Reproductive Health

India's Ailing MDG Tied to 18th Century Cure

Sunday, September 19, 2010

Wendy Graham, a champion of Millennium Development Goal No. 5, says the starkest measure of the gap between rich and poor countries is that of women dying in childbirth. And the solution is as simple as cleaner birthing practices.

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India's High Maternal Deaths

India, with the highest number of maternal deaths in the world, offers what Graham sees as a valuable lesson plan in failures. In India, 1-in-48 women is at risk of dying during childbirth.

Since India is so large and varied--in its geography, culture and politics--the efforts and outcomes of health projects can be relevant for many other parts of the world. "When India learns, it learns for many other countries," said Graham.

One instructive recent failure in India involves a project launched in April 2005 by the National Rural Health Mission to lower maternal and neonatal mortality by offering cash payments to women who keep prenatal checkup appointments and seek skilled delivery care. Although the number of women availing this incentive scheme has grown, many, especially those living in remote areas and belonging to the lowest rung of the Indian caste hierarchy, continue to face discrimination and denial of quality health care.

Graham cautioned that while increasing coverage of health services was important, more of it would not necessarily help vulnerable and marginalized woman unless it was the right kind of care.

"The coverage is important because of the vastness of India. But it cannot achieve its goal of saving the lives of mothers and newborns if there is no quality of care. The Indian government has realized that quality of services now needs to be urgently addressed. So they have learnt from their failure," she said.

Another Glaring Failure

Another glaring global failure, Graham pointed to was the persistence of unclean birthing practices, which she said Dr. Alexander Gordon, a physician in Aberdeen, Scotland, identified in 1795 as one of the major reasons for maternal deaths. These deaths can be prevented if countries prioritize clean birthing practices, Graham said.

"Our focus should be the 'six cleans' that make up a clean birth: clean hands, clean perineum, clean delivery surface, clean cord cutting implement, clean cord tying, and clean cord care," she said.

Graham added that the risk of a woman dying during childbirth in the poorest parts of the world today was still greater than it was in the United Kingdom during the time of Gordon.

"What makes the statistics all the more shocking is the length of time the world has known how to prevent women and babies dying around the time of childbirth," she said.

Graham established Immpact, a global research program at Aberdeen University, to highlight the role of research-based evidence in pushing progress towards MDG No. 5.

Such research, for instance, has helped to demonstrate that if women go to clinics with trained staff or midwives and proper equipment, an estimated 50 percent of mothers and newborns could be saved. If quality post-birth care is routinely provided for women, up to two-thirds of lives may be saved.

"Numbers are required to target policymakers to ensure women get the quality of care they deserve, including clean birth and respectful care of her body," Graham said.


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Swapna Majumdar is based in New Delhi, India, and writes about politics, development and gender.

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Reproductive Health

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Reproductive Health

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As is so often the case, there is a lack of understanding that we need an investment in nursing care. That is what is lacking here, not enough nurses or nurses educated highly enough to be able to provide the quality of care that would keep women alive through childbirth. Nurses are invisible because the "feminists" of the world think somehow that now that women can become physicians who really needs nurses anymore? But that's inaccurate thinking. Nurses are needed to deliver this care the author talks about, to educate women about how to stay well, and often, to deliver babies and teach them how to breastfeed, which is vital to staying alive in the developing world. But until there is a willingness by decision makers to find out what nurses really do to save lives and improve outcomes, we will continue to fail at reaching our Millennium Development Goals. If we want better health care, we should dare to find out what nurses really do--follow them at work! Ask them questions. Interview them for stories. Understand that they make the difference between life and death. Then we should strengthen the nursing infrastructure that will bring us better health care. At home and around the world, the problem is the same. Nurses are ignored because they are considered some sort of throwback--yesterday's girls--so their work is undervalued and underfunded, then patient care suffers, and people die. We must change how we think about nursing, or trying again to reach the same goals without learning something in the meantime will lead us to the same failed end.

Sandy Summers, RN, MSN, MPH, Founder and Executive Director, The Truth About Nursing, a 501(c)(3) non-profit working to improve public understanding of the nursing profession. Learn more at