BBC News - October 18, 2007
Stephanie Holmes

Around half a million women die annually before, during or shortly after giving birth - and almost all of these deaths occur in developing countries.

Campaigners argue that these deaths are both preventable and have repercussions that echo far beyond the woman's immediate family and community.

"We know exactly what needs to be done to save women's lives," the chief of the United Nations Population Fund (UNFPA) Thoraya Obaid told the BBC News website.

And yet, since 1990, the level of maternal mortality has decreased by less than 1% per year, far from enough to reach an internationally agreed goal of a 75% reduction by 2015.

The leading killers during pregnancy or childbirth include massive blood loss, high blood pressure, an unsafe abortion, an untreated infection and obstructed labour - where the woman's body is too small for the baby to pass through the birth canal.

But the reasons why these issues have not been tackled are political, rather than medical.

Marginalised

"The first and most important reason is a social issue: the low status of women. Leaders do not see the lives and health of women as a political priority, they invest in other sectors," Mrs Obaid said.

Women most at risk are often the most marginalised and vulnerable, living in countries with undeveloped health systems or in conflict situations, she added.

Half of all maternal deaths - some 270,000 in 2005 - occur in sub-Saharan Africa, where one in two women lacks access to a trained midwife.

"The three basic interventions are: family planning to begin with, a qualified birth attendant present at the birth and access to obstetric care if there are complications during birth," she said.

While many countries have made little progress, a few have scored startling successes.

Sri Lanka, for example, has managed to halve its maternal death rates every 12 years and South Africa reduced its level by 92% in a decade, according to non-governmental organisation Population Action International (PAI).

Yet, in most cases, reproductive health has slipped into the shadows, eclipsed by the more perplexing and dramatic threat of HIV/Aids.

"There are competing demands on donors' money and the rise of HIV/Aids has taken a great deal away," Mrs Obaid said.

"Despite the fact that HIV is a sexually transmitted virus there was a divorce between HIV and reproductive health," she said, adding that approaches tackled one issue or the other, rather than seeing them as linked.

Matters of faith

Another obstacle to reducing levels of maternal mortality has, arguably, been the increasing influence of ideology and faith on health policy, particularly in the US.

Since 2002, the US has withheld funding from the UNFPA, accusing it of actively promoting abortion or sterilisation.

"The words 'sexual' and 'reproductive' are seen by one of our major donors - the US - as being a euphemism for backing abortion," Mrs Obaid said.

She said the UNFPA neither supported or opposed abortion, but brushed off the impact of the loss of funding, saying the shortfall had been more than compensated for by increased contributions from Europe.

But others argue that the US position has nonetheless been damaging.

"It's outrageous," Amy Coen, the head of PAI told the BBC News website.

"I think the US's restrictive policies have absolutely been one of the reasons that there has not been as much progress as there could be in developing countries."

Out of focus

The White House argues that the funds diverted from the UNFPA have gone to support other reproductive rights projects, run by organisations that steer clear of abortion.

And Concerned Women for America - one of the organisations which successfully lobbied against US funding for UNFPA - said that to support the body would be a violation of US law.

"Our cash dollars cannot go to organisations that advocate coercive or forced abortions," the group's president, Wendy Wright, told the BBC news website, linking the UNFPA to the practice of forced abortion in China.

She said the UNFPA provided resources to Chinese government family planning agencies, even if it was not directly involved.

"One reason why there's not been a big drop in maternal deaths is that there has been too much of a focus on abortion rather than what works," she said.

Some 70,000 women die from unsafe abortion each year.

But making abortion more easily available, Mrs Wright argues, will not reduce maternal deaths in developing countries.

"The worse thing for countries that don't have basic healthcare is to allow abortion because they also lack penicillin and clean water. Making it legal won't make it safe," Mrs Wright said.

Yet, according to a recent report by Population Action International, 18 of the 26 countries with the highest risk of maternal mortality also have highly restrictive abortion laws.

"Women's lives are saved when abortion is legal," Ms Coen said.

"And saving women's lives strengthens the family, makes societies healthier, economies grow faster and countries stronger. It's a win-win story."

MATERNAL MORTALITY

- The number of women dying in childbirth varies dramatically worldwide from one in eight in Afghanistan and Sierra Leone to one in 47,000 in Ireland

- Maternal health is strongly linked to access to safe abortion, contraception and emergency obstetric care

- If a mother is ill or dies, the baby is less likely to survive and her other children less likely to be healthy and educated

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