Why Are Mothers Still Dying in Childbirth?

It is one of the world's greatest hidden epidemics, but the search
for a solution is hopelessly underfunded. On average, every minute of
every day a woman somewhere dies in childbirth or pregnancy, the
overwhelming majority in developing countries.

It is estimated
that they number more than half a million every year, in what Norway's
Prime Minister, Jens Stoltenberg, told the United Nations last week was
'the biggest expression of brutality to women I can imagine'.

One
of the UN's eight Millennium Development Goals in 2000 was to reduce
the ratio of maternal mortality - the number of mothers who die per
100,000 - recorded over the period 1990-2015 by three quarters. But as
the 2015 target date gets ever closer, it has become clear that
attempts to lower the death toll have failed.

Even as Sarah
Brown, wife of the British Prime Minister, became a patron last week of
the campaign to reduce deaths in childbirth, Margaret Chan,
director-general of the World Health Organisation, was conceding how
little had been achieved. 'Despite two decades of efforts,' she said,
'the world failed to make a dent.'

Chan was addressing a
high-level UN taskforce, whose members - including Gordon Brown, the
World Bank president Robert Zoellick and French Foreign Minister
Bernard Kouchner - are calling for billions more dollars in aid: $2.4bn
next year, rising to $7bn by 2015. 'We still have time, but just
barely, to make up for this failure,' Chan added. 'The number of
maternal deaths will not go down until more women have access to
skilled attendants at birth and to emergency obstetric care.'

With
almost 99 per cent of maternal deaths occurring in the developing
world, the differences in risk for women in those countries, in
comparison with Europeans, are staggering. One in every seven women in
Niger will ultimately die of pregnancy-related causes, whereas in
Sweden the lifetime risk is one in 17,400.

Sierra Leone remains a
stark reminder of that contrast, suffering one of the highest maternal
mortality rates in the world, with one in every eight women dying in
childbirth, according to Unicef. The experience there mirrors that in
most of sub-Saharan Africa, where the maternal death rate has remained
almost unchanged since 2000.

Thousands of women die every year
in childbirth in Sierra Leone, which is at the bottom of the UN's human
development index and where life expectancy is 41. Although care is
officially free for pregnant women and under-fives, the health service
is failing miserably. Only 40 per cent of the population has access to
healthcare.

For the million-strong population of the capital,
Freetown, there are only 162 government health workers trained to
deliver a baby. Countrywide, there is one doctor for every 33,000
people or more, compared with one to 600 in the UK. 'Women are dying
unnecessarily in pregnancy and childbirth,' says Barbara Stocking,
director of Oxfam, which is calling for universal access to healthcare
and for donor aid to go straight to national health budgets. 'It
destroys families - children are motherless; husbands without wives;
parents lose a daughter; siblings lose a sister.'

The health of
mothers is crucial for the survival of families and economies, and cuts
to the heart of any society. Pregnant women in Sierra Leone need what
pregnant women need everywhere: trained midwives and doctors, access to
properly equipped hospitals and essential medicines.

Deaths
relating to obstructed labour, eclampsia, severe bleeding, anaemia and
infection are often avoidable through simple measures, such as
provision of better prenatal care and primary health facilities with
trained staff.

Official government policy is to provide free
drugs, consultations and essential vaccinations for vulnerable groups,
including children under five, children attending school and pregnant
and breast-feeding women. Common drugs are also meant to be provided on
an affordable basis to everyone.

However, this is far from the
reality: a recent survey found 90 per cent of respondents were paying
for drugs, 43 per cent for consultation fees and 21 per cent for basic
vaccines. In the eastern region of the country, around 90 per cent of
those surveyed were still paying for antenatal and under-fives'
healthcare.

The White Ribbon Alliance for Safe Motherhood, led by
Sarah Brown and supported by Naomi Campbell, Erin O'Connor and Claudia
Schiffer, is campaigning to help these women, as are NGOs such as Oxfam.

What
can be achieved in this area has been shown by the experience of Sri
Lanka, a developing country that now has a trained midwife for every
1,800 people. While Sri Lanka now suffers a total of 190 maternal
deaths per year, Niger, which has a smaller population, has 14,000
maternal deaths every year - and only one midwife for every 33,500
people.

Despite the urgent need to reduce the death rate of
women in childbirth, Robert Zoellick delivered a note of caution over
the UN's ability to raise the billions of dollars that are needed,
saying that he was 'concerned' over the impact that the global
financial meltdown might have on programmes such as the Millennium
Development Goals.