Maternal Health Task Force

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Maternal Health Targets Need to Be Hard and Heard – but Realistic

By: Kaosar Afsana, Director, Health Nutrition & Population, BRAC

As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!

Targets matter. The Millennium Development Goals (MDGs) focused our collective attention in a way that was sorely needed. We’ve made progress –incredible progress– in reducing maternal deaths. It’s questionable whether some countries would have prioritized maternal health without the bright light of MDG 5. Even governments that hadn’t been known for taking bold action took note of these targets on a regular basis.

I welcome the conversation on defining the post-2015 goals. In my opinion, a hard target of 50 would be difficult for all countries to achieve within the near or even moderately distant future. Some governments might be tempted to write it off as unrealistic.

Perhaps a target such as  a percentage decline of 75% along with an absolute number figured out in the country– would create a congenial framework to get the best results in terms of saving mother’s lives.

Since the turn of the millennium, Bangladesh has made a remarkable progress in reducing maternal deaths, moving from a baseline of 574 per 100,000 live births in 1990 to 322 in 2001 and 194 in 2010. I can confidently say the MDGs kept us focused.

Now that there is some momentum, we need to keep the infrastructure, mindsets and commitments in place to make sure the downward slide continues. This won’t happen automatically. Much as we can be proud of our progress, it’s worth bearing in mind that the maternal mortality rate in Sri Lanka is 30 and in Norway just 3 per 100,000 live births. We have long ways to go.

Having a combination of percent decline and absolute target setting will encourage countries like ours to focus on the evidence at hand and act accordingly. Countries that are not currently on track might even have a chance to catch up if we set new targets in terms of a relative decline. It would also allow us to track progress at sub-national level and make it easier to see trouble spots on the map. Perverse incentives to distort the truth can also arise when the spotlight is only on a number like 50.

Counties should also set yearly milestones, which will aid in tracking progress, rectifying deviations and allocating resources as well.

Getting good data on maternal death is a critical challenge. Even at BRAC, an organization famously focused on measurement, our community health workers tended to hide abortion-related deaths for cultural reasons. Without extra research and cross-checks within the program, we’d never know the real story.

There are countries that are not in track despite having a functional health system and adequate resources. Bangladesh, on the other hand, has been able to reduce maternal deaths considerably despite economic shocks, political unrest and lack of good governance. One reason was community mobilization – frontline health workers of the government and NGOs visiting house-to-house and raising awareness on reproductive, maternal and child health care. Moreover, providing health services and linking community to facility have developed a trust on the health worker resulted in healthy, informed demand for maternal care and contraception. I think setting the right targets will encourage other countries to follow the same path.

One final note: Let’s not de-prioritize indirect causes of maternal death, such as malnutrition, non-communicable diseases and WASH-related diseases that are slowly sharing a huge proportion of maternal deaths.

The year 2030 feels so far off to me, but I do know that we need to keep our eyes focused on a collective target to stop the pain of women and suffering of motherless children. More importantly, women deserve to have dignity and rights to decent life as a citizen in the world.

Categories: Contributor Posts MMR Post-2015 Targets Series

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