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Vicious Cycle of Maternal Mortality

UNITED NATIONS, Mar 2 2011 (IPS) - Addressing the National Convention of the Medical Committee for Human Rights in Chicago, Illinois in 1966, Dr. Martin Luther King Jr. stated unequivocally that, “Of all the forms of inequality in the world, injustice in health care is the most shocking and inhumane.”

Four and a half decades later, at a time when scientific advancements in technology and medicine are growing at an exponential pace, scores of lives continue to be lost every year due to a lack of access to basic healthcare.

Perhaps the most abominable manifestation of such archaic injustice in the 21st century is the persistence of maternal mortality, which currently stands at about 251 deaths per 100,000 live births worldwide, according to the most recent statistics from the United Nations.

Though the maternal mortality rate has “fallen” since the 1980s, the number of preventable deaths per year is still a staggering 350,000 – a figure that, taken in tandem with huge advances in medical research and development, is simply unacceptable.

“The vast majority of deaths are avoidable,” said Babatunde Osotimehin, the newly appointed executive director of the United Nations Population Fund (UNFPA). “In sub-Saharan Africa alone, over a million children are left motherless at the moment of birth,” Osotimehin said, addressing a panel of experts at the 55th session of the Commission on the Status of Women (CSW) here Tuesday.

Radical Change is No Longer an Option

The International Confederation of Midwives (ICM) released a statement last year calling for the complete cancellation of international debt in order to improve health conditions, particularly safe motherhood. The statement claims, "Health and safer motherhood are inextricably linked to those economic practices which will decrease poverty and inequality."

"ICM recognises and deplores the negative impact that payment of debts is having on maternal and child health and health care in many developing countries. It calls for the complete cancellation of debt owed by the 41 most heavily indebted countries as an important part of a wider economic reform programme, which would include fairer terms of trade for developing countries."

ICM’s statement is based on the belief among internationally recognised midwives that the need to make debt repayments has severely hindered the ability of governments to provide adequate healthcare to their citizens.

ICM reports, "The International Monetary Fund and the World Bank have stepped in to take over the management of the loans but have imposed conditions which have increased poverty [and therefore ill health]."

These conditions, otherwise known as Structural Adjustment Programmes (SAPs), have compelled governments to drastically cut spending on services such as health and education; to cut subsidies, primarily on food production; increase exports, and in so doing, deprive rural workers of their land rights; and increase taxes, which the majority of developing populations can ill afford.

"In the late 1990s, under pressure from international agencies, the focus of SAPs was on ways to reduce poverty and increase citizen participation in conjunction with big debt reductions for Heavily Indebted Poor Countries (HIPCs)," ICM writes.

"However this has been insufficient to make any real impact and, in any case, cancelling debt in isolation will not lead to a permanent reduction in poverty. The debts will simply build up again unless there is a fundamental change in the economic order, particularly in the way world trade operates," they concluded.

Osotimehin echoed this sentiment, adding that governments have to make solid commitments to the people on what to do with "liquid funds".

"More important than debt cancellation is prioritisation within countries to spend money on health," Osotimehin told IPS. "In Nigeria for example, once we had debt cancellation, we agreed to spend a certain percentage of that money on achieving the Millennium Development Goals. And that has helped us considerably."

Since taking office a few short months ago, Osotimehin has been resolutely dedicated to the goal of drastically slashing the rate of maternal mortality, which he believes to be a crucial area of development – particularly in the global south.

“Education is critical,” he stressed. “Women and girls must be educated on every aspect of reproductive health and family planning – it is only education that will eventually lead to empowerment.”

The Free Market Isn’t a Fair Market

Despite the U.N.’s insistence that economic development and increased access to education will lead to a reduction in maternal mortality, evidence from the so-called “First World” suggests that the problem lies not in the under-development of post-colonial nations, but in the very essence of the modern capitalist state – which rests on unquestioning faith in the efficiency of the free market system.

A report entitled ‘Women in America: Indicators of Economic and Social Well- being’, released Tuesday by the United States Department of Commerce, mapped the areas and trajectories of women’s inclusion and exclusion within U.S. society and economy.

Presenting the report via a press teleconference on Tuesday, Deputy Secretary of the Department of Commerce Becky Blank told reporters that for the first time key indicators of women’s status in the U.S. are consolidated into one publication, and hailed the effort as a fresh new attempt to stay up to speed on women’s empowerment.

However, while the report celebrates positive trends, such as the fact that a higher percentage of women than men in the U.S. are likely to obtain a college degree, it rushes quickly past the ominous finding that maternal mortality has been on the rise for the last twenty years – due to a lack of access to the most basic healthcare.

In a scathing attack on the U.S. system of privatised healthcare, Amnesty International (AI) published an expose in 2010 entitled ‘Deadly Delivery – the Maternal Healthcare Crisis in the U.S.’

The report highlights the uncivilised face of the world’s largest “democracy”, which refuses to provide its citizens the most basic of human rights. In 2008, U.S. federal agencies set a goal of reducing maternal mortality to 4 percent of every 100,000 live births by 2010. However, the most recent statistics show that rates have skyrocketed to 13.3 percent nationwide.

According to the report, urban centres – particularly places with higher concentrations of people of colour and immigrant populations like New York – see this number rise to a staggering 83.4 percent of every 100,000 live births, or 84,000 mothers.

Nicholas Fisk and Rifat Atun discuss the implications of the pharmaceutical industrial complex in their essay ‘Market Failure and the Poverty of New Drugs in Maternal Health’.

They write, “The pharmaceutical industry’s business model is hefty investment in research and development (R&D), in expectation of high returns from future drug sales during the period of patent protection.” The model has been instrumental in keeping the benefits of medical advancements out of reach of the majority of the world’s population.

“This model, which funds around 50 percent of health care R&D in the United States generates 20-25 new licensed drugs per year, but very few for use in pregnancy,” Fisk and Atun write.

In the U.S., 75 percent of pregnant women take drugs for which safety data is not available. Not a single drug for use during pre-term labour is available.

Add to this AI’s finding that African American mothers in the U.S. are four times as likely to die during pregnancy as their white counterparts and it becomes evident that a system that privatises health care, privileges corporate pharmaceutical interests and places state responsibility in the hands of NGOs or other non-state actors, will only continue to the turn the wheel of inequality in a vicious cycle.

If the free market has failed to regulate the provision of fundamental services in the United States – a country far ahead of its developing peers in areas of individual freedoms, human rights and access to information – experts are sceptical that a similar approach to maternal health in the third world can address the root causes of the problem.

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