|Spring/Summer 2008||Volume 23, Number 2||Findings Magazine|
Without inventing a single new drug or technology, hundreds of thousands of women’s lives can be saved.
When a woman goes into labor in sub-Saharan Africa, she will often tell her children, “Mama may not come back.” That’s because she knows there is a real risk she may die.
“Every woman in Africa knows someone who has died in childbirth,” says Margaret Kruk, an assistant professor of health management and a consultant to the Averting Maternal Death and Disability Project at Columbia University and the United Nations.
When a mother dies, the baby she gives birth to, if it survives, has twice the chance of dying during its first year, so a mother’s death has significant implications for her family and her community. “Not to mention that it’s a basic human right for a woman to survive delivery,” says Kruk, a mother of two and a physician who has delivered over 200 babies.
Worldwide, nearly 540,000 women die annually from complications due to pregnancy or childbirth. When women give birth in health facilities where skilled attendants can quickly diagnose and treat complications, and where drugs, equipment, and blood supplies are readily available, their odds of survival soar.
“Without inventing a single new drug, we can save three-quarters of women’s lives—simply by making sure there are skilled health personnel and basic drugs and equipment and the ability to refer out complicated cases,” Kruk says.
But in developing nations such as Tanzania, where she’s focusing her research, well-equipped facilities are a rarity, and most women opt to deliver at home. Kruk wants policymakers to understand that women make this choice not because they’re uneducated or culturally hidebound, but because they’ve looked at the options and made a “very rational” decision.
Ninety-eight percent of the women in a survey Kruk conducted last summer in Tanzania said it was either “important or very important to deliver in a health facility,” but they also said the quality of the facility was critical. “They’re very smart health consumers,” Kruk says. She wants Tanzanian policymakers and foreign donors to put money into constructing high-quality health care facilities and improving the salaries and training of health workers rather than into building more ill-equipped dispensaries, which is the current plan. She hopes her research will provide the necessary evidence to persuade them.
“We’re really talking about what needs to happen to create a functioning health system,” she says. “And that’s going to be good not only for the women but for their husbands and children, if they have an accident or serious illness.”
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> A woman in sub-Saharan Africa has a 1 in 22 chance of dying in pregnancy or childbirth, compared to a 1 in 8,000 risk in a developed country—the largest difference between poor and rich countries of any health indicator
> In a crisis or refugee situation, one in five women of childbearing age is likely to be pregnant
> Both the International Conference on Population and Development and the United Nations Millennium Development Goals call for a 75 percent reduction in maternal mortality by 2015 from 1990 levels; globally, maternal mortality has been falling at only 0.4 percent per year since 1990—a decline that is far from sufficient to meet the goals