On the Far Reaching Consequences of Maternal Mortality

“Remedies can’t be tied to a broken system.”

Worldwide, about 290,000 women die each year from preventable causes related to pregnancy and childbirth. From a numerical perspective, this figure appears to denote a situation less urgent than that suggested by the figures for other global health threats, such as malaria (630,000 per year) and HIV (1.5 million). In the developing world, where 90 percent of maternal deaths take place, however, maternal mortality has dramatic implications for child survival and has a profound effect on the wellbeing and sustainability of the larger community. Below, FXB policy director and health rights expert Alicia Ely Yamin outlines why maternal mortality should be treated as an urgent global public health priority.

What is one of the major obstacles for reducing maternal mortality in the post-2015 context?
One challenge moving forward is not just integrating services but also increasing meaningful accountability in the health system. One way to do that is to ensure that there is judicial redress. But that’s not the only thing. We need ways to monitor, review and administer those systems. Doing so requires changing the relationship between providers, policymakers, and patients, all of whom should be active participants in the design, implementation, budgeting, and evaluation of health care services.

Are the impacts of maternal death generally well understood at this stage?
In the developed world, people might not understand how lucky they are. Fifteen to 20 percent of pregnancies have severe obstetric complications, but Westerners don’t die, because they have access to treatment.

In the developing world, maternal death is an egregious injustice. For many women, every time she gets pregnant she thinks: ‘I might die.’” The degree to which a woman is at risk has to do with her status in society, with race, with income inequality. If a woman has the misfortune to live in a remote area, is indigenous, disabled, she is far more likely to die. Health systems reflect and exacerbate the structural and systematic discrimination that already exists in societies.

Is maternal mortality sufficiently addressed by the global public health community?

Public health accounting systems tend to see maternal death as relatively rare. Although a woman dies each hour of the day in Tanzania, for example, globally the total is much fewer than the number of deaths caused by malaria and HIV. So, maternal mortality gets a lower priority. However, when mothers die, the mortality rates of children are enormously elevated. Many die within a year of their mother. Research in this area can help determine what happens to kids after their mothers have passed away.

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Alicia Ely Yamin is lecturer on global health in the Department of Global Health and Population at Harvard TH Chan School of Public Health and policy director at the FXB Center. Yamin regularly advises UN bodies in relation to health and human rights and has provided strategic guidance to NGOs and courts on landmark health, sexual and reproductive rights litigation.