Stephen Harper's maternal-health initiative could not have come at a better time. He could not possibly have known just how well timed it was.
For 20 years, it seemed as if little or no progress was being made to reduce the deaths of women during pregnancy, childbirth and the first six weeks after delivery. But a study based on more thorough data, and published this week in The Lancet, a British medical journal, shows that lower fertility rates, rising income, more education of girls and women and wider use of midwives have made a big difference. Maternal deaths have dropped to 342,900 in 2008 from 526,300 in 1980, a reduction of 35 per cent, according to researchers from the University of Washington and the University of Queensland in Australia. It had been reported in 2005 that 535,900 died that year.
Why does that make Mr. Harper's initiative, to be launched at the G8 conference in Toronto in June, propitious? Because it should be clear that concrete efforts do pay off; maternal deaths are not just a fact of life. All the more reason to put more energy and ingenuity, not to mention money, toward solving the problem. Hope is a good motivator.
Not everyone agrees. Some maternal-health advocates saw the good news as bad news for the cause of advocacy. "We were invited to 'delay' or 'hold' publication," Richard Horton, The Lancet's editor, wrote in a comment accompanying the study. He didn't say who made the invitation. His response is that slowing the pace of scientific discussion for political considerations would be far more damaging than any debate about new research could be. He's right.
Donor nations should give more money to countries that make progress, not withdraw it, as some NGOs expect. Success stories will then beget more success, there and elsewhere.
A quick turnaround, even in the poorest countries, is possible, according to the Geneva-based Partnership for Maternal, Newborn and Child Health, in a report separate from the one published in The Lancet. In India, for instance, women are given cash payments if they seek skilled care at delivery, and attend prenatal appointments. The program reached more than eight million women in 2008. India's maternal mortality rate has dropped to 254 per 100,000 live births from 677 in 1980. Some cultural practices may hide the problem, PMNCH says. In parts of south Asia, "childbirth is considered dirty, so women are forced to deliver their babies in cowsheds, where they must stay for one month." But from Egypt to Romania to China, many countries have seen big improvements.
"Hope at last," says Flavia Bustreo, head of PMNCH. With a push still to come from Canada and other wealthy nations, there's reason for more hope still.
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