The elusive MDG-5

By Rina Mukherji
30 Jun 2010

Reducing maternal mortality is critical for every nation but the key to achieving MDG 5 lies in achieving MDG 3 - promoting gender equality and empowering women.

Of all the millennium developments goals, MDG 5 - improve maternal health and reduce the maternal mortality ratio by three quarters between 1990 and 2015, and to achieve universal access to reproductive health - has been the slowest moving to accomplish. Over half a million women die every year at childbirth or pregnancy-related causes. Besides, for every woman who loses her life due to pregnancy, between 15 and 30 women suffer from life-long illness and disability.

More than 50 per cent maternal deaths at childbirth occur in 6 countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of the Congo. Maternal mortality is a major tragedy since it is inextricably to another statistic - the death of newborns. For instance, a study conducted in Malawi reported a 3.35 times increased risk of death among children whose mothers had died, with most children's deaths occurring during the first year of life.

Researchers in Nepal reported that maternal death was associated with a 54-times increased risk of death of infants who were 4-24 weeks of age. In Bangladesh, a study done by Matlab (and published in The Lancet), showed a devastating effect of maternal death on the survival of children, with the cumulative probability of children surviving to the age of 10 years being just 24 percent compared with a 89 percent survival rate of those whose mothers had not died.

More than 10,000 new born babies die every day, amounting to almost 4 million deaths each year. The major causes of maternal mortality are obstructed labour, sepsis, haemorrhage, unsafe abortions, and eclampsia and hypertensive disorders. Some of these, namely sepsis, obstructed labour and hence asphyxia, also account for the death of new- born children. A good number of maternal and new born deaths are the result of malaria, tetanus, pneumonia, diarrhoea, and of course, HIV/AIDS. Sadly, all of these are preventable.

The main stumbling blocks to achieving the aforementioned targets of MDG 5 are lack of finance and the shortage of healthcare providers and trained personnel.
Recognizing this, United Nations Secretary-General Ban Ki-Moon recently unfolded a Joint Action Plan at the Women Deliver Conference in Washington that called upon the international community to increase investment in maternal, newborn and reproductive health over current funding levels by at least an additional US $12 billion, increasing the same annually to an additional US $20 billion by 2015.

The Joint Action Plan calls on increasing the number of health care professionals and managers, and ensure information and services that are sensitive to women, especially those who are poor and marginalized. It also calls for the development of monitoring and accountability mechanisms that address wider socio-economic, political and cultural barriers to maternal and newborn health care for improved policies and programmes. With the Bill and Melinda Gates Foundation pledging $ 1.5 billion to maternal, newborn and child health which, according to Ms Melinda Gates, is slated to be spent in India, Ethiopia and other countries for the training of health workers, developing improved antibiotics, and finding better ways to treat haemorrhages, there is a ray of hope.

But alongside strong commitments to a good healthcare policy, it is equally important to pay due heed to factors that adversely affect maternal mortality- namely, access to education and women's empowerment. In fact, the key to achieving MDG 5 lies in achieving MDG 3-promoting gender equality and empowering women, which can, in turn, help us achieve MDG 4-reduce child mortality.

Maternal mortality, for the most part, affects adolescent married or unmarried mothers all over the developing world. It is primarily on account of an unmet need for contraception. But the lack of education severely impedes access to such information, and results in mothers being deprived of the necessary emergency obstetric care. Besides, most significantly, education means empowerment in the form of employment, and hence, ready cash for emergency health needs.

As impressive as its impact on fertility, higher educational attainment - especially completion of several years of secondary school - increases women's earnings, improves their life expectancy, the health outcomes of pregnancy and childbirth, and reduces infant mortality. Since women in many societies are likely to spend most of their lives in and close to homes, education facilitates the skills and confidence that can build capacity for mobilization, particularly as regards to health.

At the same time, one needs to come to terms with ground realities when chalking out programmes meant to ensure maternal health. In India, the Janani Suraksha Yojana has clocked impressive results in most parts of the country by getting women to deliver in hospitals rather than homes. But, it must be recognized that institutional deliveries can pose a problem in regions that lack a good transport infrastructure to travel over rough terrain, or are too far from health facilities. In such cases, it is wiser to train traditional birth attendants in the basics of hygiene and emergency obstetric care, so that difficult deliveries can also be successfully handled.

The UNFPA has already recognized the importance of midwives, and has initiated plans to regularize and train them all over the developing world, in collaboration with the International Confederation of Midwives. In our country, Magsaysay Award winner Dr Rajanikant Arole was the first to recognize the importance of the traditional dais (in north India) or sais ( as they are termed in West Bengal), and had taken to training them to safely manage deliveries in rural areas. Several non-governmental organizations are already working in this direction. It is high time that we regularize these efforts on a nationwide scale, and save our mothers from dying when giving birth. Mothers' lives are precious; it is time we worked to save them for the sake of families, communities and nations.

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