Maternity is a paradox: It is ordinary, yet heroic. Mundane, but potentially morbid. It is a miracle, and yet for every woman ever giving birth, a threat.
We forget about the second part of maternity, the threat part, much like women forget about the pain of childbirth. But we should not.
Each year more than half a million women around the world die from obstetric complications. And if we don’t face that fact, women will keep dying at an astonishing, heartbreaking rate.
Half a million is a big number, so to make cold sense of it, think of it as a death a minute. Or this way: It’s a 747 jetliner loaded with pregnant women, crashing three times a day, every day, for a year.
Yet maternal mortality still does not make the front pages of newspapers.
One reason, surely, is that we are not dying so much here in the developed world. For us, maternal mortality is a remote problem, reminiscent of the Victorian era or redolent of distant shores. It is not a communicable disease that can be transported on aircraft. There is no vaccine, no quick solution such as a $4 mosquito net.
But the social and economic consequences of maternal mortality are dire. That they are visited overwhelmingly upon developing countries, particularly those in Africa and Asia, makes them no less so.
It is the mothers of the world who bring their children to health clinics, who feed and clothe them, who place the mosquito netting over their beds. Mothers ensure that their daughters go to school, thereby lowering the next generation’s risk of dying in childbirth. The loss of a mother jeopardizes the security of the family, the foundation of society and, let us say, the peace of a nation.
Mothers leave behind 1 million orphans a year — uneducated, impoverished, Third World orphans.
Activists and specialists from around the world gathered in London last week for the meeting of Women Deliver. If you have heard of it — or visited its Web site at www.womendeliver.org — consider yourself in a tiny minority.
But this need not be so. Just because maternal mortality afflicts primarily second-class, Third World citizens does not mean that it should be so difficult to get it onto the global political and medical agendas.
Maternal death is an issue we can all wrap our brains around. Everyone has a mother. Delivering a baby safely and with trained personnel should be considered a basic human right. Averting maternal deaths is a moral and ethical imperative.
So when will we have a fundraising walk for our Third World sisters? Who in the celebrity world is willing to step forward to take up the cause? Would it be impolitic to suggest, perhaps, that someone like Madonna or Angelina Jolie consider the role? They, after all, are raising children left motherless by the deaths of Third World women.
But say you don’t care about the women of Afghanistan or Sierra Leone, where the odds of a woman dying during her reproductive period (ages 18 to 44) are a mind-boggling 1 in 6. As epidemiologist Les Roberts points out, by attacking the causes of maternal death you address the critical issues of public health: access to care; the numbers of trained and trusted providers; and models of early intervention.
Fix maternal mortality and you fix a lot of health problems bedeviling the Third World and holding back humanity across the globe.
So far, reductions in maternal mortality have come mainly from averting births in the first place — that is, the success of the family planning movement. Now we have to address the needs of the women who get pregnant, not only to keep them alive but also to prevent the devastating health problems that often scar survivors of Third World childbirth. Among the most grievous are obstetric fistulas that condemn women to lives of miserable physical, psychological, social and economic consequences.
We have seen some promising developments at the global political level. Reducing maternal mortality is one of the eight UN Millennium Development Goals set by 189 countries in 2000. And the issue is a focus of an initiative by the Norwegian government called the Global Business Plan.
On the medical side, innovations in obstetrical care are being applied to help rural women.
But we can do so much more, even we Americans separated from the problem by geography. Here is a start:
– Let us acknowledge that women worldwide are essential to the health and well-being of the family and the security of nations.
– Let us examine war as a public health issue and maternal mortality as a security issue.
– Let us talk about abortion as a public health issue, not just a moral issue. In some places, about a third of the maternal deaths are due to unsafe abortions.
– Let us find and support someone — preferably an African or Asian woman — to champion this issue.
– Let us encourage and entice medical students to enter the field of obstetrics and gynecology with the intention of working globally.
– Let us consider maternal mortality in our private philanthropy.
The only woman I know to have died in childbirth in the United States hemorrhaged after a Caesarean section at a New York hospital. Within days, the force of a movement sprang up around her death: A lawsuit was filed against the hospital; an education fund was established for the baby who survived her; family, friends and community rallied to express their concern and outrage.
Dying in pregnancy in the Third World is so common that when a pregnant woman goes into labor, she will often bid farewell to her other children, given the chances that she might never see them again. And when that proves tragically true, there are no lawyers, no e-mail blasts, no educational funds established. There is no outrage.
We owe this woman at least that: outrage. Maybe that would spark a movement.
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PublicHealthMom@gmail.com
Judith A. Weinstein teaches in the medical humanities and bioethics program at Northwestern University’s Feinberg School of Medicine.
