Birth Rights

New approaches to safe motherhood

Posted: 13 December 2001

Author: Judy Mirsky
The Panos Institute, London, 2001

The lifetime chance of a woman dying from complications of pregnancy, unsafe abortion or childbirth in Afghanistan, Somalia or Sierra Leone is one in seven. In Hong Kong or Spain that chance is one in 9,200.

That is the scale of the divide in this critical health area, between rich and poor countries. It is one of the most extreme contrasts of this sort in the modern world, and one of the most inexcusable. Decent care in pregnancy and childbirth can be provided in quite poor countries, as Sri Lanka, China, Cuba and Costa Rica have shown. But in many cases, it is not given the priority that it should have.

As long ago as 1987, I reported on the International Safe Motherhood Initiative at a gathering in Nairobi, organised by seven major agencies. Fifteen years later not a great deal has changed. Today, at least 525,000 women still die each year from maternal causes - 99 per cent of them in countries of the South. Another 50 million experience pregnancy-related complications and 15 million of these women are seriously ill or disabled.

The reasons for this failure and what can be done about it are set out clearly and simply in this latest booklet from the Panos Institute. I am reminded of a visit to a village in Nepal, where every aspect of the community's need had been set down as part of a development plan. Every part that is, except help for women in childbirth.

And, as this booklet points out, many countries have practices enshrined in law and culture, which inhibit women's chances of surviving pregnancy. Early marriage is one of them. Access to safe abortion is another. This has recently been made even more difficult by the US administration's so-called 'gag rule' which stops recipients of US funds from providing, or advocating, abortion information, counselling or services, even with their own funds.

One example of the consequence, cited by Panos, has been the ending after 26 years of aid from the United States to the Family Planning Association of Nepal, where one woman out of 10 dies from pregnancy-related causes, about half of them as a result of unsafe abortion. "If I were to accept the restricted US funds" says FPAN Director General, Dr Nirmal Bista, "I would be prevented from speaking in my own country to my own government about a healthcare crisis I know firsthand." (see news item, Bush gag rule hits Nepal clinics)

This report points to two other key areas of necessary change. One is the need to better equip maternity facilities, so that they can deal with those life-threatening cases that reach them. The other is the need to get rid of unnecessary medical procedures and to adopt a more woman-centred approach to maternity care.

According to Dr Mahmoud Fathalla, President of the International College of Obstetricians, "almost every maternal death is an event that could have been avoided, and should never have been allowed to happen." This little book should help raise awareness of the problem, but progress needs to be greatly speeded up if the world is to reach its target of reducing deaths by 75 per cent from 1990 levels by 2015.

Reviewer: John Rowley

Reviewer Info: John Rowley is Editor-in-Chief of Planet 21.

Printed copies of this document are available free to the media and to resource-poor non-governmental organisations. Copies are otherwise available for £5.00.Related link:Panos