Maternal Health Issues ‘Aren’t Finished Yet’ — and Neither is Jill Sheffield
In 2007, 1,700 people gathered at a large conference center in an east London borough. They’d come at the invitation of Women Deliver, a fledgling advocacy organization founded by Jill Sheffield that same year. It was time, she told them, to challenge the world’s vision of what could be done to lower maternal mortality.
The ExCeL Exhibition Center — where the European community held important gatherings and where the U.K.’s prime minister held cabinet meetings — was the venue of choice, not just for its capacity, but also for its aesthetic. The shiny, modern building was the antithesis of the dark cloud that hung over those working to reduce the overwhelming number of maternal deaths globally.
An issue that had for years been vanquished to dusty, poorly lit meeting rooms had found itself a concentrated spotlight — and a resolute champion in Sheffield.
The former teacher, who had already devoted her entire career to education and advocacy for maternal, reproductive and sexual health and rights, had conceptualized Women Deliver with the desire to mobilize more people to take action that “never thought they could or would or should,” she told Devex.
“Our community was being reluctant about confronting the central reasons for languishing maternal mortality rates … they just didn’t want to admit it in public, in the sunshine, what the principal issues were,” Sheffield said. “But we said ‘We’re not going to leave here until we can all agree to what the key problems are and what we’re going to do collectively to tackle them.’”
Conversation during that 2007 conference revolved around potential solutions to a long list of “lacks”: Lack of family planning, lack of access to contraception and lack of skilled professionals to help women during pregnancy and childbirth, combined with unsafe abortion.
Every three years since, a growing number of people have gathered to discuss the health, rights, and well-being of girls and women at Women Deliver conferences, with the topic now having expanded far beyond maternal mortality.
In May, Women Deliver will welcome close to 6,000 people to the fourth conference, this time in Copenhagen — chosen for Denmark’s long-standing investment in gender equality and in women and girls. It will be the largest yet, and also Sheffield’s last as acting president of the organization she founded. She’ll step down following the conference but will continue on as president emeritus, and she’ll certainly continue championing maternal health, she told Devex.
Sheffield’s passion for work in maternal health can be traced to Nairobi, where she worked at the tail end of the ‘60s for the then-brand-new Family Planning Association of Kenya. The outpatient family planning clinic, adjacent to a maternal hospital that performed 100 deliveries a day, had accepted Sheffield’s offer to volunteer when she moved to the East African city after finishing her graduate degree in international affairs and comparative education at Columbia University.
The doctors, nurses and midwives she worked with were incredibly talented, she said, but “I got there and they didn’t have patient registration forms, so I designed them. They didn’t have a filing system, so I set one up,” she said, describing her work at the six-bed clinic, for which she also fashioned curtains to provide privacy for patients receiving pelvic exams.
On Sheffield’s 27th birthday, she interviewed a woman who had brought her two young children with her to the clinic. The mother also happened to be 27.
“But that’s where the similarities stopped,” Sheffield said. “She had 11 pregnancies and six living children. I had none. And it was all about choice.”
It was a lightbulb moment for Sheffield, who decided if the young woman could get up in the middle of the night to bring her two babies all the way to the clinic and spend hours waiting in the hot sun to be seen by the doctor, then “I’m going to try to make changes so that more women have a choice,” she told Devex. “So that’s what I’ve been doing, 40-some odd years.”
Sheffield went on to work at the Carnegie Corp. of New York, and founded the nonprofit Family Care International before establishing Women Deliver. Her work there has ranged from fundraising to developing new advocacy tools and resources, to championing youth programming. But the conferences are what the world has come to expect from the organization, and this year’s has quite a legacy to live up to.
The second conference, held in Washington, D.C., welcomed 3,400 attendees — and a more diverse presence from throughout the development industry than the first. Maternal, reproductive and sexual health was still a small community: “We were noisy from time to time, but we knew this was part of larger development landscape, and we needed help from other sectors.”
It was clear that if you spend resources to educate girls and women and then they die a maternal death, Sheffield said, then that’s a poor outcome. So she worked hard to entice other communities to join them in conversation, and felt the industry became more inclusive in the way they looked at maternal health, mortality and morbidity thanks to that second meeting.
The third meeting, in 2013, started with a surprise. In the middle of his opening speech, the prime minister of Malaysia stated firmly that family planning is a human right.
There was stunned silence, Sheffield said, from the 4,500 people who had come to Kuala Lumpur for the conference.
It was a “landmark moment” to have the head of an Asian, predominantly Muslim, country be so bold, she said. But they’d chosen Malaysia because it was excellent example of a nation that tackled its high maternal mortality by making a political decision to institute a health system that branched out from urban centers to bring far-reaching access.
“They did it, and it showed the power of the body politic,” Sheffield said. “We had two years left of MDGs. We knew at that time that MDG 5, reducing maternal mortality making universal access to reproductive health care, that was not progressing as well as others.”
Women Deliver wanted to use that occasion to say to the world, “Hey women are really important, women deliver babies, and too often they die doing that. Not only that, women deliver almost everything. And listen up, world, because this is an enormous resource that we’re wasting,” Sheffield told Devex.
But when the 2015 deadline came, Millennium Development Goal five had made the least progress, and remained the most underfunded of the health-related MDGs.
That’s not to say zero progress was made. In Northern Africa, the proportion of pregnant women who received four or more antenatal visits rose from 50 percent to 89 percent between 1990 and 2014. There’s been progress, too, with the maternal mortality ratio, or the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. It fell by 64 percent between 1990 and 2013 in southern Asia and by 49 percent in sub-Saharan Africa, according to the Millennium Development Goals Report 2015.
Now, Women Deliver’s fourth conference will look at the “scary big” opportunities of the Sustainable Development Goals agenda, which set a target of reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, Sheffield said. She hopes to “bear down hard on what the opportunities are for the best return on investment in development for governments.”
It will also follow the formula of conferences past: not dwelling on problems and talking instead about solutions. Sheffield expects there will be discussion of the impact of climate change on women, what Zika means for women and their families and how to tackle what she sees as the lingering obstacle to stronger, inclusive maternal health: political will.
Globally, maternal mortality has declined by nearly half since 1990, but it isn’t enough, she said. With more than 220 million girls and women globally who say they would like to plan their next pregnancy but don’t have access to services or supplies or information, the role she took on as their advocate long ago still feels far from done.
“If you can’t plan your fertility, you can’t plan your life well,” Sheffield said. “But too many of our policy makers all over the world are nervous about girls and women,” Sheffield said. “They’re still not sure what investing in them is going to yield.”
This year’s conference will seek to break it down into digestible pieces for decision makers at all levels, including government, civil society and the private sector. Sheffield mentioned the letter she recently received from the first lady of a country in sub-Saharan Africa, who requested an invitation to join her minister of health at the conference.
She’s optimistic about how many minds have already been changed, and hopes attendees view the conference as a time when “reality is suspended a bit and you can think in different ways and more laterally.”
There will be a large portion of young people at the meeting, following Women Deliver’s decision that 20 percent of attendees should be under the age of 30.
“It changes the conversation, it gets lively,” Sheffield said of young attendees, and their growing young leader program is one Women Deliver initiative she’s excited to watch evolve after her departure.
Sheffield also teased that in Copenhagen, Women Deliver will be launching a new inclusive initiative that will help governments and organizations choose their investments in girls and women to speed progress in addressing the health of women and girls.
As for what’s next for Sheffield, “however I can help these ideas move forward is what I’m going to be doing. I like to work, I love to work on these issues, there are a number of things on the horizon, including spending a little more time with my husband.”
“The issues aren’t finished yet, so I’m not finished,” she said.
Photo courtesy of: Dominic Chavez/World Bank