So Many Maternal Deaths, Just Across the Water

So Many Maternal Deaths, Just Across the Water

The Sydney Morning Herald,
Wednesday, September 9, 2009
Opinion: by Carolyn Hardy

On a visit to East Timor I watched a young mother give birth after she had walked hours to medical care. Just a few hours later, she had no alternative but to take her baby and set out on the long walk home.

If she had suffered an infection or hemorrhaging, she would have, most likely, died on the road. I don't know if she made it home or not.

In Papua New Guinea's western province there is a very basic, two-bed maternity clinic. There is no ambulance, so mothers have to walk hours to get to the clinic. They often do it while they are in labour. There is no running water, so while walking, the women have to carry two buckets of water to be used in the delivery of their own babies.

If you stroll a few hundred metres from the clinic, you reach the coast. From there, you can see islands that are part of Australian territory. It is an appalling situation and even worse when you think how close to Australia it is occurring.

The awful scenes described this week in the Herald of a PNG maternity ward that was decrepit, overcrowded and understaffed, is unfortunately the norm rather than the exception. And while the latest PNG figures on maternal deaths are shocking, they are not surprising.

For every 100,000 births, 733 women die. Compare that to here in Australia, where eight women die for every 100,000 births.

Papua New Guinea suffers among the worst rates of maternal deaths in our region. Yet tragically few Pacific countries are making progress in cutting death rates suffered by women in childbirth. Women in East Timor, according to research by the United Nations Children's Fund, face a lifetime risk of death during pregnancy or childbirth of one in 35.

Around the world, the maternal health picture is bleak. Of all the millennium development goals - the world's blueprint for combating poverty - it is the goal of reducing maternal deaths that is the most off-track.

At worst, women in countries such as Niger and Afghanistan face a lifetime risk of death of one in seven. They run a deadly gauntlet just to have a family.

Some half a million women die in childbirth each year around the world. The deaths are almost entirely contained to poor nations. It is estimated up to 80 per cent of these death are preventable.

Why are we failing? Why are maternal death rates remaining stubbornly high?

A key reason for this is patriarchal. It is the ''dark little secret'' of poverty today. We too often ignore the discrimination that goes on in communities directed against girls. It is the equivalent of the glass ceiling in industrialised countries, but in developing countries it is deadly.

Today the face of poverty is a woman or a girl.

They are the least likely to be in school, the most likely to miss out on food or medicine. It's been tagged the ''Cinderella principle'' - the girl in the family only gets to go to school or to get medical treatment after everyone else has been looked after.

Conversely, we know that development in poor communities is most successful when women are put at the centre of decision-making.

This patriarchal-entrenched discrimination is highlighted as a key factor in UNICEF's research into why women die during pregnancy or childbirth.

Providing access to midwives and better obstetric care in developing nations is important - just as critical as providing education opportunities for girls, overcoming damaging cultural practices such as child marriage and giving women great opportunity to plan their families.

There is a responsibility on developing nations to put a much greater focus on tackling the incidence of maternal deaths. There must be concerted efforts to improve their health systems but they must also tackle the cultural issues that put girls at greater risk of falling pregnant at a young age.

To its credit. the Australian Government has put greater emphasis on maternal and early child health. The Government has typically spent about 12 per cent of the nation's aid budget on health; it has moved to boost this to 16 per cent.

But globally more is needed. It is estimated donor countries need to ensure 15 per cent of their aid is spent on health if we are going to achieve the millennium development goals to halve poverty by 2015, including the goal of cutting the maternal mortality ratio by three quarters.

And more is needed to be done in Australia, too.

While the Government has boosted aid significantly in pledging to get aid spending to 0.5 per cent of gross national income by 2015, that target is still short of the United Nations goal of 0.7 per cent.

As the experience of Papua New Guinea demonstrates, it is not just about increasing aid funding, it is about ensuring we spend it better.

This must involve a focus on giving girls and women better opportunities to make decisions about their family, to have access to education and to avoid a life as second-class citizens.

Carolyn Hardy is chief executive of UNICEF Australia.