Risky pregnancies

Complications during pregnancy and childbirth are the most frequent causes of death for women in developing countries, according to the United Nations Population Fund (UNFPA). While maternal health is number five on the list of Millennium Development Goals and should have long ago become a central development policy issue, the UNFPA says it is the goal that remains the farthest out of reach.

Experts have known about these shortcomings for many years. And they agree that healthcare for pregnant women can be provided effectively at low costs. Access to basic medical care and midwives for pregnant women would save the lives of many expecting mothers. These and other measures that help women could reduce the maternal death rate by an astonishing 95 %. According to UNFPA estimates, that could be achieved for less than $ 1.50 per person per day.

Reducing maternal death would also have a posi­tive effect in other areas. Maternal health has had a proven effect on supporting a country's economic growth, as well as on cutting poverty and boosting the education and the health of children.

Experts have always underscored the central role of maternal health – and yet most countries have only made minimal progress in this area. The UN's 2009 Annual Report says that the main reason is the lack of political will to address maternal deaths and the health of pregnant women. The Millennium Summit in New York in September also took up this issue. Delegates agreed that commitments made at international conferences had either failed on the ground during the implementation phase, or had been completely forgotten.

Another reason for the lack of progress in this crucial area of health policy is that it is directly related to family planning and women’s right to self-determination. Cultural norms and the social power relations are significantly hampering development. Deficiencies cannot simply be explained with the lack of or weak medical infrastructures. Experience in different parts of the world has shown that it makes sense to train traditional birth attendants to reduce maternal mortality (see, for example, the D+C/E+Z focus section 9/2008: “Healthy mothers”).

Sri Lanka and Malaysia are two examples that show the importance of a government's political commitment – and how progress can be achieved with not a lot of money. Both countries significantly improved maternal health by making healthcare for pregnant women a central aspect of their poverty-reduction programmes.

Substantial effect at low costs

Malaysia invested in the training of specialist staff in its health system, and in raising cultural awareness. The drop in the maternal death rate is proof of this approach’s success. The risk that a pregnant woman will die during or immediately following childbirth currently stands at 30 out of every 100,000 live births. In contrast, the worldwide average of maternal deaths has only dropped from 480 to 450 for every 100,000 live births, according to the Germany’s Protestant Church Development Service (EED).

A 2004 report by the UNDP states that the following measures helped to drastically reduce maternal mortality in Malaysia:
– Mothers received easier access to healthcare while medical care improved, for example through new family-planning programmes.
– Medical care in rural areas was expanded.
– Cultural barriers and scepticism towards modern medical care was addressed thanks to close cooperation with village communities.

Sri Lanka made similar efforts to improve the situation of mothers and women. One approach included the expansion and reorganisation of the healthcare system, a process that began in the 1950s according to the Centre for Global Development (CGD). Since then, the quality of medical care has risen, and more money has been poured into the education and training of medical personnel. In modern-day Sri Lanka, both the urban and the rural population receive free medical care.

Healthcare has greatly improved in quality but remained inexpensive. Sri Lanka spends only three percent of its GDP on healthcare; contrast that with India, which spends five percent. The CGD says Sri Lankan midwives have significantly contributed to boosting maternal health. Midwives support pregnant women not just on the medical level but they also help create a sense of trust in the entire health system.

A positive future for ex­pecting mothers?

These two examples show how maternal health can be improved in developing countries and that comprehensive reforms can be implemented with little money. However, not enough attention is paid to women’s rights issues, including maternal health in the Poverty Reduction Strategy Papers (PSRPs) of many countries.

Such neglect is proof of this sector being underestimated. Maternal health affects all of society – from the economy to the education of the next generation, from children's health to tackling HIV/AIDS. Investments in this area are urgently needed. The Malaysian and Sri Lankan health systems are encouraging examples.

At the UN Millennium Summit in New York, the executive director of the UNFPA, Thoraya Obaid, called improving the health of mothers and children “one of the most important social obligations of our time”. UN Secretary-General Ban Ki-moon warned that future development goals, be they financial or political, had to focus on the reduction of maternal and infant mortality. According to the United Nations, this area will see a significant increase of investments in the coming years. The UN commitment seems to have brought the issue back into the political and public mainstream, at least for the time being.