For Immediate Release:	January 2, 2001
For More Information:	Christina Horzepa, The Population Council, chorzepa@popcouncil.org, (212) 339-0520
Sponsor Organization:	Population Council
WEALTH, HEALTH, EMPOWERMENT, OR ALL OF THE ABOVE: HOW CAN POOR COUNTRIES REDUCE MATERNAL MORTALITY?
A country does not necessarily have to be wealthy to lower its rate of maternal mortality, says the author of an article in the December issue of Studies in Family Planning, a quarterly journal published by the Population Council. After reviewing data from 64 countries, Jeremy Shiffman demonstrates that wealth indicators explain only a portion of the variance in national maternal mortality levels. According to his analysis, other determinants, including women's educational levels and the proportion of deliveries attended by trained health personnel, are more clearly associated with national maternal mortality levels than are measures of wealth. "The interventions that appear to be most critical in reducing maternal mortality are educating women, devoting priority to health care, and ensuring that pregnant women have access to medical services, all measures that may be within the reach of even the poorest developing countries," Shiffman concludes. Globally, almost one in 200 live births leads to the death of the mother, with 99 percent of these deaths occurring in developing nations. Safe-motherhood advocates--proponents of the "health" perspective--have long claimed that public health and social policy interventions have the potential to decrease rates of maternal mortality. Proponents of the "wealth" perspective point to a country's economic development as the key to eliminating maternal mortality, and maintain that low standards of living in developing countries pose barriers to significant maternal mortality reduction. Yet a third perspective, the "empowerment" view, asserts that reductions in maternal mortality can be achieved primarily by improving the position of women in society rather than by raising the general standard of living or making available appropriate health services. Important Policy Implications Noting that the three perspectives are not necessarily incompatible with one another, Shiffman maintains that the different viewpoints must be evaluated because they have direct policy implications for allocating national resources. As Shiffman explains, a country's accumulation of wealth appears to reduce maternal mortality, most likely because economic growth facilitates (although does not guarantee) universal education for women, an increase in women's social status, the widespread availability and use of health care, comprehensive health services for pregnant women, and good female nutritional status. According to his analysis, the indicator of wealth loses its statistical significance when factors related to health and female education are controlled. "This result may reflect the effect of wealth as it works through the other variables, so that when we control for them, the power of wealth is hidden, or it may indicate that wealth is not a critical element," Shiffman suggests. Two variables connected to health care--the proportion of women receiving trained assistance at delivery and the percentage of gross domestic product spent on health services--emerge as statistically significant. These results provide evidence that devoting resources to health care and delivery assistance may affect maternal mortality levels, a finding that supports the health perspective on maternal mortality reduction. According to Shiffman, education also emerged as a significant variable, providing support for the empowerment perspective. However, women's education indicators measure empowerment weakly. As better indicators of women's position and status are developed, the conclusions from this analysis may receive stronger support, Shiffman suggests. Jeremy Shiffman is assistant professor, Department of Public Administration, Maxwell School, Syracuse University, Syracuse, NY. Other articles, reports, data, Vol. 31 No. 4, December 2000 Articles: Methodological Issues in Community-based Studies of Gynecological Morbidity, by Jagdish Bhatia and John Cleland The Effect of Gender Preference on Contraceptive Use and Fertility in Rural Egypt, by Kathryn M. Yount, Ray Langsten, and Kenneth Hill Reports: Abortion Trends in Japan, 1975-95, by Aya Goto, Chihaya Fujiyama-Koriyama, Akira Fukao, and Michael R. Reich Women's Reports of Severe (Near-miss) Obstetric Complications in Benin, by Véronique Filippi, Carine Ronsmans, Timothée Gandaho, Wendy Graham, Eusèbe Alihonou, and Paul Santos Mobilizing Demand for Contraception in Rural Gambia, by Margaret Luck, Ebrima Jarju, M. Diane Nell, and Melville O. George Data: Cameroon 1998 DHS; Niger 1998 DHS Book Review: Judith Helzner on Let Every Child Be Wanted: How Social Marketing Is Revolutionizing Contraceptive Use Around the World, by Philip D. Harvey For subscription information on Studies in Family Planning, call 212-339-0514, fax 212-755-6052, or email pubinfo@popcouncil.org. # # # The Population Council is an international, nonprofit, nongovernmental organization that seeks to improve the wellbeing and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council conducts biomedical, social science, and public health research and helps build research capacities in developing countries. Established in 1952, the Council is governed by an international board of trustees. Its New York headquarters supports a global network of regional and country offices.