The MHTF is soliciting reactions from the maternal health community to the newly released UN MMR data. Below is the first of these posts. Our hope is that, together, these comments will serve as a springboard for discussion and provide momentum towards MDG5.
The newly revealed UN estimates seem to fall in the category of ‘feel-good news’ – maternal deaths are in fact decreasing, as argued by Hogan and colleagues earlier this year. However, only ten countries are actually on track to meet MDG5 and three times as many have made “insufficient or no progress”. But instead of pouring over these rather depressing figures I would like to concentrate on one of the issues brought up by Thoraya Ahmed Obaid the Executive Director of UNFPA, which to me sums up how we need to move forward. – “Every birth should be safe and every pregnancy wanted.”
A lot of great things have already been written about the need for trained birth attendants, but there is painfully little attention paid to the life-saving and life-transforming potential of family planning, so I will concentrate on the latter issue. As many as a third of maternal deaths could be prevented if women in developing countries were given access to what we in the ‘developed North’ consider a basic, essential and obvious service – evidence-based family planning. The demographic statistics speak for themselves – either people in Europe and America basically stop having sex after their first child, or they use effective, safe contraceptive methods for decades. There are other, awful statistics about what happens when women are denied the basic right to control their fertility – unsafe abortions are still one of the four major causes of maternal deaths. This alone should force us to reconsider maternal and reproductive health provisioning in the developing world and is the starkest evidence of how badly family planning is wanted and needed. But by no means are the deaths caused by unsafe abortions the only ones that could be prevented by access to family planning. Allowing women to space their births would significantly decrease the rates of all maternal an newborn deaths because it would give women’s bodies time to recover and prepare for another pregnancy.
Being in control of one’s own body is a basic human right and should not only be the privilege of the rich. Women who are not always in the position to deny sex as a method of contraception, should nonetheless have the ability to limit their family size if they so wish. Moreover, women who do not wish to deny themselves and their partners the joy of consensual sex should be supported in their decision to prevent unwanted pregnancies using safe methods no matter where they live. Providing effective family planning saves lives and hugely increases the quality of life – something we’ve learned a lot about in the developed world since the introduction of the contraceptive pill fifty years ago. It’s really time we stop considering contraception a ‘delicate’ or ‘political’ matter when discussed in the context of the developing world and start seeing it as the reliable, safe, and needed service it is, and we’ve long known it to be.