Big Debate on Maternal Health

Big Debate on Maternal Health



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here at the United Nations world leaders met in 2000 and committed to eradicate extreme poverty and hunger by 2015 as part of those commitments known as the Millennium Development Goals they promised to reduce by 75 percent the number of mothers dying in childbirth 13 years later we are here in New York to review progress towards this target and to look for solutions join me for the big debate as we ask why are women still dying hello and welcome to the big debate MC game comedy each year over a quarter of a million women and over 3 million babies die from largely preventable causes related to pregnancy and childbirth and the situation is worst in poor countries where mothers are 15 times more likely to die than in richer countries but is it just a question of investing more resources or do culture and tradition also lead to maternal death well with me to discuss this are catherine hora the Minister of Health in Malawi anisole Islam Mohammed a member of parliament in Bangladesh and part of the ruling party's alliance Christian bar is development minister of Denmark Gita sin is professor in Bangalore India and here in the United States at the Harvard School of Public Health and Babatunde also ptomaine is executive director of the United Nations Population Fund or the unfpa and in our audience we have doctors health experts activists government ministers and other folk with a passion for maternal health welcome to you all and you can also make your voice heard in the debate send us your comments by SMS you can tweet us or post on our Facebook page before we ask why are women dying take a look at a forum called welcome to the world some viewers may find this forum disturbing every second of every day somewhere in the world a woman is being encouraged to push the result of all that pushing is that every year 130 million babies are born and 130 million mothers experience very special feelings of joy and love the opportunities available to these young lives will depend very much on where they are born fortunately for these twins they've been born in California Americans have a life expectancy of 78 years welcome to the world baby Rachel you are a citizen of Sierra Leone and you have a life expectancy of 49 years luckily your mother survived having you one in every eight women in this country dying childbirth cheer up surely you trust most likely though we can feel the future paths underneath underneath our skin abdominal layer so we'll have a better idea but we have to stabilize the first part I've been working 25 years in Africa I've seen this immense suffering of women and nobody seems to be doing much about it it's very difficult to do because you need trained obstetricians to do this kind of work it's very strenuous this woman who just come in with a uterus ruptures just 2 days of labor I don't have know where she's coming from I think she's coming from a very far off place had she known that after 6 or 7 now so she couldn't deliver she should have come to the hospital that's how did her life would not be in the danger they give some verbs like in the Hootie's who vomited lots and lots of little hubs even before we started the operation mr. szubin I want to make a team decision now we are going to operate her now he said all right with you you think your care at that ain't Yasuo you do understand that we could have a dinner table she could die right okay let's go hold it up yes sir baby the diagnosis is parity the baby was already macerated you two might have died at this before she arrived here sorry about this god sake no I want to finish this off very quickly she has got to survive this is worth nothing else with one you want her to survive huh I think we are going to cut the tubes and get the hell out of here do you understand thank you she'll have a story recovery associate will be very strong this patient has only about a 50% chance of surviving in do what you tell me we said just last night the doctor did all his bests once little and tonight she busts away Phil Katrin Hara Minister of Health in Malawi it is it's an emotional film yes it is in Malawi for every 100,000 births almost 500 women die we have made progress but we failing that 500 aren't we yes we are why what I think for Malawi the critical issue has been the age of the mother half of the women that are dying the 500 that we're talking about actually younger than 19 and it is because they are not economically empowered because they have not spent a lot of time in school they end up getting married early in the process they will die giving birth that's always saying that you know that that's the girls we're almost passing the buck what about government resources what are you doing and to ensure that when they do go to a clinic they will have a qualified health official looking after well in terms of government interventions actually intensified our campaign in encouraging the women to come and deliver at a health facilities but some of them the health facilities 20 30 kilometers away from them now by the time they get to the health facility some of them are already in serious complications because of access and because of the poverty that I talked about sometimes they don't even have the money to hire a simple vehicle to take them to the health facility – wilma hood from bangladesh you faced a similar problem and what katherine is talking about young girls falling pregnant in fact UNICEF says that 50% of girls in Bangladesh unmarried by age 15 it is true that some girls do get married below 18 in fact in our country the law is no girl can get married below 18 and if it is done then the parents are liable for criminal and one thing I can say today that in Bangladesh in 2000 we had 322 per 100,000 the mortalities and today a rate of 196 that means a reduction of about 40 percent and what I feel is that this type of death not only is the age is also the nutrition it is getting the right kind of treatment and in fact we have grassroot workers going out to the families and making them understand what that food they should be what their precautions you can do all of that right for the pregnant women but we need to stop young girls from falling pregnant in the first place we know that it were young women are four times more likely to die during childbirth so what are you doing to prevent the situation as I told you we have made it a criminal offense how many people have been arrested there have been er there has been arrested not only arrested sometimes there is there are preventive moves because the moment a social worker they come to know they inform the police and then the police intervenes let's bring you our Christian walk into this conversation in Denmark I think the statistic is 12 deaths per 100,000 births you put that next to the stats in Bangladesh it's 244 am not mistaken out of 100,000 and in Malawi it's about 400 196 no 196 is it 466 Oh 460 per 100,000 that's huge right you're a country that gives development aid are we forever going to have the sense that the lives of women in Africa are less worthwhile in the developing world are less worthwhile than the lives of women in the developed world each human being is equal and and these mothers can be saved and they can be saved by simple means some of them and it's Cohen sensor of Danish development policy to support women to decide how many kids they want when they want them with whom and also to have them in safe conditions but it's not just about resources in many right it's about their attitudes in the society that will help us change this no it is it's about the information as well I've been health clinics in in Kenya where they couldn't get the women into the clinic because the husband didn't allow them to go to and and of course there are cultural barriers and then you need to go out build awareness and tell the husbands that it's crucial for them and their families that these women can give birth safely at a health clinic Peterson as public health experts and as activists as well aren't you sometimes a little bit unrealistic you know it is a resources issue and there are cultural sensitivities that we have to be cognizant of what cultural sensitivity says that it's okay for something like that to happen if there is a culture that says that that's okay then I think we need to repudiate that culture that's not acceptable so what people don't understand when they keep talking about culture is that it keeps cascading we get the girl married but we don't send her to her husband's house immediately so she's married at 14 but we send her you know a couple of years later well she's still 16 when you send her so you know it's these kinds of things people sort of keep trying to put little barriers and say we're not doing anything too terrible here are we you know and but when you add it all up it adds up to the same thing or contraception is something even for married women and men after they've proven that they can bear children the girl has proven that she can bear a child well if she's 16 she shouldn't be doing that she needs contraception right away if that's a cultural barrier that needs to change right a Babatunde with the UNFPA one of the things that you've done is really to put at the center of the work that you do and the human rights of women and girls but how much can you really do from New York how what what changes can you really make in the lives of the woman that were watching on that video well UNFPA has a smaller pressure in New York they'd weigh in 150 countries working with governments civil society women's organizations youth organizations and we help governments and communities to mobilize themselves to prevent this sort of thing so we are not sitting here in New York and I believe one thing that I never said which I must say this is about the value we place on women we have to be very careful we have to have gender equality we have to have women valued just like men and they have to have their space and their rights and be able to exercise those rights after the break we're going to hear from someone who gives refuge to young women and girls who find themselves pregnant and helpless we also asked whether access to contraception is a key part of the solution to maternal mortality you're watching the big debate and welcome back to the big debate now every day 800 women die as a result of pregnancy or childbirth and many of them are young girls Neera die Goomba and lambda is the general secretary of the YWCA that's the young women's Christian Association which gives a refuge to some of these young women let's talk a little bit about the kinds of choices that yeah these young girls have I think first we need to be bored audacious and talk about what we are talking about here we are not talking about marriage marriage is supposed to be valued respectful we are talking about sexual exploitation of our girls we are talking about abuse we are talking about trafficking we are giving dignity to an unacceptable practice by calling it marriage we are giving dignity to my little daughter I think she's a bride which is a little girl who just needs to be in school we need to reshape the narrative to name what it is secondly the issue of resources I lead the world YWCA very community-based struggling every day to give these girls a little bit of dignity I challenge the leadership of this world Africa is not poorer Africa is very rich we can access the narrative of Africa and poverty we have to put the resources of Africa to invest in the daughters and sons of Africa for them to have the dignity the respect in to end child marriage we can invest in maternal health we just need to buy one helicopter less one we need to reduce military expenditure because these are political choices that our governments are making alright are we sugarcoating what this is as yards I say she's saying it's sexual exploitation let's call it what it is and only then we've got to be able to deal with it Adam looking at it at some girl child who has only enough money to God and finish primary school she's finishing primary school when she's 12 years old after that the parents cannot afford for her to go for her secondary education so indeed it is exploitation because there's somebody who come and marry this very young girl for me I totally agree whether I used to be a minister of health when I looked at the proportion of the budget of Nigeria that we spent on health it was pitiful we need to get our ministers of finance in this room let them understand that the future of the developing world of Africa depends on the young people they need education they need health and any country in Africa that is not spending 40 50 percent of his income on the education and the health of his people is not going anywhere I need to speak to the Minister of Health in Nigeria in Nigeria you're not exactly a poor country let's just be real bit if you look at the your maternal mortality it's actually gotten worse what 600 ampere 100,000 you are worse than a country poorer than yourselves that is Malawi maternal mortality rate is 350 still hypo is 350 per hundred thousand that's still hard is your heart no higher than Malawi but even if he's one single man to die just because she got pregnant I think what we just have to say that all of us are guilty even the women are guilty I've just been Minister for three years but I was a medical directors on years back and what intrigued me is that a woman comes just like what it showed us earlier on ruptured uterus and you think you need blood before you know it the man has appeared and you ask in the woman where's your heart I say never came here so I think those who have said that love really intermediated our women to an extent that the contravene speak for themselves are right do we make cannot speak for themselves for me the greatest thing we need is not necessary health care services but education education education that is the real power mentor women so a big part of this thing is dealing with those patriarchal and attitudes that you're talking about who's gonna educate that husband who ran away and intimidated his wife no way little kid you girl child she's going to be empowered she can't say no to her heavy voice you spend a lot of money as a country helping in areas such as this one how do you ever find it difficult to convince your taxpayers to give money for maternal mortality no because we are a country that recognizes that gender equality is at the core and that the value and what can you say the reason why were a prosperous country because I was raised by a mother who fought for two things she said economic empowerment of women and the second thing was that the woman should have the right to decide over her own body how many children she's going to have when she's going to have it and the access to safe abortion and that brought me up as to become a feminist and I'm a FEMINIST but in some of the countries that you are giving money to that is not the attitude so should you then not be putting conditions on you aid what we are we are investing in the future of our countries by investing in in the women of the countries by the the access to contraceptives that is one important issue because there are hundred millions women in there women in the world that don't have the kind of access to contraceptives as there will we invest in in the unfpa and in organizations working to talk about sex because you need to talk about sex to understand what kind of rights every woman should have because a girl of age of 15 should be in school and should not be the mother of the child and be married instantly contraceptives then and it's all in Bangladesh can a young girl have free and easy access to contraception not unmarried girls not unmarried girls it is the married girls they they have access though we are a Muslim country so you're saying that young girls who are unmarried cannot have access to contraceptives they don't have access to contraceptives that is because of there are conflicting ideas the one is the moment you allow them to have contraceptives okay when they are not married then it takes that the society is more or less condoning on it at the moment we don't have this problem of unwanted pregnancies who are not married there are I'm not saying that it is zero so we don't want to get into that problem by condoning it at this point of time the most important thing is what they have said is the economic empowerment of women the education you educate them you give them economic empowerment let me hear what kita sent thinks about this the access to contraceptives I mean always saying go ahead and have sex by handing our condoms and the Pope of course not people come to contraceptives because they've already decided they're gonna have sex you don't have the contraceptives and then decide oh now I've got a contraceptives let me go and have sex I think by not making contraception available all that we do is make it unavailable to those people who are actually going to have sex one way or the other a friend from English is quite right that in South Asia a lot of sex happens within marriage but increasingly there's a lot that doesn't the world is changing even in South Asia we're urbanizing at a very rapid rate ages age at marriage is going up dramatically my grandmother was married at the age of nine my mother at the age of fourteen and I was married at the age of 23 but I had my first child at 36 my one and only child my daughter is 27 and she says marriage MA now am I going to tell my 27 year old daughter excuse me you know you're not married I'll teach you about contraception after you get married and she's probably going to say oh come on ma I know all about it get lost so we need to get real in terms of the world in which we're living right now and the world in which we expect our young people to live and be themselves because this is the world all right when we return we ask whether the money and the political will is there to save women's lives you're watching the big debate and welcome back to the big debate on maternal health here in New York so let's talk now about political well let's talk about many let's talk resources and we have with us Samir you are with Action 8 if you could stand up for me the money is there I mean we were told a bit earlier Africa is not poor all right there's lots of money coming from aid lots of money coming from development we resource rich why are we not spending it on such an important issue I think that's right I mean I think work we need to connect the dots here you know where is the money in Nigeria it's an oil where is the money in Congo it's in diamonds and other resources who are to is taking that oil it's British companies it's European companies it's Norwegian companies and are they even I think the minimum they can do is actually follow the law and pay their tax but what is happening every year 300 billion dollars is lost to a combination of tax havens and tax incentives tax transfer pricing schemes and so on and the northern governments for all the big talk way back in 2009 we were told in the g20 that the era of tax havens is coming to an end well we're four years on we haven't seen the end of tax haven would the money be spent on maternal health it's indicated all right the money that's there now who's accountable for how that's spent absolutely so if we're talking about maternal health the real you know everyone knows and it's been brought up the issues are access to emergency obstetric care the issues are access to family planning contraception and so on and the issues are things like nutrition longer-term stability and so on this is a question of political will internally but it's hard for me to turn to a country like Malawi being one or even Nigeria even a rich country like Nigeria and say that look the tax to GDP ratio is so poor and security issues are real in that area of course they're security issues are very real so I can't say can you take some resources away from this and put it in this the resources need to be generated more and if you have a tax to GDP ratio that's so low it means that companies are stealing from you so let's ask them to stop stealing then let's talk about where to invest that money and invest the money in women invest the money in women rural women women farmers invest the money nutrition and invest the money in maternal health let's talk about this governor miracle of under state in Nigeria we'll be talking now about resources how much money Nigeria has and I understand that in your state in Nigeria you spending quite a lot of money on maternal and mortality in dealing dealing with this problem if you could stand and just let us know what you were doing thank you the issue of maternal mortality has been raised is so fundamental not just a moral issue is also an economic issue women are responsible for more than 80 percent of the food that we eat in Africa even the services that women provide at home is about 30 percent of GDP in Africa so it's what Mora is also economic number two political will is very critical I am the governor of his state a population of 4 million we about twice the size of Jamaica three times the size of Trinidad and Tobago when I came aboard and I told my folks we must track every pregnant woman from conception to delivery let's remove them from Statistics to our leaders pregnant woman I do statistics let's give them fresh and blood and we put in place tracking mechanism using cell phone already starred women we're giving cell phone they we are assigned to help paramedics who visited them at home we give them access transportation we use 4×4 vehicles we used tricycles we use motorcycles though the issue have not been able to access it was not arrived and we said that access must be completely innovation we must break down financial barrier to access because it is so fundamental don't talk about money it's about organizing our health services deploy resources efficiently we have been able to reduce the care of a pregnant woman from conception to delivery it add in a vaginal delivery of caesarean section blood transfusion everything together $30 by the time I give the medical director of my hospitals if I give you $300 I'm expecting 10 live babies Federal Minister in Nigeria sponsors possible in one state why can't we do it across the entire country well that's why he's the governor is it Nigeria not you guys a federal state I just told you the population that's one of the smaller states in Nigeria the up parts of the country we are we don't have the level of education as we have in Andhra state it is the reality and that is why sometimes I don't really like to talk about national averages because we not some say in Nigeria 350 per hundred times yes yeah it states in Nigeria that less than 120 hundred are like his own state now but they also states there are still posted as much as 800 that's that is the truth but we're talking about national averages and his 37 owes to drive down that of Malawi tell us a bit about their I mean it's possible in Nigeria it's possible in one state it's something that they sing in different states they're talking about political will is that something you can take on board 10 years ago we were at 1,200 per 100,000 we've gone down to 460 most of it has been because of the initiative that the president dr. Joyce Banda has put and then as much as we might say catcher is not a barrier but in my country we take that it does contribute to maternal death for example a woman would not go even if she's married at the right age shouldn't go to the hospital to do a delivery if the mother-in-law has not said yes the president has actually championed a traditional leader whom we hope in his own right in the village say these are the cultural practices which I think are not right for my people and that is make it better because it is them making that decision you're nodding because leadership is key here ice crusher well leadership is key breaking taboos is key fighting resistance is key the 200 million women who don't have access to modern contraception and just by giving them that we could cut maternal mortality by one third and that is also due to resistance it's all the way from Pope's to priests to conservative politicians and we need to confront it and you need to do something about it when you return we're gonna get the final word from our panel and our audience you're watching the big debate and welcome back to the big debate on maternal mortality why are women dying and what should be done about it what do you think my name is Aslan mint I'm an OBGYN practicing here in New York City I'm the assistant residency program director at Beth Israel Medical Center and actually brought three of my young young residents who are interested in global health and maternal issues so my question to the panel is what can we do from here from the developed world especially with young trainees that we work with what can we do to help address the global issues the governor said that beyond we need to rescue women that are not educated that unfortunately pregnant when they're not prepared to do that now these women don't have a say don't are not empowered economically for them to make choices of hiring even a taxi or hiring a bus to take them to the next health facility where they can actually seek help we need to economically empower this women so they can make decisions when it's right for them to be able to access health care delivery service the main bodies of the UN when they talk about the MDGs and maternal mortality the word sex does not come up the word contraceptives is not there are a group of Muslim countries in fact most of them and a group of of strictly Catholic countries that would think off their chairs if it were mentioned and I feel that UNFPA were talking to each other and I'd like you to comment on that the private sector has managed to reach the last mile you can probably drive to the very last mile at the very farthest corner of the earth and find some product that some private sector company has made why aren't we why aren't we not harnessing that power where is the private sector in this conversation where the ministries of Education where the ministries of Finance I have so much enjoyed UNG a week but I have really missed the other sectors who have a voice here and who have the power to make things happen I really feel we really are not creating this space for the young people to just be there to speak for themselves we are talking about them but they are here what can be done for us to create space for the young people to talk their own stories because we trusted them to vote for leaders at age 18 but we don't trust them to talk about themselves about their health my name is dr. la ballerina I'm a consultant OBGYN and I happened to be the chief medical director of the mother and child hospitals in those states as well as the chairperson of the confidential inquiry to maternal deaths in other states we discovered that once we provide quality health services once that is provided and is maintained what happens is that women come to you without issue of delays in intervening what actually makes you spend money on maternal health care and the complications following delays in management's the rupture de trois is the Atlantic's the excessive bleeding once there is a system in place where quality of cases made a priority women will make themselves available once they don't have to worry about pain at the point of service they'll make themselves available and what you find out is that less women will have complications and then you get an improvement in your health care financing thank you very much now given that MD g5 is one of the most off-track MDGs we can ensure that in the post-2015 framework maternal health care is prioritized and states are held accountable when they don't prioritize it we have this saying that like father like son and we are talking about the girl children getting pregnant but we're not talking about a young guys because most of these young girls I've got did they get impregnated by the young men and they don't marry them they just meet them and they impregnate them so is it that the girls are interested or the boys forced them to impregnate them and is there a situation that created the girls being prone to this young men those mothers who died from childbirth who is going to take care of their children these children will become by Amedeo Beebe on their own and these children might wind up becoming pregnant at teenage ages so the situation is kind of compounded we have to really sit down and digest and see what we can do to help these children it's not only the girls but the boys also my name is Zen dango and the special advisor to the Minister of Social Development in South Africa I think the point that's being made and I think that I've raised a very good case study is that we've got similar policies to what Denmark has but the outcomes are not the same and and that brings the issue of Rights into the into the equation you've got all the formal rights but the fact that 50% of our maternal mortality is driven by HIV and AIDS and complications linked to hiv/aids and if one looks at the epidemic and the fact that young women are particularly vulnerable the key driver is a lack of rights and the refusal of society to accept that women own their own bodies and patriarchy and I think what we need to do is put the issue of rights right into the equation because for us it's the attitude that there hasn't changed and you link that into your systems deficits that we're not going to get them at a low motility down my name is Audra Duker and I'm a family practice physician here in New York and I also studied family family planning and public health and my question is in regards to large-scale efforts to increase numbers of midwives and home birth attendants and that would be a significant help in reducing maternal mortality another concern of mine is in regards to improving access of women and young adolescents to emergency contraception and also access to safe abortions because many countless numbers of women are dying due to unsafe abortions so those are my concerns all for the break the final word from our panel and welcome back to the big debates let's hear a last word from our panel here at the United Nations in New York Catherine hora your final word I think if we're to address this issue it has to be a holistic approach because it has got a lot of phases to it it's got a health face it's got an education face it's got an economic face it's going to cut your face so if we are to address the maternal mortality indeed apart from the health we need to address it in a holistic approach as a government of Malawi in terms of resource sometimes the talk of resource and we think of a dollar only but I think our human resource as well as our commitment is a very critical and important resource and I would like to say that as a country we've actually also tailor-made some of the solutions to the problems for example the President did initiate a program whereby we building maternity waiting homes there women will come maybe a month or even two weeks earlier and be accommodated within the hospital premises so that when labor starts they are closer and somebody talked about private sector these waiting homes the president through her initiative she's actually coerced organisations and companies to actually put their brand name on these waiting homes but the doctors that did say that available we definitely still need them if they are available to come to us some numbers I and as briefly as possible Anatole Mahmoud your final would thank you first of all it is very easy to say what is the ideal ideal is zero and it is very easy to talk about change and we have changed we have seen how political slogan of change even in a country like United States this has not done the miracle and we have seen in Ireland where a lady lost her life because abortion is not allowed and abortion is still a debatable question in a country like United States so when we talk about change we have to be realistic the what is needed is a change change in the political with change in taking actions for example in Bangladesh we are providing not to all to the most vulnerable group a mother that stopped that is a when a vulnerable girl she is pregnant she has given a certain amount of money show that she has access to better food and better health condition we gave six months holiday for anyone who is pregnant and who is in a job six months holiday so these are the things which should be and then the most important thing that we feel are two things which is education for education what we have made is it is free education for girls students up to secondary level and books are given free we also are making resources available to the woman any any resources that is going from government the emphasises that should be directed towards the woman of the household to receive it it is no use saying a girl who is dependent on our marriage ok to say that I am going to defy it is not going to happen I can say it here to to the gallery but that is not going to happen we have to give them the economic resources available through government policies and we have to give them education if we can do that then the change will come but it will take time to change the attitude of the society thank you listen well the question was what can we do in the rich countries and and first of all I guess we can do up to our promises yeah you know there are so many there's so many countries who want to become a member of t7 and g8 and g20 and all of it so then might we have established a new club it's called u G is 0.7 and it's a club of countries who give more than 0.7 percent tariffs and and it's it's it's still a very exclusive club the only five members so you say please join but and then we can make sure that we allocate and larger share of that funding into sexual and reproductive health and rights then we must make sure there was another question we must make sure that sexual reproductive health and rights becomes part of our future post 2015 development agenda it has to be there all right let's just clarify your club because I want people to join us right so it's four countries that give more than 0.7 percent of a Jesus GDP development lead in developing and if you join you get a batch as well I want a badge Jesus in your final I wish I could join that I think it's about really at the end of the day it's about two things it is about the recognition that rights the rights of girls and the rights of women are at the heart of this problem you've got to have a much more comprehensive approach which includes comprehensive sexuality education for young people they need that as part of their education so that they know how to protect young girls know how to protect themselves how to make sure that they don't get pregnant how to make sure that they can actually become empowered it's not enough to say go to school and you're empowered they're not they've got to learn how to be able to do that and instead of shrinking and scaring ourselves by thinking somehow Oh give them contraceptives and they become from rescuers give them education and they'll all be running around having sex in fact all of the evidence says exactly the opposite exactly the opposite so it's about rights and it's about taking a much more comprehensive approach to it and it is about political will it is about those resources and much as I might agree that one has to you know make sure that the resources stolen and gone away are brought back to countries countries are so rich and they don't put the money because they don't think it's important and that's the fundamental average in dayyou'll final word well it's always nice to be the last let me start by saying I think that political will must be the first and the most important and I say this with player evidence all the best-performing countries in maternal mortality is Sri Lanka it is not a rich country but actually would have reached the MDGs 50 years ago if who had invented it because that was a political will to make sure that women and girls got services close to their homes let me also say for the point seven percent Club what is important to understand is that many of these countries actually lowered maternal mortality before they become passports Canada did it and there are many examples so it is not about money in that sense it's about the value we place on ourselves and on women and girls but finally and I say this I said everywhere and I'm proposed it in the next development agenda who must have a goal for adults and girls there are six hundred thousand a 600 million adults and girls in the world 90% of them and the developed world can you imagine a world where every of this adolescent has education health care skills to sell jobs be able to make choices in their lives who they marry have access to contraception imagine the world is transformative thank you well to contribute to our future shows don't forget to like our page on Facebook and follow us on Twitter now in 2015 world leaders will celebrate progress towards the millennium development goals including MD g5 which promise to reduce maternal mortality by three-quarters but those celebrations will ring hollow for the poorest of women who still face greatest risk of death when they become mothers have our leaders done enough to prioritize women's health are we all prepared to invest the money and change our mindset so that having a baby can be a positive life-giving experience everywhere in the world you decide thank you for watching the big debates good

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