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!
A lot of global discussion and many high level meetings are taking place to end of preventable maternal deaths in the post 2015 world. We hear of an ambitious global target being set is to reduce maternal mortality ratios to less than 50 per 100,000 live births by 2035.
The strategies that are being discussed to reach this goal are around preventing deaths by dealing with the direct medical causes of maternal deaths-like haemorrhage, pre-eclampsia and eclampsia, sepsis, unsafe abortion; and indirect causes like HIV, malaria, tuberculosis, anaemia, or non-communicable diseases.
Additional strategies that are being talked about are: universal health services, providing financial incentives, including the private sector, and urbanisation.
Working in a country which accounts for almost a quarter of global maternal deaths, I cannot but help wonder will setting targets help bring down maternal deaths in my country?
Girls and women in my country are dying not just due to lack of skilled attendance or health services. The reasons for this apathy for girls and women are very deep rooted, mired in traditional, almost misogynistic mindsets. Girls are killed before they are born. In the last 3 decades, 12 million girls have been killed in our country before they were born. In many parts of the country, sex ratio has dropped to fewer than 850 females per 1000 males. In a nation and people who do not protest the killing of unborn girls, how do you make them feel for women dying in childbirth? Will target setting for preventing of maternal deaths make any difference in the lives of girls and women in India?
India is ranked 132 out of 148 countries on Gender Inequality Index as per the 2013 Human Development Report. One in every 4 women faces violence, and a rape takes place every 22 minutes. Worse than the prevalence, is the widespread acceptance of gender based violence. Half of our adolescent girls (and 57% of adolescent boys) think it is justifiable for a man to beat his wife!
We can be called a nation of child brides-with almost half of our girls are married before the age of 18. We know that girls who give birth before the age of 15 are 5 times more likely to die in childbirth. India has 113 million adolescent girls and almost half of all adolescent girls are married before the age of 18. Women between the ages 15-24 years account for 52% of the country’s fertility and contribute to 45% of the maternal mortality. Of the 56,000 maternal deaths in India each year, more than 25000 are young mothers. Whatever be the target set for the post 2015 world, we will never meet the same if we do not look at preventing these child marriages.
One way of ensuring that we meet post 2015 maternal health targets is to prevent girls from becoming mothers,and to do so, we need to ensure that girls complete secondary schooling –which will make them six times less likely to marry early as compared to others who have little or no education. Girls who are out of school are 4 times likely to have a child before their 19th birthday. Getting girls to compete secondary education will not only lead to better reproductive outcomes like increasing contraceptive use by 4 times, but economists say that if 10% more girls go to school, our country’s GDP will increase on average by 3%!!
Setting targets is very important, but alongside targets, we need to focus on strategies that include a systematic approach, addressing different cornerstones that promote women’s empowerment, ensure that girls stay in school, delay marriage and pregnancy, ensure the availability and uptake of sexual and reproductive health information and services, and create greater economic opportunities and thus build girls’ and women’s agency.
If you would like to submit a guest post for to our ongoing series exploring potential goals for maternal health in the post-MDG development agenda, please contact Andrea Goetschius: goetschi@hsph.harvard.edu