http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/feb/26/maternal-mortality-aidanddevelopment
Traditional birth attendant Josephine Achen tends to a pregnant women in Katine. Photograph: Dan Chung
Saving women's lives and those of their babies by making childbirth safer is the new big goal in global health. But if controlling HIV/Aids was a tough target (and far from met for all the rush to broaden the focus and spread the money around), reducing maternal mortality<http://www.guardian.co.uk/society/maternal-mortality>to the core of hardest cases – which is what rich countries have done – has already been shown to be really, really tough. The Millennium Development Goal on safer childbirth <http://www.undp.org/mdg/goal5.shtml> is the one furthest from attainment.
So it's brilliant that the cause is getting so much attention and that women's leaders are foremost in making a noise about it, from the UK prime minister's wife, Sarah Brown, to Secretary of State Hillary Clinton in the USA and plenty more. Clinton has been invited to give the keynote speech at the Women Deliver conference <http://www.womendeliver.org/> in Washington in June and I understand she is keen to do so.
Ending women's deaths in childbirth is so tough because – at the end of the day – they die for lack of transport and access to emergency obstetric care. They die because they can't get a caesarean in time or because they haemorrhage, as I saw for myself with horror in northern Uganda <http://www.guardian.co.uk/society/katineblog/2009/may/08/women-death-childbirth>\. Equipping operating theatres, training surgical staff and buying and running ambulances takes big money.
But there are quick wins. One of them is preventing women who do not want a child from getting pregnant in the first place. This takes us into territory that was highly sensitive to the last US administration, but that must be easier now.
And there is an economic argument here – which is, in the end, usually the most persuasive driver of change. Family planning across the developing world may look expensive, but it's cheaper than dealing with unwanted pregnancies. Look at this from the Guttmacher Institute and UNFPA report entitled "Adding It Up: the costs and benefits of investing in family planning and maternal and newborn health"<http://www.guttmacher.org/pubs/addingitup.pdf>
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The cost of providing modern family planning methods to women with unmet need is an additional $3.6 billion. That means that for each additional dollar spent to provide modern contraceptives, $1.40 would be saved in costs of medical care because fewer women would have unintended pregnancies.
Let's add in the A-word here, in these more enlightened times following the election of Obama. He lifted the Mexico City policy<http://www.whitehouse.gov/the_press_office/MexicoCityPolicy-VoluntaryPopulationPlanning/>, which means US funding can go to those family planning organisations that permit their staff to advise women who come to them asking for an abortion. If contraceptive needs were met, says the report, induced abortions would drop from 35 million to 11 million and the number of unsafe, backstreet abortions would go down from 20 million to 5.5 million.
So family planning could save lives. So could a few more basic interventions. Maternity care needs to be free (shockingly, it isn't always). I'd like to see traditional birth attendants in rural areas given mobile phones to call for help (they don't have them in northern Uganda). Anthony Costello, Professor of International Child Health at University College London, would like to try rolling out antibiotics and misoprostol, which can stop two of the main killers, sepsis and haemorrhage, to community health workers. This is his Lancet paper.<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61566-X/abstract>
My point here is not that any of these things on their own will stop the death toll, but just that we urgently need to be doing, not talking. What the Women Deliver conference should do now – and its founder Jill Sheffield says this is exactly what is intended – is urge and assist developing country governments to get things moving on the ground. The time for awareness-raising is surely behind us.
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Marcy L. Bloom
mailto:marcybloom@comcast.net