Improving Maternal Health

  • By David Levin
  • Posted 04.14.11
  • NOVA

In the year 2000, the United Nations adopted the Millennium Development Goals—eight ambitious milestones for the world that were slated for completion by 2015. The goals include, among other things, ending gender discrimination and making access to basic maternal health care a universal right. How much progress has been made in the last decade? To find out, we talked to Adrienne Germain, president of the International Women's Health Coalition, an organization that works closely with the U.N.


In the year 2000, the U.N. set out to make maternal health care a universal right. Where does that goal stand today?


Improving Maternal Health

Posted April 14, 2011

DAVID LEVIN: You're listening to a NOVA podcast. I'm David Levin.

In the year 2000, The United Nations adopted the Millennium Development Goals—eight milestones for the world to be completed by 2015. They're ambitious. They cover issues like stopping the spread of HIV and offering universal education for every child.

Two out of the eight goals are focused on the health and rights of women. They seek to end gender discrimination, and make access to basic maternal health care a universal right. So where do those stand today?

To find out, I talked to Adrienne Germain. She's president of the International Women's Health Coalition, an organization that works closely with the UN.

DAVID LEVIN: So, when the UN was creating the Millennium Goals, what were some of the issues that spurred them to focus specifically on reproductive health?

ADRIENNE GERMAIN: So the reason that the women's health part was elevated to a goal in itself was a realization by the year 2000 that really, we have fallen down as a global community very severely in that area. Over the years, we have had investments in helping a lot of women, not all women, use contraception, but we have not invested in poor countries and helped poor countries provide skilled care for women who are pregnant and want to have a baby and get through that childbirth safely. We have done a very poor job in helping women protect themselves and their partners and their infants from sexually transmitted infections including HIV and AIDS. And that has serious consequences not just for the woman, but for the children she is bearing and rearing, for her entire family if she dies or is disabled, and even then beyond that, for the community and so on.

DAVID LEVIN: According to UN summit on the Millennium Development Goals just last year, one in 30 women in sub-Saharan Africa still dies in childbirth every year, as opposed to one in something like 5,600 women in developed nations. Where was that number before the UN started working on the Millennium Development Goals?

ADRIENNE GERMAIN: Well, actually, it hasn't changed much since 2000. The estimated number of women who are dying due to pregnancy-related causes has come down from about 550,000 in the '90s to about 325,000 today. But that is a very slow rate of decrease over those almost 20 years. So the decline in the rate of maternal deaths is so slow, because rich countries like the United States, which provide money to the poor countries for things like reproductive health, are only investing in one piece, or one service, one aspect of the problem. They're not taking a whole approach to the whole woman.

DAVID LEVIN: How do you mean, that they're just investing in medical infrastructure, or...

ADRIENNE GERMAIN: ...In other words, maternal health is a state of being. You don't just give one health service or one pill to achieve it. You have to deal with the social conditions that prevent women from going to the health clinic when they need to, you have to deal with poverty that prevents them from having enough food to go through a pregnancy safely, you have to prevent the violence against women by their own husbands or intimate partners that makes them afraid to negotiate condom use. So in other words, we have to have a multitude of interventions that really change the conditions of women's lives, so they can use the health services that are available, and then, at the same time, we have to build up many more health services that will reach women effectively. We have to work on both sides of that coin.

DAVID LEVIN: How do you go about doing that, though? Are there specific strategies or programs that you think have been effective?

ADRIENNE GERMAIN: Well, I could start with one that we've been very directly involved in, and that's Bangladesh. Bangladesh currently delivers contraceptive services to women, and they have an early, safe abortion capacity. But they don't have any obstetric care. They don't have any screening, prevention, treatment for sexually transmitted diseases. They don't work with young married couples. They don't work with adolescents. HIV/AIDS is all around them on the borders of India, etc. And so we said to ourselves, okay, so the package of health services needs to be augmented. We'll continue to do family planning and the early, safe abortion, but we'll add in the obstetric care, because Bangladesh has very high rates of maternal deaths, and then we'll begin the first stages of a sexually transmitted disease and HIV/AIDS control program. We'll reach out to the young couples, who normally are expected to have a baby immediately to prove their fertility, and we'll work with adolescents to try to change some of these patterns of very early marriage of girls to much older men. In five years, the maternal death rate had come down by 25 percent, which is unprecedented—never happened before. And the infant mortality, babies who die within three months of birth, had come down by 22 percent. Now, this was not rocket science. This was just simply logical thinking and stepwise planning.

DAVID LEVIN: So is that a strategy that you think could work in other areas of the world?

ADRIENNE GERMAIN: Well, one advantage that Bangladesh had is that the population is very large in a very small physical area. So you can do things there with a few health staff pretty easily that you can't do so easily in Ethiopia, because the population of Ethiopia is spread over a much, much bigger geographic area. But the principles remain the same, which is that you have to get the services close to where women live. So what I'm saying is that each country has to ask itself a set of questions, and then decide given their circumstances what is likely to work.

And I think what's most important is that the people who are making the decisions in these countries ensure that they have knowledgeable people around the table, including either the women themselves or people who actually are serving women. And it usually, surprisingly enough, David, it usually it does not happen that way. There's all these outside expert advisors, and they come in and they come with a particular solution in their minds. Too much of this planning and decision making is done by people who don't know what the realities of women's lives are.

DAVID LEVIN: So what kinds of cultural issues do you face? I mean, if you're working with nations that have a cultural focus that's historically male-centered, how do you start working through those barriers to improve the rights of women in deciding to have children, in their access to contraceptives, and other issues?

ADRIENNE GERMAIN: Hmm. Well, you know, the culture thing just doesn't work for me. Number one, there's a lot of cultural tradition that's in violation of fundamental human rights. Every country that is a member of the United Nations has to have ratified the Universal Declaration of Human Rights or you can't be a member of the United Nations. So there is a legal binding treaty for all of these governments that say, "you cannot impinge on the rights of a child, to force her into marriage without her free and informed consent." I mean, it's standard for this. Now, does that mean that we don't see any more forced marriages of young girls to 40- and 50-year-old men? No, but that human rights standard gives you the possibility of intervening and saying, you know what? This needs to change. And it is changing. The age of marriage is going up in most places, with a few exceptions. Governments clearly agreed in the UN that women and men should have equal opportunity, and where necessary, special investments should be made so that women can catch up.

DAVID LEVIN: The Mexico City Policy—that was put into place during the Reagan administration in 1984—it stops US funds from going to NGOs that give information or referrals for abortion. That's been in and out of use for the last 25 years. Clinton rescinded it, Bush reinstated it, Obama rescinded it again. So what kind of impact is that policy having on meeting the Millennium Development Goals?

ADRIENNE GERMAIN: Right. Well, the impact that it has is twofold. One is that if the NGOs whom it effects were supporting abortion referral and abortion research, or even abortion services, they've stopped. But also some of them as a matter of principle have been refused the U.S. funding, and as a result have either become much smaller, or have gone out of business. And that's very damaging, because in many countries those organizations were a primary source of contraception, and the abortion services, such as they were, were much, much, much smaller. So you've lost the very service that helps you prevent the need for abortion. So this is a policy at the presidential level, which unfortunately even when rescinded has lasting impact. However, I deliberately underline that it's a presidential policy. All these years, it did not have the force of law.

DAVID LEVIN: So what happens after the UN's deadline of 2015 for these goals? I mean, that's not too far away.

ADRIENNE GERMAIN: Well, clearly we're not going to reach the goals, and there is a summit or a high-level meeting, I'm not sure yet which, they haven't decided, in the United Nations where countries will review the progress and decide whether they're going to continue the Millennium development goals, and my guess is that they will. There's enough momentum to make sure that the concern about gender equality, empowering women, and maternal health continue. And I think part of that motivation is increasing realization that you cannot achieve the other goals without improving the condition of women. And, you know, that's where I started my work 40 years ago, so I'm getting a little impatient to tell you the truth [laughs]. But, hey, if people have to keep learning that lesson over and over, well, so be it. But it's no longer acceptable to say that, "Okay, we've been there, done that, it's finished." Because it isn't finished. It's far from it.

Adrienne, thanks so much for speaking with me today.

Well, you're more than welcome. Thanks so much.



Produced by
David Levin


(United Nations)
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