Maternal mortality drops, but is no “mission accomplished”

MCKAYSAVAGE // FLICKR

For the first time in decades, researchers are reporting a dramatic decrease in maternal deaths world-wide, with global Maternal Mortality Rate dropping by almost 200,000 deaths per year between 1980 and 2008. While I think this is an incredible accomplishment and a sign that current efforts to decrease global MMR are working, I am not entirely sure how much validity I would give this study.

It is safe to assume that there indeed has been a decrease of about 200,000 reported maternal deaths in the past 30 years. What I’m not buying is that the number of reported deaths is the number of actual deaths; to me it’s kind of like saying we’re making progress on campus rape-prevention when the number of reported rapes on campus decreases from 3 to 2 — we know this isn’t the whole story.

I’m doing a final paper right now on dalit (or caste-based) discrimination in maternal health care in northern India where perhaps one of the biggest problems in this region is that maternal deaths are not being reported as maternal deaths.

Maternal death is the death of a woman while pregnant or within 42 days of giving birth or terminating the pregnancy. The “within 42 days” is where reporting practices seem to be running into trouble.

A health worker in Uttar Pradesh, India, for example, explained their reporting process:

“we note down the name of the person who died…and the reasons….If it is a pregnant woman who died then we note it down—we have to report it—any death during …or after delivery—within 6 or 8 hours after delivery…if it is after that then we write a different reasons….fever or something else. These are not maternal deaths. How can they be maternal deaths?” [Human Rights Watch].

The problem here is that they are maternal deaths; imagine the number of maternal deaths that go unreported because of health workers, like this one, who are unaware that pregnancy complications extend well beyond the 6-8 hours after delivery.

This only accounts for a small portion of unreported maternal deaths. It is the areas with the highest MMRs, Sub-saharan Africa and South Asia, where it is most difficult to accurately determine the number of women dying from pregnancy-related issues simply because women are not giving birth in hospitals. Similarly, in countries like India where sex-selective abortion is illegal, a practice that is not uncommon, providers are not reporting complications and maternal deaths as a result of this procedure because of its illegality.

While I am ecstatic that global MMR is decreasing and that current efforts seem to be working, there is so much more work to be done.

The presentation of these findings holds the potential to divert attention away from maternal health care, as it gives the impression, to some, that enough progress has been made and attention can be diverted elsewhere; we must not allow this small success to divert attention away from the urgency of addressing maternal mortality.

Decreasing MMR is one of the greatest health challenges of our time, making the least amount of progress and change among the eight millennium development goals; thus far, only 23 countries in the world are on track to accomplishing the Millennium Development Goals by 2015. To make a difference will need another 28 years, at least, of increased education, economic stimulation and access to family planning where it matters most, in Sub-saharan Africa and South Asia, to truly make a difference.