Wednesday, April 21, 2010

New York Times: Good News from the Childbirth Front

April 16 2010

One of the great tragedies of the developing world is the number of women who die in pregnancy and childbirth. But what is that number? Several studies had put it at somewhat more than 500,000 a year, while a new and apparently more rigorous study suggests that it has dropped to less than 350,000 a year.

This is an issue that I’ve written about a great deal over the years, and so I was delighted by the good news — and also delighted that the Times treated it as a major story. Indeed, the article about this breakthrough was the lead news story (the article on the top right of the front page is the lead article, because it’s thought that that is where people start reading). I should quickly add that I have nothing to do with such news decisions. We in the opinion world of the Times are completely removed from news decisions. But one of the reasons maternal mortality has never gotten much traction or donor interest is that it has never been treated as very newsworthy. In recent years, there has been a bit of change in that, and my hope is that we in the news business will treat maternal health — and global health issues generally — as important news because of the numbers involved. That will make a real difference in getting these problems addressed.

One caveat is that none of the numbers are reliable. When women die in childbirth in poor countries, nobody keeps track, and so all these figures are very rough estimates. A few years ago, Honduras was considered an example of a country that had managed to cut its maternal mortality rate through hard work, and I and others cited it as a model. Then a new World Health Organization study came out in 2007 and suggested that maternal mortality had actually risen in Honduras over the previous decade. I got on the phone and called around, trying to make sense of this — and what I learned was that no one really has any idea how many women die in childbirth in Honduras. And the same is even more true of Nigeria.

Still the new figures of just under 350,000 deaths per year are based on more data and are probably as good as any. Some activists were alarmed, fearing that if the report was publicized that would discourage donors and make people think that they didn’t need to worry about maternal health. I think that view is mistaken. Indeed, I think this report is good news for those who want to cut maternal deaths — and here’s why.

One of the mistakes humanitarians sometimes make, I believe, is to emphasize all the things that go wrong. The result is that people are sometimes turned off, and that problems seem intractable. If maternal mortality has remained constant for a quarter-century (as we thought), then who wants to take up the cause? My sense is that people want to be part of something hopeful, something that manifestly can be changed and made better. And that’s what the new study confirms: there is hope in reducing deaths in childbirth, and more resources can make the toll drop even more. We know what to do, we just need to do it better.

The basic reason so many women die in childbirth is simply that they don’t matter in their societies. They are the most voiceless, most marginalized people in their societies, and so resources aren’t expended keeping them alive. There’s a strong correlation between societies where women are repressed and those with very high maternal mortality rates (indeed, in Afghanistan some years ago I came across the highest lifetime maternal mortality risk ever — 50 percent, meaning a woman in one particular region had a 50-50 chance of dying in childbirth at some point in her life). Today in Niger, a woman has a 1-in-7 chance of dying in childbirth at some point in her life, partly because if her husband is off working hundreds of miles away, it’s often considered inappropriate to take her to a hospital if she’s in obstructed labor. She’s not supposed to leave the house without her husband’s permission — and so she dies.

It was always clear that we could do better on maternal mortality, and thank God that is now finally happening.