France’s contribution in the area of reproductive, maternal, newborn and child health

Joint evaluation of French Foreign Ministry and AFD actions for maternal and child health to implement the commitments made by France in Muskoka (April2015)

At the June 2010 G8 Summit in Muskoka, Canada, the member countries and their partners undertook to devote an additional $5billion over the 2011-2015 period to speeding up the achievement of the Millennium Developments Goals of reducing child mortality (MDG4) and improving maternal health (MDG5), by strengthening national health systems.

France committed an additional €500million funding for the 2011-2015 period, making it the fourth largest contributor to the initiative. This contribution is sourced from the budget of the Ministry of Foreign Affairs and International Development (MAEDI), totalling €100million per year. The funds are spent via partnerships with international organizations (UN, Aga Khan Development Network, GAVI Alliance) and an increased contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and in the form of projects run by the Agence française de développement (AFD, French Development Agency).

Given the importance accorded to the health sector in France’s development cooperation policy, the country wished to carry out a mid-term evaluation to establish a situation report on its actions and analyse their strategic and operational approach. The evaluation contains a set of recommendations to improve the relevance, coherence, effectiveness, sustainability and visibility of France’s actions from now until the end of the initiative, and addresses points to be considered for the post-Muskoka period.

A public presentation of the evaluation’s results was organized by the French Ministry of Foreign Affairs and International Development (MAEDI) and the AFD on 29 April 2015, with over 80 people present including representatives of Parliament, the Court of Audit, civil society and the research community. The evaluation’s conclusions and recommendations were discussed, contributing to the public authorities’ debate on the action to be taken to enhance the effectiveness of the France’s work in the area of maternal and child health.



Summary of the joint evaluation of French Foreign Ministry and AFD actions for maternal and child health to implement the commitments made by France in Muskoka (PDF, 692.4KB) (French)

Volume 1 of the complete evaluation – (PDF, 3.1MB) (French)

Volume 2 of the complete evaluation – (PDF, 1.7MB) (French)

Background

Lack of access to quality health services around the world primarily affects women, newborns, children and adolescents, a great many of whose deaths are from preventable causes.

During the 2010 Muskoka Summit (French) in Canada, the G8 partners committed to increasing their contribution to the fight against maternal and child mortality under the Millennium Development Goals (2000-2015). For its part, France undertook there to increase its contribution by an €500million between 2011 and 2015, representing €100million per year in addition to the €340million estimated in 2008, the base year used in the accounting methodology approved by the G8 partners. In total, France should contribute more than €2billion over the 2011-2015period to combat maternal and infant mortality.

This mobilization was then amplified by the UN Secretary-General, and extended to the entire international community through the Every Woman Every Child” initiative. The mobilization of the G8 and, more generally, the international community, centred around the UN Secretary-General’s initiative, has helped cut maternal and infant mortality worldwide by almost half:

infant mortality has decreased from 90deaths per 1000live births in 1990 to 46per 1000 in2013 (compared to 4per 1000 in France);

maternal mortality has decreased from 380deaths per 100,000live births in 1990 to 210per 100,000 in2013 (compared to 10.3per 100,000 in France).

However, despite investments in combating maternal and infant mortality, and to support sexual and reproductive health, the situation remains worrying, particularly in West and Central Africa:

complications linked to early pregnancy and HIV/AIDS remain the two main causes of death among adolescent girls in most developing countries;

every year, 6.6million children still die before the age of five, of whom 2.9million are newborns in the first month of life, from easily avoidable disease such as malnutrition (the underlying cause of 45 % of all deaths amongst under-fives), pneumonia and diarrhoea.

The UN Secretary-General will propose a new strategy in this area for the 2015-2030 period. The Open Working Group proposal for Sustainable Development Goals, which will define the future post-2015 development goals, recommends, in its health goal (goal 3), to:

  • By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000live births;
  • By 2030, end preventable deaths of newborns and children under 5 years of age;
  • By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes;
  • Achieve universal health coverage, including -financial risk protection, and access to quality essential health-care services and to quality essential medicines and vaccines.

Achieving these goals will require the realization of gender equality, women’s rights, including their sexual and reproductive rights and autonomy (goal 5).

Sexual and reproductive health

There are numerous economic, legal and social barriers to individuals’ access to sexual and reproductive health services. Complications related to pregnancy or childbirth and HIV/AIDS are currently the two leading causes of death among teenagers and girls in low- and intermediate-income countries. These deaths can be prevented through simple, effective measures such as access to contraception, sex education, prevention, information and screening, and integrated prenatal care. The ability of women to prevent, space and limit pregnancies through the use of contraceptive methods has a direct impact on their health. All women, including adolescents, must have access to family planning services, contraception and abortion services under good conditions and to sexual health information and services.

Almost 220million women wish to limit, space out or reduce the number of pregnancies yet still remain without access to modern contraception, leading to more than 80million unwanted pregnancies every year and more than 20million unsafe abortions.

Adolescent girls and young women are most affected. More than 34million people live with HIV/AIDS, including 3.4million children under15. In 2011, 2.5million people were newly affected. Every year, 499million new cases of sexually transmitted diseases (STDs) occur, with major consequences for health, including maternal and newborn health. More than 2000 young people are infected with HIV every day.

The general wellbeing of women, in physical, mental and social terms, first and foremost requires that equality, mutual respect and bodily integrity to be guaranteed through abandonment of harmful traditional practices.

  • 30million girls are estimated to live under the threat of female genital mutilation (FGM) over the next 10years; Almost 142million girls could be married before their 18th birthdays by 2020.
  • more than 15million girls every year aged 15-19 give birth to a child, and more than 2million under 15. In most cases, this takes place in the context of a forced marriage. One in three girls under 18 is married without her consent in low- and intermediate-income countries.

Under the OuagadougouPartnership, France supports reproductive health programmes in 9French-speaking African countries: Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, Togo (€100million over the 2011-2015period).

The Ouagadougou Partnership

Maternal, newborn and child health

99% of maternal deaths occur in poor countries, making maternal mortality one of the world’s greatest injustices. Every day, around 800women die of complications linked to pregnancy or childbirth, and the risk of maternal mortality is higher among young women under 15 years of age. The concentration of maternal deaths in developing countries reflects persisting inequalities in terms of access to health services.

Women die as a result of complications during or after pregnancy or childbirth. The main complications leading to deaths include severe haemorrhages, infections, hypertension during pregnancy, and abortions carried out in poor safety conditions. Other causes of complications are linked to diseases such as malaria and HIV/AIDS during pregnancy.

35 countries still have a fertility rate in excess of 5children per woman. Child mortality under five years of age ranges from 3deaths per 1000live births in Singapore, to 283in Sierra Leone. 7.6 million children die each year before their fifth birthday.

We know where and why mothers and children die. Priority actions exist that have proven their effectiveness in reducing this mortality, and they are well-known. To combat maternal, newborn and child mortality, actions need to be carried out in three key areas: family planning, emergency obstetric and newborn care, and childbirth by qualified staff, as well as the availability of competent and motivated healthcare personnel. Other themes have also been selected as French priorities, including Integrated Management of Childhood Illness (IMCI), vaccination, maternal and child nutrition, and combating gender violence. Particular attention is given to mainstreaming the promotion of women’s rights and gender equality.

Implementation of France’s commitments for reproductive, maternal, newborn and child health

France has committed to dedicating an additional €500million under the Muskoka Initiative on Maternal, Newborn and Child Health. In practical terms, France’s commitments are as follows:

Multilateral channels

Multilaterally, a joint project with four UN agencies has been put in place, linked to the priority solidarity fund (PSF) with an annual budget of €19million. These agencies are the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women). The four agencies develop their programmes within a common framework of coordinated, harmonized activities, with the following goals: spacing of births and prevention of unwanted pregnancies; pregnancy, birth and post-natal monitoring; integrated management of childhood diseases, vaccination and mother and child nutrition.

In addition, the Aga Khan Development Network (AKDN), has an annual budget €0.5million. Using this budget, the Aga Khan Development Network funds activities for the health of women and children in border regions of Afghanistan, Pakistan and Tajikistan.

The GAVI Vaccine Alliance receives an additional annual contribution of €5.5million on top of France’s overall commitment to it via the International Finance Facility for Immunisation (IFFIm) (€1.3billion between 2006 and 2026) and its annual direct contributions (€79million in 2013). GAVI aims to protect children in poor countries from major diseases preventable by vaccination.

Finally, the French contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, worth €27million per year, demonstrates the fund’s contribution to the fight to achieve MDGs 4 and 5.

Bilateral channels

France’s commitments also include the implementation of bilateral programmes to improve maternal and child health by the Agence française de développement (AFD, French Development Agency), to the tune of €48million per year.

Geographical coverage

16 African countries are considered as priorities for all these support programmes: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Comoros, Congo, Democratic Republic of the Congo, Ghana, Guinea, Madagascar, Mali, Mauritania, Niger, Senegal and Togo. Two countries in crisis are also included (Haiti and Afghanistan).

France focuses its efforts on 16 African countries that are considered as priorities:

France focuses its efforts on 16 African countries that are considered as priorities

Updated: 24 April 2015

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