The SDGs’ Meaning for Maternity and Reproductive Health Studies

Author: Professor Sara L. Hillman, University College London

As my Reach colleagues have so eloquently described, the SDGs “come with concrete and measurable targets.” This fact chimes well with many practising obstetricians’ and reproductive health specialists’ interested in global health challenges, who can relate to interventions and practices that have measurable and direct outcomes. Such data-driven approaches can empower and motivate, providing a means of measuring impact and in turn, conveyance of that impact. In a world with endemic adverse health issues, those pertaining to reproductive health rank among the most severe and emotional, often directly revolving around life and death for pregnant people, their unborn babies, and newborns. Maternal and neonatal mortality rates remain stubbornly high, with a disproportionate number being experienced in low- and low-middle-income nations. Urgent and direct measures are required to stem the tide of inequalities and adversity that many people and their families experience globally, but the question remains how to do this effectively. 

As well intentioned as the SDGs are, there is an inherent lack of focus about how to achieve their targets. In fact, like their predecessors, the Millennium Development Goals (MDG), many targets set are not likely to be met and may even be missed by a significant margin, negating their intrinsic value. MDG Target 5A aimed to reduce the maternal mortality ratio by 75% between 1990 to 2015 but fell short reaching only a 40-50% reduction. According to the World Bank. MDG 5 made the worse progress of all the Millennium goals.  This begs the question about the utility of setting such lofty targets and their applicability in different settings or topic areas. It also provides no rectifying mechanism to change course easily or to be able to offer a “yardstick” measure of success and failure. Despite the investment and global engagement in the creation of the SDGs, it is difficult to immediately conclude that the goals have enacted positive change, which is surely their primary aim. What are the markers of and the mechanisms that lead to, improved health outcomes (the SDG areas that, as a practising obstetrician, I most relate to)? In our line of work, interventions that ask the right question, describe and disseminate the intervention, and provide evidence for the impact, are generally the ones that make the most difference. When combined successfully, this works well in the short term, but long-term change is challenging and requires funding. It also requires study of those factors that most sensitively reflect successful long-term change, along with how best to embed it within local existing health systems. 

Undoubtedly, the SDG agenda provides aspirational ideals across several domains setting the overall scene more comprehensively. SDG 3 addresses maternity directly with a pledge to reduce the MMR to 70 /100,000 live birth by 2030 and a focus on access to skilled birth attendants and quality care which certainly tries to address the needs of people at the margins of society and the disadvantaged. However, it does not provide researchers — those with actual “boots on the ground” — the necessary tools or insight to who these populations are, let alone how to reach them. In the research sphere, the SDG agenda would be bolstered by clear signposts to relevant expertise, ways to record targets that are reliable, reproducible, and standardized, along with previous work in the area, and  funding opportunities. We need awareness of local government policies and internal national priorities to more successfully integrate and deliver on individual SDG aims. Research and its priorities need to be set by those affected by the issues, not dictated by external policy (which may lead to conflict with approaches being taken to address SDGs and needs investigation). Therefore, the concept of more than one approach or target needs to be contemplated and/or described. A target is helpful to have as an end goal but the intervention and change that occurs is the thing that needs to be captured to reproduce and translate to other settings. Finally, what do we do with a “successful” SDG metric? Does one move on? Reproduce it elsewhere? Apply to other goals? And where conventional success is not achieved, are there other ways to identify if measures have alleviated some of our most debilitating and destructive health challenges?

“As well intentioned as the SDGs are, there is an inherent lack of focus about how to achieve their targets … We need awareness of local government policies and internal national priorities to more successfully integrate and deliver on individual SDG aims. Research and its priorities need to be set by those affected by the issues, not dictated by external policy (which may lead to conflict with approaches being taken to address SDGs and needs investigation). Therefore, the concept of more than one approach or target needs to be contemplated and/or described.

– Professor Sara L. Hillman, University College London

About the Faculty Mentor Paper Series

This paper is part of the Reach Alliance faculty reflection series, Reimagining the Future of Sustainable Development, in response to Mariana Prado’s Sustainable Development Goals: The End of Theory? Featuring contributions from leading scholars across the Reach Alliance global academic consortium, the series opens a timely dialogue on the evolving role of universities in shaping the future of sustainable development theory and practice. Developed as part of Reach’s commitment to advancing research-to-impact and fostering interdisciplinary collaboration, these reflections aim to engage higher education professionals in shaping the future of the Sustainable Development Goals.