Aid watchdog accuses DFID of exaggerating maternal health impacts

LONDON — The United Kingdom’s work on maternal health and family planning has fallen short of expectations and the Department for International Development may have exaggerated the number of lives saved through its work, according to an aid watchdog.

The Independent Commission for Aid Impact, an independent body that scrutinizes the U.K.’s aid budget, released its review of DFID’s maternal health efforts on Tuesday. It found that the aid department has not done enough to reach the most vulnerable women and girls, and that some of its programs have prioritized short-term access gains over quality and sustainability.

Overall, ICAI gave the department an amber-red score for its maternal health work, the second-worst rating under its color-coded system.

More than 300,000 women died from complications related to pregnancy and childbirth in 2015. The vast majority of those deaths were in lower-income countries, with adolescent girls most at risk, according to the World Health Organization. The Sustainable Development Goals pledge to reduce the global maternal mortality ratio to less than 70 per 100,000 births by 2030, but most high-mortality countries are off track.

Alison Evans, ICAI’s chief commissioner, said in a statement: “The U.K. is clearly committed to improving maternal health, and DFID has successfully expanded access to crucial services. However, given the ambition, need and level of investment, the programs fell short of what was required to achieve adequate progress.”

The report also questioned DFID’s data on the number of maternal lives saved through its work. In 2010, the department set a target of saving 50,000 lives by 2015 and subsequently announced its programs had exceeded that target, saving 103,000 lives. Yet when ICAI researchers tested DFID’s model, they said it was “based on assumptions that did not match the reality of DFID’s programs, and was too high given other data on reductions in maternal mortality over this period.”

DFID disputes ICAI’s findings, which it says are drawn from a small sample, including only two country visits; and that it does not take into account its work beyond 2015. Between 2011-2015, the U.K. aid agency spent £1.3 billion ($1.66 billion) on family planning, reproductive health care, and maternal and neonatal health. It has also been a global champion of family planning, hosting two international pledging conferences in 2012 and 2017. At the 2017 London Family Planning Summit, the U.K. promised an additional £45 million toward family planning every year until 2022.

“It is disappointing the report has made some generalizations from a selected portion of our programming and also does not fully reflect the full impact of our work, especially in recent years,” a DFID spokesperson said in a statement. DFID will publish a written response to the report in the coming months.

The ICAI review also criticized the aid agency for a “limited focus on reaching the poorest, youngest and most vulnerable women through its programming or monitoring,” especially in relation to DFID’s stated target group of 15-19-year-old girls.

It pointed to “shortcomings” in the quality of interventions supported, including “severe shortages” in beds, trained personnel, equipment, and supplies, meaning reductions in maternal and newborn deaths were not as high as they could have been, the report states. It adds that many of DFID’s programs were too focused on short-term deliverables at the expense of strengthening national health institutions and infrastructure. 

The report made five recommendations, including that DFID “clarify its approach to health system strengthening”; that it design and monitor programs to target adolescents and poor women; and put resources into tracking maternal health data.