SPEECH BY HER EXCELLENCY MRS.

JOYCE BANDA PRESIDENT OF THE REPUBLIC OF MALAWI ON RETURNS ON INVESTMENTS OF MATERNAL HEALTH: FAMILY PLANNING 202 AND THE CAMPAIGN FOR ACCELERATED REDUCTION OF MATERNAL MORTALITY IN AFRICA-CARMMA DURING TICAD V, YOKOHAMA, JAPAN SATURDAY, 1ST JUNE, 2013 1

 Chairperson Your Excellencies Distinguished Ladies and Gentlemen

I feel greatly honored and privileged to give a key note address on the Returns on investments in maternal health: Family Planning 2020 and the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA). I wish to thank the co-organizers of this very important meeting for giving major attention to issues of maternal health in Africa.

Your Excellencies, Ladies and Gentlemen Since the founding of CARMMA in May 2009, 38 African states have launched the campaign in Africa to date. The

campaign

has

attracted

very

high

level

political This has

commitment at national and regional levels.

given more visibility to issues of maternal, new born and child health as governments, communities and private sector took ownership of the programmes as they participated in the social mobilization and implementation of projects.

In

operationalising

the

Campaign

for

Accelerated

Reduction of Maternal Mortality in Africa many countries continue to implement evidence based, cost-effective and high impact interventions to ensure that No woman dies while giving life. It is important to note that improvements in Maternal, newborn and child health are critical to overall development of nations. A huge body of research work and general experience have shown quite remarkable

results of tangible returns on investment in maternal health which are far reaching.

Excellencies, Ladies and Gentlemen As a mother myself, I think how easily: it could have been me to have died when on 23 rd January 1984, I was lucky I was saved from post partum hemorrhage that I suffered during one of my deliveries. This was only because qualified doctor was available to me. However, so many women in Africa are not as lucky as I was. In many of our communities in Africa, when a woman gets pregnant, almost everyone is anxious: anxious because they have seen so many women die while giving birth. And yet in some societies, mostly in developed countries, when a woman is pregnant, she and her family celebrate and are truly expectant - expectant that she will deliver safely, expectant for the child she will deliver. This should not be the case. We need to eliminate these injustices to

our women in Africa. African women are entitled to enjoy their full reproductive health life. Excellencies, Ladies and Gentlemen I am pleased to inform you that when the Campaign for Accelerated Reduction of Maternal Mortality in Africa was launched in May 2009, Malawi was one of the 8 countries that were selected to spearhead this effort. I was honored to serve as Malawis Goodwill Ambassador for safe motherhood under the CARMMA Initiative. Because we believe in the value of CARMMA, we launched it at both national and district levels. We pledged our full support to CARMMAs agenda of accelerating actions to reduce maternal and associated infant mortality; mobilizing political commitment and support of key stakeholders and communities for additional resources and involvement, and building on tested best practices.

Excellencies, Ladies and Gentlemen I believe that in order to adequately reduce maternal mortality, it is essential to address poverty and gender 5

inequality, which together affect the demand for, utilization and supply of maternal healthcare services.

There is a critical link between population change and economic growth. In most countries, falling fertility rates have led to expanding working-adult populations and a smaller proportion of dependent children. Educated girls lead demographic change. An educated girl marries later and has fewer children. She seeks medical care sooner for self and children and thereby increases the probability of her childrens survival. She is likely to improve her childrens learning and education as a result reduces overall fertility rates. The economic and social impact can be transformative. Family planning can play an important role in facilitating economic growth.

Excellencies, Ladies and Gentlemen While it is critical for policies and programs to improve and expand services, as well as reduce the burden of cost for low-income women, these actions per see may not be sufficient to guarantee adequate returns on investments in maternal health care. disappointing progress Evidence has shown that the made toward Millennium

Development Goal 5 could be due to the failure of programs to take a comprehensive approach to the health of poor mothers. It is important that womens needs, aspirations and realities become central drivers of policies and programs to increase maternal healthcare access and utilization. Women must be empowered and have to be actively involved in all decisions related to their health and well-being. As I have said many times before in different forums, we cannot talk about empowering a particular

group without involving the group itself. should be made about women

No decisions women

without

involvement. Equally, no decisions should be made about the girl child without her involvement in the processes. Therefore, Excellencies, Ladies and Gentlemen, the message that I bring to you here and now is that nothing for us without us. Nothing for women without their involvement and inclusion.

We need to make deliberate efforts and policies that will aim at eliminating the structural barriers posed by poverty and gender inequality in economic empowerment of women. Such efforts will have a meaningful impact on maternal mortality, while creating the opportunity for real and long-lasting improvement in womens health and overall well-being.

Your Excellencies, Ladies and Gentlemen Since I took over Government in Malawi, we have made considerable progress. Key health indicators are showing a tremendous improvement, our Maternal Mortality ratio was at 675 per 100,000 live births (DHS 2010) and UN Estimates 2012 puts Malawi at 460 per 100,000 live births. Infant Mortality has declined from 72 per 1000 live births in 2004 to 66 per 1000 live births in 2010 (DHS)

As a country, we are convinced that we must invest in our people especially women taking advantage of the demographic dividend of our large numbers of women in the country. Accordingly, as women constitute the bulk of our respective population particularly in Africa, no realistic and sustainable economic growth, be it in GDP variable or in any indicator, will be registered if women are not part of

the growth and development equation and processes. As women provide the bulk of the labour force in the agriculture sector which is the hub of many African economies as well as those of many other third world countries no meaningful growth and development will be achieved if maternal problems and challenges remain unaddressed. Maternal health is one of the serious problems affecting women. Suffice therefore to say that maternal health remains one of the main challenges to realize sustainable economic development.

Your Excellencies, Ladies and Gentlemen We believe if we invest in health, especially womens health, education, and skills building, we can use this people power to transform Malawi into a medium income country.

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Malawi launched CARMMA in August 2009 and as a country we have learnt and implemented many innovative ways for the campaign. We have made sure that there is broad ownership of the campaign including private sector, traditional leadership and the local health workers.

We have been able to mobilize equipments, supplies and financial resources from the private sector for use in maternity units and training for local health workers.

From an advocacy point of view, we have taken on board both technical and traditional structures and systems in our programmes. The establishment of the Chiefs Committees has helped us sensitize communities on sexual reproductive health services and encouraged pregnant women to seek services at hospitals and clinics.

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To support this demand, we are mobilizing resources to build waiting homes for pregnant women that live far from health facilities. This will enable them to come and await labour closer to the hospital just after the eighth month of pregnancy. In this regard many of the pregnant women can have their deliveries handled by a skilled birth attendant.

Currently, 200 young women, from 20 districts across the country have been recruited through their Chiefs for an 18 months community midwifery training program. Upon graduation, the community midwives will be bonded and work for their respective communities for five years. The aim is to ensure that mothers do not travel long distances to seek maternal health care services thereby averting possible pregnancy complications.

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To further rally and galvanize our efforts and to demonstrate my governments commitment to the cause, I launched a Presidential Initiative on Maternal Health and Safe Motherhood with emphasis on reducing maternal mortality, improving girls education, promoting women rights and empowerment and championing family planning programmes. As already alluded to, a committee of chiefs facilitates advocacy and implementation of safe

motherhood initiatives at community level.

Government has decided to allocate enough resources to safe motherhood to ensure that these efforts are sustained so that our mothers should not die while giving birth.

Excellencies, Ladies and Gentlemen

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My recommendation is that globally there are strategies we should implement to ensure that women attain enjoy maternal health and full reproductive rights; and are at the centre of our economies. These strategies include: 1. Develop policies and programmes that bring incomes into household so that children are not considered as wealth for families. 2. Invest to support education for the girl child so that girls can complete primary, secondary and tertiary education, especially in Africa and Asia. This is critical in families where they have no reliable incomes. 3. Promote the involvement of traditional leaders as custodian of culture and traditions. Traditional leaders enjoy power and influence in society and we can redirect this influence to positive energies. 4. Engage and involve male folks in family planning and maternal health programmes because of patriarchal societies and attitudes.

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5. Provide economic empowerment as this leads to social emancipation. This among other things empowers women to make informed decisions that affect them including political participation, reproductive rights and education of their children. 6. Establish institutional framework that will enable women and girls to sustain the achievements made. For example, we need support mechanism for Parliamentarians, Presidents, and women who have achieved various senior decision making positions that they do not drop out from their successes. Excellencies, Ladies and Gentlemen I am committed to seeing to it that the fight for maternal health succeeds. In this regard, I have just established a Mudzi Transformation Initiative where I want to

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modernise our villages and ensure that we stop a vicious cycle of underdevelopment and poverty. To realize this, we must invest in the village where our people are.

With this Village Transformation Initiative, I see a village with a clinic. I see a village with clean water. I see a village with a modern school. I see a village with a micro-finance bank. I see majority of my people becoming financial citizens.

Excellencies, Ladies and Gentlemen If we cannot uplift this village woman to earn decent income in the household, the vicious cycle of population growth, malnutrion, maternal health and poverty will remain with us. If the Family Planning 2020 has to realise its dream of reaching additional 120 million women more

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by 2020, we need to go to the grassroot where these women are. If the Family Planning Summit of July 2012 in London has to bear fruit, we need to engage the women where they are. If we have to address the core values of poverty and human security, we need to be where the people are. We must go to the village of Africa and there uplift our people.

Excellencies, Ladies and Gentlemen I am a victim of these challenges and therefore I will not rest until this campaign for Accelerated Reduction of Maternal Mortality in Africa-CARMMA has been achieved. In this, I am very grateful to our partners UNFP, Melinda Gates and many others for helping us on this journey to realize maternal health for all our people.

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Excellencies, Ladies and Gentlemen I therefore urge you all: governments, non-governmental organizations, and private sector and development partners to ensure that womens rights and womens health are accorded the priority they deserve. We all need to reinforce our commitments to accelerating reduction of Maternal Mortality in Africa so that no woman should die while giving life. Finally, Excellencies, Ladies and Gentlemen, I salute the Ministry of Foreign Affairs of Japan, UNFPA, the African Union Commission, the Asian Population and Development Association, the International Planned

Parenthood Federation and the Japanese Organization for International Cooperation on Family Planning for

organizing this symposium. It is my hope that more

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resources for maternal health and family planning will be mobilized to save the needy women of the continents especially Africa.

I thank you all for your attention.

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