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Sexual and Reproductive Health and Rights Situation Report: Maternal Mortality

October 12, 2009

The Sexual and Reproductive Health and Rights Situation Report is a monthly column highlighting advances or setbacks in SRHR policy internationally.

This month instead of focusing on a specific country, I’m going to broaden the scope to address a global epidemic– maternal mortality.  Each year more than a half a million women die during pregnancy, giving birth, or in the critical few weeks following birth.  That’s one woman every minute; most die from preventable causes, and most deaths (99%) occur in poor countries.  In fact, the difference between maternal death rates in developing countries as compared to developed countries is absolutely staggering.  Women in the developing world are 300 times more likely to die in childbirth than their counterparts in industrialized countries.  According to a UNICEF report, “A woman in Niger has a one in seven chance of dying during the course of her lifetime from complications during pregnancy or delivery. That’s in stark contrast to the risk for mothers in America, where it’s one in 4,800 or in Ireland, where it’s just one in 48,000.”  In addition to those women who perish, for each death 20 women suffer from illness or permanent injury like fistula.

The reduction of maternal mortality is part of the fifth Millennium Development Goal (MDG) but has only recently really begun to garner international attention.  Sarah Brown, wife of the British Prime Minister, just had a piece on maternal mortality on the Huffington Post–a ticket to issue stardom.   More voices than ever before are trying to put and keep maternal mortality on the agenda.

One UNFPA communications specialist says more women die in childbirth than in wars.  Ban Ki Moon recently called current rates of maternal mortality “inexcusable,” especially in a world where we can “map the human genome and send vehicles to far reaches of space.”  In addition, simple clinical interventions could drastically reduce the numbers of deaths, according to public health journal The Lancet.

A few countries where high rates of maternal mortality have recently made news:

A hospital in Ethiopia.  Image care of The Huffington Post

A hospital in Ethiopia. Image care of The Huffington Post

Ethiopia: Twenty-two thousand women die every year in childbirth or of related causes.  According to this HuffPo series, the major issue is health systems and access.  The country of 77 million has about 200 gynecologists, and most women live far from clinics.  The Ethiopian government’s response is an army of “health extension workers,” but even they can’t provide all the necessary services to the 15% of women who experience complications due to pregnancy or birth.

Nigeria: As the Center for Reproductive Rights has reported, nearly 60,000 Nigerian women die every year from pregnancy-related causes, but only 5% of the country’s annual budget goes to the health sector.    And although “Nigeria accounts for only 1 percent of the global population, it contributes 10 percent to the number of global maternal and child deaths.”  Half of the maternal deaths are the result of postpartum hemorrhaging, which could be stopped with proper equipment and trained personnel.

Bangladesh: The BBC calls Bangladesh “one of the most dangerous places in the world to have a baby.”  As part of the “Survival” documentary series, the BBC has focused on maternal mortality there.  The documentary shows home births attended by traditional midwives, and points out that they lack access to lifesaving medical care if complications arise.  It also mentions that programs like microlending have led to the empowerment of women.

Sierra Leone: Amnesty International has just launched a campaign on maternal mortality in Sierra Leone, pointing out the fact that health is a human right.

Amnesty president Irene Khan has toured Sierra Leone and blogged the whole way, posting stats and pictures.  One in 8 women die during childbirth in the country, many because they could not afford the fees associated with reproductive health care.  In this report, Amnesty calls on the government to fix its corrupt and inadequate healthcare system, and to remove cost as a barrier to care.  The government of Sierra Leone denies the validity of Amnesty’s report.  You can write a letter to the president of Sierra Leone here.

Mother and newborn in India

A woman and her newborn in India. Image care of the Swedish International Development Agency.

India: This Human Rights Watch report points out that maternal death rates in the Indian state of Uttar Pradesh are the highest in the country, but that it’s not an isolated problem— about one in five maternal deaths last year took place in India.  All over India, women die from infection and shock after childbirth.  One nonprofit has anti-shock garments that have fallen out of favor in more developed areas because they are a time-consuming, yet simple, alternative to ongoing basic care.  The tight, girdle-like fabric must be worn on the trip home after giving birth to reduce the risk of hemorrhage, and then removed very slowly.  A friend and colleague from India once explained to me that her work with maternal mortality centered around the concept of the “five cleans,” basics like soap for washing the midwife’s hands, a clean razor, and a plastic sheet on which to deliver the baby.  Such simple interventions underscore the ease with which the international community could address maternal mortality, if the political will were there.

Swaziland: Rising maternal mortality has been attributed to “home delivery and lack of skilled attendants” and poor health infrastructure.  The country is focusing on maternal mortality as part of its National Programme on Sexual and Reproductive Health.

It seems that most of these stories point to common causes for staggering rates of maternal morality.  Poor health systems come up over and over in accounts of African countries’ maternal mortality statistics.  This often includes lack of trained staff, lack of physical infrastructure making access difficult, and inadequate healthcare delivery systems.  But given the health systems explanation for high levels of maternal mortality, what is the US’s excuse?

The United States: Black women in the US die from pregnancy or birth-related causes at almost double the rate of white women.   Check out this wonderful series on African American maternal health at Women’s Enews.

And overall, the US has been ranked among the worst industrialized countries for maternal health by Save the Children.  What’s going on here?

I think an overarching theme is the disempowerment of women by an international culture that seems to see women’s bodies as a commodity and females as expendable.  Although maternal mortality has become a bigger blip on the world’s radar, a woman dying a minute of a preventable cause is nothing short of outrageous– as Amnesty says, a human rights emergency.  The “position of women” emerges again and again as the root of maternal mortality.  “Study after study shows that investing in women brings broad economic and social benefits,” says Ban Ki Moon.  UNIFEM has said that although the medical and health systems causes are often emphasized, the solution truly lies in the empowerment of women.

Although health systems reform is critical, we must also keep working to force the heteropatriarchy to recognize women as agents in our own lives, as full citizens, and as equal human beings deserving of the full spectrum of human rights.

Brook Elliott-Buettner is a freelance human rights policy researcher and writer living in New York. More information and work is available at www.brookelliottbuettner.com.

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