PHM-Exch> Delivering Women From Death

[Claudio Schuftan]

>From Sakuntala Narasimhan <sakunara at gmail.com>

Delivering Women From Death, The Expert View



by Sakuntala Narasimhan

* *



W

hat kills 342,900 women worldwide every year, while no man is ever at risk
of being targeted? Childbirth and pregnancy-related complications, of  course.
One of the major goals of the Millennium Development Goals (MDG) that were
accepted by 192 governments around the world a decade ago is the reduction
by the year 2015, of the Maternal Mortality Rate (MMR) by 75 per cent.



As that deadline nears, researchers are finally reporting a drop in the
global MMR figures. Findings of a study published in 'The Lancet' in April
reveal that there were 342,900 deaths worldwide in 2008, down from 526,300
in 1980. The study assessed levels and trends in maternal mortality for 181
countries. However, these findings appear to contradict the figures of a
World Health Organization (WHO) study last May, which indicated that mothers
and newborns are no more likely to survive now than 20 years ago.



Whatever the figures may be, the fact is that maternal mortality remains a
major challenge to health systems worldwide and that only 23 countries are
on track to achieving the 75 per cent reduction goal.



At an international symposium held recently at the Harvard Law School in
Boston, USA, experts drawn from different continents unanimously conceded
that the world seems "woefully far from that target". The office of the UN
High Commissioner for Human Rights, UNICEF and the University of Oslo were
the co-sponsors of these deliberations.

As Mary Robinson, former President of Ireland and former UN High
Commissioner for Human Rights, observed at the symposium, "Becoming pregnant
is a health risk! And not addressing the need for reducing maternal deaths
amounts to human rights violations, no less." In her plenary address, South
African Navanethem Pillay, U.N. High Commissioner for Human Rights, agreed
with Robinson: "This is a violation of human rights, the right to life," she
declared.



According to WHO estimates, in addition to the women who die in childbirth,
a further eight million women experience lifelong health complications
following childbirth. Under the MDG, reducing MMR was one of the eight main
areas of action. The statistics are stark and eloquent - while globally the
reduction average is now pegged at 35 per cent, as per the latest study,
even this modest figure masks the wide disparities among regions and within
countries.



India leads the world in MMR with 683,000 annual deaths (the figures have
come down marginally as per the latest study). The US has an overall MMR of
13 per 100,000 live births but among women in New York City's Black
community, it is 78. Japan has a MMR of 8 and Egypt 84. The South Asian
region reduced MMR from 650 to less than 500 between 1990 and 2010, with a
target of 160 set for 2015, which the region has no chance of reaching,
given current trends.



Poverty is one reason for high MMR and reducing poverty is listed as the
first goal among the MDG. But there is more to the pathetic record on
maternal mortality than mere lack of resources. Migration of health workers
(doctors and nurses) from India and African countries seeking higher
earnings in the developed countries is a major factor. WHO is planning to
introduce a draft code at the forthcoming World Health Assembly suggesting
tighter control on migration/recruitment.



But what happens to the right of a doctor or nurse to seek employment
wherever the remuneration is better? The Harvard symposium included
discussions on whether the MDG  and Human Rights covenants converge or
clash. The consensus was that there need be no contradiction if development
got redefined as betterment that went beyond indices of economic growth and
increments in money incomes.



When there was a proposal to make a stint in the rural areas mandatory for
medical personnel in India, doctors protested widely because they feared
their earnings would be badly affected. Ethics therefore comes into the
picture, along with the distributive aspects of economic growth. Thanks to
lopsided development that has brought sizeable industrial and economic
growth but has left the poor poorer, there are state-of-the-art medical
facilities in the world's metropolises, even while pregnant women in the
interiors die because no medical help is available when complications
develop. Interestingly, Tajikistan, with a low per capita income, has
reduced MMR from 100 to 8 in a decade, thanks to the dispersion of health
workers in all regions of the country.

When we talk of a 75 per cent reduction in MMR, then, are we focusing on the
high MMR among rural women or on the relatively better record in the cities?
Do averages make sense in societies marked by wide disparities? Distributive
justice has been, in fact, identified as the main determinant in achieving
the MDG, rather than just rising incomes.



Reducing MMR also means exposing women to fewer pregnancies, which in turn
means extending their reproductive rights and granting them the right to
decide how many children they want, and when. When former US President,
George Bush, imposed a gag rule that cut off funding for NGOs overseas that
provided abortion options as part of health services, developing countries,
especially in Africa, saw a spurt in maternal mortality because women were
unable to get abortions and turned to quacks. Women's groups worldwide
protested this gag rule. But what has not helped is the confrontation
between pro-life and pro-choice lobbies that has been going on for years.
Ultimately, it's the women who end up paying with their lives.



So, what needs to be done for expectant women? More doctors and better
distribution of medical personnel in the rural areas, better pay for health
workers in rural areas, changes in social attitudes, and a stronger
political will to ensure increased budget allocation for the health sector,
that is what the experts advocated. "When financial companies had to be
bailed out during the recent recession, governments had no trouble handing
out funds in billions but when it comes to health budgets, there is never
enough money," pointed out African academic-activist Fantu Cheru, during the
symposium.



Only a multi-pronged exercise on all fronts can help us get closer to the
target of delivering more women all over the world from death.
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