Maternal Mortality Rates Drop, But That’s Not the Whole Story

As Miriam reported in What We Missed, The Lancet recently released a report revealing that maternal deaths sharply declined worldwide in 2008, meaning that less women all over the world are dying in pregnancy and childbirth. Hooray! This is excellent, inspiring news, and advocates around the world are celebrating a breakthrough in one area that had been steadily losing hope for years (Just to give you a sense of where we’ve been at with this, back in May, the WHO director of health statistics said “Maternal mortality is stuck at what it was in 1990.”)
But this figure alone doesn’t tell the whole story for women’s health. Here are a few other points I think you should consider to contextualize this new information.

The rate of maternal deaths is only one indicator of maternal health. That is to say, there are a lot of aspects of maternal health that aren’t covered by this statistic. Serious injury and illness are also factors in maternal health progress. And the ultimate goal isn’t simply that more women live through childbirth, although that certainly is one important aspect of progress. But simply surviving childbirth is not enough- the world’s women deserve to both survive and thrive. That is to say, they deserve to lead lives of agency, choice, fulfillment. All women deserve full maternal health and rights, including the ability to decide whether and when to get pregnant, and whether to carry their pregnancy to term. Highlighting these other aspects of maternal health brings me to my next point….
If you really want to save women’s lives and achieve true maternal health, you have to talk about sexual and reproductive rights and health, i.e. how maternal health is inextricably connected to a host of other issues. 13% of maternal deaths worldwide come as a result of unsafe abortion, and in 2008 alone, the world would have seen 20% fewer maternal deaths in the absence of HIV. What do these numbers say to me? They say that a woman who has access to comprehensive sexuality education, or to contraception, or to information about HIV and how it is transmitted, or to safe abortion, is less likely to die early in childbirth. She’s also less likely to die early, period. It makes no sense to hail improvements in maternal mortality rates without calling for improved access to safe abortion worldwide to drop that rate even lower. It makes no sense to hail improvements in maternal mortality rates without calling for more comprehensive sexual and reproductive rights and services for women, period. Just this weekend, I was speaking to an activist from Nicaragua at the CLPP Conference for Reproductive Justice about the total abortion ban in that country. She said that the President, Daniel Ortega, was determined to meet MDG5, a Millennium Development Goal concerning maternal health. How ironic, I thought. The country has a total abortion ban (even to save the life of the mother, abortion is illegal in Nicaragua), resulting in untold thousands of women being forced to carry unwanted pregnancies to term, or to undergo unsafe illegal back alley abortions, yet Ortega is concerned with demonstrating on the world stage that he has prioritized women by working to achieve maternal health. The utter senselessness and hypocrisy in this position brings me to my next and final point…

Women’s lives are important, whether they are mothers or not. Maternal health is incredibly important, but sometimes I am skeptical of the intentions of those who focus only on maternal health without working for women’s health more generally. It’s a lot easier and less controversial to rally people behind the idea of women being able to deliver children safely, because this already fits into a predetermined, preapproved definition of activities that women “should” be partaking in- reproduction! But women’s health involves more than that. And all too often health systems are failing women at every step of their lives, not just in pregnancy and childbirth. Sexism and antiquated notions of women’s value shouldn’t influence global health policy, but all too often they do. Women as mothers are infinitely important, but so are women as domestic workers, as widows, as sexual beings, as landowners. Anyone who will go to bat for women’s maternal health, but not for women’s health when they are in these other roles, isn’t a true ally, in my humble opinion.
There’s a post up on Akimbo with some more information on the stat, as well as further resources on things the world can do to make pregnancy safer for all. If you’re interested in this issue, I highly recommend you check it out! Another must-read, as Miriam pointed out yesterday, is Jodi Jacobson’s piece on RHRealityCheck regarding the lack of discussion on abortion in the report.