On 15th January 2015, the Bishop of Derby, the Rt Revd Alastair Redfern, took part in a question for short debate in the House of Lords, led by Baroness Hayman, on what progress has been made in reducing maternal and neonatal mortality in the developing world; and what plans they have to build on this work post-2015. The Bishop spoke of the situation in India, which has an ecumenical partnership with Derby Diocese, where one-third of global neonatal deaths occur. He noted that poverty, lack of education about basic hygine, attitudes towards women and girls and a lack of necessary infrastructure all contribute to high levels of maternal and neonatal mortality. He spoke of the grassroots responses to these conditions that he had observed in visits to India, and welcomed the partnership between DfID and development agencies such as Christian Aid, which work to channel funds to these effective local efforts.
The Lord Bishop of Derby: My Lords, I too congratulate the noble Baroness, Lady Hayman, on securing this debate and on introducing it with such expertise and such a challenging sense of the statistics. Millennium development goals 4 and 5 are not being met and, as other speakers have said, the consequences are horrendous. My contribution will be from my own experience working with people at the grass roots, and I will then tease out what the implications of that experience should be.
I work in the diocese of Derby, in England, and we are twinned with the Church of North India, which extends from Calcutta to Mumbai—the whole of north India is twinned with our diocese in an ecumenical link. I work with people in a number of Indian communities where this issue is enormous. In 2012, one-third of global neonatal deaths happened in India. The highest rate of first-day mortality is in India. That is the context in which we are working with our partners, through whose eyes we discern some factors.
The first, as other noble Lords have said, is poverty. People just do not have the means to call medical help and there is no local infrastructure available anyway even if they could. That kind of poverty is a major factor. The second factor is the lack of education about basic hygiene. I visited slums in Calcutta with the Cathedral Relief Service, which trains very young girls of 10 to 12 to wander in and out of people’s houses, giving good advice about hygiene and childcare. This helps families learn good practice in an unthreatening way and will produce a new generation of young mothers with those skills. This is a practical, grass-roots response.
My colleagues in India would say that the third factor is that a lack of respect for women and girls is behind these terrible statistics. The attitude so often is that this is their role—illness is not taken seriously—and their job is to run the household. New mothers are expected just to get up and carry on with things. Fourthly, in the urban areas, the issue is not so much a matter of the infrastructure being hundreds of miles away but that whole families live on pavements and give birth there. I was in Calcutta in December and saw families living in the street with no resources, cutting the cord with an ordinary knife because that was all that was at hand.
That was a snapshot of some of my experiences; what are the responses? I work with ISPCK—the Indian version of the publishing house—and the Cathedral Relief Service in Calcutta. As the noble Baroness, Lady Kinnock, was hinting, they say that the key is to have strong, empowered women. Research by the Cathedral Relief Service in Calcutta shows that 63% of pregnant women in the slums are anaemic. That is an appalling starting place. I visited a slum where they had just invented a green goo to give to people to build up their resources—I had to taste it, and it was a really testing moment in intercultural activity. People have to take this kind of local initiative to build, literally, physically strong women.
Women have to be empowered, too, and many people in development know that it is by building up women that families survive and have structure and leadership. We spend a lot of time in our diocese raising funds to create around providing sewing machines for women so that the family has a livelihood. This year, we are raising funds to create businesses for recycling in Delhi, where all the waste from industrialising India needs dealing with. It is only by giving women that kind of strength and security that they will be able to deal with some of the issues about family planning and their self-respect and standing in the community.
Other things that we do with our partners include running education and immunisation programmes, as well as doing home visits. We show films in the slums, and some villages have health days, when volunteers go out and gather people around. So what are the implications that I am learning? The key one is partnership.
There is a partnership between the people of Derbyshire and people in the slums and rural areas of India around this issue, which provides practical help and tries to empower women and provide infrastructure.
I am privileged to be a trustee of Christian Aid, which specialises in partnership working with local agencies. We work in Kenya, Malawi and Bangalore, in India, and there are lots of stories that I could tell—like the ones from Derbyshire—of partnership working. Most exciting is our partnership at the moment with DfID. The Minister came to the Christian Aid carol service and launched a match funding scheme for a project in Kenya on this very topic. We should congratulate the Government on their approach to partnering with organisations such as Christian Aid, which have a lot of expertise on the ground and grass-roots connections and can deliver real change. I am proud of the way that our Government are investing in that. Clearly, we can always do more and clearly we need millennium development goals that will challenge the Government more, but I record on behalf of Christian Aid our positive experience of working with DfID and what a good job comes out of it.
I finish with two questions for the Minister. If developing countries need encouragement to ensure provision for maternal healthcare, what can the Government do to up their game about partnership with those who have grass-roots contacts? That is where we need to operate—with those who are excluded at grass-roots level. We need to connect with those people. How can the Government up their game, working in partnership and investing their funds, while using their influence with other Governments for grass-roots activities?
Secondly, we all know that a lot of problems in developing countries are caused by the unsatisfactory tax base. So much of what could be raised by taxation to provide money for health and other infrastructure is shifted out of the country by the way that corporations operate financially. Both the Prime Minister and the Chancellor have spoken out against this practice, commendably, and we have had debates in this House about it. I would be interested to know what the Minister thinks about the part that getting a better tax structure in developing countries plays if we are to equip people in their own places to take up this work and meet the challenge.
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The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover): My Lords, like other noble Lords, I pay tribute to the noble Baroness, Lady Hayman, for securing today’s debate, and for her long-standing commitment to maternal and neonatal health. I commend the other contributions we have heard today, which, as ever in your Lordships’ House, have ranged very widely. I also thank noble Lords for their tributes to DfID for our work. We have heard the devastating figures, and as my noble friend Lady Hodgson pointed out, a human face was given to those figures.
The noble Baroness, Lady Hayman, my noble friend Lady Hodgson, the noble Baroness, Lady Kinnock, the right reverend Prelate, the noble Baroness, Lady Tonge and now the noble Lord, Lord Collins, have all pointed out that this relates fundamentally to the rights of women and their unequal status, unequal access to nutrition and education and being forced into early marriage—we have heard the range of challenges. Gender inequality is key…<
We need health financing systems that mean women do not have to make choices between accessing care and feeding their families. I agree with the right reverend Prelate in terms of finance that a sustainable solution can come only when countries finance their own healthcare adequately. He is absolutely right that tax reform is a key part of that…
We need to continue to work on the social determinants of health, such as poverty, better nutrition, education, and so forth, as I have said. Crucially, as noble Lords have made clear, we need the empowerment of girls and women, to enable them to have voice, choice and control within their households, their wider communities and across their nations. Noble Lords have made a powerful case for that. That means working at every level. I agree with the right reverend Prelate that that clearly involves working at community level and we have our aid-matching system as one of the key mechanisms for that. There are others in our portfolio of support for civil society…
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