Meeting Millennium Development Goals and enhancing lives, particularly those of women and children, depends on effective data gathering, writes Franscisco Songane* Sunday was World Population Day. It is thus an ideal time for us to think about an issue that does not often come to the fore, but is extremely important for improving the wellbeing of human beings: the world's population. The wellbeing of populations is of increasing concern, especially as we enter the final five years for achieving the Millennium Development Goals (MDGs). These goals, related to improving the lives of people, with particular attention to women and children, were agreed to by almost every world leader in 2000. Nevertheless, in the first 10 years we have made inadequate progress towards achieving most of the MDGs. Our collective shortcomings relate particularly to the wellbeing of women and children. But despite these shortcomings there is still hope and a real chance that we will achieve many of the MDGs if strong action is taken now to enhance our collective efforts. Focussing part of our efforts on population data is one means of enhancing these efforts. This focus is valuable because it brings together demographics and action at the level of countries, it cuts across the work of major international agencies, and it can significantly contribute to the prominence of the concerns of women and children in our common efforts. Validated population data can help us identify vulnerable populations. It can help us understand what interventions work and which ones do not. It can help us budget what is needed to improve the health and education of many people and not merely a few. It is indeed what has helped us to identify women and children as among the most vulnerable groups in society and the development strategies needed to help them. Population data can be used for policies and programmes that address development strategies while ensuring that people live in good health, enjoy equal opportunities and are treated with dignity and respect. Using population data we can make the family -- the centre of many people's lives -- rather than the number of people our common central focus. In 1994 the International Conference on Population and Development (ICPD) held in Cairo adopted a programme of action with the goals of ensuring by 2015 the following achievements: universal access to reproductive health services; universal primary education that closed the gender gap; a 75 per cent reduction in deaths during child bearing; the reduction of infants deaths; the increase in life expectancy; and the reduction of HIV infection rates. These population data based goals have been reiterated in the 2000 MDGs. World leaders reiterated the importance of the Cairo goals in an effort to lift billions of people out of poverty and deprivation. The Millennium Declaration represents a global consensus on the urgent need for development through cooperation. The MDGs are the gauge by which we can measure progress and set common priorities. Today, with only five years left to 2015, many countries' people are still suffering with poor living conditions in large numbers and many developing countries are not on track to achieve the MDGs. Progress has been slow, and sometimes it has even stagnated, or the situation of populations has deteriorated. Again we know this because of population data, especially data on maternal mortality. The global South, especially in Africa and Asia, is where progress towards the MDGs has been the weakest. There is a necessity to scale up our efforts to at least get progress started in countries that are stagnating and to urgently stop and reverse the decline in countries that are lagging behind. FAMILIES AND POPULATION IN FOCUS: Focussing on populations puts the family at the centre of our efforts. Having both population and the family as our main focus can help us make progress towards the MDGs in the following ways. The focus on population and the family emphasises the need for the MDGs to be embedded in the development strategies of countries and used as guides for setting priorities. We have already seen how both African Union and G8 leaders have started to realise this, as both have begun to focus their attention on achieving the MDGs. The theme of the upcoming African Union summit later this month will be maternal and child health, the centrepiece of a family and population focus. The main humanitarian issue on the agenda of the G8 was also maternal and child health for which an estimated more than $5 billion of the $30 billion needed over five years to achieve the MDGs in the countries that are lagging behind the most was pledged by governments. Both efforts are excellent starts, but our leaders also need to understand the interconnections of all the MDGs, including those relating to combating poverty and protecting the environment. Much of the work done on these specific issues is not well coordinated at the country level. This needs to change. For this to happen technical expertise is needed, but such expertise must also contemplate the perspective of the peoples in the countries where action is being taken. Translating each goal into a country-specific goal that matches national realities would be a good start that could help to facilitate understanding of the integrated approach that is needed. The MDGs can then function as a converging path where the efforts of different players can be focussed on common problems. The focus on population and family also necessarily points to the important role of women. Their contribution to the economy in many countries is still under-appreciated. This information must be made available, converted into figures with attribution to the work of women, and disseminated. Regular compilation of world information on progress in regards to gender issues, highlighting the reasons behind discrepancies, can be a powerful advocacy tool. Bold presentations like maps comparing regions and countries can be illustrative. And the inclusion of the topic in major regional and sub-regional political events will help to change historically tolerated situations that have disadvantaged women. Gender discrimination is still often discussed in a reserved manner. It is not understood as a major problem of women and children or as having a relationship with population. More attention to the family can help correct this situation because it requires the recognition of the central role of women in families. Reproductive health is the main link projecting the family to the national dimension, merging into population size and its dynamics. Therefore health, particularly reproductive health, and development are inextricably linked: development can't be achieved without good reproductive health services, and in its turn development is a major determinant to secure good reproductive health services. Maternal mortality reflects socioeconomic conditions in the family and the community, the quality of health services, and the performance of the government to secure the most basic necessities of its most important and often most vulnerable members. Pregnancy is not a disease. Nevertheless, women are dying in large numbers while giving birth. In the last 20 years, progress towards changing this situation and making pregnancy safer for women has been uneven. Today, women die in pregnancy or childbirth in the same numbers as they did in the late 1980s. Most important is ensuring women's access to services. This requires functioning and responsive health systems with good coverage. The resolution on maternal and child health that was passed by the UN Human Rights Council in June 2009 recognises the failure to prevent high levels of maternal deaths as a human rights violation. This resolution is a landmark step. The interconnectedness between maternal and child health and population dynamics, human rights aspects, and the functioning of health systems is particularly apparent and well documented in the areas of maternal and child health. Infant mortality is also closely related to the quality of services provided during pregnancy and delivery. Every year, four million infants die in the first month of life due to conditions related to the quality of care received by mothers. A sustainable change in the situation requires a major investment in health systems. We should continue to use maternal and child mortality as fundamental indicators of our progress towards improving human wellbeing. The survival of women during pregnancy, as well as that of their children who could grow healthy and enjoy the full potential to perform in school, is crucial for improving human wellbeing. Healthy children can fully contribute to the development of their communities and countries. Of the women who survive childbirth, many are left handicapped with life long disabilities, including the inability to bear more children, with profound social consequences. For every maternal death there are some 20 women left with disabilities. Most of these women suffer from fistula (the leaking of urine and or faeces), a strongly stigmatising condition that culminates in rejection by society, including the immediate family. Many of these victims are very young women who see their future destroyed because society fails them by not providing the services and the protection they deserve. These women's ordeals should be made known. We should expose the string of hurdles and complications they suffer, including gender imposed inequities, the perils of poverty, or simply the non-existence of health services. Population statistics increasingly show the impact of sexually transmitted infections (STIs), especially HIV on the development of countries. For example, syphilis continues to be a leading cause of stillbirths and a major contributor to neonatal and infant morbidity and mortality, although it is completely curable, perfectly preventable, and the necessary medicines are available. The elimination of syphilis as a cause of foetal loss and infant morbidity and mortality is possible, affordable, and the means to realise it are within reach for any country. The prevention and treatment of STIs, including HIV, must be one of the main areas of sexual and reproductive health. Good quality antenatal care should allow early detection and treatment. Prevention of new HIV infections, in particular, is critical. The protocol for the "Prevention of Mother to Child Transmission" should be made a required part of antenatal care. Doing this will recognise the continuation of the care of the mother after delivery, which is critical to guaranteeing that babies are brought to life without HIV and their mothers stay alive, enjoying reasonable quality of life during which they are able to provide the care their children require. More than 1.5 billion people in the world are adolescents and youth with ages between 10 and 25. These young people are exposed to many risks for which they are often not prepared. STIs, including HIV, are examples, as well as early pregnancy and its negative consequences. We know that lack of proper prenatal care creates a much higher chance of complications during delivery, and that lack of prenatal care is much more likely among adolescents and youth. The provision of counselling services to adolescents and youth is critical. This can provide them the knowledge that they need and can use to protect against infection, avoid teenage pregnancy, and finish their basic studies. While we need to respect the counsel provided by parents and guardians, we also need to find ways in our modern world to assure adolescents and youth that there will always be knowledgeable and friendly advice available to them for what we know to be their specific needs based on population data. To be able to plan adequate interventions, population data needs to be both reliable and available. These important elements are necessary for sharing with communities and hearing their feedback as well as for planning the most appropriate interventions. Most developed states have highly reliable systems for recording basic population statistics; many developing countries do not have such systems in place. The recently publicised difficulties in producing reliable maternal mortality data are an example of this problem. It is a problem that cannot be solved by external studies no matter how reliable and no matter what the regular intervals are at which data is collected. While externally driven studies may be temporary necessities, they are no substitute for building national capacity to collect population data. One of our priorities, which the focus on population and families requires, is the establishment of adequate national population statistics collection mechanisms. Lack of good vital data has been a chronic problem in the most affected countries. Often it is necessary to resort to estimates due to lack of available data on such basic questions such as the number of people who are born or who die. Partnerships between communities and civil society are key to a consultative process that can lead to finding sustainable mechanisms for the reliable registration of vital statistics. In addition, advocacy and information campaigns are required to raise awareness about the importance of indicators and their measurement based on reliably collected data. The meaning of these indicators for communities must be expressed in a way that is straightforward and easy for all to understand. We need to find practical ways of encouraging people to understand that their lives are reflected in the indicators, and that the figures change as their lives also change, and this way they can compare their quality of life with that of other communities. MOVING FORWARD: To use what we know about our populations, which combined are approaching almost seven billion people on this planet, we will need to apply ourselves to making populations and families a central focus of our efforts to achieve the MDGs. Clarity and consensus on priorities and the most suitable interventions will have to be built among diverse UN and other international and governmental agencies with rich and diverse expertise. As this consensus is being achieved we will have to work to coordinate all of these actors on how to most effectively provide the right interventions in fields like healthcare, development, education, and poverty reduction. A clear division of labour in order to minimise duplication will be essential in environments where there are already many players addressing the same issue. Universal guidance and a setting of parameters are needed, but it is at the country level where action must happen. It is at the country level that we must jointly ensure the implementation of known effective interventions. The global South is the region where indicators show that the situation is worst. Therefore, they should be our focus. We must do this, however, while maintaining the level of support that allows successful countries to continue to improve. This reinforces the importance of having good capacity at the country level. International technical assistance must be familiar with the way the issues present themselves locally and the context of interventions. The development gaps between countries in our contemporary world are very large. The most affected countries do not have the capacity to correct their situation within the timeframe suggested by the ICPD Programme of Action and the Millennium Declaration. Sufficient additional resources are needed, and must be provided within the framework of the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action. While calling on countries to exert leadership and allocate the necessary resources, continuous advocacy is needed to encourage donors to engage in long-term partnerships. In the end, people are the most important resource for any country. The wellbeing of families and communities must be the driving force behind our work to have a world where people are healthy, living with dignity and respect, and enabled to use their full potential for development. A focus on families based on population data can help us to improve the wellbeing of every individual in the world. * The writer is a former minister of health in Mozambique and is one of the world's leading advocates on maternal and child wellbeing.
