March 13, 2009

Women’s health advocates say reducing maternal deaths requires political attention

By Heather Lockwood
Scripps Howard Foundation Wire

WASHINGTON - Maternal deaths in the world’s poorest countries haven’t decreased, despite a 20-year global initiative to improve maternal health.

The goal to reduce maternal death by 75 percent by 2015 has yet to gain much momentum, and the maternal health community is looking for new ways to make the goal a political priority.

“Why has maternal health not been a priority? It seems pretty obvious, it’s a terrible problem, millions of people die, billions in lost productivity, it’s solvable, so why hasn’t it been solved?” said Ann M. Starrs, co-founder and president of Family Care International.

One woman dies every minute, and more than 530,000 women die every year, from pregnancy-related causes. The global maternal mortality ratio was 400 per 100,000 live births as of 2005, the most recent data, according to the United Nations Population Fund.

Maternal death affects the world’s poorest countries and perpetuates the cycle of poverty. Ninety-nine percent of all maternal deaths occur in developing countries where 85 percent of the world population lives. No other health statistic has a greater disparity between developed and developing countries, according to FCI.

Sierra Lionne has the world’s highest ratio, 2,100 maternal deaths per 100,000 live births, compared to one death per 100,000 live births in Ireland, the world’s lowest ratio.

The U.S. maternal mortality ratio is 11 per 100,000 live births.

When FCI was founded in 1987 it helped launch the Safe Motherhood Initiative, along with United Nations agencies and other international groups, to improve maternal health and set the stage for women’s health advocacy. In 2000 a goal was set, based on 1990 data, to lower the global maternal mortality ratio by 75 percent by 2015. The goal to improve maternal health is the fifth of eight Millennium Development Goals, set by the Millennium Summit.

Though some progress has been made in some regions of the world, the global maternal mortality ratio decreased by less than 1 percent annually from 1990 to 2005.

Starrs called the initiative’s progress “almost flat line,” adding that the goal to improve maternal health is the farthest off target of all eight Millennium goals.

Starrs joined Jeremy Shiffman, associate professor of public administration at the Maxwell School of Citizenship and Public Affairs of Syracuse University, at the Wilson International Center for Scholars last week to discuss maternal health and why some global health issues become political priorities.

“I think it’s important to at least acknowledge that there has been some progress in some regions of the world,” Starrs said. “Maternal mortality ratios have, in fact, declined significantly from somewhere between 20 to 36 percent in different subregions of the world - in Asia, Latin America and North Africa.”

The problem has not improved at all in sub-Saharan Africa.

“So what we see is, while far too many women are dying in the developing world as a whole, the problem is really extremely severe in sub-Saharan Africa, with maternal mortality ratios there that are nearly a hundred times what they are in the developed world as a whole,” Starrs said.

Sub-Saharan Africa accounts for about 10 percent of the world population, 20 percent of births annually, 50 percent of maternal deaths and less than 3 percent of the world’s health workers, she said.

The World Health Organization defines maternal mortality as the death of a woman during pregnancy or within 42 days of pregnancy termination.

Shiffman focused on the question the maternal health community has been asking for years: Why do some global health issues, such as HIV/AIDS, gain political attention and resources while others, such as maternal health, remain neglected?

Shiffman said it depends on who the issue affects.

“The people most affected are poor women with little education who have little political voice in the system. They don’t have access to political power,” Shiffman said. “To be blunt, if rich people get it, it’s an issue, and if it’s poor people - it’s sad but look at newborns, they literally and figuratively have no voice.”

Maternal health is seen as being strictly a women’s issue, making it more difficult to gain political support, and unlike HIV/AIDS, the issue lacks a grassroots initiative, Shiffman said.

Starrs also presented an economic argument for improving maternal health that may resonate with policy makers.

The United States Agency for International Development estimates an annual global loss of about $15 billion in productivity from maternal and newborn deaths, Starrs said. An additional $5 to $7 billion would be needed annually to “end the majority of these deaths,” she said.

After political attention is gained, “the big challenge is to turn that political prioritization into financial commitments,” Starrs said.

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