Time to redress the appalling historical neglect of 536,000 pregnancy-related deaths annually
Women: more than mothers Photo: Nigeria IPPF/Jon Spaull
20 years ago, the Safe Motherhood Initiative was launched by WHO and others to help reduce the severe global burden of pregnancy-related illness and death. Sadly, today, most of that burden remains unchanged. Over 300 million women in the developing world suffer from illness brought about by pregnancy and childbirth; nearly 536 000 die each year. Additionally, newborn babies whose mothers die in childbirth are three to ten times more likely to die within 2 years than those whose mothers survive. It is disappointing that little progress has been made to halt these largely preventable deaths. On Oct 18–20, 2007, to mark the initiative's 20th anniversary, the Women Deliver conference in London, UK, aims to reflect on the immense challenges faced by women and their families. This week's issue of The Lancet includes research and policy articles that should inform discussion and action that flows from the conference.
New estimates of maternal mortality for 2005, and regional mortality trends since 1990, are described by Ken Hill and colleagues, who show that most deaths occur in sub-Saharan Africa and Asia, with very little improvement in sub-Saharan Africa in the past 15 years. At a global rate of decline of only 2·5%, and no significant decline in sub-Saharan Africa, it is unlikely that Millennium Development Goal 5to reduce maternal mortality by three quarters by 2015will be met. Hill stresses the difficulties in accurately measuring maternal mortality and calls for a greater investment in development and validation of the newer methods, as well as improving countries' civil registration systems. Later this year, The Lancet will be launching its own report on this crucial issue at the Global Forum for Health Research in Beijing, China (Oct 29–Nov 2, 2007).
Among the interventions that have a significant effect on maternal mortality is access to safe abortion. Gilda Sedgh and colleagues present new findings on global rates and trends of all abortions. They found that despite the worldwide abortion rate slowly declining between 1995 and 2003, the unsafe abortion rate was essentially unchanged. The authors make a clear and compelling case for better access to contraception as well as safe and legal abortion services as a core tenet of improving the health of women worldwide. Indeed, as Carine Ronsmans and colleagues show, access to safe abortions is among the factors that have led to a substantial decrease in maternal mortality in Bangladesh during the past 30 years.
For 20 years, maternal and child survival have struggled for attention on political agendas. The perceptions and constraints that have plagued the Safe Motherhood Initiative are discussed by Jeremy Shiffman and Stephanie Smith as well as by Ann Starrs. Much can be learned from the HIV/AIDS world. The strong wave of AIDS activism in the 1980s and 1990s, and well-organised groups of civil society demanding access to life-saving services has given justified prominence to HIV/AIDS. Activism around maternal and child health has not gained anywhere near the same tractiona sad reflection of the low status accorded to women's issues in political circles.
Those working on HIV/AIDS developed a clear strategy for success, which was to take the issue beyond medical and public-health spheres so that it became recognised as a socioeconomic issue. Here, it is encouraging to see that the maternal health community has also shifted its thinking. That women are not only mothers but highly valuable contributors to society is the theme of the conference. The links between maternal health, women's status, and broader development are reviewed by Rohini Pande and colleagues. They support the notion that investing in women and their health pays off for governments as well as families.
The idea of the continuum of care (the continuity of care throughout the life cycle) is still relatively new and The Partnership for Maternal, Newborn and Child Health, launched as a larger, broader successor to the Safe Motherhood inter-agency group, is yet to find its comparative advantage among the plethora of global organisations. However, a flurry of new initiatives together with huge sums of money, suggest that a momentum is building to tackle maternal and child health.
This is a crucial moment to redress an appalling historical neglect. It is time for a new wave of 21st century activism to throw a bright light on the low status of women. The need is known as is the knowledge to fix it. More money exists than ever, and a range of existing global initiatives has yielded useful experiences and lessons. There can be no more excuses and no further delay. Women's rights are worth fighting for; their lives can and must be saved.