Perhaps nowhere is the challenge of poverty as stark as in the bald numbers about maternal mortality. In the poorest parts of the world, the risk that a woman will die as a result of pregnancy or childbirth is about one in six; in much of Europe it is one in 30,000.
It was quite normal for women to die in childbirth in the past, before major medical advances. But today a woman's death should be an extraordinary tragedy, because we have the knowledge and means to prevent it. Yet maternal mortality in the world's poorest countries remains stubbornly high. Making childbirth safe depends on making sure basic health care is available, on the family's general welfare (especially education), and on cultural attitudes towards women. Those three factors are what social justice is about.
A recent Lancet article brought some very welcome news. It reported a significant decline in maternal mortality over the period 1980 to 2008, down from around 526,000 a year to about 343,000. The figures come from 181 countries.
The drop in maternal deaths is the result of many factors, and they vary by country. Women in most parts of the world are having fewer children. That is good news for mothers and children because having a gap of a few years between children means healthier children and mothers. Women worldwide are more educated and have more income; that too means they are more likely to seek care while they are pregnant. And, slowly, prenatal health care and birthing assistance are becoming more widely available.
But there is still bad news. Deaths of women are high in areas where HIV/AIDS is widespread. Some countries show almost no progress. The numbers are still far too high overall. And we still depend too much on extrapolations and estimates rather than solid figures.
There's an ironic twist to the Lancet story. Some passionate advocates for women's health greeted the unexpected news of progress with unease, even wanted to see publication delayed. For years many (myself included) have cited maternal mortality as the social indicator that refused to budge, so when it suddenly appeared that progress was indeed being made, that story line collapsed. There is the very real fear that news of progress will damage the hard-won attention finally being paid to this global tragedy. And reporting on maternal deaths continues to be patchy, casting doubt on reports of progress.
But the advocates are adjusting and proclaiming the good news: that what seemed impossible and difficult is possible and doable.
Which brings us to religion. With the celebration of family and motherhood that is part of many faith traditions, fighting maternal mortality seems an absolute natural. With the extraordinary networks of faith-run health care, what's needed is some fire of commitment to get a grip on the basics of what makes a difference.
Most important is helping to change the attitudes that keep girls out of school and that tacitly hint that a woman's health is less important than a man's, that taking her to a medical facility is not worth the cost, even that a woman is dispensable. Also important is bringing into the open the horrors of shame and stigma that surround unwanted pregnancies (botched abortions are an important factor in women's deaths). Making sure that girls do not marry too young seems squarely in the religious domain; among the many reasons to work to raise the age of marriage is the high mortality among very young mothers.
The good news about maternal mortality should serve as a goad to action. It is proof that there is real hope for progress even in difficult areas, that education and a decent living make a difference.
