In person: Susan Clapham, health advisor WHEN a 21-year-old from Edinburgh looked on helplessly as a Bangladeshi woman died a long, slow, agonising death during childbirth, it understandably left a strong impression. For Susan Clapham, it also marked a turning point in her life. Now aged 50, Clapham was no naive youngster on a do-gooding gap year. She was born in France and schooled in Edinburgh and her father had worked in impoverished countries for the Foreign Office. As a result, she saw at first hand how extreme poverty affects people's lives. "I was raised in Africa and I got interested in the lives of others as a child," she says. I was raised to understand poverty and its impact on others, and that influenced me in terms of what I wanted to be professionally and took me into nursing and midwifery. She spent 11 years working in Nepal, then spent time in Ethiopia, Somalia and India. In fact, it was in a refugee camp in Ethiopia that she met her husband, Gerard, who hails from Fife. Now acting as a health advisor for the UK government's aid programme in Malawi, she was awarded an MBE in 2010 for public service and is now responsible for ensuring aid goes where it is needed most. One of the most pressing needs right now is saving mothers" lives. "We estimate about ten women a day die during pregnancy and childbirth," says Clapham. That's about one in 36 women, compared to one in 4,600 in the UK. There are a number of reasons for that. The first is that fertility is very high - Malawian women have on average of five or six children each, and that puts them at risk of dying in childbirth. Yet fewer than half of those women have access to modern family planning methods, and a high number die following unsafe abortions as a result. Recalling the first time she saw a mother-to-be losing her life, Clapham says, "It was in Bangladesh, and it was a very painful, slow death of a very young girl. It stuck in my mind vividly and was a pivotal point for me wanting to work in maternal health. I've seen quite a few deaths in different countries, and it is an awful way to die. And yet, saving many of these lives would be a simple matter of providing family planning, bringing down the number of children being born and also easing the financial strain on already desperately poor families. "We are making progress," says Clapham, "but we've a long way to go. The women in Malawi definitely would choose to have less children than they have at the moment. We can see that inter-generational change from mothers talking to daughters and grandmothers; it changes over the generations, and that awareness and appreciation for having less children is certainly growing. "It's up to all women," she adds. They can have as many children as they wish but generally we can see the desire to have fewer. That movement towards change culminated in a major international summit in London last week, hosted by the UK government and the Bill and Melinda Gates Foundation and aiming at giving 120 million women who want to use family planning methods the opportunity to do so by 2020. The firm commitments made last week will save the life of one woman every 20 minutes over the next eight years. "I was there as part of a delegation from Malawi," says Clapham, "which was led by the vice president, the Honourable Mr Khumbo Kachali, who is also the minister of health. He and the president of Malawi, Joyce Banda, are great champions for maternal health and passionate believers in family planning. It was a landmark moment. But the commitment for change is not just a financial one. The countries themselves are making a political commitment to do a range of activities. Many require money but others don't. For example, the vice president of Malawi has said he'll raise the legal age of marriage to 18 - it is currently 15 with consent. He's making a commitment that doesn't cost any money but will make a real difference to girls" lives." The UK's international development secretary, Andrew Mitchell, says, "This is an extraordinary breakthrough for millions of the world's girls and women. Being able to plan the size of her family is a fundamental right that we believe all women should have. Clapham now has time for a break in Mull, where she has a cottage and has been holidaying since she was ten. I'll be spending some time with family and friends. I don't think the weather will be good enough to swim but sometimes we manage to get a foot in the sea. Then she will soon return to her work in Malawi, "feeling very encouraged and quite emboldened," she says. The new programme is just taking off now so we'll have renewed energies to get that operational as soon as possible. Ruth walker www.londonfamilyplanningsummit.co.uk; www.dfid.gov.uk/changinglives