Improving maternal health was one of the eight Millennium Development Goals (MDGs) identified back in 1990 in order to provide a common blueprint for the leaders of all countries and major development agencies to work together for improving the lives of multitudes of destitute people around the world by 2015. Although we are now just a few months away from the set target date, the MGD goals are nowhere close to being achieved. The goals related to women, including gender equality and reducing maternal (and child) deaths are the most off-track.
The underlying challenges for high maternity rates are admittedly varied, ranging from poverty to lack of education and inadequate funding for family planning. Reducing the maternal mortality rate by three quarters, between 1990 and 2015, has thus proven rather difficult to achieve. Overall, the maternal mortality ratio has dropped by 45 per cent between 1990 and 2013, from an alarming 380 to 210 deaths per 100,000 live births. However, maternal mortality ratio in developing countries is still 14 times higher than that in the developed world.
While billions of dollars have been spent over the past few years to improve maternal health, the strategies used to achieve this goal have now come to be questioned. Multilateral agencies, including the UN system, have been trying to save the lives of mothers in developing countries using inexpensive drugs. However, two major studies of maternal health efforts across the developing world have found that there is little proof such an approach is working, including a study led by the Aga Khan University in Pakistan. The ongoing effort to provide pregnant women cheap drugs such as magnesium sulphate to treat labour complications, and the provision of pre-emptive antibiotics for women getting a caesarean procedure, have been particularly questioned due to their lacklustre impact. Areas that used such interventions were not found to have better survival rates for mothers than areas which did not.
Critics are now calling for a significant overhaul of this pricey global Maternal Health Initiative, which is still being implemented despite producing lacklustre results. These concerns, of course, do not justify decreasing funding for maternal health, but instead they demand investing in interventions, which are more effective.
According to the MDG report for 2014, which draws on data compiled between 2010 and 2014 by more than 28 UN and international agencies, only half of pregnant women in developing countries get the recommended four antenatal check-ups. The need for specialised medical services, including family planning, antenatal and postnatal care, skilled delivery and emergency obstetric care, cannot be replaced by providing cheap drugs alone.
In order to provide greater medical attention for maternal health, there is also an obvious need to bolster the broader public health systems across the developing world. While there are no one-fixes-all prescription to improve public health services universally, convincing decision-makers to allocate more funds to the health sector, especially for addressing maternal concerns, is one step in the needed direction.
While the impacts of the above research findings on altering the design of current global maternal health care programmes remain to be seen, it is clear that developing countries alone are not to be blamed for being unable to implement development interventions adequately to address the plight of their people. It is also the failure of international development agencies, which are not providing effective strategies to address the basic health challenge of ensuring improved maternal health.
Published in The Express Tribune, July 18th, 2014.