Human Rights Approach Needed To Conquer Global Maternal Mortality

As at any international gathering of public health specialists and women’s advocates, there was hope, hype, and a bit of hypocrisy when more than 3500 participants from 140 countries convened for the “Women Deliver 2010” conference in Washington, DC June 7 to 9.  “We’re at a tipping point,” claimed Jill Sheffield, Founder and President of Women Deliver, an organization aimed at monitoring progress toward meeting specific Millennium Development Goals established by the United Nations for 2015.  “There is hope at last,” said Dr. Flavia Bustreo, director of the Partnership for Maternal, Newborn and Child Health.  “History will show that 2010 was a year of new, decisive action,” claimed UN Secretary General Ban Ki-moon.

Some participants were not so sure, arguing for integrating maternal health and HIV/AIDS programs, for including cervical cancer prevention and screening in the mix of interventions; and for making midwives a funding priority. Nearly everyone called for significantly increased budgets. (The Gates Foundation announced at the conference that it will spend $1.5 billion over five years to support maternal and child health projects.)

Some expressed concern that the Canadian Prime Minister, Stephen Harper, did not attend given that he is hosting the G-20 Summit and planned to make maternal mortality a core issue there.  Others asked how the Canadian and American governments could claim to be taking “a woman-centered approach” to maternal health, as U.S. Secretary of Health and Human Services Kathleen Sebelius claimed, when neither country allows federal funds to be used for abortions. And the largest international conference ever held on maternal health drew strong voices calling for a human rights approach to improving maternal and child health.

But the issue that seemed to draw the most attention was whether or not there has actually been a significant and measurable reduction in the number of maternal deaths as reported by Great Britain’s respected medical journal, The Lancet, in May.  According to the journal report, a study funded by the Bill & Melinda Gates Foundation looked at maternal mortality rates for 181 countries between 1980 and 2008.  Using a variety of sources, researchers reported a drop worldwide in the number of women who die annually from pregnancy and childbirth to about 343,000 in 2008 from more than a half million in 1980.  They claimed that the new study used more and better data and more sophisticated statistical methods than were used in a 2005 study that showed maternal mortality at nearly 536,000.

“While the decrease in the maternal mortality ratio reported by The Lancet is a victory, it is anything but a ‘mission accomplished’,” Serra Sippel, President of the Center for Health and Gender Equity, noted in The Huffington Post.  “We are not off the hook — the same report also documented that HIV is responsible for more than 60,000 maternal deaths each year.  The US – whose maternal mortality rate ranks 41st in the world, tying with Serbia and Montenegro – still has a responsibility to prevent maternal death.”

Mary Robinson, former president of Ireland and now president of Realizing Rights: The Ethical Globalization Initiative wrote in a letter to The New York Times following The Lancet report, “New data on maternal mortality is hardly cause for celebration.  Only 23 nations are on track to reach the UN Millennium Development Goal on reducing by 75% maternal deaths by 2015.  … The new evidence is encouraging, but must not be allowed to undermine the urgency of addressing maternal mortality and health as a basic human right.”

Others sounded a cautionary note about research methods used in, and conclusions drawn by, the recent study conducted by the Institute for Health Metrics and Evaluation at the University of Washington.

The African Research and Medical Foundation, for example, noted that “the global estimates mask very major differences in estimated reductions in various regions of the world. It is important to note that while the data used may have improved in many countries, serious weaknesses remain in registration of vital events in most of Sub-Saharan Africa.  AMREF acknowledges and recognizes the great effort made to collect and validate the data used, but would like to point out that the authors did not comment on any change in quality of data from Sub-Saharan Africa, which has been a major issue in previous estimates.”

Dr. Wendy Graham, a professor at Aberdeen University in Scotland who specializes in maternal health research, expressed concerns about the reliability of the study’s data in a letter to The Lancet, and at the Women Deliver conference.  “The responsibility of measurement scientists today is to go the extra mile and ‘translate’ findings for an increasingly wide variety of end users or else to risk misinterpretation and confusion,” she wrote in the journal following publication of the study.

Anthropologist Kim Gutschow who has studied maternal mortality-related issues in India, worries about the methods of data collection used in the study.  “This new study by a small group of researchers is problematic in terms of its assumptions,” she says.  “For example, hospital-based studies are more reliable [than some other data collection methods] but they don’t include them.  And the study is not representative of under-reporting or erroneous information gathered in rural areas.”

Later this year, the World Health Organization will release its newest figures on global maternal morbidity and mortality.  Researchers, clinicians, program directors and others are eager to see if WHO figures are consistent with those of the recent study.

Meanwhile, the stories of what real women suffer as a result of childbearing and figures about their health status remain startling:  Every minute a woman dies in pregnancy or childbirth somewhere in the world;  In Africa and South Asia, complications during pregnancy and childbirth are the leading causes of death for women of childbearing age; only about half of the 123 million women who give birth each year receive antenatal, delivery and newborn care; about 70,000 women die as a result of unsafe abortions.

“It keeps startling me that at the beginning of this 21st century, at a time when we can map the human genome, explore the depths of the seas, and build an international space station, we have not been able to make childbirth safe for all women around the world,” Thoraya Obaid, Executive Director of UNFPA said at the conference. “Women deliver for their families, communities and nations.  Now it is time to deliver for women.  This is one of the greatest social causes of our time.”

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Elayne Clift writes about women, health and development from Saxtons River, Vt. USA. (