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Advancing maternal health without 'culture clash' Add to ...

Politicians on both sides of Canada's "culture scuffle" over Stephen's Harper's maternal health initiative, not to mention Hillary Clinton, should listen to Melinda Gates: Don't use development issues as a pretext to wage ideological warfare at home.

At the Women Deliver conference here this week, Ms. Gates gave a speech unveiling a $1.5-billion (U.S.) grant over five years from the Bill & Melinda Gates Foundation to advance maternal health in the developing world without even mentioning abortion. That was a statement in itself.

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Asked later to explain this surprising omission, Ms. Gates demonstrated characteristic tact: "The foundation specifically doesn't take a stance on abortion for exactly this reason: we don't want to be part of the controversy or stem the controversy. We're much more trying to work upstream on reproductive health rights. If you work upstream on that … then you don't even have to get into the issue of abortion downstream."

If they could set aside domestic politics for a moment, Canada's Liberals, Conservatives and the U.S. Secretary of State would all surely agree.

The three-day conference that ends Wednesday - bringing together 3,500 advocates, bureaucrats, academics and opinion leaders to discuss maternal health and reproductive rights - is unfolding against the backdrop of unprecedented optimism.

Not only is there palpable excitement at the prospect of maternal health occupying pride of place on the agenda at this month's G8 summit in Huntsville, Ont., new data are providing hard evidence that major progress is being made to end the scourge of maternal death in most parts of the world. Zeroing in on why that is happening - and trying to reproduce those conditions in countries where it's not - should be the focus of any maternal health initiative. Culture wars are just a distraction.

In a perfect world, access to safe and legal abortions would exist for women everywhere. The reality is that abortion is illegal or severely restricted in the very countries where the most basic maternal health programs are needed. No amount of foreign aid money will change that.

In calling "access to legal, safe abortion" an essential component of any maternal health initiative during her March visit to Canada, Ms. Clinton was not (as was widely believed) rebuking Mr. Harper or inserting herself into a Canadian policy debate. She was waging American cultural warfare.

As much as Ms. Clinton would like abortion funding to be part of Obama administration's foreign aid policy, Congress is not about to allow it. Since 1973, the so-called Helms Amendment has prohibited the use of federal funds to pay for abortion as a method of family planning.

"If the Obama administration and global health advocates place abortion rights at the centre of their development agenda, they will not only solidify conservative opposition on child and maternal health but will also undermine Republican support for development spending as a whole," Washington Post columnist Michael Gerson, a former Bush administration speechwriter, wrote following Ms. Clinton's Ottawa outburst.

So, why not set aside the culture war on both sides of the border and focus on areas where aid money can make a difference?

Almost all of the discussion at the Women Deliver conference has been framed by the April release of a new study that debunks much of the prevailing wisdom - propagated by the World Health Organization among others - about the lack of progress regarding maternal mortality.

The study from the University of Washington's Institute for Health Metrics and Evaluation (IHME) used innovative statistical methods to show that the number of maternal deaths - those during pregnancy, childbirth or in the 42 days after delivery - plummeted to 342,900 in 2008 from 526,300 in 1980.

The study's lead author, IHME director Christopher Murray, suggests his findings should bolster the cause of maternal health - and not lead to complacency as some advocates feared - because it shows that policy matters. Egypt and several other Middle Eastern countries stand out as true success stories; Afghanistan and sub-Saharan Africa are not.

In the case of Afghanistan, decades of armed conflict, a fertility rate that ranks among the highest in the world and low levels of female educational attainment have created the highest rate of maternal mortality - 1,575 deaths for every 100,000 live births - of the 181 countries studied. In Africa, HIV alone was responsible for about 60,000 maternal deaths in 2008.

"The good news is that in almost all countries of sub-Saharan Africa, we're seeing that levels of maternal education are going up. Every year the cohort of mothers coming into their child-bearing ages is more educated than the previous cohort," Dr. Murray explained in an interview. "That should make it easier for programs focusing on contraception, prenatal care and safe delivery - if you can deliver them - to be used."

As Ms. Gates said, focus on the upstream and the downstream will take care of itself.

Follow on Twitter: @konradyakabuski

 

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