Ending Preventable Maternal Mortality: What Will It Take?
By Kimberly Whipkey, Advocacy Manager, White Ribbon Alliance
Nearly five years into the Sustainable Development Goal (SDG) era, maternal mortality rates worldwide are still unacceptably high. Why?
It’s not for a lack of technical know-how. Many countries have made great strides in making interventions available to address the immediate causes of maternal death and disability, such as routine antenatal care services, skilled attendance at birth and life-saving maternal health medicines.
In many ways, it’s a matter of focus and prioritization of our collective efforts. If the world is to end preventable maternal mortality, we must move beyond a clinical focus. We must tackle the risk factors that begin long before labor and delivery. This includes social determinants, like place of residence, socioeconomic status and women’s empowerment. It also includes institutional factors, such as national resource allocation, data infrastructure and political accountability for evidence-based programming.
There are strong linkages between maternal mortality and a country’s water, sanitation and hygiene (WASH) systems, transportation and communication infrastructure, and educational and legal systems, to name a few. We must also prioritize multi-sectoral collaboration at every stage.
These types of approaches are strongly called for in Strategies toward Ending Preventable Maternal Mortality (EPMM), a direction-setting report released by the World Health Organization (WHO) in 2015 that outlines global targets and strategies for reducing maternal mortality in the SDG period.
Women, too, are calling for greater attention to social determinants and intersectoral approaches. For example, global results from White Ribbon Alliance’s What Women Want campaign, which queried nearly 1.2 million women and girls across 114 countries about their top request for quality maternal and reproductive health, revealed that respectful and dignified care – including the right to make decisions about their bodies – and water, sanitation and hygiene were the top two requests.
So how do we make progress on such a broad agenda that brings together so many issues and players? One key strategy is measurement for maternal health—collecting data, making data transparent and available, and using data to advocate for improved policies, programming and funding.
The Improving Maternal Health Measurement Capacity and Use (IMHM) project, a three-year project launched in 2017 by the Women & Health Initiative of the Harvard T. H. Chan School of Public Health, offers one powerful example. Specifically, the IMHM project works to advance maternal health measurement capacity and accelerate progress toward ending preventable maternal mortality by developing and validating indicators focused on oft-neglected social, economic and political determinants.
As a collaborator on the IMHM project, White Ribbon Alliance and the FCI program of Management Sciences for Health (MSH) have worked closely with the Women & Health Initiative, local partners and multilateral organizations including WHO and the United Nations Population Fund, to organize a series of multi-stakeholder dialogues on national maternal health. These dialogues have sought to better understand different countries’ specific needs and interests related to maternal health monitoring and to discuss adoption and use of prioritized indicators to inform strategic decisions about maternal health investments and programs. In partnership with national ministries of health, the project has convened dialogues in Kenya, Cote d’Ivoire, Bangladesh, India, and Mexico, and two more are planned for late 2019 and early 2020 in Pakistan and Nigeria, respectively.
Dialogues have reinvigorated country-based discussion on ending preventable maternal deaths, social determinants and measurement priorities, while bringing concrete action. In Kenya, decision-makers are now negotiating adding EPMM indicators to the country’s main register of indicators, thanks in part to the dialogue. In Cote d’Ivoire, the dialogue accelerated and informed the Ministry of Health’s efforts to develop a national operational plan to reduce maternal and newborn mortality.
There’s a saying that what gets measured matters. We owe it to the world’s women and girls to measure the social and structural issues that impede maternal well-being and survival and to use data to advocate for meaningful solutions.