• Print Edition
• Archive
  • Editorial
  • Monitor
  • Focus
  • Tribune
  • InWEnt Forum
  • Media
  • Debate
• About us
• Index
• Links
• Subscription

[ Editorial ]

Time to act

Though bearing children is the most natural thing in the world, it often becomes fatal for women in developing countries. Every minute, somewhere in the world a woman dies during pregnancy or childbirth, and 99% of those deaths occur in poor countries.

Tackling maternal mortality involves dealing with sensitive issues such as conception, childbirth and pregnancy. Much more is at stake than strictly medical matters, which, in themselves, pose daunting challenges in less developed countries with poor health-care systems. At the heart of women’s health are socio-political conditions: laws, conventions, traditions, religion, superstition and so on. What is most important is the status of women in general.

In countries which have a tradition of child marriage, young women become pregnant before their bodies are fully mature. A woman under 20 years of age is up to 25 times more likely to die in connection with pregnancy and childbirth than are older women. In many countries, there is a severe lack of professional medical care; and in many places, it is impossible to carry out standard emergency measures, such as Caesarean sections, when complications do arise.

Many women who survive difficult deliveries keep on suffering from serious complications afterwards, from obstetric fistulas for instance. Genital mutilation contributes to such problems. Other relevant factors include ignorance, limited access to contraception or the unwillingness of men to cooperate.

The health of women is particularly in danger wherever women have little influence over family planning and minimal opportunity for self-determination, including sexual self-determination. The situation is particularly grave in countries where soldiers and militias rape women for tactical reason as, depressingly, is the case in Congo, Sudan and elsewhere in crisis regions.

Many women are not in a position to make free decisions about whether or not they wish to have a child. For them, pregnancy is not a blessing but a curse. Every year, there are 42 million abortions worldwide. Abortion is thus one of the most common medical interventions. In places where abortion is illegal, however, desperate women try to solve their problem themselves, using knitting needles and other doubtful means, thus putting their own lives at risk as well.

One of the UN’s Millennium Goals is to reduce maternal mortality by three quarters by 2015. In spite of this commitment, the number of expectant mothers who die is still rising in some countries. Malawi is an example. For the situation to improve, several things must happen:
– women’s rights (including the one to self-determination) must be strengthened,
– women need access to education,
– there must be serious sex education,
– health-care systems must be improved,
– professional care during pregnancy and birth has to be made available, and
– women must have appropriate options of family planning.

So far, there is little evidence that the “invisible epidemic”, as the WHO calls maternal mortality, is being brought under control. It is a good thing that the international community is at least paying attention to the related issue of HIV/Aids. In itself, however, that will never do. What needs to happen is well understood – it is time to act.

D+C, 2008/09, Editorial, Page 310