Improving the Maternal Mortality Rate:

The current U.S. Maternal Mortality Rate (MMR) is estmated to be about 13/100,000. The average MMR for countries based on their level of development is:

• 8/100,000 for industrialized countries
• 450/100,000 for developing countries
• 870/100,000 for least developed countries

Maternal Mortality Rate Factors

The U.S. death rate of 13/100,000 is higher than average, but this is partly due to the fact that in the United States, the MMR among African American women is substantially higher at 31 per 100,000, nearly three and a half times the rate among non-Hispanic white women, which is 9 per 100,000. Racial inequities such as income levels and the quality of care provided by biased care-givers may be factors in these statistics because when you look at any birth statistics from the United States you will notice that blacks are consistently worse than whites regardless of rank. Some childbirth activists say that part of the reason for the higher U.S. maternal mortality rate is that we are just about the only country (if not the only country) that does not have universal health care and socialized medicine. Certainly, when reviewing the key factors that contribute to a low MMR, universal access to qualified healthcare providers is at the top of the list.

Even if you take into consideration all the third-world circumstances and results combined, maternal deaths in today's world are relatively rare events, even in high-mortality areas.

Fortunately, women living in industrialized countries are not affected by these third-world conditions, so "prophylactic" abortion cannot be considered as an important "life-saving" procedure for most of them. If you look at the United States, which actually has the highest MMRs of any industrialized country, and you assume that 13/100,000 deaths is accurate, and then you figure that there are about 4 million births per year, this would mean that about 520 women die each year due to maternal complications. That's a total MMR for the U.S. of about 520/4,000,000. Now, even though that's low, it's still 520 more deaths than we would like to see. And there can be no doubt that the United States needs to work on reducing its maternal mortality rate, but increasing abortion in the U.S. would not help much, if at all. To put it another way, if you reverse the math, 100,000 babies would need to be aborted to save the lives of 13 women. If you take this calculation a step further and factor in the American Journal of Obstetrics and Gynecology (AJOG)'s finding that the mortality rate associated with abortion is almost three times higher than that associated with pregnancies carried to term, this would mean that 100,000 abortions would result in 39 deaths of the mothers — a net loss of an additional 26 lives. Totally counter-productive.

The Bigger Reasons

Far more productive in preventing untimely deaths would be to address the bigger reasons for maternal mortality, especially poverty and poverty-based problems like nutritional deficiencies. Not only would this eliminate our need to deal with the moral and ethical issues of abortion, but it would yield longer-lasting results.

Meeting the Needs

Millions of maternal lives can be saved. That's because the methods for reducing maternal deaths are well established and understood. We don't need to wait for scientific advances or more tests. We just need to face up to the fact that women need better health care during pregnancy, at delivery, and in the post-partum period. Women also need services that help prevent unintended or unwanted pregnancies. And they need health care that begins when they are young girls and adolescents, well before they conceive, and continues through pregnancy, delivery, from the first week post-partum into their child's early years, and that integrates home, community, outreach and facility-based care in a dynamic health care system.

A Comprehensive Program

UNICEF has compiled the following nine key components for any program designed to improve maternal and newborn health:

• Promotion of access to family planning, based on individual countries' policies.
• Quality antenatal care—at least four visits during pregnancy—offered in every facility, with all pregnant women screened for hypertension and treated as needed, immunized against tetanus and given micronutrient supplementation and, if warranted, iron for anaemia, nutritional supplements and intermittent preventive treatment for malaria.
• Prevention of mother-to-child transmission of HIV, with services including testing, counselling and antiretroviral prophylaxis, as well as antiretroviral treatment for women in need, in every antenatal and delivery facility, according to each country's HIV prevalence rate.
• Access to skilled personnel—a doctor, nurse or midwife—for every birth.
• Basic emergency obstetric and newborn care, adapted to each country's circumstances, in every facility where deliveries take place.
• Comprehensive emergency obstetric and newborn care provided at a minimum of one facility in every district or one per 500,000 population.
• A post-partum visit for every mother and newborn as soon as possible after delivery, ideally within 24 hours, with additional visits towards the end of the first week and at four to six weeks.
• Each pregnant woman and her family with knowledge of the maternal and newborn danger signs and knowledge of the referral system.
• Integrated Management of Neonatal and Childhood Illnesses, or the equivalent, available in each facility that provides health care to children.

Education

But to begin, we must start at the beginning. Educate every child. An educated mother is less likely to die during childbirth. Every extra year of schooling a girl achieves improves her own life chances and those of her children. Education for all should therefore be an essential part of any strategy to reduce maternal mortality.

Empowerment

And then, we need to empower women. Progress to improve maternal health will come about when women's overall status in society is improved. The health sector needs to acknowledge the issues of gender and social norms. If women have greater autonomy and decision-making power, they will be more able to access available services and take charge of not only their own health, but also that of their children.

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