By Sola Stamm
A war has been declared in international reproductive health.
As Nigerian President Goodluck Jonathan stated that he was “no longer comfortable watching Nigerian mothers and newborns die of preventable causes” at the Saving One Million Lives Programme on October 16th, public figures and international organizations announced their determination to fight maternal mortality- to end a war whose origin had never been established. In response, there has been a surge of international mobilization—monetary investment, establishment of clinics, transportation of reproductive technologies, and deployment of medically trained professionals—with savior rhetoric to accompany it. When observed closely, wide gaps can be found in this approach. Amongst the international voices and political promises, certain voices are missing—the voices of mothers.
According to the World Health Organization, every day there are on average 800 pregnancy and childbirth related deaths globally; over 1/2 occur in Sub-Saharan Africa, and almost 1/3 occur in South East Asia. The lifetime risk of maternal death (likelihood that a 15 year old woman will eventually die from a maternal cause) is 1 in 26 in Sub-Saharan Africa compared to 1 in 7,300 in developed countries. Explanations for these statistics center on the premise that the nations with the highest maternal mortality rates are ‘underdeveloped’ and even ‘dysfunctional’—attributable to the absence of biomedical practices, need for clinically trained professionals, lack of information, inadequate services, and even cultural practices.
General solutions to these issues are financially based. For example, after President Goodluck Jonathan explained why he “is passionate about maternal mortality”, he affirmed that his administration would set aside $500m “over the next four years for maternal, newborn and child health intervention under the Subsidy Re-Investment and Empowerment Programme”.
It is a fact that unassisted birth, hemorrhage, anemia, and obstructed labor and etc., are life-threatening complications that thousands of expectant mothers face every year. Therefore it is absolutely critical that these individuals are fully supported and have access to resources that are appropriate for their needs. This raises the fundamental question: what resources and support is most appropriate, and where should it come from? Considering the current approaches being taken, it is clear that this question has never been asked. Not only is this question being avoided, but the victims of this ‘war’ are being excluded from global strategies and plans altogether.
What does it mean that a war has been declared on maternal mortality? Why is this warlike jargon being used? Who is the enemy and who is really suffering? To identify the core killer of mothers as the ambiguous concept of maternal mortality diverts the attention away from the reality that institutional forces, communities, and even certain individuals all share responsibility for the deaths of mothers and newborns in places of the world that still experience extreme forms of structural inequality and oppression.
To truly determine the source of maternal mortality in places like Sub-Saharan Africa and South-East Asia means to confront the lingering issues of global gender inequality, the recognition of lived experience as legitimate reason for change, the impact of domestic discrimination, and the racial legacies of colonialism.
Critiquing the work of development organizations and larger political administrations is a difficult task—where the act of criticizing ‘the hand that offers help’ renders ‘the recipient’ unthankful and unappreciative. Stuck in this circumstance (poverty, inequality, small voices amongst larger organizations), how would an individual or community express frustration or manipulation? If mothers are suffering preventable childbirth related deaths, where are their voices and why are they not being acknowledged? In their contexts and states, what would they say?