Maternal Deaths Remain High Despite International Efforts

Contact an Expert: More info on the Panos report: Judy Mirsky To arrange for an interview, contact Mark Covey More info on Safe Motherhood: Rebecca Cassanova Facts: What Does Safe Motherhood Mean in the U.S.? Saving Women and their Families Promoting Safe Motherhood Resources: PAHO's Safe Motherhood Initiative

Dec 7 - Each year more than 525,000 women die from complications of pregnancy and childbirth. In addition, over 50 million experience pregnancy-related complications, 15 million of which lead to long-term illness or disability. For years, this has been the single greatest cause of premature death and disability among women of reproductive age in the developing world. Today maternal deaths are second only to deaths from AIDS.

The tragedy is that almost every one of these deaths is avoidable. Failures to address the needs of pregnant and birthing women are a social injustice of huge proportions.

A new report from the Panos Institute (London), Birth rights: new approaches to safe motherhood, highlights the fact that since 1987, when an International Safe Motherhood Initiative was adopted, there has been little evidence of significant reductions in the number of women dying globally.

The current target of the International Safe Motherhood Initiative is a 75% reduction in deaths from 1990 levels by 2015. "This target is achievable," says Judy Mirsky, the author of the report. "But governments must be prepared to implement the necessary changes in their laws and policies and to improve maternity services for all women."

The report cites a number of factors that contribute to these deaths. Many countries have practices enshrined in law and culture which inhibit women's chances of surviving pregnancy and childbirth. Early marriage, for example, can lead to childbearing before physical development is complete. Lack of access to safe, legal abortion and advice is another example. This has recently become harder in many parts of the world as a result of the so-called 'gag' rule, which applies to organizations that receive aid funds from the US for family planning. The rule requires recipients of US funds to refrain from advocating for changes in abortion laws, or except in limited circumstances, providing abortion information, counselling or services, even with their own funds.

The impact in many developing countries has been immediate. In Nepal, a country where 1 in 10 women die from pregnancy-related causes - approximately half from unsafe abortion - the Family Planning Association of Nepal (FPAN) has had to relinquish a relationship with USAID which had lasted 26 years. "If I were to accept the restricted US funds," said FPAN director general, Dr Nirmal K Bista, "I would be prevented from speaking in my own country to my own government about a healthcare crisis I know firsthand."

The report goes on to point out another reason for maternal deaths is that maternity facilities are under-resourced - in the opinion of local experts almost half of maternity services in a study of 49 developing countries would not be able to carry out one or more of the life-saving procedures they are meant to offer.

In addition, there is a gap between what scientific evidence has shown to be best practice, and what actually happens to many women when they give birth. Regional variations in birth practices are considerable. Several procedures, routine in some maternity facilities - such as being required to adopt a supine position, being strapped down while giving birth, pubic shaving and overuse of surgical procedures - are not beneficial for women and even harmful.

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