By Isobel Coleman and Laurie Garrett - 05/21/08 07:11 PM EDT
The House this week took up H.Res. 1022, “Reducing Maternal Mortality Both at Home and Abroad.” The next step is to pass legislation that shows real resolve, with money and legislated programs behind it.
Every year, 536,000 women die during childbirth, and an additional 8 million become severely disabled. The death toll doesn’t end with the mothers: 75 percent of all newborns die after their mother’s death, and millions of other children are left orphaned.
There was a time — in our great-grandmothers’ days – when American women seemed doomed to die in childbirth, after having five or six children. Our maternal death rates came down for three simple reasons: Women over the generations have had smaller, healthier families; when women go into potentially fatal labors there are hospitals throughout the country capable of providing emergency help; and healthcare workers wash their hands with soap, observing infection control procedures. This isn’t rocket science.
Tragically, these simple solutions are nonexistent for hundreds of millions of mothers in 2008, especially those who are part of the so-called “bottom billion” — the citizens of the poorest countries in the world. Nearly nine out of 10 childbirth-related deaths today occur in South Asia and sub-Saharan Africa. Maternal death and disability account for nearly 20 percent of the total disease burden for young women in these countries. Overall, in sub-Saharan Africa, women have a 1-in-16 risk of dying from pregnancy, whereas women in developed countries have a 1-in-1,800 lifetime risk.
Tragically, these statistics have remained largely unchanged since 1990. In some cases, the statistics have gotten worse. Reducing global maternal mortality by 75 percent by 2015 is a United Nations Millennium Development Goal. MDG 5, as it is called, is a target that without considerable investment the world will fail to achieve, and in some parts of the world could actually fall backwards from.
We have witnessed unprecedented commitments by the U.S. and other governments to fight some of the world’s most devastating diseases — HIV/AIDS, malaria, tuberculosis. Yet, U.S. funding for maternal health has actually decreased over the past few years.
Yes, the interventions necessary to reduce maternal mortality rates are not as simple as handing out drugs or bed nets. However, the vast majority of maternal deaths can be prevented.
The key is putting money where it matters — in basic primary health systems. Train midwives and traditional birth attendants, provide basic birthing kits to communities, and help build and sustain more accessible maternal clinics that can handle C-sections and obstetric emergencies.
Ethiopia — one of the world’s poorest countries — is showing how a little money, combined with political will, can save tens of thousands of mothers’ lives. Although in 2000 the country had one of the world’s highest maternal mortality rates, Ethiopia experienced a 23 percent decrease in just seven years. With funding from various governments, including the U.S., the Ethiopian government addressed maternal mortality through an innovative community health worker program. To date, the government has trained nearly 30,000 community health workers. If Ethiopia continues on this path and makes emergency care more accessible, the nation will meet MDG 5 by 2015, while simultaneously building a strong health system that can fight a myriad of other diseases.
Similar programs can — and with U.S. support, should — be implemented in the 11 countries that represent 65 percent of all maternal deaths including India, Nigeria, Democratic Republic of Congo and Afghanistan.
Advocates for maternal health estimate that a donor commitment of $5 billion a year until 2015 is sufficient to help these countries hit their MDG 5 targets. This $5 billion could train 1.3 million midwives, provide 63 million basic birthing kits to even the most remote villages, 2.9 million delivery suturing kits, 600,000 health center obstetrical delivery kits, and over 80,000 health emergency kits. The money can also provide direct support to ministries of health to improve their primary health capacities. The package of services needed to make significant improvements in maternal health costs less than $1.50 per person in the 75 countries where 95 percent of maternal deaths occur.
Maternal mortality is the basic barometer of the effectiveness of a society’s health system. In the U.S., we take for granted that a woman can go to the emergency room if she has complications during her delivery. This is simply not the reality for millions of women around the world.
Coleman and Garrett are senior fellows with the Council on Foreign Relations.