Maternal health gets a lot of attention. It’s been marked as a priority by donors ranging from the UK Government to the Gates Foundation, and it’s been accepted as one of the areas of global health we actually know how to address.
A recent blog post from the Center for Global Development calls that into question. They point out that while we might know what kinds of interventions improve the health of mothers, we know almost nothing about how to get those interventions to the women who need them.
A Givewell.net review of data on maternal mortality interventions goes further. They suggest that there is no strong evidence to support any of the current priority interventions.
“There is little evidence that (training programs for traditional birth attendants) are effective in reducing maternal mortality, though they may be effective in reducing mortality among newborns. Efforts to increase the number of births attended by skilled attendants also hope to reduce deaths around the time of delivery, but have similarly failed to produce strong evidence of effectiveness. Clean delivery kits may help reduce infection during birth, but the evidence available is neither conclusive nor rigorous.”
So, what actually does work to save women’s lives? And why aren’t we doing more of it?
1. Strengthening health systems
Women are more than just mothers, and improving the health care they receive throughout their lives improves their health as mothers, too.
It doesn’t get donor support because compared to targeting a specific disease, health system strengthening is not as sexy. (And takes a while to explain.) Improving the Ministry of Health’s ability to allocate health care funds is nowhere near as photogenic as distributing prenatal vitamins.
2. Improving access to safe abortion
Unsafe abortion accounts for 13% of maternal deaths. When you add that to the number of women who die giving birth to unwanted pregnancies, it becomes clear that access to safe abortion would radically improve the health of mothers.
Access to safe abortions doesn’t get funded because abortion is incredibly controversial, and no donor will be associated with it.
3. Supporting access to contraception
It’s safer not to be pregnant than it is to be pregnant. Across the board, in all circumstances. You know what helps with that? Contraceptives. Yet 200 million women around the world want to control their family size and have no access to contraception.
Contraception does get donor support, but it’s hard to improve access because there are so many barriers. The barrier might be access to a health care provider, money, or a whole pile of other things. For example, even if a woman can easily get free contraception from a provider, she may not be allowed to use it by a husband or mother-in-law. Use of contraception is tied to women’s roles in society, and that doesn’t change overnight.