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July 13th, 2009
More Attention, But Less Funding for Reducing Maternal Mortality

A roomful of pregnant women waiting for their prenatal care appointments at La General Hospital in Accra, Ghana, got a treat on Saturday when President Barack Obama stopped by to compliment the hospital’s maternal health services.

“Part of the reason this is so important is that throughout Africa, the rate of infant mortality but also maternal mortality is still far too high,” Obama told the pool of reporters following him. Ghana’s maternal mortality ratio is about 40 times that of the United States.

Obama’s visit put the spotlight on a United Nation’s Millenium Development Goal (MDG) that, according to a new report (PDF), has seen the least progress so far out of the collection of goals aimed at halving extreme poverty by 2015. The sluggish gains made in reducing maternal mortality over the past eight years – MDG 5 – may even be reversed, especially in the poverty-stricken countries of sub-Saharan Africa and South Asia. In fact, the global economic crisis could hamper progress on all eight of the targets established by world leaders in this “blueprint for a better world.”

“Maybe this is an opportunity,” notes Francesca Perucci, chief of Statistical Planning and Development for the U.N. Statistical Division, which coordinated data gathering and preparation of the 2009 report. “Maybe donor countries will finally start giving attention to the message that is loud and clear: We don’t see progress on MDG 5.”

The halfway progress assessment shows that the developing world still accounts for 99 percent of women who die from complications during pregnancy and childbirth. The U.N. and its partner agencies measure progress on maternal mortality by tracking cause of death and monitoring access to emergency obstetric care and prenatal visits. Over the last decade, the U.N. figures have barely changed.

So far, donor countries have expressed their intention to maintain the funding targets they set for the Millenium Development Goals in 2000, but the targets are a percentage of their gross domestic product and the actual dollar amount will be reduced as the economy contracts.

“You have to consider this is a time when the poorest countries will see their own internal domestic resources decrease, so they’ll need additional money, not less,” said Perucci. “If aid decreases, this will jeopardize any positive trends.”

The limited resources have led agencies to focus on projects that deliver immediate results, such as purchasing and delivering bed nets to reduce malaria. This will likely mean less less funding for equipping hospitals with staff that can treat pregnancy complications.

“With maternal mortality, you have to rethink the overall health system. It’s a lot more complicated,” said Perucci. To reduce maternal mortality, the U.N. suggests building more hospitals, improving transportation systems so that women can reach them in time, and informing expectant mothers of what they need to do when complications arise.

Access to family planning services could also improve maternal health. Contraceptive access hovers around 22 percent in sub-Saharan Africa, and is especially limited in refugee camps. But even these programs may be hard to expand. The U.N. report points out that funding gaps for family planning programs have been conspicuous since the mid-1990s.

This week WIDE ANGLE travels to Mozambique, where a bold grassroots initiative to train midwives in advanced life-saving surgery has significantly reduced the country’s maternal mortality rate. The film Birth of a Surgeon follows Emilia Cumbane, one of the first midwives-in-training. She performs cesarean sections and hysterectomies in makeshift operating rooms in rural Mozambique.  Check your local PBS listings for air times.

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