Sunday, May 11, 2008

Happy? Mother's Day

Mother's Day seems as good a day as any to remind ourselves that being a mother for far too many women is still a death sentence. Save the Children has published its ninth annual State of the World's Mothers report, comparing the best and worst countries in which to be a mother and child. The best country for mothers? Sweden. The worst? Niger. The US? We're 27th. Yes. If you're pregnant, there are 26 countries in the world that are statistically better for giving birth than the United States. The United Nations' Safe Motherhood program (part of the UN Population Fund), also charts the dangers of motherhood around the world.

The report notes that more than 500,000 women die during pregnancy or childbirth every year. That is more than one every minute!

More than 90 percent of those deaths happen in Africa and Asia.

We are usually far more familiar with horrible childhood statistics, but today I want to examine the fact that for far too many women in this world, bearing a child is a death sentence. Today's WaPo ran an article on the continued far too high mother mortality report in Haiti, listing some of the work that has done to bring it down from 1,400 deaths per 100,000 live births in 1985 to under 100 today. (For comparison, the US number per 100,000 is 14 dead mothers).

According to the article change in Haiti came largely for three reasons.

First, our nonprofit organization, Partners in Health, has worked closely with the Haitian Ministry of Health to strengthen public health infrastructure. We have rebuilt, equipped, staffed and stocked hospitals and clinics; trained nurse-midwives and other personnel, including more than a thousand community health workers; linked villages and health centers to district hospitals by modern telecommunications and ambulance service; and established modern surgical services for obstetrical emergencies.

Second, we have broken the rule that high-quality health services are a privilege rationed by ability to pay, not a right. The case was made first for affordable medicines. Now it is being made for emergency Caesarean sections -- an essential tool to reduce maternal mortality. Faced with evidence that maternal mortality was greater where fees were higher, the district health commissioner for central Haiti announced last August that all prenatal care and emergency obstetrical services would henceforth be available free to all patients. He was later echoed by Haitian President René Préval.

Third, we have linked prenatal and obstetric care to an all-out effort to improve access to primary health care. The presence of functional, accessible public clinics and hospitals restores faith in the health system, motivates people to seek care before they are critically ill and allows for preventive interventions such as prenatal care and family planning.

All three - infrastructure, right to care, and linking prenatal to overall health care - can, and should be health goals in other nations as well. The proper training of mid-wives is a critical piece of the puzzle. For many women, it is the inability to get to a hospital or clinic that will cost them their lives during pregnancy or birth. The presence of a trained mid-wife in or near the community can help lower those deaths.

One nation not included in the Save the Child study is Afghanistan. Which is too bad - because the situation there is critical. An Afghani woman dies every 27 minutes from complications during pregnancy, making Afghanistan a horrendous place to give birth. One might honestly ask what the power in Afghanistan (the US) is doing about this. I wish I knew.


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