Playing for high stakes at the G20

The G20 summit at the end of this week must address the need for safe abortion if it is to bring down death rates in pregnancy, as the Canadian government has pledged - and it must deliver on its former pledge to keep people with HIV/Aids in Africa alive
Katine maternal health lead
Pregnant women wait to enter the maternity ward of the Katine health centre, Uganda Dan Chung/

Never have the deaths of women in childbirth and the fate of their newborn babies been paid so much attention at so high a level.

Hard on the heels of the Women Deliver conference in Washington two weeks ago, luminaries, movers and shakers from the UN, business, governments and civil society have assembled in London for the Pacific Health Summit, which has taken as this year's theme maternal and newborn health. Conversations are going on among people in a position to make a difference - from the largest pharma companies in the world to major donors like USAID.

And the moment it ends, we are into the G20 summit, where the Canadian government has promised to make maternal and newborn health its legacy issue. It wants the world's leading nations to sign up to a plan which includes better training for health workers, better nutrition for pregnant women, nursing mothers and their children, immunisation, clean water and sanitation.

Who could argue? The need is obvious. The Millennium Development Goals on cutting maternal and newborn deaths are unlikely to be reached by the target year of 2015 at the present rate of progress. Around 350,000 women die in childbirth every year. Some nine million under-5s also die - but although the numbers have come down, they are still unrelentingly high among newborns, whose life-chances depend so much on the survival and health of their mother.

But there is one issue that is specific to the survival of pregnant women that is not being addressed by the Canadian package. The elephant is still in the room. The Canadians - just like the former Bush government in the USA - don't want anything to do with safe abortion services. It's a serious omission if you want to bring down death rates - 70,000 women die from unsafe abortion every year. The Lancet took a strong line on this last month:

The Canadian Government does not deprive women living in Canada from access to safe abortions; it is therefore hypocritical and unjust that it tries to do so abroad. Although the country's decision only affects a small number of developing countries where abortion is legal, bans on the procedure, which are detrimental to public health, should be challenged by the G8, not tacitly supported. Canada and the other G8 nations could show real leadership with a final maternal health plan that is based on sound scientific evidence and not prejudice.

And while the G20 is focusing on maternal and newborn health, it should not forget its previous pledges. Stephen Lewis, co-director of Aids-Free World and former Canadian ambassador to the UN, yesterday accused the G8 - as it used to be - of being "congenitally addicted" to the betrayal of Africa. At Gleneagles in 2005, the G8 promised $25 billion extra for Africa by 2010. Recent reports estimated a shortfall of between $7 billion and $9.8 billion. But the eloquent Mr Lewis should speak for himself:

It should come as no surprise then to learn that now, the G8 is explicitly cutting back on funding for HIV/AIDS.

I see no point in beating around the bush. In the United States, the President's Emergency Plan For AIDS Relief (PEPFAR) is being flat-lined, for at least the next two years. That this should happen under President Obama seems inconceivable. It not only negates the pledge that the President (and Hillary Clinton) made during the campaign; it even fails to take advantage of the willingness of Congress to support extra funding.

Worse, the rationale hides behind intellectual sophistry. The argument is that AIDS has had too much money, and additional funds should go to other health imperatives like maternal and child health. No one in his or her right mind would argue with broader financial support for all aspects of global health. But to diminish the dollars that might be available for AIDS, rather than enlarging the financial pie overall is so wrong-headed as to defy rational analysis.

And let no one doubt the consequences. Right at the moment when we know how to treat large numbers; right at the moment when we have five million people in treatment; right at the moment when another nine million require treatment now; right at the moment when hope is finally alive, PEPFAR is flat-lining the budget. Médecins Sans Frontières (MSF) recently released a report documenting cut-backs, portending grievous consequences, in Uganda, Malawi, Zambia and Mozambique. There are AIDS projects, run by other NGOs, where new patients cannot be enrolled unless someone dies: indeed, the cutbacks have become so disastrous in places that HIV-positive pregnant women are being turned away, as are people so sick they're coming to the hospital in wheelbarrows.

Surely we've had enough of the ravenous carnage of AIDS. Let's be clear: we're threatened with another outbreak of death akin to the ghastly pattern of the early years of this decade. It cannot be allowed to happen. Someone has to get to the President and tell him that his advisors, decent and honourable though they may be, are taking Africa down a deadly path.

But that's just the half of it. The Global Fund to Fight AIDS, Tuberculosis and Malaria has a replenishment conference this fall, seeking $20 billion over three years. The Global Fund has performed magnificently in a number of areas, and yet there's every prospect that they'll fall up to $7 billion short.

Again the spectre of death will stalk the land.

If the G8 and G20 are to do more than dissemble, they have to match their actions to their commitments. This time, they must put up the money that's required for Africa along with a timetable for delivery, and then they must keep their promises by sticking to that timetable. They have to understand that maternal and child health are inextricably tied up with HIV/AIDS. If you don't address the pandemic, you'll never decisively reduce maternal and child mortality in Africa. For the proof, simply note that maternal deaths in sub-Saharan Africa increased by 61,000 last year, almost all of it due to AIDS. HIV/AIDS is the ultimate nemesis.

And for those weeping willows who use the financial crisis as the mother of all excuses, just pause a moment to think of corporate bailouts and corporate bonuses. Something is completely out of whack.