"The UK Government's spending on maternal health is increasing every year. But much more needs to be done with governments, the United Nations, and non governmental organizations if the global community is to achieve the Millennium Development Goals by 2015," says Gillian Merron, the UK Government's Under-Secretary Of State For International Development. Merron was speaking at a Women And Children First conference in London at the beginning of March, where experts met to discuss how to promote a greater focus on reproductive health in the Millennium Development Goals (MDGs).

At the conference, Dr. Francisco Songane, Director of the World Health Organisation's Partnership For Maternal, Newborn and Child Health, put the challenge into real terms. He says an additional US $10 billion is needed if the MDGs on maternal and child health are to be met by the target date of 2015. Official figures for 2005 indicate that 536,000 women die in childbirth every year, although unofficial estimates suggest this figure may be as high as 872,000. MDG 5 seeks to reduce the level of maternal mortality by 75% by 2015, but has – according to Women And Children First – made the least progress of all MDGs.

Ros Davies, Chief Executive of Women And Children First, says, "Everyone must act now if we have any hope of meeting the target. We know what needs to be done. We need more health clinics and equipment, trained workers to deliver babies, safe abortion, and full access to contraception – and all communities should be demanding these."

UNFPA has a nicely articulated chart indicating where and when and how reproductive health contributes positively to all eight MDGs. But the fact remains that reproductive health – in all its facets and disciplines and agendas – is not a strong theme in any or all of the MDGs. And while the MDGs remain, for good or bad, a primary international development agenda at least until 2015, that means a continuing compromise for reproductive health in international development.

Barbara Crossette provides one explanation for the lack of reproductive health in the MDGs, a compelling if rather depressing analysis of the hows and whys and wheres of how things get done at UN and government levels. She quotes the then IPPF Director General Steve Sinding describing the MDGs as "dead letters" if the commitments of the International Conference On Population And Development (ICPD) in 1994 were not specifically upheld in them.

Women And Children First is arranging a further meeting in April to discuss future strategies for UK-based NGOs and their work in promoting reproductive health in the MDGs agenda. The general consensus from the first meeting in March is that work is needed to establish which reproductive health organizations are doing what in terms of advocacy and the MDGs. This process should apparently increase awareness of existing expertise and experience, and hopefully ensure future collaborations are optimally effective. This is a laudable and much needed strategy, especially as we hit the half way mark of the MDGs agenda. (2000 to 2015 is the life span of the ambitious MDG targets and expectations.)

But optimum effectiveness will not be achieved by a rethink of what has already failed to attract the attention of parliamentarians and policy makers and the United Nations decision brokers for the last quarter of a decade since ICPD. Optimum effectiveness will be achieved if and when reproductive health is high on policy agendas before declarations are written, and before goals are decided, and before proposals are put to invariably compromised and compromising United Nations bodies and their pay masters. The continuing trouble with reproductive health within the development agenda is that it is always an after thought, an uphill struggle against a trenchant fait accompli, something to loudly complain about after the event rather than strategically integrate at inception.

The MDGs will come, and go. They will be replaced by some other structures and goals after 2015. Time to think longer term if reproductive health and rights are to become truly integrated into the international development agenda. We may not, as individuals or organizations AND politicians, benefit directly from this long term agenda. But some of those many many thousands of women whose lives and families are so severely threatened by a lack of comprehensive reproductive health services will benefit if we get it right. And that is exactly what development should be about.