Our Reaction to the Lancet Study
In April 2010, the Lancet Online published the paper Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, which contains new global maternal mortality estimates. The study's authors estimate a sharp decline in global maternal deaths, from roughly 525,000 in 1980 to about 343,000 in 2008.
IIMMHR shares its reaction to this study:
• We welcome academic efforts to measure the number of maternal deaths worldwide. It is important to continue improving methodologies to collect data, while continuing to emphasize the imperative to eliminate all preventable maternal deaths.
• Maternal mortality is difficult to measure accurately—but this should be no excuse for inaction. We urge the international community to convene open discussions to compare the methodologies and results of the Lancet and forthcoming UN studies, develop consensus on how best to move forward in measuring progress on maternal health, and assess the implications for policies and programs.
• Maternal mortality remains unacceptably high, even if the Lancet estimates show a significant decline. We must remember that each of these numbers represents an individual: a death that destroys a life, devastates a family, weakens a community, and has profound effects on economies and nations. Where preventable deaths are concerned, any number is too high. Every woman has the right to safe pregnancy and childbirth. We hope that the Lancet study is reviewed and compared with other studies, and that further attention is given to national-level estimates.
• Estimates of progress should not mask the fact that there still remain deep disparities and inequities, both between countries and within countries. Often, even in countries with low aggregate maternal death rates, poor and marginalized women suffer maternal mortality at rates far higher than the national average, suggesting violations of women’s human rights.
• The debate around the estimates should not distract governments and the international community from efforts to ensure equitable access to quality health services. Health services must not only be available, but also be accessible, acceptable, appropriate and of good quality. For many women, even where services are technically available, unaffordable fees pose barriers to access; and for those who do access services, many are treated in a stigmatizing and disrespectful manner. While the debate over MDG 5 too often focuses on the numbers, a human rights approach is focused on process and outcome.
• Monitoring and accountability mechanisms are a critical component of the maternal health picture. Such mechanisms should address the wider socio-economic, political, and cultural barriers to maternal health. They ensure redress as well as ongoing review and improvement of existing programs and policies. (One example is budgetary accountability: please see our publication The Missing Link: Applied Budget Work as a Tool to Hold Governments Accountable for Maternal Mortality Reduction Commitments.)
• In order to deliver the kind of care that saves lives, we need strong health systems that provide an integrated platform for the key pillars known to reduce maternal deaths. These include the provision of family planning, skilled birth attendance, access to emergency obstetric care, postnatal care, and, in the context of high HIV prevalence, access to HIV/AIDS prevention, care and treatment. Robust health systems that address the needs and rights of all women are at the core of reducing maternal death.
• The interventions that IIMMHR has being calling for—including family planning, access to quality maternal health care services, and the elimination of discrimination against women and girls—are known to lead to improvements in maternal health. This should be a strong impetus for governments, donors, and advocates to redouble their efforts to eliminate each and every preventable death. We should strive to analyze and document best practices.
• While health care interventions are crucial, maternal death will be averted only if governments act to guarantee women’s rights more broadly. Governments must create laws and policies that guarantee women’s right to comprehensive health services, including contraception; protect women from violence, subordination, and discrimination; and ensure women’s equal place in political decision-making at all levels. A rights-based approach also includes working mechanisms to provide legal redress to women who are denied access to services as well as monitoring mechanisms led by civil society to hold governments accountable.
• The Lancet study indicates that MDG5 is achievable…if we put women’s human rights at the center of the equation.
For more information on the linkages between maternal mortality and human rights, see our publication No More Needless Deaths: A Call to Action on Human Rights and Maternal Mortality.