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Political Neglect Kills Mothers by the Millions

Wednesday, October 17, 2007

Millions of women are still dying in childbirth and Ann Starrs calls it a global scandal of political indifference. A major conference opening in London tomorrow will seek to energize change-makers.

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Millions of women are still dying in childbirth and Ann Starrs calls it a global scandal of political indifference. A major conference opening in London tomorrow will seek to energize change-makers.
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Ann Starrs

(WOMENSENEWS)--The Women Deliver conference that opens Oct. 18 in London will not be examining the problem.

It won't be a talkfest. It will be an effort to create a worldwide scandal.

The idea is to bring more than 125 cabinet ministers, parliamentarians and civil society representatives from the 35 countries where women are dying at the fastest rates from childbirth and get them--and the donors who fund much of their health services--to stop doing business as usual.

For too long, governments and donors have said that maternal mortality is too small a problem, or too difficult to solve, or costs too much. The conference will answer each of these points in turn, by presenting data on the huge burden maternal deaths impose on society, by highlighting clear strategies and successful model programs and by showing that saving women's lives would actually save money.

The U.S. Agency for International Development estimated in 2001 that the global economic impact of maternal and newborn mortality was $15 billion a year in lost potential production, half associated with the deaths of women and half with newborns.

Other studies by the World Health Organization have estimated that preventing nearly all those deaths would cost only about a third as much, or $4 billion to $6 billion in international development aid to the 75 countries where 95 percent of maternal and newborn deaths occur. That's only 2 percent of current aid levels, well within the grasp of donor countries.

The 1,500 conference participants include major political and public figures, health professionals, social scientists and advocates for women's rights. They work in education, poverty reduction, human rights, gender issues, sexual and reproductive health, HIV-AIDS, nutrition, environment and child health.

Together they will outline the ways that investing in women is cost-effective and produces everything development communities work to achieve: economic progress, rising rates of literacy and productivity and better health and well-being for families, communities and nations.


Creating a Scandal

The hope is that the meeting will create a scandal big enough to change a problem that has been well understood for years. The signs of change are there; already in the past few weeks, several European donor countries have announced major new initiatives--and in the case of Norway and the Netherlands, major new money--for maternal and child health, as well as gender equality and strengthening of health services more generally. We need to make sure that for maternal and child health--MCH--programs, the "M" gets the support and funding it needs.

Twenty years ago, at a 1987 conference in Nairobi, Kenya, public health advocates worldwide united to spotlight the worst inequity in their field: Half a million women, nearly all in the developing world, were dying every year from pregnancy-related causes.

High fertility and women's low status in those countries, combined with ragged health care systems, were killing one woman every minute of every day. More than 10 million women per generation.

The global Safe Motherhood Initiative was launched at the 1987 conference by a group of U.N. agencies and nongovernmental organizations to identify ways to stop this. It researched the causes and sought to mobilize resources and political will toward solutions.

Two decades later, maternal mortality is down in some areas, notably the middle-income countries of Latin America and northern Africa.

But overall, the numbers haven't changed significantly since 1987: Women in poor countries, and poor women in all countries, continue to die at more or less the same tragic pace, one per minute. Four million newborns die every year, also from largely preventable causes. The problem is most serious and most intractable in sub-Saharan Africa; there, 1 in 22 women will die from the complications of pregnancy, compared to 1 in 8,000 for the developed world as a whole.

In 41st place, the United States has one of the lowest rankings in the developed world, lower than such countries as Slovenia, Poland, Kuwait and Korea. Maternal mortality among black women in 2000, the latest year figures are available, was almost four times the rate among non-Hispanic white women.

The Saving Newborn Lives project, launched in 2000 by Save the Children U.S., showed that most newborn deaths are directly related to a mother's poor health or to poor care during and after pregnancy and childbirth. The World Health Organization now recognizes that link in its language, speaking always of the two together: maternal-newborn health.


Clear Consensus

A broad and clear consensus has now formed about three core health sector strategies needed to improve maternal-newborn health.

    No. 1: Comprehensive reproductive health care for women, including family planning and safe abortion or post-abortion care.

    No. 2: Skilled care by trained and qualified midwives, nurses or doctors during pregnancy and childbirth.

    No. 3: Access to emergency care to deal with complications during labor and delivery.

These three strategies need to be supported by efforts to ensure that women and girls get the education, income and respect they need, and deserve.

We don't need to spend any more time examining the problem.

We just need to generate the political will to put these solutions into place in the developing world, the way they are in industrialized countries.

In Sweden, for example, where guarantees of good-quality health and family planning services minimize women's lifetime risk, only 1 woman in 17,400 will die during pregnancy or childbirth. In poor and devastated Sierra Leone, the figure is 1 in 8.


Lacking in Political Will

The cause is clear.

Women's status remains low in the developing world and the political will to make these basic investments just isn't there. This ought to be a worldwide scandal, but it isn't yet.

The year 2007 is critical for advancing the health and rights of women.

We are halfway to the 2015 deadline for achieving the eight MDGs, or millennium development goals, which were laid out at the United Nations in 2000 to eradicate world poverty.

The fifth goal--improving maternal health--underpins all the others, especially the fourth goal aimed at improving newborn and child health, the sixth goal of curbing HIV-AIDS, the second goal of universal education and the third goal of promoting gender equality.

In 2005 the Partnership for Maternal, Newborn and Child Health united a number of previously separate partnerships, and this year several new initiatives led by U.N. agencies and donor governments have come together under the Global Campaign for the Health MDGs. Some of them, such as the Norwegian, British and Canadian program Deliver Now for Women and Children, focus specifically on mothers and children.

That's because there's broad agreement on the bottom line: progress on maternal mortality isn't just good for women, it's essential for the social and economic development of families, communities and nations. It's politically smart.

The Women Deliver conference is so named because women deliver the next generation, of course. But they also deliver food, water and income for their families; energy and creativity for their communities; and production for their national economies.

The message is clear, and it's the Women Deliver conference theme: "Invest in Women--It Pays!"

Ann Starrs is executive vice president of Family Care International, based in New York, which is the organizing partner of the Women Deliver conference Oct. 18-20 in London, and is also co-chair of the Board of the Partnership for Maternal, Newborn and Child Health.

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