Counting What We Know; Knowing What to Count: Sexual and Reproductive Rights, Maternal Health, and the Millennium Development Goals

Abstract

The sole reference to sexual and reproductive health in the Millennium Development Goals (MDGs) is in MDG 5, which relates to improvement in maternal health. A great deal of attention has been focused upon measuring achievement of this goal, which called for a 75% reduction in maternal mortality ratios from 1990 by the year 2015. Although no scenario suggests that MDG 5 will have been reached by 2015, a number of new comprehensive estimation exercises have shown varying calculations. We fully concur with the need to systematically assess progress on maternal health in order to hold governments and other actors accountable. However, in this article, we agree with others that it was inappropriate for the MDGs to become national planning targets and argue that in the case of MDG 5, this elision was exacerbated by the principal indicator chosen: maternal mortality ratios (MMRs). Second, we explain why MMRs are inappropriate indicators to measure national progress from a human rights perspective and, in turn, set out criteria derived from human rights principles to apply in selecting indicators to measure maternal mortality, and provide the example of process indicators related to emergency obstetric care. Third, we go on to note that the debate about measuring maternal mortality in the context of the MDGs has in many ways displaced the larger and more important political debate, highlighted at the Cairo Conference in 1994, about what societal reforms are required to advance women's sexual and reproductive health and rights. Finally, we argue that real progress on women's health and rights pre- and post-2015 requires reopening that debate, and we call for engagement by the SRHR communities in this process.