Sue Kelly of AusAid on maternal mortality
	Video interview: Surang Janyam and the sex workers of Thailand
	Video interview: Father Joe urges, "walk the road"

The following are excerpts from an interview conducted with Sue Kelly of AusAid, the Australian government’s overseas aid program. She talks about the devastating effects of high maternal mortality rates in Southeast Asia and the Pacific Islands.

FACE to FACE: Why is maternal mortality such an intractable problem in Asia-Pacific countries such as PNG and Indonesia? Why have strategies that have worked to reduce maternal mortality rates elsewhere not worked in these countries?

SUE KELLY: Maternal mortality is closely associated with poverty; it is not so much that strategies haven’t worked. Simply, in countries such as Indonesia, Papua New Guinea (PNG) and the Solomon Islands, many more people, particularly poor women living in rural areas, still lack access to both acute and standard health care during pregnancy and birth. Therefore high rates of maternal mortality are evident in countries in the Asia-Pacific region with high rates of poverty.

Poverty leads to poor nutrition, lack of information, and lack of resources, including limited access to, or lack of funds to pay for, health care. All of these combine to produce high rates of maternal mortality.

A number of programs exist in these countries, to provide support and education about the importance of antenatal care, good nutrition in pregnancy, etc. There are some health providers available to assist rural and urban women – but not enough. In addition, at the end of the day, emergencies during pregnancy and birth require emergency medical assistance; without sufficient services in rural and isolated areas, or transportation systems and other resources to bring women to medical care, many women die as a result of complications during and following delivery.

The statistics are shocking: maternal mortality in Australia and Canada rates are approximately 6 deaths per 100,000 births; the USA is 12/100,000; in PNG the rate is 390 deaths per 100,000 births; in Indonesia 470/100,000; and in Laos the rate is as high as 650 deaths per 100,000 births. This list is only of maternal death rates; child and maternal morbidity rates are also very distressing.


F2F: How have donor governments (Australia in particular) in the region tried to fight maternal mortality? Have they had any success?

SK: Improving high rates of mortality and morbidity is very important to national governments and donor governments in the region. But solutions are complex.

There are a number of large women’s and children’s health projects being funded in the region, particularly in PNG, and the Solomon Islands; and a new initiative called “Health Mothers, Healthy Babies” in Indonesia. AusAid supports UNICEF and other NGOs that are doing work focusing on providing and supporting good antenatal care.

Some successful projects include the development of safe birthing places – clinics or birth houses – that women are encouraged to come to. Midwives in some areas have been supplied with motorbikes to improve their ability to get out to isolated populations.

However, again, these things are not much help in emergency situations. Moreover, the other issues that influence maternal mortality are not addressed by direct public health services. So, poor transport and low level of education and knowledge of health issues remain difficult to address; and girls in the populations most at risk start having children younger than their middle-class counterparts, which is another risk factor for difficult delivery or complications of pregnancy or birth.

The complexities of the issues creating the problem make finding solutions difficult. AusAid would welcome more research and evaluation of strategies being used and developed in the region to see what is most useful in lowering maternal mortality and morbidity.

F2F: Is there a role for advocacy work – such as that supported by Face to Face – in reducing maternal mortality?

SK: In terms of advocacy in donor countries, maternal mortality and morbidity do not receive the same coverage as other “fashionable” health issues, so there is room for greater coverage of these issues.

In the region, lack of coverage of the issues is not really the problem. For example, in Papua New Guinea, nobody needs to remind the local health services policy makers that maternal mortality is an issue. Economic decline there, and in other parts of the region, is causing a reduction in health service provision, and a consequent decline in the population health status. Resources are needed to address large, and increasing, gaps in health service provision.

However, more research is also something we would like to see happening in the region. Very very little money is spent on developing strategies to solve high rates of maternal mortality and this can and should be done.


Interview conducted by Face to Face volunteer Megan Grant

Meet Surang Janyam, coordinator of the Empower Patpong Center in Bangkok. Ms. Janyam spoke to Face to Face in December 2002 about her work with Bangkok’s commercial sex workers – the women she calls her sisters.

Click here to see the interview with Surang Janyam of Empower.

Empower is a non-profit community organization working collectively by and for sex workers to offer help and assistance to workers in the entertainment industry.

The Empower Patpong Center in Bangkok offers women pre-college education, language classes, health and legal workshops, and individual counseling. It is also a safe haven where women can relax with their friends.

For more information or to donate, visit www.empowerfoundation.org or email empower@empowerfoundation.org

Meet Father Joe Maier, founder and director of the Human Development Foundation. Father Joe spoke with Face to Face in December 2002 about working in partnership with the poor for over thirty years in Bangkok’s Klong Toey Slum.

Click here to see the interview with Father Joe.

The Human Development Foundation (HDF) was established as a tax-exempt, non-profit organization in 1972 with a single, steadfast goal: To help the poor in Bangkok's teeming slums help themselves.

Father Joe Maier, a Redemptorist priest, started the HDF with a single pre-school near his parish in the Klong Toey slum. The Foundation's activities have steadily expanded over the years, reaching out not just to the slum's Catholic minority, but to all of Bangkok's poorest people, the majority of whom are Buddhist and Muslim.

In the past three decades, the HDF has touched the lives of over 500,000 men, women, and children in need. Programs include education, social services, health care, and community development.

For more information or to donate, visit www.mercycenter.org