Last week UNICEF released a report card on the world’s performance at reducing maternal mortality. One of the Millennium Development Goals (MDGs) is to reduce maternal mortality by three-quarters from 1990 to 2015. To 2005, if we believe any of our data, maternal mortality only appears to have decreased by about 5% from 1990. This suggests that we have a ways to go, and that this indicator is unlikely to be met. Roughly, we would have to make changes to improve maternal mortality by about 5% a year, every year, between now and 2015. In Sub-Saharan African countries, the reduction in maternal mortality over the past few years has only been 0.1% a year. Basically, there has been almost no progress in Sub-Saharan Africa.

Although there was necessarily anything earth shattering in this report, I was however surprised by one quote in this report:

The causes of maternal mortality and morbidity are so clear – as are the means to combat them – that it is difficult to avoid the conclusion they have remained unaddressed for so long due to women’s disadvantaged social, political and economic status in many societies.

Although I am far from an expert on the causes of maternal mortality, I have begun to do some work in this area. I am currently looking at a policy change in Ghana to see if it had any impact on the utilization of services. What I have been searching for, and thus far have not found a very good source of information on, is some sense of why women die in these settings, and what types of interventions have actually been evaluated to reduce mortality. Given our knowledge of maternal mortality, and adult mortality in general, can we really say this is a no brainer?

The WHO, through the Safe Motherhood Initiatives, has released a series of guidelines for improving maternal and child health outcomes. My sense of a casual read through this literature, is that our understanding of exactly what incentives women face and the factors that lead to the decision to seek care are still very poorly understood. For example, in Ghana, coverage of antenatal services among pregnant women is extremely high, yet when it comes to giving birth, the rate of supervision of births by trained personnel remains low by international standards.

So while I agree with perhaps the message of this conclusion – we know that hundreds of thousands of women die needlessly in developing countries from factors associated with child birth – I still feel we don’t know nearly enough about the causes of these behaviors nor of the interventions needed to address them.

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