Cracking Maternal Mortality

Anika Rahman

By focusing exclusively on egregious and tragic examples of the most extreme cases of society failing women, we lose sight of the fact that, in many parts of the world, it's bad for your health just to be a woman.

When you read this, I'll be at the Women Deliver conference in London, a gathering of non-profit leaders in the health and development community as well as ministers of finance and planning, parliamentarians and staff of non-governmental organizations from 30 low-income countries. We are all gathering to address maternal mortality.

I started my first post on RH Reality with this fact: You are hard pressed to find an American who thinks 529,000 women dying each year from preventable complications of pregnancy and childbirth is not a problem worth solving.

Some people – not many but some – find contraception controversial and there is, of course, the debate about whether we should spend money on condoms or abstinence to prevent HIV. But find me one person who thinks women should die giving life. There will probably always be some cases where women die in childbirth – the human body remains something of a mystery. But almost all of the deaths that occur today as a result of pregnancy and/or childbirth are preventable.

Most health indicators have improved over the last 20 years but not maternal mortality. It continues to plague women, mostly low-income women. And that's probably because there are so many factors that must be addressed. Smallpox required health care workers to immunize a vast segment of the population, an admittedly large task, but then those people were safe. A woman can reproduce over 30 years of her life and each pregnancy presents a new risk.

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And each piece of the solution presents another set of challenges – trained health care workers need to be where the patients are, facilities need equipment, roads need to be maintained, ambulances need fuel. And these are the tangible problems. This doesn't even account for societal challenges.

A few weeks ago, my organization honored Salamatou Traoré, who runs a program for fistula patients in Niger. A trained midwife, Madame Traoré points out that in West Africa, women are supposed to bear children without crying. So they don't tell anyone about their pain or when they feel that something is wrong. Changing these societal expectations is a probably a greater challenge than building a road to the clinic.

If it weren't so complicated, this would be the kind of issue that finds its way to party platforms. But because it can't be explained in sound bites, it just hangs out there.

Instead, politicians largely ignore the issues in favor of more controversial issues over which they can beat up their opponents (condoms vs. abstinence, etc.). In the media, we get sensationalized stories about celebrity marriages, murders and even domestic violence. Of course, the media also covers some key international women issues. For example, on October 7, New York Times front page article on rape in Congo. A light should be shined on that issue.

But I find myself often annoyed about discussions on global women's health and rights. I care deeply for the rape victims and the fistula patients. And I see these problems as a part of a broader challenge. By focusing exclusively on a series of egregious and tragic examples of the most extreme cases of society failing women, we lose sight of the fact that, in many parts of the world, it's bad for your health just to be a woman. Why are we not concerned with the millions of women who marry, have children, do what they can to feed them and hope that their lives are better? Why don't these women – not the brutalized or dying, but the merely poor – deserve our attention, too?

If we found a way to end fistula, that would be a wonderful thing for the two million women who suffer from it. If we could prevent early marriage, economic development would improve around the world.

But if we could crack maternal mortality, we would truly change the world. (Or if we changed the world – or at least women's place in it — we could crack maternal mortality.) Shouldn't the United States, where maternal mortality is one tenth what it is in other parts of the world, lead that charge?

The Women Deliver conference is being billed as a landmark global conference to focus on creating political will to save the lives and improve the health of women, mothers and newborn babies around the world. Our leaders should be ashamed that we have to build political will.

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