By Liz Ford, The Guardian
World Bank says maternal mortality lower in countries where girls complete primary school and women become MPs, but bemoans lack of data on reproductive health
Lack of reliable data is hampering progress on improving reproductive health services for women and “must be seriously addressed” at global and national levels, according to the World Bank.
The bank’s report, Investing in women’s reproductive health: closing the deadly gap between what we know and what we do, launched at the Women Deliver conference in Kuala Lumpur, outlines the health, social and economic benefits of improving women’s reproductive care, but says insufficient data makes it difficult to monitor progress and improve services.
“The lack of data constrains our understanding and possibilities for holding ourselves to account for results,” says the report. “Because only a third of countries have complete civil registration systems, our ability to understand the burden of disease associated with maternal mortality is limited.
“Without such systems, too much energy is spent on the estimation, and debating estimates, of mortality than actually addressing the problems and monitoring progress. … There needs to be much greater investment in collecting accurate and timely data on reproductive health.”
Jeni Klugman, director of gender and development at the World Bank and co-author of the report, said 64 of the 75 countries with the worst maternal mortality rates do not have sufficient data on reproductive healthcare.
Awareness of the infrequency and imprecision of measurements around many key development indicators is rising as experts and policymakers turn towards discussions on what should follow the millennium development goals when they expire in 2015, and as groups lobby for issues to be included in any new set of targets.
Addressing the reproductive health needs of women is a prerequisite to achieving gender equality, said the 28-page report, a follow-up to the 2012 World Development Report, which made the economic case for investing in women and pursuing gender equality. But, despite international commitments, progress has been slow and “remains a blight on global development”.
The report explains how improved reproductive health services can result in more women joining the labour force, improving their economic contribution to their families and society. It argues that countries in which more girls complete primary education and more women hold parliamentary seats had lower maternal mortality rates.
But it says a major constraint to progress in addressing health needs is a lack of women’s agency – the cultural, social and institutional discrimination that constrains women’s ability to make choices affecting their lives. In Papua New Guinea, three in 10 women cite lack of information as a main reason for not using contraceptives.
“Women disadvantaged by class, caste, location and ethnicity experience far worse reproductive health outcomes than other women,” says the report.
However, as with the World Development Report on gender, this document does not touch on the burden of household care that often disproportionately falls on women, which can undercut efforts to improve their economic and social empowerment. The report looks only briefly at the cost of a woman’s death from pregnancy or labour on family members, specifically girls who often have to take on more household chores.
The report also fails to mention women’s reproductive health rights. “Core to women’s agency are human rights,” said Luisa Cabal, vice-president of programmes at the New York-based Center for Reproductive Rights.
“I’ve been in too many forums already where there is no talk about rights. This term makes governments nervous. Many multilateral institutions don’t feel comfortable using it. But what is behind ‘women’s agency’? It’s a powerful concept but let’s not forget about rights.”
Cabal questions the report’s light touch when it comes to looking at accountability. It discusses local and community mechanisms to educate people, but does not mention the importance of holding national governments to account over the laws they pass, and even taking them to court.
“We should not shy away from talking about that,” said Cabal. “Accountability means sometimes collaborating with governments, working with parliament to pass reforms and implement policy, but when there is no movement, we take them to court.”
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