21 years ago The Lancet posed the question, "Where is the ‘M' in ‘MCH'?" Today, we have the answer—we are all too familiar with the challenges we face when we speak of maternal (child) health. We have put into place a powerful global initiative—the fifth of the Millennium Development Goals—that weaves together a set of solutions to combat maternal mortality rates. Maternal mortality is not the only focus of the fifth MDG—a goal that is more widely set on improving maternal health, such as reducing non-fatal childbirth and pregnancy injuries—but it is a pressing concern. And it is the focus of The Lancet's Maternal Mortality Series—a collection of five articles devoted to maternal survival around the world.
The Millennium Development Goals are, at its basest, a list of human rights developed by world leaders at the Millennium Summit in 2000 and designed to serve as a guideline for a global partnership working to reduce extreme poverty by addressing both the factors that allow for extreme poverty as well as the consequences: disease, hunger, lack of adequate shelter as well as gender inequities, maternal and child mortality, and environmental degradation. The list is a set of goals: eradicate extreme hunger, ensure environmental sustainability, combat HIV/AIDS, achieve universal primary education and improve maternal health are five of the eight. It's this goal—improving maternal health—that has a host of international health organizations working together to make sure it's met by 2015. What is needed now, according to The Lancet, is the "determination, focus and resources" to reduce maternal mortality rates by 75% by the year 2015:
The costs of inaction are devastating. The next 12-18 months will be critical for safe motherhood advocacy, offering an unprecedented chance to redress errors of the past and take advantage of new opportunities.
One of those chances is The Lancet's maternal mortality series. The articles remind us however that the fifth Millennium Development Goal is far from being reached. In fact, even with the launch of The Safe Motherhood Initiative 20 years ago, it is the one towards which the least progress has been made. Still, according to The Lancet, we should have hope for being able to actually accomplish this goal and increase maternal survival drastically by 2015.
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Here's the thing: there are 529,000 maternal deaths each year. Women in developing nations, especially in Sub-Saharan Africa, are still at tremendous risk of dying during pregnancy, childbirth or immediately following childbirth. And we know how to stop it. This is a human rights issue that is now recognized as such around the world. There are a number of nations, including Sri Lanka and Thailand, which have made great gains in reducing maternal mortality in their respective countries. And there is, according to The Lancet series, broad consensus on how to drastically reduce that devastating number. So all that's left to do is to implement our ideas and watch women stay alive. Some of the "hows" include ensuring access to hospital care, including emergency obstetric care; and local, midwifery care that would help to meet other obstetric needs.
There are many organizations working independently to improve maternal mortality focusing on HIV/AIDS prevention, the liberalization of abortion laws, improving access to skilled health providers, etc. Between 1999 and 2005, there were more than 80 projects in more than 50 countries funded by the Bill & Melinda Gates Foundation and working in conjunction with local governments and with UN funds like the Children's Fund and the Population Fund as well as a host of NGOs. But it's not enough funding and it's not the only thing that needs to happen. If there is a thread that ties the crucial fix-it techniques together, The Lancet series stresses that we need strong health care systems to support these varied and important programs—systems that, if created well, would of course be able to accommodate much more than just a reduction in maternal mortality.
We all want to see safe motherhood become a reality for all women of the world. The Lancet series is a significant reminder that maternal health is not a uniform reality for all women. While pregnancy and motherhood can be a beautiful experience for some, it is a dangerous and sometimes life-threatening experience for others. The inequities do not have to be there. What is frustrating is that we have the tools and the blueprint, but we have yet to invest in the materials. In 2007, on the 20th anniversary of the Safe Motherhood Initiative, and with this series on maternal survival, The Lancet gives us a new springboard for hope and action. It's time to jump.