Dr Flavia Bustreo was appointed Assistant Director-General for Family, Women’s and Children’s Health on 1 October 2010. At WHO, she served as Deputy Director and then Director of The Partnership for Maternal, Newborn & Child Health from 2006 to 2010. In 2004-2005, she served as Interim Deputy Director of the Child Survival Partnership.
Dr Bustreo’s work has focused on policy development concerning child and maternal health, policy implementation and partnership-building with a wide range of stakeholders. In 2010, she led the development of the United Nations Global Strategy for Women’s and Children’s Health. In 2005, she contributed to the UN Taskforce on Millennium Development Goals (MDGs) 4 & 5 to reduce maternal and child mortality.
DB: Can you tell me what improvements you have seen in the area of maternal rights? Where do you see the gaps in maternal rights as they stand?
FB: Over the past six or seven years, we have really made big progress and strides in maternal mortality; of course we did not achieve the original SDG goal of reducing maternal mortality by three-quarters but we did reduce it by about 44 percent. The reduction and progress was actually almost entirely after 2010, because if you look at the data between 1990 and 2010 we had around 500,000 maternal deaths every year and now the latest data is around 300,000 deaths per year. So while we clearly still have a long way to go, the progress has been good, and for 20 years we saw no progress.
What is important now is that we continue with the progress we made since 2010 and we need to keep the accelerator on because with the present rate of change, it will take about 160 years before a pregnant woman in Africa has the same chances of carrying a pregnancy safely as a woman in a high income country like Ireland or the U.K. This inequity is what drives us.
DB: Having worked for many years in the area of maternal health and public health, as a clinician and policy-advisor, what do you see as the major issues currently facing women and threatening a safe motherhood experience?
FB: Absolutely, one point I’d also like to make is when we talk about Safe Motherhood Week, one aspect is maternal survival. The fact they can survive pregnancy and live afterwards to become fully caring mothers, starting from the beginning we need to arrive at a point where woman can decide when they want to become pregnant, with whom and being able to have a good quality of care throughout the whole pregnancy and that they can have a good birthing experience. It not just about reducing maternal deaths but it must be about improving the quality of pregnancy and childbirth and this is something that applies equally in Europe and Africa. Another issue I wish to signal, is the mistreatment and abuse of women during childbirth; a paper that was published two years ago and will be updated and published next year shows that mistreatment and abuse during childbirth is equally a problem in the developing and developed world. This mistreatment represents a violation of woman regarding human rights.
One issue that relates to the inequities I described is on one hand we have countries and women where it is “too little too late”, when women don’t have the ability to decide when to go to the health facility to deliver, because that decision is taken by, for example, the husband or by the mother in law, which in a country like Nigeria it is still the current social complex. So we have countries where for women it is too little too late but in Europe and my own country Italy we have too much too soon, and what we mean is the over medicalisation of normal pregnancy and the birth. The upshot is that we are seeing an increase in the rate of Caesarean sections well above the normal physiological sections required due to an obstructed labour.
DB: You are a leading global advocate for investment in the health, rights and wellbeing of girls and women. What form should this investment take and what solutions can it provide?
FB: Certainly the investment must begin with the strengthening of the healthcare system and the workforce that is able to accompany the woman with the motherhood experience, so that healthcare professionals can give the mother knowledge of birth control, family planning, what are the methods the woman can choose, and also that someone can accompany the mother during the experience of the pregnancy, so they can advise her during time of delivery, where to seek the delivery care. The skills and workforce delivery is key, we always indicate in our work that maternal mortality is a crucial indicator of the strength of the health system, because if you have a health system that can provide C-sections at night, at any time of the night when required, that health system is normally able to deliver many other things. Because in order to deliver a successful C-section you need to have electricity, a blood bank and you need to have a healthcare worker who can perform and is trained. All these elements enable a healthcare facility to deliver, for example, trauma care for patients or another other type of emergency that might occur.
Countries that have made the greatest progress in reducing maternal mortality are also focusing on measuring in real time what we call maternal death surveillance and response. For example, every time a new mother dies in Rwanda the health minister receives an alert; there is an immediate system that triggers an investigation why has that maternal death has occurred, could it have been preventable and what response can be put in place to insure there are no other maternal deaths in the area where it happened. This is one of`the best systems I have seen in place, because ministers are aware of the accountability impact, and that the minister and the president still have the number of maternal deaths and whether they have been able to use that.
DB: Do you think we are on the right track?
FB: We have the knowledge, and I think the main issue is the political will to do it. To make sure universal coverage is a reality for every person including for woman and those to tackle inequities, because I have mentioned inequities between high income and low income, but also inequities for example across different population groups, the poorest groups in any country will always have a higher maternal mortality rate and also a higher fertility rate, so they must focus on the women who are left behind the ones with the least knowledge and the ones who can’t fend for themselves. Among those groups we see that the like women who are migrating, we see that more and more maternal mortalities are concentrating among groups that are more vulnerable but even in those contexts we have the scientific knowledge of what needs to be done to make our motherhood safe. I really like the theme, motherhood is our power to shape the future. I believe that because we do have the knowledge to be able to shape that future and we need to claim it and to have a group that make these claims as the right of every single woman. I can tell you I am excited and optimistic.