Lords, Members of Parliament, ladies and gentlemen

It is good to be here with so many like mind on World Population Day. I’m grateful to IPPF and the White Ribon Alliance for the opportunity to talk to so many passionate advocates for maternal health today.

As many of you know, I am patron of the White Ribbon Alliance for safe motherhood. In that role, I have committed myself to everything I can to make the Millennium Development Goal to reduce maternal mortality by 75%, a reality by 2015.

I did recognise what a task that was – to address an issue not even discussed at international meetings like the G8 before this year. Even so it has been a real eye-opener to me to discover just what a mighty effort is needed by everyone who cares enough to act to begin to make a difference. To make a difference that will change the outcomes for so many women and their families around the world.

The reason I – and so many others new to this issue over this past year – have been moved to act is simple. Women and mothers are at the heart of communities and yet to all our shame, we realise that – with figures unchanged for over 20 years – every minute across the developing world a woman dies during pregnancy and childbirth. Bringing tragedy and sorrow to families at a time that should be joyful – a time when new life is being brought into the world.

All of us know from our own experience that mothers are essential to the prospects of future generations. Mothers provide for their children, they make sure they get fed (often before they feed themselves), make sure their kids get their vaccinations and make sure they go to school. 

The great tragedy of maternal mortality is that it robs families of their mothers at precisely the moment when they are needed most. A mother’s death is like no other. A newborn that has lost its mother is ten times more likely to also perish. Surviving children grow up without their mother’s nurture and care.  Families are left impoverished.

The great opportunity is that nearly all of the world’s maternal deaths are preventable. And the world has already committed to reducing maternal mortality in Millennium Development Goal 5. 

The great shame is that despite this – overall – precious little progress has been made.

It is clear that something different must now be done. National agencies, NGOs, faith organizations, organizations of doctors, nurses and midwives, grassroots members of the White Ribbon Alliance all stand ready to make the difference.

Political will is the missing ingredient we need to end the shame of maternal death. We do not need to find or invent a cure.

Clinicians and other experts throughout the international community and women themselves can already tell us what needs to happen to reduce maternal mortality. Mothers and their newborns live when they receive vital but basic health care from a skilled health worker during pregnancy and childbirth. Mothers also afford themselves better life chances when they have available to them an education, and access to health education and family planning options to better inform themselves. So to my mind, if we already know what to do, then the obvious thing would be simply to do it.

Over the past months since the Women Deliver conference, the White Ribbon Alliance has convened a different kind of campaign – the maternal mortality campaign: promise to mothers.

This year’s campaign brings together such a powerful coalition of governments, NGOs and the private sector to call for increased investment in maternal health, increased numbers of health workers and recognition that measuring maternal mortality is on of the best ways of measuring the success of a health system.

Some of the campaign’s partners have campaigned tirelessly on issues of maternal health for decades. Others come to it new. Some of the campaign’s supporters are clinical experts in their fields. Others are expert at influencing popular opinion or – like me – simply creating lots of noise exactly where it needs to be heard.

It is my firm belief that by brining together a different and growing mix of voices, we have the best chance of creating a breakthrough on an issue that has often been silent. I also believe that, in this way, every one of us can play our part in creating the political momentum we so desperately need.

It is working – slowly. The campaign is already succeeding in changing the minds of, often male, presidents and prime ministers who are beginning to place unprecedented political priority on an issue that they have previously not discussed.

In the last month, EU members have pledged increased funding to ensure 35 million more births are attended by skilled personnel by 2010 and AU members, under the chair of president Kikwete of Tanzania, have agreed to intensify their efforts to measure and improve maternal and infant health.

I have just returned from the G8 in Japan where leaders agreed a package on health that will help train and recruit 1.5 million health workers in Africa and ensure 80% of mothers are accompanied in childbirth by a trained health worker. This includes an important commitment to scale up to 2.3 health workers per 1000 of the population in 36 African countries experiencing a critical shortage.

Providing health workers is essential and I welcome the world leaders’ growing appetite to meet the crippling health worker gap faced by many poor countries. Common to every country that has dramatically cut maternal mortality rates is the political will to increase the numbers of skilled health workers and the political will to improve improve women’s ability to access them.

Grassroots organizations like the White Ribbon Alliance do an extraordinary job in helping to inform women in villages and slums of their right to life saving health care. They work out simple solutions with local communities to help make sure women can get to a clinic in time to deliver their baby with a skilled health worker.

But even when women are empowered and health workers exist, health care is often beyond the reach of millions of pregnant women. This is because the cost of fees, transport and disposables – like latex gloves, cotton wool and medicines - is ruinous.
If you have less than a dollar a day to spend, are you going to spend it on a child not yet born or feed the hungry children you already have? When the cost of delivering in a hospital comes to a quarter of a person’s annual income and a complicated delivery can cost ten times more, you can see the terrible decision families face.

In Burundi, mothers and their babies were routinely imprisoned in hospital following delivery because women and their families were unable to pay the hospital fees.

In December 2005, the president freed all those imprisoned and in May 2006, abolished all health service fees for pregnant women and young children. Within three months, the number of deliveries taking place in hospital had risen by 60% and the number of caesarean sections had nearly doubled. 

This popular political initiative has now kick-started health care reforms so that additional health workers, medicines and infrastructure will be in place to meet the increased demand.

Such successes are spurring other countries to follow suit.

In May this year, president John Kufour announced that pregnant women who attend public hospitals nationwide will now receive free medical care in Ghana.

Providing free health care for pregnant women seems to be an effective and simple step countries can take to tackle high maternal mortality. Ghana joins a growing list of African countries that have successfully made health care free for pregnant women including Kenya, Lesotho, Liberia, Malawi, Niger, Senegal, South Africa, Tanzania, Uganda and Zambia. In Asia, Nepal is actively considering adopting the same policy.

Each country will, of course, take its own precise course of action. But the basic need is the same – attention must now turn to building a growing commitment to guarantee access to health care in developing countries and to ensure that developed countries stand ready to support.

The private sector and civil society also have a vital role to play. Governments cannot meet MDG5 alone. Non-governmental support is critical. I am especially proud of the commitment made by the world’s midwives and obstetricians (through FIGO and the ICM) to be part of meeting the training need to increase skilled health worker numbers – which is essential to tackling maternal mortality.

An important moment to bring all our efforts together is coming up on 26the September when the UN is hosting a high-level event on the MDGs in New York.

This meeting will bring together governments from both developing and developed countries, leaders from the private sector, civil society and faith groups to unite and formulate plans that will accelerate action on all the Millennium Development Goals, including MDG5.

Beyond September our work must continue until MDG5 has been reached.

Change is possible – we do not need to live in a world where women fear for their own lives at the moment of giving life to others. But this change will not happen by itself.

All of us must play our parts in whatever way we can. For many of you here today that will mean continuing to advocate for changes, big and small, that help save women’s lives. For others it might mean raising the issue however best you can to help it shrug off the cloak of silence in which it has been shrouded for too long.

Many of us here today will have experienced the joy of pregnancy and family life. Let us be part of helping others to feel that same joy rather than fear. And let us be part of giving the next generation the most precious gift of all: the chance to grow up with their mothers.

Thank you.