This week, The New York Times published an article stating that the worldwide maternal mortality rate (MMR) has declined sharply – tremendous progress in the attempt to reduce childbirth related deaths by 2015. It attributes this change to a number of factors: lower fertility rates, higher income, improved access to education for women, and an increase in the number of trained birth attendants.
The report has been met with great acclaim, and rightfully so! It provides recognition for important system changes made in the last 20 years, and incentive for increased funding. More importantly, it provides researchers with more thorough health data and statistics, especially for countries with poor documentation prior to the surveys.
As any empowered reader knows, it is this information that is key to progress, providing us with an understanding of how to best facilitate future improvements. For example, the report shows that HIV prevalence is contributing to the still high MMR in East and South African countries, and implies that increased funding for anti-retroviral drugs (ARVs) can remedy this.
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I don’t want to claim any sort of broad expertise, but I know that in the case of the East African country Uganda, this is a false assumption.
For four months last year I lived in Uganda, studying public health and development and doing research in a hospital’s maternity ward. Here, I met young women giving birth to their 4th and 5th children, unable to access birth control. I heard stories of women bleeding to death in taxi-cabs, prevented from reaching a facility with the capacity to provide blood transfusions due to flooded or impassable roads. Every day I walked through a separate ward – its 50 beds always filled – for women with injuries related to attempted abortion, which is currently illegal.
The one thing all women received as part of their free prenatal care was an HIV test. Any HIV positive woman, was given Nevirapine during delivery, a medicine that effectively prevents mother to child transmission of HIV. Information about HIV/AIDS and campaigns promoting condoms are widespread throughout the country.
So, in Uganda, women are not dying because they don’t have access to ARVs, they are dying because of a lack of infrastructure, the absolute poverty in rural areas and the government’s refusal to respond to its citizens’ needs. Women are dying because they cannot make choices regarding their own reproduction.
While the report heralds good news, I am wary. Maternal mortality and its underlying issues of poverty in Uganda cannot be fixed by providing the country with ARVs or some quick fix-it scheme. In the midst of this exciting announcement, we must remember that numbers can be misleading – it is individuals who count.