Tara Cookson is a Gates Cambridge Scholar and is doing a PhD in Geography. She is critically exploring the effects of the more recent post-neoliberal policy shifts on women's lives as carers within the Latin American region, focusing specifically on those policies that seek to 'empower' women and alleviate poverty. Picture credit: Joey Clifton and Creative Commons.
Maternal health has been a hot topic in the news this year, with the 2012 London Summit on Family Planning being a big focus of media attention. The ensuing debate has not been without controversy - particularly with regard to whether boosting (or not) women's access to contraception is a development priority. The media attention makes this a good time to consider what maternal health is and why it is important.
Maternal health is most simply defined as the health of women before, during, and after pregnancy. Indeed, it is at the heart of Millennium Development Goal number 5, which seeks to reduce the maternal mortality ratio by 75% and achieve universal access to reproductive health.
The World Health Organization (WHO) notes that in 2010, approximately 800 women died every day due to complications of pregnancy and childbirth. This amounts to 287,000 preventable deaths a year.
Causes of maternal mortality include unsafe abortions, obstructed labour, high blood pressure, severe bleeding after childbirth, and post-natal infections. Poor maternal health is also influenced by malnutrition from low iron levels and iodine deficiency.
Often overlooked, inequality is another crucial factor in understanding the structural causes of high maternal mortality. For example, in most 'developed' countries women generally have access to reproductive services and support and skilled medical care. Consequently, maternal mortality rates are very low. (This is not to say that issues around maternal health in 'first world' countries are nil - indeed, recent debates in the United States around access to contraceptives indicates otherwise). Conversely, in many 'developing' countries maternal mortality is extremely high. Within these countries the rural/urban divide shows further patterns of inequality, where two out of every three rural women gives birth without the support of a skilled medical attendant. Such glaring regional discrepancies underscore the fact that most maternal deaths can be avoided.
The impacts of a lack of investment in maternal health and subsequent high maternal mortality are many and severe. From a gender-rights perspective, that such a high proportion of women's lives are put at risk over largely preventable circumstances is unacceptable and points to women's persistent inequality. There are also impacts on families and communities that might not be as obvious but are equally as tangible - for example, women are overwhelmingly responsible for the care of others. This includes babies, children, the sick and the elderly. Their care work is on top of formal (paid) and informal (unpaid) contributions to the workforce. In rural areas of developing countries (where maternal mortality is highest), women also produce over half of all food consumed. In failing to care for women, we also fail to care for the wellbeing of all other community members, not to mention the economy.
In light of all this, how can we make maternal health a priority?
The solution is simple: We must direct resources towards women. This can be done through state funding, international aid, and private donations. And it can include a whole number of things: investment in public hospitals and local health clinics, improvement and multiplication of centres for safe childbirth, and access to skilled doctors, nurses and midwives. It also includes access to education (for women and men) about reproductive health and family planning, and universal availability of contraceptives.
Across the globe we can find a diversity of important examples of what is currently being done to improve maternal health:
In rural Ghana, long travel distances over sometimes impassable roads, lack of emergency transport vehicles and a severe shortage of skilled healthcare facilities means that many women give birth -and face complications - at home. The past three years has actually seen an increase in what were already dire rates of maternal mortality. Local NGOs are demanding the improvement of road access to health clinics and increased state health funding so that women can have access to skilled emergency medical attention if necessary.
Inequality in access to skilled care at the time of childbirth is striking in Peru, where indigenous women in particular are at a severe disadvantage. Issues of poverty and imbedded racism are related to a lack of medical care that respects their cultural norms and values and is delivered in their native languages. International NGOs in the Andean region work to engage the government in an initiative to integrate indigenous birthing practices and sensitivity to cultural differences into skilled healthcare delivery. They've found that more women are likely to access skilled care during childbirth when it is provided in this way.
There are also important global campaigns to improve education for women and men around sexual and reproductive health and family planning in countries where maternal mortality and lack of access to contraceptives poses the greatest threats. Such work recognises that maternal, and community health more generally, are far better when women are able to plan how many, under which circumstances, and when they bear children.
All of these examples highlight different ways in which maternal health can be improved - and there are many more that have not not been mentioned. After twelve years, we remain a long way off achieving the 5th Millennium Development Goal. Campaigns that promote maternal health deserve our full support - maternal health is not an individual issue, but one that should be of utmost priority for all communities.