Jill Sheffield: This time, we know what to do
Reading the news is usually an ordeal of watching the world fall apart at an accelerating pace, so when four United Nations agencies offer a new count of mothers’ deaths worldwide in pregnancy and childbirth, one braces for another depressing and insoluble problem. The numbers over the past 20 years, after all, have been stubbornly high: one death per minute on average.
Today, however, the news is jarring because it’s good: the 2008 total of maternal deaths is down 35 percent from 1990. About 358,000 women died in 2008 from complications of pregnancy and childbirth, according to Trends in Maternal Mortality, a recent joint report from the World Health Organization, UNICEF, the World Bank and the United Nations Population Fund. The study reinforces one by the Institute for Health Metrics and Evaluation (IHME) earlier this year that put the number at 342,900. Both figures translate roughly to one death every 90 seconds. That’s a definite improvement over one per minute. But is it enough?
Of course not. A thousand women per day is still a horrendous toll in human devastation, and it is almost completely unnecessary. Disparities among the 171 countries ranked in the UN report prove that we know what to do to save women’s lives, and that where governments have had the political will to invest in meeting women’s needs, even in the developing world, those investments have paid off.
Resource-poor countries like Bolivia, Romania and Vietnam have lowered their counts and are on track to meet the Millennium Development Goal (MDG) of reducing maternal deaths by three-quarters below 1990 levels, the report says. Where governments have not made those investments, as in much of sub-Saharan Africa and southern Asia, pregnancy continues to be a life-threatening event and the MDG is on track for failure. So are the rest of the eight MDGs, because maternal mortality rates have been proven central to a country’s well-being.
When a woman dies after giving birth in the developing world, her newborn baby is unlikely to survive, and her other children – especially daughters – will be poorer, hungrier, less educated and more susceptible to childhood illness and abuse. A million children are left motherless every year by pregnancy-related deaths. And for every woman who dies, another 20 suffer illness or long-term disability such as infection, fistula or infertility, costing their families, communities and countries vast sums in lost productive capacity.
But finally the numbers are coming down. So what does the trick? The four main causes of maternal death are infections, hemorrhage after delivery, high blood pressure and unsafe abortions. These are all preventable or treatable where women have access to health systems that respect their rights and provide key services. Those include family planning, prenatal and post-natal care, trained assistants at delivery, emergency treatment for complications and safe abortion where it is legal.
The unmet need for family planning alone is huge: More than 215 million women want to avoid pregnancy but are not using modern contraception, and demand is expected to grow 40 percent by 2050 as history’s largest generation of young people grows up. In America we take post-natal checkups for granted, but most women in Africa never see a doctor or nurse or any health worker after giving birth.
One measure that would help is the Global MOMS Act, co-sponsored by Rep. Lois Capps (D-CA) and 74 other House members. It would expand women’s access to essential maternal and child health services in the countries of greatest need and better coordinate existing U.S. programs. This week world leaders convene at the UN to review progress on the MDGs. UN Secretary-General Ban Ki-moon and other partners are launching a Global Strategy for Women’s and Children’s Health to spur political commitment and financing.
The world is full of desperate problems, and we need to put our resources where the need and return are greatest. But the cost of not investing in women grows every year, and maternal deaths are one problem we can solve immediately, at a reasonable cost, with the technology and knowhow we already possess. That is the great hope and the really good news behind the numbers of declining maternal deaths.
Jill Sheffield is president of Women Deliver, a non-governmental initiative to reduce maternal mortality and establish universal access to reproductive health care worldwide.