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Demanding Accountability: Key for Continuing Gains in Maternal Health

I’m really pleased to hear discussion here in Delhi at the Global Maternal Health Conference about our collective accountability. For the past several decades, we have lamented the fact that half a million women’s lives were lost every year to pregnancy-related causes.  We now know, however, that our work has, in fact, resulted in fewer women dying or being disabled during pregnancy.

Maternal health successes have reenergized the global health community; this newfound energy presents an opportunity we cannot afford to waste. This opportunity has been further enhanced by newfound focus and, we hope, more resources committed to support women and girls.

We are accountable, we must be held responsible, we must respond to this opportunity by supporting communities to ensure that all women can choose if and when to get pregnant, and to safely carry a pregnancy and give birth.

I’d like to echo thoughts I heard here at the conference from Lynn Freedman, director of the Averting Maternal Death and Disability Program and of the Law and Policy Project at Columbia University.  Freedman described accountability as “a critical technical area for public health with three key elements to consider: transparency, answerability, and enforceability. “Developing programs and systems that encompass all three elements will be crucial to building on current progress. Helena Hofbauer, the partnership development manager at the International Budget Partnership, spoke about the need to address accountability at the local level, and Sigrun Møgeda, the Norwegian HIV/AIDS Ambassador, reminded us that “the global must serve the local.” This discussion prompted many questions in my mind.

How will we deal with such a sensitive issue in a way that our collective effort and great intended aim do not backfire?  How can we advocate for additional resources and commit to ensuring that they reach those most in need in the most cost-effective ways?  How do we champion our local maternal health champions and activists and the precious gains they have made? What groups or individuals are best equipped to take on this delicate advocacy task? How do we work effectively in countries where there are fragile or non-existent democracies?

And, for me, the biggest question:  what is the role of the health worker in holding governments, organizations like IntraHealth, and programs accountable for using resources wisely to save women’s lives?  How can we better prepare and equip health workers to advocate for themselves, their patients, and improvements in the health system?

Improving women’s lives and health and creating an environment that provides comprehensive reproductive health services and supports healthy pregnancies and births is both an individual and collective responsibility.  It is one we must be held accountable for in a systematic way if we are to see substantial improvements for this and future generations.