For decades, the maternal health community was sure of one thing. Continually cited in a variety of articles and reports, researchers and programmers alike knew that the risk of maternal mortality of women aged 15-19 in developing countries was twice that of women aged 20-24 years. This “fact” was nearly ubiquitous—people assumed it was true because they had heard it and seen it repeatedly.
Except, it was not a fact at all.
Maternal mortality is an enduring health crisis and challenge, costing 830 women around the world their lives every day, and eliminating it is a mammoth task. But without evidence-based policy and programming, it is a problem we will never be able to solve.
It is quite a moment to be a researcher—facts elude so much of our policy discourse. Flagrant attacks on science and reason have certainly made it feel more difficult—and so much more important.
As resources become more finite and political ideology remains divisive, the need to invest in high quality research becomes even more important. As a senior member of the research team at the non-profit Population Council, I often hear complaints that research is “expensive,” cost-prohibitive and takes too long.
In my view, it is a far greater waste of money, time and energy – and most critically, human lives – to continue pursuing programs and policies that are based on assumptions rather than evidence. Relying on hunches, intuition or anecdotes is not a good way to go about making decisions about where to invest vital resources, let alone improving and saving lives.
Take that oft-cited “fact” about adolescent maternal mortality. That one assumption, unverified by evidence, has influenced action on maternal mortality for decades. It has directed the allocation of resources, health services and human resources.
Along with my colleagues William Winfrey and John Ross, our research not only helped to dispel this myth but showed that, in fact, the excess mortality risk for adolescent girls is 28% higher than for women in their early 20s; it is women over the age of 35 who are at two to three times higher risk of maternal mortality and—because they have the most children—the absolute numbers of deaths are greatest among women in the peak childbearing years, 25-34. These patterns were subsequently confirmed by another team of researchers using a different methodology.
Why does this matter? Decades of policies and programs have been designed and implemented under an assumption that is not supported by facts or research. Think about how much more effectively resources could be deployed and how many more lives could be saved if only someone had, just a little bit earlier, asked, “But where is the evidence?”
It is part of a free and open society to question assumptions, think critically and question common knowledge. Research always starts with a question and once we stop questioning or resist acting on the answers, we are simply doomed to repeat our past mistakes.
If the global development community is serious about delivering solutions to improve and save people’s lives, we have an ethical obligation to deliver what works. That cannot be done unless we continue to invest in high-quality research. Sometimes, we have the opportunity to enlist the gold standard of rigor, such as randomized-controlled trials,. At other times, we must use the best available evidence to guide urgent decisions on the ground. Both demand an attention to rigor, an unyielding commitment to the scientific process and a willingness to call attention to weak or non-existent research.
Either way, getting these answers is critically important and can take years, not months. High quality research takes dedication, commitment and endurance. There is no instant gratification with research. It takes patience. But by pursuing the evidence, we can identify best practices, refine critical elements of programs and begin to eliminate ineffective approaches.
If we do not continue to invest in research of the highest quality, we cannot complain when programs based on hunches and guesses fail. And for the most marginalized and vulnerable people in the world, failure is not an option.
Progress is made by asking questions, challenging assumptions and finding what works. To end preventable maternal deaths and other persistent global development challenges, we need to work on implementing known solutions that are based on research and proven facts. In a time when ideology trumps science, maintaining a commitment to rigorous research is itself an act of resistance.
Explore new research from the latest MHTF-PLOS Collection: Non-Communicable Diseases and Maternal Health Around the Globe