Maternal mortality is a problem we can solve

Syria. Gun violence. A dysfunctional Congress. All serious problems that we don’t know how to fix.

But the world knows how to save 800 women a day from dying in pregnancy and childbirth. We simply choose not to.

That is the startling finding of a new report (of which I was the primary author) released by the Center for Health and Gender Equity (CHANGE). Scientific research shows that the vast majority of maternal deaths are due to preventable or treatable causes such as hemorrhage, hypertension, sepsis and unsafe abortion. Relatively simple interventions, such as skilled birth attendance, access to voluntary family planning and treatment for HIV and other sexually transmitted infections, would go a long way toward reducing morbidity and mortality. A study by Johns Hopkins University researchers showed that, in and of itself, fulfilling unmet demand for contraceptives would reduce maternal deaths by nearly one-third.

{mosads}Although ending preventable maternal and child deaths is a key goal of the United States and the international community, and over the past quarter century there has been a 45 percent reduction in maternal deaths worldwide, progress has been extremely uneven across regions and has left out some of the poorest and most marginalized women. According to the U.N.’s final report on the Millennium Development Goals, only half of women in developing countries receive the recommended number of antenatal care visits, and gains have been “modest” in the proportion of births delivered by skilled attendants.

The reasons why progress has been lagging are technically simple but politically complex. Bureaucratic structures and funding streams for maternal and newborn health, child health, nutrition, water and sanitation, family planning, HIV/AIDS, and disaster relief are stovepiped and poorly coordinated within and between donors and developing countries. Programs have been designed without sufficient country ownership and consultation with intended beneficiaries. Women fail to seek medical care because they fear disrespect and abuse from caregivers. Girls are married too young and become pregnant before their bodies are ready. And some of the most effective interventions have been subject to politically inspired constraints.

Behind the failure to solve these problems lies one stark fact: Women’s needs are not being met because women’s rights are not valued. Women lack power at many levels — within their families, in the social and economic life of their communities, under their political systems. In many places, women are not permitted to decide for themselves whether to seek medical care, or they lack the money and means of transportation to do so. Girls are subject to forced marriage, genital mutilation, sex trafficking and rape — especially during conflicts and disasters. It is rare that the needs of women, girls and adolescents are prioritized in budget allocations and policy setting, whether at the local, national, or international levels, and sometimes women are not even at the table when these decisions are made.

The U.S. Agency for International Development (USAID) has taken meaningful steps to address both the technical obstacles to progress and the power dynamics that underlie them. Its Vision for Action on maternal health establishes a strategic approach based on solid data and evidence, and the agency has adopted a policy of integrating gender equality and female empowerment into all of its work. Its groundbreaking financing framework helps identify appropriate public and private resources to meet specific health gaps.

Still, there is still a long way to go. One bright spot is bipartisan legislation introduced in the House by Reps. Dave Reichert (R-Wash.), Betty McCollum (D-Minn.), Barbara Lee (D-Calif.) and Michael McCaul (R-Texas), and in the Senate by Sens. Susan Collins (R-Maine) and Chris Coons (D-Del.), to require a “coordinated, integrated, and comprehensive” strategy for combatting the leading causes of maternal, newborn and child deaths globally. The bill would improve alignment with country-driven plans and designate a single official within the administration to lead a whole-of-government response.

No piece of legislation can remove all the obstacles that prevent the world’s women and girls from receiving the care they need. But smart legislation can remove some of the bureaucratic impediments and inefficiencies that prevent U.S. foreign assistance from achieving maximum impact. It’s the least we can do to make the world safer for mothers.

Ohlbaum is an independent consultant, co-chair of the Accountability Working Group of the Modernizing Foreign Assistance Network and a principal of Turner4D, a strategic communications firm.