MDG5: What’s in a Maternal Death?

By: Jill Sheffield, President of Women Deliver; originally posted at GLOBAL HEALTH Magazine Blog

It's been a big year for maternal health advocates. Next week we gear up for a global review of the Millennium Development Goals (MDGs), and the Secretary-General will launch the Global Strategy for Women's and Children's Health. These are huge steps forward, with path-cutting initiatives that will enable maternal health advocates, providers, and donors to do our work more effectively.

The recent UN maternal mortality figures are further good news, which confirm what we've all been hoping for: globally, mortality rates are down and we have been doing something right.

But have we been doing enough right? While the latest estimates are welcome good news, we know more must be done - both to save women's lives and better understand the magnitude of the problem.

While we have estimates, they are still just that. There is still some guesswork about how many more women, in villages and cities all over the world, are dying and enduring grave injuries from pregnancy and childbirth.

The lack of reporting mechanisms, faulty data, and many places where women simply don't matter enough to be counted, all plague efforts to paint an accurate picture of this problem. The UN reports that in 2008, 24 countries and territories were still without any national maternal mortality data, or 14% of countries worldwide.

Valid and real-time data is needed to better understand the depth and breadth of this epidemic. I was in Delhi last month for the Global Maternal Health Conference, a convening by the Maternal Health Task Force of technical experts. I was inspired by the level of innovation and ambition I saw there, which I think is critical if we are to make twice as much progress on these issues in half as much time.

One intervention that has emerged over the last decade, which warrants close re-examination, is the use of creative strategies to investigate maternal deaths and injuries both as they occur and after-the-fact. Whether it's a maternal health audit or a verbal autopsies, health workers in many places are implementing something of a sociological approach, really trying to figure out how and why women are dying in pregnancy and childbirth. Just as important as maternal deaths are maternal injuries and illnesses, or ‘near misses.'

While not without limits, maternal health inquiries are an important approach to reducing maternal mortality for a number of reasons. In places where health systems may fail, other systems often may remain intact from which we can gather data: family and community systems, for instance. A maternal health inquiry relies on the insights of sisters, mothers, friends, and neighbors to recall the circumstances of a maternal death or injury, or testify to the ongoing barriers for women in the community.

This approach enables a richer and oftentimes more accurate picture of why, how, and when maternal deaths occur. Was it a washed out bridge that prevented a woman from reaching the district hospital in time for emergency obstetric care? Was it a poor harvest that meant a nine-months-pregnant women was in the fields, tending crops, when her water broke, thus delaying her ability to seek care? Was it the cultural taboos about rape that compelled a young woman to seek an unsafe abortion?

These are difficult, complex questions to ask and answer, but they hold within them the nuanced picture of how women live their lives all over the world. While we have proven and cost-effective solutions that we know will save lives: family planning, skilled care, safe abortion; we must better understand the context in which women seek and access these interventions.

Maternal death inquiry hinges on the notion that if we better understand why a woman has died, we might make the appropriate adjustments to systems and services so that her daughter or granddaughter might not.

Another important ripple effect of maternal health inquiry is that, in places where the status of women remains low, it compels health workers, community members, and even government officials to sit up and take stock of the health and wellbeing of women. Very simply, it reinforces that every woman counts, and especially those women who continue to fall through the cracks of conventional approaches to data collection. Women Count. So it is time to count women.

Given the imperative to address this issue - to deliver for women - we must expand proven approaches, think more creatively, and better access community networks. Maternal health inquiry is simply one approach among many to understanding the problem of maternal mortality, but which rests on the fundamental truths that women are the centerpiece of their families and communities and that investing in women pays.


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