By Ximena Andión Ibañez, International Advocacy Director
An article in the recent Lancet, a weekly peer-reviewed medical journal, announced a global decrease in maternal deaths from 526,300 in 1980 to 342,900 in 2008. The Center welcomes this research and other academic studies that seek to measure progress in the reduction of maternal mortality, but it’s important to remember the magnitude of suffering that is too common and also tragically unique to each death. We must remember that every number represents an individual, whose death destroys a life, devastates a family, and reveals a far reaching impact on communities and nations.
Maternal mortality is difficult to measure. Estimates are often imprecise since country health statistics systems can be weak. Deaths occurring in isolated communities and rural areas are often not counted, and global data is based on general demographic models, rather than on actual counts. Too many deaths are disregarded.
Independently of the estimates, every woman has the right to safe pregnancy and childbirth. Where preventable deaths are concerned, any number is too high.
Preventable maternal death is a form and a symptom of discrimination against women. Women around the world encounter barriers when accessing quality reproductive healthcare services. Even in countries with low maternal mortality rates (MMRs), poor and marginalized women are at a higher risk of dying from pregnancy and childbirth complications. With this in mind, The Lancet estimates should not distract governments or the international community from ensuring equal access to quality sexual and reproductive healthcare services.
According to the article, India’s MMR declined from 677 maternal deaths for every 100,000 live births to 264 between 1980 and 2008. Despite India’s economic development, it has the largest number of maternal deaths in the world and thousands more women suffer from pregnancy and childbirth-related complications. The Center is working on a number of cases in India that demonstrate deep inequalities in access to quality maternal healthcare services in the country. Clearly, in India, as in the rest of the countries, preventable maternal death and disability cannot be eliminated merely through health policies, solutions must be grounded in a broader recognition of women’s human rights.
Like India, according to the article, Brazil’s MMR decreased from 149 to 55. Even if these estimates are corroborated, the rate remains disproportionately high for a country of its economic status. Its current MMR is still higher than many other Latin American countries. The Center’s case Alyne da Silva Pimentel v Brazil illustrates the deeply entrenched inequalities in access to maternal healtcare services in the country which disproportionately affect indigenous, low-income, and Afro-descendant women. Interestingly, in recent reports to the U.N.’s Commission on Population and Development and ECOSOC, the Brazilian Government itself cited a higher MMR than was reported in The Lancet, not only emphasizing the urgent need to combat maternal death in the country, but also underlining how hard it is to measure a precise MMR, we must always examine statistics diligently.
Though the article provides optimistic numbers, it also indicates that in certain countries the MMR has actually increased. In Nigeria the ratio rose from 516 to 608. In the report “Broken Promises: Human Rights, Accountability and Maternal Death in Nigeria ” the Center documented the infrastructural, institutional and financial barriers that women face when accessing maternal healthcare services, which often times leads to maternal death. Despite apparent progress, only 23 countries are set to reach the Millennium Development Goal 5 — Reducing maternal deaths by three quarters by 2015.
We hope the international community and national governments will analyze The Lancet’s data, compare it to the forthcoming data from the UN agencies, and examine them all against national level figures in order to create a more accurate and nuanced understanding of maternal mortality.
While health interventions that integrate the key pillars of reducing maternal deaths are necessary, broader actions that guarantee the full spectrum of women’s human rights — and that combat discrimination and violence — are critical to eliminating preventable maternal mortality and morbidity. A human rights based approach is required to ensure women’s survival of maternal mortality.
The Center hopes that at the Millennium Development Goals Summit, taking place in September, regardless of the estimates, the international community will call States to redouble their efforts and will stress the fundamental role that human rights and accountability play in eliminating preventable maternal mortality and morbidity.