Millennium Development Goal 5 (MDG 5) Target 5a, to reduce the 1990 Maternal Mortality Ratio (MMR) by three quarters by 2015, has seen the least progress of all the MDG targets. Universal access to reproductive health, the second MDG 5 Target (5b), which is essential for the reduction of maternal mortality is seriously undermined by the large unmet need for family planning, especially in Sub‐Saharan Africa, where one in four married women and countless adolescents do not have access to contraceptives
DFID and NORAD jointly commissioned this review of global evidence upon which to draw when advising their respective governments on the best strategies to support the delivery of the Consensus outcomes, to which both Governments have committed in order to help secure the achievement of MDG 5. This paper includes evidence of what makes a difference, where this is known, what is good practice, what needs to improve and where we need further information to make a judgement.
The review is presented in five parts:
Part One restates the challenge and reviews progress against MDG 5 indicators, maternal mortality as an indicator of disparity and inequality, links to the other MDGs, aspects of maternal health not directly captured in an MDG target indicator, and examines the funding challenge.
Part Two examines evidence for improving maternal health care and services for MDG 5 using evidence based packages of care, including family planning, antenatal, safe abortion, intrapartum and postpartum care and care of the neonate. In addition, evidence is reviewed on strategies for intervention including the centrality of a continuum of integrated care, the role of new technologies for increasing access, the importance of context, and district level implementation.
Part Three focuses on the evidence supporting the need for and approaches to strengthening the health system from a supply perspective (with a focus on maternal health care) including: governance and political commitment, human resources for health, referral systems, infrastructure and essential equipment, drugs and supplies. This Part also reviews evidence concerning a range of financing mechanisms for health and examines the role of the private sector.
Part Four places maternal health care within the broader health framework. It reviews health systems from a demand perspective including strategies for increasing demand, demand‐side governance, citizen participation, and voice and accountability. It also examines evidence to inform the role and place of political will and advocacy in facilitating and driving the achievement of MDG 5 and the significance of social inclusion.
Part Five explores the ways in which key indicators and methodologies are used to track progress in maternal and reproductive health at national and international levels, considering their strengths and weaknesses. It also examines evidence on aid mechanisms by looking at the complex global aid architecture for health, the Global Health Initiatives (GHI) that have emerged since the Millennium Declaration of 2000.
Options Consultancy Services Ltd, London, UK, 161 pp.