When progress is political

Maternal mortality is an issue that hit the news headlines last week. On 12 April, the respected medical journal The Lancet released a report providing evidence that global rates of maternal mortality (MMR) have significantly declined, by 35% over 28 years to be exact. This is good news, right? It means that policies to train birth attendants, provide family planning services and other strategies have been effective and that we’re on track to meet MDG 5, one of the key indicators of which is to reduce maternal mortality by 75%. Then why has this report created such a furore?

Well, The Lancet claims that it was pressured by maternal health advocates to delay publication of its findings for fear that they would detract attention – and resources – from the issue. Maternal mortality was also the focus of a UN conference last week, whose most recent research contradicts The Lancet’s findings claiming that maternal mortality rates are only declining at a rate of less than 1% per year, far off the needed targets. The lack of accurate data has been a major factor impeding efforts to account for the prevalence and causes of maternal mortality worldwide, also perhaps explaining the difference in MMR presented by the two reports.

The article by The Lancet draws attention to four factors the authors argue are driving the drop in maternal mortality: declining global total fertility rates, rising income per head, improving maternal education, and more women are benefitting from skilled birth attendance. However, a striking finding of this research is that more than half of all cases of maternal mortality occur in only six countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo). The OECD Development Centre’s Social Institutions and Gender Index (SIGI) measures social norms that discriminate against women and ranks 102 developing countries according to twelve variables that measure social institutions. Five out of these six countries (the DRC is the exception) fall within the top quintile of the index, indicating particularly high rates of discriminatory social institutions. Therefore another relevant factor driving a high incidence of maternal mortality in some countries, particularly the worst-performing, could be practices that deny women control over their reproductive health and rights, leading to high levels of fertility and early marriage which can then also contribute to higher MMR.

Clearly progress, particularly in how it is reported and communicated, can be political. What if lower figures mean less support and attention from the international community on important issues like maternal mortality? Should success stories in development be reported on? Of course, but visible progress should not then be used as an excuse for the diversion of funds. What is needed now is for efforts to be sustained, not for budgets to be cut. While a 35% drop in global MMR is good news, it is still a long way off the 75% drop that the MDGs call for by 2015. In a field where good practices and evidence of impact are often lacking, this progress in tackling maternal mortality should be seen as something positive to build on and to invest in.