities for back-up.\nSources:\n1: \"Coverage of Maternity Care: A Listing of Available Information, Fourth Edition\". World\n9: \"Strengthening Midwitery Within Safe Motherhood: Report of a Collaborative\nHealth Organization, Geneva, 1997.\nICM/WHIO/UNICEF Pre-Congress Workshop\". World Health Organization, Geneva, May 1996.\n2: AbouZahr, \"Improve Access to Quality Maternal Health Services\". Presentation at Safe\nMotherhood Technical Consultation in Sri Lanka, 18-23 October 1997.\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\n3: \"Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF\".\n(IAG). The IAG includes: the United Nations Children's Froud (UNICEF). United Nations\nWorld Health Organization, Geneva, 1996.\nPopulation Fund (UNFPA). World Bank. World Health Organization (WHO). International\n4: \"Midwitery Education: Action for Safe Motherhood, Report of a Collaborative Pre-Congress\nPlanned Parentbood Federation (IPPF). and the Population Comeil: FCI serves as the secretariat.\nWorkshop\". World Health Organization, Geneva, October 1990.\nThese fact sheets have also been prepared in more detailed versions for technical audiences. For\n5:J. Fortney, \"Ensuring Skilled Attendance at Delivery: The Role of TBAs\". Family Health\nmore information or copies of available materials, contact any IAG member, or the secretariat at:\nInternational, Research Triangle Park, NC. 1997.\nFamily Care International\n6: WHO/FIGO/International Confederation of Midwives, \"Definition of the Midwife\". 1992.\n588 Broadway. Suite 503\nNew York. NY, 10012, USA\n7: A. Tinker and M. Koblinsky, Making Motherboo of Safe. World Bank, Washington, DC, 1993.\nTel: (212) 941-5300\n8: Demographic and Health Surveys, selected countries, various years. Macro International,\nFax: (212) 941-5563\nCalverton, MD.\nEmail: [email protected]\nWeb site address: www.safemotherbood.org\n1998\nGood Quality Maternal Health Services\nMillions of women do not have access to good quality health services during pregnancy and childbirth - especially\nwomen who are poor, uneducated or who live in rural areas.' Less than half of women in developing countries get ade-\nquate health care during and soon after childbirth, despite the fact that most maternal deaths take place during these\nperiods.¹ In contrast, use of maternal health services is nearly universal in developed countries.\nAccess means that services are available and within reach of women who need them. Good quality services require\nthat health care providers have adequate clinical skills and are sensitive to women's needs; that facilities have nec-\nessary equipment and supplies; and that referral systems function well enough to ensure that women with\ncomplications get essential treatment.\nMany Women Lack Maternal Health Care\nAt least 35% of women in developing countries receive no\nMaternity Care: The Percentage of Women Who²:\nMake at Least 1 Antenatal Visit\nantenatal care during pregnancy, almost 50% give birth\n100\n97%\n98%\n99%\n95%\nDeliver with Skilled Attendance\nwithout a skilled attendant and 70% receive no postpar-\n80\n73%\n75%\ntum care in the six weeks following delivery. This lack of\n63%\n65%\n60\ncare is most life-threatening during labour, childbirth and\n53%\n42%\nthe days immediately after delivery, since these are the\n40\ntimes when sudden, life-threatening complications are most\n20\nlikely to arise.\n0\nAfrica\nAsia\nLatin America &\nEurope\nNorth America\nthe Caribbean\nWhy Women Do Not Use Available Services\nNo physical access: Most rural women (80%) live more\nPoor information: Women and community members often\nthan five kilometres from the nearest hospital. Vehicle\ndo not know how to recognise, prevent or treat pregnancy\nshortages and poor road conditions mean that walking is\ncomplications, or when and where to seek medical help.\noften the main mode of transportation, even for women\nIn Ghana, 64% of women who died of pregnancy compli-\nin labour.¹\ncations sought help from a traditional healer before going\nIn rural Tanzania. 84% of women who gave birth at home\nto a health facility. Families cited cost and their belief that\nintended to deliver at a health facility, but could not\nthe woman was not ill enough as the main reasons for not\nbecause of distance and the lack of transport.3\nseeking hospital care.'\nHigh costs: Millions of women cannot afford to use mater-\nCultural preferences: Formal health services can conflict\nnal health services. Even when formal fees are low or\nwith ideas about what is normal and acceptable, including\nnon-existent, women often face hidden fees and expenses\npreferences for privacy, modesty and female attendants.\nfor transport, drugs, and food or lodging for the woman or\nThe Saraguro Indians in Ecuador shun affordable, accessi-\nher family members.\nble maternity care because they feel that hospitals violate\nwomen's privacy during childbirth and because many\nImpact of User Fees on Obstetric Admissions, Zaria, Nigeria\nhealth providers are men.'\nObstetric\nFees for some\nIncreases\nservices\nservices\nin fees (1988)\nLack of decision-making power: In many parts of the\nfree (1983)\nintroduced (1985)\nObstetric\nworld, women's power to make decisions is limited, even\nadmissions\n7,450\n5,437\n3,376\nover matters directly related to their own health.\nDeliveries\n6,535\n4,377\n2,991\nIn Bangladesh, it is usually the mother-m-law and husband\nMaternal deaths\n2\n1\n62\nwho make the decision to seek (or not seek) care. Studies\nhave found that they are the least likely 10 know about\npregnancy-related complications and their possible fatal\nconsequences.\"\nSAFE MOTHERHOOD FACT SHEET\nHealth Services Are Inadequate\nPoor quality of care is one of the most common reasons\n- Other factors include: a lack of privacy; run-down physi-\nwomen give for choosing not to use available maternal\ncal facilities; inconvenient operating hours; and restrictions\nhealth services. Problems include:\non who can stay with a woman at the health facility.*\n- Health facilities in developing countries face chronic\nDelays in referring women from community health facilities\nshortages of equipment, drugs and basic supplies, includ-\nto hospitals are one of the most important barriers to life-\ning blood for transfusion. Families of women in labour\nsaving maternal care.\nmay be forced to purchase drugs and supplies to bring to\nIn Masavingo, Zimbabwe, a significant proportion of\nthe hospital,⁷ which can cause fatal delays.\nmaternal deaths were caused by \"avoidable factors\".\n- Health facility staff are often poorly trained. They may\nincluding failure by health workers to identify women suf-\nlack both life-saving and basic clinical skills, and may not\nfering from serious pregnancy-related complications and to\nobserve hygienic practices.\nrefer them to a higher level of the health care system.\"\n- Health workers may be rude, unsympathetic and uncar-\nA study of 718 maternal deaths in Egypt found that 92%\ning, so women prefer to use the services of traditional birth\nof them could have been avoided if good quality care had\nattendants and healers.\nbeen provided.¹\nImproving the quality of existing maternal health services is the quickest,\nProvide technical competence:\nmost cost-effective way to save women's lives:\nStaff members should be trained in technical, clinical, management, and\nGood quality care aims to:\"\ninterpersonal skills;\nMeet women's needs:\nStandards of care and written protocols should be available;\nServices should be provided In health facilities that are as close as possi-\nble to where women live and that can provide the services safely and\nPhysical facilities should be adequate, clean and convenient;\neffectively;\nNecessary drugs, equipment and supplies should be available,\nServices should be sensitive to cultural and social norms, such as prefer-\nComprehensive reproductive health services (including follow up care)\nences for privacy, confidentiality and care by female health workers;\nshould be available on-site or through established linkages to other\nhealth facilities;\nStaff should be respectful, non-judgmental and responsive to clients;\nWomen should be treated as active participants in their own health, and\nA fully functional referral and transport system should exist between all\noffered information and counselling SO they can make informed decisions\nlevels of care (home/community, health centres, and district/regional\nabout their health and treatment.\nhospitals).\nWhat Can Be Done\nGovernments and non-governmental agencies must\n- Enforcing standards and protocols for service delivery,\nexpand services, improve their quality, and tailor them to\nmanagement and supervision, and using them to monitor\nmeet the needs of women and communities by:\nand evaluate the quality of services, along with feedback\n- Ensuring that health facilities are located close to where\nfrom clients and health providers.\nwomen live, have an adequate number of trained staff, a\n- Providing free or affordable maternal and infant health\ncontinuous supply of drugs and equipment, and are\nservices that manage any complications as well as offer\nlinked to hospitals by an emergency transport and refer-\nroutine care.\nral system.\n- Educating women and communities about the impor-\ntance of maternal health and appropriate services.\nSources:\nI:C. AbouZahr. \"Improve Access to Quality Maternal Health Services\". Presentation at Safe\n9:5 Faweus et al., \"A Commumity-based Investigation of Avoidable Factors for Maternal\nMotherhood Consultation in Sri Lanka. 18-23 October 1997.\nMortality in Zimbabwe\". Studies in Family Planning, Vol. 27. No. 6, November-December 1996.\n2: \"Coverage of Maternity Care: A Listing of Available Information, Fourth Edition\". World\n10: M. Kassas, et al., \"The National Maternal Mortality Study of Egypt 1992-1993\".\nHealth Organization, Geneva, 1997.\nInternational fournal of Gynecology and Obstetrics, Vol. 50 (Supplement 2). October 1995.\n3: G. Biego CI al., Survey on Adult and Childhood Mortality, Tanzania. Macro International,\n11: Mother-Baby Package: Implementing Safe Motherhood III Countries. World Health\nCalverton, MD. 1995.\nOrganization, Geneva, 1994.\n4: H. Odoi-Agyarko, N. Dollimore, O. Owusu-Argyei, \"Risk Factors in Maternal Mortality: A\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\nCommunity-Based Study in Kassena Nankani District\". Paper presented at the National\n(IAG). The IAG includes: the United Nations Children's Froud (UNICEF). United Nations\nConsultative Meeting on Sate Motherhood, Accra. Ghana, January 1993.\nPopulation Fund (UNFPA). World Bank. World Health Organization (WHO). International\n5:1. Leshe and G.R. Gupta, \"Unlization of Formal Services for Maternal Nutrition and Health\nPlanned Parentbood Federation (IPPF). and the Population Council: FCI serves as the secretariat.\nCare\". International Center for Research on Women, Washington, DC, February 1989.\nThese fact sheets have also been prepared in more detailed versions for technical audiences. For\n6: \"Safe Motherhood: A Woman's Right to Life, Information Kir\". Ministry of Health and\nmore information or copies of available materials. contact any IAG member, or the secretariat at:\nFamily Welfare, Bangladesh, 1997.\nFamily Care International\n7:S. Thaddeus and D. Maine, \"Too Far to Walk: Maternal Mortality in Context.\" Social Science\n588 Broadway, Suite 503\nMedicine 38(8). 1994.\nNew York. NY, 10012. USA\nTel: (212) 941-5300\nS: C. AbouZahr. C. Vlassoff and A. Kumar, \"Quality Health for Women: A Global Challenge\".\nFax: (212)941-5563\nHealth Care for Women International, Vol. 17. 1996.\nEmail: [email protected]\nWeb site address: www.safemotherbood.org\n1998\nis\nUnwanted Pregnancy\nThere are an estimated 200 million pregnancies around the world each year. Approximately one-third of these, or\n75 million, are unwanted.' These pregnancies contribute to maternal health problems in two ways: first, many\npregnancies are unwanted for reasons that can threaten the woman's health or well-being; she may have an\nexisting health problem, or lack the support and resources she needs to have a healthy pregnancy and raise a\nhealthy child. Second, where women do not have access to safe abortion services, many unwanted pregnancies\nare terminated using unsafe procedures that can lead to the woman's death or disability.\nUnwanted Pregnancy Can Be Deadly\nEvery year, approximately 50 million unwanted pregnan-\ndeveloping countries, causing the deaths of at least 200\ncies are terminated. Some 20 million of these abortions\nwomen each day.\nare unsafe. About 95% of unsafe abortions take place in\nWhy Do Unwanted Pregnancies Occur?\nAlthough unwanted pregnancy occurs for many reasons,\nUnmet Need for Family Planning*.\nthe most common are non-use of contraception or contra-\n40\nSelected Countries\n37%\n35%\nceptive failure:\n30\n27%\n26%\n- Between 120 and 150 million married women want to\n25%\nstop having children or postpone their next pregnancy,\n20\nbut are not using contraception. An additional 12 to 15\n14%\nmillion unmarried women also want to avoid pregnancy\n10\nbut lack the means to do so.¹\n0\n- An estimated 8 to 30 million pregnancies each year result\nGhana\nBolivin\nTanzania\nPhilippines\nEcuador\nIndonesia\n.\nfrom contraceptive failure - either because the method\nPercentage of women who would like stop childbenring or space their next\nbirth but are not using contraception.\nwas used inconsistently or incorrectly, or because the\nmethod failed.\nCultural Traditions Can Limit the Use of Contraception\nIn many countries women have little control over sexual\nceptives. Opposition from husbands is one of the most\nrelations and contraceptive use. Social expectations and\ncommon reasons women give for not using contraception.\npressures define what is or is not acceptable for a woman\n- Between 20% and 50% of women and girls report having\nto do, and can make it difficult for a woman to protect\nbeen subject to sexual coercion, abuse or rape.⁵ Such\nherself from unwanted pregnancy:\nwomen are at high risk for unwanted pregnancy and other\n- Social taboos and unequal power relations between\nsexual and reproductive health problems.\nmen and women often prevent women from using contra-\nContraceptives Are Still Out of Reach\nAlthough nearly 60% of women and men around the\nPrevalence of Modern Contraceptive Use'\nworld use modern contraceptive methods, 350 million cou-\n80\nples do not have access to a full range of family planning\n67%\n60\nmethods, services and information.'\n55%\n49%\n45%\nWomen do not always know where to get family planning\n40\nservices. The proportion of married women age 15 to 49\nwho know where to obtain a modern contraceptive varies\n20\n15%\nwidely within regions: from 22% in Mali to 96% in\n0\nZimbabwe; from 45% in Pakistan to 99% in Thailand;\nN. America\nAsia\nLatin America\nEurope\nAfrica\n& Caribbean\nSAFE MOTHERHOOD FACT SHEET\nfrom 61% in Bolivia to 98% in Colombia and 99% in\nEMERGENCY CONTRACEPTION\nTrinidad and Tobago.¹\nEmergency 10011 emplion quart that\ncan 1,11 used-affer unpostecte (11: noth is for the\nUse of male contraceptives is low. In Brazil, condoms and\nwoman in di SDPT.) 'I pills '''' emar-\nvasectomy account for less than 4% of total contraceptive\ngency contral plls CP i! at sexual\nuse\". Comparative figures in Iran are 6% for condoms and\nntersourse ECP. aug been -! method Emergency\ncontracention 11.1° 1111 nob relate 212 ented preq\n1% for vasectomy.⁷\nname, Never The\nInadequate Family Planning Programmes\nEven where family planning services are available, they\n- Promotion of methods that may be inappropriate for a\nmay not respond to people's needs and preferences. In\nparticular client.' This can happen because facilities have\nmany countries, shortcomings in the quality of family plan-\nlimited contraceptive supplies, or because service providers\nning programmes include:\ndo not spend enough time discussing clients' needs or\ndecide for their clients what methods they should use.\n- A focus on quantitative goals (such as the percentage of\nwomen using a contraceptive method) instead of helping\n- Poor clinical skills and procedures, for example during\nclients achieve their personal goals for the number and\npelvic exams, sterilisation and IUD insertions, which can\ntiming of their children.\"\ncause the client unnecessary pain or infection.\"\n- Poor information and counselling. Studies in sub-Saharan\n- Weak or non-existent links to other reproductive health\nAfrica found only 25-54% of new contraceptive users were\nservices, including treatment of STDs, that are needed to\ninformed about side effects.¹\npreserve a woman's health and future ferrility.\"\nWhat Can Be Done\nGovernments and donors need to make programmatic\nPolicy-makers need to address regulatory, social, economic\nchanges to:\nand cultural factors within communities and at the national\nlevel to:\n- Ensure that all individuals - including adolescents and\nunmarried women - have access to good quality, confi-\n- Ensure that women have control over their sexuality and\ndential family planning services which: offer a full range\nreproduction, rectify power imbalances between men and\nof methods, including emergency contraception; are\nwomen, and promote caring, responsible behaviour\nresponsive to the needs and lifestyles of their clients; and\namong men in sexual relations, contraception, pregnancy\nenable women and men to have the number of children\nand childcare.\nthey want, while protecting themselves against sexual and\n- Address sexual coercion and all forms of sexual violence\nreproductive health problems.\nagainst women.\n- Ensure that all providers of care have the supplies, infor-\n- Address the problem of unwanted pregnancy among\nmation, and technical and communication skills necessary\nyoung people, and modify attitudes that stigmatise\nfor offering high quality care.\npregnant girls.\n- Offer reliable information and compassionate counselling\nto all women with an unwanted pregnancy, including\ninformation about when and where a pregnancy may be\n\"Each of the co-sponsors of the Safe Motherhood Initiative (see below)\nlegally terminated.*\nimplements these activities according to its specific mandate.\nSources:\nS: PATH. \"Emergency Contraceptive Pills: Safe and Effective But Not Widely Used\". Outlook,\n1: N. Sadik, The State of World Population 1997. UNFPA. New York, 1997.\n14(2), September 1996.\n2: Abortion: A Tabulation of Available Data on the Frequency and Mortality of Unsafe Abortion,\n9: Reconsidering the Rationale. Scope and Quality of Family Planning Programs. The Population\n3rd edition. World Health Organization, Geneva, 1997 (in press).\nConncil, New York, 1994.\n3: Women's Lives and Experiences: A Decade of Research bundings from the Demographic and\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\nHealth Surveys Program. Macro International, Calverton, MD. 1994.\n(IAG). The IAG includes: the United Nations Children's Froud (UNICEF). United Nations\nPopulation Froud (UNFPA). World Bank. World Health Organization (WHO). International\n4: S.J. Segal and K.D. LaGuardia. \"Termination of Pregnancy A Global View\". Balliere's\nPlanned Parentbood Federation (IPTF). and the Population Council: FCI serves as the secretariat.\nClincal Obstetric and Gynaecology, Vol. 4, No. 2, 235-247, 1990.\nThese fact sheets have also been prepared in more detailed versions for technical audiences. For\n5: Heise. K. Moore. N. Toubia, \"Sexual Coercion and Reproductive Health: A Focus on\nmore information or copies of available materials, contact any IAG member. or the secretariat at:\nResearch\". Population Council. New York. 1995.\nFamily Care International\n6: Brazil: Programme Review and Strategy Development Report. UNFPA. New York, 1992.\n588 Broadway, Suite 503\n7: Islamic Republic of Iran: Programme Review and Strategy Development Report. UNFPA,\nNew York. NY. 10012. USA\nNew York, 1994.\nTel: (212) 941-5300\nFax: (212) 941-5563\nEmail: [email protected]\nWeb site address: www.safemotherbood.org\n1998\nis\nUnsafe Abortion\nEach year, approximately 20 million unsafe abortions are performed worldwide.* They result in nearly 80,000\nmaternal deaths and hundreds of thousands of disabilities.¹ In some countries, unsafe abortion is the most com-\nmon cause of maternal death.¹ It is also one of the most easily preventable and treatable.\nDeaths from Unsafe Abortion\nEvery day, 55,000 unsafe abortions take place - 95% of\nUnsafe Abortion: Regional Estimates of Mortality and Risk of Death'\nthem in developing countries. They are responsible for one\nRisk of dying after\n% of maternal deaths\nin eight maternal deaths. Globally, one unsafe abortion\nunsafe abortion\ndue to unsafe abortion\nAfrica\n1 in 150\n13%\ntakes place for every seven births.¹\nAsia\"\nI in 250\n12%\nLatin America\n1 in 900\n21%\nEurope**\n1 in 1900\n17%\n*Excludes Japan, Australia and New Zealand\nPrimarily Eastern Europe\nDisabilities and Health Problems\nBetween 10% and 50% of all women who undergo unsafe\nfewer social contacts and less financial means to obtain an\nabortions need medical care for complications.¹\nabortion safely.3 Young women are also more likely to\ndelay pregnancy termination until late in pregnancy when\n- The most frequent complications are incomplete abortion,\nthe risk of complications is higher.\ninfection (sepsis), haemorrhage and injury to the internal\norgans, such as puncturing or tearing of the uterus.¹\nDANGEROUS METHODS AND PROCEDURES USED TO INDUCE\nABORTION INCLUDE:\n- Long-term health problems include chronic pain, pelvic\nInserting objects (sticks, wires, knitting needles) into the uterus.\ninflammatory disease and infertility.\nDrinking poisonous or harmful substances (including herbs,\nIn many African countries, up to 70% of women treated\nbleach and hair dye)\nfor abortion complications are younger than 20.²\nTaking dangerous doses of over-the-counter medicines\nDouching with poisonous and caustic substances (bleach)\n- Younger, unmarried women often have poor access to\nInflicting physical abuse (falling down stairs, blows to belly,\nfamily planning information and services. They also have\njumping from heights)\nThe Cost to the Public Health System\nTreatment of abortion-related complications often requires\nIn some hospitals in developing countries, treating the com-\nseveral days of hospitalisation and staff time, as well as\nplications of unsafe abortion consumes as much as 50% of\nblood transfusions, antibiotics, pain control medications and\nthe total budget.4\nother drugs.'\nLegislation and Policies on Abortion\nPregnancy termination is permitted in more than 131\nGovernments around the world have recognised that\ndeveloping countries (and almost every developed coun-\nunsafe abortion is a major public health issue. At the 1994\ntry) - either for broad economic or social reasons, or\nInternational Conference on Population and Development,\nfor more limited health or personal circumstances such as\nthey called for humane, high quality medical services to\nto protect the health of the woman or in case of rape or\nprevent unsafe abortion and treat its complications.\nincest. Definitions of \"health risk\" vary widely by country.\nParticipants also called for safe abortion services where not\nagainst the law.\"\n*The World Health Organization acknowledges that data on unsafe abortion are scarce and subject to substantial error due to methodological\nconstraints inherent in abortion-related research.\nSAFE MOTHERHOOD FACT SHEET\nWhy Do Women Resort to Abortion?\nMost women who decide to terminate a pregnancy are mar-\n- Sexual coercion or rape: In studies around the world,\nried or live in stable unions and already have several\nbetween 20% and 50% of women and girls report sexual\nchildren.¹ Women can find themselves with an unwanted\nabuse, rape or sexual coercion.\"\npregnancy for many reasons:\n- A variety of social and economic reasons that include:\n- Family planning is out of reach: At least 350 million cou-\nthey are unmarried, have been abandoned by their part-\nples worldwide do not have access to information about\nners, are adolescents, are in an unstable partnership, have\nfamily planning and a full range of modern\ntoo many children to support, and/or live in poverty. 10.11\ncontraceptives.\"\n- Contraceptive methods fail: Between 8 and 30 million\npregnancies each year are the result of contraceptive\nfailure- - either inconsistent or incorrect use of family\nplanning methods, or failure of the methods themselves.\"\nPoor and Unavailable Health Services Make the Problem Worse\nEven where legal, abortion is not always available: In many\nFamily planning is not always offered to women who have\ndeveloping countries, health workers, doctors and nurses\nbeen treated for abortion complications In Zambia, for\ndo not have adequate training or equipment. Some refuse\nexample, 78% of women treated for abortion complica-\nto perform abortions because they do not understand the\ntions said they wanted information about family planning;\nlaws or because they personally do not support abortion.¹⁴\n44% wanted to receive a method. However, family plan-\nning was discussed with only 33% of the women, and none\nTreatment for unsafe abortion is inadequate: When women\nwas offered a method to take home.\"\nhave complications from an unsafe abortion, good medical\ncare is often unavailable. Lack of training, equipment and\nprotocols; misdiagnosis; negative attitudes of health workers;\nand/or overcrowded emergency wards can result in life-\nthreatening and costly delays for women seeking treatment.\nWhat Can Be Done\nEnsure universal access to client-sensitive family planning\nOffer family planning counselling and services, and refer-\nservices, especially for young people and women at risk of\nrals for comprehensive reproductive health services, to all\nsexual abuse, rape and violence.\nwomen who have had an abortion.\nOffer safe abortion services by trained, compassionate\nEducate communities about reproductive health and\nstaff when allowed by law;*\nunsafe abortion.\nEnsure that high-quality services for treating and manag-\nReform laws and policies to support women's reproduc-\ning abortion complications are accessible through the\ntive health and improve access to family planning, health\nhealth system.\nand abortion-related services.*\n*Each of the co-sponsors of the Safe Motherhood Initiative (see below)\nimplements these activities according to its specific mandate.\nSources:\n1: Abortion: A Tabidation of Available Information, 3rd edition. World Health Organization,\n10: Expanding Access to Safe Abortion: Key Policy Issues. Population Action International,\nGeneva, 1997. in press.\nWashington, DC. September 1993.\n2: The Health of Young People: A Challenge and \" Promise. World Health Organization, Geneva,\n11: S.N. Kinoti, et al., Monograph on Complications of Unsafe Abortion in Africa.\n1993.\nCommonwealth Regional Health Community Secretariat for East. Central and Southern Africa,\n3: \"Care for Postabortion Complications: Saving Women's Lives\". Population Reports. Vol. 24.\nArusha. Tanzania, 1995.\nNo. 2. September 1997.\n12: Proceedings: Abortion Matters. International Conference on Reducing the Need and\n4: EM. Coeytaux, \"Abortion\". in M. Koblinksy, et al., eds., The Health of Women: A Global\nImproving the Quality of Abortion Services, Stimezo Nederland, Utrecht. Netherlands, 1997.\nPerspective. Westview Press, Oxford, 1993.\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\n5: \"Abortion Laws Into Action: Implementing Legal Reform\". Initiatives in Reproductive Health\n(IAG). The IAG includes: the United Nations Children's Fund (UNICEF). United Nations\nPolicy. Vol. 2, No. I. Ipas, Carrboro, NC. January 1997.\nPopulation Froud (UNFPA). World Bank. World Health Organization (WHO), International\nPlanned Parenthood Federation (IPPF). and the Population Council: FCI serves as the secretariat.\n6: Report of the International Conference on Population and Development. United Nations,\nNew York, 1994.\nThese fact sheets have also been prepared III more detailed versions for technical audiences. For\nmore information or copies of available materials. contact any IAG member, or the secretariat at:\n7: N. Sadik, The State of World Population 1997. UNFPA, New York, 1997.\nFamily Care International\nS: S.J. Segal and K.D. LaGuardia, \"Termination of Pregnancy A Global View\". Bailliere's\n588 Broadway. State 503\nClinical Obstetrics and Gynaecology, Vol. 4. No. 2. 235-247. 1990.\nNew York, NY. 10012. USA\n9: Heise, K. Moore, N. Toubia, \"Sexual Coercion and Reproductive Health: A Focus on\nTel: (212) 941-5300\nResearch\". Population Council, New York, 1995.\nFax: (212) 941-5563\nEmail: [email protected]\nWeb site address: www.safemotherbood.org\n1998\nis\nMeasuring Progress\nDuring the last decade, governments around the world have pledged to cut maternal mortality in half by the year\n2000*. However, accurate figures on maternal death are difficult to gather. Therefore, countries need other, more\nreliable and cost-effective ways to measure their progress toward reducing maternal mortality.\nWhat Is a Maternal Death?\n\"The death of a woman while pregnant or within 42 days\n- A rate: The maternal mortality rate is the number of\nof termination of pregnancy, irrespective of the duration\nmaternal deaths per 100,000 women aged 15-49 per year.\nand the site of the pregnancy, from any cause related to or\nIt reflects both a woman's risk of dying from maternal\naggravated by the pregnancy or its management, but not\ndeath and her risk of becoming pregnant.\nfrom accidental or incidental causes\".'\n- A \"lifetime risk\": A woman's lifetime risk of maternal\nMaternal death statistics are usually expressed as:\ndeath is the probability that she will die from complica-\ntions of pregnancy or childbirth at some point during her\n- A ratio: The maternal mortality ratio is the number of\nentire reproductive life-span. It is often used to illustrate\nmaternal deaths per 100,000 live births. It indicates the\nthe differences in the risk faced by women in developed\nrisk of maternal death among pregnant women and those\nand developing nations.³\nwho have recently delivered. 2.3\nWhy Is Maternal Death Difficult to Measure?²\nIt is under-reported: People in developing countries often\nmation is not always recorded. Deaths are sometimes inten-\ndie outside the health system, which makes accurate\ntionally misclassified, especially if they are associated with\nregistration of deaths difficult. Under-reporting can be sig-\nclandestine abortions.\nnificant; in some studies, the actual number of maternal\nMethods used to calculate maternal death rates are often\ndearhs was double or triple what was initially reported.4\ncomplex and costly to use. The acrual number of maternal\nIt is misclassified: Health workers may not know why a\ndeaths in a specific place at a specific time is relatively\nwoman died, or whether she was or had recently been\nsmall. Therefore, very large populations must be surveyed\npregnant. Even if the health worker does know, the infor-\nin order to get accurate estimates.\nWhich Estimates of Maternal Mortality Are We Using Now?\nThe World Health Organization and UNICEF have\n- sensitise policy-makers, programme-planners and others:\ndeveloped a new way to estimate maternal mortality that\n- stimulate discussion and action; and\ncompensates for under-reporting and misclassification.\nTheir estimates, for the year 1990, are generally accepted\n- mobilise national and international resources.\nfor countries without reliable data, but they still have wide\nAlthough these estimates can be used to monitor trends\nmargins of error. Therefore, they should only be used to\nover more than a decade, they cannot provide information\ndescribe the general size of the problem in each country\non short-term progress in reducing maternal mortality.\nin order to:¹⁵\nWhat Information Do We Need?\nIn order to reduce maternal deaths, it is more important to\n- Process indicators, such as the proportion of births that\nunderstand why women are dying than to know exactly\nare assisted by skilled health personnel or that take place\nwhat the level of maternal mortality is. Such information\nin health facilities.\" Studies have shown that reducing\ncan be found through:\nmaternal mortality depends primarily on women's use of\ngood quality maternal health services.\n*Including at the global Safe Motherhood Conference (1987), World Summit for Children (1990), International Conference on Population and\nDevelopment (1994), World Summit on Social Development (1995) and Fourth World Conference on Women (1995).\nSAFE MOTHERHOOD FACT SHEET\n- Case reviews of the causes and circumstances surrounding\nEVALUATING OBSTETRIC CARE:\na select number of maternal deaths. There are two types of\nIn order to reduce maternal mortality, high quality obstetric ser-\nreviews: those that focus only on what happened once the\nvices must be available to manage major complications. UNICEF,\nwoman reached the health facility (such as whether the\nWHO, and UNFPA have developed a series of process indicators\nthat focus on these essential obstetric services. Data for these\ndoctor was available), and those that also investigate what\nindicators can be collected and analysed at health facilities with-\nhappened beforehand (such as whether there was a delay\nout large-scale community surveys.'\nin reaching the facility in the first place).* These reviews\nThis series includes indicators that measure:\nprovide valuable information that can be used to identify\nthe availability of services;\nand address problems, either with the quality of services or\nthe use of services; and\nwithin communities.\nthe performance of health facilities.\nMore information on this series can be found in \"Guidelines for Monitoring the\nAvailability and Use of Obstetric Services\", UNICEF, New York, October 1997.\nMeasuring Maternal Illness and Disability\nPregnancy complications can cause serious, long-term\nHowever, it can be difficult to identify and classify mater-\nhealth problems even when they do not result in death. As\nnal illnesses and disabilities. Even trained medical\nsuch, it is important to try to assess the scope and impact\npersonnel may differ in their diagnoses. As such, experts do\nof maternal disabilities, and to understand how they are\nnot recommend using indicators of maternal morbidity as\nperceived and dealt with by women and communities.\nan alternative to maternal mortality as a way to measure\nthe impact of safe motherhood programmes.\nWhat Can Be Done\nDecide whether establishing a national maternal mortality\nUse findings from maternal mortality studies and\nfigure is the best use of scarce resources. If an estimate is\nprogramme evaluations widely. Depending on the type\nneeded to stimulate attention and action, decision-makers\nof study, clearly-presented results and recommendations\ncan use the revised WHO/UNICEF figures to indicate the\nfor action may be useful to a broad range of audiences,\nmagnitude of the problem.\nincluding: policy-makers, health providers, hospitals,\nmedical societies, community groups, and research insti-\nUse process indicators to develop, implement and evaluate\ntutes. Community involvement can be very helpful both\npolicies and programmes based on reliable information.\nHealth planners should be careful to select indicators that\nin conducting the studies and identifying and carrying\nout solutions based on the findings.\nare easy to collect and are most relevant to the activities\nbeing implemented.\nSources:\n1: International Classification of Diseases, 10th Revision. World Health Organization. Geneva,\nS:J. Ireland and W. Graham. \"Conducting a Case Review of Maternal Deaths\" Dugald Baird\n1992.\nCentre for Research on Women's Health, University of Aberdeen, May 1996 (prepared for WHO\n2: UNICEF/WHO/UNFPA. \"Guidelines for Monitoring the Availability and Use of Obstetric\nSafe Motherhood Needs Assessment).\nServices\". UNICEF New York. October 1997.\nPrepared by Family Care International (FCI) and the Safe Motherbood Inter-Agency Group\n3: \"Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF\".\n(IAG). The IAG includes: the United Nations Children's Froud (UNICEF). United Nations\nWorld Health Organization, Geneva, April 1996.\nPopulation Fund (UNFPA). World Bank. World Health Organization (WHO). International\nPlanned Parentbood Federation (IPPF). and the Population Council: FCI serves as the secretariat.\n4: H. Atrash, \"Maternal Mortality Surveillance\". Presentation at the Safe Motherhood Technical\nConsultation in Sri Lanka, 18-23 October 1997.\nThese fact sheets have also been prepared in more detailed versions for technical audiences For\nmore information or copies of available materials. contact any IAG member, or the secretariat at:\n5: O. Campbell, \"Measuring Progress in Safe Motherhood\". Presentation at the Safe Motherhood\nTechnical Consultation IN Sri Lanka, 18-23 October 1997.\nFamily Care International\n588 Broadway. Suite 503\n6: W. Graham and O. Campbell, \"Measuring Maternal Health: Defining the Issues\". London\nNew York, NY. 10012. USA\nSchool of Hygiene and Tropical Medicine, London, May 1991.\nTel: (212) 941-5300\n7: \"Indicators for Monitoring Maternal Health Goals\". World Health Organization, Geneva,\nFax: (212) 941-5563\n1994.\nEmail: [email protected]\nWeb site address: www.safemotherbood.org\n1998\nFROM : Beach House\nPHONE NO. : 3019510340\nMar. 31 1998 04:06PM P1\n03/31/96 TUE 16:10 FAX 202 456 6244\nCFC OF THE FIRST LADY\n001\nCRYPTEK TS-18A\nTUE 31 MAR 98 14:54\nPG_02\nTOCHRISTY Coul- some FIRST LADY Lave\nHILLARY RODHAM CLINTON\nTALKING IT OVER\nMARCH 31, 1998\nwill\nThe women my husband and 1 met on our ulp to Africa greeted us with song. They sang\nis\nof their lives. They sang of their hopes for themselves, their families, and a new Africal They\nThe Theirs sery of\nsang for every generation\\ Whether It's speaking out against oppression or calling out for\neconomic opportunity, the women of Africa have never stopped singing together.\nunitin sacsin then\nvorses in say.\nIn Ghana, 1 heard women singing for the chance to become full participants in their\ncountry. They were dressed in aqua, orange, yellow and other bright colors, and all united by 8\ncommon mission. Like the Queen Mother of the Ashanti Stool, who led the Ghanaian people\nagainst outside invaders at the end of the last century. these women are leading their country into\nthe Millennium They showed me the micro enterprises they've created selling jewelry, art,\nclothing, and other goods. But, nothing made them more proud than their day care center.\nThere, in bright rooms, 1 saw children being nurtured and cared for while their mothers worked to\nsupport their families.\nas benet then\niss.\nIn South Africa, I heard women singing for chance to build a home and a community.\nAs we approached the Victoria Mxenge Housing Project, we could still see the shanties where a\ngroup of homeless squatters - mostly women - used to live. Now, on the other side of the street,\nthere is a vibrant community these women have created by pooling their resources, securing small\nloans, and building homes together singing all the while\nFROM : Beach House\nPHONE NO. : 3019510340\nMar. 31 1998 04:06PM P2\n03/31/98 TUE 18:11 FAX 202 456 6244\nOFC OF THE FIRST LADY\nV\n002\nCRYPTEK TS-10A\nTUE 31 MAR 98 14:55\nPG.03\n2\n\"Strength, money, and knowledge,\" they sang to me last year, \"we cannot do anything\nwithout them.\" When my husband joined me at the village last week, we saw the remarkable\nchanges borne of these three ingredients. [We saw one family's pride as they showed us around\ncould\ntheir home and shared in others' excitement as we helped lay down the first concrete bricks of\na\ncut\nnew home.]\nLast year, I asked the women of Victoria Mxenge if they believed they would own a home\nweek-\nhad\nnew\nthemselves someday. The answer was a resounding \"yes.\" This time, I asked them how many\nbecome\nnow\nactually owned a home. Hands shot up throughout the group. In just one year, the number of\nname-\n104\ncurer\nhomes in that village has increased from 18 10 19. Roads once made of dirt are now paved.\nThe concrete slab where we gathered last year is now a community center, complete with a day\ncare center and a store. And the women have Just bought a whole new plot of land that will\nprovide fertile soil for new businesses, new homes, and the fulfillment of lifelong dreams.\non they releast\nin Rwanda, I heard women singing to rebuild lives ripped apart by genocide. I heard the\nwomen in Uganda as they worked to provide education to every boy and every girl. I heard them\nin Botswana, where women leaders were helping to combat the scourge of AIDS and promote\nlegal rights.\nFROM : Beach House\nPHONE NO. : 3019510340\nMar. 31 1998 04:07PM P3\n03/31/98 TUE 16:11 FAX 202 456 6244\nOFC OF THE FIRST LADY\n&\n003\nCRYPTEK TS-18A\nTUE 31 MAR 98 14:56\nPG B4\n3\nAnd in Senegal, I heard women singing for their health and their futures. The\ngroup of women 1 met with from the Malicounda Bambara village, had done something\nremarkable. Although female genital mutilation (FGM) only affects up to 20 percent of\nwomen in Senegal, in many villages like Malicounda, it is considered a rite of passage for\n14 &\n6,ther?\nall girls.. What drove them to change all of that? One woman explained that they had\n\"studied human rights and particularly the right to health\"\n* # A\nThese women decided that FGM had harmed their daughters' bodies and spirits for\ntoo long. They decided that it was time to and the hemorrhaging. It was time to end the\ndiadm\ninfections, AIDS, and childbirth complications caused by this tradition And that's exactly\nwhat they did.\nUsing 2 skit they showed me, the women of the Malicounda village educated their\nreligious leaders, their husbands, and their neighbors. They banned this practice - and\nthey are-now inspiring others to do the sains. Just last month, 13 villages with a combined\npopulation of more than 8,000 people joined together to end FGM in their communities.\nAnd President Diouf has now called for a new law to abolish It throughout the country.\nFROM : Beach House\nPHONE NO. : 3019510340\nMar. 31 1998 04:07PM P4\n03/31/98 TUE 16:12 FAX 202 456 6244\nOFC OF THE FIRST LADY\n5.\n004\nCRYPTEK TS- 100\nTUE 31 MAR 98 14:58\nPG.05\nhi as with own Their success ston\n1\nSuccess stories like these are being written throughout Senegal and Africa. In\nThies, I met a group of parents at the Mode Kane School. They were improving their\nchildren's lives by learning to lift up their own education, literacy, and health. And they\n(ml)\ntoo were 50.11 singing a song about their journey. It was called Women's Rights: \"All\npeople have equal rights. The right to education. The right to health. These rights have\nchanged our lives In our homes, in our neighborhoods and in our country.\"\nCMV\nWith every voice added to this song. the chorus became more powerful. With\nevery voice added, the aspirations of individuals blended into the dreams of generations\ndreams of a pety TOB for women in a new Africa.\nAs we left Senegal to return home, I thought about how one of that country's\ngreatest authors, Ousmane Sembere, described 8 group of women from Thies who\nmarched and sang in the name of simple fairness and prugress. He wrote \"Even X since\nthey left Thies, the women had not stopped singing. As soon as one group allowed the\nrefrain to die, another picked it up and new verses were born No one was very sure any\nlonger where the song began, or if it had an ending It rolled out over its own length, like\nthe movement of a serpent. It was as long as a life.\"\nI\nhope\nLike women all over the world the women of Africa will never stop singing.\n212-941-5563 FAMILY CARE INTL.\n725 P01\nAPR 01 '98 09:20\nFAMILY CARE INTERNATIONAL\n588 BROADWAY SUITE 503 NEW YORK, NY 10012 [email protected] FAX 212 941 5663 TELEPHONE 212 941 6300\n1\nmerday regist\nPren /caped\nbent people\nWednesday, 1 April 1998\n3P?\nTo:\nChristy Macy\nEmendar ment\nFrom:\nJill Sheffield\nFSH 3131 6:30\nsafe mocher hard\n- corporate partner\nDear Christy,\nTwo diner\npublic amerint sever\nAttached in two pages are some examples of success stories in several of the technical arenas.\nBut they ALL show that with a little ingenuity and a lot of determination, almost anything is\npossible.\nOne really super success story (I have the article -- if you were to want it) is from Tanzania.\nDistrict Hospital with enormously high maternal death rate. Staff decided to find out why and\ndo something did a complete audit of why each woman died. Compiled a list of what they\ncould do from moving the physician to the hospital compound in the cleaned, painted (quite\nmodest) house, dam up a little river for several hours of auto-clave access per week, ordinary,\npractical things. They had 22 things on that list. Maternal mortality came down by nearly 40% in\nthe two years and at a cost of less than $11,000.\nmusta\nJune\nHope you are having some luck. Sounds like they had a good day in Botswana -- even some rest.\nCan you come on the 7th? I may be down this Friday. Just so you know. And from Sunday,\nwe'll be staying at the Lombardy Hotel to make things easy.\n202- 413\nHave a splendid day its a wonderful one in NYC!\nMANTA\nshepped\n4486\nBest,\nfill\n473\n3691\nX 522-\n2653\nPS - Success stories are from\nthe longer varsions of our\nfact sheets.\nEmail\n1 shell W family care cry INTL\n322- 2653 ( Jab)\n212-941-5563 FAMILY CARE INTL.\n725 P02\nAPR 01 '98 09:21\nSAFE MOTHERHOOD SUCCESS STORIES\nIMPROVING ACCESS TO CARE:\nBarriers of distance and lack of transport have been reduced by:\nAssigning health workers trained in midwifery to village-based health facilities, backed up by a\nfunctioning referral system. Such a system has been instituted in Matlab, Bangladesh,\" Sri\nLanka and Cuba, where maternal mortality has declined.\nDecentralising care to the lowest level of the health care system that is able to provide it\nadequately. In Mozambique, nurses have been trained to perform Caesarean deliveries;\noutcomes are as good as for women who had Caesareans performed by specialist obstetricians.¹\nSetting up systems for emergency transport and referral of complications. The involvement of\nlocal community members and leaders in designing and implementing these systems is crucial,\nas is the support and cooperation of the health system. In Uganda, the \"Rescuer\" project ensures\nthat TBAs have radio communication to call for help, and that local transport can be obtained on\nshort notice. 20 In Sierra Leone and Ghana, community leaders were mobilised to collaborate\nwith the local transport workers' union to set up a roster of vehicles for emergency\ntransportation.\"\nEstablishing maternity waiting homes close to formal health facilities. Maternity waiting homes\ncan be useful for women living in remote areas or where transport is especially difficult, as in\nmountainous areas. Cuba, Ethiopia and Mongolia are using such homes.²\nProviding maternal and infant health services for free and assured through governmental action,\nimproves access for poor women. Several countries, including Bolivia, South Africa,\nBangladesh and Sri Lanka, have made this commitment.\nQUALITY CARE:\nA generator and blood bank were installed and an unused operating theatre made functional at a\nhospital in Makeni, Sierra Leone. In addition, drugs and supplies were provided through a\nrevolving fund, all for less than $40,000. The number of women seeking care for obstetric\ncomplications increased by over 200%, and the case fatality rate among those women dropped\nfrom 32% to 5%.\nIn Guatemala, protocols were developed for regional and departmental hospitals to maintain\noptimal levels of care for patients in out-patient clinics, labour and delivery wards, and those\nreceiving hospital-based postpartum care.\nIn Ghana, the Ministry of Health has developed clinical management protocols for identifying\nand treating pregnancy-related complications at all levels of the health system. The protocols\nalso set standards for the provision of antenatal care, supervised delivery, postpartum care,\nfamily planning and management of abortion complications.\nIn South Africa, health providers developed a set of recommendations for improving services,\nincluding more training for staff, providing a wider range of services, ensuring adequate supplies\nin all facilities and treating all patients equitably.\n212-941-5563 FAMILY CARE INTL.\n725 P03\nAPR 01 '98 09:21\nIn 1986, Malaysia launched a quality assurance system for hospital care. Hospitals are divided\ninto two categories those with specialists and those without - and compared on the basis of a\nset of clinical indicators. Those with poor performance are required to investigate the reasons\nwhy and take action to improve services. The effect of these measures on quality of care are\nmonitored by state and national quality assurance committees.\nENSURE SKILLED ATTENDANCE:\nPolicy-makers, physicians, midwives, nurses and community representatives must work together to\ncreate a supportive environment that enables health workers to provide at least some components of\nessential obstetric care. 11\nIn Lesotho, development of national midwifery protocols was completed by midwives working with\nobstetricians. 11\nIn Ghana, midwives trained in life-saving skills now provide emergency obstetric care which had\npreviously been provided only by doctors.¹³\nIn Zimbabwe, where over 30% of deliveries take place without a skilled attendant, the government has\nlaunched a national programme to increase the number of nurses trained in midwifery by 50% - by 60%\nin rural areas.\nIn Ghana, the Ministry of Health has developed clinical management protocols for identifying and\ntreating pregnancy-related complications at all levels of the health system. Designed for midwives,\nnurses, doctors and public health workers, the manual also sets standards for the provision of antenatal\ncare, supervised delivery, postpartum care, family planning, and management of abortion\ncomplications.15\nRemarks by the First Lady\nhttp://www.whitehouse.gov/WH/EOP/F.neralspeeches/1997/unspeeches.html\nRemarks by First Lady Hillary Rodham Clinton\nUnited Nations Economic and Social Council\nUnited Nations Plaza\nNew York, New York\nDecember 10, 1997\nThank you. Mr. President, your excellencies. I welcome this opportunity to be\nhere as we begin this yearlong commemoration, which is not just a\ncommemoration of the universality of human rights; it is a celebration of the\nUnited Nations. I am especially pleased that we are able to gather this morning\nin the Economic and Social Council, which at its first session in February of\n1946, established the Commission on Human Rights.\nForty-nine winters ago the world acknowledged the new common standard for\nhuman dignity, a code for the peoples and governments of the world to live by.\nOne of the people who labored to create that code was Eleanor Roosevelt, then\nthe United States representative to the U.N. Commission on Human Rights.\nThe place was Paris. The delegates who came together to craft the language\nhailed from countries as diverse as Lebanon, Chile, France, China, and Ukraine.\nThe dream was the Universal Declaration of Human Rights, the first\ninternational agreement on the rights of humankind.\nSome of humanity S greatest lessons emerge only after the deepest tragedies.\nThis Declaration took shape in a world ravaged by the horrors of militarism and\nfascism. In the wake of the most violent revelations of the depths to which\nhuman beings can dehumanize one another, the world as a whole was ready at\nlast to agree upon these standards for human rights.\nLet me read a passage from that document:\nDisregard and contempt for human rights have resulted in\nbarbarous acts which have outraged the conscience of mankind.\nThe advent of a world in which human beings shall enjoy freedom\nof speech and belief, and freedom from fear and want, have been\nproclaimed as the highest aspirations of the common people.\nTherefore, the General Assembly proclaims this Universal\nDeclaration of Human Rights as a common standard of\nachievement for all peoples and nations.\nThe document goes on to state what should be obvious, but too often is not:\nAll human beings are born free and equal in dignity and rights.\nThey are endowed with reason and conscience, and should act\ntoward one another in a spirit of brotherhood.\nHow radically idealistic an act it was at first for the nations of the world to\nsubscribe publicly to this Declaration.\nThat act did not, however, take place in a vacuum. It was a response to evil, and\nI use that word deliberately. Those who study the Holocaust know that the\nNazis were able to pursue their crimes precisely because they were able\nprogressively to constrict the circle of those defined as humans. From the\nI of 5\n03/20/98 10:13:53\nRemarks by the First Lady\nhttp://www.whitehouse.gov/WH/EOP/F.neralspeeches/1997/unspeeches.htm.\nmoment they came to power, they proceeded step by step to dehumanize,\nthrough laws and propaganda, the mentally ill, the infirm, gypsies,\nhomosexuals, Jews those whom they identified as life unworthy of life.\nThis cold, dark region of the human soul, where people withdraw first\nunderstanding, then empathy, and finally even the designation of personhood\nfrom another human being, is not, of course, unique to Nazi Germany. This\ndevice, this ability to dehumanize, has been witnessed in all times and places. It\nis precisely this device that the Declaration attempted to help us resist.\nThankfully, in the half-century since the birth of the Declaration, we have, as a\nglobal people, managed progressively to expand the circle of full human\ndignity. Because of this document, individuals and nations alike have a\nstandard by which to measure fundamental rights. Many of the countries that\nhave emerged in the last 50 years have drawn inspiration from the Declaration\nin their own constitutions. Courts of law look to the Declaration. It has laid the\ngroundwork for the world S war crimes tribunals. It has prompted governments\nto set up their own commissions to safeguard basic liberties.\nAt the United Nations Conference on Human Rights in Vienna in 1993, it was\nthe power of the Declaration that inspired the establishment of a High\nCommissioner on Human Rights. Let me add, how lucky the United Nations\nand, indeed, the world is that Mary Robinson fills that post.\nAt the United Nations Fourth World Conference on Women in 1995, it was the\nstrength of this Declaration that enabled us to say for all the world to hear that\nhuman rights are women S rights, and that women S rights are human rights.\nAnd yet, in spite of this half-century of progress, we have not expanded the\ncircle of human dignity far enough. There are still too many of our fellow men\nand women excluded from the fundamental rights proclaimed in the\nDeclaration, too many whom we have hardened our hearts against those whose\nhuman suffering we fail fully to see, to hear, and to feel.\nAny look back at history shows that every nation has had its blind spots that\nhave kept people out of the promised circle of full humanity. Take the example\nof my own country. We in the United States have had our own difficult\nexperiences with the selective or unequal application of the rights established in\nthe American Constitution. Even the founding fathers, whose ideas of human\ndignity were so far ahead of their time, proclaiming that all men are created\nequal in the Declaration of Independence, inscribed slavery in our Constitution.\nIt has taken most of our 220 years, some of them bloody, few of them easy, to\nextend the benefits of citizenship to African Americans, to those without\nproperty, and to women. Eleanor Roosevelt herself was 35 years old before she\ncould vote.\nEven today, we circumscribe the circle in what we choose not to see. Black\nSouth Africans described what it was like to work all day in white\nenvironments in which one was literally not seen. In the Balkans, people have\nwilled themselves not to see the humanity of those whose heritage is different\nfrom their own. We ourselves in the industrialized world often choose not to\nsee the child labor that goes into our beautiful carpets or our comfortable shoes.\nIn too many places today what we fail to see are the injustices done to women.\nWe choose not to see the injustice of legal systems around the world that\ncontinue to treat women as less than complete citizens. In too many places,\nfemale heirs are seeing less inheritance than male heirs. Inequitable divorce\n2 of 5\n03/20/98 10:13:53\nRemarks by the First Lady\nhttp://www.whitehouse.gov/WH/EOP/F.neralspeeches/1997/unspeeches.html\nlaws compel women to remain in cruel marriages. And some courts of law\nrequire the testimony of two women to equal that of a solitary man.\nOur vision is limited in other areas as well. We choose not to see the\ncontribution of women to the economic lives of their families and countries. In\ntoo many places, women are discriminated against for bank loans and credit,\nfirst jobs and promotions. They are denied pay equal to that of men, or any pay\nat all. They live disproportionately in poverty, making up 70 percent of the\nworld S poor.\nWe also circumscribe the circle by what we choose not to hear. Freedom and\nequality for all depend first on whether a citizen truly has a voice. It is telling\nthat even in the drafting of the Universal Declaration, there was a debate about\nwomen S voices. The initial version of the first article stated, All men are\ncreated equal. It took women members of the Commission, led by Hansa Mehta\nof India, to point out that all men might be interpreted to exclude women. Only\nafter long debate was the language changed to say, All human beings are born\nfree and equal.\nToday, we still choose not to hear the voices of many women. In too many\nplaces women are blocked from participating in the political lives of their\ncountries. Just nine days ago in Sudan, 36 women were arrested while\nattempting to deliver a petition to the United Nations office there in protest of\nhuman rights violations in their country. They were arrested, fined, and at least\none woman received 40 lashes.\nIn too many places girls and women never even learn to project their voices.\nTwo-thirds of the 130 million school-age children out of school are girls.\nTwo-thirds of the 96 million people worldwide who can neither read nor write\nare women. Even now the Taliban in Afghanistan are blocking girls from\nattending school. Not only that, they are blocking those like Emma Bonino, the\nEuropean Union Commissioner for Humanitarian Affairs, who would speak out\nagainst this injustice.\nFreedom of speech and freedom of the press, the rights to petition the\ngovernment and to assemble all these are essential. Just think how much\nweaker these rights are in a nation where the majority of young women are\nilliterate. Rights on paper that are not protected and implemented are not really\nrights at all.\nWe further constrict the circle of human rights through what we choose not to\nfeel. As Eleanor Roosevelt put it, When will our conscience grow so tender that\nwe will act to prevent human misery rather than avenge it?\nIn too many places, the suffering of women is defined as trivial, explained\naway as a cultural phenomenon. Perhaps it is for this reason that women do not\nreceive proper health care, including access to family planning. Perhaps that is\nwhy, in some countries where more than 90 percent of women have undergone\ngenital cutting, the practice continues. Perhaps that is why domestic and sexual\nviolence remains the most serious under-reported and widespread human rights\nviolation in the world.\nIn almost every country of the world, domestic violence is one of the leading\ncauses of injury and death to women. In my country, 30 percent of female\nmurder victims are killed by current or former partners. As Secretary of State\nMadeleine Albright has said, domestic violence can never again be dismissed,\nas it often has in the past, as part of a country S norm or as a set of private\nassumptions about family life. Let us say it loudly for the entire world to hear\n3 of 5\n03/20/98 10:13:53\nRemarks by the First Lady\nhttp://www.whitehouse.gov/WH/EOP/F.neralspeeches/1997/unspeeches.html\nus: We do not believe that violence against women is simply cultural; we\nbelieve it is simply criminal.\nPerhaps that is why rape and sexual assault continue to be tactics of war. It is\nthe cruelest injustice that so many wars end not in peace for women and their\nfamilies, but in refugee crises that trap women and children in lives that go\nfrom bad to worse. Women and children make up 80 percent of the world S 23\nmillion refugees.\nThe full enfranchisement of the rights of women is unfinished business in this\nturbulent century. What meaning does the language of freedom and human\nrights have for a young woman forced into prostitution and traffic in the\ncommercial sex trade? What meaning can it have for women forced into\ninvoluntary servitude as sweat- shop workers or domestic servants? What\nmeaning can it have for a woman forced either to bear a child or abort one?\nWhat about the very ingrained practices that undermine the growth and\ndevelopment of girls from their very first years, such as the common practice of\nfeeding them last or less?\nAs I have been privileged to travel around the world, I have met countless\nwomen who know nothing of this Declaration and its promises. They are,\nhowever, eloquent in their belief that they deserve respect and better treatment\nin their families, workplaces, and societies.\nYet some critics continue to dismiss women S sufferings as minor. But are\nthey? In 1958 Eleanor Roosevelt wrote:\nWhere do human rights begin? In small places, close to home, so close and so\nsmall that they cannot be seen on any maps of the world. Yet they are the world\nof the individual person the neighborhood he lives in, the factory, farm, or\noffice where he worked. Such are the places where every man, woman, and\nchild seeks equal justice, equal opportunity, equal dignity without\ndiscrimination. Unless these rights have meaning there, they have little\nmeaning anywhere.\nOther critics dismiss human rights violations as harmless. A report released this\nweek by the Carnegie Commission on Preventing Deadly Conflict proves\notherwise. According to the report, an upsurge of egregious human rights\nviolations is almost always a powerful warning of dire events to come,\nincluding massive refugee flows and civil wars.\nStill others say that human rights are a Westerner S luxury not inalienable, but\nalien. I believe, and the women I ve listened to believe, that human rights are as\nessential to life as air or water, that they are felt beyond culture and tradition as\ninnate. The women I have met do not feel that human rights are a foreign\nconcept invented by purists. Rather they know in their very hearts and souls, in\nspite of everything they are told by culture and tradition, that these are\nGod-given rights that they were born with as surely as they were born into the\nhuman family.\nFor if they are not innate, how have people throughout history known to fight\nfor them so valiantly? Paradoxically, the proof of universality lies with the\nperpetrators of human rights violations themselves. Why would those who have\ndishonored humanity run to cover their tracks were it not for the knowledge\nthat wrong had been done? The Nazis tried to hide their concentration camps.\nCommunism kept its terrors in the shadow of the Iron Curtain. Scores of bodies\nare hidden in the hard ground of places like Bosnia and deep in the forests of\nplaces like Rwanda.\n4 of 5\n03/20/98 10:13:53\nRemarks by the First Lady\nhttp://www.whitehouse.gov/WH/EOP/F.neralspeeches/1997/unspeeches.html\nThroughout my hemisphere, people have disappeared. Why go to the trouble?\nBecause human rights transcend individual regimes and customs. The beliefs\ninscribed in the Universal Declaration of Human Rights were not invented 50\nyears ago. They are not the work of a single culture or country. They have been\nwith us forever from civilization S first light.\nSophocles wrote about them 2,500 years ago when he had Antigone declare\nthat there were ethical laws higher than the laws of even kings. P.C. Chang,\nwho helped draft the Universal Declaration, pointed out that Confucious\narticulated them in ancient China. The belief that we must respect our\nneighbors as we would respect ourselves resides in the core of the teachings of\nall the major faiths of this world.\nThe principles inscribed in the document whose birth we mark today are not\nconstructed, but revealed. Every great religion exposed and taught their truth. If\nI were to tear up this declaration, its values would abide. If I were to burn this\ndocument, its meaning would remain. If I were to forbid someone from hearing\nits words, they would still ring as loudly as ever in the hearts of men and\nwomen.\nIt is because every era has its blind spots that we must see to our own\nunfinished business with even greater urgency now while we stand on the\nthreshold of a new millennium. We must rededicate ourselves to completing the\ncircle of human rights once and for all. We must challenge ourselves to see\nmore sharply, to hear more clearly, to feel more fully.\nAnd we must do something else. We must support democracies new and old\nthat work to fulfill the aspirations of this Declaration. As my husband, the\nPresident, said last night: Democracy, the rule of law, civil society those things\nare the best guarantees of human rights over the long run.\nIt is time for us as a global community to commit ourselves. We have run out of\nexcuses not to. Here we are at the very close of the 20th century, a century that\nhas been scorched by war time and time again. If the history of this century\nteaches us anything, it is that whenever the dignity of any individual or group is\ncompromised by the derogation of who they are, of some essential attribute\nthey possess, then we all leave ourselves open to nightmares to come.\nConversely, if the century has a lesson for us that is redeeming, it is that by\nextending the circle of citizenship and human dignity to include everyone\nwithout exception, then we have the basis where new worlds of hope can\nflourish.\nSo, let us in this year of commemoration walk toward those new worlds. Let us\ndo so knowing that the path will never be easy. These rights may be eternal, but\nso too is the struggle to attain them. Though the darkness of the human heart\nmay recede, it will never go away. It must be with realistic eyes that we look\nfor human rights. And it must be with open hearts that in this, the 50th\nanniversary of the Universal Declaration on Human Rights, we rededicate\nourselves to its fulfillment.\nThank you very much.\n5 of 5\n03/20/98 10:13:54\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F.generalspeeches/1997/19971016.htm\nTHE WHITE HOUSE\nOffice of the Press Secretary\nFIRST LADY HILLARY RODHAM CLINTON\nREMARKS TO THE WOMEN OF ARGENTINA\nCOLON THEATER\nBUENOS AIRES, ARGENTINA\nOctober 16, 1997\nThank you, Mrs. Schiavoni.\nTo all of you -- Ambassadors, Ministers, Representatives, of the federal and local\ngovernment, academicians, business women, homemakers, artists, teachers -- to all of you, I\nthank you for this opportunity to speak before you today. I would like to exte nd a special\nthanks to the staff of the United States Embassy, but particularly to the National Council of\nWomen and their staff for the outstanding work that was done to make this gathering\npossible, and I believe we should show appreciation to Mrs. Schi avoni and all associated\nwith the National Council of Women by another round of applause. Thank you.\nI also understand I should give a special greeting to all the mothers in the audience, on the\neve of Mother's Day, and I do so.\nI am, as you may know, an empty-nest mother now, and I called my daughter last night to\ntell her that I had seen just a small sample of tango, because she loves dance of all forms\nand wrote a paper in Latin American history on tango and its origins, so I was so pleased to\nbe able to tell her what my husband and I had done on our first night together here in this\nbeautiful city.\nI must confess that it is somewhat awe-inspiring to be in this magnificent theater on a stage\nthat has been graced by Domingo and Carusso and Callas. I am almost tempted to sing, but\nin the interest of preserving warm ties between our countries, I will refrain.\nBut I would like to talk about voices, powerful voices, the voices of women in this country\nand my country, throughout our hemisphere and our world, and what we can do to make all\nof our voices heard. To have our voices heard about our shared commitment to advancing\nthe cause of women's rights, advancing the cause of democracy, and making clear that the\ntwo are inseparable.\nI can think of no better place to do that than in Argentina. The women of Argentina have\nlong been pioneers on the frontiers of human rights and equality.\nFrom the Argentine Beneficent Society to the National Women's Council to the\nGrandmothers of the Plaza de Mayo -- with whom I will meet shortly, you and your\nforemothers have forged a remarkable record of speaking up in your communities, caring\nfor those who cannot help themselves, opening the doors of education to boys and girls,\nlifting up lives and voices for democracy and human rights.\nWe are pursuing our goals of equality at a moment in history that is full of hope, a time ripe\nfor positive social change. Countries that were once paralyzed by debt or runaway inflation\nhave embarked on tough reforms and are now on the move.\nEconomic renewal has been accompanied by democratic transformation. Across the\nI of 8\n03/20/98 10:14:43\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F..generalspeches/1997/I9971016.htm\nAmericas, military dictatorships have given way to freely elected governments. For the first\ntime in decades millions of people enjoy the right to choose their own leaders, t o engage\nactively in political life, to speak frankly, to meet in support or opposition to a cause, and to\nform opinions based on information gathered by a free and inquiring press.\nYet we know that democracy, whether newly rooted or centuries old, is fragile. The process\nof building and tending democracy is ongoing. Democracy flourishes when its principles are\ninternalized in the hearts and minds of all people, when no one fears t he consequences of\nstanding up or speaking out for justice. And democracy thrives when women are not barred\nby law, by ignorance, by tradition or by intimidation from making their voices heard at the\nballot box, and from pursuing their most cherished dre ams.\nIn short, empowering ever-more women to seek and claim their rights as citizens and as\nhuman beings will ensure that democracies -- yours and mine, old and new -- survive and\nthrive in the twenty-first century.\nThe word \"empowerment,\" I am told, does not translate well. But I am sure that every\nwoman gathered here knows its meaning. Empowerment means the right to participate in\nthe political and economic life of our countries. Empowerment means being able to lead\nlives free of sexual and domestic violence. It means access to justice under law, to\neducation, to health care, to credit and property ownership.\nEmpowering women makes sure our voices are heard and we are treated as full citizens in\nour countries.\nNo nation can hope to succeed in our global economy if half of its people lack the\nopportunity and the right to make the most of their God-given promise. And, as we can all\nattest, in too many countries, my own as well, too many rights are still denied a nd too many\ndoors of opportunity still remain tightly closed.\nToo many women and children are trapped either in an endless cycle of poverty -- a cycle\nperpetuated by inadequate health care, poor access to family planning, and limited education\n-- or they are trapped inside social constructs that impoverish their spi rits and limit their\ndreams.\nToo many women are unable to participate in the economic lives of their countries because\nthey cannot get credit on their own to start small businesses.\nToo many women live in fear of violence at the hands of family members. For them, home\nprovides no refuge, the law no protection, and public opinion no sympathy.\nToo many women, especially those who are poor and less educated, are unaware of their\nlegal rights in the workplace, of their rights to own and inherit property, of their rights to\nvote and choose their leaders. While these laws may exist on the books, t 00 many\ngovernments have not enforced them and too few women have been made aware of them.\nSuch problems as these may be daunting, but their solutions are in full view. Across the\nAmericas, from Boston to Buenos Aires, there are cutting-edge, common-sense initiatives to\ngive girls and women access to what I call the tools of opportunity: educa tion, decent\nhealth care, legal protections, and credit. These efforts prove that women can be empowered\nto lift themselves, their children, families, and communities out of poverty.\nLet me begin with education, for nothing outside the family is more central to advancing the\ncause of girls and women. And Argentina has long recognized that fact.\nOur two nations have a history of warm ties. One of the most notable was the friendship\nbetween Horace Mann, the father of public education in the United States, and President\nDomingo Sarmiento, the father of education in Argentina, who was ahead of his time with\n2 of 8\n03/20/98 10:14:43\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F.generalspeeches/1997/19971016.htm\nhis deeply held belief that girls should attend school.\nThe fruits of his conviction are there for the world to see today: In Argentina's strong and\nestablished system of education. In a literacy rate of 96 percent. And in a primary school\ncompletion rate of 90 percent.\nOther countries in the Americas are rededicating themselves to improving access to and the\nquality of education for all their citizens as you have long done. Education will be the\ncenterpiece of the Second Summit of the Americas in Santiago next April, a nd it will\nhighlight models that are working.\nYesterday in Sao Paulo, for example, I saw an elementary school in one of the city's poorest\nneighborhoods. For years, the school struggled. Many students were not learning and most\ndid not stay in school. Fortunately, the business community, recogniz ing the importance of\neducation, got involved, and created the Institute for Quality Education. Working with the\nlocal government, parents, and teachers, they have transformed the school. Teachers who\nthemselves may not have finished high school have no W received additional training.\nStudents were tested. Parents were encouraged to get involved. In less than a year, test\nscores in mathematics and language went up more than 200 percent. Even in countries like\nours, Argentina and the United States whe re we don't face such daunting challenges as\nBrazil does, we have to do more to improve the quality of education in both urban and rural\nareas and to ensure that all students have access to information technology. Concentrating\non education and insuring that all the children of the hemisphere have a chance to learn will\nbe the most important way that we can enable all of our economies to grow and flourish.\nAnd an economy that grows and flourishes in Argentina or in the United States is good for\ntheir citizens and for other neighboring countries' citizens. But if we can create the capital of\neducation in all the other countries in the hemisphere, that too i S good for Argentina and the\nUnited States.\nAnother tool of opportunity is Microenterprise. Microenterprise provides small loans to\npeople, mostly women, who would not otherwise receive them. This concept started in Asia\nabout 20 years ago when it was determined that a very small amount of money given to a\nhard-working woman who might be landless and totally ignorant, but she had skills that\nwere marketable she knew how to sew, she knew how to plant crops, she could do things\nwith a little bit of credit that could bring income into her f amily.\nI have seen all over the world how access to such credit sparks a woman's entrepenurial\nspirit. Just in the last week I have seen two more examples here in our own hemisphere. In\nPanama I visited a group of women who, with a small grant from the United States Agency\nfor International Development, started a business in a small village growing plants and\nseedlings to sell in city markets and also to sell to the Panamanian government's\nreforestation programs.\nNow here is something that women have known for the millennia how to tend and nurture\nplant life. Women have held the secrets of medicinal plants and herbs. There are so many\nwomen throughout this hemisphere with those kinds of skills. To create a m arket for their\nproduct gives them a chance to use their skills to earn income to improve the standard of\nliving of their families, and that is what I saw. Within two years, these women had sold\nenough orchids, medicinal plants and seedlings to expand t heir business. They had also\nfurnished enough seedlings to restore 48 acres in one of Panama's national parks; and I\ntalked with women who were using their new income to improve their homes and send their\nchildren to school.\nI met an equally impressive group of women in Caracas. I entered an ordinary-looking\nbuilding in one of what I was told to be one of the worst neighborhoods in Caracas. And\nyet, in this very well-kept space, sitting on an open-air, rooftop terrace, talk ing with these\nwomen, I was very moved and impressed. The walls were adorned with weavings and art\n3 of 8\n03/20/98 10:14:43\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F.generalspeeches/1997/19971016.html\nworks that they had made. As a light breeze blew in, one woman told me how she had\nstarted a thriving taxi company. She knew how to drive, she was respo nsible and\nhard-working, there was no transportation adequate to the numbers of people in her\ncommunity, so she had this idea but no one would give her the credit to purchase the van\nthat she needed until she came to this Microenterprise Institute. She S aid that when she\nfinally got her own business, it was as if \"the sky had opened up.\"\nAnother woman used a small loan to expand her juice stand that she ran with her husband.\nThen a few years later she had a restaurant and a butcher shop employing ten people. She\nhad even been able to send one of her children to university -- a woman who had never\nfinished primary school. She said the loan had given her the opportunity \"to spread her\nwings.\"\nNow these are not unique stories. I have met similar women in Nicaragua and Costa Rica, in\nBolivia and Chile and Mexico, and I know they are here in Argentina and in my country as\nwell.\nBecause a real job is the best form of social welfare, microenterprise works for the\nindividual, the family, and society. And the more we can expand credit, to both women and\nmen who appear on the surface to have no collateral, to be poor, but who have S kills that\nkeep them going every day in the hard lives that they face, the more we will create free and\nbroader markets that will enhance the economies of our countries.\nAccess to quality health care -- especially family planning and reproductive health services\n-- is also crucial to advancing the progress of women. I have seen first-hand, as I know\nmany of you have, what happens when women are given access to such healt h services.\nJust two days ago in Brazil, I witnessed the signing of an agreement between my\ngovernment and two Brazilian state governments to support a family planning initiative.\nThis came about because two years ago I visited a maternity hospital in Salvador de Bahia,\nBrazil, and I saw men and women getting the information they would need to enable them\nto make wise choices about planning their families. I saw mothers cradling their new-born\nbabies in the hallways as they stood in line for their check-ups. I S aw young women, very\npregnant, waiting for their pre-natal check-up. I saw infants were getting immunization. I\nsaw parents were being taught what to feed their young children and how to care for them.\nAnd I also saw wards of women who were there becau se they had not received good quality\nhealth care.\nIn short, family planning and reproductive health programs were integrated in that hospital\ninto maternal and child health services. And I talked with a number of mothers, as well as\nwith the Minister of Health, who told me that for the first time they felt they could\nadequately care for the children they had, that they could invest in those children not only\ntheir love but other resources as well.\nThe result of a program like that was that rates of maternal mortality and, importantly, rates\nof abortion decreased because women received the health care they needed in a timely\nmanner and furthermore, as the Minister of Health, an esteemed medical doct or and\nuniversity professor, told me, for the first time poor women received the same health\nservices that rich women have always been able to receive for themselves.\nThis approach of integrating the services and reaching out to poor women and men has\nproven so successful that it has been adopted as a hemisphere-wide strategy to reduce\nmaternal mortality, and was announced at the First Ladies of the Americas Conference in La\nPaz last year.\nNow the promotion and expansion of women's legal and political rights may, perhaps, be\nthe most difficult challenge we face. And yet slowly but surely we are witnessing the\nemergence of legal reforms that will raise the status of women in the home and in society.\n4 of 8\n03/20/98 10:14:43\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F.generalspeeches/1997/19971016.htm\nDomestic and sexual violence against women remains one of the most serious and\nunder-reported human rights violations in the Americas. In country after country, we are\nfinally bringing out into the light of day what has been thought to be a private matte r. In\nArgentina, women have worked to incorporate domestic abuse issues in police training, and\nI applaud you. Many countries now have human rights ombudsmen with special offices\ndedicated to protecting the rights of women. In Panama, legislators ha ve reformed the\nFamily Code to better regulate such matters as alimony, child support and child custody.\nAnd in the United States, we have introduced comprehensive violence against women plans\nthat provide counseling for victims, training for police officers, and prosecution of offenders\nin all 50 states.\nThroughout Latin America, countries are finding ways to open up political participation for\nwomen at all levels, from the grassroots to the voting booth, and I understand that there are\nrecord numbers of women running for political office here in Argentin a, and I know what a\ndifficult choice that is to put yourself into the electoral system, and I congratulate all the\nwomen who are standing for public office or who hold public office because of the courage\nit takes to do so.\nAs more women hold office, we have to show that we care about the issues that brought us\ninto the political process. That is especially critical when it comes to human rights.\nAt the conference in Panama City, I witnessed the signing of another agreement -- this one\nbetween USAID and the Inter-American Institute for Human Rights in Costa Rica. The\nInstitute was founded to defend and foster respect for human rights at a time wh en\nrepressive regimes controlled the lives of many people in the Americas. It offered crucial\nsupport to brave individuals throughout the region who spoke out against torture and\nrepression at a time when such acts often meant risking one's job, one's ho me even one's\nlife.\nIn 1990, the Institute embarked on a new mission in human rights advocacy: It established a\nformal program on gender and human rights. When I visited the Institute with Secretary of\nState Madeleine Albright in May, I had the opportunity to meet and spea k with women who\nare in the forefront of women's rights issues throughout the Americas. As they said, there is\nlittle difference in a woman's life between violence in politics and violence at home. Both\ndishonor democracy and respect for the God-given i ndividual dignity of each human being.\nAs the Secretary of State said on that occasion, domestic violence can never be excused as\ncultural. It is criminal and should be treated as such.\nThere are many examples that I could give you, and you could give me so many more of\nwhat you have seen happening in your own lives, in families, in workplaces, in communities\nand countries. But I have seen, as you have, how efforts such as these in educ ation and\nhealth care and credit and in human rights are transforming lives. None of this progress\nwould have happened if women themselves had not spoken out, demanded change, and\nforced their governments to respond.\nNow we must encourage more women to make their voices heard, to join together in both\ncommunity and national organizations, to press for political change beneficial to all women,\nto encourage women to vote in local and national elections, to make politics relevant to the\nlives of women, to send more women into political office.\nOnly women can make democracy work for ourselves, our children and our families. It is a\nmessage that is coming alive throughout the world. Last summer, at a conference in Vienna,\nAustria, I met with a group of women from the newly democratic countries of Eastern and\nCentral Europe. They had just begun to recognize the power of independent citizen action to\naddress challenges, and they had gathered to share ideas, to renew and strengthen their faith\nin democratic values and freedoms.\n5 of 8\n03/20/98 10:14:43\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F..generalspeeches/1997/19971016.html\nThis kind of convening might be beneficial for our hemisphere as well. As our countries\ncontinue to expand our political, economic and strategic alliances, as my husband today is\nspeaking with your President about, the women of this hemisphere can lead t he way in\nbuilding an alliance of democratic values that will strengthen our democracies into the next\nmillennium.\nNow many of the issues that are faced throughout the hemisphere and the world may seem\nfar away from the lives of women here and in the United States. Because in many ways,\nwomen of Argentina and the United States have a wider spectrum of opportunities t han the\nwomen and girls who live in the countries that lie between our own. I was reading in\nPresident Sarmiento's book, Life of the Argentine Republic, and I saw this quote which\ndescribed the lives not just of women in Argentina at the time it was written but of women\ngenerally throughout the world, and still describes the lives of most women living on earth\ntoday.\nHere is what he said: \"Women look after the house, get the meals ready, shear the sheep,\nmilk the cows, make the cheese, and weave the coarse cloth used for garments The boys\nexercise their strength and amuse themselves With early manhood comes com plete\nidleness and ease.\"\nNow I am sure the men in the audience would object to that description, but it is not mine. It\nis President Sarmiento's. And I am sure that none of us would describe our early adulthood\nas ones of \"idleness and ease\" in today's fast paced world, but th e point is still valid that\nthere are too many women whose horizons are very limited, but there are many women like\nourselves whose horizons seem to be limitless and yet we, too, face formidable challenges\nin our own lives and the life of our societies.\nI believe we have a responsibility to work on behalf of women who still struggle for the\nrights we have won. But we also must confront the new question that has edged up to our\nown front doors.\nWhile the superficial homogenization of the world means that people on every continent\nwear the same jeans, eat the same fast food, listen to the same music these surface\nsimilarities do not override a longing for a deeper identity and meaning in our 1 ives.\nDespite improving material conditions around the world, many people are not satisfied and\nfamilies are under new stresses. The gap between the rich and poor grows wider in many\nplaces. The social safety net of health care, education, pensions, de cent wages, good jobs\nis in danger of fraying for those less able to navigate this new world. And even for those of\nus blessed with good health, education, and affluence, we also ask ourselves many questions\nabout the meaning of our own lives.\nQuestions about how we strike the right balance among our personal roles as wife, mother,\nhomemaker, employed worker, citizen; about how we claim a personal identity in an age of\nanonymous globalization and high technology; about how families will raise c hildren in the\nface of pressures from the consumer culture and mass media that undermine parental\nauthority and glorify instant gratification.\nThis last question is of particular importance to those of us who are mothers concerned\nabout the future of our daughters.\nFor we have not won our places in society, we have not fought for women's rights to make\nthe choices that are best for them, to stand by while the consumer culture does its best in\nmy country and yours -- to objectify women and make girls believe that only their\nappearances, not their hearts, their minds or their souls, are important.\nAll the material possessions in the world cannot substitute for a rich and deep spiritual life;\nall the affluence in my country or yours cannot answer the eternal questions that are posed\n6 of 8\n03/20/98 10:14:43\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F..generalspeches/1997/19971016.html\nby every generation. We cannot permit the pace of our life today, the use of automation and\ntechnology, to substitute for what is most important-- the human connections and\nrelationships that are the stuff of what life is made and which are so essential to creating\nthose habits of the heart that every child needs to bel ieve in themselves, to have the\nconfidence to be able to do what they know is right.\nThis is difficult against the backdrop of this fast paced world in which we live. And I know\nthat life is changing sometimes faster before our eyes than we can even make sense of. But\nwe cannot leave the raising of our children, the inculcating of value S to the mass media and\nthe consumer culture. We have to do a better job through our churches, our families, our\ncivic associations; we have to build up civil society to reach out to all young people to help\nthem understand why so many of you have fought so long and so hard for the values, the\nrights and the privileges that now in my country can be too easily taken for granted.\nDemocracy cannot survive unless those values are passed on to the next generation and one\nof the values has to be that a woman's full humanity is an unshakable, God-given truth, and\nthat democracy itself cannot be fulfilled unless women are treated with d ignity and respect.\nLast year, I participated in a call-in show on the radio for the Voice of America which went\nall over the world. One male caller asked me very earnestly what I meant when I said,\n\"Women's rights are human rights and human rights are women's rights\" at th e Beijing\nConference on Women.\nI told the caller to close his eyes and think of all the rights and privileges he enjoyed as a\nman. Then I asked him to imagine a world where every woman enjoyed those same rights.\nThe right to make the choices that fit with that woman's conception of h er future. That\nmeans that a woman may choose to be a full-time wife and homemaker and it is a choice\nworthy of respect. That means that a woman may choose to give herself fully to a\nprofessional or business or artistic profession that means she does no t have a place she\nbelieves in her life for marriage or children.\nThat too, should be respected. And for the vast majority of us who attempt to balance our\ncommitment to family with an interest in the outside world and a profession that we care\nabout -- that too should be respected. There should no longer be \"one size fits all\"\nprescription for the way a woman's life should be lived. And because we are fortunate to be\nwomen at the end of this century with many more years than our grandmothers and\ngreat-grandmothers ever could have dreamed, we will have many opportunit ies in our\nlifetimes to fulfill our various dreams and aspirations.\nThe acoustics in this hall are famous throughout the world. So what is said here perhaps can\ncarry throughout this hemisphere and beyond if we raise our voices on behalf of women to\nproclaim that we will not rest until we have repealed discriminatory law S, expelled the\nmythology about a woman's proper and only role, stared down the forces of physical and\npsychological intimidation that stifle the potential of women and children, and gives full\nflower to the belief that a woman has the opportunity and the God-given right to chart her\nown destiny, and then to work together to provide the tools of opportunity so that every girl\nand boy in this hemisphere can look with confidence toward the future. That should be our\npromise to our children for the next cen tury. They, in many ways face, a more difficult life\nthan we did. It does not seem as clear and set as to what direction many of them should take.\nWe have to stand with them and with each other as we create conditions that give each a\nchance to stand b efore anyone and say \"I am a free person, I believe in democracy, and I\nbelieve in building a better world for those who come after.\"\nThank you all very much.\n7 of 8\n03/20/98 10:14:44\nOffice of the Press Secretary\nhttp://www.whitehouse.gov/WH/EOP/F..generalspeeches/1997/19971016.html\nwill\nTo comment on this service,\nsend feedback to the Web Development Team.\n8 of 8\n03/20/98 10:14:44\n212-941-5563 FAMILY CARE INTL.\n789 P01\nAPR 04 '98 14:18\nFAMILY CARE INTERNATIONAL\n588 BROADWAY SUITE 503 New YORK, NY 10012 [email protected] Fax 212 841 5563 TELEPHONE 212 941 5300\nSaturday, 4 April 1998\nTo:\nChristy Macy\nFrom:\nJill Sheffield\nDear Christy,\nI know that you are working on THE speech\n* Bottom of p. 2...\"A few years ago, I toured \" The group that developed that Safe Home\nDelivery Kit is a group called PATH. They are for sure going to be in the audience so it\nwould be really a good idea to list them in the USAID, Save list of partners.\n*Page 4 Para that begins \"Think about it...\" World Bank estimates that by spending $2 not\nunder $2.\nThat's it. I know you are cutting but in case these stay in\nLooking forward to seeing you Monday p.m. Going to be GREAT. So many thanks!!\nBest,\nfill\nHILLARY RODHAM CLINTON\nSAFE MOTHERHOOD: WORLD HEALTH DAY\nTHE WORLD BANK\nAPRIL 7, 1998\nIt's a great honor and pleasure to be back here at the World\nBank, and to join James Wolfensohn and all of you as we celebrate\nWorld Health Day and recommit ourselves to the global mission\nof Safe Motherhood. Thank you for giving me this opportunity to\nspeak about a subject so close to my heart and of such\nextraordinary significance to the future of our world.\nI want to thank James Wolfenson for being such a powerful\nvoice within the World Bank and throughout the globe on behalf of\nwomen, especially his work in raising public awareness that\ninvestments in women and girls are the single most important\ninvestments nations can make to ensure sustained economic\nprogress and social stability.\nI'm so pleased to be joined today by Dr. Crispus Kiyonga,\nthe minister of Health in Uganda, where I have just visited\nand Dr. Siti Hasmah Mohd the first lady of Malaysia. Deep\nappreciation also to the leaders of the Safe Motherhood\nInterAgency Group - - the World Health Organization, UNFRA (UN\nPopulation Fund), UNICEF, the World Bank, International Planned\nParenthood Federation, and the Population Council who, with\nthe support of Family Care International, lead critical efforts\nto promote the health and well being of women, children, and\nfamilies.\nI would also like to acknowledge the extraordinary work of\nthe tens of thousands of foot soldiers on the front lines the\ndoctors, nurses, midwives and public health workers who are\nstruggling to meet the often overwhelming health needs of women\nthroughout the world - - and who, against formidable odds, save\nthe lives of so many women and children every day. We owe all of\nthem our deepest gratitude.\nWe are joined here, on World Health Day, by people in cities\nand communities around the globe, who, like us, are raising our\nvoices in a united chorus to say: no woman should ever die in\nchildbirth. And that all of us governments, international\nagencies, NGOs, and communities have a critical role to play\nin saving their lives, and the lives of their children.\nWe come together this morning at a time of great promise and\nhope. I've just returned from an historic trip with my husband\nto Sub Sahara Africa, and I wish all of you could have joined us\nto see this great country, not only its pro blems, which are\nstill profound, but the energy and intelligence and determination\nof the people. Over the past few years, more than 20 nations have\nbroken the chains of authoritarian rule, and begun their journeys\ntoward economic and social recovery.\nYet in the midst of this time of growth and promise around\nthe world, we still fail to protect our most important citizens -\n- the mothers of our children. The numbers are shocking, no\nmatter how often you hear them. Every minute, somewhere in the\nworld, a woman dies from complications of pregnancy and\nchildbirth. Every minute, 190 women face an unplanned or\nunwanted pregnancy; every minute, 110 women experience a\npregnancy related complication, and every minute, 40 women have\nan abortion.\nThe tragedy that over 600, 000 women die every year in\nchildbirth is compounded by the simple yet unbearable truth that\nthe vast majority of those deaths and so much of that\nsuffering could have been avoided. The other stark truth that\nwe continue to face today: Maternal mortality is 150 to 200 times\ngreater in poorer nations than in our rich ones. And those\ndeaths are directly related to the high level of poverty, and the\nlow status of women, in those countries.\nTen years ago, many of the individuals and agencies here\ntoday launched the global Safe Motherhood Initiative, and for the\nfirst time, elevated maternal mortality to an international\npriority. And while many countries, including my own, have not\nyet met the collective goal of cutting maternal deaths by half by\nthe year 2000, we should all take pride in the strides we are\nmaking.\nThe signs of progress are all around us. In Bangladesh, Sri\nLanka, and health workers trained in midwifery are being\nassigned to village-based health facilities, and maternal\nmortality has declined. In Ethiopia and Mongolia, women living\nin remote areas where transportation is difficult can now go to\nmaternity waiting homes, and get much needed interim care. Last\nyear, I visited health care clinics in Bolivia, where prenatal\nand family planning services have resulted in safer pregnancies\nand deliveries, and in some cases, have saved lives.\nA few years ago, I toured a small health and family planning\nclinic in Kathmandu, Nepal, financed by a partnership with USAID,\nthe Save the Children Foundation, and the government. And while\nI was there, I was given a \"Safe Home Delivery Kit\" like the\none I have here today that is given to expectant mothers.\nInside is a bar of soap, twine, wax, a plastic sheet, and a razor\nblade. It's purpose is to reduce the two major causes of\nmaternal and neonatal death, tetanus and sepsis, by promoting the\n\"three cleans\" \" principle: clean hands, clean surface, clean\numbilical care. The kit was developed by a group called PATH\nwho I believe is in the audience here today.\nBlue\nin\nas\nfa\nthe\nparticipate\nThis kit symbolizes for me some of the most important\nlessons we have absorbed over the past few years First, we've\nlearned the power of partnerships. In community after community,\ngovernments voluntary agencies, and local leaders are joining\nforces and resources to develop health care strategies that\npromote safe motherhood. I was proud to be present at the\nin the\nlaunching of one of those partnerships in Bolivia a few years\nago, when USAID and the Pan American Health Organization and\nothers joined forces to reduce maternal mortality throughout the\nhemisphere. shin Loch plue a the (Con agthe cinnerl meeting\n9 the first Jadys\nWe now know, more than ever, that reducing maternal\n9th\nmortality requires sustained, long term commitments from the full\nrange of partners. I know that last night there was an important\nHowsphere.\nmeeting of new partners in the corporate sector who are joining\nthe World Bank and this Safe Motherhood campaign, and I join all\nof you in applauding their participation.\nBut just as importantly, we've also learned that the cost of\npromoting safe motherhood is often minimal in comparison to the\nextraordinary rewards in saved lives, improved maternal and child\nhealth, and revitalized communities.\nThink about it. The World Bank estimates that by spending\n$2 a year per person for maternal health care, almost all of the\n600,000 women who die as a result of complications during\npregnancy and childbirth would be alive today. And the lives of\n2 million infants would be saved.\nWe have the resources. We have strategies that work. But\nwe do not yet have the collective will to do what needs to be\ndone. The result is that today, women in every nation in the\nworld including my own lack basic health care that could\nsave their lives and ensure their health. More attention must be\npaid to ensure women receive adequate prenatal care, good\nnutrition, and quality obstetric care, SO that childbearing and\nchildbirth is a safe and healthy period of every women's life.\nWe must invest in family planning which improves maternal\nhealth. Without it, women often turn in desperation to illegal,\nunsafe abortion procedures that can account for up to half or\nmore of all maternal deaths.\nBut women can't make progress in either their social or\neconomic status unless they have other opportunities open to them\nas well. Education is inextricably tied to how women and\nchildren achieve progress. We've seen how investments in\neducation have a profound and concrete affect on women's health,\nas well as the prosperity of their families and their country.\nSo do investments in jobs and credit. I've seen how women's\nlives have been transformed, and how they've helped lift their\nfamilies out of poverty, with just a modest loan to start up a\nsmall local enterprise. But perhaps most importantly, women must\nbe empowered to participate fully in the decision making and\npolitical life of their countries. Democracy requires the active\nBrogil\nlaurena 5\nverm\nCarteffeeline\nparticipation of all citizens, including women.\nThese are the basic building blocks for a healthy and\nproductive life. These are also the building blocks for social\nand economic progress, and the spread of democracy around the\nworld.\nThree years ago, when I addressed the Women's Conference in\nBeijing, I said that women's rights are human rights, and human\nrights are women's rights. The right to health care is a\nfundamental right for all women. Yet that right is violated\nevery time a woman is denied skilled health workers during\nchildbirth; every time a woman is denied the right to plan her\nown family; and every time she is subjected to violence in her\nown home. That basic right is violated every time women are\ndenied the education and the economic opportunities they need to\nensure they and their children can lead healthy, productive, and\nengaged lives.\nWhen this level of social injustice remains commonplace\naround the world, then the potential of the human family to\ncreate a peaceful, prosperous, democratic world will not be\nrealized. But if we can apply the force of international human\nrights treaties and national constitutions to ensure mothers and\nchildren are safe healthy, then, and only then, can every woman\nbe treated with dignity and respect, every child be loved and\ncared for, and every family have a healthy and strong future. And\nthen, and only then, will communities thrive, and nations\nflourish.\nI want to conclude my remarks this morning with a story from\nmy recent trip to Africa. That trip was an extraordinary\nopportunity for me and my husband to see the flowers of progress\nand democracy take root in even the smallest village, nurtured by\nthe songs and the power of women.\nIn Senegal, a group of women I met with in the Malicounda\nBiambara village have done something remarkable. They have\ndecided that female circumcision considered a rite of passage\nfor all girls had harmed their daughters bodies and spirits\nfor too long. It was time to end the hemorrhaging, and the\ninfection, and the AIDS, and the childbirth complications caused\nby this deadly tradition. And that's what they have done.\nUsing a skit that they showed me, these women educated their\nreligious leaders, their husbands, and their neighbors. And as a\nresult, they have banned the practice of female circumcision in\ntheir village, and now in 13 other villages as well. (I should\nnote that in some Senegalese villages, this practice affects\nabout 20% of the girls but in some countries like Mali and\nEretria that figure is as high as 90%).\nWhen I asked one of the women in this small village what had\ndriven her and others to try to end such a long standing cultural\npractice, she replied simply: \"We studied human rights, and\nparticularly the right to health. 11\nThanks in large part to the work of so many of you here\ntoday, this Senegalese women and so many others around the world\nnow understand that they have a fundamental right to a healthy\nfamily, and a better life. Let's renew our VOW here during World\nHealth Day - - drawing inspiration and strength from our partners\naround the world -- to work together to guarantee every woman\ngains that opportunity for herself and her family. For in doing\nso, we will fulfill the great promise of prosperity and progress\nfor all people, and for all nations.\n212-941-5563 FAMILY CARE INTL.\n647 P01\nMAR 25 '98 16:22\nfacsimile\nTRANSMITTAL\nto:\nChristy Macy\nfax #:\n202-456-5709\nre:\nSafe Motherhood speech\ndate:\nMarch 25, 1998\npages:\n13, including this cover sheet.\nAs per your phone conversation with Jill Sheffield, attached please find some information on the\nSafe Motherhood Initiative in general and on World Health Day, specifically. Jill will speak\nwith you again this Friday.\nPlease call me if you need any additional materials.\nThanks,\nLill Shappeed\nRealarin\ncevent -\n?\nalso has\n82281\nLanbarde\nRan\n1107\nFrom the desk of\n1-3\nCaryn Levitt\nProgram Associate\nFamily Care International\natnen\n588 Broadway, #503\nNew York, NY 10012, USA\nAunhe\n473-\n212-941-5300\nFax: 212-941-5563\n4486\n3691\n10 Themes of Safe\nWorld Health Day 1998\nWorld Health Day\nAdvisory Committee\nMotherhood\nAmerican Association for the Advancement of Science\nAmerican Association for World Health\nAmerican College of Nurse-Midwives\n1. EMpower women\nAmerican College of Obstecricians and Gynecologists\nAmerican Public Health Association\nInvest in the Future:\nAssociation of Maternal and Child Health Programs\nAssociation of State and Territorial Health Officials\nAssociation of Women's Health, Obstetric and Neonatal Nurses\nCenters for Disease Control and Prevention (CDC)\n2.\nKnOw that every pregnancy carries risk\nCity MatCH\nColumbia School of Public Health\nCongress of National Black Churches\nFamily Care International\nFamily Health International\n3. Reduce T eenage pregnancy\nHealth Resources and Services Administration\nInstitute of Medicine\nMarch of Dimes\nMaternity Center Association\n4. Guarantee as a Human right\nNational Association of Local Boards of Health\nNational Coalition of Hispanic Health and Human Services Organizations\nNational Council of La Rara\nNational Institute of Child Health and Human Development\nPan American Health Organization\nE\n212-941-5563 FAMILY CARE INTL.\nNational Association of Childbearing Centers\nNational Association of County and City Health Officials\n5. Reduce unintended pr Egnancy & induced abortion\nPopulation Council\nSan Diego State University Graduate School of Public Health\nSociety for Public Health Education\nSpecial Supplemental Nutrition Program for Women, Infants and Children\nUnited Nations Children's Fund\n6. Improve access to quality mate Rnal health services\nU.S. Agency for International Development\nU.S. Conference of Mayors\nWorld Bank\nWorld Health Organization\nWorld Health Organization Collaborating Center in Perinatal Care\nSupport\nWyech-Lederle Vaccines and Pediatrics\n7. Utilize He power of partnerships\nYale University School of Medicine\nSafe Motherhood\n647 P02\nAmerican Association for World Health\nASTOCIATION\nFOR\n1823 K Street, NW, Suite 1208\n8. Measure pr Ogress\nWashington, DC 20006\nWORLD\n202-466-5883 202-466-5896 (fax)\[email protected]\nAMBRICAN\nwww.aawhworldhealth.org\nAAWH\nApril 7, 1998\nThe American Association for World Health (AAWH) was founded\n9. Make a social & ec nomic investment\nin 1953 as an educational and charitable non-governmental, non-\nprofit membership organization. It serves as a voice of opinion to\nsustain United States participation in solving international health\nproblems through governmental and voluntary channels. AAWH\nserves as the U.S. committee to the World Health Organization\nMAR 25 '98 16:23\n10. Ensure supportive care at Delivery\nbased in Geneva, Switzerland, and its western hemisphere affiliate,\nthe Pan American Health Organization, based in Washington, D.C.\nAmerican Association for World Health\nWorld Health Day\nInvest in the Future:\nFacts to Know\nSupport Safe Motherhood\nWhat and When is World Health Day?\nHalf of all U.S. pregnancies are unintended.\nThis international initiative is celebrated every\nThe American Association for World Health in\nyear on April 7 to promote a forum for informa-\nconjunction with the World Health Day Advisory\nMore than 80% of teen pregnancies are unin-\ntended.\nCommittee has selected the theme \"Invest in\ntion and discussion about health conditions world-\nwide.\nthe Future: Support Safe Motherhood\" to\nIn the United States, two to four women die\npromote World Health Day 1998 in the United\nStates. In the United States, in nearly two out of\nevery day from pregnancy-related complications.\nWhere is World Health Day?\nevery five deliveries, the woman experiences a\nSexually transmitted diseases greatly\nEverywhere. World Health Day is observed in the\ncomplication such as high blood pressure, seri-\nincrease the risk for ectopic pregnancies.\nWorld Health Organization's 191 member countries.\nous lacerations, obstructed labor, hemorrhage,\nuterine infection, diabetes or Cesarean delivery,\nThe incidence of ectopic pregnancies has\nand every day two to (our women die from preg-\nWhy is World Health Day observed?\nincreased dramatically-to more than\nnancy-related complications.\n100,000 per year.\n212-941-5563 FAMILY CARE INTL.\nThe purpose of World Health Day is to encour-\nage people around the world to think globally\nMaternal Complications\nAn expectant mother with no prenatal care\nand act locally. It is an opportunity for citizens\nduring Labor and Delivery\nis three times as likely to have a low birth-\nin both urban and rural communities to learn\nin the United States\nweight baby.\nfrom our brothers and sisters around the world\nand gain a better understanding of the challenges\nOne third of women in the United States\nwe all face. We are not an island. Rather, we are\nd Delivery\nsmoke, including 20% of pregnant women.\ninextricably linked. And it doesn't matter if it's a\non(s) and/or\nmother and child in Senegal or a mother and\nelivery\nAbout one in five women has serious com-\nchild in Seattle-what we all want is a healthy\nplications before labor begins.\noutcome.\nU.S. infant mortality rates exceed those of\nWho can participate?\nmost other industrialized nations.\nEveryone.\nMaternal and infant morbidity and mortality\nrates differ sociodemographically, ethnically and\nHow can I get more information?\nWHO estimates that about 585,000 women\nregionally. For example:\n647 P03\nworldwide die per year as a result of compli-\nGet your free resource booklet by writing or\ncations during pregnancy and childbirth. While\nAfrican American women are four times as likely\nsending electronic mail to the American\nin the United States the risk of a woman dying\nto die from pregnancy-related causes as Caucasian\nAssociation for World Health. You also can view\nfrom pregnancy has decreased dramatically\nwomen, and mortality rates of African American\nor download the booklet from AAWH's Web\nover the past 50 years and currently is similar\nbabies are twice those of Caucasian babies.\nsite. The booklet will provide you with direction\nto many other developed countries, experts\non how to get involved as well as information\nestimate that many deaths are still preventable.\nLack of prenatal care poses a major challenge\nspecific to Safe Motherhood, including repro-\nLeading a healthy lifestyle, planning pregnancies,\nfor the Hispanic-about 30% of pregnant\nMAR 25 '98 16:23\nducible Fact Sheets. It will be available early in\nand getting good prenatal, delivery and postna-\nHispanic women do not receive early prena-\n1998.\ntal care all contribute to healthy outcomes.\ntal care.\n212-941-5563 FAMILY CARE INTL.\n647 P04\nMAR 25 '98 16:23\nRelease\nPRO\nPopulation Reference Bureau\nFor Release:\nThursday, March 5, 1998\n1875 Connecticut Ave., NW, Suite 520\nWashington, DC 20009-5728\nContact:\nPhone: (202) 483-1100\nAlene H. Gelbard, 202/483-1100\nFax: (202) 328-3937\nLina Parikh, 202/483-1100\[email protected]\nhttp://www.prb.org/prb/\nThe World's Women: Making Gains but Still Widely Disadvantaged\nTo commemorate International Women's Day (March 8), the Population Reference Bureau (PRB) has just\nreleased 1998 Women of Our World, a wall chart detailing the latest available data on the quality of women's lives in 150\ncountries.\nPRB's 1998 Women of Our World highlights important gains women have made in recent years: life expectancy\nhas increased 19 years since the 1950s; women's participation in the labor force is up 21 percent since the 1960s; literacy\nrates have improved 10 percent since the 1970s; and girls' enrollment in secondary school has risen 18 percent since the\n1980s.\nDespite these gains, data for 150 countries from PRB's new wall chart show that women today still experience\nmajor disadvantages in health, education, work, and politics.\nChallenges to Health\nNearly 600,000 women die every year from causes related to pregnancy, childbirth, and abortion. The ratio of\nmaternal deaths to live births varies enormously throughout the world-from fewer than 10 maternal deaths per\n100,000 live births in many European countries and in North America, to more than 1,400 deaths per 100,000 live\nbirths in several countries in sub-Saharan Africa. The majority of maternal deaths (95 percent) occur in Africa and\nAsia (see figure 4 on wall chart).\nMore than 30 percent of births worldwide are not attended by skilled personnel, increasing the risk that mothers\nand their babies may die during childbirth. Tremendous regional variation exists in the percentage of births attended\nby skilled personnel, from only 33 percent in Eastern Africa to 99 percent in the more developed world (Australia,\nJapan, New Zealand, Europe, and North America).\nWorldwide, 56 percent of married women practice family planning. The percentage of married women practicing\nfamily planning varies greatly by region, from 13 percent of married women in Western Africa to 81 percent of\nmarried women in East Asia.\nDemographic Differences\nThe average number of children that women bear varies significantly around the world, from less than two\nchildren per woman in Europe and North America to more than six children per woman in Western, Middle, and\nEastern Africa. Data also show that in regions where family planning use is higher, women tend to have fewer\nchildren (see figure 3 on wall chart).\nEducational Gaps\nWorldwide, fewer women are literate than men (64 percent of women compared with 80 percent of men).\nThe literacy gaps are greatest in less developed regions, such as Western Africa and South-Central Asia, where\noverall literacy levels are low (see figure 1 on wall chart).\n(over)\n212-941-5563 FAMILY CARE INTL.\n647 P05 MAR 25 '98 16:24\nWorldwide, girls are less likely to be in secondary school than boys (90 girls for every 100 boys enrolled).\nThese figures mask significant regional differences. In Southern Africa, and in Latin America and the Caribbean,\nmore girls than boys are enrolled in secondary school: 119 and 114 girls, respectively, for every 100 boys. In Middle\nAfrica, however, only 61 girls are enrolled in secondary school for every 100 boys.\nWork Disparities\nWomen are less likely to work in the formal labor force than men (54 percent compared with 82 percent of men).\nThe percentage of adult women in the formal labor force varies widely, from 32 percent of all adult women in\nNorthern Africa to 71 percent in East Asia and Eastern Africa.\nPolitical Hurdles\nWorldwide, women make up a disproportionately small percentage of political decision-makers (12 percent of\nnational parliaments and 7 percent of ministerial and subministerial-level positions). Regional estimates show a\nstriking contrast in women's participation in the political process. Women make up 19 percent of national parliaments\nin Northern Europe, Western Europe, and Southern Africa, but they make up only 3 percent of national parliaments in\nNorthern Africa. These regional disparities are even greater at the ministerial level, where women hold 32 percent of\nministerial and sub-ministerial positions in North America but less than 5 percent of these positions in Northern and\nMiddle Africa, Western Asia, and Eastern Europe.\nIn addition, PRB's 1998 Women of Our World discusses several issues that also have important implications for policy-\nmakers, including:\nEconomic Inequities: Data show that women in nonagricultural jobs are paid less than men. Women's wages as\na percent of men's wages range from 60 percent in South Korea to 91 percent in the Philippines. Only in Australia do\nwomen make about the same as men (see figure 2 on wall chart).\nAIDS: In 1997, almost 6,000 women around the world became infected with HIV every day. Globally, women\naccount for 41 percent of adults who are living with HIV/AIDS (see table 1 on wall chart). The proportion of\nHIV-infected adults who are women varies by region. In sub-Saharan Africa, where 19.8 million adults are infected\nwith HIV (over two-thirds of the world total), women account for one-half of all adults infected with HIV. In most\nother regions, women account for one-fifth to one-third of HIV-infected adults. Since the beginning of the AIDS\nepidemic, 11.7 million people have died of AIDS, 4 million of whom were women.\nDomestic Violence: Women in both less developed and more developed countries are reporting this often hidden\nviolence in significant numbers (see table 2 on wall chart).\nInternational Women's Day\nOn March 8, 1857, women in New York City's garment and textile industries protested against low wages, long hours, and inhumane\nworking conditions. In 1909, the United States began observing National Women's Day. and in 1910 the Women's Socialist\nInternational designated an International Women's Day to mark the garment workers' strike. In 1975, to commemorate the struggle for\nwomen's equality. the United Nations began observing March 8 as International Women's Day.\nCopies of 1998 Women of Our World may be purchased for $5 (price includes postage) from PRB by calling 1-800-877-9881;\nemail: [email protected]. (Will be available in French and Spanish also.) Journalists may receive a free copy upon request.\nThe Population Reference Bureau is the leader in providing timely and objective information on U.S. and international population\ntrends and their implications. For more information on membership and publications, please contact PRB.\n212-941-5563 FAMILY CARE INTL.\n647 P06\nMAR 25 '98 16:25\nO\nFOR MORE INFORMATION\nCONTACT: Benna Holden\n(202) 973-0369\nSafe\n\"Year of Safe Motherhood\"\nMotherhood\nFACTS AT A GLANCE\nEvery minute of every day, somewhere in the world, a woman dies from complications related\nto pregnancy or childbirth (defined as a maternal death).\nInter-Agency Group\nfor Safe Motherhood\nApproximately 50 million women a year (equivalent to the total population of the countries of\nUNFPA\nSpain and Portugal) suffer maternal health complications.\nUNICEF\nWHO\nIn developing countries, pregnancy and childbirth are the leading causes of death, disease and\nWORLD BANK\ndisability among women of reproductive age:\nIPPF\nPOPULATION COUNCIL\nLeading Causes of the Burden of Disease in Worren Aged 1544 In the\nDeveloping World 1990\nRespiratory infection\n26%\nAnemia\n25%\nSelf Inflicted injuries\n32%\nDepressive disorders\n5.8%\nHIV\n6.6%\nTuberculosis\n7.0%\nSTD\n8.9%\nMaternal causes\n18,0%\n0%\n2%\n@%\n6%\n8%\n10%\n12%\n14%\n16%\n18%\n20%\nSource: World Development Report 1993: Investing in Health. World Bank, Washington, DC, 1993\nWorldwide, there are 430 maternal deaths for every 100,000 live births. In developing\ncountries, the figure is 480 maternal deaths for every 100,000 live births; in developed\ncountries there are 27 maternal deaths for every 100,000 live births.\nA woman's risk of dying from pregnancy and childbirth varies widely by region:\nChairing Agency:\nRegion\nRisk of Dying\nIPPF\nAfrica\n1 in 16\nAsia\n1 in 65\nRegent's College, Regent's Park\nLatin American & Caribbean\n1 in 130\nLondon NW1 4NS, UK\nNorthern Europe\n1 in 4,000\nTelephone: 44 171 487 7864\nNorth America\n1 in 3,700\nFax: 44 171 487 7865\nAll developing countries\n1 in 48\nemail: [email protected]\nAll developed countries\n1 in 1,800\nSecretariat:\nFamily Care International\nCountry-level differences are even more dramatic: for example, in Ethiopia, 1 out of every 9\n588 Broadway, Suite 503\nwomen die from pregnancy-related complications, as compared to 1 in 8,700 in Switzerland.\nNew York, NY 10012 USA\nTelephone: 212 941 5300\nFax: 212 941 5563\nemail: [email protected]\n212-941-5563 FAMILY CARE INTL.\n647 P07\nMAR 25 '98 16:25\nThere are five main causes of maternal death worldwide:\nCauses of Maternal Death\nsevere bleeding\n25%\nInfection 15%\nIndirect causes\n20%\nother\neclampsis 12%\ndirect causes 8%\nobstructed labour\nunsafe abortion\n8%\n13%\nSource: Maternal Health Around the World, WHO, 1997\nDeliverles by Relatives or Alone, Selected Countries\nEach year, 60 million deliveries take place in\nwhich the woman is cared for only by a family\nDelivery by\nDelivery alone\nmember, an untrained traditional birth\nrelative/other (%)\n(%)\nattendant -- or no one at all.\nMalawi\n41\n7\nUganda\n35\n12\nNiger\n24\n17\nNepal\n56\n11\nPakistan\n52\n2\nSource: Demographic and Health Surveys, selected countries, various years.\nSkilled Attendance at Delivery and Maternal\nMortality Ratios, selected countries\n98%\n100%\n94%\n1000\n1000\nCountries where skilled attendance at delivery\n77%\n850\n800\nis low tend to have higher rates of maternal\n75%\nSkilled Attendance M\n600\n250\nMaternal Mortality Ratio\ndeath and disability. In 1996, skilled birth\n650\nDelivery\n46%\nattendants were present at only 53% of births\n50%\nin the developing world. In developed\n31%\n400\ncountries, skilled attendance is nearly\n25%\nuniversal.\n200\n140\n5%\n90\n0%\n0\nTrinidad\n&\nSri\nLanka\nBotswane\nBolivia\nNigoria\nBangladesh\nTobago\nSkilled Attendance at Delivery\nMaternal Mortality Ratio\nSource: \"Revised 1990 Estimates of Maternal Mortality\", WHO, 1996 and \"Coverage of Maternal Care\", WHO, 1997.\n212-941-5563 FAMILY CARE INTL.\n647 P08\nMAR 25 '98 16:26\nChild Deaths When a Parent Dies, per 1,000\n200\nMotherless children are likely to get\n150\nless health care and education as they\ngrow up. A study in Bangladesh\n100\nfound that when a mother dies, her\n50\nchildren - especially daughters - are\nmuch more likely to die than children\n0\nwhose parents are both alive.\nno parent dies\nfather dies\nmother dies\nsons\ndaughters\nSource: Mother Baby Package: Implementing Safe Motherhood in countries, WHO, 1994\nMost maternal deaths, millions of cases of disease and disability, and the deaths of at least 1.5 million infants\neach year could be prevented through:\nbasic maternal care for all pregnancies, including a skilled attendant (doctor or midwife) at birth;\nprevention and treatment of complications during pregnancy, delivery and after birth; and\npostpartum family planning and basic neonatal care.\nThese health care services would cost approximately $3 per person per year in most developing countries.\n###\n212-941-5563 FAMILY CARE INTL.\n647 P09\nMAR 25 '98 16:26\nO\nThe \"Year of Safe Motherhood\"\nS\nSafe Motherhood is a global effort to increase maternal safety and\nreduce the number of deaths and illnesses associated with\npregnancy and childbirth\nWomen need not die while giving life to future generations.\nEvery minute of every day, somewhere in the world and most often in a developing nation, a woman\ndies from complications related to pregnancy or childbirth. Her death is more than a personal\ntragedy, although that alone would merit our most serious concern. In addition, her death represents\nan enormous cost to her nation, her community and her family. Any social and economic investment\nthat has been made in her life is lost. Her family loses her love, her nurturing and her productivity\ninside and outside the home. Half of all infant deaths can be attributed to poor maternal health.\nMoreover, the child that survives a mother's death is up to ten times more likely to die within two\nyears than a child with two living parents.\nThe greatest tragedy is that these approximately 600,000 maternal deaths and over 50 million cases\nof morbidity that occur each year are largely preventable. A decade of research has proven that\nsurprisingly small and affordable measures can significantly reduce the health risks that women face\nwhen they become pregnant.\nIn 1987 a coalition of the world's leaders in maternal and child health, the United Nations Population\nFund (UNFPA), the United Nations Children's Fund (UNICEF), the World Health Organization\n(WHO), the World Bank, the International Planned Parenthood Federation (IPPF) and the Population\nCouncil, joined forces and developed an Inter-Agency Task Force on Safe Motherhood to assess this\nproblem and recommend solutions.\nNow it is time to act upon what has been learned over the past ten years of research and model\nprojects, before one more woman loses her life needlessly.\nTo achieve this goal, World Health Day, 7 April 1998 will kick-off a year-long series of activities to\npromote Safe Motherhood.\nOn that day a call to action will be issued to governments, business leaders, policy makers, and\ncitizens of every country of the world. The call to action consists of four simple messages:\n1. International aid agencies are urged to provide overseas assistance to programs that promote\nmaternal care as an essential component of reproductive health services.\n2. Governments of developing countries are urged to reduce maternal mortality and morbidity by\ndeveloping and implementing health, nutrition and education programs that promote the health\nof pregnant women and their infants.\n3. Corporations around the world are urged to encourage governments and private organizations in\nthe countries where they do business to provide funds and develop programs that foster safe\nmotherhood, and to support safe motherhood among their employees and customers.\n4. Women, men and families everywhere are urged to demand and seek quality prenatal and\nobstetric care to ensure that no woman dies or suffers long-term complications from childbirth.\nMAR 25 '98 16:27\nSafe Motherhood\n647 P10\nHelping to make women's health\nand rights a reality\n212-941-5563 FAMILY CARE INTL.\nMAR 25 '98 16:27\nWhat is the greatest threat to a woman's life\nand health in developing countries?\n647 P11\nEvery minute:\n380 women become pregnant\n190\nwomen face an unplanned or unwanted pregnancy\n110\nwomen experience a pregnancy-related complication\n40\nwomen have an unsafe abortion\n212-941-5563 FAMILY CARE INTL.\n1 woman dies\nPregnancy and childbirth.\nWhy \"Safe Motherhood\"?\nEssential Safe Motherhood Services\n647 P12 MAR 25 '98 16:27\nGovernments and health advocates agree: sexual and reproductive health\nSafe motherhood services should be readily available through a network\nis essential for national development and personal well-being. And Safe\nof linked community health care providers, clinics and hospitals. The\nMotherhood is a key component of efforts to improve women's reproduc-\nintegrated services that policy-makers from around the world have\ntive health and rights. Pregnancy and childbirth are the leading causes of\npledged to provide include:\ndisability and death among women between the ages of 15 and 49, making\nSafe Motherhood programs essential for women's health and survival.\nCommunity education on safe motherhood;\nMore broadly, commitment to Safe Motherhood can galvanize action on\nPrenatal care and counseling, including the promotion of\na range of health problems that affect women and their families, including\nmaternal nutrition;\nreproductive tract infections, infertility, HIV/AIDS and other sexually\nSkilled assistance during childbirth;\ntransmitted diseases. It can also encourage attention to social issues, like\nCare for obstetric complications, including emergencies,\nlack of education, discrimination and violence against women, which can\nPostpartum care;\nlead to, or worsen, women's poor reproductive health.\nManagement of abortion complications, postabortion care and,\nDeath from pregnancy or childbirth is a social injustice that can and must\nwhere abortion is. not against the law, safe services for the\nbe addressed through political, legal and health systems in every country.\ntermination of pregnancy;\nMore than 99 percent of these deaths now take place in the developing\nFamily planning counseling, information and services;\nworld. Safe motherhood interventions, which are designed to reduce\nReproductive health education and services for adolescents.\nmaternal death and disability, are highly cost-effective: basic maternal and\nnewborn care costs an average of US$3 per person in developing\ncountries. The total cost of saving the lives of a mother or infant through\nLessons Learned\nantenatal, delivery and postnatal care is only $230, while the benefit to\ncountries, communities and families cannot be measured. Over one-half of\nEmpower women, ensure their choices: Gender inequalities and\nall infant deaths could be prevented through these interventions.\ndiscrimination limit women's choices and contribute directly to their ill-\nhealth and death. Legal reform and community mobilization can help\n212-941-5563 FAMILY CARE INTL.\nThe Safe Motherhood Initiative\nwomen safeguard their reproductive health by enabling them to understand\nand articulate their health needs, and to seek services with confidence and\nThe global Safe Motherhood Initiative was launched in 1987 to improve\nwithout delay.\nmaternal health and cut the number of maternal deaths in half by the year\n2000. It is led by a unique alliance of co-sponsoring agencies who work\ntogether to raise awareness, set priorities, stimulate research, mobilize\nEvery pregnancy faces risks: Every pregnant woman - even if she is\nresources, provide technical assistance and share information. Their\nwell-nourished and well-educated - can develop sudden, life-threatening\ncooperation and commitment have helped governments and non-govern-\ncomplications that require high quality obstetric care. Attempts to predict\nmental partners from more than 100 countries take action to make\nthese problems before they occur have not been successful, since most\nmotherhood safer. During the Initiative's first decade, these safe\ncomplications are unexpected and the majority of women with poor\nmotherhood partners developed model programs, tested new technologies\npregnancy outcomes do not fall into any high-risk categories. Therefore,\nand conducted research in a wide range of countries and settings. The\nmaternal health programs must aim to ensure that all women have access\nessential services they have identified, and the most important lessons they\nto essential services.\nhave learned, are summarized here.\nEach of the co-sponsors of the Safe Motherhood Initiative (see back\npanel) implements these activities according to its institutional mandate.\nMAR 25 '98 16:28\nEnsure skilled attendance during childbirth: The single most effective\nMeasure progress: Governments around the world have pledged to\nway to reduce maternal death is to ensure that a health professional with\nreduce maternal mortality by 50% by the year 2000. However, maternal\nthe skills to conduct a safe, normal delivery and manage complications is\nmortality is difficult to measure, due to problems with identification,\npresent during childbirth. Unfortunately, there is a chronic shortage of\nclassification and reporting. Therefore, safe motherhood partners have\nthese professionals in poor and rural communities in the developing world.\ndeveloped alternative means for measuring the impact and effectiveness\nResearch has shown that even trained traditional birth attendants (TBAs)\nof programs; for example, by recording the proportion of births attended\nhave not significantly reduced a woman's risk of dying in childbirth,\nby a skilled health provider. These indicators can identify weaknesses and\nlargely because they are unable to treat pregnancy complications. As an\nsuggest programmatic priorities so that maternal deaths can be better\n647 P13\ninterim strategy for settings where TBAs attend a significant proportion of\nprevented in the future.\ndeliveries, program planners may want to provide TBAs with adequate\ntraining and support to help them refer complicated cases effectively. In\nall settings, however, skilled attendance at delivery should continue to be\nA Call to Action\nthe long-term goal.\nSafe motherhood partnerships have been responsible for important\nImprove access to high quality maternal health services: A large\ninternational and country-level progress over the last ten years. Collabora-\ntion has enabled individual organizations to share their diverse strengths,\nnumber of women in developing countries do not have access to maternal\nand to achieve more than they could have alone. During this same decade,\nhealth services. Many of them cannot get to, or afford, high-quality care.\nhowever, six million women have died needlessly in pregnancy or\nCultural customs and beliefs can also prevent women from understanding\nchildbirth. Your support - and your partnership - can help safe mother-\nthe importance of health services, and from seeking them. In addition to\nhood partners around the world apply the lessons they have learned to save\nlegal reform and efforts to build support within communities, health\nthe lives of millions of women before the year 2000. Each minute, each\nsystems must work to address a range of clinical, interpersonal and\nday, in every country.\nlogistical problems that affect the quality, sensitivity and accessibility of\nthe services they provide.\nPlease join us.\n212-941-5563 FAMILY CARE INTL.\nAddress unwanted pregnancy and unsafe abortion: Unsafe abortion\nis the most neglected - and most easily preventable - cause of maternal\ndeath. These deaths can be significantly reduced by ensuring that safe\nmotherhood programs include client-centered family planning services to\nprevent unwanted pregnancy, contraceptive counseling for women who\nhave had an induced abortion, the use of appropriate technologies for\nwomen who experience abortion complications, and, where not against the\nlaw, safe services for pregnancy termination'.\nEach of the co-sponsors of the Safe Motherhood Initiative (see back\npanel) implements these activities according to its institutional mandate.\nPrinted on recycled paper\nWith the compliments of\nI\nNTERNATIONAL\nPrograms\nPopulation Reference Bureau, Inc.\n1875 Connecticut Ave., N.W., Suite 520\nWashington, D.C. 20009-5728\nU.S.A.\nPhone: (202) 483-1100\nFax: (202) 328-3937\nMEASURE Communication\nMEASURE Communication\nALL\nMEASURE\nRhonda Smith, MPH\nMEASURE\nRhonda Smith, MPH\nSenior Policy Analyst\nAnalyste de politiques\nCommunication Specialist\nSpécialiste en communication\nPopulation Reference Bureau\nPopulation Reference Bureau\n1875 Connecticut Ave., NW Suite 520\n1875 Connecticut Ave., NW\nSuite 520\nWashington, DC 20009-5728\nWashington, DC 20009\nEtats-Unis\nUSA\n(202) 483-1100 Fax (202) 328-3937\n(202) 483-1100\nFax (202) 328-3937\nC. élec. : [email protected]\nE-mail: [email protected]\nPHOTOCOPY\nPRESERVATION\nMEASURE Communication\nMEASURE Communication\nMEASURE\nRhonda Smith, MPH\nMEASURE\nRhonda Smith, MPH\nAnalyste de politiques\nSenior Policy Analyst\nSpécialiste en communication\nCommunication Specialist\nPopulation Reference Bureau\nPopulation Reference Bureau\n1875 Connecticut Ave., NW\nSuite 520\n1875 Connecticut Ave., NW N Suite 520\nWashington, DC 20009\nEtats-Unis\nWashington, DC 20009-5728\nUSA\n(202) 483-1100\nFax (202) 328-3937\n(202) 483-1100 Fax (202) 328-3937\nC. élec. : [email protected]\nE-mail: [email protected]\nOn behalf of the Inter-Agency Group for Safe Motherhood\nJames D. Wolfensohn, President of the World Bank\ncordially invites you to attend a special event in honor of World Health Day\nSAFE MOTHERHOOD: PROGRESS AND CHALLENGES\non Tuesday, April 7, 1998\nfrom nine thirty in the morning to one o'clock in the afternoon\nat the Lewis Preston Auditorium\nThe World Bank, 1818 H Street, N.W. Washington, DC\nRSVP BY MARCH 20, 1998\nDUE TO SECURITY REQUIREMENTS,\nMAMTA KAUSHAL, THE WORLD BANK\nPARTICIPANTS MUST BE\nTEL: 202 458-8344; FAX: 202 522-2653\nSEATED BY 9:00AM\nOR\nANNC Tinker - DirectoR of Safe Motherhood\nInitiative\n[World Bank. (502) 473-3683\nSafe Motherhood: Progress and Challenges\na symposium with:\nHis Excellency Yoweri Museveni, President of Uganda (invited)\nFirst Lady Hillary Rodham Clinton, United States of America\nThe Honorable Kofi Annan, Secretary General of the United Nations, (invited)\nJames D. Wolfensohn, President of the World Bank\nand\nMahmoud Fathalla, Senior Advisor, The Rockefeller Foundation\nNafis Sadik, Executive Director, UNFPA\nCarol Bellamy, Executive Director, UNICEF\nSir George Alleyne, Regional Director, PAHO\nDavid de Ferranti, Vice President, Human Development Network, The World Bank\nIngar Brueggemann, Secretary General, IPPF\nMargaret Catley-Carlson, President, The Population Council\nRichard Feachem, Director of Health, Nutrition & Population, The World Bank\nTuesday, April 7, 1998\n9:00 a.m.-1:00 p.m.\nLewis Preston Auditorium\nThe World Bank, 1818 H Street, N.W. Washington, D.C.\nPRS\nPRO\nHow Does\nPopulation\nReference\nFamily Planning\nBureau\n1875 Connecticut\nFamily planning is a low-cost way to save lives: Family\nAvenue, NW,\nSave Lives?\nplanning costs, on average, less than US$2 per capita per year.\nSuite 520\nWashington\nGovernments support family planning: Governments world-\nDC 20009 U.S.A.\nFactS heet\nwide are committed to improving the health and survival of\nhone:\n(202) 483-1100\nwomen and children through family planning. Approximately\nE\nvery year more than 585,000 women die from\nFax:\nthree-quarters of the costs of family planning are currently\n(202) 328-3937\ncomplications of pregnancy and childbirth, and at least\npaid for by developing countries.\n11 million children under age five die in developing countries.\[email protected]\nFamily planning can prevent\nDemand for family planning will continue to increase:\nPage:\nhttp://www.prb.org\nmany of these deaths by\nThe United Nations estimates that annual expenditures for\nInfant Mortality by Birth Interval\nhelping couples avoid child-\nfamily planning will have to double by the year 2000, from\nSeptember 1997\nbearing during times of\n140\nUS$4.8 billion in 1994 to US$10 billion, to meet projected\n134\n128\nhigh health risk for mothers\n120\nLess than\nDeaths per 1,000 infants under age one\n118\ndemands. Developing countries will need to increase their\ntwo-year\n100\ninterval\nand children.\nexpenditures to US$6.7 billion and donors will need to\n80\nAt least\n81\ntwo-year\ncontribute US$3.3 billion to cover these expected costs in\nSaving\n60\n70\ninterval'\nChildren's Lives\n40\nthe year 2000.\nClosely spaced births result\n20\n0\nin higher infant and child\nmortality: Babies born less\nMore information about the health benefits of family\nthan two years after their\nSOURCE: Unpublished analysis of Demographic and Health Surveys, 1990-1995\n(Calverton; MD: Macro International, 1996).\nplanning can be found in the booklet, Family\nnext oldest brother or sister\nPlanning Saves Lives (January 1997), available\nare twice as likely to die in\nfrom the Population Reference Bureau.\nthe first year as those born after an interval of at least two years.\nSpacing births can prevent an average of one in four\ninfant deaths: By spacing births at least two years apart,\nfamily planning can prevent an average of one in four\ninfant deaths in developing countries.\nChildren born to young mothers are more likely to die:\nChildren born to women younger than age 20 are one and\none-half times more likely to die before their first birthday as\nthose born to mothers ages 20 to 29.\nSaving Women's Lives\n76,000 deaths every year, mostly in developing countries.\nAt least one woman dies every minute from causes related to\nFamily planning can prevent many of these tragic deaths by\npregnancy and childbirth: In developing countries, a woman's\nreducing the number of unintended pregnancies that result\nlifetime risk of dying from\nin abortions.\nWomen's Risk of Death from Pregnancy\npregnancy and childbirth-\nFamily planning is safe and effective: The risk of dying from\nand Childbirth\nrelated causes is 38 times\nLifetime risk\nuse of modern methods of family planning is far less than the\nRegion\nof death\nhigher than the risk\nrisk of death associated with pregnancy and childbirth.\nWorld\n1 in 60\nfor a woman in more\nMore Developed\n1 in 1,800\nA Cost-Effective Way\ndeveloped regions.\nto Save Lives\nDeveloping\n1 in 48\nFamily planning can\nMore than half of all couples in the developing world are using\nAfrica\n1 in 16\n1 in 65\nprevent at least 25 percent\nfamily planning to achieve their desired family size, and the\nAsia\nEurope\n1 in 1,400\nof all maternal deaths:\ndemand for family plan-\nLatin America/Caribbean\n1 in 130\nFamily planning can save\nning continues to grow.\nDemand for Family Planning\nNorth America\n1 in 3,700\nwomen's lives by allowing\nThere is a large\n(Demand = Current Use + Unmet Need)\nOceania\n1 in 26\n90\nwomen to delay motherhood;\nunmet need for family\n80\nD\nSOURCE: WHO and UNICEF, Revised 1990 Estimates of Maternal Mortality,\nprevent unintended pregnan-\nplanning: Surveys find that\n70\nA New Approach by WHO and UNICEF (Geneva: World Health\n72\nUnmet need\n36\nOrganization, April 1996):3, 6.\n60\n16\nDD\n(Women who\ncies and unsafe abortions;\nwant to space\nan estimated 150 million\n50\n55\nor limit births\n48\nbut are not\nprotect themselves from\n40\nwomen in developing\n28\ncurrently using\n30\nfamily planning)\n33\nsexually transmitted diseases, including HIV/AIDS; and stop\ncountries are in need of\nPercent of married women ages 15-49\n21\n20\nCurrent use\nchildbearing when they have reached their desired family size.\n10\nfamily planning. Meeting\n12\n6\n0\nYoung women and those with pre-existing health problems face\njust the existing demand\nNigeria\nESYPI\nIndenesta\nPakistan\nColombia\nhigher risks: Women ages 15-19 are twice as likely to die from\nfor family planning could\ncauses related to pregnancy and childbirth as women in their 20s.\nreduce the number of\nSOURCE: Demographic and Health Surveys, 1990-1995 (Calverton, MD:\nMacro International).\nWomen who are physically and nutritionally drained, and those\nmaternal deaths and\nsuffering from pre-existing illnesses, are also at higher risk of\ninjuries by as much as\nillness and death.\n20 percent.\nFamily planning prevents abortions: An estimated 20 million\nunsafe abortions take place each year in places where access to\nsafe abortion is limited. Unsafe abortions result in at least\nAPR-01-98 WED 02:17 PM PUBLIC AFFAIRS & COMMUNI FAX NO. 203 226 6709\nP. 01\nY\nSave the Children.\n54 Wilton Rd. Westport CT 06881\nFAX\nFAX\nDate:\n4/1/98\nTo:\nChristie Macy\nFax:\n202-456-5709\nPhone:\n202-456-6266\nFrom:\nMarianne LeVert\nPublic Affairs and Communications\nPhone:\n203-221-4116\nFax:\n203-226-6709\nNumber of pages, including this transmittal sheet: 4\nMemo:\nPress about The First Lady's trip to Nepal (April 1995).\nWhite House press release: Clean Delivery Kits.\nAnnouncement of First Lady's receipt of Save the Children's Distinguished Service Award\nat White House ceremony (for background ).\nShould you need additional information, please do not hesitate to call me at 203-221-\n4116.\nAPR-01-98 WED 02:17 PM\nPUBLIC AFFAIRS & COMMUNI\nFAX NO. 203 226 6709\nP. 02\n04-04-1995 28:32\n00077-1-415996\nM.N. INTERNATIONAL\nResend\nNW\nWhite Houx Press Release\nNAME\nTHE SAFE HOME DELIVERY KIT\nno\nOver 700,000 babies are born in Nepal each year. 650,000 are\ndelivered at home under primitive conditions with most births not\nassisted by trained attendants. More than 75,000 die within the\nPKS\nfirst year of life, frequently due to tetanus and sepsis caused\nby unhygienic delivery practices. As a result, Nepal's maternal\nand infant death rates are among the highest in the world.\nclean\nThe\nHome Delivery Kit was designed to prevent such deaths.\nors\nIt. is the product of two years' research conducted by the Save\nthe Children Alliance/Nepal with support from His Majesty's\nCovernment Institute of Medicine and Ministry of Health, funding\nassistance from UNFPA and UNICEF, and tochnical assistance from\nUSAID and PATH/US. In 1994, a private company, Maternal and Child\nHealth Products Pvt. Ltd. (MCHP) of Kathmandu, was established\nwith start-up funding and technical assistance from USAID/Nepal\nthrough Save the Children/US. This ground-breaking micro-\nenterprise is owned and operated by Ms. Rukumani Charan Shrestha\n(Managing Director), ME. Sumitra Bantawa, and Ms. Renuka\nMunakarmi, who each have more than fifteen years' experience in\nreproductive health care and women's issues, and Ms. Nigma\nTamrakar, an experienced businesswoman.\nThe simple, affordable and easy-to-use kit was designed\nspecifically with the traditional birthing practices particular\nto Nepal in mind, which included placing the umbilical cord of\nthe newborn on a coin or betel nut while being cut. Rather than\ntrying to change traditions, the kit contains a small, clean,\ncoin-like substitute as well as soap, a new razor blade, clean\numbilical-cord ties, and a plastic sheet to provide a hygienic\nbirthing surface. The kit's use will significantly reduce two\nmajor causes of maternal and neonatal death, tetanus and sepsis,\nby emphasizing the \"three cleans\" principle promoted by the World\nHealth Organization: clean hands, clean surface, clean umbilical-\ncord care.\nDue to the high illiteracy rate among the population all\ninstructions consist of clear, unmistakable illustrations.\nI I can\nSince August 1994, Maternal and child Health Products Put. Ltd.\nupdate\n(MCHP) has produced and sold over 100,000 Safe Home Delivery Kits\nthese\nin Nepal, primarily through government and voluntary agencies,\nand commercial outlets. The First Lady's visit to Kalimati\nsold in drugstores, general stores, and through medical\nif you\nstats\nClinic represents the official launching of the kit which will be\npractitioners and community health workers for about Rs. 20 (40\nneed\ncents). Median income in Nepal is USD 210 per year.\nthem\nThe Safe Home Delivery Kit is valuable proof that governments,\ndonor and voluntary agencies, and the private sector can work\ntogether constructively to develop innovative health-care\nproducts that benefit a large segment of the population and have\na high potential for becoming self-sustaining within a short\nperiod of time.\nWHITE HOUSE PRESS RELEASE\n15/m Y,\nAPR-01-98 WED 02:18 PM\nPUBLIC AFFAIRS & COMMUNI\nFAX NO. 203 226 6709\nP. 03\nClinton visits the USAID-assisted International Center for Diarrheal Disease Control in Bangladesh, where\ngral rehydration therapy was developed.\nvisit to\nWhile in Kathmandu, Nepal, Clinton\nactivities encouraging broad-based eco-\nour program\ntoured a small health and family planning\nnomic growth, protecting the environment\nclinic financed by a partnership of USAID,\nand building democracy.\nIN NepAL\nSave the Children Foundation and the\n\"If my visit to other countries in the\ngovernment of Nepal. Here the first lady\nregion highlighted the development\nAPRIL 1995\nwas given a \"Safe Home Delivery Kit\" for\nchallenges and opportunities facing the\nexpectant mothers. The primitive kit,\nregion, my visit to Sri Lanka underlined the\nconsisting of soap, twine, wax, a plastic\nfact that those challenges can be met and\nC so \"three years\nsheet and razor blade, denotes the extent to\njust how important health, education and the\nago This month,\nwhich development still remains a challenge\ninclusion of women can be in achieving\neconomic progress anywhere in the world,\"\nClinton noted.\nIn an article the first lady wrote that ran\n\"One lesson the experience of\nin The Washington Post on May 14, she\nthe last several decades teaches\npraised USAID activities in South Asia:\n\"These projects are proof that American aid\nus is that where women prosper,\n- both financial and technical - has\ncountries prosper.\"\nprovided the tools of opportunity to people\nand nations who have shown a courageous\ncommitment to democracy and a market\nto Nepal, one of the poorest countries in the\neconomy. Today, that American aid\nworld.\nremains critical. Having watched in the last\nIn Bangladesh, Clinton visited the\n10 years as democracy has flourished and\nUSAID-assisted International Center for\nmarkets have opened around the globe, we\nDiarrheal Disease Control, which has been key\ncannot runn our backs on nations struggling\nin helping save people suffering from\nto uphold our ideals.\"\ncholera, malnutrition and diarrhea. It was at\nthis center that oral rehydration therapy was\ninitiated and then launched worldwide.\nClinton's last stop was Sri Lanka, the\nmost socially progressive of the countries\nvisited. Here USAID is committed to\nlot\nAPR-01-98 WED 02:18 PM PUBLIC AFFAIRS & COMMUNI\nFAX NO. 203 226 6709\nP. 04\nVMS\nNew York\nLos Angeles\n(212) 736-2010\nChicago\n(213)993-0111\nPhiladelphia\nSun Francisco\n(312)843-1131\n(215) 569 4990\nDetrait\n(415) 543-3361\nBoston\nDallas\n(810) 352-9220\n(617)266-2121\nWashington\nMiami\n(214) 644 9696\n(202) 393-7110\nDenver\n(305) 576-3581\nVIDEO MONITORING\nHartford\n(303) 861-7162\nSan Diego\nSERVICES\n(203) 953-1809\n(619) 544-1860\nOF AMERICA, INC.\n10260 Westheimer\nA BURRELLE'S Affiliato\nHouston, 7X 77042\n(713) 789 1635\n(713) 7800900\nDATE\nTranscript\nSeptember 18, 1995\nTIME\n7:00-7:30 PM (CT)\nNETWORK\nCNN\nPROGRAM\nHeadline News\nLynne Russell, anchor:\nFirst Lady Hillary Clinton received a Distinguished\nService Award from Save the Children at the White House\ntoday. The international relief organization commended her\nefforts to give the less fortunate--especially women and\nchildren--a chance, a voice, and a future. She plans to\npublish a book on children's issues this fall.\n# # #\nFYI: SAVE the Children\nawarded the first Lady\nthe Destyvished service AWARD\nfive months after trip\nto Nepal.\nFor a videocassette(TV) or audio cassette(radio) of this news segment contact your nearest VMS office.\nNOTICE: (c) Cable News Network, hr. 1996 AS Aights Received\nMaterial supplied by Video Manitaring Services of America, Inc. may only be used for internal revinw, analysis or research. Any publication, rebrondcast or oublic\nSave the Children.\nTo:\nChristie Macy\nOffice of the First Lady\nFr:\nMarianne LeVert\nSave the Children\nRe:\nClean Birthing Kit\nApril 2, 1998\nEnclosed please find a sample Clean Birthing Kit and an updated fact sheet about the kit\nand its use.\nThe contents of the kit include:\na fold-out pictorial guide to the birthing process using Nepalese script and women in\ntraditional clothes\na clean plastic sheet for a sanitary surface for the mother\na bar of soap with which the birthing attendant should wash her hands\na clean razor blade to cut the umbilical cord\na clean plastic disk on which to cut the cord\na clean string to tie off the cord\nManame lovert\nClean Birthing Kit\nContents:\na pictorial guide to the birthing process using Nepalese script\nand women in traditional clothes\na clean plastic sheet for a sanitary surface for the mother during\nbirth\na bar of soap with which the birthing attendant should wash her\nhands\na clean razor blade to cut the umbilical cord\na clean plastic disk on which to cut the cord\na clean string to tie off the cord\nUPDATED KITIN70\nClean Birthing Kit\nNepal is one of the most mountainous and geographically diverse countries in the\ndeveloping world. Remote villages are perched on the highest mountain ranges,\ncommunities are often isolated by the four month monsoon, and there are great\ndistances between poorly equipped government health posts. All of this makes the\ndelivery of health care difficult under the best of circumstances.\nIn Nepal, over 700,000 babies are born each year. More than 75,000 Nepali children\nwill die within the first year of life, and approximately 539 mothers will die due to\npregnancy or delivery each year per 100,000 live births*. Some of these deaths can be\nattributed to tetanus and other infections arising from delivery under unhygienic\nconditions. The vast majority of deliveries still take place at home, usually under\nunsanitary conditions. Births often take place on a floor that has been coated with a\nmud-dung preparation. Birth attendants are frequently relatives or neighbors who have\nlittle experience and no training in clean birth practices. Often, these untrained birth\nattendants do not wash their hands before assisting with birth, and do not take other\nhygienic precautions before caring for the cord. For example, the cord is usually cut\nwith a dirty sickle, knife or blade against the surface of an unclean coin or locally\navailable nut (betal nut). In addition, septic substances, typically mustard oil and/or\nprepared powders, are often applied to the cord.\nThe World Health Organization (WHO) has firmly supported the principle of the three\ncleans at delivery: clean hands, clean surface, and clean cord-cutting implement, in\nconjunction with their Expanded Program on Immunization goal to eliminate neonatal\ntetanus. Based on the importance of the \"3 cleans,\" and our desire to improve birthing\npractices in Nepal, Save the Children US, with its Alliance partners Redd Barna of\nNorway and Save/UK, initiated a research project in 1993, with support from UNICEF,\nUNFPA, and USAID, to examine the acceptability of the Clean Birthing Kit. In 1994, the\nClean Birthing Kit, or in the local Nepali Language, \"Sutkeri Samagri\" (\"Delivery Items\"),\nwent in to production. A unique, woman-owned, Nepali-based microenterprise, Maternal\nand Child Health Products Pvt, Ltd (MCHP), has been marketing and selling the product\never since. To date, over 100,000 kits have been sold, for approximately 27 cents a\npiece.\nThe contents of the kit, a small cardboard box only about 3.5 inches long by 2 inches\nwide, include fold-out pictorial instructions (using Nepali script and pictures of women\ndressed in traditional clothes) of the actual birthing process; a clean plastic sheet to\nprovide a sanitary surface during birth; a bar of soap with which the birthing helper\nwashes her hands; a clean razor blade to cut the cord; a clean plastic disk on which to\ncut the umbilical cord; and a clean string to tie off the umbilical cord.\nThe Clean Birthing Kit, a simple, cost-effective product, has broadened awareness of\nthe importance of \"a clean start\" throughout many villages of Nepal.\n*Nepal Family Health Survey, 1996, Ministry of Healthfile: C/Kim/Birthkit\nA\nRegarding the finding of epidemiologic studies of workers exposed to health and safety\nhazards:\n\"Statistics are people with the tears wiped off.\"\nIrving Selikoff, the pioneer who first\nlinked asbestos exposure to the\npremature deaths of New Jersey\ninsulation workers\nInsult, Injury, Asylum: Genital Mutilation Was Only the Beginning\nvital context for her story. Suc- Rcut SO she clean for\nthree, times flocked in maxi\nmother swexplanation of the\nDO THEY HEAR YOU\ncinclly depicted, that of her life him. In the most suspenseful chap\nmum security. wards with crimi-\nepisode after it was over\nWHEN YOU CRY\nsheds light on ethnic groups, Islam sister Avisha executes\nnals, including a cellmate who was\nThe most impressive human ac\nBy Fauziya Kassindja and Layli Miller\nand custom, which weigh far more ing,\nconvicted murderer, housed with\ncomplishment in? Do They Hear\nBashir\nthan government or law and the\nAfteria brief Germany\nsmokers despite asthma, repeated\nYou When You Cry\" is Kassindja\nDelacorte. 518 pp.\nsupreme importance of family\nKassindja arrived in the United\ny denied access to doctors, misdi\nstrength and iousness\ndelightful description of her sister\nStates: where: she has relatives\nagnosed and denied medical treat\nhough she was disappointed\nReviewed BY LOBI ROBINSON\nAyisha's four day wedding illumi\nassuming that asylum would be\nment peptict ulcer disease.\nwhen her mother apologized to her\nnates those values. particularly\neasy to secure. My, teachers\nProfound haos and appalling in\ncontributing editor of Emerge\nuncle (for the sake of peace in the\nmagazine who working on book\nwell.\nschool had:said it was great\njustices plague detained\nfamily) for helping with the es\nabout sexual\nKassindia parents followed\ncountry They said people believed\ngrants, who are portionately,\nin justice in America, she recalled\npeople of color.\ncape, Kassindja declares peace her\nmost tribal traditions but [confi-\nBut within her first hours on U.S.\nAimajor disappointment of the\ngiself. Tm grateful to the American\nround the world rituals\ndently bucked those they, founds\nsoil Kassindia was p-searched\nbook is the hasty. retelling of the\npeople and government for every\nmarking girls passage into\nunacceptable Her father married\nadulthood Jewish bat\ntwice, left naked in a putrid, freez-\nappeal hearing, arguably the\nthing they done for me, taking\nY JOHN EARLE\nonly one woman, from outside his\ning holding room, forced to shower\nbook most anticipated scene. The\nme in; giving me shelter, giving me\nFauziya Kassindja escaped the fate\nmitzvahs, Latin American quince\ntribe, provoking vocal disapproval\nin cold water while guards\nauthors should have more thor\nsate place to live\nTHE\nof millions of girls worldwide.\naneras are joyous\" occasions\nby his siblings: He also defied\nstared, and berated by an immigra\noughly explained: the legal-argu\nThen there is amputation without\ncustom by rejecting female cutting\ntion: official: SI don't know whyst\nments made by both sides of the\nanesthesia. What a way to grow up\nSo deep was his conviction that he\nthese people can't stay in their own\ncase, as they summarized well the\novernight\nMain\nsaid he would*never, forgive his\ncountries. When she asked where\nlegal and political actions leading\nAn estimated 100 million girls\nbrother for secretly arranging the\nshe could put her souled samitary\nup to that moment.\nand women have had their genitals\ncutting of their niece.\nnapkin, a, guard barked,9 Why\nUltimately, the dramatic legal\nsliced or scraped off in a procedure\nWhen Kassindja's father died,\ndon't you eat it It got worse 433\nand media strategies of lawyers,\nknown as female circumcision, cut\nthat same uncle became her legal\nDuring 16 months of confine\nlaw students; human rights advo-\nting or genital mutilation. A tradi\nguardian; as mandated by tradi-\nment in one detention center and\ncates and reporters won Kassind-\ntion practiced in more than 25\ntion. Soon she was pulled out of\nthree prisons; she was tear gassed\nja freedom; setting legal prece\nAfrican countries and a few West\nschool and forced to marry a man\nand beaten, searched with\ndents for future asylum seekers\nern and Southern countries,\nwith three wives who wanted her\nother women, placed in segrega\nYou God's chosen one, was\nit can cause a host of health prob\n250\nlems and even death To be pro\ntected from it by family in a culture\nin which women and men fiercely\nchampion it would be good for\ntune. But what if to escape cutting\nmeant fleeing into the unknown?\nN Fauziya Kassindia lived that sce\nnario; landing in the United States\nat age 17 Her special welcome to\nPHOTOCOPY\nthis country, compliments of: the\nImmigration and Naturalization\nPR\nERVATION\nService, amounted to more than a\nyear of umpr risonment and consis\ntent human rights abuses: In Do\nThey Hear You When You Cry,\nKassindja, along with one of her\nlawyers, Layli Miller Bashir, re-\ncounts her at arduous journey. from\nTogo to detention as an: illegal\nalien, and ultimately to freedom T4\nToldein Kassindja voice, (this\nmemoir is also) a precious lesson\nabout cultures, women human\nrights policy and perhaps most\nimportant, faith in God, and hu\nmanity These elements; fluidly\ninterwoven, create an incredible\nnarrative about an ordinary teen\nage girl. MAIL\n* Rarely in Western culture do\nwell rounded accounts of life\nabroad particularly in underdevel-\noped countries; get told. Kassind\nja description of her \"easy and\ntranquil childhood ma Togo: is\nrefreshing in itself and also serves\nRecord Type: Record\nTo:\nChristine N. Macy/WHO/EOP\nCC:\nSubject: MRS. CLINTON URGES FOCUS ON MATERNAL HEALTH\nI should have thought to send this to you yesterday sorry.\nForwarded by Neera Tanden/WHO/EOP on 04/08/98 11:53 AM\nTANDEN N @ A1\n04/07/98 03:58:00 PM\nRecord Type: Record\nTo:\nNeera Tanden\nCC:\nSubject: MRS. CLINTON URGES FOCUS ON MATERNAL HEALTH\nDate: 04/07/98 Time: 14:51\nMMrs. Clinton urges focus on maternal health\nWASHINGTON (AP) In the time it took Hillary Rodham Clinton to\ndeliver her World Health Day speech, she said, an estimated 15\nwomen died around the globe from pregnancy complications or unsafe\nabortions.\nNo woman should ever die in childbirth,\" Mrs. Clinton\ndeclared Tuesday, calling for renewed global attention to maternal\nhealth. The vast majority of these deaths and so much of that\nsuffering could have been avoided.\"\nNearly 600,000 women and girls, most in developing nations, die\neach year while pregnant or in labor due to complications,\nincluding self-induced abortions, according to the World Health\nOrganization and UNICEF.\nBreaking down the statistics, Mrs. Clinton said that every\nminute, a women or girl dies, 40 have unsafe abortions, 110\nexperience a pregnancy-related problem and 190 face an unplanned\npregnancy.\nMrs. Clinton, speaking to several hundred health care\nprofessionals and private and public policymakers at World Bank\nheadquarters, said countries should develop better family-planning\nand education programs for women and children to combat maternal\nmortality.\nOn that point, she criticized conservative members of Congress\nwho each year try to block U.S. government money for international\nfamily planning, which critics contend lead to abortions.\nWithout it (family planning) women often turn in desperation\nto illegal, unsafe abortion procedures that can account for up to\nhalf or more of all maternal deaths,\" Mrs. Clinton said.\nI would like to stress that point because there are some in\nour Congress and in our country who do not understand how providing\nfamily-planning services helps reduce the rate of abortion.\"\nMrs. Clinton, who last week returned from a 12-day tour of\nsub-Saharan Africa with President Clinton, noted that she and her\nhusband visited projects promoting women and children to underline\nU.S. support for human rights and particularly the right to\nhealth.\"\nSupporting Mrs. Clinton at the World Health Day celebration,\nMalaysia's first lady, Siti Hasmah Mohd Ali, called for the\nelimination of cultural and social taboos\" that often prevent\nwomen and girls from making their own reproductive decisions.\nSafe motherhood is a basic human right,\" she said.\nCarol Bellamy, executive director of the United Nations\nChildren's Fund, said her visit last week to Afghanistan, where\nwomen suffer harsh discrimination under Taliban rule, demonstrated\nto her that women without equal human rights are in mortal danger.\nIt is no coincidence that Afghanistan is distinguished\nboth by severe economic and social restrictions on women and by the\nhighest maternal mortality rate of any developing country 1,700\ndeaths per 100,000 live births a truly shocking number,\" Bellamy\nsaid.\nIn the United States, by comparison, from 10 to two dozen women\ndie for every 100,000 live births, according to various federal\nsurveys.\nBellamy and Mrs. Clinton said simple hygienic handling of mother\nand baby can save lives at an estimated cost of $3 per person per\nyear.\nAPNP-04-07-98 1450EDT\nAPR-01-98 WED 01:44 PM PUBLIC AFFAIRS & COMMUNI FAX NO. 203 226 6709\nP. 01\nY Save the Children.\n54 Wilton Rd. Westport CT 06881\nFAX\nFAX\nDate:\n4/1/98\nTo:\nChristie Macy\nFax:\n202-456-5709\nPhone:\n202-456-6266\nFrom:\nMarianne LeVert\nPublic Affairs and Communications\nPhone:\n203-221-4116\nFax:\n203-226-6709\nNumber of pages, including this transmittal sheet:\nMemo:\nAs you indicated that less material was better than more and short answers more helpful\nthan long, I am sending you several short pieces:\nPress about The First Lady's trip to Nepal (April 1995).\nOne paragraph descriptions of Clean Delivery Kits and of safe delivery programs.\nWhite House press release: Clean Delivery Kits.\nAnnouncement of First Lady's receipt of Save the Children's Distinguished Service Award\nat White House ceremony.\nShould you need additional information, please do not hesitate to call me at 203-221-\n4116.\nwhen to seek care outside the home, and proper home follow-up\ncare.\nSave the Children's community-level programs link\nvolunteers, village health action teams, and local ministry of\nhealth systems, among others, We also foster partnerships with\nresidents respected for their traditional health knowledge--\nincluding both traditional healers and traditional birth attendants.\nCommon program themes include nutrition education: improved\ncase management for illness and disease: immunization;\nbreastfeeding and family planning--including counseling for\nHIV/AIDS; safe motherhood initiatives: transport systems for\nobstetric emergencies; school health programs, and water and\nsanitation improvements.\nSuch capacity-building and system-strengthening at the\nlocal level means that even when Save the Children's active\nprograms come to a close, the benefits of improved health\nAchean Delivery Kits\nknowledge and services serve families and communities through\n(short answer)\nfuture generations.\nCollaborative multi-level program effort in\nIn Malawi, one community-based program initiated by\nNepal:\nSave the Children involves village funds for improving access to\nClean Delivery Kits\nlife-saving drugs. Working with Village Health Action Teams in\nSave the Children developed \"Clean Delivery\ncommunities more than five kilometers away from a government\nKits\" in Nepal to address common unhygienic\nbirthing practices that can cause severe\nmedical facility, Save the Children helps set up community\nmaternal and infant health problems, including\nfatal infections. To make the kits as useful and\npharmacies stocked with five drugs that are essential for treating\nculturally responsive as possible, Save the\nChildren collaborated with local organizations\nthe four most common childhood infections--fever/malaria,\non both developing and producing them. In\npneumonia, diarrhea, and eye infections. A volunteer designated\ndesigning and implementing the research for\nthe kits, we worked with a number of local\nby the team learns basic assessment and treatment skills, is\norganizations, To produce them, Save the\nChildren collaborated with a local women-\ntrained to identify danger signs pointing to the need for hospital\nowned firm. And to market the kits, we\npartnered with the Ministry of Health in a social\ncare, and keeps records of clientele, diagnosis, drugs and doses,\nmarketing program to publicize availability and\nand money received.\ncarry out ongoing distribution.\nThe informal pharmacies are typically able to provide anti-\nmalarial treatment for scores of feverish children every month--\nmany of whom may have lost their lives to the disease. In\n10f2\nP. 02\nFAX NO. 203 226 6709\nCOMMUNI\n8\nAFFAIRS\nPUBLIC\nWd\nSt:\nREPRODUCTIVE HEALTH PROGRAM PROFILES:\nCHOICES FOR A CHANCE\nSave the Children's longstanding community-based\nPromoting individual\napproach to health gives us a strong foundation to promote\nand family health, and\nparticipatory reproductive health services shaped by local needs.\nhelping people avoid the\nBy developing partnerships and reinforcing networks between\npersonal burdens associated\nlocal and national groups and government agencies, Save the\nwith reproductive and sexual\nChildren's programs strengthen the health services available to\nhealth problems are the goals\nfamilies and communities,\nof Save the Children's\nOur reproductive health programs incorporate efforts in\nreproductive health\nfive main areas: family planning, safe pregnancy and delivery,\ninitiatives.\nRefining\nsexually-transmitted diseases--including HIV/AIDS, education--\nstrategies, maximizing\nespecially for women and girls, and community-based economic\nresources, and learning from\nexperience is the constant\ndevelopment.\nwork of our programs around\nUnder the umbrella of family planning, Save the Children\nthe world.\nincludes fertility awareness, contraceptive information,\neducation, counseling, and service provision in voluntary\nprograms designed to address local concerns.\n[NEED? ELABORATE?)\nWomen's Education: The poor record of\nmany countries in educating their daughters as\nOur safe delivery programs teach women and their\ndiligently as their sons has a generational\nimpact on women, families, and societies.\nfamilies to identify danger signs during pregnancy and\nMany studies have clarified the positive,\ndelivery and develop a birth plan for accessing emergency\nprofound and lasting changes engendered by\nincreasing access to education for women and\nobstetric care if needed. We also focus on providing\ngirls. (include fundamental improvements in\nwomen's capacity to care for herself and for\ntraining for traditional birth attendants and village health\nthose who depend on her,)\npromoters, strengthening pre- and post-natal care,\nworking with safe birth kits, and establishing village-\nwhat safe\nbased referral services.\ndelivery programs\ndo for women's\nTo help communities reduce the incidence of sexually-\nhealth.\ntransmitted diseases and improve treatment programs,\nSave the Children emphasizes education, communications\nand awareness programs--including community drama\npresentations; strengthening diagnostic and treatment\n2012\nP. 03\nFAX NO. 203 226 6709\nPUBLIC AFFAIRS & COMMUNI\nAPR-01-98 WED 01:45 PM\nClinton visits the USAID-assisted International Center for Diarrheal Disease Control in Bangladesh, where\n'oral rehydration therapy was developed.\nvisit to\nWhile in Kathmandu, Nepal, Clinton\nactivities encouraging broad-based eco-\nour program\ntoured a small health and family planning\nnomic growth, protecting the environment\nclinic financed by a partnership of USAID,\nand building democracy.\nIN NepAL\nSave the Children Foundation and the\n\"If my visit to other countries in the\ngovernment ur Nepal. Here the first lady\nregion highlighted the development\nAPRIL 1995\nwas given a \"Safe Home Delivery Kid\" for\nchallenges and opportunities facing the\nexpectant mothers. The primitive kit,\nregion, my visit to Sri Lanka underlined the\nconsisting of soap, twine, war. a plastic\nfact that those challenges can be met and\nC so \"three years\nsheet and razor blade, denotes the extent to\njust how important health, education and the\na90 This month,\nwhich development still remains a challenge\ninclusion of women can be in achieving\neconomic progress anywhere in the world,\"\nClinton noted.\nIn an article the first lady wrote that ran\n\"One lesson the experience of\nin The Washington Post on May 14, she\nthe last several decades teaches\npraised USAID activities in South Asia:\n\"These projects are proof that American aid\nus is that where women prosper,\nboth financial and technical - has\ncountries prosper.\"\nprovided the tools of opportunity to people\nand nations who have shown a courageous\ncommitment to democracy and a market\nto Nepal, one of the poorest countries in the\neconomy. Today, that American aid\nworld.\nremains critical. Having watched in the last\nIn Bangladesh, Clinton visited the\n10 years as democracy has flourished and\nUSAID-assisted International Center for\nmarkets have opened around the globe, we\nDiarrheal Disease Control, which has been key\ncannot turn our backs on nations struggling\nin helping save people suffering from\nto uphold our ideals.\"\ncholera, malnutrition and diarrhea. It was at\nthis center that oral rehydration therapy was\ninitiated and then launched worldwide.\nClinton's last stop was Sri Lanka, the\nmost socially progressive of the countries\nvisited. Here USAID is committed to\n/ of\nFRONT LINES / 1995\n3\nP. 05\nFAX NO. 203 226 6709\nPUBLIC AFFAIRS & COMMUNI\nAPR-01-98 WED 01:46 PM\nResend\nNru\nWhite Houre Press Release\nTHE SAFE HOME DELIVERY KIT\nno\nOver 700,000 babies are born in Nepal each year. 650,000 are\ndelivered at home under primitive conditions with most births not\nassisted by trained attendants. More than 75,000 die within the\nPM\nfirst year of life, frequently due to tetanus and sepsis caused\nby unhygienic delivery practices. AS a result, Nepal's maternal\nand infant death rates are among the highest in the world.\ncleun\nThe\nHome Delivery Kit was designed to prevent such deaths.\n(\nIt is the product of two years' research conducted by the save\nthe Children Alliance/Nepal with support from His Majesty's\nGovernment Institute of Medicine and Ministry of Health, funding\nassistance from UNFPA and UNICEF, and technical assistance from\nUSAID and PATH/US. In 1994, a private company, Maternal and child\nHealth Products pvt. Ltd. (MCHP) of Kathmandu, was established\nwith start-up funding and technical assistance from USAID/Nepal\nthrough Save the Children/US. This ground-breaking micro-\nenterprise is owned and operated by Ms. Rukumani Charan. Shrestha\n(Managing Director), Ms. Sumitra Bantawa, and Ms. Renuka\nMunakarmi, who each have more than fifteen years' experience in\nreproductive health care and women's issues, and Ms. Nigma\nTamrakar, an experienced businesswoman.\nThe simple, affordable and easy-to-use kit was designed\nspecifically with the traditional birthing practices particular\nto Nepal in mind, which included placing the umbilical cord of\nthe newborn on a coin or betal nut while being cut. Rather than\ntrying to change traditions, the kit contains a small, clean,\ncoin-like substitute as well as soap, a new razor blade, clean\numbilical-cord ties, and a plastic sheet to provide a hygienic\nbirthing surface. The kit's use will significantly reduce two\nmajor causes of maternal and neonatal death, tetanus and sepsis,\nby emphasizing the \"three cleans\" principle promoted by the World\nHealth Organization: clean hands, clean surface, clean umbilical-\ncord care.\nDue to the high illiteracy rate among the population all\ninstructions consist of clear, unmistakable illustrations.\nI can\nSince August 1994, Maternal and child Health Products put. Ltd.\nupdate\n(MCHP) has produced and sold over 100,000 Safe Home Delivery Kits\nin Nepal, primarily through government and voluntary agencies,\nand commercial outlets. The First Lady's visit to Kalimati\ntheses\nClinic represents the official launching of the kit which will be\nifyou\nsold in drugstores, general stores, and through medical\npractitioners and community health workers for about Rs. 20 (40\nneed\ncents). Median income in Nepal is USD 210 per year.\nthem\nThe Safe Home Delivery Kit is valuable proof that governments,\ndonor and voluntary agencies, and the private sector can work\ntogether constructively to develop innovative health-care\nproducts that benefit a large segment of the population and have\na high potential for becoming self-sustaining within a short\nperiod of time.\nWMITE HOUSE PRESS RELEASE\n15/17 Yelf,\nP. 04\nAPR-01-98 WED 01:46 PM PUBLIC AFFAIRS & COMMUNI FAX NO. 203 226 6709\nVMS\nNew York\nlos Angelos\nChicago\nPhiladelphia\nSon Francisco\n(212) 736-2010\n(213)99301111\n312) 649 1131\n(215) 663-4990\n(415) 513-3301\nDetroit\nBorton\nDallas\nWashington\nMiami\n(810) 352-9220\n(617)2662121\n(2)4)844-9696\n(202) 393-7110\n(305) 570-3581\nDenver\nHarrford\nSan Diego\nVIDEO MONITORING\n(303) 861-7152\n0031 953-1889\n(613) 544-1800\nSERVICES\nOF AMERICA, INC.\n^ BURRELLE'S Affiliate\n10280 Wasthmanor\nHaustan, TX 77042\n(713) 789 1035\n(713) 789 0980\nTranscript\nDATE\nSeptember 18, 1995\nTIME\n7:00-7:30 PM (CT)\nNETWORK\nCNN\nPROGRAM\nHeadline News\nLynne Russell, anchor:\nFirst Lady Hillary Clinton received a Distinguished\nService Award from Save the Children at the White House\ntoday. The international relief organization commended her\nefforts to give the less fortunate--especially women and\nchildren-- chance, a voice, and a future. She plans to\npublish a book on children's issues this fall.\n###\nFVI ; SAVE the Children\nawarded the first hady\nthe Destuzuished senice AWARD\nfive months after trip\nto Nepal.\nFor a videocassette(TV) or audio cassette(radio) of this news segment contact your nearest VMS office.\nMaterial supplied by Video Monitoring Services of America, Inc. may only be used for Internal review, analysis or research Any publication, re-brundeast or public display for protit is fortinition.\nNOTICE: (c) Cable News Network, Inc. 1995, All Rights Reserved. Prepared by Vidoo Monitoring Services of America, Inc. which takes sale responsibility for the accuracy of transcription.\n90 'd\nFAX NO. 203 226 6709\nAPR-01-98 WED 01:47 PM PUBLIC AFFAIRS & COMMUNI\nTHE WHITE HOUSE\nWASHINGTON\nOFFICE OF\nSPEECHWRITING\nFax: (202)456-5709\nPhone: (202)456-2777\nTO:\nSill Sheffield 40 MUMTA\nFax:\n522-2653 Phone: 473-3691\nFROM:\nComments:\nDate:\nNumber of pages (including cover):\nHILLARY RODHAM CLINTON\nSAFE MOTHERHOOD: WORLD HEALTH DAY\nTHE WORLD BANK\nAPRIL 7, 1998\nIt is a great honor and pleasure to be here at the World Bank, and to join James\nWolfensohn and all of you as we celebrate World Health Day -- and recommit ourselves to the\nglobal mission of Safe Motherhood. Thank you for giving me this opportunity to speak to you\nabout a subject so close to my heart -- and of such extraordinary significance to the future of our\nworld. I'm so pleased to be joined by Dr. Crispus Kiyonga, the minister of Health in Uganda,\nwhere I have just visited -- and Dr. Siti Hasmah Mohd -- the first lady of Malaysia. Deep\nappreciation to the members of the Safe Motherhood Inter-Agency Group -- the World Health\nOrganization (WHO), UNFRA (UN Population Fund), UNICEF, the World Bank, International\nPlanned Parenthood Federation (IPPF), and the Population Council -- who, with the support of\nFamily Care International, lead such critical efforts around the globe to promote the health and\nwell being of women, children and families.\nI would also like to acknowledge the extraordinary work of the tens of thousands of foot\nsoldiers on the front lines -- the doctors, nurses, midwives and public health workers who are\nstruggling to meet the often overwhelming health needs of women throughout the world -- and\nwho, against all odds, have saved the lives of so many women and children over the years. We\nowe all of them our deepest gratitude.\nI want to begin by commending the World Bank for making women's health -- and in\nparticular -- safe motherhood -- a top priority for international agencies and countries around the\nworld. Thanks to your work and leadership, and the tireless efforts of all the international\nagencies and NGOs here today -- there's a growing understanding of the depth of the challenge\nwomen face around the globe. But perhaps more importantly, there's a growing public\nrecognition that investments in safe motherhood initiatives have an impact far beyond improving\nthe status of women and the health of their families. That such investments go hand in hand with\nsocial and economic progress throughout a nation, and the building of democracy around the\nglobe.\nWe gather here this morning at a time of great promise and hope. I've just returned from\nan historic trip to sub Saharan Africa -- where in just a few years, more than 20 nations have\nreplaced authoritarian rule with free and fair elections, and where even some of the poorest\ncountries are beginning the long road toward economic and social recovery. With the worldwide\nexplosion of technology and information, we are all moving into a global economy, and a truly\nnew world. And we are in the process -- as a community of nations -- of ending the production\nof the weapons of mass destruction, promoting greater human rights, and ensuring a healthier,\ncleaner global environment.\nYet in the midst of this time of extraordinary growth and promise -- we still fail to\nprotect the most precious symbol of the future -- the life and health of our mothers. The figures\nare shocking no matter how often they are repeated. Every minute -- 380 women become\npregnant -- 190 women face an unplanned or unwanted pregnancy; 110 women experience a\npregnancy related complication; and 40 women have an unsafe abortion. And every minute,\nsomewhere on this globe a woman dies from complications of pregnancy and childbirth.\nFor millions of women around the world, there is no basic primary, reproductive, or\nemergency care to keep them alive and healthy. For millions of women around the world, life\nthreatening complications from childbirth doom not only their own lives -- but the lives of their\nchildren, and the survival of their community. For millions of women around the world, safe\nmotherhood is a far away dream, a distant reality.\nNumbers and charts tell us the terrible dimensions of the health problems facing women\naround the world. But not the personal tragedy and pain of losing one's wife, mother, daughter,\nsister, or neighbor. As one health care worker admitted: \"statistics are people with the tears\nwiped off.\" At the Technical Consultation held in Sri Lanka last year, I'm sure many of you\nheard Dr. Mahmoud Fathalla say that \"Maternal mortality is not about statistics It's about\nwomen who have names; women who have faces; faces which we have seen in the throws of\nagony, distress, and despair.\" The agony of these deaths is compounded by the simple -- yet\nunbearable -- truth that the vast majority of them could have been avoided. They should never\nhave been allowed to happen.\nWe are being joined on this day by people in cities and communities around the globe,\nwho, like us, are raising our voices in unison to say: women need not die while giving life to\nfuture generations. Ten years ago, many of the individuals and agencies and NGOs here today\nlaunched the global Safe Motherhood initiative, and maternal mortality was elevated -- for the\nfirst time -- as an international priority, and goals were set to cut the number of maternal deaths\nin half by the year 2000. And while many countries -- including my own -- have not yet met our\ngoals, we should take pride in the strides we are making.\nThe signs of progress are all around us. In Bangladesh, Sri Lanka, and Cuba, health\nworkers trained in midwifery are being assigned to village-based health facilities -- and maternal\nmortality has declined. In Ethiopia and Mongolia, women living in remote areas or where\ntransportation is difficult can now go to maternity waiting homes, and get much needed care. In\nUganda, the \"Rescuer's\" project ensures pregnant women have radio equipment to call for help.\nIn country after country, national and local health initiatives are helping to save lives, and ensure\nhealthier futures, for women and their families.\nA few years ago, I toured a small health and family planning clinic in Kathmandu, Nepal,\nfinanced by a partnership among USAID, the Save the Children Foundation, and the government.\nAnd while I was there, I was given a \"Safe Home Delivery Kit\" -- like the one I have here today\nthat is given to expectant mothers. Inside is a bar of soap, twine, wax, a plastic sheet and a\nrazor blade. It's purpose is to reduce the two major causes of maternal and neonatal death\ntetanus and sepsis -- by promoting the \"three cleans\" principle: clean hands; clean surface; clean\numbilical care. These kits are made locally in Nepal by a woman-owned micro-enterprise.\nThis kit symbolizes for me some of the most important lessons we have absorbed over the\npast few years. First we've learned the power of partnership. In community after community,\nin nation after nation, governments, voluntary agencies, and local leaders are joining forces --\nand resources -- to develop innovate health care strategies and tools that promote safe\nmotherhood. We now know -- more than ever -- that reducing maternal mortality requires\nsustained, long term commitments from the full range of partners in a society. (I know that last\nnight there was an important meeting of new partners in the corporate sector who are now\njoining the World Bank in this safe motherhood campaign -- and agreeing to a set of principles. I\njoin all of you in applauding their participation.)\nBut just as importantly, we've learned that the cost of promoting safe motherhood is\noften minimal -- this kit costs about 40 cents -- in comparison to the extraordinary rewards in\nsaved lives, improved maternal and child health, and revitalized communities. So often, it's these\nsimple, common sense, inexpensive ideas -- like drawing up a roster of vehicles for emergency\ntransportation of women or setting up a revolving fund for drugs and supplies -- that can have\nthe greatest impact on reducing maternal mortality.\nThink about it. The World Bank estimates that that by spending under $2 a year per\nperson for health care, almost all of the 600,000 women who die every year during pregnancy or\nchildbirth would be alive today. And the lives of 1.5 million infants would be saved.\nThe cruel truth is: as much progress as we've made, as many lessons as we've learned, as\nmany conferences as we've held, as many partners as we've gained, we have yet to convince\nenough of the world's leaders and citizens that maternal mortality is not just a health crisis of\nextraordinary proportions. It's a social injustice of the highest magnitude -- and the denial of\nthe most basic human rights -- including the right to life itself. Martin Luther King Jr. once said\nthat \"of all the forms of inequality, injustice in health is the most shocking, and the most\ninhumane.\" I agree.\nThere is a painful equity in terms of peril for women during childbirth. Forty percent of\nall women -- whether they live on the upper side of New York city or the shanty towns of\nSoweto -- have complications. And 15% of all women have life threatening complications.\nWhat happens as a result of those complications -- whether a woman or her child lives or dies --\ndepends not on the content of her character, as Dr. King would have said, but on the\nneighborhood in which that woman lives, the ethnic group to which she belongs, and the social\nand economic status of her life. The inequities once again -- are shocking. One woman in\n4,000 dies of childbirth in the United States. In Eretria one woman in eleven loses her life.\nHere in the U.S., African American women are four times more likely to die from pregnancy\nrelated causes than Caucasian women -- and African American babies are twice as likely to die.\nWhen UNICEF released figures that showed infant mortality was ten times greater in\ndeveloping countries than in the developed ones -- there was a collective outcry. Yet maternal\nmortality is 150 to 200 times greater in our poorer nations than in our rich ones. And those\ndeaths are directly related to the high level of poverty and the low status of women in those\ncountries. That is a moral outrage, and must be recognized as such by every nation in the world.\nThe inequalities in access to health care are the most obvious -- such as who gets to have\na skilled practitioner by your side during childbirth. Only a third of the women in East Africa\nhave that luxury, while in most developed countries, it's a universal right.\nBut these conditions -- and these injustices are not just in our poor, developing\nnations. They exist here, in our own backyard -- in our nation's capital, and in inner city\nneighborhoods around the United States. Infant mortality here in DC is almost double that of the\nrest of the nation -- and worse than many developing countries. Poor access to health care, and\ninequalities in health and life expectancies, don't end at national boundaries -- or city limits.\nWomen everywhere lack basic services that could save their lives, and ensure their\nhealth. But more significantly, women and girls don't have equal access to the tools of\nopportunity that could transform their lives. Education is inextricably tied to how women and\nchildren achieve progress -- including better health. And the greatest literacy gaps existing in\nsuch places as Western Africa and south-Central Asia -- where there are also some of the highest\nrates of maternal deaths. It should come as no surprise that children of illiterate mothers are\ntwice as likely to die as those with educated mothers.\nBut women can't make progress in either their social or economic status unless they have\nother opportunities as well. For too long, women have been denied the opportunities of jobs\nand credit, legal protections, and the right to participate fully in the political life of their countries\nall of which are the basic building blocks for a healthy and productive life.\nThree years ago, when I addressed the World Health Organization in Beijing, I said that\nwomen's rights are human rights, and human rights are women's rights. And I believe that now,\nmore than ever, it is a violation of human rights when women are denied skilled health workers\nduring child birth; that it is a violation of human rights when women are denied the right to plan\ntheir own families; that it is a violation of human rights when the leading cause of death\nworldwide for women between 14 and 44 is the violence they are subjected to in their own\nhomes; that it is a violation of human rights when women can't get the education they need to\nensure they and their children can lead healthy, productive, and engaged lives.\nAs long as these discriminations and inequities remain commonplace around the world,\nthen the potential of the human family to create a peaceful, prosperous, democratic world will not\nbe realized. But if we can apply the the force of international treaties and national constitutions\nthat address basic human rights to ensuring safe motherhood and healthy children -- and if we\ncan demand that governments address these underlying causes through political and legal\nremedies as well as imposed health initiatives -- then, and only then, will we fulfill the\nextraordinary promise of this time. Then, and only then, will every woman be treated with\ndignity and respect, and every child be loved and care for, and every family have a healthy and\nstrong future.\nI want to conclude my remarks this morning with story from my recent trip to Africa.\nThat trip was an extraordinary opportunity for me to see the flowers of progress and democracy\ntake root in even the smallest village, in even the poorest of countries. And wherever I went, I\nheard the women of Africa singing. They sang as they cared for their children, as they wove\ntheir baskets and shawls, as they turned shanties into homes, as they rebuilt their lives.\nIn Senegal, a group of women I met with from the Malicounda Biambara village, have\ndone something remarkable. They had decided that female genital mutilation -- considered a rite\nof passage for all girls -- had harmed their daughters' bodies and spirits for too long. It was time\nto end the hemorrhaging, and the infection, and the AIDS, and the childbirth complications\ncaused by this deadly tradition. And that's what they did.\nUsing a skit that they showed me, these women educated their religious leaders, their\nhusbands, and their neighbors. They banned the practice -- and are now inspiring others to do the\nsame. Just last month, 13 villages, representing 8,000 people, joined together to end genital\nmutilation in their communities. And now President Diouf has called for a new law to abolish it\nthroughout the country.\nWhen I asked one woman what drove her and the others to change such a deeply held,\nlong standing practice, she replied simply: \"We studied human rights, and particularly the right\nto health.\"\nThank you for this opportunity to join you on Women's Health Day, but most of all, for\nyour ongoing work to make safe motherhood a reality for every women and girl, in every nation\nof the world. For me, the story of these Senegalese women is the story of how much progress has\nbeen made in promoting the health and well being of women around the globe, and how far our\nmessages have traveled about the importance of women rights to open and democratic societies.\nBut it is also a stark reminder of how much work remains to be done. I thank you for your\naccomplishments on behalf of women and children around the world -- but I thank you more for\nthe work that you will do in the months and years ahead to ensure safe motherhood is a universal\nhuman right.\nJUDY MANN\nSafe Motherhood: A First Step in Development\nT\nwo significant shifts have occurred in\nthe third involves the quality, availability and\ninternational development efforts.\nsustainability of basic health services; and the\nThe first is an agreement reached by\nfourth, the core circle, holds maternal health\nmajor funders and nongovernmental\nservices.\norganizations that women are at the center of the\nThese were patterns that emerged during\ndevelopment process.\nsuccessful efforts in Malaysia, where women do\nAs World Bank President James Wolfensohn\nnot have legal barriers, according to Datin Seri Dr.\nput it as part of his remarks during the World\nSiti Hasmah, its first lady, who spoke at the\nBank conference on Safe Motherhood this week:\nconference. Taboos were overcome, and family\n\"If you educate a woman, you educate a woman\nplanning has been stressed during the past decade.\nand a family. If you educate a man, you educate a\nToday more than 95 percent of women seek and\nman.\"\nreceive pre- and post-natal care, and 95 percent\nThe second shift has occurred in the capital flow\nhad births that were assisted by trained personnel.\ninto developing countries. Aid from donor nations\nIn another address, Crispus Kiyonga, minister\nfell from $40 billion to $37 billion from 1996 to\nof health in Uganda, noted its successes in\n1997, as developed countries tightened budgets\nincreasing contraception use.\nand cooled to the strategic importance of\nHe also made the point that the Ugandan\ninternational development now that the Cold War\nparliament has 50 female members, that the vice\nhas ended. The biggest players now are\npresident is a woman and that there are several\nprivate-sector companies, whose investments\nwomen in the cabinet. After the country started to\nwent from $247 billion in 1996 to $256 billion last\npull itself together in 1986, he said, there was \"a\nyear.\ndeliberate political decision\" to encourage women\nWolfensohn made it clear that important\nto become involved in the power structure, and\nplayers in the private sector have joined a 10-year\nthe women's vote since then has become\npartnership of governmental and nongovernment\nparticularly influential.\nagencies. Among them are Merck & Co.\nHillary Rodham Clinton told a wonderful story\npharmaceuticals, which has donated Invermectin,\nfrom her recent trip to Africa. The women of a\na drug that Wolfensohn says \"has all but\nvillage in Senegal had joined together to ban\neradicated\" river blindness in Africa, and Johnson\nfemale circumcision. \"They have decided that\n& Johnson, which recently announced\nfemale circumcision, considered a rite of passage\ndistribution of a drug that fights parasites\nfor all girls, had harmed their daughters' bodies\ncommon in Central America.\nand spirits for too long,\" she said. \"It was time to\nWhat remains lacking is a fundamental political\nend the hemorrhaging, and the infection, and the\nwill in many of these countries to make the health\nAIDS, and the childbirth complications caused by\nof girls and women central to development\nthis deadly tradition.\nplanning. \"People don't care,\" he said. \"As I travel\n\"Using a skit that they showed me, these\naround talking to ministers, conversations about\nwomen educated their religious leaders, their\nhealth and safe motherhood are very rare.\"\nhusbands and their neighbors. And as a result,\nDespite a decade of international efforts by such\nthey have banned the practice of female\ngroups as UNICEF. the World Health\ncircumcision in their village, and now in 13 other\nOrganization, the World Bank, the U.S. Agency\nvillages as well.\nfor International Development. the International\n\"When I asked one of the women in this small\nPlanned Parenthood Federation and the\nvillage what had driven her and others to try to\nPopulation Council, maternal mortality is now\nend such a long-standing cultural practice, she\nestimated at between 585,000 and 600,000 a year,\nreplied simply: We studied human rights, and\nan increase from earlier estimates, which were\nparticularly the right to health.\nprobably unreliable. Current estimates are\nWhat is so clear from that story is that the lofty\nprobably not all that good either, though, since\nconcept of women's rights being human rights-\nmany rural deaths are never officially reported.\nwhich Clinton articulated in a shot heard round\nMotherhood has been made safe in some places\nthe world at the U.N. conference on women held in\nbut not others, said Richard Feachem, who directs\nBeijing in 1995-has reached the women in\nthe health, nutrition and population programs at\nremote villages, the women who need this\nthe World Bank. During the decade-long\nassurance the most.\npartnership, he said, \"we've learned a lot.\"\nWhat was also clear from this week's conference\nHe urged the representatives of organizations\nis that some of the most important voices and\ninvolved in the Safe Motherhood effort to think\ninstitutions in the world of development are\nabout the objectives as four concentric circles: The\ncommitted to ending the scourge of maternal\nouter one involves the empowerment of women in\ndeaths from unsafe abortions, lack of family\ntheir families, villages and governments; the\nplanning, infections, obstructed delivery and other\nsecond one holds the development process in\navoidable causes. Whether the resources will be\ngeneral, the establishment of a country's\nthere wasn't clear, but they certainly should be.\ninfrastructure, housing, clean water, sanitation;\nThis is an effort whose time is way overdue.\nThe Washington Post\nFRIDAY, APRIL 10, 1998\nTHE KELIAKLE SOOKCE\nBy Ann Gerhart and Annie Groer\nFour Lovebirds\nAre Having\nA Ball\nA\nh, spring. Ah, romance. Love was\nmuch in the air at Wednesday night's\ncocktail kickoff for the Washington Opera\nBall.\nThe fete at Anderson House, off Du-\npont Circle, was for Sir Christopher Meyer,\nthe British ambassador, and his relatively\nrecent bride, Lady Catherine, who wed on\nHalloween. The Meyers will host the June\n5 black tie fund-raiser at their Embassy\nRow home.\n\"I think this ball may be specially\nblessed because helping run it are two\nsets of newlyweds,' Ambassador Meyer\ntold some 200 opera lovers, including en-\nBY 10M\nPatrick Ewing \"in the paint\" with 10-year-old Pernell Dongmo.\nvoys from the 35 nations who will host\npre-ball dinners.\nWhile much of social Washington has\nKnicks Star Patrick Ewing Paints the Town\nmet the Meyers, many at this soiree got\nThere was plenty of dribbling\nand his own book, \"In the Paint\ntheir first glimpse of another pair of love-\ngoing on when Patrick Ewing visited\nWith Patrick,\" a work-in-progress\nbirds: the opera ball general chairman for-\nthe National Museum of American\nfor young artists and their parents.\nmerly known as Betty Knight Scripps and\nMARK FINKENSTATOR OR THE WASHINGTON POST\nArt yesterday, but it involved\nmy mom and dad didn't\nher new husband, investment banker lere-\nPlacido Domingo, in back, shares a laugh with the giddy British ambassador and his wife.\npaint, not a basketball.\nencourage me, I probably would\nmy Harvey.\nThe New York Knicks center,\nhave stopped,\" said the\n\"I don't know if should introduce her\nAnd, perhaps, never so busy. Since\nAnd what might be the secret to such\nwho majored in fine arts while a\nseven-footer, who started drawing\nas Betty, Elizabeth or Mrs. Jeremy Har-\ntheir Valentine's Day marriage in the Do\nbliss (beyond the obvious means to pay\nbasketball phenom at Georgetown\nas a kid in Jamaica.\nvey,\" said artistic director Placido Domingo.\nminican Republic, they 've honeymooned\nfor it)?\nUniversity, was back in town for a\nEwing, his right wrist wrapped\nFor the record, and for the moment,\nin Hawaii and visited London (Harvey is a\n\"We're both brats,\" Harvey said, noting\n\"painting party\" with students\nin a blue bandage from a Dec. 20\nshe's Elizabeth Scripps-Harvey and semi-\nBrit). They're booked on an African safari\nthat they're only children with much in\nfrom the District's Thompson\ninjury, confessed it had been a long\ngiddy.\nin May, and after the ball it's back to Brit-\ncommon. \"Tonight we are trying to be\nElementary School, reports The\ntime since he was in a museum:\n\"It's wonderful. I've never been so in\nain to see the races at Ascot, tennis at.\ngrown up, but most days we're\nPost's Sylvia Randall.\n\"I'm not really able to enjoy it, he\nlove in my life,\" she told The Post's Rox-\nWimbledon and maybe rowing at Henley\nsomewhere between 11 and 13 years old.\nEwing plugged the museum\nsaid. \"I'd be considered one of the\nanne Roberts.\nbefore a rest in the South of France.\nIt's amazing fun.\"\nexhibit \"Time Out! Sports in Art\"\nartworks\" by fans.\nNOWYOU RNOW....\nAnd now, a multi-culti roundup\nthey also drew some jocks, includ\nOpera legend Luclano Pavarotti\ning Redskins Gus Frerotte and Dan\nThe Washington Post\nwill perform with the Spice Girls, Cel.\nTurk, as well as Baltimore Ravens\nine Dion, Jon Bon Jovi, Stevie Wonder,\nquarterback Jim Harbaugh and a\nNatalie Cole and Trisha Yearwood at a\nclutch of D.C. United players.\nFRIDAY, APRIL 10, 1998\nbenefit concert for Liberian chil-\nPresident and Mrs. Clinton attend\ndren, Reuters reports.\ned a Wednesday night salute to phi-\nThe June 9 concert for kids af-\nlanthropist Paul Mellon and his late\nfected by a decade of civil war is the\nfather, Andrew Mellon, who helped\nthird annual benefit for the Pava-\nbuild the National Gallery of Art.\nrolti & Friends Liberian Children's\nClinton first came to the museum\nVillage. It will be held in his home-\nas a Georgetown University stu-\ntown of Modena, Italy.\ndent 30 years ago, and returned as\n.\nHootie & the Blowfish had lots of\nArkansas governor by playing\nlamily and friends to cheer them on\nhooky from National Governors\nat the Bayou Wednesday night. But\nAssociation meetings here."
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