MDG 5, target 5b
Millenium Development Goal 5: Improve maternal health.
Target 5b: Achieve, by 2015, universal access to reproductive health
Largely due to firm opposition from developing countries (the G77, which comprises 130 out of the 192 UN member-states) and to the arrival of the Bush administration in 2001, reproductive health and rights were initially not integrated in the MDGs explicitly. They hadn’t been integrated in the Millennium Declaration either, although the Declaration did reiterate a commitment to all UN conferences, including the Cairo conference. But in Cairo, “debates were fierce”, and the UN Secretariat “did not want to reopen the mess of Cairo” (1). Nafis Sadik, who had been the Secretary General of the Cairo conference, left her office as Executive Director of UNFPA in 2000 and was replaced by Thoraya Ahmed Obaid who, although ideologically aligned with Sadik, was perhaps less of a militant than her.
The transnational reproductive health lobby, led by the IPPF and the UNFPA, was however staunchly determined to ensure an explicit continuum between the MDGs and the Cairo and Beijing conferences. Until it obtained victory, in 2007, it worked with increasing success at the implicit integration of reproductive health in the interpretation of the MDGs. Wasn’t the global consensus of the 1990s a holistic agenda? Didn’t the conference process determine that sustainable development rested on the pillar of gender equality which went through universal access to reproductive health?
No sooner were the MDGs published than the reproductive health lobby started emphasizing that the MDGs could not be reached without implementing Cairo. When the UN Secretary General asked Jeffrey Sachs to be in charge of the Millennium Project, the UN’s advisory body on MDGs, in 2002, he answered “on the condition we build reproductive health back into it” (1). Sachs promised he would put the emphasis back on reproductive rights. In 2005, the Millennium Project issued a report entitled Taking action: achieving gender equality and empowering women, in which it affirms that “Achieving Goal 3 requires guaranteeing women’s and girl’s sexual reproductive health and rights” (p. 53). The report dedicates a whole chapter to the issue and reintroduces - by stealth - sexual and reproductive health and rights in the MDG process.
In 2007, a target explicitly on reproductive health was added on to MDG 5 - target 5b on “achieving, by 2015, universal access to reproductive health”. The new target became effective on January 1st, 2008. Target 5b explicitly merges the Cairo platform for action and the MDGs. By that time, a growing number of developing countries had passed over to the other side, so that resistance on the part of the G77 was less of a factor.
Target 5b comes along with four indicators: contraceptive prevalence rate; adolescent birth rate; antenatal care coverage (at least one visit and at least four visits); unmet need for family planning. Let us clarify that in UN jargon, “antenatal care” is a notion which can be interpreted as including so-called “safe abortion”.
2015 is the “target date” for the implementation of both the MDGs and the Cairo conference. In developing countries, the reproductive health lobby now uses target 5b to pressure governments and “all stakeholders” to implement the Cairo agenda.
MDG 5 is about “improving maternal health”. How do reproductive health agents connect “maternal health” to their agenda, which is mainly about access to contraceptive information and services and to so-called “safe abortion”?
In a publication entitled “Contraception at a crossroads” (December 2008), IPPF plainly states the philosophy underpinning MDG 5, target 5b: “Contraception is maternal health” (2). According to UNFPA, family planning, skilled attendance at birth and what is euphemistically called “emergency obstetrical care” (a notion which includes “safe abortion”) are the way to prevent maternal deaths (UN annual estimate: 536.000).
As a matter of priority, MDG 5 on maternal health is in practice about providing access to “safe and effective methods of contraception” to those women who allegedly want them, but do not have access to them (“at least 200 million women”, according to the IPPF). Such access would allegedly prevent the “over 19 million unsafe abortions each year as a consequence of unplanned and unwanted pregnancies” (2).
In September 2008, a few months after the adoption of target 5b, the heads of four UN bodies (UNICEF, UNFPA, WHO and World Bank) jointly pledged to intensify their support to countries to achieve MDG 5 - the “MDG showing the least progress”, and accelerate implementation of reproductive, maternal and newborn care. The initiative, called the UN H4, commits these UN bodies to work with governments and civil society to “strengthen national capacity to scale-up quality health services to (...) ensure universal access to reproductive health, especially for family planning, skilled attendance at delivery and emergency obstetric and newborn care” (3).
What was a victory for reproductive health agents in 2007 was a fatal defeat for developing countries. Target 5b is used to force them to “own” what amounts to a neo-colonizing agenda.
© Marguerite A. Peeters 2010 – Permission needed for any public or semi-public use of this module.
Sources:
1. Barbara Crossette. Reproductive Health and the Millennium Development Goals
2. IPPF. Contraception at a crossroads. December 2008.
3. UN H4. Joint Country Support for Accelerated Implementation of Reproductive, Maternal and Newborn Care, WHO, UNFPA, UNICEF and World Bank. 2008