The Mark 2010

Most women who die in childbirth succumb to treatable illnesses. By addressing these, we can improve the quality of health care for all.

Every minute of every day, a woman dies giving birth. The toll is staggering: 530 000 pregnant women perish every year, 95 per cent of them in developing countries. Remarkably, 80 per cent of these maternal deaths are a result of just five entirely preventable or treatable causes: sepsis, hemorrhage, eclampsia, obstructed labour, or as a consequence of a septic abortion.

For every one of these deaths, dozens of women sustain life-altering and irreversible injuries. Many develop obstetric fistulae that leave them incontinent of urine and feces and so pariahs within their own communities. A mother’s demise is also a virtual death sentence for many of her children. Those under a year have an 80 per cent chance of dying in childhood, while of those under five, more than half will not reach adulthood.

Although the solutions to deal with this catastrophe are well known, maternal health continues to receive the least attention and resources from international donors.

The Canadian government just stated that both maternal and child health will be on the agenda at this summer’s G8 Summit in Ontario. This is a welcome announcement, but the summit cannot be just another milquetoast, feel-good document. The leaders must announce a comprehensive international action plan to reduce childhood and maternal mortality (Millennium Development Goals four and five respectively).

What should this action plan include?

Last summer, at the pre-G8 Conference on International Health in Rome, parliamentarians from around the world developed a concrete work plan to reduce maternal mortality called, “Strategic Investments in Times of Crisis.” This was given to the G8 and G20 leaders at their meeting a few days later.

The plan called for strategic investments in people’s access to primary care: basic surgical facilities, medications, a full array of family planning options, diagnostics, adequate nutrition, clean water, power, and most importantly, trained health care workers. With these assets in place, most obstetrical complications could be treated, along with 80 per cent of the medical problems one encounters in the emergency departments of developing countries. This includes major killers like gastroenteritis, which causes 2.2 million deaths per year, pneumonia, 2.1 million, malaria, 2 million, and HIV/AIDS, which claims more than 2 million lives per year.

Investing in primary care is not only the key to saving the lives of mothers and their children, but is also the most effective way to improve the health of an entire population. From an economic perspective, every dollar invested in maternal care reduces overall health care costs by $4 and wider social costs by a staggering $30. But even with this knowledge, there has been a tendency for governments, international aid organizations, and NGOs to focus on specific diseases. This can actually harm the overall health of a population when resources are diverted from the primary care system, which is essential in responding to most health problems, to narrowly addressing one specific disease.

Effective capacity building – both bricks and mortar and human resources – is key to saving lives. An underutilized way to accomplish this is to fund our universities, colleges, professional associations, and non-governmental organizations to partner with institutions in the developing world so they can “train the trainers.” Engineering departments could help to train engineers and hydrologists; medical facilities could train doctors, nurses, and lay people with basic skills in health care; business schools could train people in management so that the assets of a medical system could be used effectively.

The G8 and G20 leaders who met in Italy last year were given a plan of action to reduce maternal mortality. They can use this as a template to mobilize the world’s most powerful nations when they meet in Ontario this summer to end this human catastrophe. It is time for action.