The MHTF is soliciting reactions from the maternal health community to the newly released UN MMR data. Our hope is that, together, these comments will serve as a springboard for discussion and provide momentum towards MDG5.
Last week, the United Nations released the newest estimate of maternal mortality, which shows an important 34% decline in the last two decades. More than 220,000 fewer women died of pregnancy-related causes in 2008 when compared to 1990. These new estimates reinforce the good news reported earlier this year by The Lancet, further confirming that maternal death and disability are not intractable problems. Progress is possible. However, the new numbers also bring sharp focus to the global inequities, which for too many of the world’s girls and women mean they do not get the high-quality health care they need before, during, and after a pregnancy. This inequity is clear in the fact that the lifetime risk that a 15-year old young woman in sub-Saharan Africa will eventually die of a pregnancy-related cause (1 in 31) is more than 1000 times that of a young woman in some developed countries (1 in 4,300). These wide disparities between developing and developed regions are unacceptable. If we are serious about achieving Millennium Development Goal 5, a 75% drop in maternal mortality by 2015, we need to more than double our efforts in the next five years.
The UN press release accompanying the new report highlighted the four main causes of maternal death—postpartum hemorrhage, infections, hypertensive disorders, and unsafe abortion. Each is preventable, treatable, or both. We know the technical interventions that are needed, including modern contraception, safe abortion, antenatal care, skilled attendance for labor and delivery, and postpartum care. We also know that strong health systems are essential for improving availability, quality, and access to these services. And, essential to the health system is the health workforce. Without increased attention and innovation around solving the problem of the critical shortage of skilled health workers, continued progress in reducing maternal mortality and morbidity will not be possible. The UN report sends a clear message. Progress in reducing maternal mortality will only be achieved with increased national ownership, strong health systems, and a global commitment to recruiting, training, equipping, deploying and retaining, and supporting more motivated and productive health workers.
During a recent trip to India, I learned more about India’s ASHA (accredited social health activist) program. This innovative program recruits female health workers from the communities they serve, and trains them to educate community members and serve as a liaison between the community and the health system. The program offers these women incentives through a “pay for performance” system. Colleagues pointed out, however, that in some of the most marginalized and isolated communities in India there are no ASHA workers because in some villages there are no women who meet the basic selection criteria for being an ASHA, which includes basic literacy. Because of this, these already marginalized communities do not have community health workers to offer even the most basic health care. Continuing to make progress in these communities and the many others that are isolated or marginalized requires us to get creative about how to reach all women with the package of services they need. Doing this starts with a global commitment to value all women’s lives—only then will we be able to galvanize the resources necessary to prevent their deaths.