Neglected Mothers: MDG 5 and the Challenge of Safe Motherhood

abstract: The first global estimate of maternal mortality in 1985 revealed that over half a million women die each year due to pregnancy related causes. Although a relatively small figure compared to the deaths attributed to such diseases as malaria and HIV, this was new data. New data meant attraction from powerful international agency leaders, which eventually led to the formation of a global effort called the Safe Motherhood Initiative (SMI). In turn, the global SMI provided the framework for the World Health Organization's (WHO) Millennium Development Goal 5 (MDG 5). Both of these global campaigns, which were largely implemented through advocacy efforts, adopted time sensitive goals aimed specifically to decrease maternal mortality. Although the placement of maternal health on the public health agenda was an extraordinary accomplishment for women's health advocates, a historical examination of safe motherhood efforts will reveal that these advocacy techniques would not keep maternal health on the public health agenda. Over two decades of unsuccessful efforts to reduce maternal mortality have shown that advocacy efforts are not the answer to actually decreasing maternal mortality ratios. Due to the intrinsic difficulties in measuring maternal mortality, and the public health sector's emphasis in prioritizing the political agenda based on such measurements, maternal health has arguably fallen in last place on the agenda. This thesis will explore how the concern for mothers influenced the formation of MDG 5, and how MDG 5 has been translated into local practices. A case study of the Pan American Health Organization's advocacy effort also called the Safe Motherhood Initiative explores the underlying, culturally complex problems that are hindering progress of MDG 5. The results show that the lack of comprehensive reproductive health services for women is not only due to poor health systems in place, which is what many safe motherhood 5 efforts have attempted to address, but also due to cultural traditions and laws on sexual and reproductive health forbidding women to obtain the care they need to survive