Getting to the root of the MDGs

Reducing maternal mortality will require tackling the politics of reproductive health
Promoting women's health holds the key to development. Two years ago, Kofi Annan, then Secretary General of the United Nations, stated: “The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And this means stronger efforts to promote women's rights and greater investment in education and health, including reproductive health and family planning.”

Millennium Development Goal #5, reducing maternal mortality by three-quarters by 2015, has been called the heart of the MDGs. High levels of maternal mortality are linked to a chain of negative consequences, including decreases in infant survival and education and increases in poverty. With attainment of many of the MDGs already in jeopardy, reducing maternal mortality has become all the more urgent. Reducing maternal mortality needs not only the provision of more and better pre-and ante-natal care but also comprehensive reproductive health services—including safe abortion. Unless the politics of reproductive health and abortion are confronted head-on, MDG#5 and its accompanying targets may remain only a goal, and not reality, for millions of women in the developing world.

Maternal mortality is a phenomena largely confined to the developing world, with 99% of maternal deaths—over half a million women per year—concentrated in low income countries. While hemorrhage, eclampsia, sepsis, and obstructed labor account for many maternal deaths, the most easily prevented of the top maternal death culprits, unsafe abortion, remains a political, rather than health, issue in most of the world. The World Health Organization estimates that almost 13% of all maternal deaths are caused by complications from unsafe abortions.
Reducing maternal deaths from unsafe abortion is one of the most straight-forward public health problems to remedy. It requires increases in access to safe abortion and contraceptives. It is well-documented that countries with the lowest rates of abortion are those with the greatest access to legal abortion services and contraceptives. According to the Guttmacher Institute, a reproductive rights research center, Belgium, where abortion is legal and accessible, has an abortion rate of 7 per 100,000 women. Contrast this to Peru, where the procedure is illegal, and the rate skyrockets to 56 per 100,000. Despite the evidence, reproductive health targets were not initially included in the MDGs. These targets came late to the process in 2006--almost half way to the end date of the campaign—and were added under the goal of reducing maternal mortality only after significant pressure from UN member states, including members of the EU and several developing nations such as Cambodia, Cuba, Madagascar, and Nigeria.

MDG subgoal 5B sets out to have universal access to reproductive health by 2015. Unlike other MDG's, reducing maternal mortality and achieving universal access to reproductive heath care will take more than technical expertise and material resources. Reducing maternal mortality, unsafe abortion, and increasing access to reproductive health care requires that governments, societies, and donors confront not only the issue of abortion but also medically-accurate sex education for women and girls and access to contraceptives. These measures alone would decrease by 90% incidents of unsafe abortion—and go a long way to reducing maternal mortality.

Abortion is a reality of many women's reproductive lives. The underlying political gap is standing in the way of women's access to comprehensive reproductive health care. Without added pressure from donor governments, local women's health advocates in the developing world can only do so much to stop deaths from unsafe abortions in their countries. Donors who place restrictions on reproductive health funding, such as the United States which prohibits any organization accepting these funds from offering abortion as part of their comprehensive reproductive health care programs, do so at the peril of women's lives. Other developed nations, such as Great Britain and EU members, have made a commitment to unrestricting their reproductive health funding.

Reducing maternal deaths is a laudable goal, and one that must be achieved if the rest of the millennium development goals are to be realized. But reductions in maternal mortality can never be fully realized unless the global community of donors, governments, and public health starts including abortion in realistic approaches to protecting women's health. If the world wants to promote development, it needs to start promoting comprehensive reproductive health care.