Moving beyond the Millennium Development Goals

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The United Nations flag flies outside its New York headquarters. US Aid Images under a Creative Commons Licence

The new framework for international development may be the biggest opportunity for positive global change in our lifetimes – but it could be about to become a missed opportunity.

Last month, the United Nations held a meeting to assess progress towards achieving the Millennium Development Goals, and to chart the way forward after they expire in 2015. Both the outcome of this meeting and the High Level Panel report published earlier this year have laudable aims, but so far lack the substance to make them reality.

The positive outcomes so far are commitments to one process and a universal set of goals, an integrated approach, and a focus on sustainable development and human rights. But there is a distinct lack of ambition or new ideas on either how to maximize the fulfilment of the Millennium Development Goals in their last 15 months, or how to move beyond them in a new framework.

Especially worrying is the lack of concrete measures to explicitly address inequality – instead, we have the wholly inadequate desire to ‘leave no-one behind’. This suggests that we’re all on the same journey towards growth and prosperity and it’s only a case of making sure everyone’s on board.

In reality, reducing inequality is the key to leaving no-one behind. We live in a world of finite resources: the more the minority has, the less the majority has. Over the last 15 years inequality has been growing at an alarming rate; today the wealthiest 0.1 per cent of people own approximately 81 per cent of the world’s wealth. Reversing this trend, therefore, is vital if we are to truly leave no-one behind. And it requires a genuine commitment to a different way of doing development – one that recognizes and seeks to address the root causes of poverty and inequality.  

Yet tackling inequality is conspicuously absent from the meeting’s Outcome Document, and the report released earlier this year lacks a goal on reducing inequality. To put it starkly, the global structures that sustain inequality will not be challenged by the new framework. 

This failure to recognize that the structures – social, economic and cultural – that shape and define who is poor and excluded need to be addressed is not a minor problem in a report with no impact. It could mean the difference between billions more people living healthier, happier lives, or not.

Sarah Edwards is Head of Policy and Campaigns at Health Poverty Action

Intimidation, discrimination – the healthcare reality for indigenous mothers

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Mothers and their children, Peru. © Health Poverty Action

When Ana Luisa went to give birth at a clinic in Ayacucho, Peru, she was assigned a midwife who did not speak her native Quechan. She felt too intimidated to stay at the clinic and gave birth on the roadside on the way home.

Stories like this are not uncommon, and often end in tragedy. Every year approximately 287,000 women die before, during or just after childbirth; 99 per cent of those women are in developing countries.

Improving maternal mortality has been one of the more successful Millennium Development Goals. Maternal deaths have nearly halved since 1990, and many regions have made real progress in cutting these preventable deaths. However, indigenous women like Ana Luisa are excluded from this success story. The positive data masks the experiences of these mothers.

In being poor, female and from a minority, indigenous women face many layers of discrimination and many barriers to good health. They often lack access to health centres due to high fees and long distances to travel. Those indigenous women who do attempt to access healthcare may be intimidated, face discrimination or have difficulty communicating due to a language barrier. This means they are far more likely to die or face complications related to pregnancy. In the few places where we have the information, mortality rates can be twice as high in indigenous communities as the national averages.

A culturally appropriate delivery room, Peru.

Culturally appropriate health services (such as the delivery room pictured) make a huge difference. Women like Ana Luisa in rural Ayacucho in Peru faced some of the country’s highest maternal death rates. But then, after years of campaigning, health centres began to adapt and consider indigenous culture. They made provisions so that women in labour could squat and hold on to a rope rather than lie down, as indigenous women were used to, and they began hiring and training staff to speak the local language. The number of women using the clinics soared from only six per cent in 1999 to 83 per cent in 2007.

But we need to improve things for indigenous women on a larger scale, and to do this it is crucial that we get an accurate picture of the problems to be tackled. We must disaggregate data, and break it down by ethnicity as well as age and gender. This would allow us to understand how the experiences of indigenous and marginalized people are differing from the rest of the population. It would expose some of the inequities beneath the apparently good news story of the Millennium Development Goals by showing the reality for those at the edges of society. And it would enable the development of tailored solutions, like those found in rural Peru.

Indigenous women often lack a voice and this manifests itself in different ways – from being able to make decisions about their own health or about spending money, to having a political voice at the local, national or global level. Allowing the stories of indigenous women to be reflected in the data that is collected about development would allow their voices to be heard and therefore be a vital step in improving women’s health.

Sarah Edwards is Head of Policy and Campaigns at Health Poverty Action. Health Poverty Action has launched a report on breaking down health data by ethnicity, click here to read it.

9 August is the International Day of the World’s Indigenous Peoples

Photos: Health Poverty Action