Mr President,
Honourable Ministers
Ladies and Gentlemen

I am very pleased to be able to launch the Making Pregnancy Safer Initiative today.

As Director-General of WHO, I believe the fight against poverty to be our global cause as we set the course for a new century. I believe health must be at the heart of this struggle. And no other health issue is more directly linked to poverty than the conditions related to pregnancy. A poor woman is 300 times more likely to die during pregnancy or in childbirth than one who is better off. These are appalling numbers and a challenge to all of us.

Together with the fight against the other main diseases of poverty, making a concerted and systematic effort to making pregnancy safer is a way of reducing poverty. It works both ways – poverty leads to ill health and ill health leads to poverty. We need to invest in the health of our people, and not least in the mother and new-born child.

Let us be very clear about this issue. Women who suffer and die as a result of pregnancy-related complications are not dying because of disease. Pregnancy is a normal part of human development and should be a time of joy and happiness. Around the world, all women suffer and die from the same complications - bleeding, infection, hypertension, obstructed labour and complications of abortion.

The fate of the newborn is inextricably linked to the health of the mother both before and during pregnancy and delivery. Of the more than 4 million deaths of infants aged less than one month each year, 3 million occur within one week of delivery, largely as a consequence of poorly
managed pregnancies and deliveries. Millions more are crippled by birth trauma and asphyxia during delivery, or suffer lifelong consequences.

We simply cannot afford such a drain on precious human resources.

Good pre-natal care and qualified birth attendance mean fewer serious complications and healthier infants. It means fewer economic shocks for poor parents and a better start to life for their children. Women are often the main bread winner of poor families. Healthy pregnancies and child-births mean less of a disruption of the income-flow of the family.

We have a long way to go. Around the world, every minute of every day a woman dies due to pregnancy or child birth complications. Every 45 minutes that woman is an Indonesian. She dies because there is no skilled person to handle complications during delivery, or because she has been referred to hospital too late. She may even die in the hospital, because she does not receive the treatment she needs.

Around 20% of those who die around the world are adolescents. Special emphasis must be placed on youth. In Indonesia pregnancy during adolescence increases the risk of maternal death 2 – 4 times. A large portion of these deaths are due to unwanted pregnancies or inadequate access to care. Safe access to contraception alone may cut maternal deaths by half.

Globally, more than 20 million women experience ill health as a result of pregnancy; and for some the suffering is permanent. Nearly a quarter of all Indonesian women fall ill during pregnancy, delivery and after birth.

Women in Indonesia as well as women around the world are dying more often in rural and remote areas than in the cities, especially in areas where basic infrastructures and services remain minimal. It is unacceptable that so many of these deaths are preventable.

High levels of maternal mortality represent the failure of health systems, policies and programs to address the essential needs of women, not only in Indonesia, but all over the world.

Despite this, previous efforts to reduce maternal mortality have met with too limited success in many countries. This is why WHO now has created the Making Pregnancy Safer Initiative.

The key messages that will guide WHO' in its contribution to Making Pregnancy Safer and Safe motherhood will be:

• every pregnancy should be wanted,
• all pregnant women and their infants should be able to access skilled care, and
• all women should be able to reach a functioning health facility to obtain appropriate care for themselves or their newborns when complications arise during pregnancy, delivery or the postpartum period.

We have learnt a lot from our past efforts. The Safe Motherhood initiative has given much greater visibility to the hidden inequity of maternal ill health. It has supported evidence-based practices and contributed to a joint consensus on global action for making pregnancy safer.

The fact that we launch Making Pregnancy Safer here today, however, does not mean that Indonesia has not already made progress.

In the last decade, there has been a significant achievement in increasing access and improving quality of services in reproductive health. An impressive number of community midwives – 60,000 – has been trained and posted in villages throughout Indonesia. The target to place one community midwife in each village was achieved in 1996.

The coverage of antenatal care visits reached 90% before the economic crisis hit in 1997, and by that time 60% of deliveries were attended by trained health providers.

The multi-tiered health system reaches to the lowest levels of the community and is an important foundation for the further work to strengthen reproductive health in the country.

The Mother Friendly Movement initiative is one of several community-focused activities aimed at raising knowledge and awareness.

I am very impressed with the national policies on reproductive health that have been formulated in the Healthy Indonesia 2010 document. Any effective work to improve reproductive health must take place against a true political commitment to empowering women, respecting their rights and status. In this effort it will be essential to involve community members, health workers and government representatives from all sectors, from the central to the village level.

Although service availability has improved, there is more ground to cover. Activities need to be focused on improving the quality of services, as well as improving the co-ordination of the referral system and the health system in general.

In Indonesia you are in a process of decentralizing your health system. These changes may have a profound impact on resource development and use, and on the delivery of services, and could significantly contribute to making pregnancy safer.

The challenge for Indonesia’s policy makers and health care providers will be to ensure that the reproductive health needs of a diverse population are adequately addressed in this new, decentralized health care system.

WHO has will assist our member states in making pregnancy safer. Our goal is to reduce the global burden of unnecessary death, illness and disability associated with pregnancy, childbirth and the neonatal period.

The Making Pregnancy Safer Initiative highlights our commitment and contribution for the next five years to the world wide Safe Motherhood movement.

Indonesia has been chosen as one of the first ten countries where WHO will initiate MPS activities, expanding to a total of 50 countries over the next five years.

WHO would also like to appeal to all partners and sectors so that we work in collaboration to best ensure that all pregnancies in Indonesia are wanted, that women can go safely through pregnancy and childbirth, and that newborn children are alive and healthy.

While every death is a tragedy, the death of a young woman, who may have other children who depend on her, is a multiple tragedy.

Pregnancy is special: Let us make it safe!

In conclusion, I too would like to join the White Ribbon Alliance in saying: "Ibu selamat, bayi sehat dan keluarga bahagia" (mother is safe, baby is healthy and family is happy)